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SHORT COMMUNICATION  
Year : 2011  |  Volume : 22  |  Issue : 4  |  Page : 616
Osteochondroma of the mandibular condyle


1 Department of Community Dentistry, BJS Dental College, Punjab University, Ludhiana, India
2 Private Practice, Oral and Maxillofacial Surgery and Oral Implantolgy, Mumbai, Maharashtra, India
3 Department of Periodontics and Oral Implantology, Dr. D. Y Patil Dental College, Mumbai, Maharashtra, India
4 Head of Dental Wing, Muzaffarnagar Medical College, CCS University, Muzaffarnagar (UP), India

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Date of Submission01-Dec-2010
Date of Decision07-Dec-2010
Date of Acceptance23-Feb-2011
Date of Web Publication26-Nov-2011
 

   Abstract 

Osteochondroma (OC) of the mandibular condyle is a relatively rare condition that causes a progressive enlargement of the condyle, usually resulting in facial asymmetry, temporomandibular joint (TMJ) dysfunction, and malocclusion. Radiographically, there is a unilaterally enlarged condyle usually with an exophytic outgrowth of the tumor from the condylar head. We present a case of a left mandibular condylar OC that created a major facial asymmetry, malocclusion, and TMJ dysfunction. Discussion includes the rationale for treatment and the method used in this case. In actively growing OCs, surgical intervention is indicated to remove the tumor stopping the benign growth process and improve facial symmetry, occlusion, and jaw function.

Keywords: Mandibular dysfunction, osteochondroma, rationale for treatment

How to cite this article:
Kumar A, Rastogi S, Modi M, Nijhawan S. Osteochondroma of the mandibular condyle. Indian J Dent Res 2011;22:616

How to cite this URL:
Kumar A, Rastogi S, Modi M, Nijhawan S. Osteochondroma of the mandibular condyle. Indian J Dent Res [serial online] 2011 [cited 2019 Oct 23];22:616. Available from: http://www.ijdr.in/text.asp?2011/22/4/616/90330
Osteochondroma (OC) is one of the most common benign tumors of the axial skeleton, but it is rarely present in the facial bones. When present, the tumor most commonly affects the mandibular coronoid process or the mandibular condyle. [1] Symptomatic unilateral enlargements of the mandibular condyle are relatively uncommon. Appreciation of the embryologic development of the temporomandibular joint (TMJ) is important for an understanding of the pathology of this region. Typical facial features of condylar OCs include striking facial asymmetry, malocclusion with open-bite on the affected side, with deviation of the chin, and cross-bite to the contralateral side. [2] Pain and dysfunction often accompany the anatomic derangement. Radiographically, these lesions are radiopaque with distinct borders and easily identified on computed tomography (CT) as well as plain radiography.

Histologically, OC needs to be distinguished from osteoma, benign osteoblastoma, chondroma, and chondroblastoma. The histologic criteria for the diagnosis of an OC include chondrocytes of the cartilaginous cap arranged in clusters in parallel oblong lacunar spaces similar to those of normal epiphysial cartilage. The histologic orientation is suggestive of a benign lesion. Regular bony trabeculae produced by endochondral ossification are present. The exostosis is covered by periosteum that is continuous with that of the adjacent bone.


   Case Report Top


A 55-year-old female patient was referred to our clinic with complaints of eating and speaking difficulties and presenting a facial asymmetry. She had a history of previous TMJ treatment on the left side 10 years ago and from that time on a slowly progressing facial asymmetry with limitation in mouth opening began. Physical examination revealed that there was approximately an 8-mm deviation of midline to the right side [Figure 1]. The patient's maximum mouth opening measured was 32 mm. There was a unilateral posterior cross-bite on the right side and 8 mm negative horizontal overjet. On the panoramic radiograph, the mandibular condyle is displaced out of the fossa and is sitting beneath the articular eminence as a result of the overgrowth of the OC anterior to the articular eminence that has consequently displaced the condyle forward in the fossa [Figure 2]. On the coronal, axial, and 3-dimensional CT images, it was clearly distinguished that there was a cartilaginous/bony lesion developed from the left anterior condylar head [Figure 3] and [Figure 4]. Whole body scintigraphy revealed an increased activity in left TMJ.
Figure 1: Progressive asymmetry of the left side of the face

