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

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.

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

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