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Agenesis of the temporomandibular condyle is a congenital/developmental disorder that can present with the absence of the condyle and an incomplete development of the articular fossa and eminence, resulting in facial asymmetry as well as masticatory dysfunction. The purpose of this report is to present the case of a three-year-old girl with absence of the left temporomandibular condyle. The patient presented with pain and dysfunction in the left masseter muscle, pre-auricular area and ear as well as mild chin deviation to the left. The most common treatment modality is to wait and treat this condition with surgical intervention once the patient is grown. However, oral orthopedic appliances can be considered to promote bone formation prior to surgery. Prompt recognition and early treatment is advisable to take advantage of the child's growth and avoid further facial asymmetry, pain and dysfunction.

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This observational, cross-sectional study with retrospective collection was aimed to evaluate the prevalence of morphological changes in mandibular condyles in individuals with class II malocclusion, classified according to different vertical growth patterns (brachyfacial, mesofacial, and dolichofacial), through cone beam computed tomography (CBCT). Seventy CBCT images (140 mandibular condyles) were selected from individuals without orthodontic treatment, of both sexes, aged between 25 and 50 years. No statistically significant differences were found between facial patterns; however, there was a higher relative prevalence of bone changes in dolichofacial individuals with flattening (62%), sclerosis (44%), and subchondral bone cyst (20%). Erosion and osteophytes prevailed in mesofacial (39%), and brachyfacial individuals (32%), respectively. Thus, there was no statistically significant difference in the prevalence of degenerative changes between the vertical skeletal patterns. Flattening was the most prevalent change, whereas subchondral bone cyst was the least prevalent among the three groups studied. The observational design of this study makes it possible to analyze image banks to verify the correlation of morphological changes in the temporomandibular joint in different facial patterns in patients with class II malocclusion. A limitation of the study is that clinical characteristics were not evaluated.

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OBJECTIVES: The aim of this study was to evaluate, using cone-beam computed tomography (CBCT), the relationship of persistent foramen tympanicum (PFT) with degenerative changes in the temporomandibular joint (TMJ) and the presence of pneumatized glenoid fossae and articular eminences. METHOD: Two experienced oral and maxillofacial radiologists evaluated 510 CBCT scans, from which 94 patients were divided into two groups: G1-patients with PFT and G2-control group. The location of the PFT, presence, or absence of degenerative TMJ changes and morphology were evaluated. Similarly, all images were evaluated for the presence of pneumatized articular eminence and glenoid fossa. The Chi-square test and Fisher's Exact test were used for the categorical variables. A multinomial logistic regression model was performed for subgroup analysis. To assess the estimation-chance occurrence of TMJ alterations the Odds Ratio analysis was used. RESULTS: Statistically significant results were found for erosion, planning, and subchondral cyst. Regarding TMJ morphology, significant results were found for: round, flat, and others. Moreover, it was possible to observe that patients who had the PFT were approximately 48 times more likely to manifest TMJ alterations and approximately 3 times more likely to manifest articular eminence pneumatization. CONCLUSION: Since individuals who have FTP have a greater chance of having TMJ and PEA changes, it is important for the dental radiologist to be aware of these signs in CBCT scans for a correct diagnosis. TRIAL REGISTRATION NUMBER: CAAE: 34328214.3.0000.0104 (11/30/2014).

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PURPOSE: To perform a scoping review to identify the available evidence regarding osteochondritis dissecans (OCD) of the temporomandibular joint (TMJ). METHODS: An electronic search of the PubMed, Web of Science and Scopus databases was performed using the following terms: 'Temporomandibular Joint Disorders', 'Osteochondritis Dissecans', 'Joint Loose Bodies' and 'Temporomandibular Joint'. Full-text articles were obtained from the records after applying the inclusion/exclusion criteria. RESULTS: Ten articles were included in the analysis - six case reports, one case series, one retrospective study, one comparative study and one correlational study - with a total of 39 patients. The most frequently reported clinical presentation involved TMJ pain, locked jaw and articular noises (clicking and crepitus). The imaging methods used to identify OCD were radiographs, tomography, arthrography and magnetic resonance imaging. The reported imaging findings varied widely, but the most frequent were (single or multiple) calcified intra-articular loose bodies, signs of degenerative osseous changes, disc displacements, widening of the joint space and alterations in condylar morphology. Seven articles reported treatments (surgical or conservative), but the treatment outcome was not reported in all of the articles, which makes it difficult to make comparisons. CONCLUSION: OCD of the TMJ may present various non-specific clinical characteristics, and given the heterogeneous imaging findings, multiplanar images are required for an accurate diagnosis. Finally, the results do not allow recommending a standard treatment for OCD of the TMJ.

