Title

Temporomandibular Disorder in a Case Characterized by Unilateral Osteoarthritis, Growth Discrepency, and Chronic Pain Following Orthognatic Surgery

Poster Number

8

Lead Author Affiliation

Biomedical Sciences

Introduction

Determine the etiology of a complex TMD case in a 28y.o. caucasian female patient, presenting with a history of abnormal late growth, possible trauma, bilateral sagittal split orthognathic surgery, unilateral osteoarthritis, masseter atrophy, and chronic pain.

Purpose

To treatment(s) to relieve the patient from chronic pain associated with the presented conditions as enumerated above.

Method

Comparatively analyzed panoramic films (patient ages 8, 13, 16, 21, 24, 26), MRIs (age 21, 24), and CBCTs (age 24, 26). Reviewed orthognathic surgery notes from a bilateral sagittal split (age 22). Blood tests and neurological exams show no significant findings. Conducted clinical consultations with orofacial pain specialists, orthodontists, and anatomists in effort to determine etiology and diagnosis.

Results

Resorptive changes in the right TMJ became radiographically apparent at age 21; arthritic changes are first evident at age 24 (six months post-surgically). Patient experiences chronic pain, isolated to the right side, with loci in the preauricular region, temple, and mental foramen. Patient reports constant pain of 3-4 on the pain scale, peaking at 7-8 after a long day of speaking and functioning. The patient’s initial occlusal contact in centric relation is between teeth #8 and #25. With effort, light posterior contact can be forced between #3 and #30. Dentition shows little to no signs of wear. Study models show that the teeth have not shifted significantly since surgery, suggesting post-surgical relapse.

Significance

The patient has multifactorial contribution to her condition. Her late growth caused a hyperplastic left ramus and condyle, creating a malocclusion that necessitated surgical correction. Orthognathic surgery torques the temporomandibular joint (TMJ); this torquing may precipitate or exacerbate an osteoarthritic response. Post-surgical relapse and resorptive TMJ changes may both contribute to the patient’s malocclusion. Occluding solely on incisors increases pressure in the TMJ space. This, combined with arthritic/osteophytic changes, contributes to the patient’s chronic pain.

Location

DeRosa University Center, Stockton campus, University of the Pacific

Format

Poster Presentation

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Temporomandibular Disorder in a Case Characterized by Unilateral Osteoarthritis, Growth Discrepency, and Chronic Pain Following Orthognatic Surgery

DeRosa University Center, Stockton campus, University of the Pacific

Determine the etiology of a complex TMD case in a 28y.o. caucasian female patient, presenting with a history of abnormal late growth, possible trauma, bilateral sagittal split orthognathic surgery, unilateral osteoarthritis, masseter atrophy, and chronic pain.