[Severe degenerative changes of the temporomandibular joint associated with diffuse sclerosing osteomyelitis]

Diffuse sclerosing osteomyelitis (DSO) is a rare chronic disease, which is associated with severe jaw pain, swelling of the mandible and trismus. Involvement of the temporomandibular joint is rare and reports on cases with severe destruction of the temporomandibular joint in DSO patients are so far uncommon.

The following case report describes a 26 year-old female patient, who presented with a acute otitis media, followed by chronic mastoiditis and osteomyelitis of the skull base in her medical history, and who developed DSO in the left mandible with severe degenerative changes of the TMJ in the course of the disease. The administration of 6mg ibandronic acid in combination with arthrocentesis and arthroscopic instillation of hyaluronic acid in temporomandibular joint space led to remission of the symptoms.

Mastoiditis with osteomyelitis of the skull base, presumably caused by an acute otitis media, can lead to degenerative alterations of the temporomandibular joint, especially in cases of a prolonged course and progressive spread of inflammation. The combination with the development of a DSO of the mandible represents a possible complication. Awareness for the coincidence of the named diseases with radiating preauricular pain is of decisive importance for the correct diagnosis and for sufficient treatment protocols.