engleski

ESHNR 2022 Book of Abstracts

Learning objectives: To present radiological characteristics of idiopathic condylar resorption (ICR) on different imaging modalities and to assess contribution of radiological manifestations in setting diagnosis, follow-up and managing treatment. Background: Mandibular condyle is the process on the mandible that articulates with the disk of the temporo- mandibular joint (TMJ). It consists of the condylar process and head of the mandible. Shape and size of condyles differ among individuals as anatomical variations or as morphological changes in many diseases. ICR, also known as condylolysis or condylar atrophy is a rare progressive condition with unknown etiology that causes erosion of condylar head with consequent loss of condylar volume and alteration of condylar shape. It commonly occurs under the age of 20 years with 9:1 female-to-male frequency ratio and is almost always bilateral. First signs indicating ICR are retrognathism, decrease in posterior facial height, progressive malocclusion and symptoms of TMJ dysfunction. Most valuable imaging methods for diagnosis are cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI). Imaging fndings and procedure details: This case presents a 18-year follow-up of a 28-year-old female patient who initially complained about symptoms in the right TMJ that lasted for 2 months. On clinical examination patient reported right TMJ pain intensity 7 out of 10 at rest that escalated when opening mouth and radiated in right cheek and right ear with pain in the bilaminar zone and myofascial pain of the right masseter. Contacts between teeth were disturbed with signs of wear most prominent on anterior mandibular teeth. Radiological examination started with panoramic imaging and cephalogram that showed malocclusion with marked retrognathia. MRI proved anterior disc displacement without reduction of the right TMJ, which correlated with clinically observed clicking. Patient underwent conservative therapy with occlusal splint. Despite therapy, follow-up examinations showed signs of progressive osteoarthritis that clinically manifested as crepitations. On panoramic imaging right condyle was signifcantly smaller than healthy left condyle, right mandibular ramus was shortened and mandible was clockwise rotated with consequently open bite. CBCT and MRI in more detail showed features of osteoarthritis with irregular cortical outline and marrow signal of volume- diminished condylar head. Additional laboratory and genetic studies were made and excluded other rheumatological or hereditary primary disease. Conclusion: Pathogenesis and management of ICR are still poorly understood. Radiological fndings are often suggestive for ICR and should be considered in diagnosis, stagging and treatment planning.

TMJ ; resorption ; CBCT

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