Temporomandibular Joint Involvement Research Articles

Standardizing Terminology and Assessment for Orofacial Conditions in Juvenile Idiopathic Arthritis: International, Multidisciplinary Consensus-based Recommendations.

To propose multidisciplinary, consensus-based, standardization of operational terminology and method of assessment for temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA). Using a sequential expert group-defined terminology and methods-of-assessment approach by (1) establishment of task force, (2) item generation, (3) working group consensus, (4) external expert content validity testing, and (5) multidisciplinary group of experts final Delphi survey consensus. Seven standardized operational terms were defined: TMJ arthritis, TMJ involvement, TMJ arthritis management, dentofacial deformity, TMJ deformity, TMJ symptoms, and TMJ dysfunction. CONCLUSION: Definition of 7 operational standardized terms provides an optimal platform for communication across healthcare providers involved in JIA-TMJ arthritis management.

Temporomandibular joint involvement in children with juvenile idiopathic arthritis: a preliminary report

Children with juvenile idiopathic arthritis (JIA) are at risk for temporomandibular joint (TMJ) arthritis. This can lead to pain, limited mouth opening, facial asymmetry, and malocclusion. Our objective was to characterize patients with JIA and TMJ involvement in a single center. This was a retrospective study of children with JIA evaluated at Children's Healthcare of Atlanta. Inclusion criteria were confirmed JIA and jaw complaints. Medical records were reviewed to document demographics, JIA information, age at first TMJ complaint, and involvement of other joints. Descriptive statistics were computed. Majority of patients were white (mean age 13 years; range 5-18 years) with polyarticular rheumatoid factor (RF) negative or oligoarticular persistent JIA. Some were antinuclear antibody (ANA) positive, RF positive, or human leukocyte antigen (HLA)-B27 positive. Patients had involvement of other joints (e.g., fingers, knees, wrists). Of those with TMJ symptoms, 6 (10%) had TMJ arthritis. In our cohort, 60 (10%) of patients were diagnosed with TMJ arthritis. In this population, patients who are female, white, RF negative, HLA-B27 negative, ANA negative, and polyarticular RF-negative subtype and have involvement of other joints have a higher likelihood of having TMJ symptoms. If a patient meets these criteria, careful evaluation of TMJs should take place.

Maximum mouth opening in healthy children and adolescents in Istanbul

Objectives: Mouth opening capacity is often regarded as one of the important parameters for evaluating the function of the temporomandibular joint (TMJ) and masticatory muscle status. A reduced mouth opening capacity may be one of the first clinical signs of TMJ involvement. The purpose of this study was to create age related percentiles for the maximal interincisal distance (MID) of healthy children. Methods: The patients admitted for routine dental examinations to Istanbul University Faculty of Dentistry, Department of Pedodontics were included in this study. The interincisal measurements were performed with metallic calliper and also malocclusions were recorded for all children. Oneway Anova test, Tukey HDS test, Tamhane’s T2 test and Student t test were used for statistical analysis. Results: The study population comprised of 1059 (569 males, 490 females), 3-to 15-year-old (mean age 8.82±3.06) children. The mean score of maximal inter-incisal distance was found 33.24±5.54 for females; 33.32±5.71 for males. There was no statistically significant difference according to gender (p=0.815; p>0.05). The mean score of maximal inter-incisal distance was found 28.63±4.34 for 3-5 years; 33.52±4.84 for 6-11 years; 37.35±5.52 for 12-15 years children. Statistically significant differences were found between age groups (p: 0.001; p<0.01). The mean score of maximal inter-incisal distance was found 32.9±5.6 for class I; 34.92±5.51 for class II; 35.2±5.36 for class III malocclusions. Statistically significant differences were found between malocclusion groups (p:0.001; p<0.01). Conclusion: The result of this study indicated that positive relationship between the maximum mouth opening and age and malocclusion.

