State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST), Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China.
Stomatological Center of Peking University Shenzhen Hospital, Shenzhen, China.
Am J Orthod Dentofacial Orthop. 2022 Mar;161(3):404-415.e1. doi: 10.1016/j.ajodo.2020.09.032. Epub 2022 Feb 1.
Unilateral condylar hyperplasia (UCH) is a progressive, nonneoplastic overgrowth of the condyle of the temporomandibular joint. For treating active UCH, a popular method combines orthognathic surgery with high condylectomy and orthodontic treatment. The goal of this study was to introduce a new method to correct asymmetry for active UCH.
Retrospectively, 47 patients with active UCH were divided into horizontal-type, vertical-type, and combined-type. All patients were treated with condylectomy plus postsurgery standard orthodontics (CPSO) with applied miniscrews implanted in infrazygomatic crest and hard palate to intrude affected side of maxillary molars and apply intermaxillary traction for contralateral molars. Cone-beam computed tomography was taken at presurgery, postsurgery, and the end of orthodontics (T3).
In the vertical (n = 10) and combined (n = 28) types, deviation of the chin and the canting of the mandible and maxillary occlusal plane were significantly reduced at T3. A difference in the torque of bilateral maxillary first molar (U6) and bilateral mandibular first molar (L6) was significantly reduced at T3. The anterior, superior, and posterior joint spaces in the vertical-type and combined-type were significantly decreased at T3 compared with postsurgery. In contrast, in the horizontal-type group (n = 9), the deviation of the chin was corrected; however, the canting of the mandible and maxillary occlusal plane was significantly increased at T3 compared with presurgery.
CPSO restored facial and occlusal symmetry for vertical-type and combined-type active UCH and returned affected-side condyle to the glenoid fossa. However, CPSO was not suitable for treating the horizontal-type UCH.
单侧髁突肥大症（UCH）是一种颞下颌关节髁突的进行性、非肿瘤性过度生长。对于治疗活动性 UCH，一种流行的方法是将正颌手术与高位髁突切除术和正畸治疗相结合。本研究的目的是介绍一种治疗活动性 UCH 不对称的新方法。
回顾性地将 47 例活动性 UCH 患者分为水平型、垂直型和混合型。所有患者均采用髁突切除术加术后标准正畸（CPSO）治疗，在下颌颧突和硬腭植入微型螺钉以推上颌磨牙向患侧，对侧磨牙施加颌间牵引。在术前、术后和正畸结束时（T3）拍摄锥形束 CT。
在垂直型（n=10）和混合型（n=28）中，颏部偏斜、下颌倾斜和上颌咬合平面在 T3 时显著减小。双侧上颌第一磨牙（U6）和双侧下颌第一磨牙（L6）的转矩差异在 T3 时显著减小。与术后相比，垂直型和混合型的前、上、后关节间隙在 T3 时显著减小。相比之下，在水平型组（n=9）中，颏部偏斜得到矫正，但在 T3 时下颌和上颌咬合平面的倾斜明显增加，与术前相比。
CPSO 恢复了垂直型和混合型活动性 UCH 的面部和咬合对称性，并使患侧髁突回到关节凹。然而，CPSO 不适合治疗水平型 UCH。
