Observer consistency in radiographic assessment of. Catching condylar resorption in the early stages is important for nonsurgical treatment. Surgical treatment of adolescent internal condylar resorption. Oct 17, 2017 progressive condylar resorption pcr is a pathological process that primarily afflicts early through late adolescent females, but can present in males as well. 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. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a pdf plugin installed and enabled in your browser. Surgical treatment of adolescent internal condylar resorption aicr with articular disc repositioning and orthognathic surgery in the growing. Icr may result in malocclusion, facial disfigurement, tmj dysfunction, and pain. Early intervention by tmj treatments like a bitesplint can be used to slow the resorption and relieve pain.
Idiopathic condylar resorption icr is a progressive condition that affects the jaw joints. Hoppenreijs, thomas maal, and tong xi malpositioned condyles during osteotomy can cause remodeling of the condyles, but can also initiate condylar resorption cr. The heading sequence of the mesh terms used orthognathic surgery mesh and condylar resorption or progressive condylar. The tremendous loss of condylar mass and the resulting facial deformity in most cases requires comprehensive surgical management fig. A comprehensive treatment approach for idiopathic condylar. Background 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. Condylar resorption following orthognathic surgery. It often causes pain and limits opening of the mouth.
Idiopathic condylar resorption icr is a progressive degenerative disease of the temporomandibular joint tmj, most commonly seen in female patients femalemale ratio. The condylar morphology and condylar dimensions of the tmd patients were different, on average, from those of the asymptomatic subjects. Idiopathic condylar resorption icr, alternatively called progressive condylar resorption, is an uncommon aggressive form of degenerative disease of the temporomandibular joint seen mostly in. Pdf condylar resorption of the temporomandibular joint. Often orthodontics delay treatment of any kind until after active resorption is done. Left untreated, the rare medical condition could someday take her life. After growth completion, as the condyle resorbs, the occlusion becomes progressively class ii, with or without open bite. Oral contraceptive pill use and abnormal menstrual cycles in women with severe condylar resorption. Peripheral condylar sag type ii had developed in three of these patients.
Interpretation of mandibular condyle fractures using 2d. Condylar degeneration and diseaseslocal and systemic. The temporomandibular joint condyle is susceptible to developing a variety of problems, ranging from simple osteoarthrosis to severe condylar resorption. Pathophysiology and pharmacologic control of osseous mandibular condylar resorption, letters to the editor. 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. Condylar resorption and arthrosis of the joint dgkfo. Pcr leads to loss of condylar mass, decrease of mandible ramus height, and most noticeable an anterior open bite. Facial imbalance receding chin, smaller airway snoring, apnea and bite disturbances anterior open bite, posterior tooth wear and muscle pain. In aicr, the condylar resorption is internal with inward collapse of the overlying. In terms of etiology and clinical presentation, aicr is a distinct tmj pathology that differs from other conditions causing condylar resorption. Nov 21, 2017 heres a video about the surgery options and pros or cons of the choices.
The therapeutic effect in orthodontic treatment used in the management of temporomandibular disorders is controversial 2. Aicr is one of the most common tmj conditions seen in teenage females 8. While an increase in age is associated with an increase in the frequency of diagnosis of tmj osteoarthritis, it is not known whether the extent of condylar resorption of an osteoarthritic condyle in a 20 year old patient with tmj oa differs from that of a 55 year old patient with tmj oa. Oct 12, 2017 condylar resorption and arthrosis of the joint dgkfo 1.
Risk factors in the initiation of condylar resorption. Mouth opening and protrusion were significantly reduced after surgery 6. Idiopathic condylar resorption icr is an acquired disorder of the temporomandibular joint tmj classically affecting young women between 15 and. Osseous condylar resorption that occurs without obvious cause is termed idiopathic condylar resorption icr. Idiopathic condylar resorption international journal of applied. Treatment for icr is generally done for one of two reasons.
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. Condylar resorption and functional outcome after unilateral. 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 and arthrosis of the joints. Condylar resorptions and orthodonticsurgical treatment. Oct 29, 2019 catching condylar resorption in the early stages is important for nonsurgical treatment. This hormonally mediated condition is initiated as the adolescent enters the pubertal growth phase age of onset between 11 to 15 years. This disorder is nine times more likely to be present in females than males, and is more common among teenagers. Ideopathic osteo condylar resorption surgery options youtube. Progressive condylar resorption is a rare complication following orthog nathic surgery. Feb 17, 2017 idiopathic condylar resorption icr is a welldocumented but poorly understood progressive disease that affects the temporomandibular joint tmj.
Diagnosis and management of condylar resorption sciencedirect. The condition most often occurs in teenage girls, but can occur at any age, although rarely over the age of 40 years. Gunson, dds, md progressive condylar resorption is a process that involves the temporomandibular joint tmj and the occlusion. Its aetiology and pathogenesis remains unclear, al though several theories have been suggested to explain it. Management modalities for progressive condylar resorption range from conservative followup to a second corrective or thognathic surgery. They can be among the most challenging of orthodontic patients to successfully treat, especially if orthognathic surgery is involved in the treatment process. Sometimes other treatments like removing some tissue from the joint might be attempted to stop progression of the condition. Orthognathic surgery for patients with idiopathic condylar. Previously identified by the term idiopathic condylar resorption, it is a degenerative condition that strikes the condylar head with arthriticlike presentation and leads to pain and.
Each of these hinges is known as a temporomandibular joint tmj. 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. The condyles undergo resorption and the bone loss results in facial, bite and airway changes. A meaningless medical mouthful to most people, icr is all too real for holly anderson.
