Physical findings associated with active temporomandibular joint inflammation in children with juvenile idiopathic

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Shelly Abramowicz1, Harlyn K Susarla, Susan Kim

  • 1Assistant Professor, Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, and Attending Surgeon, Boston Children's Hospital, Boston, MA.

Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons
|August 13, 2013
PubMed

Insights

In children with juvenile idiopathic arthritis (JIA), limited maximal incisal opening (MIO) and deviation on opening are key physical indicators of active temporomandibular joint (TMJ) inflammation. These findings help predict TMJ synovitis, aiding clinical assessment.

Area of Science:

  • Pediatric Rheumatology
  • Medical Imaging
  • Orthodontics

Background:

  • Juvenile idiopathic arthritis (JIA) can affect the temporomandibular joint (TMJ).
  • Identifying active TMJ inflammation (synovitis) is crucial for managing JIA.
  • Physical examination findings require correlation with advanced imaging for definitive diagnosis.

Purpose of the Study:

  • To determine the physical examination findings associated with active TMJ synovitis in pediatric patients with JIA.
  • To establish the predictive value of specific physical signs for TMJ inflammation in JIA.

Main Methods:

  • Retrospective analysis of pediatric JIA patients undergoing TMJ MRI with contrast.
  • Review of medical records and imaging to document demographic, physical, and MRI findings.
  • Statistical analysis, including multiple regression, to identify significant associations (P ≤ .05).

Main Results:

  • Of 43 JIA patients, 27 (63%) showed TMJ synovitis on MRI.
  • Limited maximal incisal opening (MIO) and deviation on opening were significantly associated with TMJ synovitis (P = .003 and P = .043).
  • Limited MIO and deviation on opening demonstrated high specificity (86% and 94%) for synovitis.

Conclusions:

  • Limited MIO and deviation on opening are reliable predictors of TMJ synovitis in children with JIA.
  • These physical findings should be routinely documented in the clinical evaluation of JIA patients.
  • Incorporating these parameters aids in the longitudinal monitoring and management of TMJ involvement in JIA.
Abstract

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