MD Candidate, Harvard Medical School; Resident, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital.
Assistant Professor of Oral and Maxillofacial Surgery, Boston Children's Hospital, Harvard School of Dental Medicine, Boston, MA, USA.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2020 Dec;130(6):632-639. doi: 10.1016/j.oooo.2020.07.008. Epub 2020 Jul 21.
The aim of this study was to evaluate the level of evidence in the literature on etiology and management of idiopathic condylar resorption (ICR) of the mandible.
A systematic search of articles published from 1982 to 2019 was conducted via PubMed, according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. English language reports of human studies that addressed the etiology or management of ICR were included. Case reports, opinion or perspective articles, and nonhuman or non-English language articles were excluded. The quality of the included studies was assessed by using the Oxford Center for Evidence-Based Medicine criteria.
The search yielded 230 studies, and 40 met the criteria for inclusion. The etiology of ICR was the focus of 33 studies; the remaining 8 assessed its management. The total number of patients in the included studies was 1399. The level of evidence assessing the etiology of ICR averaged 3.16 (range 2b-to 3b). Proposed etiologies and contributing factors included female gender, 17β-estradiol levels, condylar anatomy, and history of orthognathic surgery. The level of evidence of studies assessing the management of ICR was 3.7 (range 2b-4). Treatment strategies included disk repositioning, autologous condylar reconstruction (costochondral graft), and alloplastic total joint reconstruction. Average follow-up was 46.8 ± 38.2 months.
The proposed etiology and management of ICR, as reported in the literature, vary considerably. Condylectomy with autogenous or alloplastic reconstruction appears to be the most stable management strategy. The levels of evidence regarding the etiology and management of ICR are low.
本研究旨在评估有关下颌骨特发性髁突吸收（ICR）病因学和治疗的文献的证据水平。
根据 PRISMA（系统评价和荟萃分析的首选报告项目）指南，通过 PubMed 对 1982 年至 2019 年发表的文章进行了系统搜索。纳入了探讨 ICR 病因学或治疗的人类研究的英文报告。排除病例报告、观点或观点文章以及非人类或非英文文章。使用牛津循证医学中心标准评估纳入研究的质量。
搜索结果产生了 230 项研究，其中 40 项符合纳入标准。33 项研究的重点是 ICR 的病因，其余 8 项评估了其治疗。纳入研究的患者总数为 1399 例。评估 ICR 病因的证据水平平均为 3.16（范围 2b 至 3b）。提出的病因和促成因素包括女性性别、17β-雌二醇水平、髁突解剖结构和正颌手术史。评估 ICR 治疗的研究的证据水平为 3.7（范围 2b-4）。治疗策略包括髁突再定位、自体髁突重建（肋软骨移植）和全关节重建。平均随访时间为 46.8±38.2 个月。
文献报道的 ICR 的提出病因和治疗方法差异很大。髁突切除术联合自体或同种异体重建似乎是最稳定的治疗策略。有关 ICR 的病因学和治疗的证据水平较低。
