CAD/CAM-assisted total joint replacement for correction of facial asymmetry caused by large osteoma of mandibular condyle

Ji Youn Maeng; Jin-Young Choi

doi:10.25056/JCM.2023.7.1.45

Case Report

Split Viewer

J Cosmet Med 2023; 7(1): 45-48

Published online June 30, 2023

https://doi.org/10.25056/JCM.2023.7.1.45

CAD/CAM-assisted total joint replacement for correction of facial asymmetry caused by large osteoma of mandibular condyle

Ji Youn Maeng, DDS, MSD¹, Jin-Young Choi, DDS, MD²

¹Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, Rep. of Korea
²Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Rep. of Korea

Correspondence to :
Jin-Young Choi
E-mail: jinychoi@snu.ac.kr

Received: May 10, 2023; Revised: June 7, 2023; Accepted: June 8, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Go to

Abstract
Figure
Reference

Osteoma of mandibular condyle is uncommon benign tumor that grows slowly. Growth of condylar osteoma can cause functional and morphological problems such as facial asymmetry and malocclusion. Surgical removal and concurrent temporomandibular condyle replacement is a strategy that can resolve functional and aesthetic problems associated with large osteoma of mandibular condyle. Total joint replacement (TJR) with computer-associated surgical simulation (CASS) and computer-aided design/computer-aided manufacturing (CAD/CAM) technology can effectively and accurately rehabilitate debilitated condyle. A 52-year-old female visited department of Oral and Maxillofacial Surgery at Seoul National University Dental Hospital with a chief complaint of facial asymmetry and discomfort of left temporomandibular joint (TMJ). Radiographic and CT images showed a large bony mass at left TMJ surrounding left condylar head. Clinical examination revealed mandibular shift to right side, causing malocclusion and facial asymmetry. TJR of left TMJ with customized alloplastic condyle prosthesis and Biomet fossa was planned for the patient. Condyle was designed and fabricated using CAD/CAM. Surgical guides and occlusal splint fabricated with CAD/CAM technology was well. After 2 years, patient still showed occlusal stability with restored facial symmetry. No complications or recurrence were observed. TJR with customized alloplastic condyle and stock fossa can be an effective treatment strategy for large symptomatic condylar osteoma in restoration of normal function and aesthetics.

Keywords: computer-aided design, osteoma, surgery, computer-assisted, total joint replacement

Figures

Go to

Abstract
Figure
Reference

Fig. 1.Preoperative: Clinical photo (A, B) shows lower midline deviation of 3 mm to right side. (C) Axial view of cone-beam computed tomography (CBCT) for three-dimensional (3D) facial shows expansion of tumor encasing left condyle head. (D) Lateral view of CBCT for 3D facial shows mediolateral and anteroposterior expansion of the tumor. Postoperative: Clinical photo (E, F) at 2-year follow-up shows stable occlusal harmony without compromise of aesthetics. (G) Coronal view of CBCT for 3D facial shows osteotomized condyle and resected tumor. (H) Lateral view of CBCT for 3D facial shows total joint replacement with alloplastic prosthesis and Biomet fossa. We received the patient’s consent form about publishing all photographic materials.

References

Go to

Abstract
Figure
Reference

Almeida LE, de Oliveira Filho MA. Giant mandibular condyle osteoma. J Craniofac Surg 2011;22:1147-9.
Misra N, Srivastava S, Bodade PR, Rastogi V. Osteoma of temporomandibular joint: a rarity. BMJ Case Rep 2013;2013: bcr2013200268.
Valente L, Tieghi R, Mandrioli S, Galiè M. Mandibular condyle osteoma. Ann Maxillofac Surg 2019;9:434-8.
Sembronio S, Tel A, Costa F, Isola M, Robiony M. Accuracy of custom-fitted temporomandibular joint alloplastic reconstruction and virtual surgical planning. Int J Oral Maxillofac Surg 2019;48:1077-83.
Boffano P, Gallesio C, Roccia F, Berrone S. Radiographic superimposition and mandibular peripheral osteoma: the importance of clinical and CT findings. J Craniofac Surg 2013;24: e141-2.
Brucoli M, Giarda M, Benech A. Gardner syndrome: presurgical planning and surgical management of craniomaxillofacial osteomas. J Craniofac Surg 2011;22:946-8.
de Sousa Gil AP, Velasques BD, Uzun N, Haas OL, de Oliveira RB. Total customized alloplastic reconstruction for treatment of severe temporomandibular joint pathologic conditions: a case series of combined intraoral and extraoral approach. J Craniofac Surg 2022;33:e250-3.
Mercuri LG. Alloplastic temporomandibular joint replacement: rationale for the use of custom devices. Int J Oral Maxillofac Surg 2012;41:1033-40.
Yadav P, Roychoudhury A, Kumar RD, Bhutia O, Bhutia T, Aggarwal B. Total alloplastic temporomandibular joint replacement. J Maxillofac Oral Surg 2021;20:515-26.
Xu X, Ma H, Jin S. One-stage treatment of giant condylar osteoma: alloplastic total temporomandibular joint replacement aided by digital templates. J Craniofac Surg 2018;29:636-9.

Article

Case Report

J Cosmet Med 2023; 7(1): 45-48

Published online June 30, 2023 https://doi.org/10.25056/JCM.2023.7.1.45