Abramowicz Shelly, Susarla Harlyn K, Kim Susan, Kaban Leonard B
Assistant Professor, Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, and Attending Surgeon, Boston Children's Hospital, Boston, MA.
J Oral Maxillofac Surg. 2013 Oct;71(10):1683-7. doi: 10.1016/j.joms.2013.04.009. Epub 2013 Aug 8.
To identify the physical findings associated with active temporomandibular joint (TMJ) inflammation (ie, synovitis) in children with juvenile idiopathic arthritis (JIA).
This was a retrospective study of children with JIA evaluated at Boston Children's Hospital. The patients were included if they had a confirmed diagnosis of JIA and had undergone a TMJ magnetic resonance imaging (MRI) study with contrast. Medical records and imaging studies were reviewed to document the demographic, physical (ie, facial asymmetry, joint noises, maximal incisal opening, deviation on opening, occlusal cant), and MRI findings. The outcome variable was TMJ synovitis on the MRI study. Descriptive and bivariate statistics were computed. Multiple regression models were used to identify associations (P ≤ .05, significance).
A total of 51 patients with JIA were evaluated during the study period. Of these, 43 patients (33 girls) with a mean age of 11.4 years met the inclusion criteria. MRI demonstrated TMJ synovitis in 27 patients. The age-adjusted limited maximal incisal opening (MIO) and deviation on opening were the only physical findings significantly associated with synovitis on MRI (P = .003 and P = .043, respectively). Using these parameters as predictors of synovitis, a limited MIO and deviation on opening had a high specificity (86% and 94%, respectively). Patients with a limited MIO were 6.7 times more likely to have synovitis than those with a normal MIO. All patients with a limited MIO and deviation on opening had TMJ synovitis on the MRI scan.
The results of this study indicate that, in children with JIA, limited MIO and deviation on opening can be used to predict the presence of TMJ synovitis. Documentation of these parameters should be an essential part of the clinical examination and longitudinal follow-up of children with JIA.
确定幼年特发性关节炎（JIA）患儿中与颞下颌关节（TMJ）活动性炎症（即滑膜炎）相关的体格检查结果。
这是一项对在波士顿儿童医院接受评估的JIA患儿进行的回顾性研究。若患者确诊为JIA且接受了有造影剂的TMJ磁共振成像（MRI）检查，则纳入研究。查阅病历和影像学检查资料，记录人口统计学、体格检查（即面部不对称、关节弹响、最大切牙开口度、开口时偏斜、咬合斜面）及MRI检查结果。观察指标为MRI检查显示的TMJ滑膜炎。计算描述性和双变量统计量。使用多元回归模型确定相关性（P≤0.05，具有显著性）。
在研究期间共评估了51例JIA患儿。其中，43例（33名女孩）平均年龄为11.4岁的患儿符合纳入标准。MRI显示27例患儿存在TMJ滑膜炎。年龄校正后的最大切牙开口度受限（MIO）和开口时偏斜是与MRI上滑膜炎显著相关的仅有的体格检查结果（分别为P = 0.003和P = 0.043）。将这些参数作为滑膜炎的预测指标，MIO受限和开口时偏斜具有较高的特异性（分别为86%和94%）。MIO受限的患者发生滑膜炎的可能性是MIO正常患者的6.7倍。所有MIO受限且开口时偏斜的患者在MRI扫描中均存在TMJ滑膜炎。
本研究结果表明，在JIA患儿中，MIO受限和开口时偏斜可用于预测TMJ滑膜炎的存在。记录这些参数应成为JIA患儿临床检查和长期随访的重要组成部分。
