THE VALUE OF BONE SCANNING IN PREOPERATIVE DECISION-MAKING IN PATIENTS WITH PROGRESSIVE FACIAL ASYMMETRY

Hemimandibular elongation is characterized by persistent unilateral gr owth, resulting in unilateral overgrowth of the mandible. The surgical treatment strategy depends on condylar growth activity, which cannot be assessed by conventional radiological procedures. Therefore, this s tudy was undertaken to evaluate the usefulness of bone scanning in hem imandibular elongation. Twenty-seven patients underwent bone scanning prior to surgery Growth activity was quantified by calculating the L/R ratio. In the case of more pronounced right-sided growth producing a L/R ratio of less than 1, inverse values were used. Corrective osteoto my was performed in the patients with a L/R < 1.10, whereas patients w ith a L/R > 1.10 underwent condylectomy. Twenty-three patients had a L /R ratio < 1.10 and were followed up for 3 years. In 16 patients, a co rrective osteotomy was performed without any relapse post-operatively. Four patients showed marked unilateral increased uptake. In one patie nt, a preoperative bone scan was not considered, and corrective osteot omy was performed with subsequent recurrence of unilateral overgrowth of the mandible. The final patient underwent condylectomy without rela pse. In two patients, it was decided to repeat the bone scan after a f ollow-up period of 12 months. In conclusion, bone scanning has signifi cant clinical value in pre-operative decision-making in hemimandibular elongation by guiding surgical strategy with respect to condylar grow th activity.