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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 28  |  Issue : 3  |  Page : 289-291

Osteophytes in temporomandibular joint, a spectrum of appearance in cone-beam computed tomography: Report of four cases


Department of Oral Medicine and Radiology, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India

Date of Submission05-Aug-2016
Date of Acceptance06-Dec-2016
Date of Web Publication13-Dec-2016

Correspondence Address:
Dr. Priyanka Khobre
Department of Oral Medicine and Radiology, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-1363.195672

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   Abstract 

Osteophyte is one of the hallmark radiographic feature of temporomandibular joint (TMJ) degenerative joint disease that has been used to define the presence of disease. The development of osteophyte is an attempt to stabilize the overload caused by occlusal forces, representing areas of newly-formed cartilage. It can cause various clinical symptoms such as pain, decreased jaw movements, nerve compression, and subsequently compromise joint function. Here, we report four cases of patients with TMJ arthritis showing different appearance of osteophyte using cone-beam computed tomography. This paper also reports two cases of bridging osteophyte at the temporomandibular joint, which has not been reported previously in literature.

Keywords: Bridging osteophyte, cone-beam computed tomography, osteophyte, temporomandibular joint


How to cite this article:
Sadaksharam J, Khobre P. Osteophytes in temporomandibular joint, a spectrum of appearance in cone-beam computed tomography: Report of four cases. J Indian Acad Oral Med Radiol 2016;28:289-91

How to cite this URL:
Sadaksharam J, Khobre P. Osteophytes in temporomandibular joint, a spectrum of appearance in cone-beam computed tomography: Report of four cases. J Indian Acad Oral Med Radiol [serial online] 2016 [cited 2018 Dec 12];28:289-91. Available from: http://www.jiaomr.in/text.asp?2016/28/3/289/195672


   Introduction Top


Osteophyte is “a fibrocartilage-capped bony outgrowth” mainly present as a bony proliferation at the surface of the articulating bone resulting in increased articular surface area.[1],[2] Osteophyte can be seen in multiple sites and was first described in Spine by Forrestier and Rotes-Querol.[3] It is mainly seen on the anterosuperior surface of the condyle of the mandible and may also arise from the medial, lateral, and posterosuperior surface of the condyle.[2] Osteophytes and other bony changes such as narrowing of joint space, sclerosis, erosion, flattening, loose bodies, and subchondral cyst are the radiologic features of arthritic conditions such as osteoarthritis and rheumatoid arthritis.[2],[4],[5]


   Case Reports Top


Case 1

A 57-year-old female reported to our department with chief complaint of pain in both the preauricular regions since 1 month. Patient also gave a history of stiffness while moving the jaw. Patient revealed history of rheumatoid arthritis since 8 months, and was on analgesics, corticosteroids and anti-inflammatory drugs for the same. The patient was seropositive for rheumatoid factor and anti-citrullinated protein antibodies. On examination, mouth opening was normal (40 mm). Tenderness was present bilaterally at the temporomandibular joint (TMJ) region, with crepitus in the right TMJ during opening and closing. For precise evaluation, the patient was subjected to cone-beam computed tomography (CBCT) of the TMJ. Coronal view of right TMJ showed two prominent hyperdense projections (osteophytes) from superior aspects of the condyle [Figure 1]a. Sagittal view of the right TMJ revealed similar osteophytes arising from the superior surface of condyle [Figure 1]b.
Figure 1: (a and b) Coronal and sagittal view of right TMJ in CBCT with two prominent osteophytes on superior surface of condyle

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Case 2

A 48-year-old female patient reported with chief complaint of reduced mouth opening and pain in the right preauricular region. Patient gave history of rheumatoid arthritis. On examination, patient showed restricted mouth opening (28 mm). CBCT was taken for evaluation of the TMJ region. Coronal view of right TMJ revealed hyperdense outgrowth from superolateral aspect of the right condyle fusing with the glenoid fossa (bridging osteophyte) along with erosion of superior surface of the condyle [Figure 2]a. Three-dimensional (3D) reconstruction view of right TMJ also showed the evidence of bridging osteophyte along with arthritic changes [Figure 2]b.
Figure 2: (a and b) Coronal and 3D reconstructed view of right TMJ with bridging osteophyte

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Case 3

A 37-year-old female reported with chief complaint of reduced mouth opening and pain in the right preauricular region. Patient gave no history of trauma or multiple joint involvement. Patient was seronegative for rheumatoid arthritis. On examination, patient showed restricted mouth opening with deviation of mandible towards right while opening and closing. CBCT of the right TMJ, in coronal, sagittal, and 3D reconstructed view showed evidence of two bridging osteophytes with erosive changes [Figure 3]a,[Figure 3]b,[Figure 3]c. Another osteophyte was also seen arising from superior surface of the condyle between two bridging osteophytes [Figure 3]c.
Figure 3: (a-c) Coronal, sagittal, and 3D reconstructed view respectively of right TMJ with evidence of 2 bridging osteophytes

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Case 4

A 44-year-old female patient reported with chief complaint of pain in the preauricular region of both sides. Patient was seropositive for rheumatoid factor. Extraoral examination showed mild tenderness at both TMJ while opening. Patient was subjected to CBCT and the TMJ was examined. Sagittal view of left TMJ showed remnant of broken osteophyte at the anterior aspect of condyle and a well-defined hyperdense mass present anterior to the condyle as “joint mouse” [Figure 4].
Figure 4: CBCT showing sagittal view of left TMJ with evidence of joint mouse

