Arthroscopy of Temporomandibular Joint in Children with Juvenile Idiopathic Arthritis

Brian E. Kinard DMD, Department of Surgery; Division of Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, GA
Gary F. Bouloux MD, DDS, MDSc, Department of Surgery; Division of OMS, Emory School of Medicine, Atlanta, GA
Shelly Abramowicz DMD, MPH, Emory School of Medicine, Atlanta, GA
Sampath Prahalad MD, Division of Pediatric Rheumatology, Emory School of Medicine, Atlanta, GA
Purpose:

The management of temporomandibular joint (TMJ) involvement in post-pubescent children with juvenile idiopathic arthritis (JIA) has been reported.1,2 However, it has not yet been established in pre-pubescent children. The purpose of this study is to report arthroscopic findings and results in children with JIA.

Patients and Methods:

This was a retrospective case series of children with JIA evaluated at Emory University, Division of Oral and Maxillofacial Surgery.  Patients were included if they had a confirmed diagnosis of JIA, failed to respond to anti-rheumatological medication, had TMJ pain and limited mouth opening. Medical records, magnetic resonance imaging, arthroscopic findings and results were reviewed.  

Results:

Five joints underwent arthroscopy followed by injection of 1-2 mL of 40 mg/mL triamcinolone (Kenalog). The mean age was 12.5 years. All subjects were female.   Arthroscopic findings consisted of mild to moderate synovitis and grade II-IV chondromalacia with or without fibrosis. Post-operatively, all patients had improvement in pain and mouth opening. 

Patient

Type of JIA

Chief complaint

Intervention

Outcome

LS

Oligoarticular

Unable to chew Right TMJ pain

Right arthroscopy with Kenalog

Decreased pain, return to normal diet

IT

Oligoarticular

Decreased MIO  Bilateral  TMJ pain

Bilateral arthroscopy with Kenalog

Improved right TMJ pain. Continued left TMJ pain

AJ

Polyarticular

clicking and popping, pain

Bilateral arthroscopy with Kenalog

No pain, improved mouth opening 

Conclusions:

TMJ involvement in children with JIA is typically associated with synovitis, chondromalacia and fibrosis. Arthroscopic lysis and lavage combined with steroid injection results in significant improvement in pain and range of motion in prepubescent subjects.

References:

(1) Mehra, P., Wolford, L. M., Baran, S., Cassano, D. S. Single-stage comprehensive surgical treatment of the rheumatoid arthritis temporomandibular joint patient. J Oral and Maxillofac Surg. 67(9), 1859–1872 

(2) Stringer, D. E., Gilbert, D. H., Herford, A. S., & Boyne, P. J. A method of treating the patient with postpubescent juvenile rheumatoid arthritis. J Oral and Maxillofac Surg. 65(10), 1998–2004