# Unilateral Condylar Hyperplasia in Surgeons' Perspective--A Narrative Review
## 7 Treatment from Surgeons' Perspective
### Condylectomy  
A condylectomy procedure can be performed using various methods. It is the first and most important surgical approach in cases of active pathological growth in the affected condyle. After achieving a good result within the affected joint, other methods and possibilities for treatment might vary greatly [17; 63; 75; 77]. After a condylectomy, the bony stump can be left in situ or smoothed and resutured with the pterygoid muscles. Various techniques exist. Other factors concern the response to a serious question: whether the bony stump with sharp edges should be smoothed or left intact to reorganize itself [63; 75]. In both articles, condylar remodeling was observed and manifested by the smoothening of the condylar surface and the return of the condyle to its normal position in the glenoid fossa. It was concluded that high condylectomy in the treatment of active CH of TMJ improved the functional occlusion and facial aesthetic. Each method should be included in patients' treatment when the condyle abnormality is stable and controlled [30; 32; 78]. In almost all cases, there is only one accurate method for the total removal of the pathological growth in the affected condyle. A condylectomy performed in one of the possible approaches is the method of choice. The removal of the most superior part of the condyle head with parts of the surrounding cartilage attached to the bone is widely performed. Other growth-arresting procedures in this type of pathology are not found or known, especially since condylectomy is a well-known, widespread, and well-described technique. A second approach in each MA related to UCH is well-defined monitoring of the growth (SPECT, RTG-PANX, CBCT/LDCT) every 6-12 months to establish if the growth is still present, active, or perhaps is in an ending decreased phase. The condylectomy procedure, performed in one of the known modalities, might lead to various outcomes (Table 1): (1) the condylectomy removes the pathological growth, and the patient is scheduled for a second surgical procedure for corrective/orthognathic surgery (two-step); (2) the condylectomy is one surgery combined with orthognathic surgery; (3) the condylectomy results in total symmetry correction and patient's bite/occlusion is not a problem for the patient; (4) the condylectomy results in total symmetry correction but patient still requires additional orthodontics or orthognathic surgery; (5) the condylectomy is performed first with early orthodontics to remove pathological growth in cases of severe asymmetry with maxillary deviated bite plane and secondary asymmetry; (6) condylectomy enables some type of rotation of the mandible towards the overgrowth resected area which causes the mandible to rotate in skeletal class II or class III features; (7) the condylectomy with surgery first approach is performed to improve the time of treatment, especially in young patients with visible lack of facial esthetics; (8) an increased necessity for a corrective genioplasty or other known techniques for definitive mandibular asymmetry correction (Table 1) [79]. After one of the condylectomy procedures is chosen as preferable for a unilateral condylar hyperplasia case, detailed diagnostics are necessary. First of all, establish if the pathology is condylar hyperplasia, or perhaps is a different pathology, such as osteochondroma (OC), osteeoma, chondroa, and osteoblastoma, or if any other possible malignant (chondrosarcoma and osteosarcoma) or metastatic co-existing features are present [19; 43; 79]. Based on the following diagnostic approaches, one of the types of condylectomy approaches can be used. There are a few known and used condylectomy techniques worth remembering and understanding:  
1. High condylectomy, [PERSON] et al. : excision of 4-5 mm of bone from the superior condyle pole is enough when this amount of bone is cut vertically from the lateral to medial pole [80; 81; 82]. High condylectomy as a sole operative treatment might be sufficient in some cases of UCH.