Arthroscopy of the Temporomandibular Joint in Patients with Juvenile Idiopathic Arthritis

• Published in: Journal of oral and maxillofacial surgery Vol. 74; no. 7; pp. 1330 - 1335
• Main Authors: Kinard, Brian E., DMD, MD, Bouloux, Gary F., MD, DDS, MDSc, Prahalad, Sampath, MD, MSc, Vogler, Larry, MD, Abramowicz, Shelly, DMD, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2016
• Subjects: Adolescent; Arthritis, Juvenile - complications; Arthroscopy; Child; Dentistry; Early Diagnosis; Female; Humans; Magnetic Resonance Imaging; Male; Radiography, Panoramic; Surgery; Temporomandibular Joint Disorders - diagnosis; Temporomandibular Joint Disorders - etiology; Temporomandibular Joint Disorders - surgery; Young Adult; temporomandibular joint; arthroscopy; Juvenile idiopathic arthritis
• ISSN: 0278-2391; 1531-5053
• DOI: 10.1016/j.joms.2016.01.028

Abstract Purpose The early diagnosis of temporomandibular joint (TMJ) involvement in patients with juvenile idiopathic arthritis (JIA) prior to joint destruction and growth disturbances may potentially allow for interceptive treatment. The purpose of this study is to report early TMJ arthroscopic findings in subjects with JIA. Patients and Methods This was a case series of three subjects with JIA treated at Emory University, Division of Oral and Maxillofacial Surgery between July 2011 and December 2012. Subjects were included if they had a confirmed diagnosis of JIA, failed to respond to anti-rheumatological medication and had TMJ pain and/or limited mouth opening. All subjects underwent TMJ arthroscopy with the injection of triamcinolone hexacetonide. Demographics, medical history, magnetic resonance imaging, arthroscopic findings and post-operative course were reported. Results Three females (five joints) with a mean age of 12.5 years underwent arthroscopy. Arthroscopic findings consisted of mild to moderate synovitis and grade II-IV chondromalacia with or without fibrosis. Post-operatively, all patients had improvement in pain and mouth opening. Conclusions There was a positive correlation between duration of JIA disease activity in the TMJ and severity of arthroscopic findings. Arthroscopic lysis and lavage combined with triamcinolone hexacetonide injection resulted in improvement in pain and range of motion.