Medical Imaging Analysis Report

1. Imaging Findings

Based on the provided SPECT/CT and 3D reconstruction images, the following major features are observed:

• In the SPECT images, the affected side (suspected right or left) shows significantly increased radionuclide uptake in the condyle, suggesting abnormal proliferation or active changes in that condyle.
• CT and 3D reconstruction images reveal marked unilateral condylar enlargement and condylar neck elongation. The cortical bone thickness and cancellous bone structure appear generally normal, with no evident bone destruction or tumor-like mass.
• Due to the continuous condylar overgrowth, the mandible tilts overall, resulting in facial and occlusal asymmetry, such as midline deviation, reverse overbite (negative overjet), and crossbite, etc.
• No obvious soft tissue swelling, fractures, or other signs of local bone destruction are noted.

2. Potential Diagnoses

Based on the clinical history (unilateral mandibular condylar overgrowth, facial asymmetry, and occlusal disturbances) and imaging findings, the following diagnoses or differential diagnoses can be considered:

1. Unilateral Condylar Hyperplasia (UCH)
   — Typically presents as persistent excessive growth of a unilateral mandibular condyle, causing facial asymmetry and occlusal abnormalities. On imaging, pronounced condylar enlargement, elongated condylar neck, and increased radionuclide uptake on SPECT are commonly seen.
2. Condylar Osteochondroma
   — An osteochondroma at the condylar region may also show localized overgrowth, but it often exhibits a cartilage cap–like appearance or a clearly protruding area, together with varied patterns of bone overgrowth.
3. Other causes of mandibular deviation
   Such as internal derangement of the articular disc or malunion after old trauma. These usually involve soft tissue or articular surface changes, lacking the typical unilateral bony overgrowth pattern.

3. Final Diagnosis

Taking into account the patient’s age (23 years), symptoms (progressive speech disorder and occlusal abnormalities), multiple orthodontic attempts without halting progression, and increased radionuclide uptake in the affected condyle on SPECT/CT, the most appropriate diagnosis is:

"Unilateral Condylar Hyperplasia (UCH)"

Further evaluation may involve clinical observation of the dynamic growth of the condyle, along with periodic nuclear medicine imaging (SPECT/CT) to determine whether the condylar activity is in an active or inactive phase. This will guide subsequent surgical or orthodontic interventions.

4. Treatment Plan and Rehabilitation

1. Treatment Strategy
   • During the “active phase” of UCH, a high condylectomy can be considered to halt abnormal condylar growth. The position of the articular disc should be evaluated to determine the need for disc repositioning or reconstruction.
   • After surgical intervention or once it is confirmed that the condylar activity has ceased, a combined orthodontic–orthognathic surgery approach may be used for comprehensive facial and occlusal reconstruction.
   • If the condition is in the “inactive phase” but presents with noticeable deformity, orthognathic surgery together with orthodontic treatment is the primary option to restore function and appearance.
2. Rehabilitation/Exercise Prescription Recommendations

   During the postoperative period or orthodontic treatment, functional training of the temporomandibular joint (TMJ) and oral musculature can help the patient regain occlusal and speech functions. Below is an example of a progressive “FITT-VP” principle:

   • Frequency: Perform mild functional exercises (e.g., gentle opening and closing of the mouth, lateral movements) 2–3 times a day. Gradually increase to 3–4 times daily as postoperative healing permits.
   • Intensity: Start with light resistance or assisted exercises that do not cause pain or fatigue. Later, under the supervision of a physician or therapist, gradually increase the degree of mouth opening and bite force.
   • Time: Each exercise session can be limited to 5–10 minutes and extended as tolerated.
   • Type: Includes mouth-opening exercises, lateral movement training, protrusion and retraction drills, as well as speech articulation practice. These may be combined with warm therapy or joint mobilization techniques.
   • Progression: As the joint stabilizes and healing progresses, range of motion and resistance can be gradually increased under guidance from specialized physicians and physical therapists.
   • Volume: The total daily exercise volume should match the joint’s capacity to avoid overuse, which could lead to pain or inflammation.

   In addition, if the patient is undergoing bite reconstruction or uses orthodontic appliances, close collaboration with dental specialists and regular follow-up are essential to prevent discomfort or complications.

Disclaimer: This report is based on the currently available information and is intended for reference only. It should not replace an in-person consultation or individualized diagnosis and treatment by professional medical personnel. Should you have any questions or experience any change in your condition, please consult a specialist promptly for further evaluation and management.