1) Condylar hyperplasia is a TMJ pathology characterized by excessive, unilateral mandibular growth resulting in facial asymmetry.
2) It is classified based on the location and direction of excessive growth. Management depends on the severity of asymmetry, age, and condylar activity level.
3) For active growth, condylectomy is usually performed to arrest growth while orthognathic surgery alone is used if growth is inactive to correct occlusal and skeletal deformities. The most complex treatment combines condylectomy and orthognathic surgery.
Hibernoma is a rare, painless, and benign soft tissue tumor arising from brown fat cells. We present a 28 year old gentleman with a large and tender left anterior neck swelling associated with restricted left shoulder movement for one week duration after he was involved in a motor vehicle accident. Due to the nature of the injury and presentation, it was unexpected to fi nd a well encapsulated fat density suggestive of lipoma from Computed Tomography (CT) scan. Surgical exploration and excision were performed, and the histopathological examination of the excised mass noted to be hibernoma. Patient recovered well and regained full shoulder movement post operatively.
This case illustrated the importance of having broad differentials when approaching patients with post traumatic neck swelling.
Hibernoma is a rare, painless, and benign soft tissue tumor arising from brown fat cells. We present a 28 year old gentleman with a large and tender left anterior neck swelling associated with restricted left shoulder movement for one week duration after he was involved in a motor vehicle accident. Due to the nature of the injury and presentation, it was unexpected to fi nd a well encapsulated fat density suggestive of lipoma from Computed Tomography (CT) scan. Surgical exploration and excision were performed, and the histopathological examination of the excised mass noted to be hibernoma. Patient recovered well and regained full shoulder movement post operatively.
This case illustrated the importance of having broad differentials when approaching patients with post traumatic neck swelling.
Traditionally, obtaining tissue diagnosis from the Temporomandibular Joint (TMJ) has required invasive open techniques. In this case-series, the authors demonstrate a minimally invasive technique using arthroscopy to diagnose and treat Pigmented Villonodular Synovitis (PVNS) and pseudogout of the TMJ, followed by a review of the literature.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Scrotal Masses
98-100% accuracy in distinguishing intra and extra-testicular masses.
*** Most extratesticular masses are benign & most intratesticular masses are malignant
Malignant lesions are msotly hypoechoic.
Malignant neoplasia pts usually presents as
painless , unlateral testicular mass .
Clinically it is important to differentiate between Seminomas and Non Seminomatous germ cell tumors.
Exploring Materials for Orthodontic Mini-Implants: A Comprehensive Overview.pdfsafabasiouny1
A temporary anchorage device (TAD) is a device that is temporarily fixed to bone for the purpose of enhancing orthodontic anchorage either by supporting the teeth of the reactive unit ( indirect anchorage ) or by obviating the need for the reactive unit altogether(direct anchorage), and which is subsequently removed after use.
They can be located transosteally, subperiosteally or endosteally; and they can be fixed to bone either mechanically (cortically stabilized) or biochemecially (osseointegrated). It should also be pointed out that dental implants placed for the ultimate purpose of supporting a prosthesis, regardless of the fact that they may be used for orthodontic anchorage, are not considered temporary anchorage devices since they are not removed and discarded after orthodontic treatment. By using dental implants and temporary anchorage devices for orthodontic purposes we are able to obtain zero anchorage loss.
Currently, several terms are used to refer to skeletal anchorage devices, the most inclusive being temporary anchorage devices. Other names include implants, mini-implants, miniscrews, micro-screws, screws, mini-plates, and plates.
Implants and mini-implants usually necessitate osseointegration for stability, whereas screws, miniscrews and micro-screws are generally loaded immediately after placement and receive their stability from mechanical retention in the bone
Plates are attached to bone through a surgical procedure necessitating the elevation of a flap. A portion is left emerging in the oral cavity to serve as appoint of application of the force system
Strategies for Managing White Spot Lesions in Orthodontic Patients and A Sugg...safabasiouny1
“white opacity,” occur as a result of subsurface enamel demineralization that is located on smooth surfaces of teeth. Or “subsurface enamel porosity from carious demineralization” that presents itself as “a milky white opacity when located on smooth surfaces
Etiology:
1. prolonged “undisturbed” plaque accumulation on the affected teeth surface, commonly due to inadequate oral hygiene. Under these conditions, acids diffuse into the enamel and the demineralization continues in the subsurface enamel, then the intact enamel surface collapses and becomes cavitated.
