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CASE REPORT TUMORS/CYSTS
Year : 2014  |  Volume : 4  |  Issue : 2  |  Page : 220-223

True chondroma of the mandibular condyle: A rare case


Department of Oral and Maxillofacial Surgery, Hitkarini Dental College and Hospital, Jabalpur, Madhya Pradesh, India

Date of Web Publication16-Dec-2014

Correspondence Address:
Bhushan Thakkar
"Bhavdarshan", Opposite Home Guards Office, Near Sai Mandir, South Civil Lines, Jabalpur - 482 001, Madhya Pradesh
India
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DOI: 10.4103/2231-0746.147152

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  Abstract 

Chondroma of the mandibular condyle is a rare benign tumor, with just a handful of cases reported in the literature. Chondromas are rare in the maxillofacial region, but are quite common in the bones of the hands and feet. So far only eight cases of true chondroma have been reported. Here, we present a case of true chondroma of the mandibular condyle of the right side, for which condylectomy was done. No signs of recurrence are noted at 2 years follow-up.

Keywords: Chondroma, preauricular, temporomandibular joint


How to cite this article:
Dhirawani RB, Anand K, Lalwani G, Pathak S, Thakkar B. True chondroma of the mandibular condyle: A rare case. Ann Maxillofac Surg 2014;4:220-3

How to cite this URL:
Dhirawani RB, Anand K, Lalwani G, Pathak S, Thakkar B. True chondroma of the mandibular condyle: A rare case. Ann Maxillofac Surg [serial online] 2014 [cited 2019 Sep 23];4:220-3. Available from: http://www.amsjournal.com/text.asp?2014/4/2/220/147152


  Introduction Top


Chondroma is a benign tumor of mature hyaline cartilage of mesenchymal origin. [1],[2] Based on their location, chondromas can be classified as (1) enchondromas that are located in the medullary cavity of the bony skeleton; (2) juxtacortical or periosteal chondromas that originate adjacent to the periosteum below the cortical surface; and (3) extra-skeletal or soft tissue chondromas, which have been reported in the tongue and buccal mucosa. [3],[4],[5],[6],[7],[8],[9]

The differential diagnosis for bony or cartilagenous hyperplastic lesion of the temporomandibular joint (TMJ) may include condylar hyperplasia, osteochondroma, osteoma, chondroma, osteoblastoma, fibrous dysplasia, ossifying fibroma, chondromyxoid fibromas, synovial chondromatosis, chondroblastoma, chondrosarcoma, and osteosarcoma. [10],[11],[12],[13]


  Case report Top


A 42-year-old male reported to our Department of Oral and Maxillofacial Surgery in 2011, with the chief complaint of obvious facial asymmetry, which was gradually increasing from past 2 years [Figure 1]. He recounted the history of developing a progressive derangement in occlusion. He presented with clicks and mild pain in the right TMJ region.
Figure 1: Preoperative extraoral view

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He gave no history of facial trauma and had not noted any paresthesia. The patient's medical and family histories were noncontributory. Social history was negative for smoking, alcohol or drug abuse. His systemic review and general condition were normal.

Maxillofacial examination revealed bony hard right preauricular swelling that moved with condylar translation. The skin overlying the swelling was normal in appearance with no signs of erythema or ulcerations. The external auditory canal was patent on the right side, with normal tympanic membranes. The auriculotemporal nerve was intact with no signs of paresthesia. There was obvious deviation present, while opening the mouth. The maximum interincisal opening was 34 mm. Clicking was present on the right TMJ. There was no palpable lymphadenopathy.

On intraoral examination, there was a 10 mm shift from the midline toward the left [Figure 2]. Right side open bite and left side cross bite was present due to overgrowth of right mandibular condyle.
Figure 2: Intraoral view: Deviation of the mandibular midline toward left side

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Radiograpic examination

The orthopantomogram (OPG) showed a right sided enlarged condyle of the mandible [Figure 3]. The computed tomography scan confirmed the right sided mass and also helped to rule out any intracranial extension of the same [Figure 4].
Figure 3: Preoperative orthopantomogram

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Figure 4: Preoperative computed tomography scan (axial view)

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Surgical plan

The clinical and radiological presumptive diagnosis was made to be a slow growing neoplasm of the condyle. Local excision of the lesion was planned under general anesthesia through the right preauricular approach.

Preoperative routine investigations were within normal range. A standard preauricular incision was taken to expose the right condyle of the mandible [Figure 5]. Condylectomy of the right side was performed [Figure 6]. Local excision of the surrounding soft tissue was also done and the sharp margins of the condylar stump were rounded off and smoothened. The mandible was rotated toward right side, the midline was established and inter maxillary fixation (IMF) was done. Wound was closed in layers. In our case, reconstruction was not deemed necessary. The microscopic histological examination confirmed it to be chondroma of the condyle, showing mature hyaline cartilage with numerous chondrocytes [Figure 7].
Figure 5: Intraoperative picture

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Figure 6: Intraoperative picture

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Figure 7: Mature hyaline cartilage with numerous chondrocytes

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Postsurgically the patient was kept on IMF for 4 weeks with elastics. The patient was followed-up regularly. In the 2 years follow-up, the patient had maintained a stable facial symmetry.

