The diagnosis of unilateral condylar hyperplasi (UCH) has been made possible with 99Tcm-MDP SPECT. 105 cases of UCH and 49 patients who were considered control cases were studied. In all affected condyles, there was increased bone activity. In addition, 99Tcm-MDP SPECT uptake was greater on the affected side than the contralateral side. The ratio of the condyle to the skull on the affected side was higher as well.
Treatment options for unilateral condylar hyperplasia
Unilateral condylar hyperplasia (UCH) is a rare genetic disorder characterized by progressive, excessive growth of one or both of the condyles. Although this disorder is often considered a self-limiting disease, if left untreated, it can progress to cause functional and esthetic problems. Unilateral condylar resorption is a possible complication.
Unilateral condylar hyperplasia can occur in either male or female. In both sexes, the condition is caused by an overgrowth of the mandibular condyle. Surgical intervention can correct this condition and can sometimes be combined with other procedures to create a balanced appearance. While the exact cause of unilateral condylar hyperplasia is unknown, there are several causes that may result in its progression.
One of the most reliable and accurate methods to diagnose condylar hyperplasia is the use of 99Tcm-MDP SPECT. This technique allows for accurate identification of UCH patients with ongoing bone growth and may help with treatment decisions. The authors declare that they have no conflict of interest. The authors have no financial or intellectual relationship with a pharmaceutical company. These findings should be useful for the development of treatment options for unilateral condylar hyperplasia.
A careful history and physical examination can provide important information about the condition. Radiographic examination, CT, and SPECT scans can help in making the diagnosis. Surgery is the best choice in the majority of cases, as it is successful and yields both an esthetic and functional outcome. The authors of this study studied the temporomandibular function of patients who underwent a high partial condilectomy.
Unilateral condylar hyperplasia is a genetic condition that affects the growth of the condyle. It can cause facial asymmetry, jaw deformities, and temporomandibular joint dysfunction. While the disorder can occur at any age, the clinical manifestations of the disease generally present during adolescence and early adulthood. The occurrence peak of this disorder is between 14 and 30 years of age.
SPECT scans have a greater sensitivity for identifying the type of CH in an individual. While 99mTc-MDP is still the gold standard for confirming CH, SPECT is often superior in identifying a specific form of the disorder. However, SPECT cannot distinguish between inflammatory, healing, and infective conditions. It is also inconclusive for younger patients and those with hyperplasia that has progressed over time.
Diagnosis
There are several methods used for the diagnosis of unilateral condylar hyperpasia. First, a physical examination can help determine if the patient is suffering from this condition. Diagnostic imaging is also used to quantify the severity of the condition and better plan treatment. This technique can produce hybrid images that evaluate both morphological and functional alterations of the jaw. The diagnosis and treatment are then based on the findings of these images.
Diagnostic tests for the condition include imaging and cephalometric measurements. The radiologists used a SPECT scan to analyze the tissue samples. Then, they visually examined the bone metabolism of each TMJ. They then marked ROIs around each TMJ to represent prominent 99Tcm-MDP uptake. After this, the ROIs were copied to the contralateral condylar region. The relative uptake was then determined and the condition was diagnosed. If the patient had an abnormally high radioactivity uptake, a partial condylectomy was recommended.
SPECT imaging was also used in the diagnosis of unilateral condylar hyperpasia. The 99Tcm-MDP SPECT scans evaluated active growth in condyles and were also helpful in determining the cause of the disorder. The results were consistent with those of previous studies of unilateral condylar hyperplasia. A SPECT study of 105 patients with unilateral condylar hyperplasia was performed and compared to 49 normal controls. Patients with the condition showed an increased activity in the condyles on both sides of the affected side of the head. A relative percentage uptake was 41% on the affected side of the affected side, and 59% on the contralateral side.
SPECT/CT imaging allows for the accurate determination of the location and extent of the disease. The CT portion of the SPECT/CT scan helps assess the condylar dimensions. It is also useful to assess the progression of the pathology. If the patient’s condition is mild to moderate, a SPECT-CT may be used to make a definitive diagnosis.