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OBJECTIVE: There are studies showing clinical and laboratory differences between elderly-onset rheumatoid arthritis and young-onset rheumatoid arthritis. Temporomandibular joint involvement in rheumatoid arthritis is not rare. In this study, we aimed to examine the temporomandibular joint involvement and magnetic resonance imaging findings in elderly-onset rheumatoid arthritis and young-onset rheumatoid arthritis patients. METHODS: A total of 87 rheumatoid arthritis patients were investigated retrospectively. The onset ≥60 years was considered elderly-onset rheumatoid arthritis. Erosion, flattening, and resorption of the condyle, narrowing of the joint space, joint effusion, synovial hypertrophy, and synovitis were interpreted as temporomandibular joint involvement with magnetic resonance imaging. Patients' age, gender, rheumatoid factor, and anti-cyclic citrullinated peptide positivity, extra-articular findings, medical treatment, and disease activity score were noted. RESULTS: A total of 15 (17.2%) patients had elderly-onset rheumatoid arthritis. Temporomandibular joint involvement was detected in 67 (77%) patients; 9 (60%) of them were in the elderly-onset rheumatoid arthritis group (n=15) and 58 (80.6%) of them were in the young-onset rheumatoid arthritis group (n=72). Patients with temporomandibular joint involvement were significantly higher than those without temporomandibular joint involvement in both the elderly-onset rheumatoid arthritis and young-onset rheumatoid arthritis groups (p<0.001). No significant difference was found between elderly-onset rheumatoid arthritis and young-onset rheumatoid arthritis for the temporomandibular joint involvement (p=0.100). In the young-onset rheumatoid arthritis group, rheumatoid factor positivity and anti-cyclic citrullinated peptide positivity were more frequent in the patients with temporomandibular joint involvement (p=0.011, p=0.024). A comparison of the elderly-onset rheumatoid arthritis and young-onset rheumatoid arthritis patients showed no significant difference in the magnetic resonance imaging findings except for the resorption of the condyle. CONCLUSION: According to our findings, elderly-onset rheumatoid arthritis is not much different from young-onset rheumatoid arthritis in terms of temporomandibular joint involvement, magnetic resonance imaging findings, and clinical and laboratory features.

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OBJECTIVE: The aim of the study was to investigate the influence of facemask treatment with skeletal anchorage on the temporomandibular joint (TMJ) using magnetic resonance imaging (MRI), in patients with Class III malocclusion, accompanied by maxillary retrusion. METHODS: Fifteen patients with a mean age of 12.1±1.43 years were included in the study. All patients were treated using facemask with skeletal anchorage after eight weeks of Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) protocol. Magnetic resonance imaging was performed before and immediately after facemask treatment for TMJ evaluation. Disc position, condylar translation, degenerative changes of the condyles, and joint effusion were evaluated. To assess whether the alterations associated with the treatment were statistically significant, McNemar and marginal homogeneity tests were used. RESULTS: After facemask treatment, a statistically significant change was observed in the disc position (an anterior disc displacement with/without reduction in five TMJs) (p<0.05). The alteration in the condylar translation was not statistically significant (p>0.05). This treatment did not cause degenerative changes of the condyles or effusion in any of the TMJs. CONCLUSION: Facemask treatment with skeletal anchorage following the Alt-RAMEC protocol had a minimal influence on the TMJ, only by means of disc position, which was not negligible. Long-term results of such treatment are required for following up the changes observed in the TMJs.

