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Idiopathic Condylar ResorptionDo we need condyles?

Idiopathic Condylar Resorption (ICR)• Condylar resorption of the temporomandibular joint (TMJ) with no identifiable cause.

• Can be unilateral or bilateral, and may be associated with anterior open bite.

• Commonly affects young, adolescent females.

• Occurs in the absence of pathology, injury or systemic diseases.

• Often self-limiting, however can re-activate later in life.

• Treatment often involves a combination of orthodontics and orthognathic surgery +/- TMJ

surgery.

Clinical features of ICR

• Class 2 skeletal changes:

• Retrognathic mandible

• Anterior open bite

• Increased overjet

• High mandibular plane angles

• May experience discomfort and/or functional limitations during the active phase of

resorption, or be completely asymptomatic.

Management of ICR is controversial

We report an unusual case where the mandibular condyles did not exhibit any functional

limitations in their resorbed condition and TMJ prosthetic replacement was not required for

rehabilitation of occlusion, aesthetics and function.

Dr Tony Collett1, Dr Laura Chen2, Dr Rosie Pritchett4 and Mr Christopher Poon3

Specialist Dental and Oral Maxillofacial Surgery Unit, Monash Medical Centre Clayton, VIC 3168 1 – Consultant Orthodontist, BDSc MDSc PhD MRACDS(Orth) AOB Cert FICD2 – Dental Resident, BDSc(Hons)3 – Dental Registrar, BDS BSc (Hons)4 – Consultant Maxillofacial Surgeon, MBBS BDSc FRACDS (OMS)

01.12.09

06.11.17

10.07.18

11.07.19

Case Report – Patient SJPatient SJ sought orthodontic treatment between 2007-

2009 for moderate upper and lower arch crowding.

Re-presented in 2016 (Age 21) concerned with:

• “Disappearing chin”

• Rapid change in facial profile over the past 6 months

• Pain free, no limitations in function.

Patient SJ is currently asymptomatic with no functional limitations and an initial favourable

aesthetic outcome following treatment.

Interdisciplinary treatment planning and management

with the Orthodontic and Oral and Maxillofacial Surgery

teams at Monash Health was performed following the

diagnosis of ICR.

Combined treatment of fixed orthodontics and

orthognathic surgery was completed following ICR

stabilization.

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Idiopathic Condylar ResorptionDo we need condyles?

Orthodontic Assessment

2017Age: 22

ICR Stabilized

2019Age: 24

Review following treatment

Patient SJ – 2017 following ICR stabilization:

• Skeletal pattern: Class II

• Severe retrognathic

• Convex mesio-facial pattern

• Negligible further growth expected

• Soft tissue pattern:

• Competent lips, deep labiomental

fold

• Vertical maxillary excess

• Dental pattern:

• Incisors: Class II div 1

• Overjet 12 mm

• Absence of anterior open bite

• Third molars: present

• Temporomandibular function: acceptable and

asymptomatic despite loss of condyles

CT and Nuclear Medicine (NM) Bone Scan - 99m Technetium

Hydroxydiphosphonate tracer (99mTc-MDP)

Along with clinical findings, imaging can aid in the diagnosis of ICR e.g. radiographs,

tomograms, CT, MRI and nuclear medicine (Technetium-99 bone scans).

Technetium-99 bone scans are used to determine whether condylar resorption is active or has

stabilized.

ICR Diagnosis

• NM Bone Scans demonstrated active condylar resorption (Figure 1).

• Loss of condylar height consistent with ICR seen on CT Scan (Figure 2).

• Rheumatology and endocrinology review excluded any inflammatory or systemic conditions.

Figure 1

Date: 13.07.2016

Key:

C = Condyle

R = Ramus

B = Body Figure 2

Date: 07.10.2016

CT Scan showing

resorbed left condyle.

Dr Tony Collett1, Dr Laura Chen2, Dr Rosie Pritchett4 and Mr Christopher Poon3

Specialist Dental and Oral Maxillofacial Surgery Unit, Monash Medical Centre Clayton, VIC 3168 1 – Consultant Orthodontist, BDSc MDSc PhD MRACDS(Orth) AOB Cert FICD2 – Dental Resident, BDSc(Hons)3 – Dental Registrar, BDS BSc (Hons)4 – Consultant Maxillofacial Surgeon, MBBS BDSc FRACDS (OMS)

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Idiopathic Condylar ResorptionDo we need condyles?

November 2019

- Fixed upper and lower appliances

placed for pre-surgical detailing.

January 2019

- Orthognathic surgery - bilateral

sagittal split osteotomy for mandibular

advancement of 10mm + genioplasty

advancement of 8mm.

- Removal of non-functioning third

molars.

- No TMJ surgery, resorbed condyles

accepted.

- Vertical maxillary excess accepted as

per patient request.

- Bilateral Class II elastics placed.

- Post-surgical orthodontic detailing.

June 2019

- Fixed upper and lower appliances

removed.

- Removable retainers (upper

circumferential and lower spring)

provided.

Treatment Timeline

Figure 3

Date: 30.01.2019

Lat Ceph and OPG

Post orthognathic surgery

11.07.19

At the one year review:

• Patient SJ is asymptomatic and pleased with function and aesthetics.

• The combined orthodontic/orthognathic approach addressed the concerns of the patient.

• Condylar prosthetic replacement was not performed, and the mandibular condyles were

accepted in their resorbed anatomical form and relationship.

• SJ will require ongoing monitoring in case of orthodontic or surgical relapse.

Conclusion

This case report illustrates the adaptive capabilities of the mandible and its associated

musculature, to which complex condylar reconstructive procedures are not always required

in the management of ICR.

Dr Tony Collett1, Dr Laura Chen2, Dr Rosie Pritchett4 and Mr Christopher Poon3

Specialist Dental and Oral Maxillofacial Surgery Unit, Monash Medical Centre Clayton, VIC 3168 1 – Consultant Orthodontist, BDSc MDSc PhD MRACDS(Orth) AOB Cert FICD2 – Dental Resident, BDSc(Hons)3 – Dental Registrar, BDS BSc (Hons)4 – Consultant Maxillofacial Surgeon, MBBS BDSc FRACDS (OMS)