title: Is Alloplastic Temporomandibular Joint Reconstruction a Viable Option in the Surgical Management of Adult Patients With Idiopathic Condylar Resorption?
abstract: OBJECTIVE
  Idiopathic condylar resorption (ICR) presents diagnostic and therapeutic challenges to practitioners because of the rarity of the condition, progressive deformity, and simultaneous involvement of skeletal, occlusal, and articular disorders. The objective of this study was to report clinical outcomes after prosthetic replacement of the temporomandibular joint (TMJ) for the management of ICR.
  
  
  METHODS
  A retrospective analysis of patients with ICR managed by bilateral total TMJ replacement and concomitant mandibular advancement with or without maxillary surgery was performed using data gathered from medical records. The primary treatment outcomes of interest were 1) correction of anterior open bite malocclusion, 2) mandibular advancement, and 3) increase in posterior facial height. Secondary outcomes included subjective assessment of pain, dietary restrictions, and functional disability and objective evaluations of TMJ sounds, occlusal relation, mandibular range of motion, cranial nerve VII injury, and objectionable scarring. Radiographs were used to measure surgical change and relapse.
  
  
  RESULTS
  Twenty-one patients met the inclusion criteria for this retrospective study. The average patient age was 25.6 years (range, 22 to 32 yr) and mean follow-up was 6.2 years (range, 5 to 12 yr). Mean mandibular advancement at the B point was 24.3 mm and mean change in occlusal plane was -10.2°. Sixteen patients (76%) underwent maxillary orthognathic surgery for posterior downgrafting with rigid fixation and grafting. Long-term follow-up showed excellent stability of surgical movements with a decrease in TMJ and myofascial pain, headaches, and dietary restrictions.
  
  
  CONCLUSIONS
  Patients with ICR can be effectively treated using total TMJ prostheses with maxillary orthognathic surgery when indicated for the correction of an associated dentofacial deformity. Use of alloplastic joint prostheses allows for the execution of large mandibular advancements in a predictable and accurate manner with a meaningful decrease in symptoms of TMJ dysfunction.
authors.affiliation: Professor and Chair, Department of Oral and Maxillofacial Surgery, Boston University School of Dental Medicine, Boston; Chief, Department of Oral and Maxillofacial Surgery, Boston Medical Center, Boston, MA. Electronic address: pushkar.mehra@bmc.org.
authors.forename: Pushkar
authors.initials: P
authors.lastname: Mehra
authors.affiliation: Former Resident, Department of Oral and Maxillofacial Surgery, Boston University School of Dental Medicine and Boston Medical Center, Boston, MA; Assistant Professor, Department of Oral and Maxillofacial Surgery, King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Nadershah
authors.affiliation: Associate Professor, Department of Oral and Maxillofacial Surgery, Boston University School of Dental Medicine, Boston, MA.
authors.forename: Radhika
authors.initials: R
authors.lastname: Chigurupati
mesh_terms: D000328:Adult; D019643:Arthroplasty, Replacement / Q000379:methods*; D001862:Bone Resorption / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007595:Joint Prosthesis; D019186:Mandibular Advancement; D008335:Mandibular Condyle / Q000473:pathology / Q000601:surgery*; D056948:Orthognathic Surgical Procedures / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013705:Temporomandibular Joint Disorders / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome