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upporting
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39
Volume1 Issue5
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3
CasePresentation
A41-year-oldmanwas referred tous complainingof jawdislocation, joint sounds, limitation
of openingandpainonchewing. He reportedprogressive facial asymmetry that had
developed slowlyover 18months andwas clearlyvisible. Physical examination revealed
mandibular prognathismanda13-mmdeviationof themandibularmidline to the left. The
patient’smaximum jawopeningwas 36mm. Abilateral clicking soundcouldbeheard
duringmandibularmovements. Nopainonpalpationof the temporomandibular joints
(TMJs)waspresent.Massetermusclesweremildlypainful topalpation. Hehadaunilateral
posterior cross-biteon the left side, 4-mmnegativehorizontal overjet andaclass IIImolar
occlusal relationship (
Fig. 1
).
Apanoramic radiograph showeda radiopaquemass attached to the right condyle.
Thedensityof the lesionwas similar to that of adjacent bone. Themasshadabeak-like
appearanceandprojectedanterior to the right articular eminence. Coronal, axial and
cone-beamcomputerized tomography images revealeda lesionwithcartilaginous features
developingon thecondylar head (
Fig. 2
). The lesionhaddevelopedmediallyand superiorly
topterygoidmusclefibres, causingerosionof thebaseof thecranial cortex superiorly.
No translationwaspossiblewith the right condylewhile the left condyle showeda
13.20-mm translation.
Anextraoral vertical ramusosteotomywasperformedand theproximal segment containing
thecondyleand the lesionwas removed. Theexcised tumourmeasured3cm×2cm×
1cm.Microscopicexaminationof thedecalcified tissue revealeda layer of hyalinecartilage
containingbenignchondrocytes in their lacunae. This cartilage formedacapoverlying
normal-appearing trabeculaeof cancellousbone (
Fig. 3
). Thecartilaginous capwas
coveredbya layer of fibrous connective tissue (perichondrium). Theosteochondral junction
resembledgrowthplateswithchondrocytes arrangedperpendicular to the surface.
What isthediagnosis?
Visit
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a
SevereUnilateralCross-BiteSecondary to
Tumourof theMandibularCondyle
The following is a condensed version of an article published in the
‘ClinicalDentistry’ section of
jcda.ca
—CDA’s online, open access
scholarly publication that features articles indexed inMedline,
Journal CitationReports and ScienceCitation Index.
DiagnosticChallenge
NathalieRei
DMD,MSc
NormandBach
DMD,MSc,FRDC(C)
MichelEl-Hakim
DMD,MD,MSc,
FRDC(C),DipABOMS
AdelKauzman
DMD,MSc,FRDC(C)
➊
Frontal view
of theocclusionat
presentation.
➋
Axial cone-beam
computerized tomography
shows amass anterior and
medial to thecondylar head.
➌
Photomicrographof the
decalcified specimen
showing
ahyalinecartilagecapcovering
cancellousbone trabeculae
and fattymarrow.
MoreOnline
Access the full-text
articleat:
➌
➊
➋
