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Ferrillo M, Gallizzi R, Marotta N, Longo UG, Spagnolo A, Ammendolia A, Giudice A, de Sire A. Temporomandibular joint rehabilitative approaches for children and adolescents affected by juvenile idiopathic arthritis: A systematic review. Int J Paediatr Dent 2024. [PMID: 38863137 DOI: 10.1111/ipd.13225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/14/2024] [Accepted: 05/27/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood, and temporomandibular joints (TMJs) are involved in 39%-78% of patients. AIM The aim of this systematic review was to assess the effectiveness of conservative approaches in improving TMJ arthritis in children and adolescents affected by JIA. DESIGN PubMed, Scopus, and Web of Science were systematically searched from the inception until February 25, 2024, to identify observational studies presenting participants with a diagnosis of JIA affecting the TMJ, rehabilitative approaches for TMJ arthritis as interventions, and clinical or radiological assessment of TMJ arthritis as outcome. RESULTS Of 478 papers suitable for title/abstract screening, 13 studies were included. The studies evaluated the effectiveness of intra-articular (IA) corticosteroid (CS) injections, IA infliximab injections, arthrocentesis alone or in combination with IACS injections, occlusal splint, functional appliance, and physiotherapy. The effectiveness of IACS injections was shown in eight studies. IA infliximab injections did not appear to significantly improve TMJ arthritis. CONCLUSION Results of this systematic review suggested that conservative treatments, especially IACS injections, might be effective in improving TMJ arthritis in patients affected by JIA. Further studies with a higher level of evidence and more representative samples should be conducted.
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Affiliation(s)
- Martina Ferrillo
- Dentistry Unit, Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Romina Gallizzi
- Paediatric Unit, Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Nicola Marotta
- Physical Medicine and Rehabilitation Unit, Department of Experimental and Clinical Medicine, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Alessandra Spagnolo
- Paediatric Unit, Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Antonio Ammendolia
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Amerigo Giudice
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Alessandro de Sire
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
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Wroclawski C, Mediratta JK, Fillmore WJ. Recent Advances in Temporomandibular Joint Surgery. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1409. [PMID: 37629699 PMCID: PMC10456345 DOI: 10.3390/medicina59081409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 08/27/2023]
Abstract
Temporomandibular disorders (TMDs) affect a high percentage of children and adults worldwide. Surgery may be indicated in severe or recalcitrant cases. Several recent advancements in TMD and temporomandibular joint (TMJ) surgery have elevated understanding and the ability to treat affected patients. We discuss recent advances in TMD epidemiology, juvenile idiopathic arthritis (JIA) of the TMJ, and surgical techniques and technologies. Technical advancements have been identified in TMJ arthroscopy, the treatment of TMJ subluxation and dislocation, and extended prosthetic total TMJ reconstruction (eTMJR). Overall, this review provides valuable insights into significant recent advancements in TMJ disorders and their surgical management.
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Affiliation(s)
| | - Jai Kumar Mediratta
- Resident, Oral and Maxillofacial Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - W. Jonathan Fillmore
- Consultant, Oral and Maxillofacial Surgery, Mayo Clinic, Rochester, MN 55905, USA
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Temporomandibular joint in juvenile idiopathic arthritis: magnetic resonance imaging measurements and their correlation with imaging findings. Oral Radiol 2022; 38:459-467. [PMID: 34797517 DOI: 10.1007/s11282-021-00576-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the TMJ components in patients with juvenile idiopathic arthritis (JIA) and to compare them with a control group based on magnetic resonance imaging (MRI) measurements. METHODS This study comprised an assessment of MRI measurements of 96 temporomandibular joints (TMJ) following classification criteria set by the International League of Associations for Rheumatology (ILAR). Three measurements were considered for study: condyle excursion angle (CEA), height of articular eminence (HAE) and inclination of articular eminence (IAE). All TMJs were assessed by linear measurements made by using the OnDemand 3D software. The comparison between the groups was performed by using Mann-Whitney's test. RESULTS Lower measurement values were found for IAE, HAE and CEA in JIA patients (P-values < 0.001, 0.005 and < 0.001, respectively). CONCLUSION The study showed the differences in MRI measurements between JIA patients and controls, with the former with the lowest indices.
