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DENTAL SCIENCE - CASE REPORT
Year : 2013  |  Volume : 5  |  Issue : 6  |  Page : 139-141  

Hyperplasia of the mandibular body: An anomaly in a developmental anomaly


1 Department of Conservative Dentistry, Vivekanandha Dental College for Women, Trichengode, Namakkal, Tamil Nadu, India
2 Department of Oral and Maxillofacial Surgery, Navodaya Dental College, Raichur, Karnataka, India
3 Department of Oral and Maxillofacial Pathology, Vinayaka Missions Sankarachariyar Dental College and Hospital, Ariyanoor, Salem, Tamil Nadu, India

Date of Submission16-May-2013
Date of Decision24-May-2013
Date of Acceptance24-May-2013
Date of Web Publication1-Jul-2013

Correspondence Address:
Vaiyapuri Ravi
Department of Conservative Dentistry, Vivekanandha Dental College for Women, Trichengode, Namakkal, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-7406.114308

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   Abstract 

Hyperplasias of the mandible are usually seen in relation to the condyle or affecting one half of the mandible, such cases being described as hemimandibular hyperplasia or elongation. This article presents a rare case of hyperplasia of the right body of the mandible. The case being unique in that although being present from childhood did not cause any functional disturbances or any occlusal disharmony characteristically seen in such developmental anomalies. Here, we describe the clinical, radiographic and histopathologic findings that led to the diagnosis hyperplasia of the mandibular body and the treatment rendered to provide the esthetic correction.

Keywords: Developmental anomaly, esthetic, hyperplasia, mandible


How to cite this article:
Ravi V, Srinivasan S, Jacob M, Kesavan P, Palani R, Balakrishnan S. Hyperplasia of the mandibular body: An anomaly in a developmental anomaly. J Pharm Bioall Sci 2013;5, Suppl S2:139-41

How to cite this URL:
Ravi V, Srinivasan S, Jacob M, Kesavan P, Palani R, Balakrishnan S. Hyperplasia of the mandibular body: An anomaly in a developmental anomaly. J Pharm Bioall Sci [serial online] 2013 [cited 2020 Dec 3];5, Suppl S2:139-41. Available from: https://www.jpbsonline.org/text.asp?2013/5/6/139/114308

Developmental disturbances of craniofacial structures affect the normal growth of the maxilla and the mandible resulting in gross changes in the normal morphology and structure of hard and the overlying soft-tissues. Since, these changes are present during childhood they tend to alter the function and esthetics. Hemimandibular hyperplasia is one such developmental disturbance observed to affect the condyle or affect one half of the mandible not extending beyond the midline or symphysis region. Females are most commonly affected the reason for such predilection is unknown. [1] The etiology for this anomaly is still not understood. However, genetic factors, circulatory problems, hormonal disturbances and traumatic lesions have been proposed as probable etiologic factors. Hemimandibular hyperplasias including condyle requires more elaborate treatment planning as when compared with those anomalies restricted to the ramus and body of the mandible thus requiring precise diagnosis to render the appropriate treatment. [2] Hyperplasia or excessive growth can also affect other parts of the mandible more situated away from the condyle as seen in the present case.


   Case Report Top


A 30-year-old male reported to dental O.P. with the complaint of asymmetric appearance of the face. The swelling had been present from childhood and had become evident after puberty. Patient had no history of significant medical problems, trauma or family history of any hereditary disease.

Clinical examination revealed a diffuse enlargement of the lower one-third of the right side of the face. The enlargement was also seen to involve the lower border of the right mandible [Figure 1]. Intra oral examination revealed a swelling involving both the buccal and lingual aspect of the right mandible. The enlargement was more prominent on the buccal side, extending from the distal aspect of 45 to the distal aspect of 47 obliterating the vestibule. On palpation, the enlargement was bony hard in consistency. No sign of inflammation of the overlying mucosa was seen. Intra oral examination revealed an impacted 38 and missing 48 [Figure 2]. Furthermore, observed was that the lesion had not caused any malocclusion [Figure 3].
Figure 1: Extra oral view: (a) Swelling of the lower right side of the face, (b) Swelling involving the lower aspect of mandible

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Figure 2: Intra oral view: Swelling involving both the buccal and lingual aspect of the right mandible

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Figure 3: Intra oral view: Right and left side, showing normal occlusion

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Orthopantamogram (OPG) revealed an increase in vertical height of the body of the right mandible of normal bone density. The ramus and condyle of the affected side were normal. An OPG taken at the age of 25 years (5 years back) and the current OPG showed the lesion was stable [Figure 4].
Figure 4: Orthopantamogram: (a) Taken at the age 25 years, (b) Taken at the age of 30. Both the films show an increase in the vertical dimension of the right mandible and no change even after 5 years duration

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Computed tomography (CT) axial image revealed a solitary well-defined homogenous mass seen on the right body of the mandible measuring around 2 cm × 3 cm with uniform radiopacity. Bony enlargement was seen on both buccal and lingual side, buccal aspect being more prominent than the contralateral side. The bony enlargement can be well-appreciated in three dimensional (3D) CT. Furthermore observed in the radiographs, the enlargement was restricted to the body and did not extend to the condyle, which later aided in the diagnosis [Figure 5].
Figure 5: (a) Computed tomography axial: Well-defined solitary mass on the right body of mandible, (b) Three dimensional CT: Expansion of buccal aspect of the right mandibular body

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The histopathology showed compact bone and numerous, small marrow spaces. The compact bone exhibited reversal and resting lines with osteoblastic rimming. Osteocytes could also be seen entrapped within the bone [Figure 6].
Figure 6: (a) Low power view showing compact bone of normal architecture, (b) High power view showing osteocytes within the normal bone

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Based on the clinical, radiographic and histopathologic findings the diagnosis of hyperplasia of the right mandible was given.


