Resorption of the mandibular condyles and coronoid processes in progressive systemic sclerosis (scleroderma)

Characteristics of the Maxillofacial Morphology in Patients with Idiopathic Mandibular Condylar Resorption

Idiopathic mandibular condylar resorption (ICR) is a pathological condition characterized by idiopathic resorption of the mandibular condyle, resulting in a decrease in the size and height of the mandibular condyle. The purpose of this study was to characterize the maxillofacial morphology of ICR patients. Subjects were selected from patients that attended our orthodontic clinic between 1991 and 2019. Twenty-five patients were diagnosed with ICR by magnetic resonance imaging; however, growing patients were excluded. In total, 18 patients were finally selected. The control group comprised 18 healthy volunteers. Lateral and frontal cephalograms were also used. The ICR group had significantly more severe skeletal class II malocclusions than the control group, mainly due to retrusion of the mandible. In the ICR group, there was a tendency for a skeletal open bite due to a significantly larger clockwise rotation of the mandible than in the control group. There was no significant difference between the two groups in the inclination of the upper and lower central incisors or protrusion of the upper and lower central incisors and first molars. ICR patients have been suggested to exhibit skeletal open bite and maxillary protrusion with changes in maxillofacial morphology due to abnormal resorption of the mandibular condyle.

Rehabilitation of the face and temporomandibular joint in systemic sclerosis

BACKGROUND

Systemic sclerosis (SSc) alterations of the face and of the mouth cause aesthetic modifications and disability, impairing self-esteem and quality of life (QoL). The aim of this study was to verify the effects of two rehabilitation protocols on facial mimic and mouth opening.

METHODS

A total of 47 SSc patients (40 females and 7 males, mean age ± SD 59.08 ± 10.31 years), were consecutively selected: 22 were randomly assigned to protocol 1 [home exercises for temporomandibular joint (TMJ), mimic, masticatory and cervical spine muscles] and 25 to protocol 2 (home exercises and combined physiotherapeutic procedures performed by a physiotherapist). Each treatment had a duration of 12 weeks with a follow up of 8 weeks. TMJ dysfunction, orofacial involvement, disability, QoL, and safety were assessed at enrollment (T0), at the end of the treatment (T1), and at follow up (T2).

RESULTS

Both Protocol 1 and Protocol 2 induced significant improvements of some clinical and clinimetric parameters, but better results were obtained with Protocol 2. In the comparison between the effects of Protocol 1 and Protocol 2 at T1 and T2, a significant difference was observed only for Mouth Handicap in SSc [MHISS; Total (p = 0.00178] and for MHISS Mouth opening (p = 0.0098) at T1. No significant difference of indices of short-form 36 was observed.

CONCLUSION

The present data suggest that TMJ involvement in SSc may be managed by rehabilitation treatments. The action of a physiotherapist prescribing and personalizing exercises may induce better therapeutic effects.

Comprehensive Management of Rheumatic Diseases Affecting the Temporomandibular Joint

The temporomandibular joint (TMJ) is a synovial joint and thus is vulnerable to the afflictions that may affect other joints in the fields of rheumatology and orthopedics. Too often temporomandibular complaints are seen strictly as dental or orofacial concerns. Similarly, patients with known rheumatic disease may not have their TMJs included in routine screening and monitoring protocols. The purpose of this review is to highlight the rheumatic conditions likely to affect the TMJ and outline medical and surgical management in these patients with a focus on the need for continued patient reassessment and monitoring.

Osteolysis Affecting the Jaws in Systemic Sclerosis: Clinical and Osseous Changes Based on a Case Presentation

OBJECTIVES

The aim of the current paper is to present a case of systemic sclerosis of the jaws with all the characteristics and some extensive findings.

METHODS

Systemic sclerosis is a connective tissue condition characterized by chronic inflammatory changes, presenting with a number of symptoms. The paper aims to present a case of systemic sclerosis that had some of the characteristics of the condition unilaterally. The features were prominent and well demarcated on the panoramic radiograph.

RESULTS

The panoramic radiograph of the patient showed extensive condylar head resorption almost to the level of complete flattening.

DISCUSSION

The rarity of the condition and the awareness the oral radiologist must have upon presentation of similar images is the main reason for the presentation of the case. The features the case presents are both characteristic and well demarcated. Finally, the authors try to alert the clinician, who should be mindful of the fact that sclerodermatous involvement of organ systems is so pleotropic, that it may include the oral cavity, which is not always thoroughly observed, and is often left unattended by medical practitioners.

Analysis of the masseter muscle in patients with systemic sclerosis: a study by magnetic resonance imaging

OBJECTIVES

The aim of this study was to investigate the relationship between mandibular osteolysis and the T1 and T2 tissue signal strength and morphology of the masseter muscle in patients with systemic sclerosis (SS).

METHODS

All patients with SS underwent panoramic radiography to detect mandibular osteolysis. MRI of the masseter was performed on 15 patients with SS and 10 healthy control subjects.

