Fibrous condylar dysplasia: Resection and reconstruction with a custom-made TMJ prosthesis using virtual surgical planning

Abstract

The main objective of this article is to describe the indications for custom-made alloplastic reconstruction of the temporomandibular joint (TMJ) using the new techniques of virtual surgical planning and computer-aided design/computer-aided manufacturing (CAD/CAM) technology through the study of a clinical case and an updated review of the literature. The patient was a 45-year-old male with a fast-growing condylar dysplasia that produced a progressive facial deformity with limited mandibular mobility, which required a radical resection. Predictable, satisfactory, and stable results over time are described from the aesthetic, functional, and symptomatic points of view, through a comprehensive approach to all the aspects of this case by following an appropriate line of development and using the most current techniques.

Introduction

Fibrous dysplasia is a benign lesion of the bone that can affect the craniofacial skeleton [1]. It constitutes approximately 5–10% of benign lesions of the bone. A monostotic form is the most common, as observed in up to 70% of cases [1], [2]. In the maxillofacial area, fibrous dysplasia usually affects the mandibular body or the posterior region of the maxilla; the condyle is a very rare location [1], [2]. It is characterized clinically by an expansive, slow, and painless growth, which causes the patient to consult a doctor after the deformity is evident [2].

Histologically, it is defined by the replacement of healthy bone by immature fibro-osseous tissue composed mainly of collagen and fibroblasts [3]. Radiologically, bone expansion and a ground-glass opacity appearance are the most common characteristics, and expansive lytic forms are the least common [1].

Because this is a benign bone disease with little potential for malignancy, the treatment will depend on several factors, including the location and size of the lesion and the functional and aesthetic alterations caused by the lesion [2], [4]. Fibrous dysplasia can be treated by partial resection with reshaping of the bone contour or by radical resection [4]. When the lesion affects the mandibular condyle and its radical resection is indicated, multiple reconstructive techniques can be used, such as autologous grafts [2] or different alloplastic devices [5], [6].

In this clinical case the indications of using a custom-made alloplastic prosthesis together with the current CAD/CAM technology are analyzed and described in order to achieve the maximum anatomical and biomechanical adaptability in the reconstruction of the temporomandibular joint.