RESUMO

A hiperplasia hemimandibular é responsável por prejuízos estéticos, funcionais, motores e psicossociais. Com etiologia incerta, ocorre frente ao desequilíbrio de fatores regulatórios de crescimento presentes na camada cartilaginosa do côndilo. O relato objetiva descrever a tomada de decisões baseada em exames complementares específicos aliados à adequada intervenção cirúrgica da lesão. Paciente gênero feminino, 33 anos de idade, compareceu à clínica particular com queixa principal de "face assimétrica", foi requerido uma avaliação cintilográfica objetivando e confirmando a interrupção do crescimento condilar, descartando a hipótese de Osteocondroma e condilectomia. Após preparo ortodôntico prévio, os exames tomográficos foram utilizados na criação de um protótipo que foi impresso após a realização dos movimentos ósseos planejados. Mediante à reconstrução, foi concluído que a assimetria presente não seria totalmente corrigida somente através da intervenção ortognática, sendo necessária também uma osteotomia removendo parte da base do corpo e ângulo mandibular, através da confecção de um guia de corte, promovendo à reanatomização sem a necessidade de acesso extra oral submandibular, evitando uma cicatriz em face feminina. Paciente encontra-se em pós-operatório de 60 meses, sem queixas e satisfeita. Portanto, é evidenciado cada vez mais a influência positiva que o planejamento virtual pode trazer aos profissionais na otimização dos resultados cirúrgicos.

Hemimandibular hyperplasia is responsible for aesthetic, functional, motor, and psychosocial impairments. With an uncertain etiology, it occurs due to the imbalance of regulatory growth factors present in the cartilaginous layer of the condyle. The report aims to describe decision-making based on specific complementary exams combined with the appropriate surgical intervention for the condition. A 33-year-old female patient presented at a private clinic with the main complaint of "asymmetric face." A scintigraphic evaluation was requested to objectively confirm the interruption of condylar growth, ruling out the hypothesis of Osteochondroma and condylectomy. After prior orthodontic preparation, tomographic exams were used to create a prototype that was printed after planned bone movements. Through the reconstruction, it was concluded that the existing asymmetry would not be entirely corrected through orthognathic intervention alone, necessitating also an osteotomy to remove part of the base of the body and mandibular angle. This was done through the creation of a cutting guide, allowing for reanatomization without the need for submandibular extraoral access, thus avoiding a scar on the female face. The patient is 60 months postoperative, with no complaints and satisfied. Therefore, the increasingly positive influence of virtual planning on optimizing surgical outcomes for professionals is evident.

Assuntos

RESUMO

BACKGROUND: This study aims primarily to assess the mandibular condyles and patient response to MAD therapy using cone-beam computed tomography (CBCT). Also, the study proposes to analyze whether variations in condylar position, OSA severity and mandibular protrusion influence patient response. METHODS: 23 patients diagnosed with mild/moderate OSA and treated with MAD comprised the sample. Clinical, CBCT, and PSG assessments were conducted at baseline and with MAD in therapeutic protrusion (4-6 months of MAD use). The condyle position was vertically and horizontally evaluated at baseline and at the therapeutic protrusion. RESULTS: The condyle position significantly changed with MAD, showing anterior (7.3 ± 2.8 mm; p < 0.001) and inferior (3.5 ± 1 mm; p < 0.001) displacement. Patients with mild OSA required more protrusion (p = 0.02) for improvement. Responders exhibited a significantly prominent (p = 0.04) anterior baseline condyle position. A negative modest correlation was found between treatment response and baseline condyle anterior position (p = 0.03; r=-0.4), as well as between OSA severity and the percentage of maximum protrusion needed for therapeutic protrusion (p = 0.02; r=-0.4). The patient protrusion amount did not predict condylar positional changes. Neither condyle position, OSA severity, nor therapeutic protrusion were predictors of MAD treatment response. CONCLUSION: MAD resulted in anterior and inferior condylar displacement, and the amount of protrusion did not predict condylar positional changes. Responders showed a more anterior baseline condyle position. OSA severity and mandibular protrusion did not predict treatment response.

