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Published on: May 23, 2020
Simultaneous Orthognathic Surgery and Condylectomy for Active Unilateral Condylar Hyperplasia: Indications and
Rodrigo Fariña1, Emilio Moreno2, Jorge Lolas2
1Maxillofacial Surgeon, Head, Service of Oral and Maxillofacial Surgery, Hospital del Salvador, Santiago, Chile; Full Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universidad de Chile, Santiago, Chile.
Background:
Active unilateral condylar hyperplasia (AUCH) leads to progressive facial asymmetry and occlusal imbalance and may coexist with preexisting skeletal discrepancies. In such cases, a single-stage approach combining condylectomy and orthognathic surgery can address both pathological growth and the associated dentofacial deformity.
Purpose:
The aim of this study was to present a treatment protocol and surgical algorithm for simultaneous orthognathic surgery and condylectomy in subjects with AUCH and to evaluate clinical outcomes in a retrospective case series.
Study Design, Setting, And Sample:
This retrospective case series included 24 adult subjects with AUCH treated between 2012 and 2018 in Santiago, Chile. Diagnosis was based on clinical evaluation, cone beam computed tomography, and single-photon emission computed tomography demonstrating ≥55% condylar activity. All subjects had completed growth and presented AUCH associated with dentofacial deformities requiring orthognathic correction, including maxillary hypoplasia, reduced upper airway, or mandibular advancement.
Predictor/Exposure/Independent Variables:
Not applicable.
Outcome Variables:
Primary outcomes included postoperative occlusal stability (achievement and maintenance of Class I occlusion), facial symmetry (clinical and patient-reported), temporomandibular joint symptoms, mouth opening, complications, and need for reintervention.
Covariates:
Covariates included age, sex, follow-up duration, type of condylectomy (high or adapted), type of mandibular osteotomy, surgical sequence, and concomitant procedures, all determined through virtual surgical planning.
Analyses:
Descriptive statistics were used to summarize subject characteristics and outcomes. No inferential analyses were performed.
Results:
Twenty-four subjects (mean age 20.8 ± 3.6 years; 66.7% female, 33.3% male) were included, with a median follow-up of 6 years. All subjects achieved stable Class I occlusion and satisfactory facial symmetry. No temporomandibular joint symptoms or reinterventions were observed. The mean mouth opening was 45 mm. Minor complications (transient facial paresis) occurred in 12.5% of subjects.
Conclusions And Relevance:
Simultaneous orthognathic surgery and condylectomy is an effective approach for managing AUCH associated with dentofacial deformities, providing stable functional and aesthetic outcomes. Virtual surgical planning enables a structured surgical algorithm, guiding both the surgical sequence and the selection of the appropriate type of condylectomy, and may reduce the need for more invasive mandibular procedures.
