Diagnosis and management of condylar resorption.
OBJECTIVE
This article discusses the cause, appropriate diagnostic evaluation, and management of progressive condylar resorption.


METHODS
This retrospective study evaluated 28 adult patients with bilateral progressive condylar resorption. Investigation included serial clinical examination, lateral cephalograms, tomograms, and a technetium isotope bone scan when indicated. Twenty-two patients were managed by either condylectomy and reconstruction with a costochondral graft (n = 5 patients) or orthognathic surgery (n = 18 patients). One patient initially had orthognathic surgery and subsequently underwent condylectomy and costochondral grafting, making a total of 23 procedures on 22 patients. Six patients received no surgical treatment. All patients were observed at least 2 years postoperatively.


RESULTS
Of the 18 patients who underwent orthognathic surgery, four again demonstrated condylar resorption with recurrence of open bite and retrognathism. Four patients had a stable result, but currently have temporomandibular joint (TMJ) symptoms, whereas 10 patients had a stable result (no change in postoperative occlusion or jaw position) without TMJ symptoms. The five cases receiving condylectomy and costochondral grafting were stable and asymptomatic, with good mandibular function. Analysis of the 18 orthognathic surgery patients showed that relapse occurred in patients having bimaxillary surgery with mandibular advancements greater than 5 mm and with a preoperative posterior ramus height of less than 35 mm.


CONCLUSIONS
The management of progressive condylar resorption remains controversial. Orthognathic surgery in this small sample was associated with a complication rate (relapse or TMJ dysfunction) of approximately 45% (8 of 18). In contrast, condylectomy and costochondral grafting appeared to produce stable and functional results. Further long-term outcome studies for patients with condylar resorption are needed to corroborate these results.
Huang
Y L
YL
Department of Oral and Maxillofacial Surgery, University of California, San Francisco 94143-0440, USA.
Pogrel
M A
MA
Kaban
L B
LB
D000293:Adolescent; D000328:Adult; D001862:Bone Resorption / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D002508:Cephalometry; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000009:adverse effects; D008335:Mandibular Condyle / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008336:Mandibular Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D019340:Osteotomy, Le Fort / Q000009:adverse effects; D011859:Radiography; D011877:Radionuclide Imaging; D012008:Recurrence; D012189:Retrospective Studies; D013705:Temporomandibular Joint Disorders / Q000209:etiology; D016896:Treatment Outcome