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asympomatic Does condylar resorption always progress?

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Although my daughter is not in pain, her bite has markedly changed in the last two years and she's been told she needs total jaw replacement. This seems very dire, painful and dangerous surgery to have without current pain. She does have some problems biting, but otherwise is asympomatic. Surgeons like to do surgery, and both doctors she saw were jaw surgeons. How do we find an expert in this area who has no vested interest in the answer? Why would a healthy 33 year old opt for such drastic measures?

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replied January 31st, 2011
TMJ Answer A19151
Hello, and thanks for your medical question on E Health Forum.

From the history and description it seems that your daughter has Idiopathic Condylar Reabsorption.

ICR causes mandibular condylar resorption and, with loss of vertical height of the condyle, creating occlusal (bite relationship) and musculoskeletal instability, resulting in the development of dentofacial deformities, TMJ dysfunction, and pain.

ICR can progress for a while and then go into remission or progress until the entire condylar head has been resorbed.

In cases that go into remission, excessive joint loading (i.e., parafunctional habits, trauma, orthodontics, or orthognathic surgery) can reinitiate the resorption process later in life.

The recommended treatment protocol for definitive management is

(1) removal of hyperplastic synovial tissue that is inducing the resorption.

(2) disk repositioning and ligament repair; and

(3) orthognathic surgery (Condylectomy and reconstruction with costochondral graft). This corrects the functional and aesthetic facial deformity.

Early treatment is recommended in this condition so that all symptoms and morbidity can be avoided and the disease process is eliminated.

Maintain caution against embarking on “any expensive, irreversible treatment” before a thorough diagnosis is completed. Treatment should be determined through consultation with a dental professional highly experienced in temporomandibular joint problems.

You might consider to take a second opinion in case of any doubt.

I hope this helps.

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Tags: TMJ, surgery, jaw pain
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