Abstract
Hyperplasia of articular eminence is a rare condition embedded in the structural incompatibility disorders of temporomandibular joint, where the joint surfaces are altered in shape, resembling a pseudo-ankylosis case. This disorder is normally associated with a history of trauma, leading to deviation of the condyle from its normal trajectory.
In the present case, a 49-years-old male patient, complaining of mouth opening limitation and pre-auricular pain after a sport trauma in a soccer game (face vs. ball) 10 years ago. Clinically, presented a 15 mm mouth opening with left chin deviation associated with retrognathism and facial asymmetry. At the time of the examination, the patient had no pain in the temporomandibular joint or masticatory muscles. After clinical examination and imaging, a surgical treatment was proposed based on Kaban’s protocol in which an eminectomy was performed followed by coronoidectomy, obtaining a 33 mm mouth opening after 14 months of follow up.
Highlights
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Hyperplasia of articular eminence is a rare condition of structural incompatibility disorders of temporomandibular joint.
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Signs and symptoms are similar to an ankylosis, due chin deviation to the affect side and mouth opening limitation.
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Kaban’s Protocol modified is an option for treatment of severe hyperplasia of articular eminence.
1
Introduction
Hyperplasia of articular eminence is an extremely rare condition embedded in the structural incompatibility disorders of temporomandibular joint (TMJ), where the joint surfaces are altered in shape. This kind of disorder is normally associated with a history of local trauma, due to the potential of overload to generate changes in bone surfaces, leading to deviation of the condyle from its normal trajectory and in some cases, pseudo-ankylosis [ ].
Clinically, patients presented of condylar motion limitation or deviation of its normal trajectory, clicks associated or not with pain. Not all the patients present symptoms, this condition can be present for years before a patient presents with any complaint [ ].
The signs and symptoms of this condition are similar to an ankylosis, due facial asymmetry caused by the chin deviation to the affect side and mouth opening limitation. Therefore, the diagnosis is made through imaging exams (orthopantomography and computer tomography – CT). In fibro-ankylosis there is a decrease in joint spaces, whereas in the bones ankylosis, there is formation of dense sclerotic bone [ ].
Tumors and pseudo-tumors in the TMJ are infrequent entities, especially when compared to other conditions that affect the TMJ [ ]. However, they should be considered for differential diagnosis of ankylosis and structural deformities of the TMJ, due similar symptoms, signs and radiographic characteristics. Diagnosis is given by means of incisional or excisional biopsy.
The treatment depends on the severity of the deviation found in the structures involved and the symptoms the patient has. Cases of mild dysfunction, without pain complaints and without functional limitations, follow-up in order to monitor possible progressions of the disorder is often enough. In cases where significant functional limitation and pain are present, the presence of extra joint disorder should be evaluated and treated primarily [ ]. Severe functional limitations with altered anatomy will require surgery due mouth opening limitation and facial asymmetry.
The kind of surgery depends on the anatomical structures involved in the disorder and the degree of alteration of the structures can vary from an arthroplasty with removal of part of the structure (eminectomy, coronoidectomy and condylectomy) to total arthroplasty with replacement by joint prosthesis. If the articular disc has the shape or position altered, correction can be performed [ ].
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Case report
A 49-years-old male patient, complaining of pre-auricular pain on the left side and progressive mouth opening limitation. He reported having good mouth and facial symmetry util he suffered sport trauma in a soccer game (face vs. ball) 10 years ago. After the trauma, he found it difficult to open his mouth, pain and mandibular deviation to the affected side. Denied other comorbidities and allergies.
Clinically presented with facial asymmetry due left chin deviation associated with retrognathism, 15 mm mouth opening ( Fig. 1 ) and no pain in the temporomandibular joint or masticatory muscles at the time of the exam. There was a palpable right condyle (condylar rotation) and non-palpable left condyle with limited mandibular excursion movements and no odontogenic infection signs.
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