CAD/CAM-assisted total joint replacement for correction of facial asymmetry caused by large osteoma of mandibular condyle

Abstract

Osteoma of mandibular condyle is uncommon benign tumor that grows slowly. Growth of condylar osteoma can cause functional and morphological problems such as facial asymmetry and malocclusion. Surgical removal and concurrent temporomandibular condyle replacement is a strategy that can resolve functional and aesthetic problems associated with large osteoma of mandibular condyle. Total joint replacement (TJR) with computer-associated surgical simulation (CASS) and computer-aided design/computer-aided manufacturing (CAD/CAM) technology can effectively and accurately rehabilitate debilitated condyle. A 52-year-old female visited department of Oral and Maxillofacial Surgery at Seoul National University Dental Hospital with a chief complaint of facial asymmetry and discomfort of left temporomandibular joint (TMJ). Radiographic and CT images showed a large bony mass at left TMJ surrounding left condylar head. Clinical examination revealed mandibular shift to right side, causing malocclusion and facial asymmetry. TJR of left TMJ with customized alloplastic condyle prosthesis and Biomet fossa was planned for the patient. Condyle was designed and fabricated using CAD/CAM. Surgical guides and occlusal splint fabricated with CAD/CAM technology was well. After 2 years, patient still showed occlusal stability with restored facial symmetry. No complications or recurrence were observed. TJR with customized alloplastic condyle and stock fossa can be an effective treatment strategy for large symptomatic condylar osteoma in restoration of normal function and aesthetics.

Keywords

• computer-aided design; osteoma; surgery
• computer-assisted; total joint replacement