A case report in the July 2019 issue by Wang et al reported the treatment of a 14-year-old girl with severe bilateral idiopathic condylar resorption (ICR) and resultant mandibular retrusion, increased overjet, and anterior open bite. (Wang J, Veiszenbacher E, Waite PD, Kau CH. Comprehensive treatment approach for bilateral idiopathic condylar resorption and anterior open bite with customized lingual braces and total joint prostheses. Am J Orthod Dentofacial Orthop 2019; 156:125-136). The treatment mentioned in the article included presurgical orthodontics for arch alignment and leveling, orthognathic surgery with condylar prosthesis, and postsurgical orthodontics. However, there are alternative treatments for ICR, including orthognathic surgery, repositioning and stabilization of the disc, and condylar reconstruction with a costochondral graft, , which can be used to treat active ICR and provides long-term occlusal stability. How did the authors decide that the management choice for the 14-year-old patient was temporomandibular joint prostheses replacement instead of distraction osteogenesis or autologous costochondral graft reconstruction?
Distraction osteogenesis is the surgical technique to correct skeletal deformity using bone lengthening by gradual mechanical distraction, which was developed and popularized in the 1950s and has been accepted as an effective method since the 1990s in the field of maxillofacial and plastic surgery. It can be used to increase the height of the mandibular ramus and the length of the mandibular body both in growing patients and adults. Schendel et al had treated cases of ICR with mandibular distraction and the outcome was satisfactory, stable and no reactivation of the disease after 4 years. Mandibular advancement shows more stability in distraction osteogenesis cases. Mandibular distraction is considered beneficial to postoperative stability because of the gradual lengthening of the soft tissues and a generally less invasive procedure. In addition, distraction osteogenesis using curvilinear distractors can mimic the natural growth curve of the mandible. In this case, we prefer mandibular distraction osteogenesis combined with maxillary LeFort I osteotomy in considering the age of the patient and distraction osteogenesis as an autologous reconstruction. We recommend magnetic resonance imaging to evaluate the blood supply of the condylar before planning. Would magnetic resonance imaging be considerable and valuable in the authors’ opinion?
∗ The viewpoints expressed are solely those of the author(s) and do not reflect those of the editor(s), publisher(s), or Association.