RESULTS

All patients presented mean T1 values that were statistically equal. The patients with osteolysis presented mean T2 values that were the same as those of patients without osteolysis and normal individuals. The patients without osteolysis showed stronger T2 signals than did the normal individuals. The morphological analysis showed more atrophy, fatty replacement and rectified morphology in relation to the healthy subjects.

CONCLUSIONS

The patients with SS presented more atrophy, fat replacement and rectification than did the normal individuals. The T2 signal was significantly stronger among the patients with SS without osteolysis than among normal individuals and among patients with SS and osteolysis.

Bilateral mandibular condylysis in a patient with systemic sclerosis

A case of progressive osteolysis of the mandibular condyles in a 55-year-old female patient with systemic sclerosis (SSc) is described. Orofacial involvement and radiological manifestations of SSc are discussed.

Factors related to oral hygiene in persons with scleroderma

OBJECTIVES

The purpose of this study was to assess potential risk factors for the development of poor oral hygiene and increased dental caries in individuals with scleroderma.

METHODS

Twenty-two subjects with scleroderma participated in this study. All subjects were examined with the Patient Hygiene Performance (PHP) Index, which assesses the extent of plaque and debris over a tooth surface. In addition, oral aperature, xerostomia and dominant upper extremity strength, motion, skin thickness, and dexterity were measured.

RESULTS

None of the subjects had good or excellent hygiene. Fifteen subjects had fair oral hygiene and seven subjects had poor oral hygiene as measured by the PHP Index. Significant differences were seen between these two groups for oral aperture, percentage of teeth with caries, skin thickness, dexterity and finger flexion. Dexterity and joint motion correlated significantly with the number of decayed surfaces and number of caries. Oral aperture correlated with the PHP Index and the number of dental caries.

CONCLUSIONS

Subjects with poor oral hygiene required more time to complete manual dexterity task and had decreased hand strength and joint motion. Moreover, these same subjects had more contractures, scars, ulcers, and higher skin scores (more disease activity) than subjects in the fair hygiene group. In addition to frequent dental exam and routine cleaning, dental personnel may want to consider exercises to increase oral aperature and investigate toothbrush and dental floss selection used by persons with scleroderma.

Imagerie des atteintes faciales de l’hyperparathyroïdisme

Facial changes in hyperparathyroidism, rarely described, are better depicted at CT imaging. This article reviews the maxillo-mandibular, ocular and temporo-mandibular findings associated with the different types of hyperparathyroidism.

Diagnosis and management of condylar resorption

PURPOSE

This article discusses the cause, appropriate diagnostic evaluation, and management of progressive condylar resorption.

PATIENTS AND METHODS

This retrospective study evaluated 28 adult patients with bilateral progressive condylar resorption. Investigation included serial clinical examination, lateral cephalograms, tomograms, and a technetium isotope bone scan when indicated. Twenty-two patients were managed by either condylectomy and reconstruction with a costochondral graft (n = 5 patients) or orthognathic surgery (n = 18 patients). One patient initially had orthognathic surgery and subsequently underwent condylectomy and costochondral grafting, making a total of 23 procedures on 22 patients. Six patients received no surgical treatment. All patients were observed at least 2 years postoperatively.

RESULTS

Of the 18 patients who underwent orthognathic surgery, four again demonstrated condylar resorption with recurrence of open bite and retrognathism. Four patients had a stable result, but currently have temporomandibular joint (TMJ) symptoms, whereas 10 patients had a stable result (no change in postoperative occlusion or jaw position) without TMJ symptoms. The five cases receiving condylectomy and costochondral grafting were stable and asymptomatic, with good mandibular function. Analysis of the 18 orthognathic surgery patients showed that relapse occurred in patients having bimaxillary surgery with mandibular advancements greater than 5 mm and with a preoperative posterior ramus height of less than 35 mm.

CONCLUSION

The management of progressive condylar resorption remains controversial. Orthognathic surgery in this small sample was associated with a complication rate (relapse or TMJ dysfunction) of approximately 45% (8 of 18). In contrast, condylectomy and costochondral grafting appeared to produce stable and functional results. Further long-term outcome studies for patients with condylar resorption are needed to corroborate these results.

Mandibular resorption due to systemic sclerosis. Case report of surgical correction of a secondary open bite deformity

Systemic sclerosis (SSc) is a connective-tissue disorder of unknown origin causing a multisystem disease. While erosions of the distal phalanges are commonly described, resorption of the mandible has been considered an unusual finding. However, systematic radiographic screening of different groups of patients suffering from SSc revealed a resorption incidence of 20-33% of the examined mandibles. Women especially seem to be affected, and the male/female ratio is 1/7. Bilateral condylysis due to SSc has been described in seven cases, or 13.7% of the reported cases. To the best of our knowledge, this is the fourth report of surgical correction of secondary dysgnathia due to systemic sclerosis and the first with a 2-year follow-up period.