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Leite DDFC, Costa ALF, Appenzeller S, Campos PSF, Soares MQS, Martins JS, Prado GD, Panzarella FK. Magnetic resonance imaging assessment of juvenile idiopathic arthritis using OMERACT and EuroTMjoint classifications. Int J Oral Maxillofac Surg 2022; 51:1473-1481. [PMID: 35597667 DOI: 10.1016/j.ijom.2022.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 04/13/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
This retrospective case-control study compared inflammatory and structural damage in the temporomandibular joint of patients with juvenile idiopathic arthritis (JIA) and its subtypes and healthy patients using the Outcome Measures in Rheumatology Clinical Trials (OMERACT) and EuroTMjoint classifications. Correlations between the scores of the two classifications and time of diagnosis were evaluated. Twenty-nine JIA patients and 48 age-matched healthy participants were examined. TMJ images on each side were considered individually. Oligoarticular and polyarticular subtypes were present in 44.8% and 55.2% of patients, respectively. The JIA group presented a higher frequency and more severe signs of inflammatory and structural changes (P < 0.05), except for effusion (P = 0.83). The polyarticular subtype showed a higher change intensity. The time of JIA diagnosis was not correlated with inflammatory and structural changes. Positive correlations between inflammation and bone deformity scores were observed for the EuroTMjoint classification (r = 0.462, P < 0.001; low correlation) and OMERACT classification (r = 0.737, P < 0.001; high correlation). Positive correlations between the OMERACT and EuroTMjoint classifications were found for inflammation score (r = 0.907, P < 0.001; very high correlation) and bone deformity score (r = 0.854, P < 0.001; high correlation). Both classifications showed a higher frequency and intensity of inflammation and bone deformity in JIA patients. The results of this study suggest that the appropriate management of inflammation may reduce the potential for structural damage to the TMJ.
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Affiliation(s)
- D de F C Leite
- Oral Radiology Division, São Leopoldo Mandic Research Institute, Campinas, São Paulo, Brazil
| | - A L F Costa
- Postgraduate Program in Dentistry, Cruzeiro do Sul University (UNICSUL), São Paulo, São Paulo, Brazil
| | - S Appenzeller
- Rheumatology Unit, Department of Orthopedics, Rheumatology and Traumatology, School of Medical Science, University of Campinas, São Paulo, Brazil
| | - P S F Campos
- Department of Oral Radiology, Federal University of Bahia, Salvador, Bahia, Brazil
| | - M Q S Soares
- Oral Radiology Division, São Leopoldo Mandic Research Institute, Campinas, São Paulo, Brazil
| | - J S Martins
- Medical Pathophysiology, School of Medical Science, University of Campinas, São Paulo, Brazil
| | - G D Prado
- Department of Oral Radiology, Federal University of Bahia, Salvador, Bahia, Brazil
| | - F K Panzarella
- Oral Radiology Division, São Leopoldo Mandic Research Institute, Campinas, São Paulo, Brazil.
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Electromyographic Activity of Masticatory Muscles in Subjects with Juvenile Idiopathic Arthritis: A Case—Control Study. Symmetry (Basel) 2022. [DOI: 10.3390/sym14050962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to evaluate the effect of juvenile idiopathic arthritis (JIA) on the activity of masticatory muscles using surface electromyography (sEMG). Forty-one JIA subjects (ten males, thirty-one females; average age 13 years ± 3) and thirty-two healthy control subjects (twenty-seven females, five males; average age 14 years ± 2) were recruited. sEMG of anterior temporalis (TA), masseter (MM), and sternocleidomastoid (SCM) muscles was performed by using the occlusal contact analyzer software called Teethan (BTS S.p.A., Garbagnate Milanese, Milan, Italy). Comparisons between groups were assessed with unpaired t-tests for non-normally distributed data and with Mann–Whitney U tests for normally distributed parameters. The JIA group showed a significant increased percentage overlapping coefficient of TA (POC TA) (p = 0.01) and impact index (IMP) (p = 0.003). No significant differences were observed for the POC MM, POC SCM, percentage overlapping coefficient between posterior and anterior teeth contact (BAR), the torsion index (TORS), and the asymmetry index (ASIM). Masticatory muscles seemed to be slightly affected by JIA. sEMG could be an effective aid in the early clinical detection of TMJ involvement in JIA. Further research is needed to confirm its validity.
