DIAGNOSIS AND MANAGEMENT OF CONDYLAR RESORPTION

Purpose: This article discusses the cause, appropriate diagnostic eval uation, and management of progressive condylar resorption, Patients an d Methods: This retrospective study evaluated 28 adult patients with b ilateral progressive condylar resorption. Investigation included seria l clinical examination, lateral cephalograms, tomograms, and a technet ium 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 patien t initially had orthognathic surgery and subsequently underwent condyl ectomy 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 pa tients who underwent orthognathic surgery, four again demonstrated con dylar resorption with recurrence of open bite and retrognathism. Four patients had a stable result, but currently have temporomandibular joi nt (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 stab le and asymptomatic, with good mandibular function, Analysis of the 18 orthognathic surgery patients showed that relapse occurred in patient s having bimaxillary surgery with mandibular advancements greater than 5 mm and with a preoperative posterior ramus height of less than 35 m m. Conclusion: The management of progressive condylar resorption remai ns controversial. Orthognathic surgery in this small sample was associ ated with a complication rate (relapse or TMJ dysfunction) of approxim ately 45% (8 of 18), In contrast, condylectomy and costochondral graft ing appeared to produce stable and functional results, Further long-te rm outcome studies for patients with condylar resorption are needed to corroborate these results.