Decreased Mouth Opening Research Articles

Arthroscopic treatment of temporomandibular dysfunction: preliminary results from a prospective follow up of over five years

Patients with refractory temporomandibular dysfunction (TMD) despite conservative therapies often require surgical intervention. Although techniques such as arthrocentesis or arthroscopy have been established for years, there remains a dearth of evidence regarding the long-term efficacy of these interventions. This preliminary prospective study aims to elucidate the outcomes of arthroscopic treatment conducted over five years ago in patients with temporomandibular dysfunction. A study involving 31 patients with temporomandibular dysfunction who underwent level II arthroscopic surgery prior to 2019 is presented. The principal objective parameter for joint function was mouth opening, while the primary subjective parameters included pain, which was measured using the visual analogue scale (VAS), and quality of life, assessed using the OHIP-14sp questionnaire. Objective parameters were assessed preoperatively at one year and five years postoperatively, while quality of life was evaluated both preoperatively and five years after the procedure. Subsequently, the long-term status of patients was analysed, including surgical outcomes and the necessity for supplementary techniques such as second arthroscopy or open surgery. The quality-of-life scores significantly improved (p < 0.001) after five years of follow up when compared with preoperative assessments. Pain levels exhibited a statistically significant decrease over the follow-up period (p < 0.001). Significant differences were observed between preoperative and both 12-months’ and five-years’ follow up (both p < 0.001) but not between the 12-month and five-year marks (p = 0.899). Similar trends were noted for maximum mouth opening, with differences between pre-surgery and both 12-months’ and five-years’ follow up (p = 0.049 and p = 0.005, respectively) but not between the 12-month and five-year assessments (p = 0.482). Mouth opening at 12 months (p = 0.003) and five years (p = 0.032), as well as OHIP results at five years (p = 0.003), demonstrated statistically significant differences between groups according to the final status. In all cases, poorer clinical outcomes post-surgery (requiring a second arthroscopy or meniscectomy) correlated with decreased mouth opening and worse OHIP results. Arthroscopy emerges as an effective technique in the long-term treatment of temporomandibular joint dysfunction, as parameters such as pain and maximum mouth opening improve, and this improvement remains stable at the five-year follow up.

Prognostic Factors and Outcomes Associated With Neck Lymphedema in Head and Neck Cancer Survivors.

The purpose of this study is to determine the predictors of neck lymphedema and to explore its association with symptoms and patient-reported outcomes (PROs) in Head and Neck Cancer (HNC) patients who underwent non-operative treatment. This study involved a cross-sectional secondary analysis of data from patients diagnosed with head and neck squamous cell carcinoma who underwent radiation therapy (±chemotherapy). Patients with visits <6 weeks or >2 years following completion of radiation and those with recurrent or metastatic cancer were excluded. Presence of post-treatment lymphedema, demographics, clinical characteristics, health-related behaviors, and symptoms were collected. PROs were obtained using validated questionnaires that assessed depression, anxiety, swallowing dysfunction, and quality of life (QOL). Multivariable regression models were used to examine the relationship between lymphedema with predictors and symptoms. Of the 203 patients included, 88 (43.4%) developed post-treatment lymphedema. In multivariable analysis, pre-treatment Body Mass Index (BMI) (odds ratio [OR] = 1.07, 95% confidence interval [CI] [1.01, 1.14] p = 0.016) and N stage (OR = 1.96, 95% CI [1.06, 3.66], p = 0.032) were found to be independently associated with lymphedema. Regarding PROs, lymphedema was associated with greater swallowing dysfunction (3.48, 95% CI [0.20, 6.75], p = 0.038), decreased mouth opening (-3.70, 95% CI [-7.31, -0.10], p = 0.044), and increased fatigue (1.88, 95% CI [1.05, 3.38], p = 0.034). Higher pre-treatment BMI and greater N stage are identified as independent predictors for lymphedema development in non-operative HNC patients. Additionally, patients experiencing lymphedema reported worsening swallowing dysfunction and increased symptoms related to trismus and fatigue. Recognizing patients at elevated risk for lymphedema allows for early intervention, alleviation of symptom burden, and optimization of health care resources. 4 Laryngoscope, 134:3656-3663, 2024.