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Increased risk of temporomandibular joint disorders and craniofacial deformities in patients with juvenile idiopathic arthritis: a population-based cohort study. Int J Oral Maxillofac Surg 2022; 51:1482-1487. [DOI: 10.1016/j.ijom.2022.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/01/2022] [Accepted: 04/19/2022] [Indexed: 01/07/2023]
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Garner AJ, Saatchi R, Ward O, Hawley DP. Juvenile Idiopathic Arthritis: A Review of Novel Diagnostic and Monitoring Technologies. Healthcare (Basel) 2021; 9:1683. [PMID: 34946409 PMCID: PMC8700900 DOI: 10.3390/healthcare9121683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 12/29/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood and is characterized by an often insidious onset and a chronic relapsing-remitting course, once diagnosed. With successive flares of joint inflammation, joint damage accrues, often associated with pain and functional disability. The progressive nature and potential for chronic damage and disability caused by JIA emphasizes the critical need for a prompt and accurate diagnosis. This article provides a review of recent studies related to diagnosis, monitoring and management of JIA and outlines recent novel tools and techniques (infrared thermal imaging, three-dimensional imaging, accelerometry, artificial neural networks and fuzzy logic) which have demonstrated potential value in assessment and monitoring of JIA. The emergence of novel techniques to assist clinicians' assessments for diagnosis and monitoring of JIA has demonstrated promise; however, further research is required to confirm their clinical utility.
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Affiliation(s)
- Amelia J. Garner
- The Medical School, University of Sheffield, Sheffield S10 2TN, UK
| | - Reza Saatchi
- Industry and Innovation Research Institute, Sheffield Hallam University, Sheffield S1 1WB, UK;
| | - Oliver Ward
- Department of Paediatric Rheumatology, Sheffield Children’s Hospital, Sheffield S10 2TH, UK; (O.W.); (D.P.H.)
| | - Daniel P. Hawley
- Department of Paediatric Rheumatology, Sheffield Children’s Hospital, Sheffield S10 2TH, UK; (O.W.); (D.P.H.)
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Cavagnetto D, Abate A, Caprioglio A, Cressoni P, Maspero C. Three-dimensional volumetric evaluation of the different mandibular segments using CBCT in patients affected by juvenile idiopathic arthritis: a cross-sectional study. Prog Orthod 2021; 22:32. [PMID: 34595615 PMCID: PMC8484372 DOI: 10.1186/s40510-021-00380-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is currently no information on how different mandibular segments are affected by juvenile idiopathic arthritis. The aim of this paper is to assess volumetric differences of different mandibular segments in subjects with unilateral and bilateral JIA and to compare them with non-JIA control volumes. MATERIALS AND METHODS Forty subjects with unilateral TMJ involvement and 48 with bilateral TMJ involvement were selected for the case group and 45 subjects with no known rheumatic comorbidities for the control group. The mandible of each subject was divided according to a validated method into different paired volumes (hemimandible, condyle, ramus and hemibody). RESULTS The ANOVA test revealed a statistically significant difference in all the groups for condylar and ramus volumes, and the pairwise comparison evidenced a statistically significant higher condylar and ramus volume in the control group (1444.47 mm3; 5715.44 mm3) than in the affected side in the unilateral JIA group (929.46 mm3; 4776.31 mm3) and the bilateral JIA group (1068.54 mm3; 5715.44 mm3). Moreover, there was also a higher condylar volume in the unaffected side in the unilateral JIA group (1419.39 mm3; 5566.24 mm3) than in the bilateral JIA group and the affected side in the unilateral JIA group. CONCLUSIONS The affected side of unilateral JIA patients showed statistically significant lower volumes in the hemimandible, in the condyle and in the ramus. The largest total mandibular volume was observed in the control group, followed by the unilateral JIA group and, lastly, by the bilateral JIA group.
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Affiliation(s)
- Davide Cavagnetto
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy.,Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy
| | - Andrea Abate
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy.,Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy
| | - Alberto Caprioglio
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy.,Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy
| | - Paolo Cressoni
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy.,Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy
| | - Cinzia Maspero
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy. .,Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy.