2. The presence of fixed orthodontic appliances causes an increasing number of plaque retention sites as a result of the presence of brackets, bands, wires, and other applications, which makes the cleaning of teeth more difficult. furthermore, excess bonding, long etching time (>15 s), decayed/treated molars, and the duration of treatment are considered other risk factors
3. The other important factors that impact this process are the patient’s modifying factors, including medical history, dental history, medication history, diet, levels of calcium, phosphate, and bicarbonate in saliva, fluoride levels, and genetic susceptibility.
Incidence:
• Orthodontic treatment has been reported as the most frequent factor for this situation, and equal susceptibility has been reported whether teeth are banded or bonded.
• The prevalence of WSLs varies widely in the literature. It ranges from 23 to 95%. The reported prevalence of WSLs is quite variable, depending on the sample size, method of detection, the use of a fluoride regimen during treatment, inclusion of pre-existing developmental enamel defects, and selected patients' groups.
• WSLs developed more frequently in the maxillary arch than they did in the mandibular.
• The researchers identified other risk factors during the treatment such as treatment time exceeded 36 months, patients with poor oral hygiene, and patients whose oral hygiene declined during treatment and pre-existing WSLs.
• They observed that the lesions are often symmetrical.
• WSLs are often seen under loose bands, around the periphery of the bracket base and in areas that are difficult to be detected by the patient and not easily accessed by the toothbrush
• More frequently on the maxillary laterals, maxillary canines, and mandibular molars. In other studies, different results were obtained. According to these studies, the most inclined teeth to demineralization are the first permanent molars, the maxillary incisors, the mandibular lateral incisors, and canines.
More Related Content
Similar to Condylar Hyperplasia and Othodontics.pptx
Traditionally, obtaining tissue diagnosis from the Temporomandibular Joint (TMJ) has required invasive open techniques. In this case-series, the authors demonstrate a minimally invasive technique using arthroscopy to diagnose and treat Pigmented Villonodular Synovitis (PVNS) and pseudogout of the TMJ, followed by a review of the literature.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Scrotal Masses
98-100% accuracy in distinguishing intra and extra-testicular masses.
*** Most extratesticular masses are benign & most intratesticular masses are malignant
Malignant lesions are msotly hypoechoic.
Malignant neoplasia pts usually presents as
painless , unlateral testicular mass .
Clinically it is important to differentiate between Seminomas and Non Seminomatous germ cell tumors.
Exploring Materials for Orthodontic Mini-Implants: A Comprehensive Overview.pdfsafabasiouny1
A temporary anchorage device (TAD) is a device that is temporarily fixed to bone for the purpose of enhancing orthodontic anchorage either by supporting the teeth of the reactive unit ( indirect anchorage ) or by obviating the need for the reactive unit altogether(direct anchorage), and which is subsequently removed after use.
They can be located transosteally, subperiosteally or endosteally; and they can be fixed to bone either mechanically (cortically stabilized) or biochemecially (osseointegrated). It should also be pointed out that dental implants placed for the ultimate purpose of supporting a prosthesis, regardless of the fact that they may be used for orthodontic anchorage, are not considered temporary anchorage devices since they are not removed and discarded after orthodontic treatment. By using dental implants and temporary anchorage devices for orthodontic purposes we are able to obtain zero anchorage loss.
Currently, several terms are used to refer to skeletal anchorage devices, the most inclusive being temporary anchorage devices. Other names include implants, mini-implants, miniscrews, micro-screws, screws, mini-plates, and plates.
