Temporomandibular Joint Involvement In Patients Research Articles

Temporomandibular joint involvement in patients with Juvenile Idiopathic Arthritis: comparison of ultrasonography and magnetic resonance imaging in assessing the periarticular space width

ObjectivesThis study aimed to compare the performance of Ultrasonography (US) and Magnetic Resonance Imaging (MRI) in assessing the Lateral Periarticular Space (LPAS) of Temporomandibular Joints (TMJs) in patients with Juvenile Idiopathic Arthritis (JIA).MethodsThe LPAS width was evaluated in two different patient groups. In the JIA group, including 29 children (13 ± 2.8 years) with JIA, the LPAS width was measured with both MRI and US. In the healthy group, including 28 healthy children (12.6 ± 2.5 years), the LPAS width was measured only with US. Comparisons of LPAS width based on patient groups and TMJ contrast enhancement in MRI were evaluated by applying the Mann–Whitney U test. Correlation and agreement between MRI and US measurements in JIA group were tested using Spearman rank correlation and Bland–Altman method.ResultsThe LPAS width was significantly greater in the JIA group than in the healthy group. In the JIA group, the LPAS width was significantly greater in TMJs with moderate/severe enhancement than those with mild enhancement. A positive significant correlation between MRI and US measurements of LPAS width was found in the JIA group. In the same group, Bland–Altman method showed a good level of agreement between MRI and US measurements.ConclusionAlthough, US cannot replace MRI in the evaluation of TMJ in patients with JIA, US could be used as a supplementary imaging method to MRI in assessing the TMJ disease.

Temporomandibular joint involvement in patients with juvenile idiopathic arthritis: a retrospective chart review

Objective To study the proportion of patients with temporomandibular joint (TMJ) involvement among patients with juvenile idiopathic arthritis (JIA), as well as associated clinical characteristics and signs/symptoms. Method We performed a retrospective chart review on consecutive patients followed in the Hamburg Centre for Paediatric and Adolescent Rheumatology Eilbek between January 2010 and July 2012. TMJ involvement was diagnosed based on clinical examination; a subgroup of patients was also assessed by magnetic resonance imaging (MRI). Results The study included 2413 patients with JIA (52.1% girls, mean age at JIA onset 9.5 years). The most frequent JIA category was oligoarthritis (46.6%), followed by enthesitis-related arthritis (ERA; 38.1%). TMJ involvement was diagnosed in 843/2413 patients (34.9%) (677 MRI-confirmed, four not MRI-confirmed, no MRI examination in 162). Female gender (p = 0.017), higher number of additional joints with active arthritis (p < 0.001), anti-nuclear antibody (ANA) positivity (p = 0.005), higher age (p = 0.020), and oligoarthritis (persistent and extended; p = 0.043) were significantly associated with TMJ involvement. Human leucocyte antigen-B27-positive patients were less likely to have TMJ involvement (p = 0.023). Pain on palpation and pain while chewing were statistically significantly associated with TMJ involvement (p = 0.008 and p = 0.020, respectively). Conclusions Based on our findings, to identify TMJ involvement special attention should be paid to JIA patients with female gender, ANA positivity, and oligoarthritis, as well as those with a higher number of additional joints with active arthritis; and regular examinations of the TMJ should be performed.

Temporomandibular joint involvement in patients with multiple myeloma—a retrospective study

Multiple myeloma (MM) is a common hematological malignancy that has widespread manifestations in multiple organs, including bones and joints. This retrospective study aimed to evaluate the involvement of the temporomandibular joint (TMJ) in patients with MM. Consecutive subjects with a diagnosis of MM who presented to the oral and maxillofacial surgery clinic for routine evaluation between 2008 and 2014 were identified. Patients who had a computed tomography (CT) scan of the TMJs as part of their MM staging were included in the study. Outcome variables were the presence of TMJ myelomatous changes on CT and the presence of TMJ symptoms. Of the 88 patients included in the study, 28 demonstrated TMJ myelomatous lesions on CT scans and 10 patients complained of TMJ pain or dysfunction. The CT scans of seven of the 10 symptomatic patients demonstrated myelomatous involvement of the TMJ area. Myelomatous involvement of the TMJ is common in MM patients and the majority of lesions are asymptomatic. An MM patient complaining of temporomandibular symptoms is relatively highly likely to having a lesion in the TMJ. Diagnosing the myelomatous lesions in the TMJ is important for accurate hemato-oncologic staging and providing treatment without delay.