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Clinical and Instrumental TMJ Evaluation in Children and Adolescents with Juvenile Idiopathic Arthritis: A Case—Control Study. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11125380] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
To investigate temporomandibular joint (TMJ) involvement signs such as muscle pain, the ratio of masseter and temporal muscle activity, mouth opening width and jaw deviation during mouth opening in children and adolescents with juvenile idiopathic arthritis (JIA), a group of 32 subjects with JIA and a control group of 32 healthy subjects were evaluated. Data were collected clinically by muscle palpation (masseters, anterior temporalis and sternocleidomastoids) and instrumental analysis (electromyography and kinesiography). Higher pain was registered in the masseter and sternocleidomastoid muscles on both sides and in the right anterior temporalis in the JIA group compared to the control group (p < 0.05). Electromyography showed no statistically significant difference in the frequency of the pathological ratio of masseter and temporal muscle activity (MM/TA < 1) both in the JIA group and in the control group. Kinesiography showed a statistically significant difference in mouth opening width and jaw deviation during mouth opening between the groups (p < 0.05): JIA subjects showed lower mouth opening values and wider deviation on mouth opening; 29 out of 32 JIA subjects showed jaw deviation towards the right side. JIA affects the TMJ, causing myalgia in the head and neck muscles, a reduction in mouth opening width and an increase in jaw deviation during mouth opening.
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Gholamzadeh M, Abtahi H, Ghazisaeeidi M. Applied techniques for putting pre-visit planning in clinical practice to empower patient-centered care in the pandemic era: a systematic review and framework suggestion. BMC Health Serv Res 2021; 21:458. [PMID: 33985502 PMCID: PMC8116646 DOI: 10.1186/s12913-021-06456-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/27/2021] [Indexed: 11/28/2022] Open
Abstract
Background One of the main elements of patient-centered care is an enhancement of patient preparedness. Thus, pre-visit planning assessment tools was emerged to prepare and involve patients in their treatment process. Objective The main objective of this article was to review the applied tools and techniques for consideration of putting pre-visit planning into practice. Methods Web of Science, Scopus, IEEE, and PubMed databases were searched using keywords from January 2001 to November 2020. The review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Then, qualitative analysis was done to suggest an appropriate framework by mapping the main concepts. Results Out of 385 citations were retrieved in initial database searches, 49 studies from ten countries were included. Applied pre-visit techniques can be classified into eight categories. Our results showed that almost 81% of studies were related to procedures that were done between each visit, while 42% of articles were related to before visits. Accordingly, the main approach of included articles was patient preparedness. While 38 studies reported this approach is effective, three studies reported the effectiveness of such tools as moderate, only two articles believed it had a low effect on improving patient-centered care. Conclusion This survey summarized the characteristics of published studies on pre-visit planning in the proposed framework. This approach could enhance the quality of patient care alongside enhancement patient-provider communication. However, such an approach can also be helpful to control pandemic diseases by reducing unnecessary referrals. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06456-7.
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Affiliation(s)
- Marsa Gholamzadeh
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, 5th Floor, Fardanesh Alley, Qods Ave, Tehran, Iran
| | - Hamidreza Abtahi
- Pulmonary and Critical care Medicine Department, Thoracic Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Ghazisaeeidi
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, 5th Floor, Fardanesh Alley, Qods Ave, Tehran, Iran.
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Juvenile idiopathic arthritis of the temporomandibular joint - no longer the forgotten joint. Br J Oral Maxillofac Surg 2021; 60:247-256. [PMID: 35249742 DOI: 10.1016/j.bjoms.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/25/2021] [Indexed: 11/22/2022]
Abstract
Juvenile idiopathic arthritis (JIA) of the temporomandibular joint (TMJ) is common in children, with an increasing awareness of the condition in all healthcare professionals. TMJ involvement presents a challenge in both diagnosis and treatment, as late presentation can still occur as the disease often develops asymptomatically. This can result in facial deformity and/or functional difficulties including obstructive sleep apnoea. Early diagnosis is therefore essential, requiring a high index of clinical suspicion coupled with the judicious use of gadolinium contrast magnetic resonance imaging (MRI). Long-term management is best provided by a multidisciplinary team as patients often need a combination of pharmacological management, surgical interventions, orthodontics, and psychological support. End stage deformity can be treated by different surgical options, each with their own risks and benefits, however recently there is increasing recognition for the role of total alloplastic TMJ replacement. This review focuses on the diagnosis and management of TMJ arthritis and aims to highlight the important role of maxillofacial surgeons in JIA treatment.
