Temporomandibular Joint Arthrocentesis: A Simplified Treatment for Severe, Limited Mouth Opening

The American Academy of Orofacial Pain (AAOP) defines ankylosis of the temporomandibular joint (TMJ) as a restriction of movements due to intracapsular fibrous adhesions, fibrous changes in capsular ligaments (fibrous-ankylosis) and osseous mass formation resulting in the fusion of the articular components (osseous-ankylosis). The clinical features of the fibrous-ankylosis are severely limited mouth-opening capacity (limited range of motion during the opening), usually no pain and no joint sounds, marked deflection to the affected side and marked limitation of movement to the contralateral side. A variety of factors may cause TMJ ankylosis, such as trauma, local and systemic inflammatory conditions, neoplasms and TMJ infection. Rheumatoid arthritis (RA) is one of the systemic inflammatory conditions that affect the TMJ and can cause ankylosis. The aim of this study is to present a case of a female patient diagnosed with bilateral asymptomatic fibrous-ankylosis of the TMJ associated with asymptomatic rheumatoid arthritis. This case illustrates the importance of a comprehensive clinical examination and correct diagnosis of an unusual condition causing severe mouth opening limitation.

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Concomitant Temporomandibular Joint Ankylosis and Maxillomandibular Fusion in a Child with Klippel- Feil Syndrome: A Case Report

Journal of Clinical Pediatric Dentistry ◽

10.17796/1053-4625-42.5.11 ◽

2018 ◽

Vol 42 (5) ◽

pp. 386-390

Author(s):

Deepika Pai ◽

Abhay T Kamath ◽

Pushpa Kini ◽

Manish Bhagania ◽

Saurabh Kumar

Keyword(s):

Oral Health ◽

Temporomandibular Joint ◽

Cervical Vertebrae ◽

Clinical Signs ◽

Mouth Opening ◽

Facial Asymmetry ◽

Limited Mouth Opening ◽

Oral Manifestation ◽

Temporomandibular Joint Ankylosis ◽

Joint Ankylosis

Klippel-Feil syndrome (KFS) is classically characterized by fusion of any of the two of seven cervical vertebrae. It is identified by the presence of a triad of clinical signs including short neck, limitation of head and neck movements and low posterior hairline. Unusual bony malformations leading to facial asymmetry is the most common oral manifestation associated with KFS. Such maxillomandibular fusion can also result in restricted mouth opening in children. It's a challenge to provide complete rehabilitation in such children. This paper presents a report of a type II KFS with both maxillomandibular fusion and temporomandibular joint ankylosis which led to the limited mouth opening in a six-year-old child. Also, the child showed an inadequate development of speech, facial asymmetry and compromised oral health owing to the restricted mouth opening. After thorough investigations, surgery was done which restored limited mouth opening which led to normalizing of speech and oral health.

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Development of temporomandibular ankylosis after diagnosis of Jacob’s disease: clinical and tomographic assessment

ARCHIVES OF HEALTH INVESTIGATION ◽

10.21270/archi.v9i5.4778 ◽

2020 ◽

Vol 9 (5) ◽

pp. 426-428

Author(s):

Rafael Linard Avelar ◽

Roque Soares Martins Neto ◽

Bruno da Silva Gaspar ◽

Raimundo Antonio de Lima Praxedes Neto ◽

Paulo Paulo Goberlânio Barros Silva

Keyword(s):

