Evaluation of 99mTc Uptake in the Mandibular Condyle, Comparison Between the Two Sides, and Correlation with the First Cervical Vertebra in Patients with Mandibular Deviation
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Abstract
Introduction: This pilot study aimed to evaluate the uptake of the radiopharmaceutical 99mTc in the mandibular condyles and cervical vertebrae on bone scintigraphy and to assess the correlation between inter-condylar metabolic disparities and longitudinal soft-tissue changes in patients presenting with progressive mandibular deviation. Materials and Methods: This prospective longitudinal pilot study enrolled patients referred to orthodontic and oral and maxillofacial surgery clinics with suspected condylar hyperactivity and mandibular deviation. Bone scintigraphy was performed at baseline to assess 99mTc-MDP uptake in both mandibular condyles normalized against the first cervical vertebra (C1). Standardized facial photographs were obtained at baseline and after a 6-month prospective follow-up period to evaluate soft-tissue asymmetry changes. Results: Over the 6-month observation period, the most pronounced soft-tissue variations were observed in An.b (mean: 62.40 ± 33.69) and Gn.a (mean: 38.59 ± 34.41). Bivariate Pearson correlation analysis revealed a statistically significant, strong negative correlation between inter-condylar 99mTc uptake differences (L−R) and changes in pog.oc (r = -0.821, 95% CI: [-0.96, -0.26], p = 0.012). Non-significant moderate-to-strong correlations with inter-condylar uptake differences were noted for Gn.b (r = -0.643, p = 0.086), ph.b (r = 0.607, p = 0.110), and pog.b (r = 0.571, p = 0.139). Conclusion: Preliminary findings suggest that quantitative 99m Tc bone scintigraphy demonstrated preliminary correlations with specific regional soft-tissue changes. Given the small sample size and lack of diagnostic validation against a reference standard, these findings reflect exploratory associations rather than predictive capability. Larger prospective studies are required to clarify the clinical utility of semi-quantitative scintigraphy in asymmetry management. Keywords: Mandibular condyle; Condylar hyperactivity; Bone scintigraphy; Technetium 99mTc medronate; Facial asymmetry.
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15. Ceratti C, Maspero C, Consonni D, Caprioglio A, Connelly ST, Inchingolo F, Tartaglia GM. Cone-beam computed tomographic assessment of the mandibular condylar volume in different skeletal patterns: a retrospective study in adult patients. Bioengineering. 2022;9(3):102.
16. Almashraqi AA. Dimensional and positional associations between the mandibular condyle and glenoid fossa: a three-dimensional cone-beam computed tomography-based study. The Journal of Contemporary Dental Practice. 2021;21:1075-83.
17. Lo Giudice A, Rustico L, Caprioglio A, Migliorati M, Nucera R. Evaluation of condylar cortical bone thickness in patient groups with different vertical facial dimensions using cone-beam computed tomography. Odontology. 2020;108(4):669-75.
18. Xiao J, Wu Z, Ye W. Using 3D medical modeling to evaluate the accuracy of single-photon emission computed tomography (SPECT) bone scintigraphy in diagnosing condylar hyperplasia. Journal of Oral and Maxillofacial Surgery. 2022;80(2):285. e1-. e9.
19. López DF, Castro MA, Muñoz JM, Cárdenas‐Perilla R. Reference values of mandibular condyles metabolic activity: A study using 99mTc‐MDP single‐photon emission computed tomography. Orthodontics & Craniofacial Research. 2021;24(3):328-34.
20. Kwon T-G, Lee K-H, Park H-S, Ryoo H-M, Kim H-J, Lee S-H. Relationship between the masticatory muscles and mandibular skeleton in mandibular prognathism with and without asymmetry. Journal of oral and maxillofacial surgery. 2007;65(8):1538-43.
21. Hwang H-S, Youn I-S, Lee K-H, Lim H-J. Classification of facial asymmetry by cluster analysis. American Journal of Orthodontics and Dentofacial Orthopedics. 2007;132(3):279. e1-. e6.
22. Haider S, Younis M, Hanan S, Bader R. Comparison of bone scan and SPECT/CT in detection of condylar hyperplasia. Pakistan Journal of Medical & Health Sciences. 2022;16(1):189-91.
23. Arora KS, Bansal R, Mohapatra S, Pareek S. Review and classification update: unilateral condylar hyperplasia. BMJ Case Reports. 2019;12(2):bcr-2018-227569.
24. Wen B, Shen Y, Wang C-Y. Clinical Value of 99Tcm‐MDP SPECT Bone Scintigraphy in the Diagnosis of Unilateral Condylar Hyperplasia. The Scientific World Journal. 2014;2014(1):256256.
2. Roberts WE, Goodacre CJ. The temporomandibular joint: a critical review of life‐support functions, development, articular surfaces, biomechanics and degeneration. Journal of Prosthodontics. 2020;29(9):772-9.
3. Park I-Y, Kim J-H, Park Y-H. Three-dimensional cone-beam computed tomography based comparison of condylar position and morphology according to the vertical skeletal pattern. Korean journal of orthodontics. 2015;45(2):66.
4. Willems NM, Langenbach GE, Everts V, Zentner A. The microstructural and biomechanical development of the condylar bone: a review. European journal of orthodontics. 2014;36(4):479-85.
5. Ahmed J, Sujir N, Shenoy N, Binnal A, Ongole R. Morphological assessment of TMJ spaces, mandibular condyle, and glenoid fossa using cone beam computed tomography (CBCT): a retrospective analysis. Indian Journal of Radiology and Imaging. 2021;31(01):078-85.