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Covert L, Mater HV, Hechler BL. Comprehensive Management of Rheumatic Diseases Affecting the Temporomandibular Joint. Diagnostics (Basel) 2021; 11:diagnostics11030409. [PMID: 33673675 PMCID: PMC7997293 DOI: 10.3390/diagnostics11030409] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Lauren Covert
- Department of Pediatrics, Division of Rheumatology, Duke University Hospitals, Durham, NC 27710, USA; (L.C.); (H.V.M.)
| | - Heather Van Mater
- Department of Pediatrics, Division of Rheumatology, Duke University Hospitals, Durham, NC 27710, USA; (L.C.); (H.V.M.)
| | - Benjamin L. Hechler
- Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Hospitals, Durham, NC 27710, USA
- Department of Head and Neck Surgery and Communication Sciences, Duke University Hospitals, Durham, NC 27710, USA
- Correspondence:
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Starck L, Andersen E, Macíček O, Angenete O, Augdal TA, Rosendahl K, Jiřík R, Grüner R. Effects of motion correction, sampling rate and parametric modelling in dynamic contrast enhanced MRI of the temporomandibular joint in children affected with juvenile idiopathic arthritis. Magn Reson Imaging 2021; 77:204-212. [PMID: 33359424 DOI: 10.1016/j.mri.2020.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/07/2020] [Accepted: 12/20/2020] [Indexed: 12/23/2022]
Abstract
The temporomandibular joint (TMJ) is typically involved in 45-87% of children with Juvenile Idiopathic Arthritis (JIA). Accurate diagnosis of JIA is difficult as various clinical tests, including MRI, disagree. The purpose of this study is to optimize the methodological aspects of Dynamic Contrast Enhanced (DCE) MRI of the TMJ in children. In this cross-sectional study, including data from 73 JIA affected children, aged 6-15 years, effects of motion correction, sampling rate and parametric modelling on DCE-MRI data is investigated. Consensus among three radiologists determined the regions of interest. Quantitative perfusion parameters were estimated using four perfusion models; the Adiabatic Approximation to Tissue Homogeneity (AATH), Distributed Capillary Adiabatic Tissue Homogeneity (DCATH), Gamma Capillary Transit Time (GCTT) and Two Compartment Exchange (2CXM) models. Effects of motion correction were evaluated by a sum of least squares between corrected raw data and the GCTT model. The effect of systematically down sampling the raw data was tested. The sum of least squares was computed across all pharmacokinetic models. Relative difference perfusion parameters between the left and right TMJ were used for an unsupervised k-means based stratification of the data based on a principal component analysis, as well as for a supervised random forest classification. Diagnostic sensitivity and specificity were computed relative to structural image scorings. Paired sample t-tests, as well as ANOVA tests, were used (significant threshold: p < 0.05) with Tukeys post hoc test. High-level elastic motion correction provides the best least square fit to the GCTT model (percental improvement: 72-84%). A 4 s sampling rate captures more of the potentially disease relevant signal variations. The various parametric models all leave comparable residues (relative standard deviation: 3.4%). In further evaluation of DCE-MRI as a potential diagnostic tool for JIA a high-level elastic motion correction scheme should be adopted, with a sampling rate of at least 4 s. Results suggest that DCE-MRI data can be a valuable part in JIA diagnostics in the TMJ.
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Affiliation(s)
- Lea Starck
- Department of Physics and Technology, University of Bergen, Bergen, Norway; Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Bergen, Norway.
| | - Erling Andersen
- Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Bergen, Norway; Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway.
| | - Ondřej Macíček
- Institute of Scientific Instruments of the Czech Academy of Sciences, Brno, Czechia.
| | - Oskar Angenete
- Department of Radiology and Nuclear Medicine, St. Olav Hospital HF, Trondheim, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Thomas A Augdal
- Section for Paediatric Radiology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT The Arctic University of Norway, Norway.
| | - Karen Rosendahl
- Department of Clinical Medicine, UiT The Arctic University of Norway, Norway.
| | - Radovan Jiřík
- Institute of Scientific Instruments of the Czech Academy of Sciences, Brno, Czechia.
| | - Renate Grüner
- Department of Physics and Technology, University of Bergen, Bergen, Norway; Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Bergen, Norway; Department of Radiology, Haukeland University Hospital, Bergen, Norway.