Assuntos

RESUMO

As indicações de tratamento das fraturas mandibulares em paciente pediátrico variam em conservador, fixação não rígida e interna rígida. Alterações no crescimento ósseo, disfunções na articulação temporomandibular e assimetrias faciais podem ser decorrentes ao insucesso do tratamento. O objetivo deste trabalho consiste em relatar abordagem cirúrgica em fratura de sínfise e côndilo mandibular bilateral em paciente pediátrico. Paciente gênero feminino, 09 anos de idade, foi encaminhada ao Hospital Geral do Estado - Bahia vítima de queda de nível, cursando com trauma em face. Apresentou queixa principal, referida pela progenitora, de dificuldades em fechar a boca. Ao exame físico, a paciente apresentou mobilidade atípica à manipulação da mandíbula, mordida aberta anterior, equimose sublingual, ausência das unidades dentárias 74 e 75, com abertura bucal regular e suturas em posição em região de mento. Ao exame de imagem de tomografia computadorizada da face, pôde-se notar sinais sugestivos de fratura em região de sínfise e côndilos mandibulares bilateral. Após diagnóstico das fraturas, a paciente foi submetida à cirurgia sob anestesia geral para redução e fixação das mesmas. Realizou-se acessos em ferimento na região mentual e retromandibular bilateral com posterior síntese das fraturas utilizando fixação interna rígida com placas do sistema 2.0mm, associada a odontossíntese na fratura de sínfise. Ao acompanhamento periódico, a eleição do tratamento cirúrgico para fraturas mandibulares em pacientes pediátricos, pode permitir segurança no crescimento ósseo mandibular e facial(AU)

The indications for treatment of mandibular fractures in pediatric patients vary from conservative, non-rigid fixation and rigid internal fixation. Changes in bone growth, temporomandibular joint disorders and facial asymmetries may be due to treatment failure. The objective of this work is to report a surgical approach to bilateral symphysis and mandibular condyle fractures in a pediatric patient. Female patient, 9 years old, was sent to the State General Hospital - Bahia, victim of a fall in level, suffering from trauma to the face. She presented a main complaint, mentioned by her mother, of difficulties in closing her mouth. On physical examination, the patient presented atypical mobility when manipulating the jaw, anterior open bite, sublingual ecchymosis, absence of dental units 74 and 75, with regular mouth opening and sutures in position in the chin region. When examining the computed tomography image of the face, signs suggestive of fracture in the region of the symphysis and bilateral mandibular condyles were noted. After diagnosis of the fractures, the patient underwent surgery under general anesthesia to reduce and fix them. Access was performed on a wound in the mental and bilateral retromandibular region with subsequent synthesis of the fractures using rigid internal fixation with 2.0mm system plates, associated with odontosynthesis in the symphysis fracture. With periodic monitoring, the choice of surgical treatment for mandibular fractures in pediatric patients can allow for safe mandibular and facial bone growth(AU)

Assuntos

RESUMO

OBJECTIVES: To evaluate the temporomandibular joint (TMJ), condylar and mandibular movements in obstructive sleep apnea (OSA) patients treated with mandibular advancement device (MAD) and to identify the influence of these anatomic factors on upper airway (UA) volume and polysomnographic outcomes after treatment. MATERIALS AND METHODS: Twenty OSA patients were prospectively treated with MAD. Clinical examinations, cone-beam computed tomography, and polysomnography were performed before MAD treatment and after achieving therapeutic protrusion. Polysomnographic variables and three-dimensional measurements of the TMJ, mandible, and upper airway were statistically analyzed. RESULTS: Condylar rotation, anterior translation, and anterior mandibular displacement were directly correlated with total UA volume, while vertical mandibular translation was inversely correlated with the volume of the inferior oropharynx. MAD treatment resulted in an increase in the volume and area of the superior oropharynx. There was no statistically significant correlation between condylar rotation and translation and polysomnographic variables. With MAD, there was a significant increase in vertical dimension, changes in condylar position (rotation and translation), and mandibular displacement. The central and medial lengths of the articular eminence were inversely correlated with condylar rotation and translation, respectively. The lateral length of the eminence was directly correlated with condylar translation, and the lateral height was directly correlated with condylar rotation and translation. CONCLUSION: Condylar and mandibular movements influenced UA volume. The articular eminence played a role in the amount of condylar rotation and translation. CLINICAL RELEVANCE: Individualized anatomical evaluation of the TMJ proves to be important in the therapy of OSA with MAD.

