# Unilateral Condylar Hyperplasia in Surgeons' Perspective--A Narrative Review
## 7 Treatment from Surgeons' Perspective
### Further Surgical Steps  
Despite the knowledge of the principles of orthognathic surgery and each modification of the condylectomy procedure, the treatment of each case of UCH can still be performed in various ways. The main aspects involved in selecting the most sufficient method of treatment should address the following topics: (1) scope of dentoalveolar discrepancies; (2) vertical ramus height and their disproportions; (3) degree of maxillary tilting on the affected side; (4) presence of an open bite; (5) patient's willingness to undergo the full osteotomy protocol or camouflage surgery; (6) if the type of condylectomy procedure is performed  
Figure 8: Intraoperative view on low condylectomy with modified pterygoid muscle re-attachment via a classic preauricular approach. as a sole procedure or with the combination of orthognathic surgery; (7) the volume and scope of mandibular overgrowth and the necessity for genioplasty, chin-wing osteotomy, or other future total symmetry correction of the asymmetrical lower mandibular margins; (8) patient's age and the possibilities of early or late orthodontic treatment; (9) presence and position of retained wisdom teeth and the timing for their removal; (10) what are the main patient's goals and wishes? To improve esthetics, function, symmetry, quality of life, or other important topics [26; 27; 28; 29; 30; 31; 32; 33; 34; 35; 36; 37; 38; 39; 40; 41; 42; 43; 44; 45; 46; 47; 48; 49; 50; 51; 52; 53; 54; 55; 56; 57; 58; 59; 60; 61; 62; 63; 64; 65; 66; 67; 68; 69; 70; 75; 76; 77; 78; 79; 80; 81; 82; 83; 84; 85; 86; 87; 88; 89; 90; 91; 92; 93; 94; 95; 96; 97; 98; 99; 100; 101; 102; 103; 104; 105; 106; 107; 108; 109; 101; 103; 105; 107; 108; 109; 110; 111; 1112]. The indications for choosing a one-stage treatment are mostly related to the scope of malocclusion and the degree of overgrowth. Simultaneously performed condylectomy and orthognathic surgery has good outcomes; however, the unstable joint syndrome after condylectomy and the necessity for early orthodontics are demanding. Two-stage orthognathic surgery is focused firstly on condylectomy, and later on, orthognathic surgery, when the entire joint is entirely healed and stable, and good orthodontics grants full osteotomy protocol during mostly surgery consisting of Lefort I and BSSO osteotomies [75; 76; 77; 113; 114]. In Table 1, the authors' proposed algorithm is presented (Table 1). The main goal is to achieve proper symmetry and a balanced profile. This can be achieved in various ways and methods. Most authors focus on the importance of condylectomy as a gold standard. From there, either orthodontic treatment leads to finalizing the treatment or the patient must be prepared for a total osteotomy protocol, namely, orthognathic surgery. Other treatment modalities might consist of one-stage surgery or two-stage surgery. A condylectomy is one of the possible surgical interventions that can be used simultaneously after a condylectomy or only after major orthodontic treatment to ensure a good, stable occlusion. It is mandatory to perform any surgical intervention only after fully treating the condy abnormal growth or after ensuring that the growth is not present [75; 76; 77; 113; 114]. 1. [label=(0)]
2. Mandibular ramus osteotomy on the affected condyle's side (unilateral osteotomy) suggested by [PERSON], 1996 [114]: this is a simple and accurate method; however, the rotation of the unaffected condyle might become troublesome;
3. Condylectomy followed by a surgery-first approach after a month (SFA) suggested by [PERSON] et al., 2017 [115]: when patients benefit from achieving a balanced facial profile faster without any orthodontic approach, which is mostly scheduled after the surgery in a short period of time;
4. Orthognathic surgery: BSSO or BSSO with Lefort I on severely asymmetric maxillary and mandibular bones with a prognathic profile and open bite [116];
5. BSSO with Ferguson modification [117]: for achieving a more balanced chin and lower mandibular border symmetry;
6.