GP3b - What Is Post-Traumatic Arthritis of the Temporomandibular Joint? Case Series and Literature Review

Abstract: BackgroundPost-traumatic arthritis (PTA) is extensively studied in the orthopedic literature, but the knowledge on pathogenesis in the temporomandibular joint (TMJ) and publications in oral and maxillofacial surgery are scant. While preventative treatments for PTA do not yet exist, we suggest clinicians recognize PTA of the TMJ as a possible diagnosis in post-traumatic patients, as chronic PTA frequently results in debilitating TMJ pain, dysfunction, and aggressive degenerative condylar changes.

Purpose: To report the characteristics, arthroscopic, and histologic findings of patients presenting with a symptomatic PTA of the TMJ (TMJ-PTA).Study design, setting, sample:This is a retrospective case-series study on subjects who reported a history of direct maxillofacial trauma, developed a symptomatic TMJ arthropathy, underwent diagnostic and operative TMJ arthroscopy at a single institution between 2021 and 2024, and were found to have TMJ-PTA. Inclusion criteria included a symptomatic TMJ arthropathy, a reported history of direct trauma, and the completion of a diagnostic and operative TMJ arthroscopy. Exclusion criteria were incomplete medical charts and subcondylar fractures.

Results: Of the 246 patients in our RedCap TMJ Arthroscopy database, 64 patients met inclusion criteria of a symptomatic TMJ arthropathy, reported history of direct trauma, and underwent an operative TMJ arthroscopy. There was an 82% female predominance (n = 53) and a mean age 39 years old. The time interval between the trauma and symptom onset varied widely, ranging between 24 hours and several years. The arthroscopic findings frequently included thick sheet-like adhesions, focal areas of severe synovitis, chondromalacia, lateral capsular impingement, and disc displacement without reduction. Synovial biopsies frequently demonstrated fibrosis, hyalinization, cellular infiltration, hyperplasia, reactive vascular proliferation, and proliferation of subsynovial myofibroblasts.

Discussion: PTA of the TMJ may result in debilitating temporomandibular joint disorder (TMD) symptoms and aggressive degenerative changes. Diagnostic considerations for TMJ-PTA are non-specific, diverse and include chronic intra-articular pain; significant degenerative changes in a short timeframe; arthroscopic findings of synovitis and adhesions; and histologic findings of proliferation of subsynovial myofibroblasts. Even in the absence of mandibular fractures, TMJ-PTA is a relevant differential diagnosis in post-traumatic patients presenting with TMD symptoms or mandibular dysfunction. While preventative treatment for PTA does not yet exist, we suggest clinicians recognize TMJ-PTA as a potential sequelae of direct maxillofacial trauma.

Dense Pseudowall Adhesion with focal severe Synovitis
Focal Grade 3 Synovitis and Creeping angiogenesis
Grade 3 Chondromalacia with Fibrillations