TMJ pathomorphology in patients with JIA-radiographic parameters for early diagnosis-
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RESEARCH
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TMJ pathomorphology in patients with JIA-radiographic parameters for early diagnosisDaniela Klenke1* , Anja Quast1, Martina Prelog2, Annette Holl-Wieden2, Maximilian Riekert3, Angelika Stellzig-Eisenhauer3 and Philipp Meyer-Marcotty1
Abstract Background: Juvenile idiopathic arthritis (JIA) is often accompanied by pathomorphological changes to the temporomandibular joint (TMJ). By analyzing orthodontical orthopantomograms of JIA patients the aims of the study were a) classification of condyle changes, b) quantification of bony asymmetries of condylar destruction and c) detection of relationships between disease duration and TMJ-involvement. Patients/Methods: 46 caucasian JIA-patients (28 female; 18 male; < 16.0 years) were enrolled, each joint (n = 92) was morphologically assessed by means of orthopantomogram, quantitatively analysed and compared with duration of general disease. Condyle morphology was assessed using the Billiau scale for severity of destruction [1]. The quantitative analysis was based on ratios of condyle, ramus and mandible height. Results: Patients were divided into groups (Group I – slightly affected, n = 36; Billiau severity 0–2; condyle findings: X-ray normal, condyle erosions, condylar flattening; Group II – severely affected, N = 10; Billiau severity 3–4; condyle findings: condylar flattenings and erosions, unilateral/bilateral complete loss of condyles), based on morphological analysis of condylar destruction. Duration of disease was significantly longer in Group II (8.9 ± 5.2 years) than in Group I (4.6 ± 4.7 years). Asymmetries of condyle, ramus and mandible height, quantitatively analysed by contralateral comparison, were significantly more marked in patients of Group II than of Group I. Conclusions: Orthopantomogram imaging can be used in orthodontics clinical routine to detect TMJ-pathologies and is an important reference for monitoring progression of JIA. Classification into severe and slightly affected TMJ is possible by analysis of condylar pathomorphology. An association between degree of destruction, extent of lower jaw asymmetry and disease duration is suggested by the results. Keywords: Juvenile idiopathic arthritis, TMJ, OPT, Asymmetry, Condyle pathomorphology
Background Juvenile idiopathic arthritis (JIA) is a heterogeneous rheumatological disease of unknown cause, which occurs before the age of 16. The main clinical symptoms are a persistent swelling of one or more joints, restriction of joint mobility and pain on movement that has lasted for at least 6 weeks [2]. With a prevalence of 2.0 per 10,000 children, JIA is one of the most common chronic inflammatory-rheumatic
* Correspondence: [email protected] 1 Department of Orthodontics, University Medical Centre Göttingen, Poliklinik für Kieferorthopädie Robert-Koch-Str. 40 D-, 37075 Goettingen, Germany Full list of author information is available at the end of the article
diseases of childhood and adolescence [3]. Girls are affected about twice as often as boys [4]. The International
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