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Calderon MF, Nucci RAB, de Souza RR. Age-related changes in the articular cartilage of the mandible of rats. Acta Histochem 2020; 122:151501. [PMID: 31892437 DOI: 10.1016/j.acthis.2019.151501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/22/2019] [Accepted: 12/23/2019] [Indexed: 12/31/2022]
Abstract
This study investigated the effects of aging on the articular cartilage of the mandible. Wistar rats were divided in two groups (n = 10/per group): 3-months-old group (young group); and 13-months-old group (aged group). After euthanasia, the head of the mandible was collected and stained with hematoxylin and eosin (HE) to evaluate the thickness of the articular layer and cartilage. Sections stained with Picrosirius red and Safranin O were used to evaluate the collagen and proteoglycans deposition, respectively. First, aging has decreased the articular layer thickness. Second, the results suggest a decrease of chondrocytes followed by an increase of the matrix to maintain the mandible homeostasis. Finally, both collagen and proteoglycans increased with aging. Aging displayed important effects to the mandible of aged rats.
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Affiliation(s)
- M F Calderon
- School of Dentistry, Uninove University, São Paulo, Brazil
| | - R A B Nucci
- Department of Pathology, University of São Paulo Medical School, São Paulo, Brazil.
| | - R R de Souza
- Department of Anatomy, Institute of Biomedical Sciences of University of São Paulo, São Paulo, Brazil
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Bernini JM, Kellenberger CJ, Eichenberger M, Eliades T, Papageorgiou SN, Patcas R. Quantitative analysis of facial asymmetry based on three-dimensional photography: a valuable indicator for asymmetrical temporomandibular joint affection in juvenile idiopathic arthritis patients? Pediatr Rheumatol Online J 2020; 18:10. [PMID: 32005249 PMCID: PMC6995089 DOI: 10.1186/s12969-020-0401-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/06/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) can cause osseous deformity in the temporomandibular joint (TMJ) and may impair mandibular growth. This study aimed to evaluate whether facial asymmetry determined clinically or by morphometric analysis of three-dimensional (3D) photographs in JIA patients is associated with an asymmetric affection of theTMJ. METHODS Of 76 consecutive JIA patients with a mean age of 11.7 years (range: 6.3-17.9), facial asymmetry was evaluated clinically (chin asymmetry, gonion asymmetry), and stereophotogrammetrically with 3D photographs. The facial surfaces were demarcated, then mirrored, superimposed using semi-automated landmarks, and quantitatively assessed (chin asymmetry, Hausdorff distances). Clinical and digital measurements were related to the diagnosis of right and left TMJ involvement derived from magnetic resonance images (MRI). RESULTS Twenty-seven (34%) patients had an asymmetrical osseous deformity of the TMJ. By clinical evaluation, chin asymmetry was related to asymmetrical osseous destruction (p = 0.02), but gonion asymmetry was not (p = 0.14). In regard to 3D-photograph based morphometric measurements, chin asymmetry was also related to asymmetrical osseous destruction (p = 0.01), but neither the mean (p = 0.06) nor the maximal Hausdorff distance (p = 0.67). Despite the attested significance, none of the chin asymmetry evaluation methods appeared to hold sufficient predictive value (positive predictive values ≤54%; coefficient of determination ≤7%). CONCLUSIONS For the assessment of facial asymmetry in JIA patients, morphometric measurements originating from 3D-photographs seem to deliver results comparable to the clinical assessment methods. The asymmetry of the face, especially around the chin, appears to be related to asymmetrical TMJ destruction, but none of the investigated measurement methods of the face were able to reliably predict the TMJ affection. Thus, facial asymmetry assessments, both qualitatively in a clinical setting and quantitatively based on 3D-photographs, have limited diagnostic value for TMJ involvement in JIA patients.
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Affiliation(s)
- Joëlle M. Bernini
- 0000 0004 1937 0650grid.7400.3Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich, Plattenstrasse 11, 8032 Zurich, Switzerland
| | - Christian J. Kellenberger
- 0000 0001 0726 4330grid.412341.1Department of Diagnostic Imaging, University Children’s Hospital Zürich, Zurich, Switzerland
| | - Martina Eichenberger
- 0000 0004 1937 0650grid.7400.3Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich, Plattenstrasse 11, 8032 Zurich, Switzerland
| | - Theodore Eliades
- 0000 0004 1937 0650grid.7400.3Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich, Plattenstrasse 11, 8032 Zurich, Switzerland
| | - Spyridon N. Papageorgiou
- 0000 0004 1937 0650grid.7400.3Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich, Plattenstrasse 11, 8032 Zurich, Switzerland
| | - Raphael Patcas
- Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich, Plattenstrasse 11, 8032, Zurich, Switzerland.
