The early diagnosis of temporomandibular joint (TMJ) involvement in patients with juvenile idiopathic arthritis (JIA) before joint destruction and growth disturbances could allow for interceptive treatment. The purpose of this article is to report early TMJ arthroscopic findings in patients with JIA.
This was a case series of 3 patients with JIA treated at the Emory University Division of Oral and Maxillofacial Surgery from July 2011 through December 2012. Patients were included if they had a confirmed diagnosis of JIA, did not respond to anti-rheumatologic medication, and had TMJ pain or limited mouth opening. All patients underwent TMJ arthroscopy with an injection of triamcinolone hexacetonide. Demographics, medical history, magnetic resonance imaging findings, arthroscopic findings, and postoperative course were reported.
Three female patients (mean age, 12.5 yr; 5 joints) underwent arthroscopy. Arthroscopic findings consisted of mild to moderate synovitis and grade 2 to 4 chondromalacia with or without fibrosis. Postoperatively, all patients had improvement in pain and mouth opening.
There was a positive correlation between duration of JIA activity in the TMJ and severity of arthroscopic findings. Arthroscopic lysis and lavage combined with triamcinolone hexacetonide injection resulted in improvement in pain and range of motion.