Scripties UMCG - Rijksuniversiteit Groningen
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Intra-Oral Condylectomy; evaluating Outcomes and Mandibular Function in Patients with Unilateral Condylar Hyperplasia

(2017) Amerongen, C.A. van (Cynthia)

Introduction: In Unilateral Condylar Hyperplasia (UCH) a disturbed growth of the affected mandibular condyle may result in facial asymmetry with possible functional disturbances such as temporomandibular joint (TMJ) dysfunction and aesthetic consequences. The conventional treatment to halt growth progression of the mandibular condyle and achieve facial symmetry is based on a condylectomy through a pre-auricular approach. Important risks of this surgical approach include neurovascular injury, salivary gland complications and a visible facial scar. The aim of this study was to evaluate the outcomes of an alternative, intraoral endoscopic approach to perform a condylectomy and to assess temporomandibular function after surgery.
Material and methods: In this multicenter cohort study a total of 49 patients diagnosed with progressive UCH who underwent an intraoral condylectomy as treatment were included. Retrospective chart data was collected and possible TMJ dysfunction was scored by questionnaires and matched with age- and gender controls. IBM SPSS statistics 24 was used. A p-value of 0.05 was considered significant.
Results: Endoscope-assisted intraoral condylectomy was initially performed on 49 patients. In 7 patients the condylectomy unintentionally had to be converted to the pre-auricular approach. The incidence of conversion reduced with growing surgical experience. One patient presented with lasting minor facial nerve paresis. Transient injury of the inferior alveolar nerve occurred in three patients. No salivary fistula occurred. Patients and controls did not differ significantly in mandibular functional disability.
Conclusion: The endoscope-assisted intraoral approach to perform a condylectomy has the potential to minimize the incidence of facial nerve paralysis, a salivary fistula and avoids a visible facial scar compared with the conventional pre-auricular approach. Furthermore, patients who underwent intraoral condylectomy for UCH did not present with significant more TMJ dysfunction than age- and gender- matched controls. This study provides us with valuable insights of this novel technique and the results suggest that this alternative approach could become the treatment of choice for most condylar hyperplastic conditions.

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