SEARCH WITHIN CONTENT
Citation Information : Australasian Orthodontic Journal. Volume 36, Issue 2, Pages 195-204, DOI: https://doi.org/10.21307/aoj-2020-022
License : (CC BY 4.0)
Published Online: 20-July-2021
Background: Idiopathic condylar resorption (ICR) is a well-documented but poorly understood condition, characterised by the progressive degeneration of the temporomandibular joint without an identifiable cause. ICR most commonly presents as a spontaneous, self-limiting episode of bilateral condylar resorption in the absence of pathology, injury or systemic disease. The condition most commonly affects physically active adolescent females, and has a strong predilection for individuals with a Class II skeletal relationship. Some ICR patients exhibit symptoms such as discomfort and/or functional limitations during the active phase of resorption, though some may be completely asymptomatic.
Aim: This case report describes the ICR management of a 20-year-old female with asymptomatic bilateral condylar resorption, resulting in a rapid development of mandibular retrognathia. The retrognathic appearance was of concern to the patient and treatment was desired for this reason.
Methods and results: Combined orthodontic-orthognathic treatment was undertaken. Pre-surgical orthodontics was completed following ICR stabilisation, and surgical correction consisted of a mandibular advancement plus a genioplasty. The resorbed condyles were accepted given the temporomandibular joints remained asymptomatic and there were no functional limitations. Following treatment, the patient remained asymptomatic, functioning without restrictions, and satisfied with the aesthetic outcome.
Conclusion: The combined orthodontic-orthognathic approach addressed the aesthetic and functional concerns of the patient. The condyles were not reconstructed with prostheses and were left in their resorbed anatomical form and relationship. This illustrates the adaptive capabilities of the mandible and associated musculature, and that more complex condylar restorative procedures are not always required.
1. Posnick JC, Fantuzzo JJ. Idiopathic condylar resorption: current clinical perspectives. J Oral Maxillofac Surg 2007;65:1617-23.
2. Wolford LM, Cardenas L. Idiopathic condylar resorption: diagnosis, treatment protocol, and outcomes. Am J Orthod Dentofacial Orthop 1999;166:667-77.
3. Wolford LM. Idiopathic condylar resorption of the temporomandibular joint in teenage girls (cheerleaders syndrome). Proc (Bayl Univ Med Cent) 2001;14:246-52.
4. Mitsimponas K, Mehmet S, Kennedy R, Shakib K. Idiopathic condylar resorption. Br J Oral Maxillofac Surg 2018;56:249-55.
5. Papadaki ME, Tayebaty F, Kaban LB, Troulis MJ. Condylar resorption. Oral Maxillofac Surg Clin North Am 2007;19:223-34.
6. Hatcher DC. Progressive condylar resorption: pathologic processes and imaging considerations. Semin Orthod 2013;19:97-105.
7. Huang YL, Pogrel MA, Kaban LB. Diagnosis and management of condylar resorption. J Oral Maxillofac Surg 1997;55:114-20.
8. Sansare K, Raghav M, Mallya SM, Karjodkar F. Managementrelated outcomes and radiographic findings of idiopathic condylar resorption: a systematic review. Int J Oral Maxillofac Surg 2015;44:209-16.
9. Young A. Idiopathic condylar resorption: the current understanding in diagnosis and treatment. J Indian Prosthodont Soc 2017;17:128- 35.
10. Lee GH, Park JH, Lee SM, Moon DN. Orthodontic treatment protocols for patients with idiopathic condylar resorption. J Clin Pediatr Dent 2019;43:292-303.
11. Chuong R, Piper MA. Avascular necrosis of the mandibular condyle: pathogenesis and concepts of management. Oral Surg Oral Med Oral Pathol 1993;75:428-32.
12. Abubaker AO, Hebda PC, Gunsolley JN. Effects of sex hormones on protein and collagen content of the temporomandibular joint disc of the rat. Oral Maxillofac Surg 1996;54:721‐7.
13. Gunson MJ, Arnett GW, Formby B, Falzone C, Mathur R, Alexander C. Oral contraceptive pill use and abnormal menstrual cycles in women with severe condylar resorption: A case for low serum 17beta‐estradiol as a major factor in progressive condylar resorption. Am J Orthod Dentofacial Orthop 2009;136:772‐9.
14. Nicolielo LF, Jacobs R, Ali Albdour E, Hoste X, Abeloos J, Politis C et al. Is oestrogen associated with mandibular condylar resorption? A systematic review. Int J Oral Maxillofac Surg 2017;46:1394-1402.
15. Chigurupati R, Mehra P. Surgical management of idiopathic condylar resorption: orthognathic surgery versus temporomandibular total joint replacement. Oral Maxillofacial Surg Clin North Am 2018;30:355-67.
16. Wolford LM. Clinical indications for simultaneous TMJ and orthognathic surgery. Cranio 2007;25:273-82.
17. Zulma C, Breton P, Bouletreau P. Management of dentoskeletal deformity due to condylar resorption: literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 2016;121:126-32.
18. Mehra P, Nadershah M, Chigurupati R. Is alloplastic temporomandibular joint reconstruction a viable option in the surgical management of adult patients with idiopathic condylar resorption? J Oral Maxillofac Surg 2016;74:2044-54.
19. Mercuri LG, Ali FA, Woolson R. Outcomes of total alloplastic replacement with periarticular autogenous fat grafting for management of reankylosis of the temporomandibular joint. J Oral Maxillofac Surg 2008;66:1794-803.
20. Troulis MJ, Tayebaty FT, Papadaki M, Williams WB, Kaban LB. Condylectomy and costochondral graft reconstruction for treatment of active idiopathic condylar resorption. J Oral Maxillofac Surg 2008;66:65-72.