Implants and mini-implants usually necessitate osseointegration for stability, whereas screws, miniscrews and micro-screws are generally loaded immediately after placement and receive their stability from mechanical retention in the bone
Plates are attached to bone through a surgical procedure necessitating the elevation of a flap. A portion is left emerging in the oral cavity to serve as appoint of application of the force system
Strategies for Managing White Spot Lesions in Orthodontic Patients and A Sugg...safabasiouny1
“white opacity,” occur as a result of subsurface enamel demineralization that is located on smooth surfaces of teeth. Or “subsurface enamel porosity from carious demineralization” that presents itself as “a milky white opacity when located on smooth surfaces
Etiology:
1. prolonged “undisturbed” plaque accumulation on the affected teeth surface, commonly due to inadequate oral hygiene. Under these conditions, acids diffuse into the enamel and the demineralization continues in the subsurface enamel, then the intact enamel surface collapses and becomes cavitated.
2. The presence of fixed orthodontic appliances causes an increasing number of plaque retention sites as a result of the presence of brackets, bands, wires, and other applications, which makes the cleaning of teeth more difficult. furthermore, excess bonding, long etching time (>15 s), decayed/treated molars, and the duration of treatment are considered other risk factors
3. The other important factors that impact this process are the patient’s modifying factors, including medical history, dental history, medication history, diet, levels of calcium, phosphate, and bicarbonate in saliva, fluoride levels, and genetic susceptibility.
Incidence:
• Orthodontic treatment has been reported as the most frequent factor for this situation, and equal susceptibility has been reported whether teeth are banded or bonded.
• The prevalence of WSLs varies widely in the literature. It ranges from 23 to 95%. The reported prevalence of WSLs is quite variable, depending on the sample size, method of detection, the use of a fluoride regimen during treatment, inclusion of pre-existing developmental enamel defects, and selected patients' groups.
• WSLs developed more frequently in the maxillary arch than they did in the mandibular.
• The researchers identified other risk factors during the treatment such as treatment time exceeded 36 months, patients with poor oral hygiene, and patients whose oral hygiene declined during treatment and pre-existing WSLs.
• They observed that the lesions are often symmetrical.
• WSLs are often seen under loose bands, around the periphery of the bracket base and in areas that are difficult to be detected by the patient and not easily accessed by the toothbrush
• More frequently on the maxillary laterals, maxillary canines, and mandibular molars. In other studies, different results were obtained. According to these studies, the most inclined teeth to demineralization are the first permanent molars, the maxillary incisors, the mandibular lateral incisors, and canines.
"Breath Easy: The Role of Orthodontics in Managing Obstructive Sleep Apnea"safabasiouny1
obstructive sleep apnea and orthodontics including diagnosis and treatment
Sleep disruption caused by breathing disorders are potentially life-threatening and therefore an important global health issue.
Sleep disorders, particularly untreated obstructive sleep apnea (OSA) has been known as a risk and possible causative factor in
1.
development of systemic hypertension,
2.
depression,
3.
stroke, angina
4.
cardiac dysrhythmias.
5.
can be associated with motor vehicle accidents,
6.
poor work performance and therefore, also makes a person prone to occupational accidents and reduced quality of life.
7.
adversely affects patients on their personal, social and professional levels.
Obstructive sleep apnea (OSA)
Definition: cessation of airflow for more than 10 seconds and hypopnoea is 50% reduction in air flow
It is Classified as central, obstructive and mixed and can be graded as mild, moderate and severe
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
3. What is condylar hyperplasia (CH)
As described by Robert Adams (1836) CH is a TMJ pathology that is characterized by
excessive mandibular growth that almost always presents unilaterally, resulting in facial
asymmetry. The condition is slowly progressive and self-limiting, but the longer it persists
the greater the developing asymmetry and associated occlusal changes.
Excessive growth can occur in several different locations as
An enlarged condyle
01
An elongated condylar neck
02
Outward bowing or downward growth of the
body and ramus.
03
4. Incidence
Age: Occur at any age and can continue past the growth period.
Sex: Predominantly affect women.
