Planar scintigraphy in assessment of mandibular asymmetry: Unilateral condylar hyperplasia vs asymmetric mandibular hyperplasia

Lo John, Yau Yat Yin, Yeung Wai Chow David, Cheung Lim Kwong

Department of Diagnostic Imaging, Hong Kong Adventist Hospital, Hong Kong, China.
Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, the University of Hong Kong, Hong Kong, China.

DOI: 10.4236/jbise.2012.512A106                

Abstract

Objectives: To 1) explore the planar scintigraphic findings in asymmetry patients caused by unilateral condylar hyperplasia (UCH) or asymmetric mandibular hyperplasia (AMH); 2) develop a local agecondylar activity reference norm; and 3) check the accuracy of the new norm and compare with other analytical methods. Material and Method: Chinese patients with mandibular asymmetry and scintigraphic findings available were recruited. Clinical, radiographic records and scintigraphic condylar activity ratio (CAR) were studied. Regression analysis was performed to quantify the relationship between age and CAR to develop a new norm. The sensitivity of condylar activity assessment using a) traditional norm; b) new norm; and c) percentile difference was compared. In patients with serial data available, longitudinal analysis of the scintigraphic changes were checked. Result: 109 patients were eligible for the study. Significant difference in CAR was noted between UCH and AMH patients. Linear relationship was observed between age and CAR. A new norm of the age-CAR was established, which showed improved sensitivity in condylar activity prediction in UCH and AMH when compared with traditional norm. Relative to percentile difference, the sensitivity of new norm was lower in AMH but not in UCH patients. Serial analysis revealed gradual decline in CAR with minimal change in percentile difference. Conclusion and Clinical Relevance: There is difference in scintigraphic condylar activity between UCH and AMH patients. A norm of age-CAR relationship was established, which showed improved sensitivity in condylar activity prediction in UCH patients. Further study is required to confirm the role of scintigraphy in AMH.

Keywords

cintigraphy; Bone Scan; Facial Asymmetry; Mandibular Asymmetry; Unilateral Condylar Hyperplasia

