Using High Condylectomy and Optimal Symmetry Plane Based Analysis in Treatment of Unilateral Temporomandibular Joint Osteochondroma: Report of Three Cases and Review of Literatures

以高位髁突切除術及最佳對稱面分析法於單側下顎骨髁突骨軟骨瘤之治療：三病例報告與文獻回顧

蕭凱元(Kai-Yuan Hsiao) ； 劉景勳(Chiang-Shin Liu) ； 方晶晶(Jing-Jing Fang) ； 王東堯(Tung-Yiu Wong)

《臺灣口腔顎面外科學會雜誌》 33卷1期 (2022/03) Pp. 45-58

摘要

Complete condylectomy has been the mainstream technique in managing condylar osteochondroma (COC). Recently, conservative resection of the condyle or tumor excision alone is becoming popular. Herein, we evaluate the efficacy of high condylectomy for unilateral COC with simultaneous restoration of facial symmetry by orthognathic surgery (OGS). Three patients with unilateral COC were reviewed. Optimal symmetry plane (OSP) based analysis was used to evaluate the facial bone symmetry. Case A was followed for 132 months, case B, 102 months, and case C, 98 months post-condylectomy. There were no recurrences. Near-normal temporomandibular joint (TMJ) function, satisfying facial symmetry, and stable occlusion were noted. In the OSP-based analysis, the 3-dimensional (3D) deviation angle went from 8.66 to 1.82 in case A; 5.55 to 1.52 in case B; and 24.5 to 6.02 in case C. The results show that tumor excision and high condylectomy is an effective treatment option for unilateral COC. This method appears to be more conservative than low condylectomy while obtaining adequate tumor removal and preserving TMJ function. When combined with OGS, facial symmetry can be restored. The OSP analysis provides graphical and numerical information in 3D and aids in diagnosis, treatment planning, and post-operative evaluation of facial symmetry.

關鍵字

Condylar osteochondroma ； High condylectomy ； Optimal symmetry plane ； Orthognathic surgery ； Facial asymmetry

並列摘要

發生於下顎骨髁突之骨軟骨瘤傳統上採取全髁突切除術，然而近年來愈來愈多醫師選擇採取較保守的手術方式切除髁突、或只切除腫瘤本體。在此提出三例以高位髁突切除術合併正顎手術治療單側髁突骨軟骨瘤之療效，其中顏面歪斜程度採用最佳對稱面分析法分析之。A、B、C三位病人分別經過132、102及98個月之長期追蹤，期間並無腫瘤復發之情況，亦維持正常的顳顎關節功能、令人滿意的顏面對稱性及穩定的咬合。由最佳對稱面分析報告可見，A病人下顎骨之立體偏差角度由8.66度進步至1.82度、B病人下顎骨之立體偏差角度由5.55度進步至1.52度、C病人下顎骨之立體偏差角度由24.5度進步至6.02度。追蹤結果顯示，以高位髁突切除術治療單側下顎骨髁突骨軟骨瘤不僅可達足夠的切除範圍，亦比採用低位髁突切除術能保存更多顳顎關節功能，若合併正顎手術，更可恢復病人之臉部對稱性。使用最佳對稱面分析法，能提供醫師圖像化及數據化之立體資訊，並可協助醫師於顏面對稱性方面之診斷、手術計畫擬定及治療結果之追蹤比對。

並列關鍵字

下顎髁突骨軟骨瘤 ； 高位髁狀突切除術 ； 最佳對稱面 ； 正顎手術 ； 顏面不對稱