Side: Sex-based laterality (sex linked), with women more in RT side, men
affected more in LT side
LT
RT
5. The etiology of condylar hyperplasia is controversial and not well understood. Some
theories suggest that it is caused by
1 Trauma
2 Heredity/Intrauterine factors
3 Infections
4 Hypervascularity
5 Familial history
6 Hormonal (estrogen)
Etiology
7. Type I (Hemi-mandibular Elongation)
Clinical findings
Chin deviation towards contralateral side
Midline shift to contralateral side
Ipsilateral class III malocclusion on the same side.
Lingual deviation of contralateral mandibular molars
Possible posterior crossbite
Anatomical finding
Excessive growth in the horizontal vector
Condyle often unaffected
Elongated mandibular ramus
Misshapen and slender condylar neck
8. Anatomical finding
Excessive growth in the vertical vector
Enlarged and often irregularly shaped condylar head
Neck of condyle can be thickened and/or elongated
Type II (Hemi-mandibular Hyperplasia)
Clinical finding
Sloping rima oris (comisures) with minimal chin deviation
No midline shift
Possible open bite
Supraeruption of maxillary molars on affected side and severe
OC
9. Type III (Hybrid)
Clinical findings
Chin deviation towards contralateral side with a sloping
rima oris
Midline shift
Possible open bite and/or cross bite
Anatomical finding
Excessive growth in both vectors
Enlarged condylar head, neck and ramus
Irregularly shaped condylar head, neck and/or ramus
10. Anatomical finding
Clinical finding
Age of
onset
Type
• Bilateral mandibular
elongation
• No midline deviation
• Prognathism and Class III
occlusion
• Accelerated and prolonged
growth
Pubertal
growth
Type
IA
• Unilateral mandibular
elongation
• Chin deviation towards
contralateral side
• Midline shift to contralateral
side
• Lingual deviation of
contralateral mandibular
molars
• Possible posterior crossbite
• Ipsilateral Class III occlusion
Type
IB
• Excessive growth in the horizontal vector
• Condyle often unaffected
• Bilateral elongated mandibular head, neck
and ramus
• Misshapen and slender condylar neck
11. Anatomical finding
Clinical finding
Age of
onset
Type
• Excessive growth in the vertical vector
• Condylar enlargement without horizontal exophytic
growth of condyle
• Enlarged and often irregularly shaped condylar head
• Neck of condyle can be thickened and/or elongated
• Unilateral vertical elongation
of face
• Sloping rima oris with
minimal chin deviation
• Supraeruption of maxillary
molars on affected side
• Possible open bite
• No midline shift
Two thirds
of cases
begin in
second
decade
Type
IIA
• Excessive growth in the vertical vector
• Condylar enlargement with horizontal exophytic
growth off condyle (osteochondroma)
• Enlarged and often irregularly shaped condylar head
• Neck of condyle can be thickened and/or elongated
Type
IIB
12. Anatomical finding
Clinical finding
Age of
onset
Type
- Caused by benign tumor growth
- Osteomas, neurofibromas, fibrous dysplasia, giant cell
tumor, chondroma, chondroblastoma, etc.
• Unilateral facial
enlargement
No
specific
age
Type III
-Caused by malignant tumor growth
-Caused by chondrosarcoma, multiple myeloma,
osteosarcoma, Ewing sarcoma, and metastatic lesions
Type IV
14. A. Panoramic & cephalometric
Serial panoramic and cephalometric radiographs (6- to 12-
month intervals) can be used to determine if the condition is
active.
On plain radiographs the following observed:
Type
II
1. Double mandibular bodies observed in profile
radiograph.
2. Anteroposterior radiograph will show evidence
of maxillary and OC
3. Difference in height of gonial angles evident on
panoramic and anteroposterior radiographs
and CT
4. Loss of the antegonial notch and asymmetry of
the mandibular body.
5. The affected condylar head is larger and the
neck is longer than on the contralateral side.
Type Imaging charecteristics
Type
I
1. Panoramic radiograph or CT will show changes
in length and condylar volume
2. PA radiograph will show evidence of
mandibular lateral deviation and mild maxillary
canting
3. No differences in mandibular ramus length
(condylion to gonion) or gonial angle height.