Morphological evaluation of temporo-mandibular joint in indian population

The temporomandibular joint (TMJ) is one of the most complex joints in the body and its harmonious functioning is very important to maintain a normal masticatory system. The morphologic alterations and the asymmetrical position of the TMJ structures may lead the various clinicalsigns & symptoms. Morphology of the temporomandibular joint may be influenced by gender of patients, environmental factor and also food habits at various places. Objective: To evaluate the morphology of the temporomandibular joint using computed tomography, in order to determine the condyle shape, joint space and glenoid fossa roof thickness. Material and Methods: One hundred and six healthy patients (212 TMJs) who visited a private hospital (or the University’s Hospital) for CT brain scan were included to this cross-sectional study sample.The patients were aged between 20–50 years with an average age of 35.46 years. All the images were taken by positioning patients in supine position with 120kvp , 50ma,2.33minute exposure with 0.7mm thick slicesby computed topography machine in all three projection that is Axial, Coronal and Saggital view. Results: For all variables, the mean and standard deviation were calculated, based on gender, and TMJ sides. The Paired t-test was used and P<0.05 will be considered to be significant. Conclusion: Present study showed that thereis positive evidence of temporomandibular joint involvement in elderly patients. Change in morphology and position of condylar head with glenoid fossa and roof thickness are one of the most common cause of degenerative diseases.KeywordsTemporomandibular joint; Morphology; Condyle; Joint space.KeywordsTemporomandibular joint; Morphology; Condyle; Joint space

Rheumatoid Arthritis of the Temporomandibular Joint, A Clinical and Radiographical Study

To determine the extent of temporomandibular joint (TMJ) involvement in patients with rheumatoid arthritis compared with a matched control group. And to evaluate the correlation between clinical findings and radiographical findings.The studied sample comprised 50 patients with rheumatoid arthritis, age ranged from 18 to 72 years with the mean age of 40.98 (± 13.67.The control group consisted of 63 subjects age–matched non rheumatic patients: Each patient was informed about the purpose of the investigation and that it would include questionnaire, clinical and radiographical examinations. The radiographic examination was done by using double TMJ lateral panoramic technique.It was found that 64% of RA patients complained of two or more clinical signs and symptoms compared with 44% of the control group ,the difference was statistically significant (P< 0.05), the most important clinical findings were pain on palpation and on opening and closing, crepitation, limitation of jaw opening and morning stiffness, difference were statistically significant (P< 0.05). Among the clinically involved subjects in study RA group 28 subjects (56%) had bilateral involvement, 3 subjects (6%) had right side involved and 1 subject (2%) had only left side involvement. The radiographic involvement of TMJ was found in 16 subjects (32.0 %) of the study group compared with 1subject (1.6 %) of the control group. There is a highly statistically significant difference between the study group and the control group (P< 0.05); the most common radiographical finding was erosion. Complete condylar destruction was found in 1 patient which resulted in anterior open bite. Among involved cases 11 subjects (22%) had bilateral involvement, 5 subjects (10%) had unilateral involvement (3subjects (6%) had left side involved and, 2 (4 %) subjects had only right side involved. There was no correlation between clinical and radiographic find ings. There was correlation between the extent of radiographical findings and duration of Rheumatoid Arthritis p value (P< 0.05).The clinical and radiographic findings were more common in RA group than in control individual. The clinical and radiographic findings are not always bilateral in TMJs of patients with rheumatoid arthritis.Key words: TMJ disorders, TMJ

Dentoalveolar characteristics in children with juvenile idiopathic arthritis.

Juvenile idiopathic arthritis (JIA) is an autoimmune disease with multiple potential causal factors. In case of temporomandibular joint (TMJ) affection, the inflammatory reaction can result in restricted mandibular growth with implied skeletal and facial deformities. Aim of the present study was to examine dentoalveolar and occlusion characteristics in children with JIA. The sample consisted of 66children (27boys, 39girls) with JIA. Thirty-three of them showed unilateral or bilateral condylar destruction, while the other half did not manifest any TMJ involvement. Corresponding dental casts of these patients were evaluated and Angle classification, overjet, overbite, crossbite, crowding, and ectopic teeth were registered. All dental casts were subsequently scanned and digitized to analyze 26 additional variables. Subgroups according to sex and condylar affection were formed. Statistical analysis was performed using Fisher's least significant difference (LSD) post hoc test of analysis of variance (ANOVA). The prevalence of ClassII, division1 malocclusion in this JIA sample was high (28.8%). Compared to girls, boys had significantly greater dental arch widths and lengths. The group with bilateral condylar affection had significantly decreased lower arch length and increased irregularity index (p < 0.035) compared to the non-affected group. Bilateral condylar involvement in children with JIA seems to reduce the lower arch length, while increasing the irregularity index of the lower front teeth.

