Multidisciplinary approach in the management of absolute trismus with bilateral temporomandibular joint replacements for a patient with juvenile idiopathic arthritis.

Juvenile idiopathic arthritis (JIA) is an exclusion diagnosis that gathers together all forms of arthritis that begin before the age of 16 years, persist for more than 6 weeks and are of unknown origin. We present the case of a 42 year old woman with a 20 year history of absolute trismus, secondary to bilateral temporomandibular joint (TMJ) ankylosis caused by JIA. The trismus resulted in grossly compromised oral hygiene and limited the patient to a semi-solid diet. JIA also affected her neck leading to a severe cervico-thoracic kyphosis. The patient who had been wheelchair bound developed severe lymphoedema of both lower limbs, complicating the pre-operative work up further. This particularly challenging case required input from specialists in anaesthetics, neurosurgery, special care dentistry, intensive care and maxillofacial surgery. Treatment consisted of ankylosis release, dental clearance and bilateral alloplastic replacement of her TMJs with custom implants. A full range of hinge movement and good functional outcome was achieved. This case presents the multidisciplinary approach to a severely compromised patient and illustrates the pre-, intra- and postoperative management of bilateral TMJ ankylosis with bespoke implants.

Oral Cancer Diagnosis in Primary Care.

The incidence of oral cancer in the UK is rising, with approximately 7,300 new cases diagnosed in 2012. The number of oral cancer cases in the UK has risen by more than a quarter in the last decade. Mouth cancer is within the ten most common cancers encountered among men in the UK. Primary care practitioners, both in a dental and medical setting, have a role in the early diagnosis of oral malignancy, and in providing patients with information regarding risk factors such as smoking, alcohol and betel quid use. The purpose of this paper is to present the epidemiology and risk factors related to oral cancer and particularly review the literature regarding the level of awareness and practice in primary care as recorded in relevant research.