Condylar hypoplasia and hyperplasia: optimal surgical timing and functional rehabilitation

Background and objectives: The primary objective in treating temporomandibular joint anamolies is to acheive adequate mouth opening and to restore function. Condylar deformities are challenging from a diagnostic and treatment point of view. The dilemma in treating the hypoplastic condyle in children and the importance of functional matrix theory is discussed. An indigenous method of aggressive physiotherapy following surgery in hospital and home is presented.

Methods: Seven patients were treated for condylar hyperplasia of which two were adolescents. Two children of 2.5 and 4 years old with mouth opening of 7–8 mm were treated for condylar hypoplasia with elongated coronoid. CT volumetric analysis and planar scintigraphy were used to evaluate the growing hyperplastic condyle, and condylar surgery was timed accordingly. In hypoplastic condyle, supportive surgeries like coronoidectomy and release of fibrous ankylosis were performed. Primary teeth were protected with customized splints and an indegenously designed mouth opener was used for aggressive physiotherapy.

Discussion: The use of costochondral graft is well documented in cases of condylar malformations. However its use in hypoplastic condyle is not common. In our cases of hypoplastic condyles, 29–31 mm of mouth opening was achieved with coronoidectomy, and the same was maintained after two years of follow up. The potential impact on mandibular growth with relevance to functional matrix theory by restoring function of masticatory muscles in children with hypoplastic condyle is a hypothesis. The morphological changes associated with hypoplastic condyle is still an issue.

Conclusion: In condylar hypoplasia the function was restored with coronoidectomy. Growth and asymmetry are to be assessed periodically. With linear growth analysis of the hyperplastic condyle, high condylar shave was performed with or without secondary mandibular correction in adolescents. Condylectomy was the treatment choice in adults with hyperplastic condyle.

Key words: condylar hypoplasia; paediatric mouth opening exercises; high condylar shave

Disclosure : Nil.

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Jan 21, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Condylar hypoplasia and hyperplasia: optimal surgical timing and functional rehabilitation
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