Osteochondroma of condyle: case discussion and review of treatment modalities

Abstract

Temporomandibular joint (TMJ) forms a synovial articulation between the condyle and the cranium. It is a complex joint and shows hinge and gliding movements. Unlike other articulating heads, condyle grows with intramembranous ossification. TMJ is subjected to excessive loads throughout life as it supports essential functions such as mastication, deglutition, speech and respiration. Traumatic, neoplastic or non-neoplastic pathologies sometimes necessitate joint replacement therapy. Osteochondroma is one such benign tumour originating from condyle which requires surgical replacement of condyle with prosthesis. Various replacement methods have been designed in the past. Alloplastic grafts have been successfully used in joint replacement surgeries like hip joint, knee joint, etc. This case discussion supports the use of titanium-made condylar prosthesis for long-term functional stability of TMJ.

Figure 1

Clinical picture showing facial asymmetry with downward displacement of left mandibular border.

Figure 2

(A) Three-dimensional CT showing a deformed condyle with bony exostosis from medial surface. (B) Coronal CT section showing a dense radiopaque proliferation of condyle in superiomedial direction on the right side.

Figure 3

Titanium condyle prosthesis with elongated arm and fixation screws.

Figure 4

Histopathological section showing thick reserve cell layer with hyperchromatic nuclei differentiating into chondroblasts (×100 magnification).

Figure 5

Histological section showing areas with multiple chondrocytes in lacunae and ossification in the surrounding matrix (×400 magnification).

Figure 6

Histological section showing different phases of ossification. Periphery is basophilic chondroid tissue and central is osseous tissue (×200 magnification).