Is Alloplastic TMJ Reconstruction a viable option in the Surgical Management of Adult Idiopathic Condylar Resorption Patients?

Publication date: Available online 23 April 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Pushkar Mehra, Mohammed Nadershah, Radhika Chigurupati
PurposeIdiopathic condylar resorption (ICR) presents diagnostic and therapeutic challenges to practitioners due to the rarity of the condition, progressive deformity, and simultaneous involvement of skeletal, occlusal and articular disorders. The objective of this study is to report our clinical outcomes following prosthetic replacement of the TMJ for management of ICR.Patients and MethodsA retrospective analysis of ICR patients managed by bilateral TMJ total joint 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 relationship, mandibular range of motion, cranial nerve VII injury, and objectionable scarring. Radiographs were used to measure surgical change and relapse.ResultsTwenty-one patients met the inclusion criteria for this retrospective study. The average patient age was 25.6 years (range: 22 - 32 years) and mean follow-up was 6.2 years (range: 5 - 12 years). The mean mandibular advancement at Point B was 24.3 mm and mean occlusal plane change was - 10.2 degrees. Sixteen patients (76%) underwent maxillary orthognathic surgery for posterior down grafting with rigid fixation and grafting. Long-term follow-up revealed excellent stability of surgical movements with a decrease in TMJ and myofacial pain, headaches, and dietary restrictions.ConclusionsICR patients can be effectively treated using TMJ total joint prostheses with maxillary orthognathic surgery when indicated for correction of the associated dentofacial deformity. Use of alloplastic joint prostheses allows for execution of large mandibular advancements in a predictable and accurate manner with a significant reduction in TMJ dysfunction symptoms.



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