Condylar resorption is an irreversible complication following orthognathic surgery. Condylar resorption and arthrosis of the joint dgkfo. During growth, condylar resorption may decrease the projection of the mandible and be unrecognized as the source of a class ii malocclusion. The sagittal condylar path inclination was constructed by joining the heights of. A meaningless medical mouthful to most people, icr is all too real for holly anderson. Development and growth of the mandible mansoura university. Upon orthognathic mandibular advancement surgery the adjacent soft tissues can displace the distal bone segment and increase the load on the temporomandibular joint causing loss of its integrity. Since most of the research on condylar remodelling or condylar resorption has involved. Conditions such as osteoarthritis, rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, gout, ankylosis, spondylitis, and idiopathic condylar resorption require a comprehensive diagnostic model that integrates clinical, morphological and biomolecular assessments. On the other hand, condylar resorption cr is defined as a progressive change in condylar configuration followed by a decrease in mass 68. The aim of this study was to better understand how surgical repositioning and stabilization of anteriorly displaced articular discs using the mitek minianchor technique affects condylar growth in growing patients with adolescent internal condylar resorption aicr. The superposition of the condyle models showed the. Effect of postorthognathic surgery condylar axis changes.
Computed tomography images showed new cortical bone formation filling the former cavity space, and a partial recovery of condylar and temporal bones. Although the appropriate management of condylar process fractures after. Reports of condylar resorption associated with sapho syndrome have also been documented. Condylar resorption also known as condylysis is an event rarely seen in normal orthodontic practice, but when it occurs, it is a very unhappy occurrence and often puzzling and inexplicable. The present study was undertaken to evaluate the prevalence of radiographic changes in the condylar morphology and its association with age, clinical signs and symptoms of temporomandibular dysfunction and dentition status and also to evaluate the intra examiner and inter examiner reliability in assessing condylar changes using panoramic radiographs. This phenomenon represents an aggressive and fastmoving form of degenerative joint disease. Evaluation of condylar resorption before and after orthognathic surgery. Quantification of condylar resorption in temporomandibular joint osteoarthritis.
This is a welldocumented but poorly understood disease process that occurs with a 9. Condylar changes and its association with age, tmd, and. Twentyeight more publications were found by manual search of the. There is rapidly progressive condylar erosion resulting in widening of the joint space with the chin becoming less prominent from retrognathia. Superimposition of serial cephalometric tomograms helps document the presence of active condylar resorption. Class ii position in 2 forms of condylar resorption. Various combinations of keywords related to tmj changes disc displacement, arthralgia, condylar resorption cr and aspects of surgical intervention fixation.
Evaluation of condylar resorption before and after orthognathic. Idiopathic condylar resorption icr is a condition with no known cause, which. Condylar resorption can be aggressive months or slow years. Bone loss at the mandibular condyle has been described as a result of orthognathic surgery, systemic and local arthritides, posttraumatic remodeling, andor hormonal imbalance osseous condylar resorption that occurs without obvious cause is termed idiopathic condylar resorption icr. Comparison of condylar morphology changes and position. Condylar changes after orthognathic surgery for class iii dentofacial. Kerstens and colleagues 4 reported on 12 of 206 patients with highangle mandibular retrognathia and open bite who developed condylar resorption after bimaxillary surgical treatment. Progressive condylar resorption pcr, although rare, is a major complication of orthognathic surgery. Twentytwo adolescent patients diagnosed with aicr and anterior temporomandibular disc displacement were compared to. Development and growth of the mandible 201220 1ass. Pdf evaluation of condylar resorption before and after. Idiopathic condylar resorption icr, alternatively called progressive condylar resorption, is an uncommon aggressive form of degenerative disease of the temporomandibular joint seen mostly in. In patients with the condition of uncertain etiology that is commonly referred to as idiopathic condylar resorption, the condyles of the mandible partially resorb, thereby causing a loss of condylar height with secondary alterations of the maxillofacial morphology, occlusion, and head and neck function.
