Yang So Jin, Chung Nam Hyung, Kim Jong Ghee, Jeon Young-Mi
Department of Orthodontics, School of Dentistry, Jeonbuk National University, Jeonju, Korea.
Institute of Oral Biosciences, School of Dentistry, Jeonbuk National University, Jeonju, Korea.
Korean J Orthod. 2020 May 25;50(3):206-215. doi: 10.4041/kjod.2020.50.3.206.
Osteochondroma is a common benign tumor of bones, but it is rare in the mandibular condyle. With its outgrowth it manifests clinically as deviation of the mandible limitation of mouth opening, and facial asymmetry. After the tumor is diagnosed on the basis of clinical symptoms and radiographic examination including cone-beam computed tomography (CBCT) analysis, an appropriate surgery and treatment plan should be formulated. Herein, we present the case of a 44-year-old female patient who visited our dental hospital because her chin point had been deviating to the left side slowly but progressively over the last 3 years and she had difficulty masticating. Based on CBCT, she was diagnosed with skeletal Class III malocclusion accompanied by osteochondroma of the right mandibular condyle. Maxillary occlusal cant with the right side down was observed, but it was confirmed to be an extrusion of the molars associated with dental compensation. Therefore, after intrusion of the right molars with the use of temporary anchorage devices, sagittal split ramus osteotomy was used to remove the tumor and perform orthognathic surgery simultaneously. During 6 months after the surgery, continuous bone resorption and remodeling were observed in the condyle of the affected side, which led to a change in occlusion. During the postoperative orthodontic treatment, intrusive force and buccal torque were applied to the molars on the affected side, and a proper buccal overjet was created. After 18 months, CBCT revealed that the rate of bone absorption was continuously reduced, bone corticalization appeared, and good occlusion and a satisfying facial profile were achieved.
骨软骨瘤是一种常见的骨良性肿瘤，但在下颌髁突中较为罕见。随着肿瘤生长，临床上表现为下颌偏斜、开口受限和面部不对称。在根据临床症状及包括锥形束计算机断层扫描（CBCT）分析在内的影像学检查确诊肿瘤后，应制定合适的手术及治疗方案。在此，我们报告一例44岁女性患者，她因在过去3年中颏点逐渐缓慢地向左偏斜且咀嚼困难而前来我院牙科就诊。基于CBCT，她被诊断为骨骼Ⅲ类错牙合伴右侧下颌髁突骨软骨瘤。观察到右侧上颌牙合平面下降，但证实这是与牙齿代偿相关的磨牙挤压。因此，在使用临时锚固装置压低右侧磨牙后，采用矢状劈开下颌升支截骨术切除肿瘤并同时进行正颌手术。术后6个月期间，观察到患侧髁突持续的骨吸收和重塑，这导致了咬合变化。在术后正畸治疗期间，对患侧磨牙施加压低力和颊向转矩，并形成适当的颊侧覆盖。18个月后，CBCT显示骨吸收速率持续降低，出现骨皮质化，实现了良好的咬合和令人满意的面部轮廓。
