Simultaneous Orthognathic Surgery and Condylectomy for Active Unilateral Condylar Hyperplasia: Indications and Outcomes of a Single-Stage Protocol.

内容摘要

Active unilateral condylar hyperplasia (AUCH) leads to progressive facial asymmetry and occlusal imbalance and may coexist with preexisting skeletal discrepancies. In such cases, a single-stage approach combining condylectomy and orthognathic surgery can address both pathological growth and the associated dentofacial deformity. The aim of this study was to present a treatment protocol and surgical algorithm for simultaneous orthognathic surgery and condylectomy in subjects with AUCH and to evaluate clinical outcomes in a retrospective case series. This retrospective case series included 24 adult subjects with AUCH treated between 2012 and 2018 in Santiago, Chile. Diagnosis was based on clinical evaluation, cone beam computed tomography, and single-photon emission computed tomography demonstrating ≥55% condylar activity. All subjects had completed growth and presented AUCH associated with dentofacial deformities requiring orthognathic correction, including maxillary hypoplasia, reduced upper airway, or mandibular advancement. Not applicable. Primary outcomes included postoperative occlusal stability (achievement and maintenance of Class I occlusion), facial symmetry (clinical and patient-reported), temporomandibular joint symptoms, mouth opening, complications, and need for reintervention. Covariates included age, sex, follow-up duration, type of condylectomy (high or adapted), type of mandibular osteotomy, surgical sequence, and concomitant procedures, all determined through virtual surgical planning. Descriptive statistics were used to summarize subject characteristics and outcomes. No inferential analyses were performed. Twenty-four subjects (mean age 20.8 ± 3.6 years; 66.7% female, 33.3% male) were included, with a median follow-up of 6 years. All subjects achieved stable Class I occlusion and satisfactory facial symmetry. No temporomandibular joint symptoms or reinterventions were observed. The mean mouth opening was 45 mm. Minor complications (transient facial paresis) occurred in 12.5% of subjects. Simultaneous orthognathic surgery and condylectomy is an effective approach for managing AUCH associated with dentofacial deformities, providing stable functional and aesthetic outcomes. Virtual surgical planning enables a structured surgical algorithm, guiding both the surgical sequence and the selection of the appropriate type of condylectomy, and may reduce the need for more invasive mandibular procedures.