Influence of removable prostheses on mastication in elderly subjects with rheumatoid arthritis.

Rheumatoid arthritis (RA) is a prevalent disease in the elderly population, and it may affect the temporomandibular joint (TMJ) and the stomatognathic system. This study evaluated masticatory function in elderly patients with RA before and after oral rehabilitation with removable prostheses. Forty-five elders with partial or total edentulism who were using unsatisfactory removable prostheses were selected and assigned to 3 groups: RA with TMJ involvement, RA without TMJ involvement and healthy controls. Masticatory function was assessed in terms of masticatory performance (MP) and maximum bite force (MBF). The former was determined by the sieving method, and the latter was measured by pressure sensors placed in the bilateral molar regions. The variables were first evaluated in elderly subjects wearing unsatisfactory prostheses and re-assessed after participants had received new removable prostheses. Comparisons between groups and among time points were performed with analysis of variance for repeated measures and the Tukey-Kramer test (P<.05). Comparison among groups showed decreased MP in elders with RA before new prosthesis insertion (P<.05). Irrespective of TMJ involvement, MP improved after treatment in subjects with RA. Rheumatoid arthritis groups also showed decreased MBF (P<.05), which improved after new prosthesis insertion. Rheumatoid arthritis might impair masticatory function, and well-fitted removable prosthesis insertion might be very beneficial in elders with RA.

Temporomandibular Joint Involvement in Juvenile Idiopathic Arthritis: Challenges in Diagnosis, Treatment, and Outcomes

Juvenile idiopathic arthritis (JIA) is the most common arthritis in the pediatric population. Manifestation of arthritis in the temporomandibular joint (TMJ) presents unique challenges in diagnosis and treatment. This review critically analyzes recent literature, emphasizes new findings, and offers guidance on controversial clinical practices. Imaging: Magnetic resonance imaging with gadolinium contrast (Gd-MRI) is the current gold standard for diagnosis. A new TMJ-MRI scoring system has been developed by the Omeract JIA interest group. Clinical examination: Consensus-based clinical orofacial examination recommendations for monitoring patients have been developed and are currently validated. Treatment: Treatment of TMJ arthritis includes local and systemic drug therapy, treatment with orthodontic devices, and potentially maxilla-facial surgery. A novel Gd-MRI scoring system and clinical examination recommendations for evaluating TMJ arthritis in JIA patients are available, enabling physicians to compare patients and treatment responses. Intra-articular injections should only be used in certain patients with caution. A combination of systemic medications combined with orthodontic appliances is necessary to treat these patients, warranting a multidisciplinary approach.

Immuno-biological Assessments of Temporomandibular Joint Disease in Patients with Immune-mediated Rheumatic Conditions. A cross sectional study of 273 cases

Temporomandibular joint (TMJ) is commonly involved in various immune-mediated rheumatic disorders accounting for significant disability and impaired quality of life. The aim of our study was to assess inflammatory and immune parameters in patients with TMJ arthritis related to rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) and to identify potential relation with severity and dysfunction of TMJ pathology. We performed a cross-sectional study in a cohort of 433 consecutive RA, 32 JIA, 258 AS, and 103 PsA. Only patients presenting with clinically significant TMJ involvement (273) related to their rheumatic condition were included in the final analysis. TMJ involvement is traditionally described in chronic inflammatory rheumatic disorders, particularly in patients with higher levels of inflammation as detected in rheumatoid arthritis and psoriatic arthritis. Disease activity and severity, as well as biological and positive serological assessments (rheumatoid factor, anti-cyclic citrullinated peptide, IL-1) remain significant determinants of the severity of TMJ arthritis.

Oral health and temporomandibular joint involvement of patient with juvenile idiopathic arthritis

Oral health and temporomandibular joint involvement of patient with juvenile idiopathic arthritis

A rare case of ankylosing spondylitis with severe temporomandibular joint and dental involvement

Ankylosing spondylitis (AS) is a chronic inflammatory disease that primarily affects the axial skeleton, resulting in functional deterioration. Temporomandibular joint (TMJ) ankylosis is characterized by bony or fibrous adhesion of the anatomic joint components, which results in limited mouth opening. Despite the high prevalence of the disease, ankylosis of the TMJ and tooth secondary to AS are rare conditions. Here, a patient with AS admitted to the outpatient clinic with a chief complaint of TMJ pain and restricted mouth opening was diagnosed with TMJ and dental sclerosis. The patient’s dental history included fracture of a wisdom tooth during an attempted extraction and difficulty in mouth opening. TMJ and dental ankylosis should be considered in patients with AS with a poor dental history and difficulty in mouth opening. For such suspected cases, a panoramic radiograph of the jaws and teeth should be obtained to detect abnormalities.

