Temporomandibular Joint ‘Mice:’ Report of Two Cases

Abstract

Background: The temporomandibular joint (TMJ) is subject to frequent loading, related mostly to its functional capabilities, and it commonly exhibits bone remodeling. The physiological adaptability and tolerance might be compromised and signs of degenerative change will appear. The presence of loose calcified bodies in the TMJ space might suggest osteochondritis dissecans or synovial chondromatosis, and patients may have symptoms of pain, joint sounds and limitation in the range of motion of the jaw.Methods: In this paper, two cases with radiological loose and detached bone bodies in the TMJ suggestive of osteochondritis dissecans are discussed, including medical history, clinical findings, radiological appearance and treatment.Results: The first case is a 66-year-old female with systemic conditions who presented with TMJ crepitus. The second case is a 55-year-old female with a previous diagnosis of rheumatoid arthritis who has jaw clicking and facial pain. Panoramic imaging in both cases revealed joint loose bodies, and conservative treatment was implemented.Conclusions: The use of panoramic imaging as a preliminary diagnostic approach is useful to identify the presence of TMJ alterations. The management for these “joint mice” ranges from conservative treatment to surgical options.Practical implications: A conservative approach includes physical therapy and activity modification to improve muscle mobility and increase range of motion of the TMJ. Close monitoring will identify the need to intervene with a surgical procedure.