His dental rehabilitation was done for missing teeth with fabrication of the prosthesis. He maintains a functional and stable occlusion.

His serial OPGs taken over a period of 2 years show no signs of recurrence [Figure 8]. The patient has an excellent range of motion with the maximum interincisal opening of 42 mm. The patient is asymptommatic [Figure 9] and [Figure 10].
Figure 8: Postoperative orthopantomogram

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Figure 9: Postoperative extraoral view

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{Figure 10}


  Discussion Top


In a report by Dahlin and Inni, [14] chondromas account for 2.38% of all osteocartilagenous tumors. Chondromas are usually seen in long tubular bones and in the hand, particularly in the proximal phalanges. According to a review of orthopedic literature 48% of chondromas are reported in the extremities and 80% of these are seen in the hands. [15]

Chondromas can be classified into three types: (1) If it arises from the medullary cavity of the bone, it is called enchondroma. (2) If a chondroma arises from beneath the periosteum, adjacent to the cortical surface of the bone, it is termed as juxtacortical or periosteal chondroma. (3) The last variant of chondroma is the extra-skeletal or soft tissue chondroma, which is reported to be seen in the cheek, tongue, soft palate, etc. [16],[17]

There are certain syndromes associated with chondromas. Multiple chondromas, with a tendency for unilateral and widespread involvement is termed as "Ollier disease," which is a nonhereditary sporadic disorder. When multiple chondromas are associated with angiomas of soft tissues and skeletal chondromatosis, it is called "Maffucci syndrome." [18]

There is no significant association between development of tumor and trauma. [19]

Chondromas have no specific sex predilection and are usually discovered in the third and fourth decade of life. [20] Most chondromas are asymptomatic. Chondromas involving the TMJ may often go undetected or be clinically confused with joint dysfunction, owing to its rarity. This condition may be associated with a variety of symptoms ranging from clicking, limited mouth opening, deviation, mild symptoms to episodes of condylar dislocation. They are almost always slow growing in nature. [21],[22]

In our case, the patient's main concern was the growing facial asymmetry and the gradual progressive derrangement in occlusion. After the surgery both his complaints were resolved.

Radiographically, chondromas are predominantly radiolucent, irregular masses. They may have some calcified foci ranging from powder like to dense aggregates. [23]

Microscopically enchondromas comprise of normal looking chondrocytes residing in well formed lacunar spaces, with abundant hyaline chondroid matrix. [24] Mitotic figures are rare. [25]

The microscopic distinction between chondroma and low-grade chondrosarcoma may at times be very difficult. The distinction between the two becomes even more ambiguous owing to their common radiological and clinical findings. [18] So in such cases careful histological examination is essential to take note of cellular atypia, change in nuclear-cytoplasm ratio, increased cellularity or any other dysplastic features. The incidence of malignant transformation in cases of multiple chondromas is reported to be as high as 20-33%. [25],[26]

Surgical resection is the treatment of choice for the chondroma of the mandibular condyle. Surrounding portion of normal tissue must also be excised to prevent local recurrence. [3],[8],[20] These tumors are radiation resistant. Furthermore, radiation is contraindicated because of the potential of malignant transformation. [26]

After condylectomy, often, reconstruction is undertaken to restore the height of the ramus and establish proper TMJ function. In our case reconstruction was not deemed necessary due to adequate ramus height and proper positioning of the reshaped condylar stump into the fossa, with adequate gap between the two bony surfaces. If reconstruction is undertaken, then it can be done with using either autogenous costochondral graft or sternoclavicular graft or an alloplast. [18]

It is very essential in such cases to keep a long-term follow-up. It is also important to report such cases to take into account the nature, behavior and pattern of disease progression, opinions of operating surgeons and any modifications in the line of treatment of such rare cases.

 
  References Top

1.
Marchetti C, Mazzoni S, Bertoni F. Chondroma of the mandibular condyle-relapse of a rare benign chondroid tumour after 5 years' follow-up: Case report. Br J Oral Maxillofac Surg 2012;50:e69-71.  Back to cited text no. 1
    
2.
Neville BW, Damm DD, Allen CM. Oral and Maxillofacial Pathology. Philadelphia, PA: Saunders; 1993. p. 477.  Back to cited text no. 2
    
3.
Chandu A, Spencer JA, Dyson DP. Chondroma of the mandibular condyle: An example of a rare tumour. Dentomaxillofac Radiol 1997;26:242-5.  Back to cited text no. 3
    
