Osteochondroma is rare in the craniofacial skeleton and in particular in the mandibular condyle. The debate continues as to whether the osteochondroma represents a true neoplasm or is a hyperplastic response to previous trauma to the condylar region. Although it is uncommon to find pain associated with benign neoplasms, the involvement of the mandibular condyle and the temporomandibular joint may result in producing painful symptoms. This may lead to diagnostic confusion with temporomandibular dysfunction. This case presentation focuses on an unusually large osteochondroma which was initially missed due to confusion with TMJ related pain. Osteochondroma in the maxillofacial region may often merit surgical excision to confirm diagnosis or to resolve troublesome symptoms. The unusually large tumour necessitated an elective condylotomy and the division of the zygomatic arch to facilitate a complete excision of the mass. Pre-adaptation of miniplates prior to osteotomy ensured an accurate reconstruction of the condyle with very good aesthetic and functional outcome. Further the presentation endorses the importance of maintaining clinical vigilance and the value of employing modern imaging techniques in the diagnostic work-up of pain associated with temporomandibular joint.

Conflict of interest: None declared.