Pdf condylar resorption cr is a common sequela of some temporomandibular joint tmj abnormalities. During growth, condylar resorption may decrease the projection of the mandible and be unrecognized as the source of a class ii malocclusion. Pushkar mehras pioneering surgery to repair idiopathic. 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.
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. 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. Observer consistency in radiographic assessment of condylar resorption article in oral surgery, oral medicine, oral pathology, oral radiology, and endodontology 934. The cortical bone on the head of the condyle may lose some integrity. Aicr causes condylar resorption in all three planes of space by loss of condylar subcortical and cancellous bone, while maintaining the fibrocartilage on the condylar head and in the fossa. Condylar degeneration and diseaseslocal and systemic etiologies. Idiopathic condylar resorption of the temporomandibular. Unilateral condylar resorption was observed in 1 patient and bilateral signs of resorption with loss of ramus height were observed in a further patient.
Surgical management of idiopathic condylar resorption oral and. Pdf idiopathic condylar resorption icr, alternatively called progressive condylar resorption, is an uncommon aggressive form of. The condylar morphology and condylar dimensions of. Pdf condylar resorption after orthognathic surgery m.
Idiopathic condylar resorption icr is a condition with no known cause, which manifests as progressive malocclusion, esthetic changes, and often pain. Idiopathic condylar resorption dr sylvain chamberland. There are no other joints involved in aicr and no known genetic predisposition 10, 17. Idiopathic condylar resorption public group facebook. Condylar resorption can be aggressive months or slow years. Second, our cases and controls were not agematched. 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. Condylar resorption following orthognathic surgery is affected by various surgical and nonsurgical factors, and its incidence rate has been reported to vary from 1 to 31%.
This phenomenon represents an aggressive and fastmoving form of degenerative joint disease. This article will focus on issues related to the etiology of these conditions. This article discusses the cause, appropriate diagnostic evaluation, and management of progressive condylar resorption. Evaluation of condylar resorption before and after orthognathic surgery theo j. Condylar resorption causes and treatment bauer smiles. It is also often met in literature under the following terms. It is usually encountered in adolescent and young females, although it has also been observed in males. This is especially true when the resorption starts in the 20s rather than in the early teens fig. 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. In the video above, surgeon pushkar mehra, a boston university goldman school of dental medicine professor, preps holly anderson for surgery to repair a jaw disfiguration caused by a rare medical condition.
Idiopathic condylar resorption icr is a specific condition that affects the jaw joints temporomandibular joints or tmjs and most commonly occurs in teenage girls. The radiological signs of cr are similar to juvenile osteoarthritis and osteoarthrosis. Diagnosis and management of condylar resorption joms. Quantification of condylar resorption in tmj osteoarthritis. Evaluation of condylar resorption before and after. The sutures are used as artificial ligaments to secure and stabilize the disc to the condylar head. Oct 14, 2012 idiopathic condylar resorption in teenage girls most common tmd in adolescent 9f. The disc becomes anteriorly displaced, and the condyle is then surrounded by the hyperplastic synovial tissue that continues to release chemical substrates that penetrate the condylar head causing internal condylar resorption, creating a slow but progressive decrease in size of the condyle and retrusion of the mandible figure 5. Idiopathic condylar resorption in teenage girls most common tmd in adolescent 9f. The average condylar morphology in the tmd patients showed resorption of the anterior surface of the lateral pole and flattening of the articular surface compared to the mean morphology in asymptomatic subjects. Can orthodontic relapse be blamed on the temporomandibular. The current understanding in diagnosis and treatment article pdf available in the journal of indian prosthodontic society 172. Its diagnosis, etiology, and management options are controversial. 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.
This item appears in the following collections academic publications 176271 academic output radboud university. Idiopathic condylar resorption icr is a relatively uncommon condition. Adolescent internal condylar resorption aicr larry m. Adolescent internal condylar resorption acir cases 3 and 4. 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. Idiopathic condylar resorption icr is an acquired disorder of the temporomandibular joint tmj classically affecting young women between 15 and 40 years of. Progressive condylar resorption pcr synonyms pcr of the tmj is also known by the terms idiopathic condylar resorption and condylysis. Superimposition of serial cephalometric tomograms helps document the presence of active condylar resorption. Open access publications 51571 freely accessible full text publications. The condylar resorption is shown by the green arrow and the resorption of the eminence is shown by the blue arrow. Facial imbalance receding chin, smaller airway snoring, apnea and bite disturb. Mar 30, 2020 condylar resorption is a condition that affects the bone of the lower jaw. Condylar resorption in orthognathic patients after mandibular. Progressive condylar resorption is a process that involves the temporomandibular joint tmj and the occlusion.
On the other hand, condylar resorption cr is defined as a progressive change in condylar configuration followed by a decrease in mass. The involved condylar head will appear smaller in size. Progressive condylar resorption pcr, which is alternatively called idiopathic condylar resorption icr, is an uncommon degenerative disease of the temporomandibular joint tmj of an aggressive nature that is seen mostly in female adolescents and young women. The management of progressive condylar resorption remains controversial. Condylar resorption in patients with tmd europe pmc. Quantification of condylar resorption in temporomandibular joint osteoarthritis. A significant portion of the reported icrs followed orthognathic surgery, but icr can also occur without a history of prior surgery. Progressive condylar resorption pcr or idiopathic condylar resorption icr. Idiopathic condylar resorption of the temporomandibular joint. Surgery idiopathic condylar resorption metal mouth. The mitek minianchor technique is applicable to cases of disc displacement of various etiologies, including adolescent internal condylar resorption aicr 15, 16. 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. 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. The indicated orthognathic surgery is then performed at the same operation to correct the associated dentofacial deformity, or it can be delayed and performed at a secondary surgical stage.
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