Anesthesia/facial pain
Arthroscopy of the Temporomandibular Joint in Patients With Juvenile Idiopathic Arthritis

https://doi.org/10.1016/j.joms.2016.01.028Get rights and content

Purpose

The early diagnosis of temporomandibular joint (TMJ) involvement in patients with juvenile idiopathic arthritis (JIA) before joint destruction and growth disturbances could allow for interceptive treatment. The purpose of this article is to report early TMJ arthroscopic findings in patients with JIA.

Patients and Methods

This was a case series of 3 patients with JIA treated at the Emory University Division of Oral and Maxillofacial Surgery from July 2011 through December 2012. Patients were included if they had a confirmed diagnosis of JIA, did not respond to anti-rheumatologic medication, and had TMJ pain or limited mouth opening. All patients underwent TMJ arthroscopy with an injection of triamcinolone hexacetonide. Demographics, medical history, magnetic resonance imaging findings, arthroscopic findings, and postoperative course were reported.

Results

Three female patients (mean age, 12.5 yr; 5 joints) underwent arthroscopy. Arthroscopic findings consisted of mild to moderate synovitis and grade 2 to 4 chondromalacia with or without fibrosis. Postoperatively, all patients had improvement in pain and mouth opening.

Conclusions

There was a positive correlation between duration of JIA activity in the TMJ and severity of arthroscopic findings. Arthroscopic lysis and lavage combined with triamcinolone hexacetonide injection resulted in improvement in pain and range of motion.

Section snippets

Report of Cases

Consecutive patients referred to the Emory Oral and Maxillofacial Surgery Service from the Children's Healthcare of Atlanta Pediatric Rheumatology Service (Atlanta, GA) were enrolled in this study. Institutional review board exemption was obtained from Emory University. All patients were treated with anti-rheumatologic systemic medications and had recalcitrant TMJ symptoms. Patients underwent a thorough history and physical examination and preoperative magnetic resonance imaging (MRI) of their

Discussion

Approximately 300,000 children in the United States are diagnosed with JIA every year.6 There are 7 JIA subgroups distinguished by clinical characteristics, laboratory values, and patient history: 1) systemic onset, 2) oligoarthritis, 3) polyarthritis rheumatoid factor positive, 4) polyarthritis rheumatoid factor negative, 5) psoriatic arthritis, 6) enthesitis-related arthritis, and 7) undifferentiated arthritis. Additional classification of arthritis is beyond the scope of this report and has

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  • Cited by (10)

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      Nevertheless, in a symptomatic (pain, limited maximal incisal opening) patient with otherwise well-controlled disease where MPD has been eliminated, TMJ lysis and lavage, perhaps with steroid injections as a temporary measure to decrease symptoms, should be considered. Another option is TMJ arthroscopy, which allows for direct examination of the synovium.19 This is part of an ongoing investigation, which will serve as a follow-up to the present study.

    • Benefit of Temporomandibular Joint Lavage With Intra-Articular Steroids Versus Lavage Alone in the Management of Temporomandibular Joint Involvement in Juvenile Idiopathic Arthritis

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      Surgeons in the great majority of previous studies performed IACS injection without prior lavage,10,12-16,25-27 which makes the technique used in the present study stand out. Only 1 case report,20 1 case series,17 and 2 studies18,21 have looked at patients who received a TMJ lavage with or without IACS. Moreover, only 1 study to date has compared lavage with versus lavage without IACS injections,21 with results showing an improvement in pain at mouth opening for the 2 groups but no difference between groups.

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