Treatment of a Large Mandibular Osteochondroma With Secondary Malocclusion With a Hybrid TMJ Custom Prosthesis and Orthognathic Surgery
Source: Oral Health, June 8, 2020 by by Jakob Nickerson, BSc, DDs; Peter Ta, BSc, MSc, DDS, FRCD(C); Thomas Kertesz, BSc, MSc, DDS, FRCD(C); Fred Murrell, BSc, MSc, DDS, Cert. Ortho; Walter Montanera, MD, FRCP(C); Ian J. Witterick MD, MSc, FRCSC; Marco Caminiti, BSc, MSc, DDS, FRCD(C); David J. Psutka DDS, FRCD(C)
Overview:
Osteochondroma (OC) is also known as osteocartilaginous exostosis. It arises from the bone cortex as an exophytic lesion with a hyaline cartilaginous cap. It is one of the most common benign tumors of the axial skeleton. It accounts for approximately one-third of benign bony lesions. OC may arise in any bone that develops from endochondral ossification and it is rare in maxillofacial region as most of the craniofacial skeleton develops from intramembranous ossification. Embryonic development of temporomandibular joint by endochondral ossification predisposes the coronoid and condylar process. The other reported sites are mandibular symphysis, body of mandible, in the soft tissues at the angle of the mandible, maxillary sinus and posterior maxilla. OC is usually seen in younger individuals with male predominance. OC may present in a solitary fashion or as multiple OCs seen in autosomal dominant syndrome known as osteochondromatosis.1
Report of a case:
A 32 year old female presented to the senior author with a 3 year history of progressively worsening malocclusion and associated left TMJ pain and limited interincisal opening. She complained of severe pain being 8/10 on the visual analogue scale. Her medical history was otherwise noncontributory.
The clinical examination confirmed facial asymmetry and left TMJ pain with palpation. She had a class III malocclusion with severe open bite and asymmetry and deviation of the mandible to the right. Her interincisal opening was moderately limited to 32 mm with deviation to the left. (Figs. 1-4)
Summary:
This paper presents a case of a patient with a large osteochondroma of the mandibular condyle. The patient had a successful outcome with a collaborative multidisciplinary approach. This included orthodontics, interventional neuroradiology, otolaryngology-head and neck oncology surgery and oral and maxillofacial surgery. A patient fitted custom TMJ prosthesis was made using digital work flow design and CAD-CAM technolgy. There is ever increasing evidence to support the use of alloplastic devices for total TMJ replacemeent as the procedure of choice in adult patients.