# Unilateral Condylar Hyperplasia in Surgeons' Perspective--A Narrative Review
## 4 Signs and Symptoms  
A close, detailed patient evaluation might be made according to clinical and radiological signs and symptoms. Facial and/or mandibular asymmetry can cause various co-existing problems related to facial appearance, chewing, bite, occlusion, TMJ function, and in some cases even breathing and an unbalanced proper posture [20; 21; 22; 23; 24]. To begin with, the scope of mandibular asymmetry should be closely evaluated since its intensity and occurrence and changes in patients' skeletal appearance are greatly correlated with the excess of growth pathology [1; 2; 3; 4; 5; 6; 7; 8; 9; 10]. Some typical signs and symptoms can be addressed according to the [PERSON], Wolford, or Kaban classifications of asymmetries, in detailed relation to the type of mandibular and skeletal asymmetry [1; 2; 3; 4; 5; 6; 7; 8; 9; 10; 20; 21]. First of all, a detailed evaluation of any pain-related TMJ joint symptoms should be performed since, in some cases, patients' TMJ pain in UCH might be present and result in condy volume \begin{table}
\begin{tabular}{p{42.7 pt} p{56.9 pt} p{56.9 pt} p{56.9 pt} p{56.9 pt} p{56.9 pt}} \hline \hline
**1.** & **Growth Activity** &
\begin{tabular}{c} **SPECT** \\ **Monitoring** \\ \end{tabular} & **Condylectomy** & **Maxillary Tilting** & **Presence of Overgrowth** \\ \hline \multicolumn{6}{c}{No growth present} & \multicolumn{3}{c}{Are orthodontics sufficient?} & Surgical camo \\ \hline A & Not present & One study & NO & ORT or surgical camo & Genioplasty \\ \hline \multicolumn{6}{c}{Some forms of growth:} & YES & NO & - \\ \hline \multirow{6}{*}{B} & Active growth: rapidly progressive in time & SPECT: at least two studies & YES & \(\pm\) BIMAX & \(\pm\) BSSO & - \\  & & & & BSSO/ Leftor I & \(\pm\) ORT & Marginectomy \\  & & & & \(\pm\) ORT & \(\pm\) ORT camo & - \\  & & & & \(\pm\) ORT camo & \(\pm\) Surg camo & Bone drilling and chiseling \\  & & & & \(\pm\) Surg camo & - \\ \hline \multirow{6}{*}{C} & Active growth: slowly progressive in time & SPECT: at least two studies & YES & \(\pm\) BIMAX & \(\pm\) BSSO & Corrective osteectomies \\  & & & & BSSO/ [PERSON] & \(\pm\) ORT & - \\  & & & & \(\pm\) ORT & \(\pm\) ORT camo & Bone remodeling procedures \\  & & & & \(\pm\) ORT camo & \(\pm\) Surg camo & - \\  & & & & \(\pm\) Surg camo & Facial contouring \\  & & & & & \(\pm\) Surg camo & - \\ \hline \multirow{6}{*}{D} & Growth self-limiting in time & Each one per year till absence of growth & NO & \(\pm\) Surg camo & \(\pm\) BSSO & Facial implants \\  & & & & BSSO/ Leftor I & \(\pm\) ORT & \\  & & & & \(\pm\) ORT & \(\pm\) ORT camo & \\ \hline \multirow{6}{*}{E} & Growth cessation & One study & NO & \(\pm\) Leftor I & \(\pm\) ORT & \\  & & & & \(\pm\) BSSO & \(\pm\) ORT camo & \\  & & & & \(\pm\) ORT & \(\pm\) Surg camo & \\ \hline \hline \end{tabular}
\end{table} 
Table 1: Authors’ proposal on the scope of approaches. Each of the presented cases should be scheduled for orthodontic treatment because of various scopes of dentoalveolar discrepancies. (1) Case A: asymmetry (MA) without pathological growth and no UCH symptoms: scheduled for orthodontic or surgical camouflage or solely bone remodeling if no dentoalveolar discrepancies are present. (2) Case B–C: rapid or slowly progressive in time FA with MA asymmetry and pathological growth still present in the affected condyline confirmed in SPECT and during clinical examination: mandatory condylectomy followed by orthodontic treatment. After 3–6 months the scope of asymmetry, degree of maxillary tilting, and patient’s willingness to undergo total symmetry correction decide the final approaches. If the scope of mandibular overgrowth is extensive some surgical camouflage or bone remodeling procedures can be chosen. (3) Case D: low growth in SPECT with a tendency to decrease in time: early orthodontics followed by patient monitoring. If the orthodontics is sufficient, then the treatment is finalized.