Temporomandibular joint osteoarthritis: a case report

Öz

INTRODUCTION: Unilateral reduction in condylar size together with temporomandibular joint (TMJ) symptoms can be due to bone destruction as a result of TMJ osteoarthritis or other arthrides. Condylar hypoplasia due to childhood trauma or radiotherapy together with secondary TMJ problem should also be considered in the differential diagnosis.

CASE REPORT: Fourty six-year-old female patient attended with the complaint of TMJ pain. Extraoral examination revealed deviation, crepitus and mild pain on the right TMJ and subluxation on the left side. Range of motion was within normal limits. Cortical bone loss and deviation in form were detected on panoramic radiographs. Computed tomography examination and rheumatologic consultation was made. The complaints of the patient disappeared after prosthetic restoration. The patient was diagnosed with TMJ osteoarthritis.

CONCLUSION: Osteoarthritis, poliarthrides, and hypoplastic condyle demonstrating degenerative changes should be included in the differential diagnosis when condylar morphologic changes on radiographs accompany clinical TMJ symptoms. Besides clinical and radiographic findings, cross-sectional imaging techniques and rheumatological asessment should be used for definitive diagnosis.

Anahtar Kelimeler

• Mandibular Condyle,Multidetector Computed Tomography,Osteoarthritis,Radiography,Panoramic,Temporomandibular Joint

Temporomandibular eklem osteoartriti: olgu bildirimi

Öz

TANITIM: Eklem şikayetleri ile birlikte radyograflarda mandibular kondillerden birinin küçük olması, temporomandibular eklemde (TME) osteoartrit veya diğer artritler nedeniyle oluşan kemik yıkımına bağlı olabilir. Çocukluk çağında geçirilen travma veya alınan radyoterapiye bağlı kondil hipoplazisi ile birlikte sekonder TME problemi de ayırıcı tanıda düşünülmelidir.

OLGU BİLDİRİMİ: Kırk altı yaşında kadın hasta çene ekleminde ağrı şikayeti ile kliniğimize başvurdu. Ekstraoral muayenede deviasyon, sağ tarafta krepitasyon şeklinde eklem sesi ve hafif ağrı, sol tarafta sublüksasyon tespit edildi. Ağız açmada kısıtlılık yoktu. Panoramik radyografta sağ mandibular kondilin kortikal tabakasında kayıp ve şekil bozukluğu tespit edildi. Bilgisayarlı tomografi incelemesi ve romatoloji konsültasyonu yapıldı. Hasta protetik tedavisini yaptırdıktan sonra şikayetleri ortadan kalktı. Hastaya TME osteoartrit tanısı koyuldu.

SONUÇ: Eklem şikayetleri ile birlikte radyograflarda mandibular kondillerden birinde kemik değişiklikleri görülüyorsa, osteaoartrit, poliartritler ve dejeneratif değişiklikler gösteren hipoplazik kondil, ayırıcı tanıda yer almalıdır. Kesin tanıya varabilmek için klinik ve radyografik bulguların yanı sıra kesitsel görüntülerden yararlanılmalı ve hasta romatolojik yönden de değerlendirilmelidir.

Anahtar Kelimeler

• Çok Tarayıcılı Bilgisayarlı Tomografi,Mandibular Kondil,Osteoartrit,Radyografi,Panoramik,Temporomandibüler Eklem

Kaynakça

1. Oliveira C, Bernardo RT, Capelozza AL. Mandibular condyle morphology on panoramic radiographs of asymptomatic temporomandibular joints. Int J Dent 2009;8:114-8.
2. Petrikowski G. Diagnostic imaging of the temporomandibular joint. White SC, Phaorah MJ, eds. Oral radiology: Principles and interpretation. St. Louis: Mosby; 2009. p.473-505.
3. Ahmad M, Hollender L, Anderson Q, Kartha K, Ohrbach R, Truelove EL, et al. Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:844-60.
4. Winocur E, Reiter S, Krichmer M, Kaffe I. Classifying degenerative joint disease by the RDC/TMD and by panoramic imaging: a retrospective analysis. J Oral Rehabil 2010;37:171-7.
5. Okeson JP. Management of temporomandibular disorders and occlusion. 6th edn. St. Louis: Mosby; 2008.
6. Honey OB, Scarfe WC, Hilgers MJ, Klueber K, Silveira AM, Haskell BS, et al. Accuracy of cone-beam computed tomography imaging of the temporomandibular joint: comparisons with panoramic radiology and linear tomography. Am J Orthod Dentofacial Orthop 2007;132:429-38.
7. Kaneyama K, Segami N, Hatta T. Congenital deformities and developmental abnormalities of the mandibular condyle in the temporomandibular joint. Congenit Anom (Kyoto) 2008;48:118-25.
8. Pirttiniemi P, Peltomäki T, Müller L, Luder HU. Abnormal mandibular growth and the condylar cartilage. Eur J Orthod 2009;31:1-11.

9. Helenius LM, Tervahartiala P, Helenius I, Al-Sukhun J, Kivisaari L, Suuronen R, et al. Clinical, radiographic and MRI findings of the temporomandibular joint in patients with different rheumatic diseases. Int J Oral Maxillofac Surg 2006;35:983-9.
10. Davidson C, Wojtulewski JA, Bacon PA, Winstock D. Temporo-mandibular joint disease in ankylosing spondylitis. Ann Rheum Dis 1975;34:87-91.
11. Goodwill CJ, Steggles BG. Destruction of the temporo-mandibular joints in rheumatoid arthritis. Ann Rheum Dis 1966;25:133-6.
12. Strobl H, Emshoff R, Kreczy A. Calcium pyrophosphate dihydrate crystal deposition disease of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;85:349-51.
13. Ogus H. Degenerative disease of the temporomandibular joint and pain-dysfunction syndrome. J R Soc Med 1978;71:748-54.
14. Bermejo-Fenoll A, Sáez-Yuguero R. Differential diagnosis of temporomandibular joint disorders (TMD). Med Oral Patol Oral Cir Bucal 2005;10:468-9.
15. Badel T, Marotti M, Šimunković SK, Keros J, Kern J, Krolo I. Radiological characteristics of osteoarthritis of temporomandibular joint without disc displacement. Period Biol 2009;111:289-92.
16. Cevidanes LH, Hajati AK, Paniagua B, Lim PF, Walker DG, Palconet G, et al. Quantification of condylar resorption in temporomandibular joint osteoarthritis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;110:110-7.
17. Krisjane Z, Urtane I, Krumina G, Neimane L, Ragovska I. The prevalence of TMJ osteoarthritis in asymptomatic patients with dentofacial deformities: a cone-beam CT study. Int J Oral Maxillofac Surg 2012;41:690-5.
18. Schmitter M, Essig M, Seneadza V, Balke Z, Schröder J, Rammelsberg P. Prevalence of clinical and radiographic signs of osteoarthrosis of the temporomandibular joint in an older persons community. Dentomaxillofac Radiol 2010;39:231-4.
19. Machon V, Hirjak D, Lukas J. Therapy of the osteoarthritis of the temporomandibular joint. J Craniomaxillofac Surg 2011;39:127-30.
20. Dimitroulis G. The role of surgery in the management of disorders of the temporomandibular joint: a critical review of the literature. Part 2. Int J Oral Maxillofac Surg 2005;34:231-7.