Navigating into the Dental Management of a Child with Morphea: A Case Report

Morphea, a morphological variant of Localised Scleroderma (LoS) that typically occurs in children, is an inflammatory disease of connective tissue leading to skin and underlying tissue sclerosis due to increased deposition of collagen. The aetiology of morphea is quite elusive. Morphea, along with other regions also affects oral and perioral tissues; the most common affected implication being facial skin and tongue rigidity. The author reports a case of a 10-year-old female who reported to the Department of Paediatric and Preventive Dentistry for retained maxillary anterior deciduous teeth. The patient also presented with scarring on her face, chest, and arms. Her lips were thin, rigid and partially fixed producing microstomia with decreased mouth opening. Clinical examination, blood tests, Contrast-Enhanced Computed Tomography/High-Resolution Computed Tomography (CECT/ HRCT) of thorax, Antinuclear Antibody (ANA) test, Antineutrophilic Cytoplasmic Antibody (ANCA) Test, Anti-dsDNA Test, systemic sclerosis/myositis profile, and histopathological evaluation confirmed the diagnosis of morphea. The management of morphea is multidisciplinary. Hence, the role of a paediatric dental surgeon in recognising the development of disease progression in a patient and avoiding any oral complications is very important.

Fabrication of obturator using intraoral scanning impression technology: A clinical report

This article presents a digital technique for the fabrication of surgical obturator for patient with decreased mouth opening planned for hemimaxillectomy. Here fabrication of obturator was done without conventional impression. Obturator was placed in position intra-orally post tumor resection to complete obturation. Procedure followed led to an accurate fit of the prosthesis.

Physiotherapeutic Approach in Oral Submucous Fibrosis: A Systematic Review.

One of the most poorly recognized and inadequately managed diseases, oral submucous fibrosis progresses over time. Betel nut eating is the foremost cause of oral submucous fibrosis.One such condition is oral submucous fibrosis, which is characterized by severe trismus, disability, and a higher risk of cancer. The mouth opening gradually decreases, which is related to difficulty eating, altered gustatory sensation, and mouth dryness, leading to decreased oral intake. The main and beginning signs include decreased mouth opening, pain, difficulty eating, dry mouth, and blanching of the buccal mucosa.This is treated first with medication, then with exercises for the mouth that a physiotherapist has recommended. However, the function of a physical therapist is not clearly defined. Physiotherapy may be used with other therapies to treat oral submucous fibrosis. Mouth-opening exercises, ultrasound, and other therapeutic interventions are available. This article tries to describe the kind of physical therapy that can be recommended for treating oral submucous fibrosis. It is crucial to understand pain management, physiotherapy management for grade III and IVoral submucous fibrosis various additional exercises, modalities and their ideal dose, and strategy for the long-term effect of the treatments to conduct further research.

A modified technique of using digital technology to fabricate surgical obturator in patients with limited mouth opening

This article presents a digital technique for the fabrication of an immediate surgical obturator for a patient with decreased mouth opening planned for maxillectomy. The amalgamation of pre-operative Cone Beam Computed Tomography (CBCT) data and 3D printing allowed for the fabrication of the immediate surgical obturator without conventional pre-surgical diagnostic impression. The surgical obturator was placed in position intraorally post tumor resection to complete the obturation. The procedure followed led to an accurate fit of the prosthesis without any need for relining during surgery.

