Condylar Resorption

[Pennylane]

What is the best treatment approach for condylar resorption? I have consulted with Gunson and I am thinking I will go with the Gunson/Arnett approach to treating the issue. They focus on removing compression factors by fixing the bite and a supplement/prescription medication protocol. Alternatively, there is the total joint replacement approach like Dr. Wolford usually recommends where they surgically remove the diseased joint and replace it with an artificial joint. The major drawback seems to be that the joint ends up failing after a certain amount of time. I also found someone on Youtube who seems to have had a successful outcome from replacement of the diseased condyle with a piece of rib. Not sure how common this one is but seems a bit more natural. Lastly, perhaps there is just a conservative splint treatment. Which do you think is best/leads to the most favorable long-term results for those suffering with condylar resorption? I have condylar resorption in one of my joints initiated by a double jaw surgery I had a couple years ago and really need to figure out what treatment to pursue to stop the resorption process.

[GJ]

I wouldn't do that total joint replacement unless absolutely necessary.

How bad are your pain and symptoms (describe them?). What did Dr. Gunson say about your current situation...specifically is the joint compressed as-is, etc, and if so what is causing the compression, and what's the long-term prognosis if you don't do anything?

[Pennylane]

I wouldn't say my symptoms are that bad. They really just started this month. I can kinda feel a slight burning-type sensation. The physical symptoms are pretty mild so far but I just had a cone beam scan done and the head of the condyle is rather flattened out. It looks pretty bad to me.

Dr. Gunson recommeded revision BSSO and Le Forte last time I saw him but that was almost a year ago now. The cost of the surgery scared me away until this last cone beam. Now the resorption is scaring me more than the cost of the surgery. He did not specifically mention the cause of compression. I will have to ask him. I am going to meet with him to see if his treatment plan would be any different.

I hate that I listened to the advice of another surgeon I consulted with to wait 6 months to see if the resorption "burned out" on its own since my condition has gotten worse over that time. I will have to ask Dr. Gunson about the prognosis if I don't do anything but I don't think it would be good. I imagine that would mean somewhere down the road I would be forced to look into TJR which sounds horrible. Since it will probably be awhile since I could book a surgery with Gunson, I suppose I might get the opportunity to see if the medication protocol alone could stop the resorption.

[JimmyTheGent]

Does anyone (Gunson or any surgeon) know what it was about the first surgery that caused the Condylar Resorption?  It was caused by the surgery so something must have been done incorrectly?  I'm also wondering why & how Gunson thinks double jaw surgery can fix it when double jaw surgery caused it??  Fixing one thing (bite or sleep apnea) only to have something else go wrong (TMJ problems, numbness, infection, paralysis) really makes this surgery seem like such a gamble. 

 

[Pennylane]

It might have just been having the surgery in general and the fact that I exhibited some of the non-surgical risk factors associated with initiation of condylar resorption following orthognathic surgery. Due to the erosion of the joint, I developed a crossbite. Dr. Gunson also said I had a yaw of about 4mm. Looking back at Dr. Gunson's letter to my orthodontist, he said the compression from the bite discrepency caused by the resorption was a contributing factor to the erosion. I guess it turned into a cyclical problem. The joint deterioration caused the bite discrepancy and the bite discrepancy contributed to additional resorption. I guess the key is the medication protocol to stabilize the joints for revision surgery and then revision surgery to repair the bite. I agree, more surgery seems kinda risky but at the same time I worry the medications or splint treamtent alone might not be enough to stablize the joint long term or even short term.

[ditterbo]

Just curious, did you have any TMJ issues at all pre-surgery?  This is a big concern for me with the large advancement #'s getting thrown around by docs.

[Pennylane]

I had no symptoms at all but the cone beam scan I had done before surgery (not with my actual surgeon) showed some wear on the one side compared to the other. It might have been from when I first had braces as a teenager. I had them at a teaching hospital and they kept them on for like 5 years. I'm no professional, but I would recommend getting a cone beam scan done prior to your surgery and after to monitor the health of your joints. Not all surgeons seem to do this which seems kinda crazy to me now since it is such a horrible thing to have your joints deteriorate. Also, maybe see if you have any of the associated risk factors. I did and I should have been more considerate of this.

http://www.arnettgunson.com/files/2015/02/2013-SEM-ORTHOD-Risk-Factors-in-the-Initiation-of-Condylar-Resorption.pdf

[Jbird]

Have you been to dr. Wolford for a second opinion?   I'm thinking I will probably use him for my MMA unless he insists on joint replacement, which if that happens I will get more opinions before I do that.

[Pennylane]

I have not seen him. It sounds like he is really quick to recommend TJR and I am not sure I want to go that route unless I have to. For those who are familiar with him, would you recommend I schedule a consult for a second opinion?