Literature Review ◽

Temporomandibular Joint ◽

Delayed Diagnosis ◽

Mouth Opening ◽

Rare Condition ◽

Temporomandibular Joint Disorders ◽

Zygomatic Arch ◽

Coronoid Process ◽

Limited Mouth Opening ◽

Joint Formation

Jacob's disease is a rare condition that consists of the formation of a pseudo joint structure between the mandibular coronoid process and the zygomatic bone, resulting in limited mouth opening. The disease is difficult to diagnose and etiology is uncertain. This article describes a clinical case of a 6-year-old child with limited mouth opening, which resulted in the formation of a temporomandibular ankylosis leading to complete immobility due to delayed diagnosis and treatment of the disease. A review of this pathology and the most precise imaging exams are discussed for the early and differential diagnosis of the disease. Descriptors: Ankylosis; Temporomandibular Joint; Temporomandibular Joint Disorders. Referências Wang WH, Xu B, Zhang BJ, Lou HQ. Temporomandibular joint ankylosis contributing to coronoid process hyperplasia. Int J Oral Maxillofac Surg. 2016;45(10):1229-33. Zhong SC, Xu ZJ, Zhang ZG, Zheng YH, Li TX, Su K. Bilateral coronoid hyperplasia (Jacob disease on right and elongation on left): report of a case and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Mar;107(3):e64-7. Coll-Anglada M, Acero-Sanz J, Vila-Masana I, Navarro-Cuéllar C, Ochandiano-Caycoia S, López de-Atalaya J, Navarro-Vila C. Jacob's disease secondary to coronoid process osteochondroma. A case report. Med Oral Patol Oral Cir Bucal. 2011;16(6):e708-10. Yesildag A, Yariktas M, Doner F, Aydin G, Munduz M, Topal U. Osteochondroma of the coronoid process and joint formation with zygomatic arch (jacob disease): report of a case. Eur J Dent. 2010;4(1):91-4. Çorumlu U, Kopuz C, Demir MT, Pirzirenli ME. Bilateral elongated mandibular coronoid process in an Anatolian skull. Anat Cell Biol. 2016;49(3):217-20. Choi JG, Kim SY, Perez-Atayde AR, Padwa BL. Bilateral coronoid process hyperplasia with pseudocartilaginous joint formation: Jacob disease. J Oral Maxillofac Surg. 2013;71(2):316–21. Losa-Muñoz PM, Burgueño-García M, González-Martín-Moro J, Sánchez-Burgos R. Osteochondroma of coronoid process: a rare etiology of jacob disease. Craniomaxillofac Trauma Reconstr. 2014;7(4):306-9. Escuder i de la Torre O, Vert Klok E, Marí i Roig A, Mommaerts MY, Pericot i Ayats J. Jacob's disease: report of two cases and review of the literature. J Craniomaxillofac Surg. 2001;29(6):372-76. Hernández-Alfaro F, Escuder O, Marco V. Joint formation between an osteochondroma of the coronoid process and the zygomatic arch (Jacob disease): report of case and review of literature. J Oral Maxillofac Surg. 2000;58(2):227-32. Sreeramaneni SK, Chakravarthi PS, Krishna Prasad L, Raja Satish P, Beeram RK. Jacob's disease: report of a rare case and literature review. Int J Oral Maxillofac Surg. 2011;40(7):753-57. D'Ambrosio N, Kellman RM, Karimi S. Osteochondroma of the coronoid process (Jacob's disease): an unusual cause of restricted jaw motion. Am J Otolaryngol. 2011;32(1):52-4. Shackelford RT, Brown WH. Restricted jaw motion due to osteochondroma of the coronoid process. J Bone Joint Surg Am. 1949;31A(1):107-14.

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Non-invasive treatment modalities of limited mouth opening due to diseases and internal disorders of the temporomandibular joint

SUCHASNA STOMATOLOHIYA ◽

10.33295/1992-576x-2021-3-76 ◽

2021 ◽

Vol 107 (3) ◽

pp. 76-81

Author(s):

M. Drogomyretska ◽

◽

R. Mirza ◽

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Temporomandibular Joint ◽

Mouth Opening ◽

Resonance Imaging ◽

Invasive Treatment ◽

Limited Mouth Opening ◽

Open Mouth ◽

Non Invasive ◽

Patient Complaints

Abstract. Magnetic resonance imaging is widely used in the presence of such patient complaints as clicking, locking and pain in the temporomandibular joint. The different problems in the treatment of temporomandibular joint pathology, which is accompanied by limited mouth opening, requires certain recommendations for magnetic resonance imaging, supported by current classifications. The purpose of the study: to substantiate the need for the use of an individual mandibular fixator, made before magnetic resonance imaging in the open mouth position to systematization of the treatment outcomes. Materials and methods. On the basis of clinical examination and objectification of the temporomandibular joint status by magnetic resonance imaging the results of treatment of diseases and internal disorders of the temporomandibular joint, which can be obtained by a dentist-gnathologist using non-invasive methods, was analyzed. To obtain images after treatment of the temporomandibular joint an individual mandibular fixator was used, which provided the possibility of evidencebased determination of the articular head position in the open mouth state. To systematize the analysis results of magnetic resonance imaging of the temporomandibular joint, the most convenient classification was chosen. Results. From a clinical sight, the gnathological treatment of temporomandibular joint dislocation without reposition is considered effective if the distance between the incisors, at maximum mouth opening, is 41–50 mm, the articular head is located at the apex of articular tubercle, and in the questioning and isometric tests the patient complaints are absent. Conclusions. The most effective non-invasive treatment of limited mouth opening is possibly with early ambulation, i.e. from three to seven months after onset. Key words: temporomandibular joint, gnathologist, magnetic resonance imaging.