Study of Facial Nerve Function Following Retromandibular Open Reduction of Mandibular Condylar Fracture

At least 1/3rd (26–40%) of all mandibular fractures occur in the condylar region, making it one of the most common fracture sites. They can further lead to morphological &amp; functional damage when undetected or poorly managed. Condylar fractures that are misdiagnosed or improperly treated can cause substantial functional impairment, such as malocclusion, decreased mouth opening due to jaw deviation, and restricted lateral mandibular motions. Objectives: The aim of the study was to examine facial nerve function following retromandibular trans parotid ORIF for mandibular sub-condylar fractures. Methodology: After receiving the necessary ethical approval, 50 patients who presented with unilateral condylar fractures, sub condylar fractures (36), &amp; neck fractures (14) (Ellis classification)5 were chosen. All of the research participants, who underwent open reduction using a retromandibular technique, provided informed consent. Results: All 50 patients were assessed and no patients were excluded. The healing went well, and no one experienced significant scarring or hardware infection. 7 (14%) individuals experienced transient buccal branch weakness, while 2 (4%) experienced transient zygomatic branch dimness Keywords: Condylar fracture, Open reduction, Retromandibular approach, Anatomical reduction

A Retrospective Study on Profile of Patients with Faciomaxilary Fractures in a Tertiary Care Center.

Maxillofacial injuries in general occur quite commonly following trauma and these injuries if not properly managed can negatively influence both the psychosocial and functional activities of the patient. This is as a result of the centrality of the facial region as a key factor in human identity, aesthetics, and general well-being. Fractures involving the facial skeleton may be isolated or complex. High velocity trauma is usually seen in urban and semi-urban areas while low velocity trauma is the common setting in rural areas. The pattern of faciomaxillary fractures vary with geographical area, socioeconomic condition, enforcements of law and order of a country. Trauma to the faciomaxillary region mandates special attention as important sensory systems are contained within the face (e.g. vision, auditory, somatic sensation, gustatory, olfaction and vestibular), also, vital structures in the head and neck region are intimately associated (airway, blood vessels, nerves and gastrointestinal tracts. It should be noted that the treatment outcome of maxillofacial fractures is mainly dependent among other things on the degree of injury, type of fracture, the expertise of the surgeon, and available technology. The aim of this study is to find out the incidence of faciomaxillary injuries resulting from various etiological factor Classification of facial bone fractures; Diagnosis and different treatment modalities. This is a prospective cross sectional study comprising of 75 patients who were having different faciomaxillary fractures and visited to L.G. hospital from December 2020 to April 2022. Patients were evaluated thoroughly by history taking, proper examination and routine investigations. In general examination consciousness, orientation to time, place and person, neck movements, and general mobility of the patients were checked. In local examination- facial oedema, facial asymmetry, skin lacerations, deep cuts, decreased mouth opening, improper teeth occlusion, teeth loss, nasal bleeding, black eye, eyeball movements and redness of eyes were checked. In specialized radiological investigations x- rays, 2D & 3D Computed Tomography (CT) of Facial bones were done in all cases. CT Brain and CT Cervical spine were done in patients if needed. From our study, it seems reasonable to assume that road traffic accident remains the leading cause of faciomaxillary fractures and is closely followed by fall especially among men in their productive years. It is necessary to diagnose faciomaxillary fracture at the earliest to prevent the complications of fractures such as infection and malocclusion, for that thorough clinical examination and radiological investigations are very important. 3D CT face is the gold standard investigation in case of different faciomaxillary fractures. In isolated fractures nasal bone fractures remains the most affected bone of the facial skeleton followed by mandible. Among the different sites of mandibular fractures body of the mandible is the most common site for mandibular fractures.

Incisional Release and Fat Grafting for the Surgical Management of Perioral Fibrosis in Scleroderma: A Technical Report and Institutional Review.

