Wolford Larry M, Movahed Reza, Dhameja Amit, Allen Will R
Clinical Professor Departments of Oral and Maxillofacial Surgery and Orthodontics, Texas A&M Health Science Center, Baylor College of Dentistry, Baylor University Medical Center, Dallas TX.
Clinical Assistant Professor, Department of Oral and Maxillofacial Surgery, Center for Advanced Dental Education, Department of Orthodontics, Saint Louis University, St Louis, MO.
J Oral Maxillofac Surg. 2014 Sep;72(9):1704-28. doi: 10.1016/j.joms.2014.03.009. Epub 2014 Mar 24.
To evaluate the outcomes from surgical treatment of mandibular condylar osteochondroma (condylar hyperplasia [CH] type 2) using a specific surgical protocol. CH type 2 is a unilateral benign pathologic condition, with progressive proliferation of osseous and cartilaginous tissues in the condylar head. This causes condylar enlargement, often with exophytic growth, resulting in significant facial deformity, pain, and masticatory and occlusal dysfunction.
This was a retrospective cohort study of 37 patients (28 females and 9 males), with an average age of 26.3 years (range 13 to 48), with CH type 2, and associated dentofacial deformity. The condylar pathologic features were confirmed by histologic analysis. All patients were treated with low condylectomy, recontouring of the condylar neck to form a new condyle, repositioning of the articular disc over the condylar stump and repositioning of the contralateral disc, if displaced, and any indicated orthognathic surgical procedures. Postoperative follow-up averaged 48 months (range 12 to 288). Patients were assessed preoperatively and at the longest follow-up point for incisal opening, lateral excursions, pain, jaw function, diet, disability, and occlusal and skeletal stability. The pre- and postoperative assessments were compared using paired t test.
At the longest follow-up point, a nonsignificant decrease (2.3 mm) was seen in the maximum incisal opening; however, the excursive movements had decreased significantly an average of 2.5 mm on the right and 2.2 mm on the left. A statistically significant improvement was seen in pain, jaw function, diet, and disability. A stable Class I skeletal and occlusal relationship was maintained in 34 of the 37 patients (92%). Two patients developed relatively minor postoperative malocclusions that were managed with orthodontics. In 1 patient, a high condylectomy was performed, and the tumor continued to grow, causing malocclusion and jaw deformity to recur. A low condylectomy and sagittal split were performed 14 months later, with a stable result at 4 years after surgery.
The results of the present study have demonstrated that a low condylectomy procedure with recontouring of the condylar neck to function as a condyle and repositioning of the articular discs, combined with orthognathic surgery, is a viable option for the treatment of osteochondroma of the mandibular condyle and associated jaw deformity.
采用特定手术方案评估下颌髁突骨软骨瘤（2型髁突增生[CH]）手术治疗的效果。2型CH是一种单侧良性病理状况，髁突头部骨组织和软骨组织进行性增生。这会导致髁突增大，常伴有外生性生长，从而引起明显的面部畸形、疼痛以及咀嚼和咬合功能障碍。
这是一项对37例患者（28例女性和9例男性）的回顾性队列研究，平均年龄26.3岁（范围13至48岁），患有2型CH并伴有牙颌面畸形。通过组织学分析证实髁突病理特征。所有患者均接受低位髁突切除术、对髁突颈部进行重塑以形成新的髁突、将关节盘重新定位在髁突残端上，若对侧关节盘移位则进行重新定位，以及任何必要的正颌外科手术。术后平均随访48个月（范围12至288个月）。在术前及最长随访点对患者进行评估，内容包括切牙开口度、侧向运动、疼痛、颌功能、饮食、功能障碍以及咬合和骨骼稳定性。术前和术后评估采用配对t检验进行比较。
在最长随访点，最大切牙开口度有不显著的减小（2.3毫米）；然而，侧向运动显著减小，右侧平均减小2.5毫米，左侧平均减小2.2毫米。在疼痛、颌功能、饮食和功能障碍方面有统计学上的显著改善。37例患者中有34例（92%）维持了稳定的I类骨骼和咬合关系。2例患者出现相对轻微的术后错牙合畸形，通过正畸治疗得以解决。1例患者进行了高位髁突切除术，肿瘤继续生长，导致错牙合畸形和颌骨畸形复发。14个月后进行了低位髁突切除术和矢状劈开术，术后4年结果稳定。
本研究结果表明，低位髁突切除术联合髁突颈部重塑以发挥髁突功能及关节盘重新定位，并结合正颌外科手术，是治疗下颌髁突骨软骨瘤及相关颌骨畸形的可行选择。
