Onkoloji bakımının yeterince fark edilmeyen bir yönü: baş ve boyun kanserli hastalarda temporomandibular eklem değerlendirmesi

Year 2025, Volume: 8 Issue: 6, 1043 - 1048, 25.10.2025

Melisa Öçbe , Mahmut Sabri Medişoğlu , Çetin Batuhan Öçbe

https://doi.org/10.32322/jhsm.1785306

Abstract

Amaç: Baş-boyun kanseri (BBK) tedavisi stomatognatik sistemde komplikasyonlara yol açabilir; buna karşın temporomandibular eklem (TME) değişiklikleri çoğu zaman yeterince fark edilmemektedir. Bu çalışmada, BBK hastalarında MRG ile tanımlanan disk pozisyonu ve BT ile sınıflandırılan kondil morfolojisi, eşleştirilmiş kontrollerle karşılaştırıldı.
Yöntemler: Geriye dönük olgu-kontrol tasarımında, standartlaştırılmış maksillofasiyal BT ve TME MRG’si bulunan 145 BBK hastası ve 147 kontrol değerlendirildi. Anterior disk deplasmanı (ADD) mid-sagital MRG kesitlerinde tanımlandı; kondil morfolojisi (normal, düzleşme, erozyon, osteofit) sagital BT kesitlerinde sınıflandırıldı.
Bulgular: Toplam 292 birey analiz edildi (BBK %49,7). Yaş benzerdi (ortalama fark −3,11 yıl; p=0,097; Mann–Whitney p=0,0737). ADD sıklığı BBK grubunda daha yüksekti: sağ %49,0’a karşı %37,4 (risk farkı +11,6 yüzde puan [yp]; RR 1,31; ki-kare p=0,046), sol %52,4’e karşı %32,7 (risk farkı +19,8 yp; RR 1,61; p=0,00064) ve herhangi bir tarafta ADD %60,7’ye karşı %46,9 (risk farkı +13,8 yp; RR 1,29; p=0,018); Holm–Bonferroni düzeltmesi sonrası anlamlılık korundu. Kondil morfolojisi dağılımları her iki tarafta farklıydı (sağ p=9,6×10⁻⁵; sol p=8,1×10⁻¹⁰) ve BBK’da daha fazla erozyon izlendi (sağ %26,9’a karşı %11,6; sol %27,6’ya karşı %13,6). “Herhangi bir kondiler patoloji” BBK’da daha sıktı (%93,8’e karşı %85,7; risk farkı +8,1 yp; OR 2,52; ki-kare p=0,023; Fisher p=0,033). ADD, grupların içinde lateral bir tercih göstermedi (McNemar p>0,30). Kontrollerde—BBK hastalarının aksine—“herhangi bir kondiler patoloji” için sağ lehine sağ-sol uyumsuzluğu izlendi (McNemar p=2,5×10⁻⁵’e karşı 1,000).
Sonuç: BBK, özellikle ADD ve kondilde eroziv değişiklikler ile karakterize, daha sık TME anormalliği yükü ile ilişkili bulunmuştur; bu durum tedaviye ve hastalığa bağlı eklem dokusu duyarlılığı ile uyumludur. BBK görüntülemelerinde TME değerlendirmesinin eklenmesi ve erken çene mobilizasyonu ile çiğneme kaslarını koruyucu stratejilerin birlikte uygulanması fonksiyonun korunmasına yardımcı olabilir.

Keywords

baş-boyun kanseri , temporomandibular eklem , onkoterapi , manyetik rezonans görüntüleme.

Ethical Statement

Bu çalışma, Kocaeli Sağlık ve Teknoloji Üniversitesi Klinik Olmayan Araştırmalar Etik Kurulu tarafından 10.03.2025 tarihinde onaylanmıştır (Proje No: 2025-128).

Thanks

Bu çalışma, kanser ve beraberindeki birçok komplikasyonla mücadelesi sırasında sergilediği cesaretiyle bize kalıcı bir güç kaynağı olan Mehmet Uğur Bozkurt’un anısına ithaf edilmiştir.