Scleroderma (systemic sclerosis [SSc]) is a rare autoimmune, connective tissue disorder. Perioral fibrosis is a local cutaneous complication, negatively impacting functional capabilities and aesthetic satisfaction. Fat grafting has been postulated to aid in the management of SSc fibrosis thanks to stem cell enrichment. This technique's success has been demonstrated using different graft origin sites and different injection targets. We aim to demonstrate our SSc patients' success using abdominal fat and perioral target. We queried our records for patients with preexisting SSc who underwent incisional release and fat grafting for perioral fibrosis from 2018 to 2021. For perioral release, a semisharp cannula was tunneled under the vermilion border into the vermilion and along the skin. For grafting, cannulas were used to infiltrate the fat with a retrograde filling technique in a radial-fanning manner. Their autoimmune diagnosis, anesthetic risk assessment, systemic disease complications, and degree of presenting symptoms were reviewed along with their postoperative outcomes. From 2018 to 2021, 16 patients diagnosed with SSc were treated with incisional release and fat grafting for the management of perioral fibrosis. Of the SSc patients, 8 presented with limited SSc, and 8 presented with diffuse SSc. The mean patient age was 54.31 years. All SSc patients presented with functional symptoms with the most common concern (n = 9) being "decreased mouth opening." Other common complaints were "difficulty eating" (n = 3) or "difficulty drinking" (n = 2). Some patients (n = 11) also presented with cosmetic concerns with "perioral rhytids" being the most common (n = 6). The mean number of systemic complications, at the time of presentation, was 3.06. The mean anesthetic risk assessment was 2.44. The average amount of fat grafted intraoperatively was 14.89 mL. Two patients with SSc required regrafting. For one patient, this was part of the original treatment plan and for the other due to fat resorption. Patients who followed up reported improved functionality and were pleased aesthetically. Patients with perioral fibrosis due to SSc can benefit from autologous fat grafting. Incisional release in combination with fat grafting can enhance procedure outcomes. This technique provides beneficial functional and aesthetic outcomes. Patients with both diffuse and limited disease are appropriate candidates for this procedure.

Clinical measurement of maximum mouth opening and its relation to different facial types in children of Saudi Arabia

Background/Aim. The decreased mouth opening (MO) is a key factor in diagnosing most oral health-related issues. The aim of the study was to assess the magnitude of the maximum mouth opening (MMO) and its correlation with the facial types of children in the southern part of Saudi Arabia. Methods. A cross-sectional study was conducted in a group of 555 children ranging from 2 to 12 years of age. The MMO was measured as the distance between the incisal edge of maxillary and mandibular central incisors in the midline using the digital Vernier caliper. Three readings of MMO value were obtained, and the average mean of these readings was taken as the final MMO value. Based on the calculated facial index (FI), five facial types were determined in the study subjects: hypereuryprosopic (very broad face, FI range ? 79.9); euryprosopic (broad face, FI range 80? 84.9); mesoprosopic (round face, FI range 85?89.9); leptoprosopic (long face, FI range 90?94.9); hyperleptoprosopic (very l ong f ace, F I range ? 95). Subjects were categorized and compared accordingly. The facial profile, height, weight, and body mass index (BMI) of each subject were recorded as well. The data hence obtained was subjected to statistical analysis using SPSS (version 19.0, SPSS Incorporated, Chicago, IL, USA). Results. The overall mean value ? standard deviation of MMO for all the subjects in the study was 47.3 ? 8.7 mm. The mean value of MMO in hyperleptoprosopic children (FI range ? 95.0) was significantly higher than in other children. The mean difference value of MO in mesoprosopic (FI range 85.0?89.9) children was significantly lower than in leptoprosopic (FI range 90.0? 94.9) and hyperleptoprosopic (FI range ? 95.0) children. The mean difference value of MO of the leptoprosopic (FI range 90.0?94.9) type was significantly lower than that of the hyperleptoprosopic type (FI range ? 95.0). Conclusion. Based on the analyzed results, it was found that the MMO correlates with different facial types and facial profiles among the studied population.

The use of platelet-rich plasma, hyaluronic acid, and botulinum toxin for the treatment of TMJ disorders

