RESUMO
Temporomandibular joint (TMJ) involvement is common but usually delayed in patients with juvenile idiopathic arthritis (JIA). We describe the case of a JIA patient with bilateral TMJ involvement, mandibular retrognathia, bone erosion, and severely restricted mouth opening. The use of cone beam computed tomography and a 3D diagnostic protocol in young patients with JIA provides reliable, accurate and precise quantitative data and images of the condylar structures and their dimensional relationships. Analgesics and conventional disease modifying antirheumatic drugs were ineffective, but interdisciplinary treatment with etanercept and a Herbst functional appliance improved functional TMJ movement and bone resorption.
Assuntos
Artrite Juvenil/complicações , Tomografia Computadorizada de Feixe Cônico , Imageamento Tridimensional , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/etiologia , Adolescente , Humanos , MasculinoRESUMO
AIM: The aim of this study was to show the importance of Cone Beam Computerized Tomography (CBCT) to volumetrically quantify temporomandibular joint (TMJ) damage in patients with juvenile idiopathic arthritis (JIA), measuring condylar and mandibular real volumes. Methods. Thirty-four children with temporomandibular involvement by JIA were observed by CBCT. Four were excluded because of several imaging noises. The mandible was isolated from others craniofacial structures; the whole mandibular volume and its components' volumes (condyle, ramus, emibody, emisymphysis on right side and on left side) has been calculated by a 3D volume rendering technique. Results. The results show a highly significant statistical difference between affected side volumetric values versus normal side volumetric values, above all on condyle region (P<0.01), while there was no statistical difference between right versus left side. Conclusion. The CBCT represents a huge improvement in understanding of the condyle and mandibular morphological changes, even in the early stages of the JIA. In children the JIA can lead to TMJ damage with facial development and growth alterations.