Orthodontic-surgical management of the horizontal unilateral condylar hyperplasia

Introduction: To describe the orthodontic-surgical approach we used in a sample of patients affected by the horizontal type of Unilateral Condylar Hyperplasia (UCH), that is a progressive disease that leads to mandibular asymmetry and midline deviation. Material and Methods: A retrospective observational cohort study was designed on 29 consecutive patients affected by horizontal UCH (23 females, 6 males; mean age, 22.4 y.o.±7.9) treated in the Units of Orthodontics and Maxillo-Facial Surgery. Descriptive statistics was performed. Correlations were tested between type of surgery and stage of skeletal maturation, presence of Temporo-mandibular Disorders, and condylar activity, evaluated with SPECT. Duration was correlated with type of surgery, and the mean duration of therapy was compared between patients who underwent condylectomy and those who underwent orthognathic surgery. Results: Females were more affected than males and had higher mean age. Temporo-mandibular Disorders were present in 31% of the sample. All patients with positive SPECT (15) were treated with condylectomy, alone or associated with orthognathic surgery, followed by post-surgical orthodontics. Patients with negative SPECT were treated with orthognathic surgery if adult (12), condylectomy if in age of skeletal growth (2). Discussion: The choice of the therapeutic approach has depended on skeletal maturation, condylar activity, and extent of dental compensations. Early condylectomy eliminates the etiologic cause of the Hyperplasia in patients with active condylar growth. In patients in age of growth, either if positive or negative to SPECT, early TMJ surgery eliminates the asymmetric growth and leads to symmetrization of the mandibular growth rate, acting as interceptive treatment.