The temporomandibular joint (TMJ) is a synovial joint that connects the mandibular to the skull. Its main function is to facilitate the movement of the jaw and when it suffers any type of damage or injury, it leads to a decrease in mobility and pain in the area. This localized pain is called temporomandibular joint disorders (TMJD), and it can be caused by intraarticular or extraarticular disorders. The most common symptoms include acute pain, decreased mouth opening, tightening of the muscle, headache, and loss of joint function. Nowadays, there are treatments for temporomandibular joint dysfunction from surgical procedures up to less invasive methods, such as the use of splints. Platelet rich plasma (PRP), hyaluronic acid (HA) and botulinum toxin (BTX) injections have been categorized as a complement of primary treatment in TMJD, as well as decrease drug excess in patients. Due to their natural origin, PRP and HA can regenerate tissue in cases of cartilage degeneration, inhibit inflammation, slow down the progression of osteoarthritis and increase the production of natural lubricating fluid in the joint. Its intra-articular application reduces pain due to lubrication and nutrition to the avascular areas of the disc and condylar cartilage. Botulinum toxin (BTX) has been used for years in the medical and cosmetic field, but its use in TMJD refers to injections specifically within masseter muscle, with the objective to reduce the muscular tension TMJ overload, therefore, pain decreases, and movement increases. Over the years these less invasive methods have been increasing in the medical area due to the great pain management in the neuro-muscular and articular complex.

To Assess the Effect of Trauma on the Temporomandibular Joint in Postoperative Cases of Zygomaticomaxillary Complex Fractures.

The study aims to assess the incidence and features of temporomandibular joint(TMJ) dysfunction in post-surgical treatment of unilateral zygomaticomaxillary complex(ZMC) fractures.The objectives are:To assess severity of TMJ dysfunction in postoperative cases of ZMC fractures.To create awareness of the same among clinicians. Patients presenting with zygomaticomaxillary complex fractures were evaluated prospectively. Evaluation of TMJ dysfunction was done by different parameters via questionnaire, clinical and radiographic examination preoperatively and a follow-up period of 1week, 3months and 6months. The parameters were, clicking of joint, pain on opening /closing, pain on biting, deviation of mandible, pain in the preauricular region, ringing sound and mouth opening. Statistical analysis was done by the Friedman test and Post Hoc analysis. On presentation, 69.1% patients diagnosed with ZMC fractures presented with symptoms related to TMJ dysfunction. Post-surgery 1week majority findings persisted, with 21 patients complained of pain on opening or closing and 2 patients with a persistent opening click. These symptoms, however, decreased over the 3month and 6month follow up period. 5 patients presented with decreased mouth opening which was attributed to lack of adequate physiotherapy. Patients presented with mild symptoms of TMJ dysfunction until 6months post-surgery, however these symptoms weren't significant as the pain score assessed was found to decrease in the following post-operative periods. And the symptoms present were'nt exclusive to conclude a TMJ dysfunction. Early treatment and a close follow up are key to prevent progression of symptoms.

Methylprednisolone and Hyaluronic Acid versus Each Agent Alone to Control Complication of Impacted Wisdom Removal.

Introduction Extraction of impacted molars is commonest operation in oral cavity and associated with complications disturbing patient's quality of life. Hyaluronic acid is a nontoxic agent recommended for wound management due to its anti-inflammatory effects. Also, methylprednisolone sodium is used to reduce pain and edema. The aim this study was to compare the effect of combined use of corticosteroid and hyaluronic acid versus each agent alone in controlling postextraction complications of impacted mandibular third molars. Materials and Methods This prospective randomized trial included patients suffering from impacted mandibular third molar. Patients were divided into four groups. Group I, control, and group II received methylprednisolone sodium succinate injection preoperatively, group III received hyaluronic acid applied in extraction socket, and group IV received preoperative methylprednisolone sodium succinate injection and topical hyaluronic acid in the socket. All patients were evaluated preoperatively and postoperative day to assess swelling, pain, mouth opening, and total analgesic dose. Results Group IV showed insignificant edema along the study period, and other groups showed significant edema on third postoperative day that improved on seventh postoperative in group II and III and tenth postoperative day in group I. Significant decreased mouth opening occurred on second postoperative day in group I, while in other groups, it occurred in third postoperative day. Significant improvement occurred on seventh postoperative day in all groups except in group I which occurred on tenth postoperative day. There was less pain and analgesic dose reported in group IV than other groups. Conclusion Combined use of methylprednisolone sodium succinate and hyaluronic acid significantly decrease postoperative complications than using each agent alone.

Study of Orofacial Function in Preschool Children Born Prematurely.

