A case of condylar hyperplasia treated with a right condylectomy and exteriorisation of the right inferior alveolar nerve.

To cite: Hussain A, Myuran T, Bentley R. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2016215215 DESCRIPTION A 25-year-old woman presented with a 10-year history of gradually increasing right-sided facial asymmetry. Over the preceding 6 months, she developed increasing trismus and right temporomandibular joint (TMJ) pain. There was no history of trauma, infection, other systemic diseases or facial surgery. Extraoral examination revealed significant facial asymmetry with laterognathia to the left, and an elongated right ramus and body of mandible. There was mild clicking of the right TMJ, but no obvious locking and a normal occlusion. An orthopantomogram and CT showed an enlarged right hemimandibular condyle and elongation of the right ramus with a comparatively normal left side (figure 1). An isotope scan showed active ongoing hyperplasia, confirming the clinical diagnosis of condylar hyperplasia. The patient underwent a right condylectomy via a preauricular approach and a sagittal split osteotomy to recontour the inferior border of the mandible while preserving the inferior alveolar nerve. The interarticular disc was maintained and secured over the respective condylar neck. Histology confirmed condylar hyperplasia: active endochondral ossification with normal haematopoiesis and adipose marrow. At writing, 12 months postoperatively, the patient has a well-balanced occlusion and excellent condylar function (figure 2). Condylar hyperplasia is a non-neoplastic malformation of the mandible, usually unilateral and affecting a younger age group (20–30s). Although its aetiology is still uncertain, it is important to differentiate it from other causes of mandibular asymmetry such as osteochondromas, condylar resorption, trauma or infection related.