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Review
. 2017 Jun;4(2):151-156.
doi: 10.5152/eurjrheum.2016.035. Epub 2017 Feb 23.

Management of the temporomandibular joint in inflammatory arthritis: Involvement of surgical procedures

Rory C O'Connor  1 , Fiona Fawthrop  2 , Rami Salha  3 , Andrew J Sidebottom  4
Affiliations
Review

Management of the temporomandibular joint in inflammatory arthritis: Involvement of surgical procedures

Rory C O'Connor et al. Eur J Rheumatol. 2017 Jun.

Abstract

Many conditions may affect the temporomandibular joint (TMJ), but its incidence in individual joint diseases is low. However, inflammatory arthropathies, particularly rheumatoid and psoriatic arthritis and ankylosing spondylitis, appear to have a propensity for affecting the joint. Symptoms include pain, restriction in mouth opening, locking, and noises, which together can lead to significant impairment. Jaw rest, a soft diet, a bite splint, and medical therapy, including disease-modifying antirheumatic drugs (DMARDs) and simple analgesia, are the bedrock of initial treatment and will improve most symptoms in most patients. Symptom deterioration does not necessarily follow disease progression, but when it does, TMJ arthroscopy and arthrocentesis can help modulate pain, increase mouth opening, and relieve locking. These minimally invasive procedures have few complications and can be repeated. Operations to repair or remove a damaged intra-articular disc or to refine joint anatomy are used in select cases. Total TMJ replacement is reserved for patients where joint collapse or fusion has occurred or in whom other treatments have failed to provide adequate symptomatic control. It yields excellent outcomes and is approved by the National Institute of Health and Care Excellence (NICE), UK. Knowledge of the assessment and treatment of the TMJ, which differs from other joints affected by inflammatory arthritis due to its unique anatomy and function, is not widespread outside of the field of oral and maxillofacial surgery. The aim of this article is to highlight the peculiarities of TMJ disease secondary to rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis and how to best manage these ailments, which should help guide when referral to a specialist TMJ surgeon is appropriate.

Keywords: Temporomandibular joint; ankylosing spondylitis; arthroscopy; joint replacement; psoriatic arthritis; rheumatoid arthritis.

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Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the authors.

Figures

Figure 1
Figure 1
Anatomical location of the TMJ joint space for the injection of local anesthetic or steroid (red circle) TMJ: temporomandibular joint
Figure 2
Figure 2
TMJ Concepts (Ventura, CA, USA) custom-fitting total joint replacement in situ, showing the mandibular ramus component
Figure 3
Figure 3
TMJ Concepts (Ventura, CA, USA) custom-fitting total joint replacement in situ, showing the condylar head articulating with the new prosthetic glenoid fossa
Figure 4
Figure 4
Treatment algorithm for patients with inflammatory arthritis affecting the TMJ OMFS: oral and maxillofacial surgery; TMJ: temporomandibular joint
See this image and copyright information in PMC

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