Unilateral condylar hyperactivity Progressive understanding in diagnostics and therapy

Unilateral condylar hyperactivity (UCH) is a growth disorder characterized by progressive asymmetry of the mandible and, in some cases, secondary asymmetry of the maxilla. The exact cause of this condition remains unknown. To develop an effective treatment plan, it is crucial to assess whether there is ongoing and/or excessive condylar activity. This assessment can be performed through skeletal scintigraphy, using either a SPECT or SPECT-CT scan.
In this thesis, a critical evaluation of the most effective diagnostic nuclear test is presented. Quantification of condylar activity using SPECT or SPECT-CT scans demonstrates good diagnostic accuracy in detecting UCH. However, the added value of incorporating CT in addition to SPECT remains questionable.
When excessive condylar activity is identified, the recommended treatment typically involves removing the active portion of the mandibular condyle and, in some cases, correcting the facial asymmetry. This thesis evaluates the safety and efficacy of a new surgical technique in which the mandibular condyle is removed via an endoscopic-assisted transoral approach. Based on an analysis of the first 100 procedures, it can be concluded that this transoral approach is safe and offers several advantages over traditional methods. The learning curve plateaued after 53 procedures.
Lastly, part of this thesis provides insights into the bone structure of resected mandibular condyles in UCH patients. The bone structure was examined using microCT, a technique that shows potential in better classifying various UCH subtypes.