López Diego Fernando, Orozco Martín Fernando, Ochoa Gómez Sofia, Herrera Guardiola Santiago, Almeida Luis Eduardo
Orthodontics Department, Universidad del Valle, Cali 760043, Colombia.
Department of Maxillofacial Surgery, Universidad del Bosque, Bogotá 110111, Colombia.
Diagnostics (Basel). 2025 Mar 22;15(7):809. doi: 10.3390/diagnostics15070809.
Condylar hyperplasia (CH) leads to mandibular overgrowth with anatomical, aesthetic, and functional consequences, particularly affecting facial harmony. It is characterized by severe mandibular prognathism (MP) in bilateral cases. This study aims to propose a therapeutic algorithm for diagnosing and treating bilateral condylar hyperplasia (BCH) based on demographic, clinical, craniofacial growth, and clivus ratio uptake conditions. Ten patients with severe skeletal Class III by MP, whose alteration was clinically associated with BCH, were consecutively evaluated in a specialized dentofacial deformity center between the period of 2019 and 2024. A detailed protocol was followed to gather clinical history, assess anatomical features, evaluate malocclusion, and identify potential BCH. When suspicion arose, a nuclear medicine test measured condylar scintigraphy uptake. If the result was positive, patients underwent bilateral condylectomy, following one of three treatment protocols. Severe PM, pronounced Class III with excessive negative overjet, elongated condyles of normal anatomy, absence of family history, and accelerated growth since preadolescence and adolescence were common characteristics in these patients. Regarding the treatment protocol chosen according to the characteristics of the patients, five cases followed treatment protocol A: condylectomy and surgical correction of the alteration in two surgical stages. Two cases followed protocol B: bilateral condylectomy and orthognathic surgery in the same surgical time, and three cases followed protocol C: condylectomy and later post-surgical orthopedics and/or orthodontics without a second surgical intervention. Histopathological results confirmed bilateral hyperplastic growth and stability in mandibular size, and occlusion was observed during follow-up. Specialists need to recognize the clinical signs of BCH and use scintigraphy tests to measure condylar metabolic activity when suspected. Early detection of BCH is crucial, as it influences treatment decisions and helps prevent relapses in orthodontic or surgical interventions aimed solely at correcting or compensating for Class III malocclusion caused by MP.
髁突增生（CH）会导致下颌过度生长，产生解剖学、美学和功能方面的后果，尤其会影响面部协调性。双侧病例的特征是严重的下颌前突（MP）。本研究旨在基于人口统计学、临床、颅面生长以及斜坡比率摄取情况，提出一种用于诊断和治疗双侧髁突增生（BCH）的治疗算法。2019年至2024年期间，在一家专门的牙颌面畸形中心对10例因MP导致严重骨骼III类错牙合且临床改变与BCH相关的患者进行了连续评估。遵循详细方案收集临床病史、评估解剖特征、评价错牙合情况并识别潜在的BCH。当产生怀疑时，进行核医学检查测量髁突闪烁显像摄取情况。如果结果为阳性，患者接受双侧髁突切除术，遵循三种治疗方案之一。严重的PM、明显的III类错牙合伴过度的负覆盖、正常解剖结构的髁突延长、无家族史以及自青春期前和青春期起生长加速是这些患者的常见特征。关于根据患者特征选择的治疗方案，5例遵循治疗方案A：在两个手术阶段进行髁突切除术和手术矫正改变。2例遵循方案B：在同一手术时间进行双侧髁突切除术和正颌手术，3例遵循方案C：髁突切除术以及术后后期的正畸和/或正牙合治疗，无需二次手术干预。组织病理学结果证实了双侧增生性生长以及下颌大小的稳定性，随访期间观察到了咬合情况。专科医生需要识别BCH的临床体征，并在怀疑时使用闪烁显像检查测量髁突代谢活性。BCH的早期检测至关重要，因为它会影响治疗决策，并有助于预防仅旨在矫正或补偿由MP引起的III类错牙合的正畸或手术干预中的复发情况。
