Purpose
Unilateral condylar hyperplasia (UCH) is a rare condition that may require surgical intervention based on the activity of the affected condyle. Semi-quantitative assessment using SPECT/CT can support early detection of active growth and guide treatment decisions. This study aimed to identify a local semi-quantification ratio threshold that may inform surgical management in patients with UCH.

Materials and Methods
A retrospective review was performed on 29 patients diagnosed with UCH between 2022 and 2025. Semi-quantification on Tc99m HMDP SPECT/CT was introduced at our centre in 2022 and local condylar activity ratios generated. These ratios were then compared with management planning (surgical vs non- surgical) to identify a potential threshold favouring surgical management- condylar shaving.

Results
Of the 29 patients, 9 proceeded to surgery. The lowest ratio observed among surgical cases was 57%, seen in two patients. Patients with ratios below this were managed conservatively or with orthognathic procedures, suggesting 57% as a preliminary threshold for surgical condylar shaving.

Conclusion
A local semi-quantification ratio of 57% may serve as an initial guide for surgical decision-making in UCH, compared to the previously referenced 55% cutoff. Further prospective studies with larger patient cohorts are needed to validate this threshold.

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