Hipoplasia condilar de provável origem otológica

Abstract

The temporomandibular joint is one of the most complex of the human body and the condylar process is responsible for the expression of mandibular growth. The condylar hypoplasia is characterized by a defective formation of the condylar process. The acute otitis media is an inflammatory process, triggered from infections of the nasal cavity, paranasal sinuses and, nasopharynx, propagated through the Eustachian tube. In the presented case, the patient had facial asymmetry since the first year of life, and recurring cases of otitis just in the early stages of closing the temporotimpânica suture and in the foramen of Huschke, which would facilitate the dissemination of this ear infection which would undermine the development of condyle resulting in hypoplasia identified, only in the right side. Thus, professionals who work in temporomandibular joint and ear regions must have knowledge of the existence and clinical implications of the foramen of Huschke for early diagnosis and prevent the development of facial asymmetry where this association presents with clinical signs of infection of the affected areas, restoring function, aesthetic and, psychological state of the patient. Keywords: Temporomandibular Joint; Facial Asymmetry; Otitis Media RESUMO A articulação temporomandibular é uma das mais complexas do corpo humano sendo o processo condilar responsável pela expressão do crescimento mandibular. A hipoplasia condilar é caracterizada por uma formação defeituosa do processo condilar. A otite média aguda é um processo inflamatório, desencadeada a partir de infecções das fossas nasais, cavidades paranasais e rinofaringe, propagadas por meio da tuba auditiva. No caso apresentado, a paciente apresentava assimetria facial desde o primeiro ano de vida, além de recorrentes casos de otite justamente nos estágios iniciais do fechamento da sutura temporotimpânica e do forame de Huschke o que facilitaria a disseminação dessa infecção otológica o que comprometeria o desenvolvimento do côndilo resultando na hipoplasia identificada, somente do lado direito. Assim, os profissionais que atuam na região da articulação temporomandibular e ouvido devem ter o conhecimento da existência e das implicações clínicas do forame de Huschke para um diagnóstico precoce e evitar o desenvolvimento das assimetrias faciais nos casos em que esta apresenta associação com sinais clínicos de infecção das áreas afetadas, restabelecendo função, estética e o estado psicoló-gico do paciente.

Temporomandibular joint alterations: two clinical case-reports of bifid condyle and temporomandibular joint ankylosis

“…Youngsters are at greater risk for otological infections, due to the immaturity of the auditory tube, and they do not yet have complete bone development of the temporal bone, glenoid cavity, and TMJ. This combination of factors places this age group at high risk for dissemination of infection among these distinct anatomic regions 4 . In the first case reported, it was not possible to establish a specific cause as etiological agent, since the family members did not report the occurrence of an associated trauma event.…”

“…The embryonic development of this region occurs in the 8th week of intrauterine life, in which two widely areas widely separated by mesenchymal cells have been observed in the region of the mandibular head and articular cavity 4 . During development, morphological and functional changes may occur, such as condylar hyperplasia, post-radiotherapy changes, defects associated with diseases or specific syndromes (primary brachial arch syndrome, mandibulofacial dysostosis), bifid condyle, ankylosis, among others 5 .…”

“…However, this foramen could persist throughout the individual's life. When this occurs, the retrodiscal region of the temporomandibular joint and medial portion of the external auditory canal are separated by soft tissue only, which facilitates the dissemination of infectious processes in the region 4 .…”

Kondylenhypoplasie: Klinischer Fall

“…LKGS tritt zum ersten Mal in der 8. Schwangerschaftswoche auf, wo zwei Bereiche beobachtet werden können, die weit von mesenchymalen Explosionen entfernt sind und nahe der möglichen Position des Unterkieferkondylus und der Fossa glenoidale auftreten (HORN et al, 2016). Knochen und Knorpel werden ungefähr in der 10.…”

“…Schwangerschaftswoche zum ersten Mal im Unterkieferkondylus gesehen (PEDRA et al, 2003). Bei der Geburt sind die Gelenkflächen von fibrösem Bindegewebe bedeckt, im Laufe der Zeit wandelt sich das Gewebe langsam in Faserknorpel um und im gleichen Zeitraum kommt es zu einer Vertiefung der Gelenkfossa (HORN et al, 2016). Der Kopf des Unterkiefers spielt eine sehr wichtige Rolle im Gelenk, da er für die Expression des Unterkieferwachstums verantwortlich ist (VASCONCELOS et al, 2012 Die Bewertung des Gesichtswachstums ist von großer Bedeutung bei Skelett-, kraniofazialen oder zahnbedingten Gesichtsdeformitäten sowie bei Asymmetrien, die durch hyper-oder kondyläre Hypoplasie verursacht werden (BITTENCOURT et al, 2005) (CISNEROS und KABAN, 1984.…”