Children born prematurely often exhibit orofacial dysfunction. We conducted Nordic Orofacial Test Screening and analyzed chewing and swallowing functions of 243 children aged 3–5 years, consisting of 142 and 101 children born full-term and preterm, respectively, to evaluate the orofacial function of preschool premature children. Categorical variables were analyzed using chi-square test for a comparison. The univariate analysis of variance was used to analyze the effects of birth weight, gestational age, intubation at birth, use of nasal continuous positive airway pressure support after birth, and use of nasogastric tube on the chewing and swallowing functions of children born prematurely. In this survey, term-born children had a higher incidence of bad oral habits, grinding teeth while sleeping, and abnormal gulping compared to preterm-born children. Preterm-born children had a higher incidence of choking, decreased mouth opening (<30 mm), abnormal dental arch form, abnormal palatal vault, and dysarthria compared to term-born children.

Evaluation of Clinical Profile and Various Treatment Modalities in Oral Sub Mucous Fibrosis in North India: Our Experience.

Oral submucous fibrosis is a chronic disease affecting oral cavity and sometimes the pharynx. Etiology seems to be local irritants such as capsaicin, tobacco, areca nut and spicy foods. The main concern in this is the management of trismus and burning sensation of the oral mucosa. The aim of this study was to compare various medical treatment protocol of OSMF. 210 patients were divided randomly in 3 groups. In Group A, patients were given biweekly intralesional Hyaluronidase/Dexamethasone for 6weeks. Group B patients were given tablet Pentoxifylline 400mg TDS.Group C patients were given Eprisone hydrochloride. All three groups were given Lycopene 10,000 mcg for period of 6weeks. All patients were given topical Triamcelone for local application. The examinations for mouth opening were repeated at weekly intervals for a period of 6weeks.The most common complaint was burning sensation in 75.98% cases, difficulty in mouth opening in77.45% and difficulty in swallowing food in 61.76% cases. Group A showed improvement in 41.17% cases presenting with burning sensation followed by decreased mouth opening 39.70%. Group B showed improvement in 45.58% burning sensation, 17.64% with decreased mouth opening. Group C showed improvement in 48.52% patients having pain with spicy food, 32.35% with decreased mouth opening and 17.64% with difficulty in swallowing. We conclude that patients which received intralesional dexamethasone and hyaluronidase along with oral Lycopene showed better clinical and symptomatic improvement, and at present appears to be best non-surgical treatment.

Conservative Management of Submandibular Space Infection in a 5-Year-Old Child: A Case Report

Submandibular space infection is a potentially fatal infection that could arise as a result of odontogenic or non-odontogenic infections. The management should be prompt as the infection can spread rapidly leading to airway obstruction. A 5-year-old child reported with a complaint of swelling on the left side of the face for four days. On examination, patient had a diffuse swelling involving the left submandibular region with decreased mouth opening secondary to carious 75. The patient was administered intravenous (i.v) fluids, antibiotics and analgesics. Incision and drainage of the abscess was done extraorally under i.v sedation using midazolam with local anaesthesia followed by rubber drain placement. Patient responded to the treatment with progressive decrease in the swelling. Pulpectomy of 75 was performed followed by stainless-steel crown placement. This case highlights the importance of prompt appropriate treatment supplemented by salvage treatment to overcome the associated morbidity at this very young age.&#x0D;

Comparative evaluation of efficacy of muscle relaxant, vasodilator and combined intralesional steroid with hyalaronidase use in oral submucous fibrosis

