"Multidisciplinary management of post- infective osteoarthritis and secondary condylar resorption of temporomandibular joint: a case report in a 9 years-old female patient and a review of literature"

Abstract

Background: Osteoarthritis and condylar resorption of temporomandibular joint (TMJ) has rarely been reported in children as consequence of otologic disease. We describe the management of a case in a 9-year-old female as long-term complication of an otomastoiditis and review the literature currently available on this topic.

Case presentation: A nine-years-old female patient referred to Emergency Room of Bambino Gesù Children's Research Hospital, IRCCS (Rome,Italy) for an acute pain in the left preauricular area and reduced mandibular movements. In the medical history an otomastoiditis and periorbital cellulitis was reported at the age of six with complete remission of symptoms after antibiotic treatment. No recent history of facial trauma and no previous orthodontic treatment were reported. She was referred to a pediatric dentist that conducted a clinical examination according to the Diagnostic Criteria of Temporomandibular Disorders (DC/TMD) and was diagnosed with bilateral myalgia of the masticatory muscles and arthralgia at the level of the left TMJ. Then, a complete diagnostic path was performed that included multidisciplinary examinations by a rheumatologist, infectious disease specialist, ear nose and throat (ENT) doctor, a maxillofacial surgeon and a medical imaging specialist. Differential diagnosis included juvenile idiopathic arthritis, idiopathic condylar resorption, trauma, degenerative joint disease, neurological disease. Finally, unilateral post-infective osteoarthritis of the left TMJ with resorption of mandibular condyle was diagnosed. The patient went through a pharmacological therapy with paracetamol associated to counselling, jaw exercises and occlusal bite plate. After 1 month, the patient showed significant reduction of orofacial pain and functional recovery that was confirmed also one-year post-treatment. The novelty of this clinical case lies in the accurate description of the multidisciplinary approach with clinical examination, the differential diagnosis process and the management of TMD with conservative treatment in a growing patient.

Conclusions: Septic arthritis of temporomandibular joint and condylar resorption were described as complications of acute otitis media and/or otomastoiditis in children. We evidenced the importance of long-term follow-up in children with acute media otitis or otomastoiditis due to the onset of TMJ diseases. Furthermore, in the multidisciplinary management of orofacial pain the role of pediatric dentist is crucial for the diagnostic and therapeutic pathway to avoid serious impairment of mandibular function.

Keywords: Case report; Child; Osteoarthritis; Temporomandibular disorders; Temporomandibular joint.

Fig. 1

Images of maxillofacial computed tomography (CT) performed 2 years earlier showing both TMJs in coronal view (A), right TMJ in sagittal view (B) and left TMJ in sagittal view (C)

Fig. 2

Intraoral photographs in frontal (A), right lateral (B) and left lateral (C) views

Fig. 3

Evaluation of dynamic mandibular movements by mean of ruler: mouth opening measures 31 mm (A), left laterotrusion measures 6 mm (B), right laterotrusion measures 9 mm (C)

Fig. 4

Images of maxillofacial computed tomography (CT) showing both TMJs in coronal view (A), right TMJ in sagittal view (B) and left TMJ in sagittal view which showed the mandibular condyle significantly erosed (C)

Fig. 5

Intraoral photographs in frontal (A) and right lateral (B) views showing rigid bite plate

Fig. 6

Images of TMJ MRI showing both TMJs in coronal view (A), right TMJ in sagittal view (B) and left TMJ in sagittal view(C)

Fig. 7

Evaluation of dynamic mandibular movements after therapy which shows an improvement in mouth opening (43 mm) (A), left laterotrusion measures 6 mm and right laterotrusion measures 9 mm