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Osteochondroma of the temporomandibular joint: a case report

Brazilian Dental Journal ◽

10.1590/s0103-64402010000300014 ◽

2010 ◽

Vol 21 (3) ◽

pp. 253-258 ◽

Cited By ~ 11

Author(s):

Estevam Rubens Utumi ◽

Irineu Gregnanin Pedron ◽

Andréia Perrella ◽

Camila Eduarda Zambon ◽

Marcelo Minharro Ceccheti ◽

...

Keyword(s):

Temporomandibular Joint ◽

Mandibular Condyle ◽

Mouth Opening ◽

Facial Asymmetry ◽

Contralateral Side ◽

Limited Mouth Opening ◽

Oral And Maxillofacial Region ◽

Preauricular Approach ◽

Condylar Morphology

Osteochondroma of the mandibular condyle has been found in the oral and maxillofacial region rarely. This paper describes a case of osteochondroma of the mandibular condyle in a 20-year-old woman, who was referred to our service with facial asymmetry, prognathic deviation of chin, cross-bite to the contralateral side, changes in condylar morphology, limited mouth opening, and malocclusion. Computed tomography (CT) was performed for better evaluation to the pathological conditions on the temporomandibular joint. Based on the clinical examination, patient history, and complementary exams, the hypothesis of osteochondroma was established. Condylectomy was performed using a preauricular approach with total removal of the lesion. After 3 years of postoperative follow up and orthodontic therapy, the patient is symptom-free, and has normal mouth opening with no deviation in the opening pattern.

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Prevalence of temporomandibular joint disorder symptoms in Cibodas Maribaya Village Bandung District

Padjadjaran Journal of Dentistry ◽

10.24198/pjd.vol22no1.14073 ◽

2010 ◽

Vol 22 (1) ◽

Author(s):

Erna Kurnikasari

Keyword(s):

Temporomandibular Joint ◽

Muscle Pain ◽

Mouth Opening ◽

Masticatory Muscles ◽

Temporomandibular Joint Disorder ◽

Limited Mouth Opening ◽

Stomatognathic System ◽

The People ◽

Joint Disorder ◽

System Disorder

Temporomandibular joint disorder is a stomatognathic system disorder causing mandibular function disturbance that clinically shows the following symptoms: clicking, crepitation, limited mouth opening, pain in masticatory muscles, pain in the jaw area, deviated mouth opening, ringing ear, pain around ear area, and headache. Experts stated that the prevalence of joint disorder was high. A study was conducted to the people of Cibodas Maribaya Village Bandung District who came to the Community Work event with results showing that the prevalence of clicking was 34 people or 32.4%, the deviation was found in 36 people or 34.3%, muscle pain was found in 28 people or 26.7%, a headache was found in 35 people or 33.3%, ear disorders was found in 23 people or 21.9%.

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Adult Sized Fibreoptic Bronchoscope Aided Nasal Intubation In A Child with Left Sided Temporomandibular Joint Ankylosis

Health Renaissance ◽

10.3126/hren.v12i1.11986 ◽

2015 ◽

Vol 12 (1) ◽

pp. 49-51

Author(s):

Ashish Ghimire ◽

B Bhattarai ◽

A Subedi ◽

S Koirala

Keyword(s):