6. Farronato M, Cavagnetto D, Abate A, Cressoni P, Fama A, Maspero C. Assessment of condylar volume and ramus height in JIA patients with unilateral and bilateral TMJ involvement: Retrospective case-control study. Clinical Oral Investigations. 2020;24(8):2635-43.
7. Villanueva-Alcojol L, Monje F, González-García R. Hyperplasia of the mandibular condyle: clinical, histopathologic, and treatment considerations in a series of 36 patients. Journal of Oral and Maxillofacial Surgery. 2011;69(2):447-55.
8. Mendoza LV, Bellot-Arcís C, Montiel-Company JM, García-Sanz V, Almerich-Silla JM, Paredes-Gallardo V. Linear and volumetric mandibular asymmetries in adult patients with different skeletal classes and vertical patterns: a cone-beam computed tomography study. Scientific Reports. 2018;8(1):12319.
9. Bharathi SC, Senthilnathan S, Kumar LD, Mohan AC, Taranath M. Unilateral condylar hyperplasia: A case report and review of literature. Journal of International Society of Preventive & Community Dentistry. 2014;4(1):67.
10. Jones RHB, Tier GA. Correction of facial asymmetry as a result of unilateral condylar hyperplasia. Journal of oral and maxillofacial surgery. 2012;70:1413-25.
11. Karssemakers L, Besseling L, Schoonmade L, Su N, Nolte J, Raijmakers P, Becking A. Diagnostic accuracy of bone SPECT and SPECT/CT imaging in the diagnosis of unilateral condylar hyperplasia: A systematic review and meta-analysis. Journal of Cranio-Maxillofacial Surgery. 2024;52(4):447-53.
12. Raijmakers PG, Karssemakers LH, Tuinzing DB. Female predominance and effect of gender on unilateral condylar hyperplasia: a review and meta-analysis. Journal of Oral and Maxillofacial Surgery. 2012;70(1):e72-e6.
13. Shintaku WH, Venturin JS, Langlais RP, Clark GT. Imaging modalities to access bony tumors and hyperplasic reactions of the temporomandibular joint. Journal of oral and maxillofacial surgery. 2010;68(8):1911-21.
14. Farronato G, Salvadori S, Nolet F, Zoia A, Farronato D. Assessment of inter-and intra-operator cephalometric tracings on cone beam CT radiographs: comparison of the precision of the cone beam CT versus the latero-lateral radiograph tracing. Progress in Orthodontics. 2014;15(1):1.
15. Ceratti C, Maspero C, Consonni D, Caprioglio A, Connelly ST, Inchingolo F, Tartaglia GM. Cone-beam computed tomographic assessment of the mandibular condylar volume in different skeletal patterns: a retrospective study in adult patients. Bioengineering. 2022;9(3):102.
16. Almashraqi AA. Dimensional and positional associations between the mandibular condyle and glenoid fossa: a three-dimensional cone-beam computed tomography-based study. The Journal of Contemporary Dental Practice. 2021;21:1075-83.
17. Lo Giudice A, Rustico L, Caprioglio A, Migliorati M, Nucera R. Evaluation of condylar cortical bone thickness in patient groups with different vertical facial dimensions using cone-beam computed tomography. Odontology. 2020;108(4):669-75.
18. Xiao J, Wu Z, Ye W. Using 3D medical modeling to evaluate the accuracy of single-photon emission computed tomography (SPECT) bone scintigraphy in diagnosing condylar hyperplasia. Journal of Oral and Maxillofacial Surgery. 2022;80(2):285. e1-. e9.
19. López DF, Castro MA, Muñoz JM, Cárdenas‐Perilla R. Reference values of mandibular condyles metabolic activity: A study using 99mTc‐MDP single‐photon emission computed tomography. Orthodontics & Craniofacial Research. 2021;24(3):328-34.
20. Kwon T-G, Lee K-H, Park H-S, Ryoo H-M, Kim H-J, Lee S-H. Relationship between the masticatory muscles and mandibular skeleton in mandibular prognathism with and without asymmetry. Journal of oral and maxillofacial surgery. 2007;65(8):1538-43.
21. Hwang H-S, Youn I-S, Lee K-H, Lim H-J. Classification of facial asymmetry by cluster analysis. American Journal of Orthodontics and Dentofacial Orthopedics. 2007;132(3):279. e1-. e6.
22. Haider S, Younis M, Hanan S, Bader R. Comparison of bone scan and SPECT/CT in detection of condylar hyperplasia. Pakistan Journal of Medical & Health Sciences. 2022;16(1):189-91.
23. Arora KS, Bansal R, Mohapatra S, Pareek S. Review and classification update: unilateral condylar hyperplasia. BMJ Case Reports. 2019;12(2):bcr-2018-227569.
24. Wen B, Shen Y, Wang C-Y. Clinical Value of 99Tcm‐MDP SPECT Bone Scintigraphy in the Diagnosis of Unilateral Condylar Hyperplasia. The Scientific World Journal. 2014;2014(1):256256.
| Files | ||
| Issue | Vol 13, No 3 (Summer 2026) | |
| Section | Original Article(s) | |
| Keywords | ||
| Mandibular condyle; Condylar hyperactivity; Bone scintigraphy; Technetium 99mTc medronate; Facial asymmetry. | ||
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How to Cite
1.
Sarabikia H, Abbasi H. Evaluation of 99mTc Uptake in the Mandibular Condyle, Comparison Between the Two Sides, and Correlation with the First Cervical Vertebra in Patients with Mandibular Deviation. J Craniomaxillofac Res. 2026;13(3):320-326.
