66:312-318, 2008
This study evaluated some of the characteristics of this disorder in a series of 61 patients with active CH.
Patients and Methods: A total of 61 patients with active temporomandibular CH who had been
evaluated in our departments were included. Demographic, clinical, radiologic, and bone scintiscan data
were collected and analyzed. Asymmetries were classified as transverse, vertical, or combined.
Results: CH was diagnosed during the growth period in 22 patients, and 39 patients were older than
20 years (range, 11 to 80 years). In 66% of the patients, the main complaint was progressive facial
asymmetry; and in the remainder, the main complaint was pain, dysfunction, or both. Transverse
asymmetry predominated (52%), and vertical or combined asymmetry occurred in 31% and 16% of
patients, respectively; asymmetry type was independent of age. The occlusal plane deviated in 48% of the
patients. Laterality was significantly gender-biased (females, 72% right; males, 64% left; P .017). The
condylar head shape was normal in 15% of patients, deformed in 27%, and enlarged in 58%; the condylar
neck was elongated in 69% and enlarged in 19%. All of these changes were uncorrelated with the type
of asymmetry (vertical, transverse, or combined).
Conclusions: CH may occur at any age and is more prevalent in females. Clinicians should be aware
that only some patients complain primarily of facial asymmetry, and that symptoms of temporomandibular disease also may be present. Because there is no correlation between the radiologic findings and the
clinical evaluation, classification should be simplified and based on clinical manifestation onlyin other
words, the direction of asymmetry.
2008 American Association of Oral and Maxillofacial Surgeons
J Oral Maxillofac Surg 66:312-318, 2008
Temporomandibular joint (TMJ) condylar hyperplasia
(CH) is a rare pathology that was first described in
1836 as overgrowth of the mandibular condyle; comparable pathology has not been described in any
other joint. CH is a distinct entity, a unilateral disorder
0278-2391/08/6602-0018$34.00/0
doi:10.1016/j.joms.2007.08.046
312
313
NITZAN ET AL
314
Characteristics
Females/males, n (%)
Age (years), mean standard deviation (SD) (range)
Duration, months, mean SD (range)
Main complaint, n (%)
Asymmetry, n (%)
Pain and dysfunction, n (%)
Asymmetry, pain, and dysfunction
Affected joint (right/left bilateral), n (%)
Males (right/left), n (%)
Females (right/left/bilateral), n (%)
Maximal mouth opening (mm), mean SD (range)
Asymmetry type: transverse/vertical/combined
Occlusal plane inclined, n (%)
Severity of asymmetry (VAS 0 to 5), mean SD (range)
46 (75)/15 (25)
27.85 14.7 (1180)
31; 18.03 12.81 (672)
40 (65.6)
17 (27.9)
4 (6.6)
39 (64)/21 (34)/1 (1.6)
5 (36)/9 (64)
34 (72)/12 (26)/1 (2)
44.31 7.48 (1065)
32 (52)/19 (31)/10 (16.9)
29 (48%)
3.24 1.04 (15)
Nitzan et al. Clinical Characteristics of Condylar Hyperplasia. J Oral Maxillofac Surg 2008.
Results
The demographic and clinical data of the study
group are detailed in Table 1. A total of 61 patients
(46 females [75%] and 15 males [25%]), with a mean
age of 27.8 14.7 years (range, 11 to 80 years) were
diagnosed as having active CH. As shown in Figure 1,
22 of the patients were diagnosed during the
growth period and 39 after age 20 years. The age
distribution was similar for both genders (mean age
of females, 28.51 15 years; of males, 25.87
14.21 years).