Assuntos

RESUMO

OBJECTIVES: To investigate the pain perception (PP) and condyle-fossa relationship (CFR) after botulinum toxin A (BoNTA) injection in the masseter muscles of painful muscular temporomandibular dysfunction (TMD) patients. MATERIALS AND METHODS: Fourteen women (aged 29.7 ± 5.4 years) diagnosed with myogenic TMD were randomized in the BoNTA-treated group (TG) and control group (CG). TG masseter muscles (n = 7) were bilaterally injected with 30 U. The CG (n = 7) were injected with saline injections. Condyle-fossa relationship (CFR) spaces were measured in sagittal (SP) and frontal planes (FP) of images of cone-beam computed tomography (CBCT) done before (T0) and after 30 days' interventions (T1). Visual analogue scale (VAS) measured the patients' TMD pain perception (PP). Data were compared by generalized linear models considering the results over time (α = .05). RESULTS: There were no statistical differences in CFR in the SP or FP for TG and CG over time (p ˃ .05), except for frontal lateral space CFR (p < .05). In both groups, the condyle was positioned medially after interventions. Frontal lateral space increased in TG for both, left and right sides, over time (p < .05), as well as PP decreased over time (p < .05) for TG and CG. CONCLUSIONS: The results depicted that there was no significant association with BoNTA injection in TMD masseter muscles in PP and CFR, except considering the frontal lateral space of CFR. CLINICAL RELEVANCE: BoNTA injection in the masseter muscles may not promote clinically significant shifts in the condyle-fossa relationships of muscular TMD patients.

Assuntos

RESUMO

Abstract This observational, cross-sectional study with retrospective collection was aimed to evaluate the prevalence of morphological changes in mandibular condyles in individuals with class II malocclusion, classified according to different vertical growth patterns (brachyfacial, mesofacial, and dolichofacial), through cone beam computed tomography (CBCT). Seventy CBCT images (140 mandibular condyles) were selected from individuals without orthodontic treatment, of both sexes, aged between 25 and 50 years. No statistically significant differences were found between facial patterns; however, there was a higher relative prevalence of bone changes in dolichofacial individuals with flattening (62%), sclerosis (44%), and subchondral bone cyst (20%). Erosion and osteophytes prevailed in mesofacial (39%), and brachyfacial individuals (32%), respectively. Thus, there was no statistically significant difference in the prevalence of degenerative changes between the vertical skeletal patterns. Flattening was the most prevalent change, whereas subchondral bone cyst was the least prevalent among the three groups studied. The observational design of this study makes it possible to analyze image banks to verify the correlation of morphological changes in the temporomandibular joint in different facial patterns in patients with class II malocclusion. A limitation of the study is that clinical characteristics were not evaluated.

RESUMO

Study Design: Face and content validation of a surgical simulation model. Objective: Open reduction and internal fixation in displaced subcondylar mandibular fractures is standard care. This requires an extraoral (eg: retromandibular, transparotideal) or intraoral approach. An intraoral approach requires further training since specialized instrumentation such as the 90° screwdriver system and endoscopes might be needed. Currently, no simulation models are available for training residents in intraoral reduction and fixation of subcondylar mandibular fractures. Therefore, we present a validated simulation model for intraoral treatment of subcondylar mandibular fractures. Methods: Based on a computer tomography data set, we designed and printed a 3D model of a mandible with a unilateral subcondylar fracture. To simulate intraoral work depth, it was positioned inside a dental phantom. We tested the model by a group of experts (n = 8), simulating intraoral reduction and fixation of a unilateral subcondylar fracture, using a 90° screwdriver system, a 1.0 subcondylar plate (lambda), and 5-6 mm screws.We assessed Face and Content validity by survey. Results: We provided an open-source printable fracture model. Printing costs were approximately US $10. Experts "Agreed" the model resembling the real scenario and its use for training intraoral reduction and fixation of subcondylar mandibular fractures. Conclusions: We developed a low cost, reproducible, open-source simulator for subcondylar mandibular fractures. Face and Content validity was achieved through evaluation by a group of experts.

RESUMO

OBJECTIVE: The aim of this study was to describe the prevalence of anatomical variants in the bifid mandibular condyle (BMC) and report its association with temporomandibular joint (TMJ) pathology. METHODS: We searched the Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS databases from their inception up to September 2023. Two authors independently performed the search, study selection, and data extraction, and they also assessed the methodological quality with an assurance tool for anatomical studies (AQUA). Finally, the pooled prevalence was estimated using a random effects model. RESULTS: A total of 50 studies met the eligibility criteria. Twenty studies, with a total of 88,625 subjects, were included in the meta-analysis. The overall prevalence of the bifid mandibular condyle (BMC) variant was 1% (95% CI = 1% to 2%). CONCLUSIONS: The correlation between the BMC and TMJ pathologies has a relatively low prevalence in studies that present a considerable number of subjects. From a clinical point of view, a direct association cannot be made between the presence of the BMC and TMJ pathologies or symptoms.

