JIA & the Temporomandibular Joint: Diagnostic Challenges & Treatment Options

Maxillofacial surgery is often a last resource for severely affected patients for either functional or esthetic reasons. In the biologic era, the need for orthognathic surgery or joint replacement has decreased, and severe growth impairment, such as the bird-face appearance, is rarely seen. Maxillofacial surgical options include orthognathic surgery, distraction osteogenesis and TMJ reconstruction—autogenous or alloplastic. The TMJaw surgical group has developed surgical recommendations for JIA-associated TMJ arthritis describing the timing for the different options.¹³

Conclusion
JIA-associated TMJ arthritis occurs frequently and can have a devastating impact on TMJ function and facial growth and development.

Diagnosis is complicated by the need for a gadolinium-enhanced MRI to confirm the presence of active arthritis and to steer the right treatment. Facial signs and symptoms and dentofacial deformity may progress in well-treated patients.

Patients with TMJ arthritis should receive systemic treatment, and skeletally mature patients should receive intra-articular corticosteroid injections. Symptoms due to TMJ involvement, including TMJ dysfunction, can be treated with orthopedic devices, physiotherapy and, in extreme cases, with surgical intervention. Outcomes improve with early diagnosis and initiation of treatment.

To improve the oral, maxillofacial, health-related quality of life of our JIA patients, rheumatologists need to be aware of the potential involvement of the TMJs in JIA. Monitoring the TMJs during each clinic visit through a standardized clinical examination is necessary.

Dr. Twilt

Marinka Twilt, MD, MSCE, PhD, is an assistant professor of pediatrics at the Cumming School of Medicine, University of Calgary, Alberta, Canada, and a pediatric rheumatologist at the Alberta Children’s Hospital, Calgary.

Peter B. Stoustrup, DDS, PhD, is an associate professor of orthodontics in the Section of Orthodontics, Aarhus University, Denmark.

Dr. Stoustrup

References

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