Gout of the Temporomandibular Joint: Report of a Case

Oliveira, Isaac Nilton Fernandes; Gomes, Renata Caroline Ferreira; Santos, Raiane Rodrigues dos; Oliveira, Thiago de Paula; Pereira, Larissa Loiuse Cândida; Mainenti, Pietro

doi:10.1055/s-0033-1363464

“…Bei Gicht handelt es sich um eine metabolische Erkrankung, die durch Hyperurikämie verursacht wird und zur Ablagerung von Natriumuratkristallen in Gelenken und Weichgeweben führen kann. Zu einer maxillofazialen Beteiligung kommt es nur selten und bislang liegen nur wenige Berichte von Fällen mit Anomalien des Kiefergelenks vor [52]. Gicht im Bereich des Kiefergelenks kann zu einer begrenzten Mundöffnung mit Seitenabweichung des Unterkiefers, Schmerzen und Schwellung führen [52].…”

Section: Gichtunclassified

“…Bei Gichtpatienten können gut umschriebene Erosionen mit sklerotischem Randsaum und überhängenden Ecken vor dem Hintergrund eines ansonsten erhaltenen Knochens beobachtet werden [53]. Ein Gichtbefall des Kiefergelenks kann zu einer abnormen Morphologie der Kondylen führen [52]. In MRT-Aufnahmen zeigen sich eine Verdickung der Synovialmembran mit intermediärer T1w und hoher T2w Signalintensität und peripherer Kontrastmittelanreicherung (Gichttophus) [54], ein Gelenkerguss und ein Ödem im Bereich des benachbarten Knochenmarks und Weichgewebes [53].…”

Section: Gichtunclassified

Kraniofaziale Manifestationen von systemischen Erkrankungen: CT- und MRT-Befunde

Arasa¹,

Chapman²,

Kuno³

et al. 2019

Neuroradiol Scan

0

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Many systemic diseases or conditions can affect the maxillofacial bones; however, they are often overlooked or incidentally found at routine brain or head and neck imaging performed for other reasons. Early identification of some conditions may significantly affect patient care and alter outcomes. Early recognition of nonneoplastic hematologic disorders, such as thalassemia and sickle cell disease, may help initiate earlier treatment and prevent serious complications. The management of neoplastic diseases such as lymphoma, leukemia, or Langerhans cell histiocytosis may be different if diagnosed early, and metastases to the maxillofacial bones may be the first manifestation of an otherwise occult neoplasm. Endocrinologic and metabolic disorders also may manifest with maxillofacial conditions. Earlier recognition of osteoporosis may alter treatment and prevent complications such as insufficiency fractures, and identification of acromegaly may lead to surgical treatment if there is an underlying growth hormone-producing adenoma. Bone dysplasias sometimes are associated with skull base foraminal narrowing and subsequent involvement of the cranial nerves. Inflammatory processes such as rheumatoid arthritis and sarcoidosis may affect the maxillofacial bones, skull base, and temporomandibular joints. Radiologists should be familiar with the maxillofacial computed tomographic and magnetic resonance imaging findings of common systemic disorders because these may be the first manifestations of an otherwise unrevealed systemic process with potential for serious complications.

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“…Gout is a metabolic disorder caused by hyperuricemia that may result in deposition of sodium urate crystals in joints and soft tissues. Maxillofacial involvement is uncommon, and only a few cases of TMJ abnormalities have been reported (52). TMJ gout may cause limited mouth opening, with mandibular deviation, pain, and swelling (52).…”

Section: Goutmentioning

confidence: 99%

“…In patients with gout, well-circumscribed erosions with sclerotic margins and overhanging edges can be seen in a background of otherwise preserved bone (53). TMJ involvement from gout may result in abnormal condylar morphology (52). MR imaging shows thickening of the synovial membrane with intermediate T1 and high T2 signal intensity and peripheral enhancement (gouty tophus) (54), joint effusion, and edema in the adjacent bone marrow and soft tissues (53).…”

Section: Goutmentioning

confidence: 99%

Craniofacial Manifestations of Systemic Disorders: CT and MR Imaging Findings and Imaging Approach

Arasa

¹

,

Chapman

²

,

Kuno

³

et al. 2018

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Many systemic diseases or conditions can affect the maxillofacial bones; however, they are often overlooked or incidentally found at routine brain or head and neck imaging performed for other reasons. Early identification of some conditions may significantly affect patient care and alter outcomes. Early recognition of nonneoplastic hematologic disorders, such as thalassemia and sickle cell disease, may help initiate earlier treatment and prevent serious complications. The management of neoplastic diseases such as lymphoma, leukemia, or Langerhans cell histiocytosis may be different if diagnosed early, and metastases to the maxillofacial bones may be the first manifestation of an otherwise occult neoplasm. Endocrinologic and metabolic disorders also may manifest with maxillofacial conditions. Earlier recognition of osteoporosis may alter treatment and prevent complications such as insufficiency fractures, and identification of acromegaly may lead to surgical treatment if there is an underlying growth hormone-producing adenoma. Bone dysplasias sometimes are associated with skull base foraminal narrowing and subsequent involvement of the cranial nerves. Inflammatory processes such as rheumatoid arthritis and sarcoidosis may affect the maxillofacial bones, skull base, and temporomandibular joints. Radiologists should be familiar with the maxillofacial computed tomographic and magnetic resonance imaging findings of common systemic disorders because these may be the first manifestations of an otherwise unrevealed systemic process with potential for serious complications. Online supplemental material is available for this article. RSNA, 2018.

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“…Because of that, it is important that, before any dental intervention, differential diagnosis is made, requiring medical assessment to rule out the possibility of presence of systemic pathologies with similar TMD symptoms, as gout, 7 osteosarcoma 8 and pseudotumor 9 in TMJs, Eagle’s syndrome, 10 fibromyalgia, 11 rheumatoid arthritis 12 and trigeminal neuralgia. 13 …”

Section: Final Considerationsmentioning

confidence: 99%

Class II Division 2 subdivision left malocclusion associated with anterior deep overbite in an adult patient with temporomandibular disorder

Maruo

¹

2017

Dental Press J. Orthod.

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The orthodontic treatment of patients with chief complaint of temporomandibular disorders (TMD) presents doubtful prognosis, due to the poor correlation between malocclusions and TMDs. The present case report describes the treatment of an adult patient with Angle Class II Division 2 subdivision left malocclusion associated with anterior deep overbite and TMD. This case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO), as part of the requirements to obtain the title of BBO Diplomate.

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Gout of the Temporomandibular Joint: Report of a Case

Cited by 12 publications

References 5 publications

Kraniofaziale Manifestationen von systemischen Erkrankungen: CT- und MRT-Befunde

Kraniofaziale Manifestationen von systemischen Erkrankungen: CT- und MRT-Befunde

Craniofacial Manifestations of Systemic Disorders: CT and MR Imaging Findings and Imaging Approach

Class II Division 2 subdivision left malocclusion associated with anterior deep overbite in an adult patient with temporomandibular disorder

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