# Unilateral Condylar Hyperplasia in Surgeons' Perspective--A Narrative Review
## 5 Imaging Tests for Diagnosis
### Panoramic Radiographs and Computed Tomography  
First of all, the evaluation of routine panoramic radiographs can be essential for establishing the type and scope of other, more advanced diagnostics [37]. The shape and size of the mandibular ramus and condylar process in any case of mandibular asymmetry should be carefully evaluated for typical and atypical signs of condylar hyperplasia; however, the estimation of any asymmetry via classic radiographs has its limitations and should be used with special consideration [38]. Nevertheless, routine radiographs are fast and cheap diagnostic tools that are helpful in surgical planning, especially if they are compared and evaluated with cone beam/low-dose computed tomography studies (CBCT/LDCT) (Figures 3 and 4). As suggested by some authors, after evaluation of routine panoramic radiographs, those radiographs can be useful only for screening as a \"first glimpse of an eye diagnostics\" [39]. When evaluated, symptoms such as the presence of a clear antagonist notch, the occurrence of an open bite on the affected site (canine/premolar area), a low downward position of the maxillary bone with tilting, an asymmetrical chin position towards the healthy side, a low-positioned mandibular canal and increased vertical ramus height, and other atypical ones are the most common ones for unilateral condylar hyperplasia's quick and easy identification on routine panoramic radiographs as a basic screening  
Figure 2: Visible lack of balance in lip contour with deviated maxillary bite plane and open bite present on the affected right side. The degree of maxillary deviation is related to the degree and volume of abnormal growth in the affected condyle over time. Open bite suggests an increased volume of pathological growth and low compensatory maxillary downward rotation. In the following cases, orthodontic treatment has its limitations, even after a condylectomy. procedure [37; 38; 39; 40]. A similar study compared the usage of 3D cone beam computed tomography (CBCT) and routine panoramic radiographs in hemifacial microsomia (HFM/HCMF) and established that CT is superior to a classic radiograph, but both diagnostic methods are necessary for each case and the combination of the two is very important [38; 40; 41]. [PERSON] et al. 's study on the usage of panoramic radiographs in UCH indicated that the following diagnostic method is not sufficient for routine diagnostics and follow-up and should be used for the screening and evaluation of some of the atypical anatomies of the herein-mentioned UCH cases [41; 42]. Computed tomography (CT) is quite good and accurate enough to estimate the degree of mandibular asymmetry and condylar head shape and size, further improving diagnostics. Nowadays considered a gold standard, CT should always be evaluated with basic routine radiographs, which have many limitations. Furthermore, in CT, additional BD (bone density) and bone structure components might be measured and evaluated in 3D (Figure 4). [PERSON] et al. 's study on 37 UCH patients underlines that CBCT is the best method for surgical planning, objective patient monitoring, and evaluating the degree and scope of asymmetry, especially when the height of the mandibular ramus is comparable to the condylar and body segments of the affected side of the mandible [41; 42]. Close measurements of the scope of mandibular overgrowth are essential for proper condjectomy planning and later orthognathic surgery, or the estimation of any definitive correction of mandibular asymmetry if still present after surgeries. A study by [PERSON] et al. estimated how important CBCT is in the evaluation and estimation of mandibular condylar (MC)-related pathologies [43].