Liete Figueiredo Zwir

Anatomic and dynamic aspects of stomatognathic structures in osteogenesis imperfecta: a case report.

Abstract The osteogenesis imperfecta congenita (OMIM 166210) type II phenotype can be caused by mutation in either the COL1A1 gene or the COL1A2 gene that encode the chains of type I procollagen, the major protein in bones. Patients can therefore present a combination of features, including multiple long bone fractures and deformities, growth deficiency, joint laxity, hearing loss, blue sclera, and dentinogenesis imperfecta. The purpose of this study is to describe a clinical case of this syndrome, focusing on the anatomy of the temporomandibular joint (TMJ) that was assessed using computed tomography (CT) method. Clinical examination included evaluation of mandibular dynamics and investigation of temporomandibular dysfunction (TMD).

Radiological findings and dynamic aspects of stomatognathic structures in Treacher Collins syndrome: clinical case report.

Treacher Collins syndrome usually affects bilateral and symmetric structures that include the orbits, mandible, and ears. The purpose of this report is to describe a clinical case of the syndrome, focusing on the anatomy of the temporomandibular joint, which was assessed using the computed tomography method. Clinical examination included evaluation of mandibular dynamics, investigation of temporomandibular dysfunction, and measurement of bite force. Significant morphological and functional alterations were observed but without significant documented clinical consequences.

Frequency and Location of Referred Pain in Patients with Temporomandibular Disorder

Basado en la encuesta de registros relativos a la ubicacion y frecuencia de dolor referido en pacientes con trastorno temporomandibular al palpar ciertas areas preestablecidas, propusimos una division topografica anatomica de cabeza y cuello para permitir la estandarizacion y reproducibilidad de los lugares de dolor referido. Al examinar los graficos de 835 sujetos, 419 un (50,2%) de los pacientes reportaron dolor referido a la palpacion de las regiones sobre la base de los Criterios Diagnosticos para la Investigacion de Trastornos Temporomandibulares (CDI/TTM) y palpacion de la region cervical, con analisis de frecuencia con prueba de Cochran Q. El coeficiente de concordancia de Kendall examino la correlacion entre las regiones de dolor referido en relacion a los sitios palpados. Las regiones nuevas fueron definidas como, pre-auricular, facial lateral, temporoparietal, cabeza posterior, posterior y lateral cervical, cervical anterior y boveda craneal. La region de palpado en la cual se origino el dolor mencionado con mayor frecuencia, corresponde al musculo masetero, seguido por la region del musculo esternocleidomastoideo, independientemente del lado palpado. Durante la palpacion de las regiones establecidas por los CDI/TTM, la zona mas frecuente de dolor referido fue la region facial lateral. A la palpacion del cuello, el dolor referido se reporto en la parte posterior y en las regiones cervicales laterales. Los sitios en los que se origino el mayor dolor referido a la palpacion, fueron los musculos maseteros, musculos temporales, esternocleidomastoideo y trapecio.

THU0322 Does intense synovial enhancement in temporomandibular joints of juvenile idiopathic arthritis patients correlate with disease activity

Background The temporomandibular joint (TMJ), like any other synovial joint, may be involved in Juvenile Idiopathic Arthritis (JIA). According to the literature, the frequency of TMJ involvement varies from 17-87%, depending on the population under study, on the subtypes of the disease and on the method used to evaluate joint involvement. Condylar damage may be present early in the disease course and progress even in absence of clinically detectable symptoms or signs. Gadolinium-enhanced magnetic resonance imaging (MRI) is considered to be the gold standard in diagnosing early inflammatory changes of the TMJ in patients with JIA. Objectives The aims of our longitudinal study were to perform a comprehensive clinical evaluation of temporomandibular joint (TMJ) and to investigate the association between the magnetic resonance imaging (MRI) and clinical findings in TMJs and the disease activity of patients with JIA. Methods Seventy five patients with JIA participated in this study and were divided into 3 groups: patients with active disease, patients with clinical remission on medication and patients with clinical remission off medication. Thirty-nine patients had oligoarticular course and 36 had poliarticular/ systemic course. All patients underwent a rheumatologic examination performed by a pediatric rheumatologist, a TMJ examination performed by a dentist and MRI of the TMJs. These examinations were scheduled at the same date. The patients were examined again with one-year interval. Results The mean age at diagnosis was 6.0 years and the mean age at the first examination was 12.4 years. According to the degree of activity at the first examination, 33 patients were characterized as active, 21 were in remission on medication and 21 were in remission off medication. At the second examination, 21 patients were active, 28 were in remission on medication and 26 in remission off medication. At the first examination no symptoms were reported in 47 (62.7%) of patients and at the second evaluation in 64 (85.3%). The most common symptoms were pain in function, TMJ sounds and pain at rest. Synovial enhancement was present in 70 (93.3%) patients at the first phase exams compared with 65 (86.7%) at the second phase, one year apart. Intense contrast enhancement was significantly associated with active disease only at the first evaluation (p=0.0008), with poly/systemic subtypes at both evaluations (p=0.028 and p=0.049 respectively), with the presence of erosions at both evaluations (p=0.0001 and p<0.0001 respectively) and with altered condylar shape at the second evaluation (p=0.0005). Conclusions The TMJ should always be evaluated in JIA patients even in the absence of signs and symptoms; accordingly to the current established concepts TMJ synovial enhancement could be present even in patients in remission; although synovial enhancement is considered the gold standard in assessing TMJ involvement, we should be cautious in interpreting this finding. Disclosure of Interest None Declared

Prevalence of degenerative joint disease of the temporomandibular joint: a systematic review

ObjectivesThe purpose of this systematic review was to evaluate evidence about the prevalence of degenerative joint disease (DJD) of the temporomandibular joints (TMJ).Materials and methodsWe performed search on electronic databases and gray literature from their inception to January 2018. Studies reporting prevalence data of DJD on TMJ were included. DJD was assessed through clinical and imaging diagnosis. Studies risk of bias was evaluated using the Critical Appraisal Checklist for Studies Reporting Prevalence Data.ResultsFrom 1082 studies, 32 were identified, and the sample size included 3435 subjects. They were clustered into two groups: the first comprised studies that reported prevalence of DJD in TMJ secondary to rheumatic systemic diseases like juvenile idiopathic arthritis (JIA) and rheumatoid arthritis (RA) and the second group comprised studies that reported prevalence of DJD on temporomandibular disorder patients. The prevalence of DJD on JIA patients ranged from 40.42% (n = 47) to 93.33% (n = 15) and on RA patients from 45.00% (n = 20) to 92.85% (n = 56). Among TMD patients, the prevalence of DJD reported according to patients ranged from 18.01% (n = 1038) to 84.74% (n = 118) and reported according to joints ranged from 17.97% (n = 178) to 77.23% (n = 224).ConclusionThis review attempts to high prevalence of DJD in patients with systemic rheumatic disease and a less prevalent, but still high, occurrence in patients with TMD without systemic involvement.Clinical relevanceSpecialist doctors and dentists should be alert to not underestimate and to correctly diagnose DJD of the TMJ early in patients with rheumatic disease and TMD.

PReS-FINAL-2261: Prevalence of orofacial symptoms and signs in patients with juvenile fibromyalgia

Fibromyalgia may coexist with other clinical conditions such temporomandibular disorders (TMD). Temporomandibular disorder is a term embracing clinical disorders that involve the masticatory musculature, the temporomandibular joints, and associated structures.