Condylar resorption, also called idiopathic condylar resorption, ICR, and condylysis, is a

temporomandibular joint disorder Temporomandibular joint dysfunction (TMD, TMJD) is an umbrella term covering pain and dysfunction of the muscles of mastication (the muscles that move the jaw) and the temporomandibular joints (the joints which connect the mandible to the skul ...

in which one or both of the mandibular condyles are broken down in a

bone resorption Bone resorption is resorption of bone tissue, that is, the process by which osteoclasts break down the tissue in bones and release the minerals, resulting in a transfer of calcium from bone tissue to the blood. The osteoclasts are multi-nuclea ...

process. This disorder is nine times more likely to be present in females than males, and is more common among teenagers.

Symptoms and signs

Symptoms that may be associated with condylar resorption are both aesthetic and functional. These include: * Occlusion *Anterior

open bite Open bite is a type of orthodontic malocclusion which has been estimated to occur in 0.6% of the people in the United States. This type of malocclusion has no vertical overlap or contact between the anterior incisors.Shapiro PA. Stability of open ...

*Receding chin *Loss of ramus height *Antegonial notching *

Hyperplasia Hyperplasia (from ancient Greek ὑπέρ ''huper'' 'over' + πλάσις ''plasis'' 'formation'), or hypergenesis, is an enlargement of an organ or tissue caused by an increase in the amount of Tissue (biology), organic tissue that results from ...

of the

coronoid process of the mandible In human anatomy, the mandible's coronoid process () is a thin, triangular eminence, which is flattened from side to side and varies in shape and size. Its anterior border is convex and is continuous below with the anterior border of the ramus. ...

*Clicking or popping when opening or closing the jaw *Pain when opening or closing the jaw *Limited jaw mobility

Causes

The cause of condylar resorption is unknown, but there are theories. Because condylar resorption is much more likely to occur in young females, hormonal mediation may be involved. Strain on the temporomandibular joint from

orthodontics Orthodontics (also referred to as orthodontia) is a dentistry specialty that addresses the diagnosis, prevention, management, and correction of mal-positioned teeth and jaws, as well as misaligned bite patterns. It may also address the modificati ...

orthognathic surgery Orthognathic surgery (), also known as corrective jaw surgery or simply jaw surgery, is surgery designed to correct conditions of the jaw and lower face related to structure, growth, airway issues including sleep apnea, TMJ disorders, malocclusio ...

may be related to the condition.

Reactive arthritis Reactive arthritis, previously known as Reiter's syndrome, is a form of inflammatory arthritis that develops in response to an infection in another part of the body (cross-reactivity). Coming into contact with bacteria and developing an infect ...

rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects synovial joint, joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and h ...

, and

psoriatic arthritis Psoriatic arthritis (PsA) is a long-term inflammatory arthritis that may occur in some people affected by the autoimmune disease psoriasis. The classic features of psoriatic arthritis include dactylitis (sausage-like swelling of the fingers ...

are other possible causes.Fonseca, Raymond J., ''Oral and Maxillofacial Surgery: Temporomandibular disorders'', Elsevier Health Sciences, 2000, ,

Diagnosis

A diagnosis of condylar resorption can be made following clinical evaluation and imaging, often

cone beam computed tomography Cone beam computed tomography (or CBCT, also referred to as C-arm CT, cone beam volume CT, flat panel CT or Digital Volume Tomography (DVT)) is a medical imaging technique consisting of X-ray computed tomography where the X-rays are divergent, ...

, and less frequently

single-photon emission computed tomography Single-photon emission computed tomography (SPECT, or less commonly, SPET) is a nuclear medicine tomography, tomographic imaging technique using gamma rays. It is very similar to conventional nuclear medicine planar imaging using a gamma camera ...

and

positron emission tomography Positron emission tomography (PET) is a functional imaging technique that uses radioactive substances known as radiotracers to visualize and measure changes in metabolic processes, and in other physiological activities including blood flow, r ...

Treatments

Treatment of condylar resorption is controversial.

Orthodontics Orthodontics (also referred to as orthodontia) is a dentistry specialty that addresses the diagnosis, prevention, management, and correction of mal-positioned teeth and jaws, as well as misaligned bite patterns. It may also address the modificati ...

can address malocclusion without surgery, but this is often unstable or compensatory, and fails to address the aesthetic impacts of condylar degeneration.

Orthognathic surgery Orthognathic surgery (), also known as corrective jaw surgery or simply jaw surgery, is surgery designed to correct conditions of the jaw and lower face related to structure, growth, airway issues including sleep apnea, TMJ disorders, malocclusio ...

in conjunction with orthodontics may be done to reconstruct and stabilize the condyles and disc of the temporomandibular joint. However, this does not address the underlying etiology of the disease. Meta-analysis shows that 46-100% of idiopathic condylar resorption cases treated with orthognathic surgery experience some degree of relapse. Adverse effects of this approach also include pain, nerve damage, and loss of sensation due to the location of the

inferior alveolar nerve The inferior alveolar nerve (IAN) (also the inferior dental nerve) is a sensory branch of the mandibular nerve (CN V3) (which is itself the third branch of the trigeminal nerve (CN V)). The nerve provides sensory innervation to the lower/mandibu ...

. Anti-inflammatory medication can be used to slow the resorption process.

Arthrocentesis Arthrocentesis, or joint aspiration, is the clinical procedure performed to diagnose and, in some cases, treat musculoskeletal conditions. The procedure entails using a syringe to collect synovial fluid from or inject medication into the joint c ...

, and

arthroscopic Arthroscopy (also called arthroscopic or keyhole surgery) is a minimally invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is inserted into the j ...

surgery are also sometimes used to treat disc displacement and other symptoms. The condition can only be fully addressed with total removal of the diseased condyles. The condyles are replaced with a temporomandibular joint total joint replacement (TJR) device, often in conjunction with orthodontics and orthognathic surgery. The device restores lost ramus height, providing a stable occlusion.

References

{{Dentofacial anomalies and jaw disease Musculoskeletal disorders Idiopathic diseases Jaw disorders Pathology of temporomandibular joints, muscles of mastication and associated structures

Symptoms and signs

Causes

Diagnosis

Treatments

See also

References