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Severt, T.R. and Proffit, W.R. (1997) The prevalence of facial asymmetry in the dentofacial deformities popula- tion at the University of North Carolina. International Journal of Adult Orthodontics & Orthognathic Surgery, 12, 171-176.
[2]	Haraguchi, S., Takada, K. and Yasuda, Y. (2002) Facial asymmetry in subjects with skeletal Class III deformity. Angle Orthodontist, 72, 28-35.
[3]	Samman, N., Tong, A.C., Cheung, D.L. and Tideman, H. (1992) Analysis of 300 dentofacial deformities in Hong Kong. International Journal of Adult Orthodontics & Or- thognathic Surgery, 7, 181-185.
[4]	Kaban, L.B. (2009) Mandibular asymmetry and the fourth dimension. Journal of Craniofacial Surgery, 20, 622-631. doi:10.1097/SCS.0b013e318195249c
[5]	Chan, W.L., Carolan, M.G., Fernandes, V.B. and Abbati, D.P. (2000) Planar versus SPET imaging in the assess- ment of condylar growth. Nuclear Medicine Communica- tions, 21, 285-290. doi:10.1097/00006231-200003000-00013
[6]	Obwegeser, H.L. and Makek, M.S. (1986) Hemimandibular hyperplasia—Hemimandibular elongation. Journal of Maxillofacial Surgery, 14, 183-208. doi:10.1016/S0301-0503(86)80290-9
[7]	Obwegeser, H.L. (2001) Bilateral hemimandibular elon- gation. In: Mandibular Growth Anomalies, Springer, New York, 242.
[8]	Fahey, F.H., Abramson, Z.R., Padwa, B.L., Zimmerman, R.E., Zurakowski, D., Nissenbaum, M., Kaban, L.B. and Treves, S.T. (2010) Use of (99m)Tc-MDP SPECT for as- sessment of mandibular growth: Development of normal values. European Journal of Nuclear Medicine and Mole- cular Imaging, 37, 1002-1010. doi:10.1007/s00259-009-1337-0
[9]	Pogrel, M.A., Kopf, J., Dodson, T.B., Hattner, R. and Kaban, L.B. (1995) A comparison of single-photon emission computed tomography and planar imaging for quantitative skeletal scintigraphy of the mandibular condyle. Oral Surgery, Oral Medicine, Oral Pathology, Oral Ra- diology and Endodontology, 80, 226-231. doi:10.1016/S1079-2104(05)80206-9
[10]	Henderson, M.J., Wastie, M.L., Bromige, M., Selwyn, P. and Smith, A. (1990) Technetium-99m bone scintigraphy and mandibular condylar hyperplasia. Clinical Radiology, 41, 411-414. doi:10.1016/S0009-9260(05)80603-8
[11]	Saridin, C.P., Raijmakers, P.G., Tuinzing, D.B. and Bec- king, A.G. (2011) Bone scintigraphy as a diagnostic meth- od in unilateral hyperactivity of the mandibular condyles: A review and meta-analysis of the literature. International Journal of Oral & Maxillofacial Surgery, 40, 11-17. doi:10.1016/j.ijom.2010.09.015
[12]	Cisneros, G.J. and Kaban, L.B. (1984) Computerized ske- letal scintigraphy for assessment of mandibular asymme- try. Journal of Oral and Maxillofacial Surgery, 42, 513- 520. doi:10.1016/0278-2391(84)90010-7
[13]	Kaban, L.B., Cisneros, G.J., Heyman, S. and Treves, S. (1982) Assessment of mandibular growth by skeletal scintigraphy. Journal of Oral and Maxillofacial Surgery, 40, 18-22. doi:10.1016/S0278-2391(82)80010-4
[14]	Kaban, L.B., Treves, S.T., Pogrel, M.A. and Hattner, R.S. (1995) Skeletal scintigraphy for assessment of mandibu- lar growth and asymmetry. In: S. T. Treves, Ed., Paediat- ric Nuclear Medicine, Springer, New York.
[15]	Pogrel, M.A. (1985) Quantitative assessment of isotope activity in the temporomandibular joint regions as a means of assessing unilateral condylar hypertrophy. Oral Sur- gery, Oral Medicine, Oral Pathology, 60, 15-17. doi:10.1016/0030-4220(85)90206-3
[16]	Hodder, S.C., Rees, J.I., Oliver, T.B., Facey, P.E. and Sugar, A.W. (2000) SPECT bone scintigraphy in the di- agnosis and management of mandibular condylar hyper- plasia. British Journal of Oral and Maxillofacial Surgery, 38, 87-93. doi:10.1054/bjom.1999.0209
[17]	Saridin, C.P., Raijmakers, P.G., Tuinzing, D.B. and Bec- king, A.G. (2008) Comparison of planar bone scintigra- phy and single photon emission computed tomography in patients suspected of having unilateral condylar hyperac- tivity. Oral Surgery, Oral Medicine, Oral Pathology, Or- al Radiology and Endodontology, 106, 426-432. doi:10.1016/j.tripleo.2008.01.028