RESUMO

OBJECTIVE: To correlate the volume of the mandibular condyle (MC) and the coronoid process (CP) with sex, age, and skeletal deformities. METHODS: The structures were visualized through semi-automatic segmentation of the 3D model and complemented with manual segmentation, using the ITK-SNAP 3.0 software. Mann-Whitney, Kruskal-Wallis, and the Dunn test were performed (p < 0.05). RESULTS: The MC volume showed statistical differences between sex and skeletal deformities. Men and Class III patients showed higher values. CP volume was not influenced by age or skeletal deformities. However, statistical differences were found between sex, with higher values for men. CONCLUSION: MC volume was influenced by sex and skeletal deformities, while CP was influenced only by sex. Women have smaller volumes for these structures. Age is not correlated with the volume of MC and CP. The highest and lowest values of condylar volume were found for Class III and II individuals, respectively.

Assuntos

RESUMO

As fraturas de côndilo representam grande frequência das fraturas mandibulares em relação às demais localizações. Podem ser classificadas em uni ou bilaterais, intra ou extracapsulares, com ou sem desvios. Geralmente, são resultantes de impactos em região de sínfise ou parassínfise. O tratamento das fraturas condilares ainda é um assunto muito controverso na literatura. É fundamental abordar inicialmente as indicações e contraindicações do tratamento cirúrgico ou conservador. Ao optar-se pelo tratamento cirúrgico, permanecem as dúvidas de qual o acesso seria o mais indicado para a fixação da fratura. Por meio de um relato de caso, temos como objetivo estudar a relevância e indicação do acesso retromandibular para as fraturas de côndilo.

Condyle fractures represent a high frequency of mandibular fractures in relation to other portions. They can be classified as unilateral or bilateral, intra or extracapsular, with or without deviations. Generally, they result from impacts in the symphysis or parasymphysis region. The treatment of condylar fractures is still a very controversial subject in the literature. To start the debate, we have the indications and contraindications for surgical or conservative treatment. When opting for surgical treatment, doubts remain as to which access would be the most suitable for fracture fixation. Through a case report, this dissertation aims to study the relevance and indication of retromandibular access for condyle fractures.

Assuntos

RESUMO

Objective To evaluate, through a tomographic analysis, the positional changes of the condyle when using a mandibular advancement device (MAD) for the treatment of obstructive sleep apnea (OSA), and to assess if the condylar positions influence OSA polysomnographic patterns. Materials and Methods Ten OSA patients underwent treatment with an MAD, and polysomnographic and tomographic examinations were performed before therapy (T0) and after MAD placement (T1). Results By comparing the T0 and T1 measurements, we observed advancement and extrusion of the condyles in all patients ( p < 0.001), as well as a decrease in the apnea-hypopnea index (AHI) ( p < 0.001), increases in the mean ( p = 0.001) and minimum ( p < 0.001) oxyhemoglobin saturation, and a significant correlation between the anterior displacement of the right ( p = 0.003) and left ( p = 0.015) condyles. Discussion Condylar advancement was directly correlated with OSA improvement: the greater the advancement, the better the AHI.

RESUMO

Aim: To describe cone-beam computed tomography (CBCT) features in patients with temporomandibular disorders (TMDs), in terms of degenerative changes, condylar excursions and positioning as well as their possible correlations with signs and symptoms. Methods: Clinical records of patients diagnosed with TMD who were seen between January 2018 and December 2019 were retrospectively evaluated. These patients were divided into the following groups based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD): arthralgia, myalgia, and arthralgia and myalgia groups. The CBCT examination findings of the patients were evaluated in relation to degenerative changes, estimates of condylar excursion, and condylar positioning. The likelihood ratio test was used to verify the possible differences among the three groups, whereas the chi-square test was used to verify the possible differences among the signs and symptoms for the tomographic findings (p ≤ 0.050). Results: In this study, 65 patients with TMD were included. These patients were predominantly female (84.6%) with a mean age of 40.6 years. Tomographic findings of flattening, hyperexcursion and posterior condylar positioning were frequent. A significant correlation was noted between osteophyte and lateral capsule pain (p = 0.027), erosion and posterior capsule pain (p = 0.026), and flattening, pseudocysts (p < 0.050) and condylar excursion (p < 0.001) with mouth opening. Conclusion: Few correlations were noted between degenerative changes and signs of joint pain as well as degenerative changes and condylar hypoexcursion with mouth opening. These correlations were likely associated with division by diagnosis, whereas condylar positioning did not correlate with signs and symptoms

