Idiopathic Condylar Resorption of the Temporomandibular Joint in Teenage Girls (Cheerleaders Syndrome)

Abstract

Idiopathic condylar resorption (ICR) is a specific condition that affects the jaw joints (temporomandibular joints or TMJs) and most commonly occurs in teenage girls. It sometimes has been referred to as “cheerleaders syndrome,” because it frequently occurs in teenage girls participating in sports activities which, through minor or major trauma to the jaws, can initiate or exacerbate the condition. ICR is also known as idiopathic condylysis, condylar atrophy, and progressive condylar resorption. This is a well-documented but poorly understood disease process that occurs with a 9:1 female-to-male frequency ratio and rarely develops after the age of 20 years. A number of local and systemic pathologies or diseases can cause mandibular condylar resorption. Local factors include osteoarthritis, reactive arthritis, avascular necrosis, infection, and traumatic injuries. Systemic connective tissue or autoimmune diseases that can cause condylar resorption include rheumatoid arthritis, psoriatic arthritis, scleroderma, systemic lupus erythematosus, Sjogren syndrome, ankylosing spondylitis, and others. ICR is a specific disease entity different from these other disease processes. Therefore, it has a specific diagnostic presentation and treatment protocol. ICR causes mandibular condylar resorption and, with loss of vertical dimension of the condyle, it can create occlusal (bite relationship) and musculoskeletal instability, resulting in the development of dentofacial deformities, TMJ dysfunction, and pain. The occurrence of ICR has been identified by many authors as being associated with orthodontic treatment and orthognathic (i.e., corrective jaw) surgery (1–10). This association may, in fact, be coincidental and not reflect a specific cause-and-effect relationship. Recommended treatment for ICR at one time included splint therapy to minimize joint loading, nonloading orthodontic and orthognathic surgical procedures after the disease had been in remission 6 to 12 months, arthroscopic lysis and lavage, condylar replacement with a costochondral graft if the ICR could not be controlled or recurred, and maxillary surgery only to correct the occlusal deformity (5, 6, 11–14). None of these management strategies for ICR provides predictable, stable outcomes for the TMJ, optimizes function and aesthetic results, or eliminates pain. Wolford and Cardenas recently published a treatment protocol that effectively stops the disease process, provides reliable functional and aesthetic results, and eliminates or significantly reduces pain levels (15). This article presents the diagnostic factors for ICR, the specific treatment protocol, and the expected outcomes.