Clinical-surgical treatment of temporomandibular joint disorder in a psoriatic arthritis patient

Abstract

IntroductionCondylotomy is a surgical procedure that has been used as an option to treat temporomandibular disorder (TMD) patients. This technique has the advantage of avoiding intra-capsular alterations that might be found involving other surgical procedures. Its use, even when unilateral, has positive effect on treatment of both joints.MethodsIn order to better evaluate the benefits of a clinical-surgical treatment for TMD, the present report describes the case of a psoriatic arthritis patient. The case was clinically characterized by dental malloclusion, and imaging exams showed joint degeneration of the right mandibular condyle. The patient was treated by condylotomy technique after a prosthetic oral rehabilitation.ResultsNo clinical-radiological signs or symptoms of progression of articular disease were observed within a period of 16 months after surgery. Furthermore, there was functional stability of the temporomandibular joint, total absence of local pain and improvement of mouth opening.ConclusionThe present study suggests that condylotomy can be considered as a valid option for the management of TMD, since it has low surgical morbidity and favorable clinical outcomes. In this case, the patient had a medical diagnosis of systemic disease presenting general pain and pain at the temporomandibular joint (TMJ), in addition of causal agent of TMD (dental malloclusion). The difficulty of finding a single etiology (malocclusion vs. systemic disease) did not exclude the indication of a clinical-surgical treatment to re-establish the balance of TMJ.

Psoriatic Arthritis Involving TMJ: A Review on Pathogenesis and Consideration on Eventual Gender Differences

“…Another therapy option for treating PsA-TMD is surgery, which is reserved for severe cases where pharmacological therapy was not successful [53]. The surgical therapy options include arthrocentesis, arthroplasty, condylotomy, and custom-made, total TMJ replacement [65][66][67].…”

“…This procedure aims to alleviate pain and improve joint function by reducing inflammation and restoring the balance within the joint [65]. Arthrocentesis has shown promising results in patients with PsA-TMD, particularly in cases where conservative treatments have failed to provide adequate relief [66].…”

Psoriatic arthritis of the temporomandibular joint: A systematic review

“…18,22,23 As a treatment scheme, in five cases were used no-steroidal anti-inflammatory drugs 14,15,18,20,22 ; corticosteroids in four cases, 14,18,19,20 ; chemotherapy agents and immune-system suppressant in four cases 14,15,20,23 ; an occlusal splint in two cases 18,25 ; homeopathy in one case 22 ; and surgical treatment in two cases. 19,25 A positive outcome was reported in eight cases. 15,[18][19][20][21][22][23]25…”

“…panoramic radiography and computed tomography of TMJs, 25 CT scans of her temporomandibular joints, 19,20,22,23,38 panoramic radiograph and CBCT images for advanced imaging of TMJs, 18,21 MRI 15,20,21,[30][31][32][33] and US. 32,33 MRI a considered the gold standard method, when compared to US examinations.…”

“…35 As surgical methods were performed: intra-articular infliximab administration, 23 TMJ condylar shave, bilateral total TMJ replacement, 19 surgical treatment of the removal of the ankylotic block and subsequent arthroplasty, 38 condylotomy. 25 Orthodontic and prosthetic rehabilitation along with stabilisation appliances were used. 25…”