Management of temporomandibular joint osteochondroma with facial asymmetry: a case report

Abstract

Osteochondroma is rare in the facial region and osteochondroma of the mandible typically causes facial asymmetry and malocclusion. Resection of the affected condyle and orthognathic surgery has been frequently reported as the treatment of choice. The aim of this study was to manage a case of osteochondroma of the temporomandibular joint (TMJ) causing facial asymmetry. After extensive treatment plan discussions between the surgeon and the patient, the patient was reluctant to undergo the surgeries and chose to wait and see if there was cessation of the condylar hyperplasia instead of undergoing orthognathic surgery and condylectomy. Thus, this case was followed up by performing clinical examinations, radiographs, CT, and bone scintigraphy for approximately eight years. Subsequently, the facial asymmetry and the skeletal discrepancy became more severe. Furthermore, the bone scan revealed evidence of ongoing condylar hyperplasia. Based on these findings, the patient chose to undergo surgery. Low condylectomy with bimaxillary orthognathic surgery were selected for this case. The intraoperative sequence, however, differed from other studies in that the maxilla orthognathic surgery was performed prior to resecting the condyle and bilateral sagittal split osteotomy (BSSRO). The histopathologic results indicated that the tumor was consistent with osteochondroma. His facial asymmetry and malocclusion had been appropriately corrected. The patient did not experience restricted mouth opening, whereas postoperative complications, such as lip paresthesia and facial weakness were reported after three months. However, three months later, these complications had resolved. Moreover, the radiographic evaluation demonstrated no recurrence of the osteochondroma.