Riechmann Merle, Schmidt Christopher, Ahlers M Oliver, Feurer Ima, Kleinheinz Johannes, Kolk Andreas, Pautke Christoph, Schön Andreas, Teschke Marcus, Toferer Astrid, Lux Christopher J, Kirschneck Christian, Krombach Gabriele A, Ottl Peter, Vieth Ulla, Stengel Johanna, Völker Caroline, Neff Andreas
Department of Oral and Craniomaxillofacial Surgery, University Hospital Gießen and Marburg GmbH, University Hospital Marburg, and Faculty of Medicine, Philipps University, 35043 Marburg, Germany.
Department for Radiology and Nuclear Medicine, GPR Hospital Rüsselsheim, 65428 Rüsselsheim am Main, Germany.
J Clin Med. 2023 Jul 27;12(15):4946. doi: 10.3390/jcm12154946.
Idiopathic condylar resorption (ICR), though a rare event, is associated with severe detrimental sequelae for the patient. To date, the etiology remains unknown, and treatment strategies are highly controversial. Therefore, the aim of this study is to present an analysis of the consensus- and evidence-based approach to ICR by a German interdisciplinary guideline project of the AWMF (Association of the Scientific Medical Societies in Germany). Following a systematic literature search, including 56 (out of an initial 97) publications, with a predominantly low level of evidence (LoE), two independent working groups (oral and maxillofacial surgery and interdisciplinary, respectively) voted on a draft comprising 25 recommendations in a standardized anonymized and blinded Delphi procedure. While the results of the votes were relatively homogeneous, the interdisciplinary phase required a significantly higher number of rounds ( < 0.001). Most of the controversial recommendations were related to initial imaging (with consensus on CT/CBCT as the current diagnostic standard for imaging), pharmacotherapy (no recommendation due to lack of evidence), discopexy (no recommendation possible due to low LoE) and timing of orthognathic surgery (with consensus on two-staged procedures after invasive TMJ surgery, except for single-stage procedures if combined with total joint reconstruction). Overall, the Delphi procedure resulted in an interdisciplinary guideline offering the best possible evidence- and consensus-based expertise to date in the diagnosis and treatment of ICR.
特发性髁突吸收（ICR）虽然是一种罕见病症，但会给患者带来严重的不良后果。迄今为止，其病因尚不明确，治疗策略也极具争议性。因此，本研究旨在展示德国医学科学协会联合会（AWMF）的一个跨学科指南项目对ICR基于共识和证据的分析方法。在进行系统的文献检索后，从最初的97篇文献中筛选出56篇，这些文献的证据水平大多较低，两个独立的工作组（分别为口腔颌面外科和跨学科组）以标准化的匿名和盲法德尔菲程序对包含25条建议的草案进行投票。尽管投票结果相对一致，但跨学科阶段所需的轮次显著更多（<0.001）。大多数有争议的建议涉及初始影像学检查（目前对CT/CBCT作为影像学诊断标准已达成共识）、药物治疗（因缺乏证据未给出建议）、关节盘固定术（因证据水平低无法给出建议）以及正颌手术时机（对于侵袭性颞下颌关节手术后采用两阶段手术已达成共识，但如果联合全关节重建则采用单阶段手术除外）。总体而言，德尔菲程序产生了一个跨学科指南，为目前ICR的诊断和治疗提供了基于最佳证据和共识的专业意见。