Temporomandibular joint involvement in ankylosing spondylitis

Joint Bone Spine - In Press.Proof corrected by the author Available online since mercredi 22 novembre 2017

Juvenile Idiopathic Arthritis Practice Patterns Among Oral and Maxillofacial Surgeons

The purpose of this investigation is to assess the current clinical practices by oral and maxillofacial surgeons (OMSs) in the United States regarding diagnosis and treatment of temporomandibular joint (TMJ) involvement in children with juvenile idiopathic arthritis (JIA). We implemented a cross-sectional survey of academic OMSs in the United States via an electronic survey. The survey included respondent demographic data, patient volumes, diagnostic methods, and management practices for children with JIA and TMJ involvement. The results of the survey were analyzed using descriptive statistics. The study respondents were composed of 52 surgeons. Most respondents were men (n=43, 87.8%), were aged 51 to 60years (n=20, 39.2%), were in full-time academics (n=42, 84%), had more than 20years of experience (n=26, 50%), and were seeing 1 to 5 patients with JIA per month (n=21, 46.7%). Most patients were aged 11 to 15years (n=22, 61.1%) and were managed with 1 to 2 systemic medications (n=30, 81.1%). All OMSs reported evaluating TMJ involvement by reviewing patient history, clinical examination, and imaging. The most commonly used imaging modality was panoramic radiographs (n=24, 63.2%) and magnetic resonance imaging (n=22, 57.9%). OMSs decided to inject intra-articular medication based on history and symptoms (n=36, 94.7%). Once in remission, patients were followed up at yearly (n=12, 36.4%) or 6-month (n=10, 30.3%) intervals. Our study shows that, in general, there is consensus among US OMSs regarding diagnosis of TMJ involvement in children with JIA. There is less concordance among the respondents regarding treatment. Currently, management of TMJ involvement in children with JIA is mostly based on expert opinions and retrospective studies. This study further highlights the need for randomized clinical trials and multi-institution collaboration to allow for evidence-based diagnosis and treatment.

Temporomandibular Joint Involvement in Association With Quality of Life, Disability, and High Disease Activity in Juvenile Idiopathic Arthritis.

To evaluate the demographic, disease activity, disability, and health-related quality of life (HRQOL) differences between children with juvenile idiopathic arthritis (JIA) and their healthy peers, and between children with JIA with and without clinical temporomandibular joint (TMJ) involvement and its determinants. This study is based on a cross-sectional cohort of 3,343 children with JIA and 3,409 healthy peers, enrolled in the Pediatric Rheumatology International Trials Organisation HRQOL study or in the methotrexate trial. Potential determinants of TMJ involvement included demographic, disease activity, disability, and HRQOL measures selected through univariate and multivariable logistic regression. Clinical TMJ involvement was observed in 387 of 3,343 children with JIA (11.6%). Children with TMJ involvement, compared to those without, more often had polyarticular disease course (95% versus 70%), higher Juvenile Arthritis Disease Activity Score (odds ratio [OR] 4.6), more disability, and lower HRQOL. Children with TMJ involvement experienced clearly more disability and lower HRQOL compared to their healthy peers. The multivariable analysis showed that cervical spine involvement (OR 4.6), disease duration >4.4 years (OR 2.8), and having more disability (Childhood Health Assessment Questionnaire Disability Index >0.625) (OR 1.6) were the most important determinants for TMJ involvement. Clinical TMJ involvement in JIA is associated with higher disease activity, higher disability, and impaired HRQOL. Our findings indicate the need for dedicated clinical and imaging evaluation of TMJ arthritis, especially in children with cervical spine involvement, polyarticular course, and longer disease duration.

