Systematic Review
Clinical Pathology
Histologic findings and related diagnostic methods in condylar hyperactivity

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Abstract

Condylar hyperactivity (CH) is a rare condition that entails a progressive deviation and deformation of the mandible. There is no consensus regarding characteristic histopathological features or a standardized diagnostic process; thus, histopathological analysis of the condyle cannot confirm or exclude an active CH after condylectomy is performed. An electronic search was performed in Medline, Embase, Web of Science, LILACS and grey literature up to December 2019. Additionally, a manual search was performed. Risk of bias of the included studies was assessed using the Newcastle–Ottawa Scale and the Institute of Health Economics Quality Appraisal. All analyses were performed independently and in duplicate. Seventeen articles from 660 were included. Six articles were cross-sectional studies and 11 were case series. Almost all the articles (14) described an augmented thickness of the cartilage layer associated with cartilage islands within the subchondral bone in patients affected by CH. Histological findings seem to be mostly related to the age of the sample rather than a characteristic description of CH. No clear association was found between SPECT/scintigram uptake and a specific histological finding. Hence, there is a necessity for the development of specific tools for evaluating and reporting studies where histology is needed for diagnosis confirmation.

Section snippets

Material and Methods

This systematic review was conducted according to the PRISMA guidelines32 and the PICO question was: for patients affected by CH (P), are histological (I) or clinical/imaging diagnostic tools (C) able to describe a characteristic disease pattern (O)?

Results

An initial source of 660 articles was identified after duplicates removal (κ = 0.78). Of these, 579 were dismissed after revising titles/abstracts, resulting in 81 articles eligible for full-text analysis (κ = 0.8). Then, 64 articles were excluded when revised against the inclusion criteria. Finally, 17 articles (Fig. 1) were included in the review (κ = 0.8)3, 4, 5, 6, 8, 11, 17,26, 27, 29, 35, 36, 37, 38, 39, 40, 41. Eleven articles were case series and six were cross-sectional studies. The data

Discussion

Taken together, these results confirm that there is no consensus on a characteristic histological description in CH. Two of the main contributors to this lack of histological consensus are the heterogeneity found among the diagnostic methods used and the RoB of the included articles. Beyond the methodological issues mentioned, another explanation for this could be the clinical scenario that CH entails, where there is no possibility of having a reliable control sample of the contralateral

Funding

None.

Competing interests

None.

Ethical approval

Not required.

Patient consent

Not required.

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      Citation Excerpt :

      The common histopathological features mentioned above could well be related to the age of the specimens, and the available studies on this subject show a high risk of bias. Other authors have also concluded that condylar hyperplasia is a diagnosis based on a combination of clinical evaluation, imaging, and histological evaluation.16 Together with the long follow-up period, the combined gold standard used in the present study aims to overcome the disadvantages of using a single gold standard.

    a

    These authors contributed equally to this work.

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