A Modified Subcondylar Endaural Approach for Proportional Condylectomy in Condylar Hyperplasia: Clinical Report

BACKGROUND: Condylar hyperplasia is characterized by excessive unilateral growth of the mandibular condyle, resulting in facial asymmetry, occlusal disturbances, and functional impairment. It is usually managed by proportional condylectomy. Different surgical approaches have been described, each associated with functional and aesthetic implications. METHODS: A systematic review was conducted following PRISMA guidelines using PubMed, Scopus, Web of Science, and Cochrane databases. Studies reporting extraoral approaches for proportional condylectomy in patients with condylar hyperplasia were included. In parallel, a retrospective case series of 10 patients treated with proportional condylectomy using a modified endaural approach with subcondylar blunt dissection was analyzed. RESULTS: Seven studies comprising 150 patients met the inclusion criteria. Preauricular approaches accounted for 75.9% of cases, whereas endaural approaches represented 24.1%. Complementary orthognathic surgery was required in 43.3% of patients, while 56.7% were treated exclusively with proportional condylectomy. Neurological complications were generally transient, and articular disc preservation was favored. In the clinical series, all patients underwent unilateral proportional condylectomy using the modified endaural approach without routine capsulotomy or disc manipulation. Sixty percent achieved functional and aesthetic stability without secondary orthognathic surgery. CONCLUSION: The modified endaural approach may represent a safe and conservative surgical option for the management of condylar hyperplasia in selected patients. However, given the retrospective design, small sample size, and the absence of a control group, further studies with larger cohorts and comparative designs are needed to confirm these findings.