外耳道穿孔をきたしたリウマチ性顎関節炎の１例

Abstract

We report a case of temporomandibular joint rheumatoid arthritis with perforation into the external auditory meatus.The patient was 64-year-old man with progressive rheumatoid arthritis, associated with otopyorrhea and difficulty in mouth opening with pain. He had difficulty with the occlusion and was nearly edentulous jaw for a long time. He was also infected with MRSA in inflammatory granulation tissue in the meatus. He was treated with difficulty by an otorhinolaryngologist, who introduced him to our clinic.We first made and applied dentures. Intermaxillary traction was applied by rigidly fixing the denture with an occlusal pivot to the jaw by means of an osseous screw and circumferential wiring. Antibiotics active against MRSA in the granulation tissue were given. After intermaxillary fixation for 2 weeks and intermaxillary elastic traction for the next 2 weeks, the TMJ space was enlarged and the granulation tissue in the meatus disappeard. Epithelialization successfully occurred. We finally attempted occlusal adjustment by raising the bite of the upper and lower dentures.We fortunately treated the case successfully, but long-term observation is necessary.