Idiopathic Condylar Resorption
At Arizona Jaw Surgery, we evaluate Idiopathic Condylar Resorption (ICR) patients from all across the United States. We believe the process for treating ICR begins with a thorough diagnosis and discussion of options to ensure the patient and their family are as comfortable as possible in dealing with this condition. This often starts with an in-person or telehealth consultation with progression to treatment as needed. Below is a brief outline of ICR, its manifestations, and how it can be treated.
Idiopathic Condylar Resorption (ICR) is a destructive and often debilitating condition affecting the Temporomandibular Joints (TMJs). The name of the condition is descriptive and means that there is destruction/resorption of the mandibular condyles for which the cause is unknown and not attributable to any other specific cause or condition (Idiopathic).
Idiopathic Condylar Resorption typically presents in teenage females and rarely in people over 40. It often leads to pain (not always), esthetic changes such as a long convex facial profile with a retrusive chin (photo below), anterior open bite malocclusion (photo below), and sometimes breathing disorders such as Obstructive Sleep Apnea. Because ICR is a diagnosis of exclusion (no other cause attributed to the condylar destruction) a thorough history and evaluation must be completed to make a confident diagnosis. This often consists of imaging such as CT scans and/or MRIs as well as possible testing for arthritis and other autoimmune conditions.
Once ICR is diagnosed, the treatment options are multiple and often dependent on the severity of the disease, the amount of esthetic changes, and the wishes of the patient. There is also inherent risk with some treatments of ICR as there is always the potential for the condition to appear dormant/stable only to reactivate and worsen at a later time, making some treatments unstable. Each treatment option caries both risks and benefits. A brief outline of the major treatments are as follows:
1. No treatment: No treatment is always an option and no treatment should ever be forced upon a patient nor should a patient ever feel they are talked into a treatment they do not want. The benefits of this option would be decreased risks, costs, and treatment time initially.
The risks of this option would be continued progression of ICR with possible manifestations of malocclusion, poor esthetics, and poor chewing/biting function. With severe malocclusion, there is also increased risk of damage to teeth as the teeth are not contacting/working as they should be. Due to these long-term issues and their associated costs, undergoing no treatment for ICR can ultimately lead to more treatment time, increased costs, and increased risks resulting in the opposite of the initial goal of no treatment.
2. Non-Surgical Therapy: This often involves medications to attempt to control inflammation and progression of the disease as well as possible splint therapy. This option is not well proven or supported in the literature although there are reports of it being successful. The benefits of this option would be possible avoidance of surgery, possible decreased short-term costs, and keeping the normal anatomy of the TMJ (although pathologic and not normal, the TMJ would not be removed or replaced).
The risks of this option would be long-term medication usage and the risks that come along with the medications chosen. These often include possible cessation of birth control (not well supported but often recommended), long-term antibiotic usage, and long-term anti-inflammatory usage (NSAIDs). Other risks would be that this treatment is not effective and despite going through this treatment, the disease continues to progress or returns once the medications are stopped.
3. Orthodontics alone or in conjunction with Orthognathic Surgery: Depending on the severity of any resultant malocclusion that is present, treatment for the malocclusion could be completed with orthodontic treatment alone, or if more severe, orthodontics and orthognathic surgery. The key factor this and any treatment for ICR is WHETHER OR NOT THE CONDITION IS STABLE. If ICR continues to progress/worsen then any movement or changes made by this option will not be stable. For example, if you undergo orthodontic treatment to correct the malocclusion caused by ICR but the ICR continues to worsen, you and the orthodontist will essentially be chasing a moving target that cannot be reached. Or, upon completion of treatment, the malocclusion returns due to ICR remaining active. This is the largest risk of this treatment option for ICR.
Other risks of this option would be time and cost. With the addition of surgery, risks include pain and swelling, partial temporary numbness, need for recovery time, and general risks of any surgery (pain, bleeding, swelling, infection, etc.).
4. TMJ Total Joint Replacement: This treatment option involves removing the diseased condylar/TMJ portion of the mandible and replacing it with a prosthetic joint. This may also require orthodontics and possible maxillary (upper jaw) surgery if needed based on the severity of the condition and malocclusion. The benefits to this option is IT IS A DEFINITIVE TREATMENT. All other treatment options require an assumption that ICR is stable and no longer progressive. However, if that is not the case then any treatment performed risks being unstable and ineffective with a possible need to re-treat. With total joint replacement, the diseased portion of the mandible is removed and thus cannot have continued worsening or progression meaning the treatment is stable and definitive. Other benefits include the ability to correct malocclusions, esthetic concerns, and make large movements that cannot easily be done with other treatment options.
Risks of this procedure include: Cost, time, longer recovery time, possible facial nerve injury, possible visible scarring (minimal and well hidden), and limitations to certain mouth movements (tend to already be present with destructive disease of the condyles and thus not usually a concern for patients).
If you believe you may have Idiopathic Condylar Resorption or any other form of condylar pathology and you wish to schedule a consultation, please contact us so we may be of assistance.