Osteochondritis dissecans of the temporomandibular joint

Abstract

A case is reported of a 43-year-old female patient presenting bilateral osteochondritis dissecans (OCD) of the temporomandibular joint (TMJ), in different stages for each side, associated with avascular necrosis (AVN) of the right condyle. Additionally observed was anterior disk displacement without reduction for both sides. We have proposed an adaptation of the previous classification of OCD for cases affecting the TMJ. We have also stressed the fundamental role of panoramic radiography on the diagnosis of stage 3 and stage 4 OCD of the TMJ. In relation to MRI, we have recommended sagittal (slice thickness of 2 mm) and coronal (slice thickness of 1 mm) fast spin-echo proton density-weighted sequences to better identify bone lesions (stage 1 and 2) and also localize osteochondral loose bodies; and coronal (slice thickness of 1 mm) fat-suppressed fast spin-echo T2 weighted sequence to better evaluate OCD (stable or unstable) and the features of the occasionally associated AVN (acute or chronic).

Analysis of magnetic resonance imaging characteristics and pain in temporomandibular joints with and without degenerative changes of the condyle

“…These alterations are considered to be radiological signs of osteoarthritis (OA) and have been demonstrated in painful TMJs 1,7,8,22 . Osteochondritis dissecans is frequently found in association with avascular necrosis 2,31 , and thus they have been considered similar conditions that may represent a spectrum of the same pathophysiology (bone necrosis) 34 .…”

The temporomandibular joint of California sea lions (Zalophus californianus): Part 2-osteoarthritic changes

“…29 Although it is difficult to assert the cause of OCD, possible factors may be focal trauma, abnormal ossification, avascular necrosis, genetic factors or combination of these factors. 28,30 Importantly, in humans it can be symptomatic causing pain, swelling and limited jaw movement or it can be entirely asymptomatic.…”

Frequency, location, morphology and aetiology of osseous mandibular condylar concavities

“…Schellhas et al (1989:551) also suggested that mandibular condyle OCD is relatively common and often associated with internal derangement of the TMJ. While OCD in general can occur in both adolescents and adults, it tends to be more common in males (Campos et al, 2005). When considering OCD as a candidate for the condylar concavities described in this study, it is important to note Bohndorf (1998:106): '[a]s a general rule, most OCD lesions occur at the weight-bearing convex cartilage'.…”

“…OCD is characterised by necrosis of the subchondral bone which can become detached and form a loose body within the joint space (Campos et al, 2005). While there is a rich literature on the aetiology of OCD, Bohndorf (1998:105) summarised the consensus view implicating joint overuse and/or repetitive microtrauma as particularly important.…”