Loose Intra-articular Body in the Temporomandibular Joint: Case Report of a Successful Conservative Management

Year 2021, Volume: 48 Issue: 2, 69 - 73, 31.08.2021

Yumi Chokyu Del Rey , Hian Parize Christiano Oliveira-santos Marina De Godoy Almeida

https://doi.org/10.52037/eads.2021.0014

Abstract

Loose intra-articular bodies are a rare finding in the temporomandibular joint. Surgical removal of the loose bodies isoften described as the only treatment option; however, it presents possible postoperative complications. The aim of thispaper is to report the successful conservative management of a temporomandibular disorder associated with a singleloose intra-articular body. A 62-year-old woman presented with pain in the right temporomandibular joint andpre-auricular region, limited mouth opening and open-lock episodes. Panoramic radiography and cone-beam computedtomography exams revealed the presence of a single loose body located anterior to the right condyle. Magnetic resonanceimages showed bilateral anterior disc displacement without reduction. A non-invasive approach consisting of an occlusalsplint and low-level laser therapy associated with home-based physical therapy was performed for management ofclinical signs and symptoms. The patient was followed up for 2 years and presented significant pain reduction andimprovement in the range of mandibular movements. The combination of conservative therapies may be an alternativefor surgical intervention to control pain and improve mandibular function in patients with temporomandibulardysfunction associated with a loose body in the temporomandibular joint.

Keywords

temporomandibular dysfunction, conservative management, low-level laser therapy, loose body

Supporting Institution

School of Dentistry of Ribeirão Preto - University of São Paulo

Project Number

No specific funding was received for this study

Thanks

The authors would like to thank Aline Fernanda Vicentin and Prof. Dr. César Bataglion for the clinical support.

References

• 1. Carls FR, von Hochstetter A, Engelke W, Sailer HF. Loose bodies in the temporomandibular joint. J Cranio-Maxillofacial Surg. 1995;23(4):215–21.
• 2. Guarda-Nardini L, Piccotti F, Ferronato G, Manfredini D. Synovial chondromatosis of the temporomandibular joint: A case description with systematic literature review. Int J Oral Maxillofac Surg. 2010;39(8):745–55.
• 3. Milgram JW. The classification of loose bodies in human joints. Clin Orthop Relat Res. 1977;124:282–91.
• 4. Cömert Kiliç S, Kiliç N, Sümbüllü MA. Temporomandibular joint osteoarthritis: Cone beam computed tomography findings, clinical features, and correlations. Int J Oral Maxillofac Surg. 2015;44(10):1268–74.
• 5. Pastore GP, Goulart DR, Pastore PR, Prati AJ. Removal of a solitary synovial chondromatosis of the temporomandibular joint using arthroscopy. J Craniofac Surg. 2016;27(4):967–9.
• 6. Bag AK. Imaging of the temporomandibular joint: An update. World J Radiol. 2014;6(8):567.
• 7. González-García R, Rodríguez-Campo FJ, Escorial-Hernández V, Muñoz-Guerra MF, Sastre-Pérez J, Naval-Gías L, et al. Complications of Temporomandibular Joint Arthroscopy: A Retrospective Analytic Study of 670 Arthroscopic Procedures. J Oral Maxillofac Surg. 2006;64(11):1587–91.
• 8. Ercoli C, Boncan RB, Tallents RH, Macher DJ. Loose joint bodies of the temporomandibular joint: a case report. Clin Orthod Res. 1998;1(1):62–7.
• 9. Sodhi A, Naik S, Pai A, Anuradha A. Rheumatoid arthritis affecting temporomandibular joint. Contemp Clin Dent. 2015;6(1):124–7.
• 10. Kalladka M, Quek S, Heir G, Eliav E, Mupparapu M, Viswanath A. Temporomandibular joint osteoarthritis: Diagnosis and long-term Conservative management: A topic review. J Indian Prosthodont Soc. 2014;14(1):6–15.
• 11. Campos MIG, Campos PSF, Cangussu MCT, Guimarães RC, Line SRP. Analysis of magnetic resonance imaging characteristics and pain in temporomandibular joints with and without degenerative changes of the condyle. Int J Oral Maxillofac Surg. 2008;37(6):529–34.
• 12. Benslama L, Schouman T, Toure S, Chardain J, Goudot P. Synovial chondromatosis of the temporomandibular joint: Report and analysis of 12 cases. J Stomatol Oral Maxillofac Surg. 2019;(5):10–3.
• 13. Cai X, Yang C, Chen M, Jiang B, Wang B. Arthroscopically guided removal of large solitary synovial chondromatosis from the temporomandibular joint. Int J Oral Maxillofac Surg. 2010;39(12):1230–3.
• 14. Casares G, Thomas A, Carmona J, Acero J, Vila CN. Influence of oral stabilization appliances in intra-articular pressure of the temporomandibular joint. Cranio - J Craniomandib Pract. 2014;32(3):219–23.
• 15. Pimentel G, Bonotto D, Hilgenberg-Sydney PB. Self-care, education, and awareness of the patient with temporomandibular disorder: a systematic review. Brazilian J Pain. 2018;1(3):263–9.
• 16. Gomes CAF de P, El-Hage Y, Amaral AP, Herpich CM, Politti F, Kalil-Bussadori S, et al. Effects of massage therapy and occlusal splint usage on quality of life and pain in individuals with sleep bruxism: A randomized controlled trial. J Japanese Phys Ther Assoc. 2015;18(1):1–6.
• 17. Xu GZ, Jia J, Jin L, Li JH, Wang ZY, Cao DY. Low-Level Laser Therapy for Temporomandibular Disorders: A Systematic Review with Meta-Analysis. Pain Res Manag. 2018;2018:22–7.