Risk factors for post-orthognathic condylar resorption: A review

UCL Eastman Institute, Unit of Orthodontics, Eastman Dental Hospital, London, UK.
World journal of orthodontics 02/2008; 9(1):21-5.
Source: PubMed


To evaluate the current evidence identifying risk factors for post-orthognathic mandibular condylar resorption.
Studies published between January 1980 and August 2006 related to post-orthognathic condylar resorption were identified by searching the following databases: PubMed, Medline, EMBASE, PsycInfo, DARE, CENTRAL, and the Cochrane database of systematic reviews. The following keywords were used to identify relevant publications: condylar resorption, progressive condylar resorption, condylar atrophy, dysfunctional remodeling, and condylysis. A hand search of these papers was also carried out to identify additional articles.
A number of methodological flaws are present within the current literature, including the comparison of nonmatched patient groups and poor imaging techniques, which makes evaluation difficult. Significant risk factors identified for condylar resorption include being female with mandibular retrognathia associated with an increased mandibular plane angle, the presence of pretreatment condylar atrophy, and undergoing posterior condylar displacement and upward and forward rotation of the mandible at the time of surgery.
Better-controlled studies are required to fully understand the link between condylar resorption and orthognathic surgery. A number of risk factors have been identified within this article. It is important for orthodontists to consider these, particularly when consulting patients for treatment and identifying patients who may require closer postsurgical follow-up.

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    • "A decrease in the pharyngeal air way space has also been mentioned. Both joints can be symmetrically affected, or just one with minor occurrence, while bilateral involvement with an asymmetric outline is also common56,144. Several studies23,33,68,72,74,78,81,92,94,96have shown that the first signs of postsurgical development were detected 6 months or more after surgery and developed up to 2 years after surgery and was related to a long-term skeletal relapse. On the other hand, idiopathic CR has not been found only after orthognathic surgery, and may be observed during or after active dental restorative, orthodontic or before orthognathic surgery113. "
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    ABSTRACT: Objective: In order to understand the conflicting information on temporomandibular joint (TMJ) pathophysiologic responses after mandibular advancement surgery, an overview of the literature was proposed with a focus on certain risk factors. Methods: A literature search was carried out in the Cochrane, PubMed, Scopus and Web of Science databases in the period from January 1980 through March 2013. Various combinations of keywords related to TMJ changes [disc displacement, arthralgia, condylar resorption (CR)] and aspects of surgical intervention (fixation technique, amount of advancement) were used. A hand search of these papers was also carried out to identify additional articles. Results: A total of 148 articles were considered for this overview and, although methodological troubles were common, this review identified relevant findings which the practitioner can take into consideration during treatment planning: 1- Surgery was unable to influence TMJ with preexisting displaced disc and crepitus; 2- Clicking and arthralgia were not predictable after surgery, although there was greater likelihood of improvement rather than deterioration; 3- The amount of mandibular advancement and counterclockwise rotation, and the rigidity of the fixation technique seemed to influence TMJ position and health; 4- The risk of CR increased, especially in identified high-risk cases. Conclusions: Young adult females with mandibular retrognathism and increased mandibular plane angle are susceptible to painful TMJ, and are subject to less improvement after surgery and prone to CR. Furthermore, thorough evidenced-based studies are required to understand the response of the TMJ after mandibular advancement surgery.
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    ABSTRACT: Objective Condylar resorption has been described as a possible complication of orthognathic surgery. In this condition, condyles are partially or completely reabsorbed, with a consequent shortening of condylar height and an alteration in maxillofacial morphology and occlusion. The aim of this review was to clarify risk factors for condylar resorption, its diagnosis and the treatments used, and to design a protocol for the prevention of post-orthognathic surgery condylar resorption (POCR).Materials and methodsStudies related to POCR published between 1990 and 2011 were identified and reviewed in the following databases: PubMed, MedLine, EMBASE, TESEO and Cochrane. The key words used were orthognathic surgery, condylar resorption, condylar atrophy, dysfunctional remodeling and condylysis. A manual search was carried out to identify other possible studies.ResultsThe main risk factors associated with POCR were dolichofacial growth pattern, small or posteriorly inclined condyles, disk displacement, being female, hormonal disorders, and compression or postsurgical condylar torque. Proposed treatments consisted of stabilizing condylar position and decreasing condylar loading; improving fibrocartilaginous homeostasis with drug therapy, infiltrations or arthrocentesis; and temporomandibular joint surgery (arthroscopy, condylar revascularization, discal reposition, condylectomy and autogenic or alloplastic reconstruction).ConclusionsPOCR is a complex condition and a highly controversial issue, as reflected in the numerous articles published.
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    World Pumps 04/2012; 34(2). DOI:10.1016/j.maxilo.2011.09.009
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