Treatment management of children with juvenile idiopathic arthritis with temporomandibular joint involvement: a systematic review

This study aimed to systematically review the available literature on the treatment of patients with juvenile idiopathic arthritis (JIA) with temporomandibular joint (TMJ) involvement. According to the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, studies were included until August 2012. A total of 40 articles were identified. TMJ involvement in patients with JIA varies between 17% and 87%. The mean age at diagnosis of JIA is 7.2 years. TMJ treatment can be divided into 2 main groups, an arthritis group and a dentofacial deformity group. The main treatment modalities are counseling, pharmaceutical interventions, physiotherapy, orthodontic treatment, surgery, or a combination of the aforementioned therapies. TMJ involvement in patients with JIA has a high incidence. There is no consensus on the treatment of TMJ pathology and dentofacial deformities in patients with JIA, and treatment varies from counseling to surgery. Treatment to improve aesthetics and function and to obtain pain reduction can be effective. However, the articles are heterogeneous, andthe level of evidence is low (level IV).

Clinical Profile of Obstetric Patients Admitted to the Medical-Surgical Intensive Care Unit (MSICU) of an Inner-City Hospital in New York

BackgroundPregnancy is associated with physiological and anatomical changes that usually occur uneventfully in majority of women. However, these changes can cause major maternal morbidity with potential catastrophic consequences. The purpose of this study is to evaluate the clinical characteristics of obstetric patients admitted to the MSICU of an inner-city hospital in New York.MethodsA prospective, observational study was conducted among all the obstetric patients admitted to the MSICU between June 1, 2009 and June 30, 2012.ResultsA total of 19 obstetric patients were admitted to the MSICU between June 1, 2009 and June 30, 2012. The most common comorbidity on admission was hypertensive disorder. Hemodynamic unstability and shock was the most common admission diagnosis. The mean length of stay was 3.5 days. One patient died.ConclusionsObstetric hemorrhage and pregnancy-induced hypertensive disorders remains as the most common entities requiring intensive care unit (ICU) admission among obstetric patients. A multidisciplinary team involvement is essential in the management of these patients.

Clinical and Magnetic Resonance Imaging Findings of the Temporomandibular Joint in Patients With Rheumatoid Arthritis

BackgroundThe aim of this study is to evaluate temporomandibular joint (TMJ) involvement in patients with rheumatoid arthritis by magnetic resonance imaging (MRI), jaw clenching force, mouth opening, and Fonseca’s questionnaire, and to establish the relationship between these findings and clinical, radiologic, and laboratory activity parameters that are unique to rheumatoid arthritis.MethodsIncluded in the study were 30 RA patients and 30 healthy volunteers. Jaw clenching force of the entire cases was measured with Istanbul Bite Force Recorder (kg) and the mouth opening was measured with a ruler (cm). Additionally, hand grip forces of patients with rheumatoid arthritis were measured with hand dynamometer (kg). Hand and feet graphs and TMJ MRIs of patients were obtained. MRI findings were classified as normal, mild, medium, and severe. DAS28 and sharp scores of patients were estimated. Sedimentation rate (ESR), C-Reactive protein (CRP) and rheumatoid factor (RF) were checked in the patient group and Fonseca’s questionnaires were filled in.ResultsA significant difference was not observed between age, gender, and level of education of the groups. Jaw clenching force and mouth opening were established as significantly low in RA group compared to the control group (P < 0.001). A significant correlation was found between jaw clenching force, hand grip force, mouth opening, questionnaire, and MRI findings with the disease duration sharp score, DAS28, and hand grip force of the RA group (P < 0.05). However, a significant correlation was not established with ESR, CRP, and RF (P < 0.001).ConclusionsJaw clenching force, mouth opening, and Fonseca’s questionnaire can be used as parameters pointing to TMJ involvement in patients with RA. Yet, further studies in which TMJ involvement is followed up since the onset of the disease are of necessity.