Type
III
Combination
15. B. CBCT
The following measurement can be taken and
compared to the contralateral side
Measurement Description
Condylar
length
In the sagittal view, a tangent to the
posterior ridge of the mandibular ramus
and a perpendicular tangent to it from
the deepest part of the mandibular
notch are traced; the length is
measured from the most superior
contour of the condyle to a medium
point located in the perpendicular plane
that goes from the mandibular notch to
the tangent to the posterior ridge of the
mandibular ramus
16. Measurement Description
Mandibular
ramus length
In the sagittal view of 3D reconstruction, a
line perpendicular to the Frankfort plane and
extended from the deepest point of the notch
to the inferior ridge of mandibular body is
traced
Ramus width In the sagittal view of 3D reconstruction, a
line parallel to the Frankfort plane and
extending from the deepest point of the
anterior contour of the mandibular ramus to
the posterior ridge is traced
Mandibular
body length
In the sagittal view of 3D reconstruction, a
line that goes from the bone–tissue gonion to
the bone–tissue pogonion is traced
B. CBCT
The following measurement can be taken and
compared to the contralateral side
17. Measurement Description
Deviation of
midpoint of
symphysis
In the frontal view of 3D reconstruction, the
distance from the point of the menton to a
line going from the lower third, projected
from the middle part of the apophysis crista
galli perpendicular to the bizygomatic line,
is measured in millimeters
B. CBCT
The following measurement can be taken and
compared to the contralateral side
18. Skeletal scintigraphy is the gold standard to evaluate
growth activity in the condylar head
Idea:
Capable of providing physiological details of CH using
radionuclide-labeled tracers which is injected and
absorbed into hydroxyapatite crystals and calcium in
the bone. The bone is then scanned, and the hyperplastic
condyle is quantitatively compared to the contralateral
side.
Planar
scintigraphy
SPECT
(Single
photon
emission
computed
tomography)
PET(Positro
n emission
Tomography
)
Radionucleotid
e
technetium-
99m-labelled
methylene
diphosphonate
(99mTc-MDP)
technetium-
99m-labelled
methylene
diphosphonate
(99mTc-MDP)
[18F]-fluoride.
Produced
image
2D 3D 3D
Sensitivity Less than
SPECT
higher
sensitivity
less
Interpretation Descriptive
(hot spot)
Quantitative Quantitative
Nuclear imaging
19. Interpretation of SPECT
Uptake levels Indication
Difference in uptake levels of
less than 10%
normal condyles or individuals
without progressive asymmetry
Differences greater than 10% active growth due to CH.
uptake value greater than 55% condylar hyperplasia
Comparison of the uptake with normal standards by
age
A ratio of uptake to 4th lumbar vertebra (standard bone for
scanning purposes) is calculated. The ratio is then compared to
normal standards by age
Ratio
Age
2-1.85
0-2
1.85-1.65
2-5
1.65-1.30
5-10
1.30-1.10
10-15
1.10-0.7
15-20
ᐸ0.7
20
Comparison of the uptake levels between two
sides
20. Both condylar hyperplasia and condylar
osteochondroma
showed a cartilage cap that covered the
surface of the
condyle. The cartilage cap was divided into
four layers:
Histopathologic features
H&E staining showed that the cartilage cap that
covered the surface of the condyle was divided into
four layers:
• The fibrous layer,
• Undifferentiated mesenchyme layer,
• Cartilage layer including pre-hypertrophic and
hypertrophic
• Chondrocytes and the calcified cartilage layer
22. ONSET CLINICAL FINDINGS IMAGING FINDINGS
Condylar hyperplasia 13-30 year -Elongation or enlargement of
the hemimandible Mandibular
asymmetry away from the
affected side
-Malocclusion (crossbite/open
bite)
-Slowly progressive
-Enlargement of the condylar head and
elongation of the condylar neck
-Scintigraphy positive
Condylar tumors:
osteochondroma,
osteoma, chondroma,
osteoblastoma
40.5 years Elongation or enlargement of
the hemimandible
–Mandibular asymmetry toward
the contralateral side
-Malocclusion (crossbite/open
bite)
-Slowly progressive
-“Mushroom-shaped” mass associated
with the condylar head
-Scintigraphy positive
Differential diagnosis
23. ONSET CLINICAL FINDINGS IMAGING FINDINGS