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Klenke D, Quast A, Prelog M, Holl-Wieden A, Riekert M, Stellzig-Eisenhauer A, Meyer-Marcotty P. TMJ pathomorphology in patients with JIA-radiographic parameters for early diagnosis. Head Face Med 2018; 14:15. [PMID: 30223858 PMCID: PMC6142390 DOI: 10.1186/s13005-018-0173-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 09/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is often accompanied by pathomorphological changes to the temporomandibular joint (TMJ). By analyzing orthodontical orthopantomograms of JIA patients the aims of the study were a) classification of condyle changes, b) quantification of bony asymmetries of condylar destruction and c) detection of relationships between disease duration and TMJ-involvement. PATIENTS/METHODS 46 caucasian JIA-patients (28 female; 18 male; < 16.0 years) were enrolled, each joint (n = 92) was morphologically assessed by means of orthopantomogram, quantitatively analysed and compared with duration of general disease. Condyle morphology was assessed using the Billiau scale for severity of destruction [1]. The quantitative analysis was based on ratios of condyle, ramus and mandible height. RESULTS Patients were divided into groups (Group I - slightly affected, n = 36; Billiau severity 0-2; condyle findings: X-ray normal, condyle erosions, condylar flattening; Group II - severely affected, N = 10; Billiau severity 3-4; condyle findings: condylar flattenings and erosions, unilateral/bilateral complete loss of condyles), based on morphological analysis of condylar destruction. Duration of disease was significantly longer in Group II (8.9 ± 5.2 years) than in Group I (4.6 ± 4.7 years). Asymmetries of condyle, ramus and mandible height, quantitatively analysed by contralateral comparison, were significantly more marked in patients of Group II than of Group I. CONCLUSIONS Orthopantomogram imaging can be used in orthodontics clinical routine to detect TMJ-pathologies and is an important reference for monitoring progression of JIA. Classification into severe and slightly affected TMJ is possible by analysis of condylar pathomorphology. An association between degree of destruction, extent of lower jaw asymmetry and disease duration is suggested by the results.
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Affiliation(s)
- Daniela Klenke
- Department of Orthodontics, University Medical Centre Göttingen, Poliklinik für Kieferorthopädie Robert-Koch-Str. 40 D-, 37075, Goettingen, Germany.
| | - Anja Quast
- Department of Orthodontics, University Medical Centre Göttingen, Poliklinik für Kieferorthopädie Robert-Koch-Str. 40 D-, 37075, Goettingen, Germany
| | - Martina Prelog
- Paediatric Department, Paediatric Rheumatology, Würzburg University Hospital, Würzburg, Germany
| | - Annette Holl-Wieden
- Paediatric Department, Paediatric Rheumatology, Würzburg University Hospital, Würzburg, Germany
| | - Maximilian Riekert
- Department of Orthodontics, Würzburg University Hospital, Würzburg, Germany
| | | | - Philipp Meyer-Marcotty
- Department of Orthodontics, University Medical Centre Göttingen, Poliklinik für Kieferorthopädie Robert-Koch-Str. 40 D-, 37075, Goettingen, Germany
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Stoll ML, Kau CH, Waite PD, Cron RQ. Temporomandibular joint arthritis in juvenile idiopathic arthritis, now what? Pediatr Rheumatol Online J 2018; 16:32. [PMID: 29695255 PMCID: PMC5918758 DOI: 10.1186/s12969-018-0244-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/04/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Arthritis involving the temporomandibular joint (TMJ) complicates 40 - 96% of cases of juvenile idiopathic arthritis (JIA), potentially leading to devastating changes to form and function. Optimal evaluation and management of this joint remains a matter of ongoing discussion. METHODS We performed a PubMed search for all articles with keywords "temporomandibular" and "arthritis", covering the dates 2002 through February 28, 2018. A separate PubMed search was performed for all articles with keywords "temporomandibular joint", "arthritis", and "treatment" covering the same dates. FINDINGS The TMJ is a particularly challenging joint to assess, both clinically and with imaging studies. Clinical assessment of the TMJ is hampered by the low sensitivity of joint pain as well as the absence of physical exam findings early in the disease process. As with all joints, plain radiography and computed tomography only detect arthritic sequelae. Additionally, there is mixed data on the sensitivity of ultrasound, leaving magnetic resonance imaging (MRI) as the optimal diagnostic modality. However, several recent studies have shown that non-arthritic children can have subtle findings on MRI consistent with TMJ arthritis, such as joint effusion and contrast enhancement. Consequently, there has been an intense effort to identify features that can be used to differentiate mild TMJ arthritis from normal TMJs, such as the ratio of the enhancement within the TMJ itself compared to the enhancement in surrounding musculature. With respect to treatment of TMJ arthritis, there is minimal prospective data on medical therapy of this complicated joint. Retrospective studies have suggested that the response to medical therapy of the TMJ may lag behind that of other joints, prompting use of intraarticular (IA) therapy. Although most studies have shown short-term effectiveness of corticosteroids, the long-term safety of this therapy on local growth as well as on the development of IA heterotopic bone have prompted recommendations to limit use of IA corticosteroids. Severe TMJ disease from JIA can also be managed non-operatively with splints in a growing child, as well as with surgery. CONCLUSION In this review, we summarize literature on the diagnosis and management of TMJ arthritis in JIA and suggest a diagnostic and therapeutic algorithm for children with refractory TMJ arthritis.
