Condylar growth disorders Flashcards
hemimandibular hyperplasia (HH)
increase in total mass of the mandible with bowing of the inferior border
excessive growth in all direction including AP, vertical, transverse
hemimandibular elongation
increase in the length of mandible in AP
presentation of HH
facial asymmetry
minimal chin deviation
no or minimal crossbite
posterior ipsilateral open bite
presentation of HE
facial asymmetry
prominent chin deviation
crossbite
no posterior open bite
Diagnosis of HH or HE
serial tracings bone scintigraphy (technetium-99)
treatment options
growing patients: - high condylar resection - Ogs once growth is stable stable growth: - ogs for correction of asymmetry Consider shaving/recontouring with genioplasty
causes of condylar hypoplasia or aplasia
Congenital
- treacher collins syndrome
- hemifacial microsomia
- Goldenhar syndrome
- Hurler syndrome
- Hallerman-streiff syndrome
Acquired
- trauma
- infection
- juvenila RA
Tx options of condylar hypoplasia/aplasia
Orthognathic surgery
Distraction osteogenesis
TMJ reconstruction with autografts (skeletally immature)
TMJ recon with alloplast prosthesis (matured/adult)
Idiopathic condylar resorption causes
Patient related.
- young age. Female
- TMJD symptoms
- mandibular hypoplasia
Surgery related
- counter clockwise rotation of MM segment (in VME type of correction)
- condylar distraction after orthognathic surgery
Idiopathic condylar resorption presentatio
Progressive worsening of AOB
Short posterior ramus
Retrognathia
With or without TMJD symptoms
Radiograph
- generalized condylar resoprtion with a condylar stump anteriorly
Bone scan - increased uptake
Management of ICR
- Determining the progress of the condition - progressing or ceased
- During active ICR - nosurgical measures to stabilize the tmj by:
- soft diet
- nsaids
- occlusal splint with stabilization splint - After stabilize - ogs to correct malocclusion
- If progressive until causing severe retrognathia - total joint replacement with alloplastic or autografts.