Juvenile idiopathic arthritis – implications on facial growth and contemporary management

The aim of the present study was to describe a case with juvenile idiopathic arthritis (JIA) with bilateral temporomandibular joint (TMJ) involvement and long-term facial growth implications, requiring complex surgical treatment and multidisciplinary teams. CPD/Clinical Relevance: Consideration was given to TMJ replacement with alloplastic graft, however, the final management strategy involved bimaxillary surgery.

Benign Temporomandibular Joint Lesions Presenting as Masses in the External Auditory Canal.

Describe benign lesions arising from the temporomandibular joint (TMJ) that presented as masses in the external auditory canal (EAC). Retrospective case series of two academic medical centers. Six patients with lesions emanating from the TMJ that presented as EAC masses. Lesions included pigmented villonodular synovitis (PVNS), nodular fasciitis, foramen of Huschke herniation with salivary fistula, fibroepithelial polyp, superficial angiomyxoma, and giant cell tumor (GCT). Surgical resection. Tumor control, TMJ function, and hearing. All patients presented with hearing loss, TMJ pain, and otalgia. Three patients with EAC occluding masses developed entrapment cholesteatoma between the mass and tympanic membrane. Following surgical resection, four patients were free of disease. The patient with PVNS has a stable remnant at 3 years follow up and the patient with giant cell tumor is under active surveillance. Hearing improved in three patients, remained stable in one patient, and worsened in two patients. All had resolution of their TMJ and ear pain. EAC masses of uncertain origin should be imaged preoperatively to exclude lesions best not biopsied (e.g., encephalocele, facial nerve schwannoma, paraganglioma). In the differential of EAC masses, lesions emanating from the TMJ need to be considered, especially for those based anteriorly. Understanding the extent of TMJ involvement is crucial for surgical planning which optimizes outcome. Goals for therapy are to control the underlying disease process, restore patency of the EAC, improve hearing, and preserve function of TMJ.

MR Imaging of the Temporomandibular Joint in Juvenile Idiopathic Arthritis: Technique and Findings.

The term juvenile idiopathic arthritis (JIA) encompasses a group of arthritides of unknown cause that begin before 16 years of age and last for at least 6 weeks. Temporomandibular joint (TMJ) involvement has been described in up to 87% of children with JIA and has been associated with all JIA subtypes. TMJ involvement is difficult to detect clinically. In one study, 71% of JIA patients with active TMJ synovitis were asymptomatic and 63% had normal physical examination results. Moreover, the main growth center of the mandible is located in the condyle, separated from the joint space by only a thin layer of fibrocartilage. This makes mandibular growth vulnerable to arthritic changes, eventually resulting in facial asymmetry and retrognathia. Therefore, early detection and treatment of TMJ arthritis are paramount to preserving motility and preventing deformity. As clinical symptoms and physical examination results are not good markers of TMJ involvement, imaging plays a key role in diagnosis and treatment monitoring. Magnetic resonance imaging is the technique of choice for the study of TMJ arthritis. It has the advantages of displaying both soft tissue and bone, is the most sensitive technique for detecting acute synovitis, and is the only one able to demonstrate bone marrow edema. In addition, it allows the assessment of changes to the joint over time and evaluation of the effectiveness of therapeutic interventions. ©RSNA, 2017.

Frequency and morbidity of temporomandibular joint involvement in adult patients with a history of juvenile idiopathic arthritis

Purpose Most patients with juvenile idiopathic arthritis (JIA) have temporomandibular joint (TMJ) involvement, but little is known about the natural history of TMJ disease as these children enter adulthood. The purpose of this study was to evaluate adults with a history of JIA to document the frequency and severity of TMJ abnormalities and morbidity. The authors hypothesized that most would have persistent TMJ disease as adults. Materials and Methods This cross-sectional study included adults (>19 years of age) with JIA who were managed at Boston Children's Hospital (BCH) as children and at Brigham and Women's Hospital (BWH) as adults. History of a TMJ problem was not considered for enrollment. Patients completed a questionnaire and underwent physical examination and maxillofacial cone-beam computed tomography (CBCT). Additional data were obtained from medical records. Associations between TMJ abnormalities at CBCT and arthritis history, TMJ pain and function, facial asymmetry, malocclusion, and cephalometric analysis were examined. Results Of 129 eligible patients contacted, 21 (42 TMJs) were enrolled. Mean age was 26.0 ± 6.1 years and mean duration of care for JIA at the BCH and BWH was 13.7 ± 6.5 years. TMJ pain was present in 62% of patients (n = 13); 43% (n = 9) had a TMJ functional limitation and 76% (n = 16) had lower facial asymmetry. Abnormalities were found in the TMJs on 55% of CBCT scans, with 79% showing bilateral deformities. There was at least 1 cephalometric measurement of mandibular size or position that was more than 1 standard deviation beyond normal in 81% of patients (n = 17). Only 4 patients (19%) had previously been evaluated for a TMJ problem. Conclusion TMJ abnormalities and related morbidity are common in adult patients with a history of JIA. Therefore, an early screening protocol for TMJ involvement in children with a new diagnosis of JIA would be beneficial and long-term follow-up into adulthood should be routine.