An underrecognized aspect of oncology care: temporomandibular joint evaluation in patients with head and neck cancer

Abstract

Aims: This study aimed to evaluate and compare temporomandibular joint (TMJ) disc position and condylar morphology on magnetic resonance imaging (MRI) and computed tomography (CT) images of patients with head and neck cancer (HNC) and healthy controls, to determine the prevalence and coexistence of soft-tissue and osseous alterations and to explore their potential clinical relevance.
Methods: In this retrospective case-control study, 145 HNC patients and 147 controls that underwent standardized maxillofacial CT and MRI. Anterior disc displacement (ADD) was defined on mid-sagittal MRI; condylar morphology (normal, flattening, erosion, osteophyte) was classified on sagittal CT.
Results: Two hundred ninety-two individuals were analyzed (HNC 49.7%). Age was similar (mean difference -3.11 years; p=0.097; Mann-Whitney p=0.0737). ADD prevalence was higher in HNC: right 49.0% vs 37.4% (RD +11.6 percentage points [pp]; RR 1.31; χ² p=0.046), left 52.4% vs 32.7% (RD +19.8 pp; RR 1.61; χ² p=0.00064), and any ADD 60.7% vs 46.9% (RD +13.8 pp; RR 1.29; χ² p=0.018); significance was retained after Holm–Bonferroni adjustment. Condylar morphology distributions differed on both sides (right χ² p=9.6×10-⁵; left p=8.1×10-¹⁰), driven by more erosion in HNC (right 26.9% vs 11.6%; left 27.6% vs 13.6%). “Any condylar pathology” was more frequent in HNC (93.8% vs 85.7%; RD +8.1 pp; OR 2.52; χ² p=0.023; Fisher p=0.033). ADD showed no lateral preference within groups (McNemar p>0.30). Controls, but not HNC patients, exhibited right-greater-than-left discordance for “any condylar pathology” (McNemar p=2.5×10-⁵ vs 1.000).
Conclusion: HNC is associated with a high burden of TMJ abnormalities; particularly ADD and an erosive change in condyle; consistent with treatment- and disease-related vulnerability of joint tissues. Providing TMJ assessment into HNC imaging, coupled with early jaw-mobilization and masticatory-muscle–sparing strategies, may help preserve function.

Keywords

Temporomandibular joint , head and neck neoplasms , magnetic resonance imaging , tomography , X-Ray computed , condyle , neoplasm-associated inflammation

Ethical Statement

This study was approved by the Non-Clinical Research Ethics Committee of Kocaeli Health and Technology University on 10.03.2025 (Project No: 2025-128).

Supporting Institution

None.

Thanks

This study is dedicated to the memory of Mehmet Uğur Bozkurt, whose courage during his battle with cancer and its many complications remains a lasting source of strength.

