Two-Stage Approach for Treatment of Two Patients with Facial Asymmetry Caused by Unilateral Condylar Hyperplasia

Abstract

Unilateral condylar hyperplasia often causes severe facial asymmetry, malocclusion and temporomandibular joint pain. We present two cases of unilateral condylar hyperplasia with significant facial asymmetry and severe malocclusion. The first case was a 46-year-old female whose complaint was temporomandibular joint pain, facial asymmetry and trismus. The clinical diagnosis was left condylar tumor because these symptoms were recognized in post-adolescence and continued to progress. Low condylectomy with extraction of condylar disk was performed. The pathological diagnosis was condylar hyperplasia. Orthodontic treatment was continued for 5 months after condylectomy, and orthognathic surgery were performed. The second case was a 34-year-old female whose complaint was facial asymmetry and temporomandibular joint pain. These symptoms were recognized in adolescence and progressed slowly. The clinical diagnosis was left condylar hyperplasia. During pre-operative orthodontic treatment, 99mTc scintigram revealed proliferative activity in the left condylar lesion, and resection of the lesion was performed. The residual condyle was trimmed and contoured. Orthodontic treatment was continued for 10 months after the condylar operation, followed by orthognathic surgery. Four years and one year have passed since the orthognathic surgery, and esthetic and functional improvements and patient satisfaction have been obtained in both cases. In cases of facial asymmetry with condylar hyperplasia, it is often difficult to predict the occlusal and esthetic status without the improvement of condylar shape and function. The two-stage approach was a valid procedure to predict and obtain post-operative stability for the jaw and temporomandibular joint deformity.