Postoperative Functional Remodeling of Preoperative Idiopathic Condylar Resorption: A Case Report

You, Myung-Su; Yang, Hoon-Joo; Hwang, Soon-Jung

doi:10.1016/j.joms.2010.01.012

Cited by 13 publications

(6 citation statements)

References 14 publications

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“…Predominantly downward and backward mandibular growth with a steep mandibular plane, short ramus vertical height, and anteroposterior mandibular deficiency have been associated with a greater susceptibility to TMJ internal derangements 3-13 regardless of orthognathic surgical treatment. Changes in condylar position and TMJ loading during surgical maxillomandibular advancement (MMA) have been associated with postsurgical condylar remodeling, resorption, and instability of the surgical correction, 14-16 particularly in young female patients. 17,18 Hormonal imbalances and the use of oral contraceptives also have been considered potential etiologic factors for condylar resorption.…”

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confidence: 99%

“…19,20 A history of untreated TMJ arthritic changes (disc displacements or osteoarthritis) has been associated with poor outcomes of surgical MMA, in which further condylar arthritic changes may lead to instability after surgery. 14,21-23 Among alternative treatment options, simultaneous articular disc repositioning has been advocated to avoid condylar resorption and improve stability. 22,24,25 …”

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Temporomandibular Joint Condylar Changes Following Maxillomandibular Advancement and Articular Disc Repositioning

Gonçalves

Wolford

Cassano

et al. 2013

Journal of Oral and Maxillofacial Surgery

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Purpose To evaluate condylar changes 1 year after bimaxillary surgical advancement with or without articular disc repositioning using longitudinal quantitative measurements in 3-dimensional (3D) temporomandibular joint (TMJ) models. Methods Twenty-seven patients treated with maxillomandibular advancement (MMA) underwent cone-beam computed tomography before surgery immediately after surgery and at 1-year follow-up. All patients underwent magnetic resonance imaging before surgery to assess disc displacements. Ten patients without disc displacement received MMA only. Seventeen patients with articular disc displacement received MMA with simultaneous TMJ disc repositioning (MMA-Drep). Pre- and postsurgical 3D models were superimposed using a voxel-based registration on the cranial base. Results The location, direction, and magnitude of condylar changes were displayed and quantified by graphic semitransparent overlays and 3D color-coded surface distance maps. Rotational condylar displacements were similar in the 2 groups. Immediately after surgery, condylar translational displacements of at least 1.5 mm occurred in a posterior, superior, or mediolateral direction in patients treated with MMA, whereas patients treated with MMA-Drep presented more marked anterior, inferior, and mediolateral condylar displacements. One year after surgery, more than half the patients in the 2 groups presented condylar resorptive changes of at least 1.5 mm. Patients treated with MMA-Drep presented condylar bone apposition of at least 1.5 mm at the superior surface in 26.4%, the anterior surface in 23.4%, the posterior surface in 29.4%, the medial surface in 5.9%, or the lateral surface in 38.2%, whereas bone apposition was not observed in patients treated with MMA. Conclusions One year after surgery, condylar resorptive changes greater than 1.5 mm were observed in the 2 groups. Articular disc repositioning facilitated bone apposition in localized condylar regions in patients treated with MMA-Drep.

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confidence: 99%

Temporomandibular Joint Condylar Changes Following Maxillomandibular Advancement and Articular Disc Repositioning

Gonçalves

Wolford

Cassano

et al. 2013

Journal of Oral and Maxillofacial Surgery

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“…Other factors, therefore, must be included to establish a definitive diagnosis to differentiate from degenerative diseases. For example, condylar resorption on conventional imaging is described as being characterized by altered shape (flattening, erosion) and decreased volume of the condyle, as well as a reduction of 6-10% in ramus height [2,8,13,18,[26][27][28][29]. However, it is important to consider the underlying pathogenesis and concomitant clinic when evaluating these diagnostic findings of conventional imaging.…”

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confidence: 99%

Controversial Aspects of Diagnostics and Therapy of Idiopathic Condylar Resorption: An Analysis of Evidence- and Consensus-Based Recommendations Based on an Interdisciplinary Guideline Project

Schmidt

Ahlers

Feurer³

et al. 2023

JCM

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Idiopathic condylar resorption (ICR), though a rare event, is associated with severe detrimental sequelae for the patient. To date, the etiology remains unknown, and treatment strategies are highly controversial. Therefore, the aim of this study is to present an analysis of the consensus- and evidence-based approach to ICR by a German interdisciplinary guideline project of the AWMF (Association of the Scientific Medical Societies in Germany). Following a systematic literature search, including 56 (out of an initial 97) publications, with a predominantly low level of evidence (LoE), two independent working groups (oral and maxillofacial surgery and interdisciplinary, respectively) voted on a draft comprising 25 recommendations in a standardized anonymized and blinded Delphi procedure. While the results of the votes were relatively homogeneous, the interdisciplinary phase required a significantly higher number of rounds (p < 0.001). Most of the controversial recommendations were related to initial imaging (with consensus on CT/CBCT as the current diagnostic standard for imaging), pharmacotherapy (no recommendation due to lack of evidence), discopexy (no recommendation possible due to low LoE) and timing of orthognathic surgery (with consensus on two-staged procedures after invasive TMJ surgery, except for single-stage procedures if combined with total joint reconstruction). Overall, the Delphi procedure resulted in an interdisciplinary guideline offering the best possible evidence- and consensus-based expertise to date in the diagnosis and treatment of ICR.

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“…Condylar remodelling might result from an acquired functional occlusion producing balanced mechanical loading on the TMJ after correction of the mandibular retrognathism. 21 The postoperative seating position of the condyle in the fossae and the consequent occlusion likely gave rise to an antero-superiorly directed loading vector at the TMJ that was biomechanically optimal. 22 The positioning of the condyle 14,16 before the BSSO is noted to prevent postoperative structural changes in the TMJ.…”

Section: Discussionmentioning

confidence: 99%

Skeletal Class II open-bite malocclusion with idiopathic condylar resorption: a case report

Oka

Kurosaka

Yashiro

et al. 2018

Australasian Orthodontic Journal

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Background The orthodontic treatment of patients with idiopathic condylar resorption (ICR) remains controversial. The effect of molar intrusion using temporary anchorage devices (TADs) and the consequential gradual counterclockwise rotation of the mandible in patients with ICR remains unclear. Aims To present the long-term treatment result of an adult skeletal Class II open-bite malocclusion with a history of ICR corrected by the combination of orthognathic surgery and TADs. Methods After six months of occlusal splint therapy, a surgically-assisted intrusion of the maxillary molars was performed using TADs, followed by a bilateral sagittal split osteotomy (BSSO) and genioplasty. Results The five-year post-treatment records showed a good facial appearance, occlusion and mandibular/condylar position with no progress in the condylar resorption. Conclusion Based on a single case, this treatment option is an effective alternative to a bimaxillary osteotomy for patients presenting with ICR.

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Postoperative Functional Remodeling of Preoperative Idiopathic Condylar Resorption: A Case Report

Cited by 13 publications

References 14 publications

Temporomandibular Joint Condylar Changes Following Maxillomandibular Advancement and Articular Disc Repositioning

Temporomandibular Joint Condylar Changes Following Maxillomandibular Advancement and Articular Disc Repositioning

Controversial Aspects of Diagnostics and Therapy of Idiopathic Condylar Resorption: An Analysis of Evidence- and Consensus-Based Recommendations Based on an Interdisciplinary Guideline Project

Skeletal Class II open-bite malocclusion with idiopathic condylar resorption: a case report

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