Assuntos

RESUMO

Aim: This study aimed to evaluate the relationship between clinical findings and some factors such as age, gender, and remaining teeth on the anatomy of the temporomandibular joint in order to diagnose normal variations from abnormal cases. Methods: In this cross-sectional study, cone-beam computed tomography (CBCT) images of 144 patients referring to Tabriz Dental School for various reasons were selected and evaluated. The different aspects of the clinical parameters and the morphology of the condyle were evaluated on coronal, axial, and sagittal views. The CBCT prepared using the axial cross-sections had been 0.5 mm in thickness. The sagittal cross-sections had been evaluated perpendicular to the lengthy axis of the condyle at a thickness of 1 mm and the coronal cross-sections had been evaluated parallel to the lengthy axis of the condyle at a thickness of 1 mm. Data were analyzed with descriptive statistical methods and t-test, chi-squared test, using SPSS 20. The significance level of the study was p < 0.05. Results: There was a significant relationship between the condyle morphology, number of the teeth, and mastication side (p = 0.040). There were significant relationships between the condyle morphology, age between 20-40, and occlusion class I on the all the three views (coronal, axial, sagittal) (p = 0.04), (p = 0.006), (p = 0.006). Also, significant relationships were found in the condyle morphology and location of pain according to age, the number of remaining teeth, and gender. (p = 0.046) (p = 0.027) (p = 0.035). Conclusion:There are significant relationships between the clinical symptoms and condyle morphology based on age, gender, and the number of remaining teeth. The clinical finding that has the most significant relationship between the condyle morphology, remaining teeth (9-16 teeth), all of the age range (20-80 year), and gender was mastication side

Assuntos

RESUMO

Introduction: Mandibular fractures are the most common facial fractures affecting various anatomical sites of the mandible. Among the various mandibular fractures, management of condylar fractures remains a challenging task for surgeons. Case Report: We report the case of a 28 year old male patient who presented with pain in the chin and restricted mouth opening. Computed tomography revealed a sagittal fracture of the right condylar head with medial displacement of the fractured fragments. Management of diacapitular fractures includes open reduction and internal fixation of the right condyle using a single lag-screw. Results: The postoperative outcomes were favorable, where normal mandibular movements, desired dental occlusion and exact positioning of the condyle with rigid fixation were established thereby maintaining the shape of the condyle. Conclusion: Use of single lag screw fixation is highly recommended as it greatly supports the stabilized fracture fragments and also aid in prevention of fracture fragment rotation medially.

Introducción: Las fracturas mandibulares son las fracturas faciales más comunes que afectan a diversos sitios anatómicos de la mandíbula. Entre las diversas fracturas mandibulares, el manejo de las fracturas condilares sigue siendo una tarea desafiante para los cirujanos. Reporte del Caso: Presentamos el caso de un paciente masculino de 28 años que consultó por dolor en el mentón y restricción de la apertura de la boca. La tomografía computarizada reveló una fractura sagital de la cabeza condilar derecha con desplazamiento medial de los fragmentos fracturados. El tratamiento de las fracturas diacapitulares incluye la reducción abierta y la fijación interna del cóndilo derecho con un solo tirafondo. Resultados: Los resultados postoperatorios fueron favorables, donde se establecieron los movimientos mandibulares normales, la oclusión dentaria deseada y el posicionamiento exacto del cóndilo con fijación rígida manteniendo así la forma del cóndilo. Conclusión: Se recomienda encarecidamente el uso de una fijación con un solo tornillo de tracción, ya que soporta en gran medida los fragmentos de fractura estabilizados y también ayuda a prevenir la rotación medial de los fragmentos de fractura.

