TREATMENT OF CONDYLAR HYPERPLASIA OF THE MANDIBLE USING UNILATERAL RAMUS OSTEOTOMIES

Purpose: The long-term outcome of bilateral and unilateral ramus osteo tomies used for the treatment of unilateral condylar hyperplasia of th e mandible are evaluated and compared. Materials and Methods: Thirteen cases of unilateral condylar hyperplasia of the mandible were surgica lly treated during a 10-year period from 1985 to 1995. Seven of the pa tients were treated by bilateral ramus osteotomies alone; six were tre ated by unilateral ramus osteotomies of the affected side, Unilateral ramus osteotomy was combined with a maxillary Le Fort I procedure in t wo of the six cases, Preoperative analysis of patients, indications fo r case selection, and postoperative results relating to facial symmetr y, temporomandibular joint (TMJ) pain, occlusion, and stability were c ompared in the two groups, Results: The postoperative findings and lon g-term results in both groups of patients were favorable. Symmetry, ar ch coordination, and occlusion remained stable. TMJ pain and dysfuncti on were invariably cured postoperatively. Unilateral ramus osteotomies alone, or in combination with maxillary surgery when deemed feasible and applicable by preoperative clinical analysis, was sufficient to re store symmetry and occlusion in dentally compensated cases. Conclusion s: This study shows that patients with unilateral condylar hyperplasia of the mandible and deviation can be treated favorably by unilateral ramus osteotomy of the affected side; bilateral ramus osteotomy did no t have any advantage in such cases. In addition, this procedure, combi ned with a Le Fort I osteotomy of the maxilla, was also effective in r estoring occlusal canting and facial symmetry in dentally compensated cases. However, bilateral ramus osteotomy was required in prognathic c ases and in cases in which a unilateral procedure would cause excessiv e rotation of the contralateral condyle.