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Figure 2: OPG reveals irregular radiopacity associated with the left condyle

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Figure 3: Axial CT scan reveals a radiopaque mass associated with medial border of the left condyle

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Figure 4: 3D CT scan shows a dense opaque mass arises from anterior border of the left condyle

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Tumor excision was performed under general anesthesia and nasotracheal intubation. Surgical access was through the intraoral vertical ramus incision on the left side and the tumor was excised sparing the coronoid and condyle. Dimensions of the excised tumor were 4 × 3.5 × 3 cm. Histopathologic examination revealed a nodular lesion having cartilaginous cap and mature bone tissue beneath [Figure 5], consistent with OC. Patient recovery was uneventful. The postoperative follow-up examinations revealed no recurrences after five years and maintenance of facial symmetry and joint function.
Figure 5: Histologic section reveals the confirm diagnosis of osteochondroma

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   Discussion Top


Condylar OCs are frequently situated on the anteromedial surface of the condylar head. The occurrence of these tumors in the condyle tends to support the theory of aberrant foci of epiphysial cartilage on the surface of the bone. [3] One theory states that stress in the tendinous insertion region of lateral pterygoid muscle, where focal accumulations of cells with cartilaginous potential exist, leads to formation of these tumors. This may also explain the occurrence of the OCs in the coronoid process stressed by the tension of temporalis muscle. [4] Other theories as to the cause include neoplastic, developmental, reparative, and traumatic etiologies. [5] Early occurrence of the unilateral condylar hyperplasia results in gradual deviation of the midline away from the affected side with increased vertical mandibular growth. When growth of the lesion is slow, there is reciprocal compensatory vertical growth of the maxilla with canting of the occlusal plane to accommodate the increasing mandibular vertical dysplasia.

A conservative condylectomy with articular disc repositioning combined with orthognathic surgery is an acceptable option for treatment of condylar OC. [6] Most case reports include no TMJ reconstruction, only tumor removal. For the reconstructed cases, varieties of procedures have been used including condyloplasty, discectomy, costochondral grafting, disc plication, coronoidectomy, eminoplasty, alloplastic spacer placement, Le FortI osteotomy, and extraoral and intraoral vertical ramus osteotomies.

The OC had not invaded the whole condyle in the present case. That is why our conservative approach removed the tumor completely with curetting some intact bone and left the remaining condyle in place. Condylectomy was not our choice of treatment, so no condylar reconstruction or any other adjunctive surgeries were needed.


   Conclusion Top


Due to the distinctive radiographic appearance of mandibular OCs, CT provides an invaluable tool to assist in evaluation and treatment planning. The recommended treatment of choice for symptomatic OCs is surgical resection.

 
   References Top

1.Lichtenstein L. Bone Tumors, 5 th ed. St Louis; MO, Mosby; 1977. p. 26-30.  Back to cited text no. 1
    
2.Kurita K, Ogi N, Echiverre NV, Yoshida K. Osteochondroma of the mandibular condyle. A case report. Int J Oral Maxillofac Surg 1999;28:380-2.  Back to cited text no. 2
[PUBMED]    
3.Karras SC, Wolford LM, Cottrell DA. Concurrent osteochondroma of the mandibular condyle and ipsilateral cranial base resulting in temperomandibular joint ankylosis: Report of a case and review of the literature. J Oral Maxillofac Surg 1996;54:640-6.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Wolford LM, Mehra P, Franco P. Use of conservative condylectomy for treatment of osteochondroma of the mandibular condyle. J Oral Maxillofac Surg 2002;60:262-8.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Dahlin DC, Unni KK. Bone Tumors. General aspects and data on 8542 cases. Springfield (IL): Charles C. Thomas; 1986. p. 18-32.  Back to cited text no. 5
    
6.Stevao ELL, Wolford LM, Morales-Ryan CA. Osteochondroma of the mandibular condyle: Conservative reconstruction with condylectomy. J Oral Maxillofac Surg 2003;61:65.  Back to cited text no. 6
    

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Correspondence Address:
Sanjay Rastogi
Private Practice, Oral and Maxillofacial Surgery and Oral Implantolgy, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.90330

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]

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