Cross-linked elastin and collagen degradation products in the urine of patients with scleroderma

OBJECTIVE

To measure the urinary excretion of specific cross-link amino acid markers for mature elastin (desmosine [DES] and isodesmosine [IDES]) and fibrillar collagen (hydroxylysylpyridinoline [HP] and lysylpyridinoline [LP]) in systemic sclerosis (SSc) patients and healthy controls.

METHODS

Urine specimens from 20 patients with SSc and 22 controls were assessed for DES, IDES, HP, and LP using high performance liquid chromatography and ultraviolet absorption spectroscopy, in combination with an isotope dilution technique in which the urine specimen was spiked with isotopically labeled cross-link amino acids.

RESULTS

Mean +/- SD levels of urinary DES and IDES were elevated in SSc patients by 2-3-fold, and urinary HP and LP by 3-4-fold, compared with controls (DES 21.0 +/- 9.4 versus 7.5 +/- 1.4 micrograms/gm creatinine; HP 109.0 +/- 72.9 versus 24.9 +/- 5.7 nmoles/mmole creatinine). Nineteen of the 20 SSc patients had urinary DES and HP values that were > 3 SD above the control mean. A significant elevation in the HP:LP ratio in SSc patients as compared with controls (mean +/- SD 6.9 +/- 1.5 versus 5.5 +/- 1.3) indicated a soft tissue origin for much of the increased HP.

CONCLUSION

Patients with SSc have higher levels of urinary cross-link amino acids specific for the degradation of mature collagen and elastin. These markers distinguish most SSc patients from healthy controls.

Treatment of systemic sclerosis

Proper classification of patients into diffuse cutaneous and limited cutaneous subsets and the anticipation of complications are the keys to the management of subjects with systemic sclerosis (scleroderma). Patients with early diffuse disease and rapidly progressive skin thickening are at highest risk of developing serious disease of the internal organs (intestine, lung, heart, kidney) and should be considered for disease modifying treatment. The targets of the disease and sites of possible intervention are vascular endothelium (vasoprotective agents), mononuclear cell subsets (immunosuppressive agents), and fibroblasts (colchicine, D-penicillamine). A number of new agents with sound scientific rationale are currently undergoing therapeutic trials. Much can be done to improve the lifestyle of those with scleroderma. The most dramatic recent development is the ability to reverse kidney disease by the prompt use of angiotensin converting enzyme inhibitors and modern methods of renal dialysis and transplantation. Scleroderma is not a hopeless disease.

The contributing role of condylar resorption to skeletal relapse following mandibular advancement surgery: report of five cases

The contribution of condylar resorption to relapse following mandibular advancement surgery has not been fully evaluated, yet may contribute substantially to postoperative occlusal and skeletal changes too often considered simply as "relapse." Five cases showing a typical relapse pattern are presented, illustrating the role of condylar resorption. Preoperative factors that may contribute to the development of condylar resorption (age, sex, high preoperative mandibular plane angle, and the presence of preoperative temporomandibular joint disease), as well as intraoperative and postoperative factors, are discussed. A target group is defined in which special considerations should be made with regard to preoperative and postoperative management.

Unilateral osteolysis of the mandibular angle and coronoid process in scleroderma

A patient with scleroderma who showed extensive unilateral osteolysis of the angle of the mandible and coronoid process is described. She maintained normal muscle function in the temporalis muscle, but there was greatly decreased function in the masseter muscle.

Mandibular condylosis and apertognathia as presenting symptoms in progressive systemic sclerosis (scleroderma). Pattern of mandibular bony lesions and atrophy of masticatory muscles in PSS, presumably caused by affected muscular arteries

Apertognathia (open bite) is usually a developmental deformity of the jaws and the dentoalveolar segments in childhood and adolescence. The sudden insidious appearance of an open anterior bite in adult life is extremely rare and may be due to pathologic condylar fractures (with displacement) or to bilateral condylosis. To the best of our knowledge, only five cases of bilateral mandibular condylosis in progressive systemic sclerosis (PSS) have been reported in the literature, and the present article deals with the sixth known case. In the 22-year-old woman presented in this article the mandibular manifestations were the very early symptoms of PSS, which had a very rapid fatal course. A review of the literature is presented, and attention is called to the serious significance of sudden apertognathia. PSS is a chronic generalized disease of the small arterial vessels and the mesenchyme tissues of unknown origin. The musculoskeletal system is often involved, and the disease may affect the mandible, causing bony erosions, osteolysis, and atrophy of the masticatory muscles. It is believed that these bony lesions are of ischemic origin. The lesions, which are usually bilateral, occur only in the condyles, the coronoid processes, and the gonial angles. The main arterial blood supply to the mandible and to the major part of the ascending ramus originates from the inferior alveolar artery. The blood supply of the condyles, the coronoid processes, and the gonial angles originates in small muscular arteries.(ABSTRACT TRUNCATED AT 250 WORDS)