Treatment options
One study in a 22-year-old man described treatment options for unilateral condylar hyperplastic bone. The patient’s chin deviated to the right side. He underwent surgery to correct this condition, and his quality of life improved following surgery. This article outlines the surgical intervention and sequence, and the quality of life survey. While these procedures are not effective for all patients, they can improve the overall quality of life and functional capacity of the patient.
Orthognathic surgery and orthodontics are common treatment options for patients with stable UCH. Treatment for patients with active hyperplastic process includes condylectomy with an orthognathic surgical procedure. Treatment options for active UCH are different from those for stable UCH. Patients with active UCH can undergo condylectomy to remove the hyperplastic condyle. Orthognathic surgery is another option for active UCH.
Imaging studies include facial and intraoral photographs and posteroanterior cephalograms. Three-dimensional computed tomography and panoramic radiographs show that the left condyle is 14.4 mm long. Computerized tomography and nuclear medicine studies have helped establish the underlying pathology. CT and SPECT scans are more sensitive for detecting active CH. However, they are inconclusive in younger patients with a slow-progressive hyperplasia.
When an active condylar growth is present, the most effective treatment option is surgical removal of the condyle. A condylectomy is the most common procedure for unilateral condylar hyperplasia, and can be performed alone or in conjunction with orthognathic surgery. A condylectomy involves a number of surgical procedures, including low-condylectomy, complete condylectomy, and joint reconstruction.
A recent case report involving a woman referred to the Department of Maxillo-Facial Surgery at Sapienza University of Rome for treatment of a mandibular asymmetry was published in J Oral Surg. She had been diagnosed with a left UCH at the age of 24 and was treated with orthognathic surgery without undergoing bone SPECT assessment of her condylar growth state. She relapsed with mandibular asymmetry at age 51. The authors of the case discussed the clinical role of bone SPECT and its impact on the patient’s outcome.
Bilateral osteotomies have no proven advantages over unilateral osteotomies. However, they may be necessary if the affected condyle is severely prognathic. The resulting occlusal discrepancy can be improved with bilateral osteotomies combined with Le Fort I surgery. Although the results of these procedures are inconsistent, they are effective for a number of patients.
Results of surgery
A recent study examined the surgical results of high condylectomy for unilateral condylar hyperpasia in 80 patients. During the scientific sessions, the authors described the surgical intervention, the sequence of the surgeries, and the results of a quality of life survey. Although results vary, the study’s results are encouraging and suggest that the condition can be successfully treated with surgery.
While the classical classification of CH has been used for decades, the gold standard for diagnosis is the clinical examination and an accurate imaging study. This is because diagnostic imaging can quantify the degree of hyperplasia and provide the basis for surgical planning. For this reason, high condylectomy may be the best option for patients with active UCH. However, there is one caveat to this method: a patient’s hyperplastic condylar head can reappear if the surgery is not successful.
A SPECT scan may be required to determine the cause of the hyperplasia. A SPECT image of the mandibular condyles revealed intense focal activity on the right mandibular condyle, with normal uptake of physiological tracer on the left side. Ultimately, the patient was diagnosed with unilateral CH on the right side of the face and was referred to a tertiary center for further treatment.
The patient had been referred to the Department of Maxillo-Facial Surgery at the Sapienza University of Rome for mandibular laterodeviation. She was previously diagnosed with unilateral UCH at the age of 24. The patient underwent orthognathic surgery without bone SPECT evaluation of the condylar growth state. At age 51, she relapsed with mandibular asymmetry. During the study, the authors examined the role of bone SPECT in prognosis and outcome.
Postoperatively, a patient had asymmetric facial growth, MXTOP cant, and a posterior open bite. The CT scan showed an elongated mandibular neck, and the mandibular intercisal line shifted 3 mm to the right. A subsequent cone beam CT revealed that the left mandibular condyle had significant structural changes. Additionally, the ROI and quantitative analysis of the scan revealed a significant difference in tracer uptake.