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Affiliation(s)
- Matthew L. Stoll
- 0000000106344187grid.265892.2Department of Pediatrics, University of Alabama at Birmingham (UAB), 1600 7th Avenue South, Children’s Park Place North Suite G10, Birmingham, 35233 AL USA
| | - Chung H. Kau
- 0000000106344187grid.265892.2Department of Orthodontics, UAB, 1720 2nd Avenue South, School of Dentistry Building 305, Birmingham, 35294 AL USA
| | - Peter D. Waite
- 0000000106344187grid.265892.2Department of Oral and Maxillofacial Surgery, UAB, 1720 2nd Avenue South, School of Dentistry Building 419, Birmingham, 35294 AL USA
| | - Randy Q. Cron
- 0000000106344187grid.265892.2Department of Pediatrics, University of Alabama at Birmingham (UAB), 1600 7th Avenue South, Children’s Park Place North Suite G10, Birmingham, 35233 AL USA
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Temporomandibular Joint Septic Arthritis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1648. [PMID: 29464173 PMCID: PMC5811303 DOI: 10.1097/gox.0000000000001648] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 12/04/2017] [Indexed: 12/15/2022]
Abstract
Infection of the temporomandibular joint (TMJ) is a rare pediatric condition resulting from the introduction of pathogens into the joint by hematogenous seeding, local extension, or trauma. Early recognition of the typical signs and symptoms including fever, trismus, preauricular swelling, and TMJ region tenderness are critical in order to initiate further evaluation and prevent feared complications of fibrosis, ankylosis, abnormal facial structure, or persistence of symptoms. Contrast-enhanced computed tomography with ancillary laboratory analysis including erythrocyte sedimentation rate, C-reactive protein, and white blood cell count are beneficial in confirming the suspected diagnosis and monitoring response to therapy. Initial intervention should include empiric parenteral antibiotics, early mandibular mobilization, and joint decompression to provide synovial fluid for analysis including cultures. This report describes a case of TMJ bacterial arthritis in a healthy 6-year-old male who was promptly treated nonsurgically with intravenous antibiotics and localized needle joint decompression with return to normal function after completion of oral antibiotics and physical therapy.
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Young A. Idiopathic condylar resorption: The current understanding in diagnosis and treatment. J Indian Prosthodont Soc 2017; 17:128-135. [PMID: 28584413 PMCID: PMC5450893 DOI: 10.4103/jips.jips_60_17] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 03/29/2017] [Indexed: 02/06/2023] Open
Abstract
Idiopathic condylar resorption (ICR) is a condition with no known cause, which manifests as progressive malocclusion, esthetic changes, and often pain. Cone-beam computed tomography and magnetic resonance imaging are the most valuable imaging methods for diagnosis and tracking, compared to the less complete and more distorted images provided by panoramic radiographs, and the higher radiation of 99mtechnetium-methylene diphosphonate. ICR has findings that overlap with osteoarthritis, inflammatory arthritis, physiologic resorption/remodeling, congenital disorders affecting the mandible, requiring thorough image analysis, physical examination, and history-taking. Correct diagnosis and determination of whether the ICR is active or inactive are essential when orthodontic or prosthodontic treatment is anticipated as active ICR can undo those treatments. Several treatments for ICR have been reported with the goals of either halting the progression of ICR or correcting the deformities that it caused. These treatments have varying degrees of success and adverse effects, but the rarity of the condition prevents any evidence-based recommendations.
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Affiliation(s)
- Andrew Young
- Department of Diagnostic Sciences, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, CA 94103, USA
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