Oral Sub Mucous Fibrosis (OSMF) is a disease , which predominately occurs in Indians and South East Asians. It is characterised by mucosal rigidity of varying intensity due to fibroelastic changes of the juxta-epithelial layer, resulting in a progressive inability to open mouth. The main concern in the condition is the management of trismus and burning sensation of oral mucosa. this study was conducted to compare various medical treatment protocol of OSMF, so as to arrive at definitive and effective protocol for the management of OSMF. 105 patients of OSMF attending the ENT OPD and satisfying the criteria for inclusion were enrolled for the study. The subjects were randomly divided into age sex matched into three study groups( Dexa with hyaluronidase , Oral vasodilator, Muscle relaxant) in which the relief in symptoms was noted. Lycopene was given in all patients. Group A, patients were given intralesional injection Dexamethasone with Hyaluronidase biweekly for five weeks and marked improvement was seen in cases of pain with spicy food 13 cases (76.47%), followed by decreased in mouth opening 9 cases (56.25%). In Group B, oral vasodilator Tablet Pentoxifylline 400 mg TDS was given and showed improvement in difficulty in protruding tongue in 9 cases (60%), pain with spicy food 8 cases (50%), decreased mouth opening 6 cases (37.5%), oral ulceration 3 cases (42.85%). In Group C with muscle relaxant Tablet Myosone 50 mg BD showed improvement pain with spicy food 8 cases (42.10%), decreased mouth opening 8 cases (42.10), difficulty in swallowing 3 cases (37.5%). As there is still paramount of controversy regarding the ethology of OSMF there is no definite treatment protocol. Patients which received intralesional dexamethasone and hyaluronidase along with oral lycopene showed better clinical and symptomatic improvement in comparison to others groups, which at present appears to the best option for OSMF.

Approach to temporomandibular disorders in a patient with internal derangement type III associated with the presence of juvenile idiopathic arthritis: a case report

Introduction: Like any other synovial joint, the temporomandibular joint (TMJ) can be involved in juvenile idiopathic arthritis. TMJ can be affected unilaterally and bilaterally at the beginning or during the course of the disease, and can also often be affected by the first and only affected joint. Objective: To describe the clinical case of the patient diagnosed with temporomandibular disorder due to juvenile idiopathic arthritis, emphasizing the need for professionals to address the temporomandibular joint even in the absence of clinical symptoms. Case Report: Child, male, 10 years old, diagnosed with juvenile idiopathic arthritis, complained of pain in the region of the temporomandibular joint and limited mouth opening. During the clinical examination, he did not report pain on accessory muscles palpation, masticatory and cervical muscles. However, during palpation of the temporomandibular joint, it was found the presence of bilateral pain and decreased mouth opening, the maximum forced opening, with pain, marked 18 mm. The examination by cone beam computed tomography was requested and images out of the normal range were observed in both heads of the mandible, with the left side being more affected, showing flattening and erosion. After examining the exams, a diagnosis suggestive of type 3 internal derangement was reached. Thus, the proposed treatment consisted of using an occlusal splint and physiotherapeutic follow-up to reduce painful symptoms and increase mouth opening. After two weeks, an increase of 4 mm in the mouth opening was noted, with no effort or pain. After 3 months of proservation, an opening of 32 mm was observed with a stable patient regarding the initial complaints. Conclusion: The approach of the temporomandibular joint is extremely important in patients with juvenile idiopathic arthritis, since this association occurs quietly in most cases. Early recognition is essential in favor of favorable conducts and prognoses.

Snapshots Quiz.

A 45 year old woman presented with decreased mouth opening, foul smell from the oral cavity, and chain of nodular swellings over chin, neck, chest region since three months. These had increased in size and number since one month. Also, dimpling over her left cheek and scar mark over her neck and chin region was noted. What is the diagnosis?

Functional and Aesthetic Outcome Following Simultaneous Temporomandibular Joint Ankylosis Release and Correction of Chin Discrepancy by Lower Border Osteotomy-A Case Report

This is a case report of a 19 year old adult female with facial asymmetry secondary to right Temporomandibular Joint (TMJ) ankylosis with a history of previous surgery at the age of 10 years with gap arthroplasty for tmj ankylosis which was unsuccessful and lead to relapse .Because of decreased mouth opening and facial disfigurement patient was not able to have a quality life. She reported to our department where she got operated simultaneously for tmj ankylosis with interpositional arthroplasty using temporalis myofascial flap and novel osteotomy technique for correction of chin asymmetry. After surgery there is a significant improvement in patient both functionally and aesthetically.