References

• Mesia R, Iglesias L, Lambea J, et al. SEOM clinical guidelines for the treatment of head and neck cancer (2020). Clin Transl Oncol. 2021;23(5):913-921. doi:10.1007/s12094-020-02533-1
• Alfouzan AF. Radiation therapy in head and neck cancer. Saudi Med J. 2021;42(3):247-254. doi:10.15537/smj.2021.42.3.20210660
• Alterio D, Marvaso G, Ferrari A, Volpe S, Orecchia R, Jereczek-Fossa BA. Modern radiotherapy for head and neck cancer. Semin Oncol. 2019;46(3):233-245. doi:10.1053/j.seminoncol.2019.07.002
• Guigay J, Le Caer H, Ortholan C, Aupérin A, Michel C, Mertens C. Treatment of inoperable elderly head and neck cancer patients. Curr Opin Oncol. 2019;31(3):152-159. doi:10.1097/CCO.0000000000000526
• Wierzbicka M, Bartochowska A, Strnad V, et al. The role of brachytherapy in the treatment of squamous cell carcinoma of the head and neck. Eur Arch Otorhinolaryngol. 2016;273(2):269-276. doi:10.1007/s00405-014-3332-8
• Yuwanati M, Gondivkar S, Sarode SC, et al. Oral health-related quality of life in oral cancer patients: systematic review and meta-analysis. Future Oncol. 2021;17(8):979-990. doi:10.2217/fon-2020-0881
• Kalita O, Hrabalek L, Halaj M, et al. Very late complications of oncotherapy in glioblastoma patients: a case series. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2022;166(2):236-241. doi:10.5507/bp.2021.012
• Borrelli MR, Shen AH, Lee GK, Momeni A, Longaker MT, Wan DC. Radiation-induced skin fibrosis: pathogenesis, current treatment options, and emerging therapeutics. Ann Plast Surg. 2019;83(4S Suppl 1):S59-S64. doi:10.1097/SAP.0000000000002098
• Gupta A, Peyrin-Biroulet L, Ananthakrishnan AN. Risk of cancer recurrence in patients with immune-mediated diseases with use of immunosuppressive therapies: an updated systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2024;22(3):499-512.e6. doi:10.1016/j.cgh.2023.07.027
• Romero-Reyes M, Bassiur JP. Temporomandibular disorders, bruxism and headaches. Neurol Clin. 2024;42(2):573-584. doi:10.1016/j.ncl.2023.12.010
• Garstka AA, Kozowska L, Kijak K, et al. Accurate diagnosis and treatment of painful temporomandibular disorders: a literature review supplemented by own clinical experience. Pain Res Manag. 2023;2023:1002235. doi:10.1155/2023/1002235
• Singer SR, Mupparapu M. Temporomandibular joint imaging. Dent Clin North Am. 2023;67(2):227-241. doi:10.1016/j.cden.2022.11.001
• Omami G, Miller CS. Imaging evaluation of the temporomandibular joint. Dent Clin North Am. 2024;68(2):357-373. doi:10.1016/j.cden.2023.10.001
• Office of the Surgeon General (US). Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville (MD): Office of the Surgeon General (US); 2004. Chapter 2, The Basics of Bone in Health and Disease. Available from: https://www.ncbi.nlm.nih.gov/books/NBK45504/
• Hashida N, Shamoto H, Maeda K, Wakabayashi H. Impact of geniohyoid and masseter muscle masses on dysphagia after salvage surgery and radiotherapy in head and neck cancer. Sci Rep. 2021;11(1):2278. doi:10.1038/s41598-021-82039-0
• Somay E, Topkan E, Pehlivan UA, et al. The use of pre-chemoradiotherapy total masseter muscle volume as a novel predictor of radiation-induced trismus in locally advanced nasopharyngeal carcinoma patients. Tomography. 2024;10(1):79-89. doi:10.3390/tomography10010007
• Wallace JD, Calvo RY, Lewis PR, et al. Sarcopenia as a predictor of mortality in elderly blunt trauma patients: comparing the masseter to the psoas using computed tomography. J Trauma Acute Care Surg. 2017;82(1):65-72. doi:10.1097/TA.0000000000001297
• Vlăduțu D, Popescu SM, Mercuț R, et al. Associations between bruxism, stress, and manifestations of temporomandibular disorder in young students. Int J Environ Res Public Health. 2022;19(9):5415. doi:10.3390/ijerph19095415
• Pauli N, Fagerberg Mohlin B, Mejersjö C, Finizia C. Temporomandibular disorder as risk factor for radiation-induced trismus in patients with head and neck cancer. Clin Exp Dent Res. 2022;8(1):123-129. doi:10.1002/cre2.511
• Klein RE. Onchologic stress: its causality in myofascial pain disorder or in temporomandibular disorder. Am J Hosp Palliat Care. 1998;15(2):117-121. doi:10.1177/104990919801500211
• Tresoldi M, Dias R, Bracci A, Segù M, Guarda-Nardini L, Manfredini D. Magnetic resonance imaging evaluation of closed-mouth TMJ disc-condyle relationship in a population of patients seeking for temporomandibular disorders advice. Pain Res Manag. 2021;2021:5565747. doi:10.1155/2021/5565747
• Kamel ZSAS, El-Shafey MHR, Hassanien OA, et al. Can dynamic magnetic resonance imaging replace static magnetic resonance sequences in evaluation of temporomandibular joint dysfunction? Egypt J Radiol Nucl Med. 2021;52(1):19. doi:10.1186/s43055-020-00396-8