Temporomandibular Joint ◽

Pediatric Patients ◽

Mouth Opening ◽

Fibreoptic Bronchoscope ◽

Tooth Decay ◽

Nasal Intubation ◽

Limited Mouth Opening ◽

Tmj Ankylosis ◽

History Of ◽

Joint Ankylosis

In temporomandibular joint (TMJ) ankylosis, direct laryngoscopy and intubation are not feasible. The scenario becomes more challenging in paediatric patients. The best technique would be fibreoptic bronchoscope (FOB) aided nasal intubation. We report successful nasal intubation with the aid of orally placed adult sized fibreoptic bronchoscope in a child with a limited mouth opening. A 6-yr-old child was brought with history of inability to open the mouth. Diagnosis of left sided TMJ ankylosis was made and interpositional arthoplasty was planned. Airway examination revealed interincisor gap of 4.6 mm. Due to tooth decay, a maximum mouth opening of 5.2 mm was observed on the left side. The airway was successfully secured through the nasal route aided by the adult sized bronchoscope inserted orally through the gap between the eroded upper and the lower teeth. Adult sized fibreoptic bronchoscope may be useful in aiding nasal intubation in pediatric patients if the mouth opening permits its introduction orally.DOI: http://dx.doi.org/10.3126/hren.v12i1.11986Health Renaissance 2014;12(1):49-51

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Management of progressive facial asymmetry owing to a rare temporomandibular joint tumour: A case report

Journal of Orthodontics ◽

10.1177/1465312520908272 ◽

2020 ◽

Vol 47 (2) ◽

pp. 163-169

Author(s):

Geetanjali Sharma ◽

Mohammad Shorafa ◽

Gurdeep Hans

Keyword(s):

Case Report ◽

Temporomandibular Joint ◽

Male Patient ◽

Mouth Opening ◽

Facial Asymmetry ◽

Temporomandibular Joint Dysfunction ◽

Limited Mouth Opening ◽

History Of ◽

Slow Growing ◽

Park Hospital

Osteochondroma of the condyle is a rare, slow-growing, benign tumour of the temporomandibular joint that can result in facial asymmetry, limited mouth opening, temporomandibular joint dysfunction and malocclusion. The large majority of osteochondromas occur at the distal metaphysis of the femur and the proximal metaphysis of the tibia, whereas only 0.6% of osteochondromas have been reported as occurring in the craniofacial region. We discuss the diagnosis and treatment of a 56-year-old fit and well male patient who presented to the Orthodontic Department at Wexham Park Hospital with a four-year history of progressive facial asymmetry and functional concerns, owing to a rare osteochondroma of the condyle.

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Temporomandibular joint pain and associated magnetic resonance findings: a retrospective study with a control group

Acta Radiologica Open ◽

10.1177/2058460120938738 ◽

2020 ◽

Vol 9 (9) ◽

pp. 205846012093873

Author(s):

Elisabeth Schilbred Eriksen ◽

Sølve Hellem ◽

Liv Skartveit ◽

Johan G Brun ◽

Olav E Bøe ◽

...

Keyword(s):

Magnetic Resonance ◽

Healthy Volunteers ◽

Temporomandibular Joint ◽

Clinical Symptoms ◽

Temporomandibular Disorder ◽

Mouth Opening ◽

Staging System ◽

Control Group ◽

Limited Mouth Opening ◽

Age Related

Background To better understand and evaluate clinical usefulness of magnetic resonance imaging (MRI) in diagnosis and treatment of temporomandibular disorders (TMD), parameters for the evaluation are useful. Purpose To assess a clinically suitable staging system for evaluation of MRI of the temporomandibular joint (TMJ) and correlate the findings with age and some clinical symptoms of the TMJ. Material and Methods Retrospective analysis of 79 consecutive patients with clinical temporomandibular disorder or diagnosed inflammatory arthritis. Twenty-six healthy volunteers were included as controls. Existing data included TMJ pain, limited mouth opening (<30 mm) and corresponding MRI evaluations of the TMJs. Results The patients with clinical TMD complaints had statistically significantly more anterior disc displacement (ADD), disc deformation, caput flattening, surface destructions, osteophytes, and caput edema diagnosed by MRI compared to the controls. Among the arthritis patients, ADD, effusion, caput flattening, surface destructions, osteophytes, and caput edema were significantly more prevalent compared to the healthy volunteers. In the control group, disc deformation and presence of osteophytes significantly increased with age, and a borderline significance was found for ADD and surface destructions on the condylar head. No statistically significant associations were found between investigated clinical and MRI parameters. Conclusion This study presents a clinically suitable staging system for comparable MRI findings in the TMJs. Our results indicate that some findings are due to age-related degenerative changes rather than pathological changes. Results also show that clinical findings such as pain and limited mouth opening may not be related to changes diagnosed by MRI.

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