In 40 patients (65.6%), the main complaint was
progressive facial asymmetry; 17 (27.9%) complained
of pain, dysfunction, or both. Among the latter, 1
patient had ankylosis, and 2 patients were diagnosed
315
NITZAN ET AL
Discussion
The clinical characteristics of CH are controversial,
because such issues as the effect of gender, age of
onset, type of asymmetry, and structure of the con-
Asymmetry
Transverse
Vertical
Combined
5 (18%)
23 (82%)
7 (39%)
11 (61%)
2 (33%)
4 (67%)
13 (46%)
15 (54%)
14 (78%)
4 (22%)
3 (50%)
3 (50%)
19 (68%)
2 (7%)
7 (25%)
13 (72%)
4 (22%)
1 (6%)
4 (67%)
0
2 (33%)
316
that 3 of our patients had ankylosis, due to trauma,
associated with the disease.
Attention to the patients primary complaint is important for the early diagnosis of CH, because the
patients awareness of the exact nature of such a
slowly growing pathology may be low. Almost one
third of the patients complained not about asymmetry, but rather about swelling on the contralateral
side, pain, and dysfunction; therefore, attention must
be paid to facial symmetry even when it is not among
the patients complaints. Pain, dysfunction, and clicking were common findings, indicating that the disease
may be associated with various degrees of pain and/or
dysfunction, as as been reported by others.6,18 This
persistent pain is most likely caused by changes in the
length, form, and size of the condyle and occasionally
unstable occlusion.
The classification of asymmetry in CH suggested by
Obwegeser and Makek5 was challenged by 3-dimensional reconstructions from computed tomography
data showing that the mandibular morphology varied
from one case to another uncorrected with the classification.27 We have classified the asymmetries by 3
types according to the clinical criteria as vertical (akin
FIGURE 3. A, Facial asymmetry in the vertical aspect in an 11-year-old girl with a marked inclined occlusal line. B, Marked open bite in the affected
side with deviation of the midline contralaterally. C, In the panoramic view, the left condyle is slim and long.
Nitzan et al. Clinical Characteristics of Condylar Hyperplasia. J Oral Maxillofac Surg 2008.
317
NITZAN ET AL
FIGURE 4. A, Facial asymmetry in the vertical aspect in a 56-year-old man. B, Marked deviation of the mandibular midline to the contralateral side,
with no inclination of an occlusal line or an ipsilateral open bite. C, In the panoramic view, the right condyle is large and deformed.
Nitzan et al. Clinical Characteristics of Condylar Hyperplasia. J Oral Maxillofac Surg 2008.
References
1. Norman JE, Painter DM: Hyperplasia of the mandibular condyle: A
historical review of important early cases with a presentation and
analysis of twelve patients. J Maxillofac Surg 8:161, 1980
318
12. Matteson SR, Proffit WR, Terry BC, et al: Bone scanning with
99m-technetium phosphate to assess condylar hyperplasia: Report of two cases. Oral Surg Oral Med Oral Pathol 60:356-67,
1985
13. Kaban LB, Cisneros GJ, Heyman S, et al: Assessment of mandibular growth by skeletal scintigraphy. J Oral Maxillofac Surg
40:18, 1982
14. Cisneros GJ, Kaban LB: Computerized skeletal scintigraphy for
assessment of mandibular asymmetry. J Oral Maxillofac Surg
42:513, 1984
15. Beirne OR, Leake DL: Technetium-99m pyrophosphate uptake
in a case of unilateral condylar hyperplasia. J Oral Surg 38:385,
1980
16. de Bont LG, van der Kuijl B, Stegenga B, et al: Computed
tomography in differential diagnosis of temporomandibular
joint disorders. Int J Oral Maxillofac Surg 22:200, 1993
17. Henderson MJ, Wastie ML, Bromige M, et al: Technetium-99m
bone scintigraphy and mandibular condylar hyperplasia. Clin
Radiol 41:411, 1990
18. Slootweg PJ, Muller H: Condylar hyperplasia: A clinico-pathological analysis of 22 cases. J Maxillofac Surg 14:209, 1986
19. Yang J, Lignelli JL, Ruprecht A: Mirror-image condylar hyperplasia in two siblings. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod 97:281, 2004