Orthognathic Management of Facial Asymmetry Due to Inactive Idiopathic Condylar Hyperplasia: Accuracy and Morbidity Reduction Without Condylectomy.

Abstract

Background: Idiopathic condylar hyperplasia (ICH) is a challenging cause of progressive facial asymmetry, particularly when condylar growth becomes inactive. While condylectomy is traditionally recommended in active forms, its necessity in inactive cases remains controversial.

Objective: This study aimed to evaluate the accuracy and outcomes of a conservative orthognathic protocol for facial asymmetry secondary to inactive ICH, avoiding condylectomy and using patient-specific digital planning.

Methods: Ten patients (aged 19-56) with confirmed inactive ICH were retrospectively analyzed. All underwent orthodontic preparation followed by bimaxillary orthognathic surgery guided by 3D virtual planning and patient-specific surgical guides. Postoperative accuracy was assessed by comparing 1-year CT scans to the preoperative plan. Long-term follow-up was conducted over 5 years.

Results: Mean deviations between planned and actual postoperative bone positions were 0.79 mm for the maxilla and 1.33 mm for the mandible. No cases of condylar reactivation or relapse were observed. Orthodontic finishing and physiotherapy were completed in all cases without complications. Surgical time and intraoperative adjustments were minimized, with no significant postoperative morbidity.

Conclusions: This study supports the use of a conservative orthognathic protocol in selected cases of inactive ICH, offering precise, stable, and low-morbidity outcomes without requiring condylectomy. Computer-assisted planning and patient-specific instruments allow for accurate translation of surgical simulations into clinical reality. Further studies with larger samples and multicenter designs are encouraged to validate these findings.