Temporomandibular joint osteochondritis dissecans: case report

Kaan Orhan, Ahmet Arslan, Doruk Kocyigit
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics 2006, 102 (4): e41-6

BACKGROUND: Osteochondritis dissecans is a process in which segment(s) of cartilage separate from an articular surface. It is most often reported in the larger joints of the body, including the knee, elbow, hip, wrist, and ankle. Involvement of the temporomandibular joint (TMJ) is exceedingly rare.

OBJECTIVES: To describe a probable case of osteochondritis dissecans and discuss the differential diagnosis for this condition.

STUDY DESIGN: In addition to clinical examination the patient was imaged using panoramic radiography, computed tomography and magnetic resonance imaging.

RESULTS: Panoramic radiography showed separation of 2 rounded fragments superior to the right mandibular condyle. These were more precisely located using 3-dimensional computerized tomographic reconstructions. Magnetic resonance imaging demonstrated the right condyle as having low signal intensity area on T1-weighted images and a heterogeneous signal on T2-weighted images, with low signal dominance. No abnormality was apparent in the left TMJ.

CONCLUSIONS: The patient was treated nonsurgically with a splint, occlusal adjustment, physiotherapy, and nonsteroidal antiinflammatory medications. Maximum mouth opening has increased from 24 mm to 39 mm 6 months following initiation of treatment, and pain has subsided.

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