Assuntos

RESUMO

OBJECTIVE: To describe a cross-sectional study of TMJ dislocation in a Brazilian level-one trauma center. METHODS: The data were collected and analyzed from electronic medical records in a period from 2013 to 2020. RESULTS: Bilateral TMJ dislocation occurred in the majority of cases, being reduced by the Nélaton maneuver associated with Barton's bandage. The average time between the dislocation and specialist appointment was 30.69 hours. Elderly patients were associated with an increased number of recurrent dislocations (p = 0.03). Furthermore, a longer dislocation time was associated with the reduction under intravenous (IV) sedation (p < 0.05). CONCLUSION: The literature is still scarce concerning demographic data, treatment modalities, and follow-up. More studies are necessary to better understand TMJ dislocation management.

RESUMO

Objetivo: Evaluar los efectos de la aplicación de un dispositivo intraoral de uso permanente en el comportamien- to de los cóndilos con hiperplasia condilar (HC) confirmada por tomografía computarizada de emisión por fotón único (SPECT), estableciendo una comparación con un grupo de pacientes con HC que no utilizó el dispositivo. Materiales y métodos: 30 pacientes con una edad promedio de 21,7 años (+/-5,56) con HC confirmada con SPECT fueron asignados al azar a dos grupos: a los del grupo I (n=18) se les colocó un dispositivo intraoral de uso perma- nente para modificar la posición de la mandíbula, mientras que a los del grupo II (n=12) no se les colocó ningún dispo- sitivo. Se realizaron evaluaciones de dolor, del desvío de la línea media, de la apertura máxima y del disconfort al inicio del estudio y a los 2, 4, 6, 10, 12 y 14 meses. A los 19 meses promedio, la actividad osteoblástica (AO) fue reevaluada me- diante SPECT. Resultados: En el grupo I, la AO en los cortes coro- nales y transversales cesó o disminuyó (p<0,001) respecto a la condición inicial, mientras que en el grupo II la AO au- mentó (p<0,001). Los datos fueron analizados utilizando el test de Wilcoxon de rangos signados. Al ajustar un modelo de ANCOVA robusto utilizando el valor inicial como covariable también se observa que el efecto del grupo fue estadística- mente significativo en ambos cortes (p<0,001). Conclusiones: La aplicación de un dispositivo intrao- ral de uso permanente mejora la evolución de la hiperplasia condilar, lo que lo puede convertir en un tratamiento de uti- lidad para el tiempo que se aguarda para realizar una condi- lectomía alta de cuello de cóndilo, o incluso para evitar este procedimiento (AU)

Objective: To evaluate the effects of the application of an intraoral device for permanent use on the behavior of con- dyles with condylar hyperplasia (CH) confirmed by single photon emission computed tomography (SPECT), establish- ing a comparison with a group of patients with CH that did not use the device. Materials and methods: Thirty patients with an aver- age age of 21.7 years (+/-5.56) with CH confirmed by SPECT were randomly divided into two groups: the ones in group I (n=18) received an intraoral device for permanent use to align the mandible, while those in group II (n=12) did not get any device. Pain, midline shift, maximum opening, and discomfort were evaluated at the beginning of the study and at 2, 4, 6, 10, 12, and 14 months. At an average of 19 months, osteoblastic activity (AO) was reassessed by SPECT. Results: In group I, the AO in the coronal and trans- verse sections ceased or decreased (p<0.001) in comparison to the initial condition, while in group II the AO increased (p<0.001). The data was analyzed by the Wilcoxon signed rank test. Adjusting a robust ANCOVA model using the ini-tial value as a covariate made it possible to observe that the effect of the group was statistically significant in both cuts (p<0.001). Conclusions: The application of an intraoral device for permanent use improves the evolution of condylar hyperpla- sia, which can make it a useful treatment until a high condylectomy of the neck of the condyle is performed, or even to avoid this procedure (AU)

Assuntos

RESUMO

Central giant cell granulomas (CGCG) are not common in the mandibular condyle. In teenagers, the problem is more complex because of difficulties in diagnosis and treatment involving the potential growth of the mandibular process and development of the face. In this short communication a case is presented of an eleven-year-old female under diagnosis of central giant cell granuloma affecting the mandibular condyle treated surgically in two steps using a condylectomy and vertical ramus osteotomy at the first time and later orthognathic surgery, showing the clinical evolution after 13 years of follow-up. In addition, we performed a review of the scientific reports related to CGCG in the mandibular condyle to compare this treatment with others, in terms of follow-up and results. We concluded that the CGCG affecting the mandibular head can be properly treated with low condilectomy, vertical mandibular ramus sliding osteotomy, and discopexy.

