Li Hui, Hu Jing, Luo En, Zhu Songsong, Li Jihua
Resident, State Key Laboratory of Oral Diseases and Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, China.
Professor and Chair, Center of Orthognathic and TMJ Surgery, West China College of Stomatology, Sichuan University, Chengdu, China.
J Oral Maxillofac Surg. 2014 Nov;72(11):2295-317. doi: 10.1016/j.joms.2014.03.021. Epub 2014 Mar 31.
Osteochondroma is a benign tumor that is rare in the craniofacial region. When it does occur, the condyle and coronoid process have been the most commonly affected sites. The secondary progressive malocclusion and facial asymmetry will be common physical signs in most cases. The traditional surgical treatment of osteochondroma of the mandibular condyle has been condylectomy, with or without reconstruction of the condyle. We believe more attention should be paid to restoring joint function, improving the facial appearance, correcting malocclusion, and re-establishing harmony among them.
From January 2000 to March 2013, 27 patients (17 women and 10 men) who had been diagnosed with osteochondroma of a unilateral mandibular condyle underwent condylectomy and condylar reconstruction using a pedicled posterior mandibular border obtained by ramus osteotomy. The secondary dentofacial deformities were simultaneously corrected using orthognathic and facial contouring procedures, followed by orthodontic treatment, when necessary. Occlusion and temporomandibular joint pain and function, including the maximal mouth opening and maximal protrusion, were recorded preoperatively and postoperatively.
The patients were followed for an average of 13 months (range 24 to 48). The outcomes of, and feedback information from the patients showed apparent improved joint function, with no cases of osteochondroma recurrence. The secondary dentofacial deformities were corrected significantly. Satisfactory occlusion was achieved with orthognathic and orthodontic treatment.
Our data suggest that condylectomy and condylar reconstruction, with simultaneous correction of the secondary dentofacial deformities using orthognathic procedures, might be a better approach to manage osteochondroma accompanied by dentofacial deformities. In addition to facial contouring procedures, orthodontic treatment should be considered for better improvement in facial esthetics and occlusion.
骨软骨瘤是一种良性肿瘤，在颅面部区域较为罕见。当其发生时，髁突和冠突是最常受累的部位。在大多数情况下，继发性进行性错牙合和面部不对称是常见的体征。下颌髁突骨软骨瘤的传统外科治疗方法是髁突切除术，可伴有或不伴有髁突重建。我们认为应更加注重恢复关节功能、改善面部外观、纠正错牙合以及重建它们之间的协调性。
2000年1月至2013年3月，27例（17例女性和10例男性）被诊断为单侧下颌髁突骨软骨瘤的患者接受了髁突切除术，并使用经升支截骨获得的带蒂下颌后缘进行髁突重建。同时，采用正颌和面部轮廓整形手术纠正继发性牙颌面畸形，必要时进行正畸治疗。术前和术后记录咬合情况以及颞下颌关节疼痛和功能，包括最大开口度和最大前伸度。
患者平均随访13个月（范围24至48个月）。患者的治疗结果及反馈信息显示关节功能明显改善，无骨软骨瘤复发病例。继发性牙颌面畸形得到显著纠正。通过正颌和正畸治疗实现了满意的咬合。
我们的数据表明，髁突切除术和髁突重建，同时采用正颌手术纠正继发性牙颌面畸形，可能是治疗伴有牙颌面畸形的骨软骨瘤的更好方法。除了面部轮廓整形手术外，还应考虑正畸治疗以更好地改善面部美观和咬合。
