Güncel Veriler Işığında Mandibular Kondiller Hiperplazide Tanı ve Tedavi Yaklaşımları
Özet
Mandibular kondiller hiperplazi, mandibular kondilin patolojik büyümesiyle karakterize, etiyolojisi tam bilinmeyen nadir bir hastalıktır. Genellikle 10-30 yaş arası bireylerde görülen bu durum, yüz asimetrisi ve okluzal bozukluklara yol açar. Tanı aşamasında klinik muayene, fotoğraflar ve dental modellerin yanı sıra iki ve üç boyutlu radyolojik görüntüleme yöntemleri (BT, KİBT, MR) kritik önem taşır. Büyüme aktivitesinin belirlenmesinde ise fonksiyonel bir görüntüleme tekniği olan SPECT/BT'den veya süreli sefalometrik röntgenlerden faydalanılır. Tedavi yaklaşımı, büyümenin aktif olup olmamasına göre şekillenir. SPECT ile aktif büyüme saptanan hastalarda kondiller redüksiyon (kondillektomi) yapılarak patolojik odak ortadan kaldırılır ve artmış mandibular yükseklik düzeltilir; bu sayede erken dönemde müdahale edilerek ileride oluşabilecek daha karmaşık ortognatik cerrahi gereksinimleri azaltılabilir veya tamamen ortadan kaldırılabilir. İnaktif dönemde ise simetrik bir yüz profili ve normal temporomandibular eklem fonksiyonu sağlamak amacıyla geleneksel ortognatik cerrahi (mandibular osteotomi, Le Fort 1 osteotomisi) tercih edilir. Sonuç olarak, hastalığın nadir görülmesi nedeniyle daha fazla randomize kontrollü klinik çalışmaya ihtiyaç duyulmakla birlikte, doğru tanı ve multidisipliner yaklaşımla başarılı estetik ve fonksiyonel sonuçlar elde edilmektedir.
Mandibular condylar hyperplasia is a rare disease characterized by pathological growth of the mandibular condyle, with an unknown etiology. Typically seen in individuals aged 10-30, this condition causes facial asymmetry and occlusal disturbances. In the diagnosis phase, clinical examination, photographs, and dental models, as well as two- and three-dimensional radiological imaging methods (CT, CBCT, MRI), are of critical importance. To determine growth activity, SPECT/CT, a functional imaging technique, or periodic lateral cephalometric radiographs are utilized. The treatment approach is shaped by whether the growth is active or inactive. In patients with active growth detected via SPECT, condylar reduction (condylectomy) is performed to eliminate the pathological focus and correct the increased mandibular height; this early intervention reduces or completely eliminates the need for more complex orthognathic surgery in the future. Conversely, during the inactive period, traditional orthognathic surgery (mandibular osteotomy, Le Fort 1 osteotomy) is preferred to achieve a balanced facial profile and normal temporomandibular joint function. Consequently, although more randomized controlled clinical trials are required due to the rarity of the disease, successful aesthetic and functional outcomes are achieved through accurate diagnosis and a multidisciplinary approach.
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