Custom Made Replacement of the Mandibular Condyle in a Case of Fibrous Dysplasia with Cystic Degeneration; A Case Report

This paper describes a rare case of fibrous dysplasia with cystic degeneration in the mandibular condyle. Diagnostic and therapeutic considerations are discussed. A 40-year old woman presented with pain near the region of her right ear. Physical and radiographic examination showed no abnormalities besides the presence of a mixed radiopaque/radiolucent expansive lesion of the right condyle. Pathologic examination showed high bone-turnover with bone formation. Bone scintigraphy showed a monostotic active fibrous lesion in the right part of the mandible. Bisphosphonate treatment did not sufficiently treat the patient's symptoms and physiotherapy to treat craniomandibular dysfunction as a factor in the pain was also unsuccessful. The patient later developed an acute external otitis due to a narrowed outer ear canal and had to be admitted to the hospital for treatment with intravenous antibiotics. Approximately two years after first presentation, resection of the affected bone (condylectomy) and reconstruction with a custom total joint prosthesis was indicated due to repeated functional deficits with considerable morbidity. Pathologic examination of the resected mandibular condyle showed increased bone formation including formation of neocortex and some cystic formation. This was diagnosed as fibrous dysplasia with cystic degeneration. Approximately two years after surgery, the patient functioned well.