[18]	Saridin, C.P., Raijmakers, P.G., Al Shamma, S., Tuinzing, D.B. and Becking, A.G. (2009) Comparison of different analytical methods used for analyzing SPECT scans of patients with unilateral condylar hyperactivity. International Journal of Oral & Maxillofacial Surgery, 38, 942- 946. doi:10.1016/j.ijom.2009.04.019
[19]	Pruzansky, S. (1969) Not all dwarfed mandibles are alike. Birth defects, 1.
[20]	Burrows, M., Baxter-Jones, A., Mirwald, R., Macdonald, H. and McKay, H. (2009) Bone mineral accrual across growth in a mixed-ethnic group of children: Are Asian children disadvantaged from an early age? Calcified Tis- sue International, 84, 366-378. doi:10.1007/s00223-009-9236-8
[21]	McKay, H.A., Petit, M.A., Khan, K.M. and Schutz, R.W. (2000) Lifestyle determinants of bone mineral: A com- parison between prepubertal Asian- and Caucasian-Ca- nadian boys and girls. Calcified Tissue International, 66, 320-324. doi:10.1007/s002230010067
[22]	Yokoyama, M., Atsumi, T., Tsuchiya, M., Koyama, S. and Sasaki, K. (2009) Dynamic changes in bone metabo- lism in the rat temporomandibular joint after molar ex- traction using bone scintigraphy. European Journal of Oral Sciences, 117, 374-379. doi:10.1111/j.1600-0722.2009.00635.x
[23]	Lo, J., Yau, Y.Y. and Cheung, L.K. (2010) Diagnostic ac- curacy of planar bone scintigraphy in mandibular asym- metry using a new reference. XX Congress of the European Association for Cranio-Maxillo-Facial Surgery: Bruges.
[24]	Kajan, Z.D., Motevasseli, S., Nasab, N.K., Ghanepour, H. and Abbaspur, F. (2006) Assessment of growth activity in the mandibular condyles by single-photon emission com- puted tomography (SPECT). Australian Orthodontic Jour- nal, 22, 127-130.
[25]	Gray, R.J., Sloan, P., Quayle, A.A. and Carter, D.H. (1990) Histopathological and scintigraphic features of condylar hyperplasia. International Journal of Oral & Maxillofa- cial Surgery, 19, 65-71. doi:10.1016/S0901-5027(05)80196-1
[26]	Villanueva-Alcojol, L., Monje, F. and Gonzalez-Garcia, R. (2011) Hyperplasia of the mandibular condyle: Clini- cal, histopathologic, and treatment considerations in a se- ries of 36 patients. Journal of Oral and Maxillofacial Surgery, 69, 447-455. doi:10.1016/j.joms.2010.04.025
[27]	Saridin, C.P., Raijmakers, P.G., Slootweg, P.J., Tuinzing, D.B., Becking, A.G. and van der Waal, I. (2010) Unilat- eral condylar hyperactivity: A histopathologic analysis of 47 patients. Journal of Oral and Maxillofacial Surgery, 68, 47-53. doi:10.1016/j.joms.2009.07.033
[28]	Obwegeser, H.L. (2001) Scintigraphy, a diagnostic and treatment planning aid. In: Mandibular Growth Anomalies, Springer, New York, 31-33.
[29]	Kim, J.H., Kim, Y.K., Kim, S.G., Yun, P.Y., Kim, J.D. and Min, J.H. (2011) Effectiveness of bone scans in the diagnosis of osteoarthritis of the temporomandibular joint. Dentomaxillofacial Radiology.
[30]	Coutinho, A., Fenyo-Pereira, M., Dib, L.L. and Lima, E.N. (2006) The role of SPECT/CT with 99mTc-MDP image fusion to diagnose temporomandibular dysfunction. Oral Surgery, Oral Medicine, Oral Pathology, Oral Ra- diology and Endodontology, 101, 224-230. doi:10.1016/j.tripleo.2005.03.018
[31]	Epstein, J.B., Rea, A. and Chahal, O. (2002) The use of bone scintigraphy in temporomandibular joint disorders. Oral Diseases, 8, 47-53. doi:10.1034/j.1601-0825.2002.10753.x
[32]	Guner, D.D., Ozturk, Y. and Sayman, H.B. (2003) Evaluation of the effects of functional orthopaedic treatment on temporomandibular joints with single-photon emission computerized tomography. European Journal of Ortho- dontics, 25, 9-12. doi:10.1093/ejo/25.1.9
[33]	Paulsen, H.U., Rabol, A. and Sorensen, S.S. (1998) Bone scintigraphy of human temporomandibular joints during Herbst treatment: A case report. European Journal of Orthodontics, 20, 369-374. doi:10.1093/ejo/20.4.369