NEMESIS Negative effects in medical science: oral and maxillofacial surgery

Introduction: Reconstruction of the mandibular condylar process is one of the most challenging procedures in maxillofacial surgery due to the complex anatomy of the temporomandibular joint (TMJ) and to the proximity of the facial nerve. These difficulties are further amplified in situations involving proliferative lesions that require radical resection. Periosteal chondroma is a rare, benign mesenchymal tumor that only exceptionally affects the craniofacial region yet may cause significant functional and aesthetic disturbances.
Case Report: A 39-year-old male presented with progressive facial asymmetry and limited mouth opening. Radiological examination revealed marked enlargement of the left mandibular condyle. The patient underwent resection of the affected condylar process with immediate reconstruction using an individual TMJ endoprosthesis. The postoperative course was complicated by recurrent dislocations of the implant and transient facial nerve dysfunction. Management required repeated reductions, occlusal stabilization with intermaxillary fixation and individualized occlusal splint, intensive physiotherapy, and long-term follow-up. Histopathological examination confirmed the diagnosis of periosteal chondroma. Over time, gradual improvement in mandibular function, facial nerve recovery, and occlusal stability was achieved without evidence of tumor recurrence.
Discussion: The TMJ plays a crucial role in mastication, speech and daily routine, therefore, precise reconstruction after condylar resection is essential. The use of traditional autogenous grafts to replace TMJ is limited by complications such as necrosis, ankylosis, unpredictable bone growth, and fracture. Advances in digital technologies, including Computer Aided Design/Computer Aided Manufacturing (CAD/CAM) and virtual surgical planning, have enabled patient-specific TMJ implants that accurately restore anatomy and mandibular function, with long-term favorable outcomes reported. However, individualized implants remain associated with complications such as implant dislocation. Comprehensive rehabilitation, including physiotherapy and facial nerve monitoring, is crucial to optimize functional recovery and guarantee long-term success.
Conclusions: Successful reconstruction of the mandibular condylar process after tumor resection requires meticulous preoperative planning, stable occlusal support, and coordinated collaboration among surgeons, prosthodontists, physiotherapists, and other specialists.