It is usually encountered in adolescent and young females, although it has also been observed in males. Pdf tmj response to mandibular advancement surgery. Pdf condylar resorption after orthognathic surgery m. Pathophysiology and pharmacologic control of osseous mandibular condylar resorption, letters to the editor. The heading sequence of the mesh terms used orthognathic surgery mesh and condylar resorption or progressive condylar. Facial imbalance receding chin, smaller airway snoring, apnea and bite disturbances anterior open bite, posterior tooth wear and muscle pain. Idiopathic condylar resorption icr presents diagnostic and therapeutic challenges to practitioners because of the rarity of the condition, progressive. In contrast to previous reports, of particular interest in our case is the presence of condylar resorption, which is.
The condyles are knobs of bone which protrude from the sides of the jaw bone to form hinge joints with the skull, one on each side of the head. Condylar resorption is a condition that affects the bone of the lower jaw. Progressive condylar resorption is a rare complication following orthog nathic surgery. Progressive condylar resorption pcr of the temporomandibular joint tmj occurs mostly in adolescent female individuals, who are likely to request orthodontic treatment. It sometimes has been referred to as cheerleaders syndrome, because it frequently occurs in teenage girls participating in sports activities which, through minor or major trauma to the jaws, can initiate or exacerbate the condition. A good occlusal relationship and a normal condylar position after orthogna. It consists of a curved, horizontal portion, the body, and two. Many causes have been hypothesized including estrogen. Early intervention by tmj treatments like a bitesplint can be used to slow the resorption and relieve pain. It is also often met in literature under the following terms. Gunson, dds, md progressive condylar resorption is a process that involves the temporomandibular joint tmj and the occlusion. Hypoxic progressive condylar resorption impngement retrodiscal tssue inflammatory tissue bone resorption, tmj condyle loose body joint mice, tmj malignant neoplasm of bones of skull and face open lock tmj, recurring osteoarthritis tmj, active degeneration osteoarthrosis inactive osteochondritis dissecans tmj. Idiopathic condylar resorption and arthrosis of the joints. Reactive arthritis cases 5 and 6 reactive arthritis also called seronegative spondyloarthropathy is an inflammatory process that can occur in the tmjs commonly with displaced discs, with or without condylar resorption usually related to bacterial andor viral pathology.
Adolescent internal condylar resorption acir cases 3 and 4 aicr is one of the most common tmj conditions seen in teenage females 8. Idiopathic condylar resorption icr can cause open bite in affected individuals. This disorder is nine times more likely to be present in females than males, and is more common among teenagers. Risk factors in the initiation of condylar resorption. The cell injection fully reverted the condylar resorption, l eading to functional and structural regeneration after 6 months. It can be defined as the process of destructive remodelling of the condylar process of the mandible that leads to progressive alteration of condylar shape and decrease in mass 1.
The aim of this study was to evaluate the changes in condylar volume and joint spaces occurring in patients undergoing bimaxillary orthognathic surgery for the treatment of class ii deformities, by means of cone beam computed tomography cbct. Sometimes other treatments like removing some tissue from the joint might be attempted to stop progression of the condition. Idiopathic condylar resorption icr is a progressive degenerative disease of the temporomandibular joint tmj, most commonly seen in female patients femalemale ratio. Anterior open bite due to idiopathic condylar resorption. Anterior open bite due to idiopathic condylar resorption during. Pushkar mehras pioneering surgery to repair idiopathic. Chronic diffuse sclerosing osteomyelitis of the mandible. Peripheral condylar sag type ii had developed in three of these patients. Heba mahmoud elsabaa development and growth of the mandible development of the mandible the mandible is the largest and strongest bone of the face, serves for the reception of the lower teeth. On the other hand, condylar resorption cr is defined as a progressive change in condylar configuration followed by a decrease in mass. Therefore, larger sample size evaluation of patients follow. Left untreated, the rare medical condition could someday take her life.
Treatment for icr is generally done for one of two reasons. This hormonally mediated condition is initiated as the adolescent enters the pubertal growth phase age of onset between 11 to 15 years. Idiopathic condylar resorption icr is a specific condition that affects the jaw joints temporomandibular joints or tmjs and most commonly occurs in teenage girls. Soobum an, soobyung park, yongil kim, and woosung son 2014 effect of postorthognathic surgery condylar axis changes on condylar morphology as determined by 3dimensional surface reconstruction.