   Discussion Top


Until 1980, hemimandibular hyperplasia were called as condylar hyperplasias, although not totally incorrect, implying the role of mandibular condyle in the development of this condition. Excessive growth can affect other parts of the mandible and the term hemimandibular hypertrophy is now preferred. Obwegeser and Makek had subdivided this condition as hemimandibular hyperplasia, hemimandibular elongation or hybrid forms depending on the segment of the mandible affected. [3]

Hyperplasias of the mandible cause increased dimension of the bone in all aspects, which can be visualized clinically as a gross painless enlargement of the lower third of the face. [4],[5] In the present case, enlargement was seen to be increased in all dimensions increase of the right body of the mandible with excessive growth was seen on the buccal and lingual aspect, more prominently on the buccal aspect. Radiographic examination along with different views can give more insight on the extent of involvement and also probable pathogenesis of such lesions. OPG of the present case showed an increase in the vertical height of the body of the right mandible of normal bone density. [6],[7] The lesion was also stable and had not increased in size, which was inferred from comparing the OPG taken 5 years before and the recent OPG. CT axial view had shown bicortical expansion, the buccal expansion being more prominent than the lingual aspect. Given the clinical picture alone, the differential diagnosis would include bone pathologies such as a benign bone neoplasm, osteoma and advanced fibrous dysplasia. The lesion favored to be a developmental lesion based on the duration, stability and the 3D involvement of the mandible. With the radiographic findings, the case corroborated to be a developmental entity than a neoplastic process.

The histopathology of hemimandibular hyperplasia shows bone of normal cellularity and architecture as was observed in the present case. The histopathology of the present case showed normal bone with osteocytes evenly spaced with normal bony architecture, suggesting a non-inflammatory non neoplastic entity. Knowledge of normal bone present in these lesions can be vital as any pulpal inflammation spreading to the periapical region can be treated as routine and does not require any added consideration.

One of the causes for facial asymmetry is hemimandibular hyperplasia as was seen in the present case. Depending on the site involved there can be an increase in vertical or horizontal dimension. In the present case, since the body of right mandible was involved, the lower third of the face showed a diffuse swelling with involvement of inferior border of mandible. Treatment of hemimandibular hyperplasia is based on the site involved. Treatment plan depend on the severity of the structures affected and the esthetic correction of the dominant aspects. In moderate to severe cases, surgical procedures consist of osseous debulking with reconstruction. Certain cases may also require soft-tissue debulking, due the compensating growth of the overlying soft tissues surrounding the hypertrophy of the hard tissues. [8],[9],[10] In the absence of any functional disturbance, esthetic correction suffices as growth ceases after the last growth spurt. In the present case, peripheral trimming of the buccal cortical plate along with reduction of height of the body of the mandible was carried out to improve the facial appearance.

Apart from esthetics, most cases also show mild to severe functional disturbances with malocclusion being the foremost. Cases have also been reported where patient also developed habits due to malocclusion. Usually, due to gradual enlargement, the dentition, overlying and surrounding soft-tissue attain harmony thus maintaining almost normal function. The present case did not show any significant malocclusion or any habits due to the anomaly. The present case being unique that although present throughout childhood, did not cause any functional disturbance.

 
   References Top

1.White SC, Pharoah MJ. Oral radiology, principles and interpretation. 5 th ed. Missouri: Mosby Elsevier; 2008. p. 639.  Back to cited text no. 1
    
2.Aravind WS, Sathasivasubramanian S. Unilateral condylar hyperplasia: A rare case report. Sri Ramachandra J Med 2010;3:19-22.  Back to cited text no. 2
    
3.Obwegeser HL, Makek MS. Hemimandibular hyperplasia: Hemimandibular elongation. J Maxillofac Surg 1986;14:183-208.  Back to cited text no. 3
[PUBMED]    
4.Mitani H. Unilateral mandibular hyperplasia associated with a lateral tongue thrust. Angle Orthod 1976;46:268-75.  Back to cited text no. 4
[PUBMED]    
5.Matthew SY, Naini FB, Gill DS. The aetiology, diagnosis and management of mandibular asymmetry. J Orthod (Ortho Update) 2008;1:44-52.  Back to cited text no. 5
    
6.Bertolini F, Bianchi B, De Riu G, Di Blasio A, Sesenna E. Hemimandibular hyperplasia treated by early high condylectomy: A case report. Int J Adult Orthodon Orthognath Surg 2001;16:227-34.  Back to cited text no. 6
[PUBMED]    
7.Kaya B, Arman A, Uçkan S. Orthodontic and surgical treatment of hemimandibular hyperplasia. Angle Orthod 2007;77:557-63.  Back to cited text no. 7
    
8.Pirmsinthavee S, Supranee D, Siripong S. Treatment of unilateral active condylar hyperplasia: A case report. Online J Thai Assoc Orthod 2011;1:24-32.  Back to cited text no. 8
    
9.Marsh J, Vannier M. Comprehensive care for craniofacial deformities. 1 st ed. Missouri: Mosby; 1985. p. 234-5.  Back to cited text no. 9
    
10.Proffit WR, White RP Jr, Sarver DM. Contemporary treatment of dentofacial deformity. 1 st ed. Missouri: Mosby Elsevier; 2008. p. 51-2.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]


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