The Three Dimensional Orofacial Changes Occurring After Proportional Condylectomy in Patients with Condylar Hyperplasia Type 1B (Unilateral Hemimandibular Elongation)

Publication date: Available online 20 November 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Waseem A. Abboud, Maria Krichmar, Daniela Blinder, Alex Dobriyan, Gilad Yahalom, Ran Yahalom

Abstract

Purpose

To evaluate the three dimensional orofacial changes occurring after proportional condylectomy that was not followed by orthognathic surgery in patients with condylar hyperplasia type 1B (unilateral hemimandibular elongation).

Patients and Methods

A retrospective analysis of the medical records of 14 skeletally-mature patients. Transverse, vertical, and horizontal cephalometric analyses of photographs and radiographs were undertaken. A comparison of the preoperative and postoperative measurements was conducted.

Results

After proportional condylectomy, transverse chin position and vertical lip cant improved to various degrees; whereas, ramus-condyle height and mandibular lower border discrepancy worsened to different extents. The prominence of the gonial angle of the affected/operated side increased in all patients after surgery, and this contributed to better symmetry only when the preoperative prominence was small (flat); whereas, the opposite when the preoperative prominence was large (bulky). After condylectomy, there was a posterior displacement of the pogonion point (setback), which was favorable in cases with a preoperative concave profile and unfavorable in cases with a preoperative convex profile.

Conclusion

Proportional condylectomy can successfully arrest the hyperplastic growth of the affected condyle; however, it rarely achieves perfect symmetry of the face. While it improves some facial features, other facial traits are worsened. Surgeons should have a full understanding of the three-dimensional changes occurring after proportional condylectomy, and should be able to predict based on the preoperative findings the anticipated improvement or worsening of the different facial features.

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