Temporomandibular disorders in primary fibromyalgia

Background: Fibromyalgia (FM) is a syndrome characterised by chronic widespread pain at multiple tender points, joint stiffness, systemic symptoms (e.g. mood disorders, fatigue, cognitive dysfunction, insomnia), without a well-defined underlying organic disease. FM is the second most common rheumatologic disorder, with peak prevalence 30–60 years and with a female:male ratio of 10:1. The link between FM and temporomandibular disorders (TMD) was first assessed in 1988 by Eriksson et al. Other authors showed a prevalence of TMD in FM from 67 to 94%. Objectives: Evaluation of signs and symptoms of TMD in patients with primary FM by evaluating a correspondence between subjective symptoms of temporomandibular joint (TMJ) involvement, TMD clinical diagnosis and TMJ ultrasonographic (US) features, then comparing the clinical with the US data. Methods: A joint maxillofacial/rheumatologic outpatient clinic was set up at the University Hospital of Ferrara, with the aim to diagnose TMD in rheumatologic patients and provide an appropriate therapy. A double-blind study was carried on patients with primary FM and a control group; they were evaluated by a maxillofacial surgeon for TMJ and rheumatologist for TMJ US evaluation, then data were compared. Findings: In most of FM patients TMD were present regarding muscular disorders. All FM patients showed US variations, mostly degenerative. Conclusion: In FM patients TMJ US can support clinical examination for early diagnosis of articular changes due to muscle disorders in order to establish a proper treatment. The US findings suggest the TMJ overload due to muscle disorder as a cause of degenerative articular variations.

Minimally invasive surgical treatment for temporomandibular joint in patients with various rheumatic diseases

Temporomandibular joint (TMJ) involvement occurs in patients with different rheumatic diseases (RDs). Pain, limitation of mouth opening can lead to significant problems in both oral hygiene and when eating. Conservative treatments for TMJ lesions are not always effective. Objective: to evaluate the efficiency of minimally invasive surgical interventions (TMJ arthrocentesis and arthroscopy) in patients with RDs. Patients and methods. The investigation enrolled 64 patients with different RDs (43 with rheumatoid arthritis, 11 with psoriatic arthritis, 8 with systemic lupus erythematosus, and 2 with ankylosing spondylitis) who were divided into three groups in relation to the severity of TMJ involvement in accordance with the Wilkes classification. All the patients underwent TMJ magnetic resonance imaging at baseline and 6 months after treatment. Also at baseline, 14 days, and 1, 6, and 12 months after surgery, the investigators assessed TMJ pain intensity by visual analogue scale and the parameters of mandibular movements. Patients with Wilkes stages IV and V TMJ involvement underwent arthroscopic intervention into the TMJ and those with III stage received TMJ arthrocentesis with arthrolavage. Results and discussion. After surgical treatment, all the groups were noted to have a significant decrease in TMJ pain intensity compared with the baseline level; moreover, the severity of TMJ pain most significantly decreased on day 7 after surgery. Later on, positive changes remained within subsequent follow-up months. There were data similar in the higher degree of mouth opening. The results of surgical treatment in patients with Wilkes stage V TMJ involvement were worse than in those with stages III and IV. Conclusion. Minimally invasive TMJ surgery in patients with RDs is effective and associated with the low frequency of postoperative complications and exacerbations of RDs. The efficiency of minimally invasive TMJ surgery is higher in patients with the early and middle stages of TMJ involvement according to the Wilkes classification. Further investigations are needed to assess the long-term results of minimally invasive TMJ surgery in patients with RDs.