Limited Mandibular Movements as a Consequence of Unilateral or Asymmetrical Temporomandibular Joint Involvement in Juvenile Idiopathic Arthritis Patients.

Tamara Pawlaczyk-Kamieńska,Marek Niedziela,Maria Borysewicz-Lewicka,Tomasz Kulczyk,Elżbieta Pawlaczyk-Wróblewska

doi:10.3390/jcm9082576

Abstract

This study aimed to assess the asymmetry of the lower face and motor dysfunction of the masticatory system resulting from unilateral or asymmetrical bilateral temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA) patients. The study consisted of clinical examination and cone beam computed tomography (CBCT) of TMJs. Statistical analysis showed correlations between several factors: facial asymmetry and mandibular lateral deviation; the direction of mandibular deviation and the degree of radiological deformities in TMJs; the child’s age at the time of the onset and the range of lateral movement towards the healthy or less destructed joint. In addition, there was a significant difference in ranges of lateral movements; a significantly smaller range was observed for the joint with fewer condylar abnormalities compared to the range in the opposite direction. In JIA children, among the clinical markers of unilateral or asymmetrical TMJ involvement, the asymmetry of the lower face, deviation of the mandible on opening, and an uneven range of mandibular lateral movements deserve attention. The obtained results do not show a relationship between the degree of condylar changes and the asymmetry of the lower face and the presence and degree of mandibular motor dysfunction.

Highlights

Inclusion criteria were (1) the diagnosis of juvenile idiopathic arthritis (JIA) according to the criteria outlined by the International League of Association for Rheumatology (ILAR) [1] and (2) unilateral condylar deformity or bilateral condylar changes with different forms of abnormalities diagnosed via cone beam computed tomography (CBCT)
We have found that the side of asymmetry and deviation on MOO related to the more severely affected side (p = 0.04)
That CBCT examination allowed the precise analysis of condylar morphology, but it did not enable the diagnosis of soft tissue inflammation

Summary

Introduction

Juvenile idiopathic arthritis (JIA) is the most common systemic inflammatory disease of connective tissue during developmental ages [1]. It begins before the age of 16 and persists for at least six months. TMJ arthritis, by damaging the intra-articular growth site of the condylar cartilage, can contribute to the inhibition of mandibular growth and development, leading to dentofacial deformity [7]. This dysmorphic development in JIA patients is a consequence of condylar growth disturbances rather than arthritis-induced condylar damage. Orofacial consequences of TMJ involvement are very diverse—from clinically asymptomatic and visualizable only by magnetic resonance imaging (MRI), to dysfunctions and/or morphological deformations that can adversely affect the quality of life [20]

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