RESUMO

La reabsorción condilar (RC) después de una cirugía ortognática (CO) es una consecuencia no deseada y en ocasiones con complicaciones irreversibles. El propósito de la investigación fue determinar los factores de riesgo que inciden en la RC posterior a una CO, mediante una revisión bibliográfica. Para lo cual se planteó un estudio exploratorio y documental, se realizó una revisión de literatura de los artículos desde el periodo de 2000 hasta el 2020, sin restricción de idioma, se excluyeron las investigaciones en animales e in vitro, resúmenes de congresos, publicaciones de RC relacionadas por enfermedad sistémica y estudios sobre remodelación condilar sin especificar RC posquirúrgica. La búsqueda de información se efectuó entre julio-agosto del 2021, en las bases de datos de Pubmed, Embase y SciELO, inicialmente fue con los términos de RC, CO, reabsorción condilar progresiva, "RC y CO", reportando 1346 artículos iniciales, después se hizo una selección de los estudios en función de los factores de riesgo, identificando 53 artículos, siguiendo los lineamientos de PRISMA. Se incluyeron 23 artículos, el análisis de los mismos demostró que los principales factores de riesgo implicados en la RC posquirúrgica son el sexo femenino de los pacientes, entre 14 y 58 años, con maloclusión clase Angle II, con ángulos del plano mandibular alto (24º- 50º), expuestos a una cirugía bimaxilar, avance mandibular (AM) mayor a 5 mm en sentido antihorario, utilizar una fijación intermaxilar rígida y que la recaída posquirúrgica se puede relacionar con la RC.

Condylar resorption (CR) after orthognathic surgery (OS) is an undesirable consequence and sometimes with irreversible complications. The purpose of the research was to determine the risk factors that affect CR after OS by means of a literature review. For which an exploratory and documentary study was proposed, a literature review of the articles from 2000 to 2020 was carried out, without language restriction, excluding animal and in vitro research, conference abstracts, CR publications related to systemic disease and studies on condylar remodeling without specifying postoperative CR. The search for information was performed between July-August 2021, in Pubmed, Embase and SciELO databases, initially it was with the terms of CR, OS, progressive condylar resorption, "CR and OS", reporting 1346 initial articles, then a selection of studies was made according to risk factors, identifying 53 articles, following the PRISMA guidelines. Twenty-three articles were included, the analysis of which showed that the main risk factors involved in postoperative CR are the female sex of the patients, between 14 and 58 years old, with Angle II class malocclusion, with high mandibular plane angles (24º - 50º), exposed to bimaxillar surgery, mandibular advancement (MA) greater than 5 mm counterclockwise, use of rigid intermaxillary fixation and that postoperative relapse can be related to CR.

RESUMO

BACKGROUND: Chronic mandibular hypomobility is characterized by a long-standing limitation of the mouth opening related to multiple etiologies, including elongation of the coronoid apophysis. Unlike the most frequent pathologies that cause coronoid elongation, such as hyperplasia, osteoma (OM), and osteochondroma (OC), the accessory mandibular condyle (AMC) is a rare entity. Clinical Presentation: The AMC shows a configuration similar to a normal mandibular condyle with an articular surface covered by fibrocartilage that articulates with the temporal wall of the zygomatic bone, and histologically, does not show neoplastic growth. The patient was treated with a coronoidectomy, removing the coronoid apophysis as well as the AMC. CLINICAL RELEVANCE: This case report presents a case of an AMC to describe the clinical, imaging, surgical, and histological characteristics, establishing its differential diagnosis with hyperplasia, OM, and OC of the coronoid apophysis.

Assuntos

RESUMO

Objective: To analyze the relationship between the size of the mandibular condyle and the temporomandibular joint disc position using computed tomography and magnetic resonance imaging.Methods: One hundred joints were retrospectively analyzed. The measures analyzed included the condylar head height, the medio-lateral and antero-posterior dimensions of the condylar head, and the TMJ disc position. ANOVA correlation coefficient and Tukey's post hoc test were employed.Results: The mean age of the subjects was 20.3 years. There were no significant correlations between the disc position in closed-mouth and the condylar head sizes. There was no significant correlation between the position of the disc in open mouth and the height of the condylar head, but there were statistically significant associations between the position of the disc and the horizontal condylar dimensions, the medial-lateral (p < .014), and the anterior-posterior sizes (p < .020).Conclusion: The condylar head size was smaller in subjects with disc displacement without reduction.

Assuntos