Aicr is one of the most common tmj conditions seen in teenage females 8. Future studies are needed to address to role of anterior disc displacement in the icr condition. Adolescent internal condylar resorption aicr larry m. The bsso may cause alteration of the position of the condyle in the fossa. Among the causes of anterior open bite, idiopathic condylar resorption icr. This condition is most commonly seen in females and does not usually begin until the late teenage. The name idiopathic condylar resorption may therefore not be a comprehensive term as it indicates a oneside resorptive nature of a condition that also seems to affect condylar growth and development. By combining condylar changes and 3d cephalometric data and comparing pre. Idiopathic condylar resorption icr presents diagnostic and therapeutic challenges to practitioners because of the rarity of the condition, progressive deformity, and simultaneous. Condylar degeneration and diseaseslocal and systemic. The condylar seating is due to focal bone resorption andor bone apposition.
Management modalities for progressive condylar resorption range from conservative followup to a second corrective or thognathic surgery. Its aetiology and pathogenesis remains unclear, al though several theories have been suggested to explain it. A condylar risk profile can be formulated combining the 5point. The objectives of combined orthodonticsurgical treatment of dentofacial deformities are to improve facial aesthetics, maintaining a static and functionally healthy occlusion and stable results 6. A comprehensive treatment approach for idiopathic condylar. For growing patients, combining functional treatment.
Condylar sag is an immediate or late alteration in the position of the condylar process in the glenoid fossa after the fixation of the osteotomy. Adolescent internal condylar resorption acir cases 3 and 4. Future studies should focus on the effects of the different types of medication and diseases in. Evaluation of mandibular condylar changes in patients.
The involved condylar head will appear smaller in size. A number of local and systemic pathologies or diseases can cause mandibular condylar resorption. Catching condylar resorption in the early stages is important for nonsurgical treatment. The term progressive condylar resorption pcr was coined by arnett and tamborello. Interpretation of mandibular condyle fractures using 2d. Further investigations on serum estrogen concentrations in women with condylar resorption are needed. The cortical bone on the head of the condyle may lose some integrity. Idiopathic condylar resorption icr of the temporomandibular joint tmj is a. They can be among the most challenging of orthodontic patients to successfully treat, especially if orthognathic surgery is involved in the treatment process. Condylar changes in patients with idiopathic condylar. Idiopathic condylar resorption icr, which is alternatively called progressive condylar resorption pcr, is an uncommon aggressive form of degenerative disease of the temporomandibular joint tmj.
Request pdf anterior open bite due to idiopathic condylar resorption during orthodontic retention of a class ii division 1 malocclusion a. Progressive condylar resorption pcr or idiopathic condylar resorption icr. Condylar resorption, also called idiopathic condylar resorption, icr, and condylysis, is a temporomandibular joint disorder in which one or both of the mandibular condyles are broken down in a bone resorption process. Surgical treatment of adolescent internal condylar. Remodeling of the condyle and temporal fossa with destruction of condylar cartilage and subchondral bone leads to postsurgical condylar resorption, with arthralgia and functional limitations.
Condylar resorption case report aao 2019 ehandout update. Idiopathic condylar resorption also known as condylysis or cheerleader syndrome is primarily a disease of tmj affecting teenage girls. Condylar resorption in orthognathic patients after. Idiopathic condylar resorption in teenage girls most common tmd in adolescent 9f. Each of these hinges is known as a temporomandibular joint tmj. Condylar resorption was first reported by burke in 1961. In contrast, some researchers considered that although threedimensional changes in condylar head position are observed in patients post ssro, there are no significant changes that would clinically affect the patients 7. Idiopathic condylar resorption of the temporomandibular.
1272 508 469 964 584 49 1176 746 1223 1077 24 64 549 51 1424 316 823 1168 118 523 1301 936 219 543 1103 426 107 1408 267 859 693 3 467 949 289 70