4.
Dahlin DC. Bone Tumors. 2 nd ed. Springfield, IL: Thomas; 1967. p. 48-57.  Back to cited text no. 4
    
5.
Dahlin DC, Unni KK. Bone Tumors. 4 th ed. Springfield, IL: Thomas; 1986. p. 33-48.  Back to cited text no. 5
    
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Takayuki N, Krishnan KU, Richard AM. Douglas JP. Periosteal chondroma and periosteal chondrosarcoma. Am J Surg Pathol 1985;9:666-77.  Back to cited text no. 6
    
7.
Lichtenstein L, Hall JE. Periosteal chondroma; a distinctive benign cartilage tumor. J Bone Joint Surg Am 1952;24-A-3:691-7.  Back to cited text no. 7
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8.
Blum MR, Danford M, Speight PM. Soft tissue chondroma of the cheek. J Oral Pathol Med 1993;22:334-6.  Back to cited text no. 8
    
9.
Chang SE, Lee MW, Choi JH, Sung KJ, Moon KC, Koh JK. A case of lingual chondroma. Br J Dermatol 1999;141:773-4.  Back to cited text no. 9
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10.
Jokinen K, Stenbäck F, Palva A, Sutinen S. Benign cartilagenous tumour of the temporomandibular joint. J Laryngol Otol 1976;90:299-303.  Back to cited text no. 10
    
11.
Shintaku WH, Venturin JS, Langlais RP, Clark GT. Imaging modalities to access bony tumors and hyperplasic reactions of the temporomandibular joint. J Oral Maxillofac Surg 2010;68:1911-21.  Back to cited text no. 11
    
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Lazow SK, Pihlstrom RT, Solomon MP, Berger JR. Condylar chondroma: Report of a case. J Oral Maxillofac Surg 1998;56:373-8.  Back to cited text no. 12
    
13.
Fechner RE, Mills SE. Atlas of Tumor Pathology - Tumors of the Bones and Joints. Washington, DC: Armed Forces Institute of Pathology; 1993.  Back to cited text no. 13
    
14.
Dahlin DC, Inni KK. Bone tumours. General aspects and data on 8542 cases. 4 th ed. Springfield, IL: Charles C. Thomas; 1986. p. 120-8.  Back to cited text no. 14
    
15.
Unni KK. Dahlin's Bone Tumor: General Aspects and Data on 11,087 Cases. 5 th ed. Philadelphia, PA: Lippincott-Raven; 1996.  Back to cited text no. 15
    
16.
Vázquez Mahía I, López-Cedrún Cembranos JL, Ferreras Granado J, Lorenzo Franco F. Temporomandibular juxtaarticular chondroma: Case report. Med Oral Patol Oral Cir Bucal 2007;12:E171-4.  Back to cited text no. 16
    
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Heitz C, Vogt BF, Bergoli RD, Hirsch WD, de Souza CE, Silva DN. Chondroma in temporomandibular region - case report and therapeutic considerations. Oral Maxillofac Surg 2012;16:75-8.  Back to cited text no. 17
    
18.
Lazow SK, Pihlstrom RT, Solomon MP, Berger JR. Condylar chondroma: Report of a case. J Oral Maxillofac Surg 1998;56:373-8.  Back to cited text no. 18
    
19.
Lichtenstein L, Hall JE. Periosteal chondroma; a distinctive benign cartilage tumor. J Bone Joint Surg Am 1952;24-A-3:691-7.  Back to cited text no. 19
[PUBMED]    
20.
do Egito Vasconcelos BC, Porto GG, Bessa-Nogueira RV. Rare benign tumors of the mandibular condyle: Report of 2 cases and literature review. J Oral Maxillofac Surg 2007;65:1830-5.  Back to cited text no. 20
    
21.
Izzo L, Caputo M, Buffone A, Casullo A, Perrone A, Sassi S, et al. Benign tumors and pseudotumors of temporo-mandibular joint: Radiologic aspects. G Chir 2005;26:314-7.  Back to cited text no. 21
    
22.
Vázquez Mahía I, López-Cedrún Cembranos JL, Ferreras Granado J, Lorenzo Franco F. Temporomandibular juxtaarticular chondroma: Case report. Med Oral Patol Oral Cir Bucal 2007;12:E171-4.  Back to cited text no. 22
    
23.
Fechner RE, Mills SE: Atlas of Tumor Pathology - Tumors of theBones and Joints. Washington, DC: Armed Forces Institute of Pathology; 1993.  Back to cited text no. 23
    
24.
Lurie R. Solitary enchondroma of the mandibular condyle: A review and case report. J Dent Assoc S Afr 1975;30:589-93.  Back to cited text no. 24
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25.
Resnick D. Diagnosis of Bone and Joint Disorders. 3 rd ed. Philadelphia, PA: Saunders; 1993. p. 3697-710.  Back to cited text no. 25
    
26.
Huvos AG. Bone Tumors. 2 nd ed. Philadelphia, PA: Saunders; 1991. p. 268-80.  Back to cited text no. 26
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 9]


This article has been cited by
1 Recurrent osteochondroma of the mandibular condyle: A case report
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Imaging Science in Dentistry. 2017; 47(1): 57
[Pubmed] | [DOI]



 

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