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OBJECTIVE: To perform a scoping review to identify the available evidence regarding intra-articular injections in the inferior joint space (IJS) of the temporomandibular joint (TMJ). METHODS: An electronic search of the PubMed, Web of Science and Scopus databases was performed using the following terms: "Arthrocentesis", "injection", "joint injection", "technique", "Temporomandibular joint", "Temporomandibular joint disorder". Full-text articles were obtained from the records after applying the inclusion/exclusion criteria. Only articles with full-text access were included. RESULTS: Thirteen articles were included for analysis-one technical note, three cadavers studies, one animal study, two case reports, five randomised clinical trials and one retrospective study; studies were classified as 'patients-based studies' and 'non-patients-based studies'. Most 'patients-based studies' show moderate or high risk of bias. Techniques were categorised as 'anatomical technique' and 'image-guided technique'. Most 'patients-based studies' show favourable outcomes such as pain reduction, increase in maximum mouth opening, improvement in quality of life and improvement in TMJ dysfunction indexes for the treatment of arthrogenic TMDs. Comparisons between superior and IJS injections are scarce. On the other hand, 'non-patients-based' studies show that image-guided or ultrasound-checked injection techniques achieved a higher effectiveness for needle location than anatomical (or blind) techniques. CONCLUSION: The amount of available evidence is scarce, heterogeneous in design, and most 'patients-based studies' show moderate or high risk of bias, which demands the generation of new research to obtain definitive conclusions. The tendency observed suggests that intra-articular injections for the IJS of the TMJ are able to relieve TMJ pain, increase mouth opening and improve TMJ dysfunction, and image-guided injection techniques seem to be more effective than anatomical techniques to locate the needle in the IJS.

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OBJECTIVE: To determine the frequency of radiographic changes in the temporomandibular joint, in a representative population of patients with Juvenile Idiopathic Arthritis (JIA) and to compare with findings in healthy controls matched by sex and age. PATIENTS AND METHODS: One hundred and thirty-seven panoramic radiographies (PR) from JIA patients of a pediatric rheumatology outpatient clinic were prospectively evaluated and compared to 137 PR from healthy individuals. RESULTS: 102 (74.5%) JIA patients and 47 (34.3%) controls showed at least one radiological alteration (p < 0.001). The following radiographic alterations were more frequently observed in JIA patients than in controls: erosion (p < 0.001), altered condylar morphology (p < 0.001), disproportion between condylar process and the coronoid process (p < 0.001) and accentuated curve in the antegonial notch (p = 0.002). Twenty patients (14.6%) presented the four radiographic alterations simultaneously compared to only two controls (1.5%) (p < 0.001). CONCLUSION: Due to the difference in the frequency of findings in the PR of patients and controls, we concluded that PR has value as a screening tool. In the presence of major changes in the mandible head in the PR of patients with a confirmed diagnosis of JIA, MRI should be considered to detect an active inflammatory process in this joint.

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BACKGROUND: There is no established acquisition protocol based on scientific evidence for the acquisition of cone-beam computed tomography (CBCT) exams to evaluate the temporomandibular joint (TMJ). OBJECTIVES: To evaluate the influence of acquisition protocols and jaw positioning on the diagnostic accuracy of TMJ condylar morphological alterations (CMA), dimension, position and excursion. METHODS: Thirty-six TMJs on 18 dry skulls were imaged using a CBCT unit (OP300 Maxio, Instrumentarium, Tuusula, Finland) at two exposure settings (4.5 and 6.3 mA), three voxel resolutions (0.085, 0.125 and 0.280 mm), three jaw positions (concentric, anteriorised and posteriorised) and three jaw excursions (normoexcursion, hyperexcursion and hypoexcursion). The macroscopic anatomy examination and high-resolution CBCT images were used as ground truth for CMA. Twenty-five TMJs had at least one CMA with 11 healthy TMJs serving as controls. Three experienced oral and maxillofacial radiologists evaluated the parasagittal images for the presence of CMA, position and excursion and measured dimensions. The area under the ROC curve, sensitivity and specificity were calculated. Weighted Kappa (α = 0.05) was used to determine intra- and interexaminer reliability and comparisons between dependent variables analysed by Analysis of Variance at an a prior level of significance of 0.05. RESULTS: The agreement of the evaluation of the position and excursion with the reference standard was high, independent of the protocol (range, 0.75-0.91). Various combinations of acquisition protocols and jaw position did not influence the CMA evaluation. Erosion was overdiagnosed in protocols with larger voxel sizes and the detection of osteophytes greater in images with smaller voxel sizes. The anteroposterior dimension was greater in the open jaw position (p < .05). CONCLUSION: CBCT protocols using reduced radiation exposure from the CBCT machine evaluated in this study can be used to assess condylar morphology, dimension, position and excursion, without compromising diagnostic performances for these parameters.

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