Surgical treatment for facial deformity caused by temporomandibular joint tumors and condylar tumor-like lesions

To investigate the effective surgical methods for facial asymmetrical deformity caused by temporomandibular joint tumors and condylar tumor-like lesions as well as the post-surgical influence on cosmetic aspects and occlusal function.

The study included 82 cases with temporomandibular joint tumors and condylar tumor-like lesions from 1995 to 2015 in the Hospital of Stomatology, Sun Yat-sen University. Among them, 54 cases (65.9%) were diagnosed with benign tumor, 25 cases (30.5%) with tumor-like lesions (hyperplasia of condyle) and 3 cases with malignant neoplasm (3.7%). 61 cases with the chief complaint of progressive facial deformity underwent surgeries, including: simple resection of neoplasms and hyperplasia condyle for 34 cases; resection of neoplasms plus repair with costochondral graft for 9 cases; vertical ramus osteotomy of the affected side (EVRO) and re-implantation of condyle after tumor excision for 3 cases; subcondylar ramus "L"-shaped osteotomy for 3 cases; bilateral ramus vertical osteotomy for 4 cases; bilateral sagittal split ramus osteotomy for 3 cases; bilateral sagittal split ramus osteotomy (BSSRO) plus Le FortⅠosteotomy for correction of the upper occlusal plane for 3 cases. Resection of partial or hemimandible for 2 cases. All patients were followed up from 6 months to 10 years after operation.

During the follow-up period, no recurrence was found in the 58 cases with benign tumor, and 53 cases got satisfactory restoration in appearance and occlusal function. Among the cases who underwent simple resection of tumors and condyle, two patients appeared a serial of clinical symptoms because of unstable occlusal relationship, three cases did not obtain satisfied appearance. Among the three cases with malignant neoplasm, two cases got stable results and one died.

Simple resection of the temporomandibular joint neoplasms is the main surgical methods for facial asymmetrical deformity caused by temporomandibular joint tumors and condylar tumor-like lesions. But results of some cases are not satisfied. Comprehensive surgical techniques could be applied in the treatment of asymmetric deformity of face based on different scenarios to improve the appearance, occlusal relationship and temporomandibular joint function.