Magnetic Resonance Imaging Findings in Rheumatoid Arthritis Patients with Temporomandibular Joint Disorder

Objective: To evaluate the ability of magnetic resonance imaging to identify temporomandibular joint involvement in patients with rheumatoid disease.Patients and Methods: Eight patients with temporomandibular joint symptoms of pain and impaired function, who satisfied the 1987 criteria of the American College of Rheumatology for rheumatoid arthritis were enrolled. Clinical findings in the masticatory system were recorded. Open and closed mouth sagittal protondensity and T2-weighted sequences were performed for all patients, and the images were examined for Condylar configuration, presence of erosion, disc position, and disc abnormality.Results: Four of the 8 patients had mild rheumatoid arthritis activity, 2 had moderate activity and rheumatoid arthritis was inactive in the other 2 patients. Six of the 8 patients had Steinbrocker's class II disease and the others had class III disease. Seven of the 8 patients had temporomandibular joint tenderness or jaw opening pain. Coarse crepitus on opening (5 temporomandibular joints) was the commonest joint sound abnormality. Anterior disc displacement without reduction was present in 6 patients and pannus in 2 patients. Condylar deformity was present in all patients. Four patients showed joint effusion.Conclusion: The results of this study clearly demonstrated the ability of magnetic resonance imaging to detect and define abnormalities in the temporomandibular joint of patients with rheumatoid arthritis.

Radiologic changes in temporomandibular, hand, and foot joints of patients with rheumatoid arthritis

Radiologic changes in the temporomandibular joint (TMJ) and in the joints of the hand and foot were recorded for 90 adult patients with rheumatoid arthritis. The severity of the changes was graded according to the Larsen classification of six grades (0 to V), and mainly erosive changes were recorded. The assessment of the radiographs was performed with the aid of reference films. The radiologic changes in the TMJs corresponded to grade II (definite early abnormality) and paralleled those of most of the metacarpophalangeal and metatarsophalangeal joints. The most severe changes were localized to the wrists, with a median grade of III (moderate destructive abnormality). The severity of the changes was similar on the right and left sides of the TMJ. We conclude that TMJ involvement in patients with rheumatoid arthritis is severe and warrants a thorough initial clinical examination. Such a strategy will facilitate the diagnosis and treatment of TMJ changes in the early stages of the disease.

Comparison of three radiographic methods in screening of temporomandibular joint involvement in patients with psoriatic arthritis

Fifty-three randomly selected subjects with psoriatic arthritis (PA) were examined radiographically by means of orthopantomography, transcranial radiography, and transmaxillary radiography. Two examiners graded the radiographic signs of flattening, osteophytes, erosion, and sclerosis. The findings obtained were then compared, to determine the best technique for screening of temporomandibular joint (TMJ) bone changes. Together the techniques showed definite (24%) and possible (6%) changes suggesting TMJ involvement in 31 (30%) of 106 joints. In all projections radiographic signs suggesting TMJ involvement were most frequent in the condyle. Erosion in the condyle was the most frequent finding. Agreement with regard to definite changes in the condyle was found in only one-third to half of the cases. It is concluded that in radiography of the TMJ in subjects with PA a combination of radiographic techniques should be used to obtain maximum information. However, orthopantomography is well suited for screening of TMJ involvement in subjects with PA.