Idiopathic condylar resorption
A 22-year-old man underwent MRI and CBCT examinations which show the resorption of his right condyle. He had pain in the right jaw joint about one year and a half ago and the pain intensified about 6 months ago. This young man had an orthodontic treatment when he was 13 years old and a joint noise was noticed at that time.
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Here is my point-by-point analysis.
1— The joint noise observed at about 13 years of age was presumably the sign of a disc displacement with reduction. This is frequent in teenagers and does not foreshadow any consequences. The causes are multifactorial. It is not necessary to go into details in this column.
2— The pain felt a year and a half (1 ½) ago is the important item to remember. It is possible that your son had what is called a disc displacement without reduction (the disc becomes stuck in front of the joint). See on YouTube: TMJ anterior disc displacement without reduction.
It is possible that your son had problems opening his mouth and that it would deviate on the side where he felt pain. It was the beginning of a mechanism of chronic injury which caused inflammation in the joint.
3— Inflammation changes the viscosity of synovial fluid which is designed to lubricate the joint. Researchers have shown the presence of free radicals when inflammation is present. Cytokines are secreted, they activate osteoblasts which, in turn, activate osteoclasts. Osteoclasts secrete proteinases (matrix metalloproteinases (MMPs)). They are endopeptides involved in degradation of the extracellular matrix of collagen and elastin of articular surfaces of the TMJ. This results in resorption.
4— A person’s susceptibility for condylar resorption depends on several factors: gender (male, female), nutritional state (anorexia, bulimia), genetics (inheritance), perioral habits (nail or cuticle biting, teeth clenching, gum chewing) and iatrogenic compression.
5— An article written by Gunson and Arnett and recently approved for publication discusses a pharmacological approach for the control of mandibular condylar resorption: cytokine blockers, control of MMPs, prostaglandin and leukotriene inhibitors, IL-6 receptor inhibitors.
Research is thus very promising.
Wolford recommends the repositioning and ligature of the disc posterior to the condyle. Tissue in excess in the bilaminary zone (posterior to the disc) is cut and removed.
The disc is mobilized and repositioned. Two Ethibond sutures are inserted through the eyelets of the Mitek anchor. The anchor is inserted into the posterior head of the condyle, 8 mm from the head, laterally from the center of the condyle. The sutures are attached to the posterior band of the disc.
6— As far as your son is concerned, I recommend a complete blood count, the dosage of Rh factor and of surface antigens, sedimentation rate, testosterone level. I also recommend a Tc-99 scintigraphy to determine if there is a higher bone turnover on the right side.
Wearing a plate is useful to reduce the parafunctions. Physiotherapy is indicated. Taking anti-inflammatory drugs is indicated (Celebrex, Feldene). Consult with a physician or a rheumatologist regarding this.
New X-rays will have to be taken in 6 months and in 1 year and a CBCT in 1 year.
7- In short, your son has arthrosis on the right TMJ. It is confirmed, for that matter, by the examinations he had. It can take up to 6 years before the resorption stabilizes.
Here are clinical pictures of a similar case described above. The anterior open bite is shown by the black arrows. The posterior autorotation is shown by the blue arrow. The condylar resorption is shown by the green arrow and the resorption of the eminence is shown by the blue arrow.
Wolford, L. M., Dhameja, A., Planning for Combined TMJ Arthroplasty and Orthognathic Surgery, Atlas of the Oral and Maxillofacial Surgery Clinics,2011, v.19 #2, 243-270 Current Concepts in Temporomandibular Joint Surgery
Gunson,M.J., William Arnett, G.W., Milam, S.B. Pathophysiology and Pharmacologic Control of Osseous Mandibular Condylar Resorption, JOMS 2011, In press.
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