Condylar hypoplasia/
degeneration
1st-6th
decades
-Shortening of the ipsilateral
hemimandible
-Mandibular asymmetry toward the
affected side
-Malocclusion (premature contact on
the affected side)
-Slowly progressive
-Degenerative changes in the condylar
head
-Scintigraphy positive or negative
(consistent with DJD)
Condylar fracture Any -Shortening of the ipsilateral
hemimandible
-Mandibular asymmetry toward the
affected side
-Acute
-Evidence of fracture (acute) –Degenerative
changes in the condylar head (old)
-Scintigraphy negative
Craniofacial
syndromes:
hemifacial microsomia
Congenital -Shortening of the ipsilateral
hemimandible
-Mandibular asymmetry toward the
affected side
-Slowly progressive
-Variable degrees of DJD to absence of the
condyle
-Scintigraphy negative
Differential diagnosis
24. CH treatment options are detailed from the simplest, least invasive to most
complex procedures:
Treatment of CH
01
Condylectomies
(if active growth)
02
Orthognathic
(if not active)
03
Condylectomy
and
orthognathic
(if active growth)
25. Treatment depends on:
Treatment of CH
3 The level of asymmetry and malocclusion
2 Age (growing versus adult)
1 Mandibular condyle activity (active
versus non active hyperplasia)
26. Condylectomy
Low or proportional High
Low condylectomy is used for removing TMJ tumors. Used for active CH
Indicated in type II CH Indicated in type I CH
Involves not only removing the hyperactive portion, but also
restoring the occlusal plane by resecting the necessary
quantity of bone to match the non-affected side in case of mild
occlusal canting.
The hyperplastic portion of the condyle is visually identified
(approximately the superior 4–5 mm of the condyle) and is
resected, and the apparent normal condyle is left in place.
Disadvantage:
If condylectomy is performed on the affected side before
cessation of condyle growth, there is risk of a mandibular
shift to the affected side because the condyle on the
unaffected side will continue normal growth.
Disadvantage:
Less stable than low condylectomy. Most patient require
second surgery because the condyle may continue to grow.
Advantages:
Offers highly predictable and stable outcome.
If carried out early in the process, secondary dental and maxillary compensations may be avoided.
Effective method for avoiding unnecessary secondary surgeries in active condylar hyperplasia.
27. Orthognathic surgery only
Indication:
Inactive growth of CH
Type I condylar hyperplasia (hemi-mandibular elongation).
Disadvantage:
Surgery is delayed until growth is complete, which could be in the early to mid-20s.
The longer the abnormal growth is allowed to precede, the worse the facial
deformity, asymmetry, occlusion, and dental compensations will become, in addition
to warping of the mandible and ipsilateral excessive soft tissue development.
Adverse effects on mastication, speech, and psychosocial problems.
28. 05
04
03
02
01 BSSO or vertical ramus osteotomy on the
affected side.
Unilateral ramus osteotomies
• Patients with severely prognathic profiles
• Patients in whom unilateral osteotomies could
possibly lead to excessive rotation of the
unaffected condyle.
Bilateral osteotomies
According to the need to level occlusal plane
Lefort I osteotomy
To correct any residual chin deviation
Genioplasty
Involves facial recontouring with reshaping of
mandibular body and nerve repositioning. Indicated
for most type II patients
Mandibular limbic reduction
Orthognathic surgery only
29.
30. Condylectomy and orthognathic surgery
The most complex surgical treatment for CH.
Indication:
1. To prevent relapse after surgery because condylar growth may not be complete at the time of
surgery. The combination provides more stable results.
2. If the condition is active with severe malocclusion and asymmetry: perform a growth
arresting procedure (high condylectomy) combined with orthognathic surgery.
3. Most patients with hybrid type
Mandibular prognathism without CH: Patients start out as skeletal Class III in early childhood and maintain harmonious growth between maxilla and mandible, with cessation of growth at the normal ages.
In such cases an extended mandibular sagittal split applied as described by Ferguson