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   Discussion Top


Osteophyte also known as bony spur is one of the hallmark radiographic feature of TMJ degenerative joint disease.[6] There are three types of osteophytes, the traction spur present at the site of insertion of ligaments and tendons, the inflammatory spur, present as a syndesmophyte at the site of insertion of tendons and ligaments to bone; and the genuine osteophyte, arise at the junction between cartilage and bone from the periosteum overlying the bone.[1] Osteophyte may lie freely after breaking off from the condylar surface within the joint space as loose bodies also known as “joint mouse.”[2] The presence of joint mouse in our fourth case report is possibly due to a broken osteophyte. Development of osteophyte is seen previous to joint space narrowing and is associated with misalignment of joint to the side of the osteophyte, which is a main risk factor for the development of arthritic conditions.[1],[7] Patients who are seropositive for rheumatoid factors, half to three-fourth of them will have complaints of TMJ symptoms.[8] Clinically, osteophyte may cause nerve compression, orofacial pain, limitation of joint mobility, fibrous ankyloses, and eventually compromise TMJ function.[1],[6],[8] The presence of bridging osteophyte in second and third case reports may be the cause of restricted mouth opening of the patients.

Instability of the joint is found to be a biomechanical trigger for the formation of osteophyte.[9] Nagosa et al. stated that osteophyte may differ in shapes, and its curvature or placement may stabilize the joint.[7] The cartilage of the articular surface of the condyle and glenoid fossa/eminence can undergo bony remodeling when mechanical stresses exceed the adaptive capacity of the host to repair the joint and withstand loading forces by increasing the surface area.[5],[6],[9] Chondrocalcinosis that occurs because of deposition of calcium pyrophosphate crystals has been suggested to influence osteophyte formation.[9] Transforming growth factor β (TGFβ) as a growth factor has been proposed to be expressed by human osteophytes. Insulin like growth factor- I (IGF-I) has been detected in growing osteophyte. Okazaki et al. proposed type 1 IGF receptors and IGF-I to be present in developing osteophyte.[1] Bone scintigraphic studies have shown increased vascularity in growing osteophyte.[10]

Treatment of osteophytes varies from conservative management with anti-inflammatory drugs to surgical removal.[11] In experimental models of osteoarthritis, formation of osteophyte in an unstable joint is stimulated by joint movement and immobilization causes inhibition of osteophyte development.[9] Bisphosphonates are theoretically proven class of drug for osteophyte inhibition.[1] Pelletier et al. showed that the non-steroidal anti-inflammatory induced drugs, carprofen, and tenidap considerably limit osteophyte formation along with reduction in the size of cartilage lesions.[1] In all our cases, patients responded to conservative treatment with anti-inflammatory, analgesic, and corticosteroids.


   Conclusion Top


This case series described different presentation of osteophyte of TMJ causing clinical symptoms in patients with arthritis. CBCT is an effective modality to find out osseous changes at the TMJ region. To the best of our knowledge, presence of bridging osteophyte at the TMJ region is first time reported in literature based on its location.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Van der Kraan PM, Van den Berg WB. Osteophytes: Relevance and biology. Osteo Arthritis Cartilage 2007;15:237-44.  Back to cited text no. 1
    
2.
Petrikowski CG. Diagnostic imaging of temporomandibular joint. In: White SC, Pharoah MJ, editor. Oral Radiology: Principles and Interpretation. 6th ed. Jordan Hill, Oxford: Elsevier Mosby Inc; 2008. p. 473-502.  Back to cited text no. 2
    
3.
Rogers J, Shepstone L, Dieppe P. Bone formers: Osteophyte and enthesophyte formation are positively associated. Ann Rheum Dis 1997;56:85-90.  Back to cited text no. 3
    
4.
Ardic F, Gokharman D, Atsu S, Guner S, Yilmaz M, Yorgancioglu R. The comprehensive evaluation of temporomandibular disorders seen in rheumatoid arthritis. Aust Dent J 2006;51:23-8.  Back to cited text no. 4
    
5.
dos Anjos Pontual ML, Freire JS, Barbosa JM, Frazao MA, dos Anjos Pontual A, Fonseca da Silveira MM. Evaluation of bone changes in the temporomandibular joint using cone beam CT. Dentomaxillofac Radiol 2012;41:24-9.  Back to cited text no. 5
    
6.
Bechtold TE, Saunders C, Decker RS, Um HB, Cottingham N, Salhab I, et al. Osteophyte formation and matrix mineralization in a TMJ osteoarthritis mouse model are associated with ectopic hedgehog signaling. Matrix Biol 2016;52-54:339-54.  Back to cited text no. 6
    
7.
Felson DT, Gale DR, Gale ME, Niu J, Hunter DJ, Goggins J et al. Osteophytes and progression of knee osteoarthritis. Rheumatol 2004;44:100-4.  Back to cited text no. 7
    
8.
Herb K, Cho S, Stiles MA. Temporomandibular joint pain and dysfunction. Curr Pain Headache Rep 2006;10:408-14.  Back to cited text no. 8
    
9.
Nagaosa Y, Lanyon P, Doherty M. Characterisation of size and direction of osteophyte in knee osteoarthritis: A radiographic study. Ann Rheum Dis 2002;61:319-24.  Back to cited text no. 9
    
10.
Messent EA, Ward RJ, Tonkin CJ, Buckland-Wright C. Osteophytes, juxta-articular radiolucencies and cancellous bone changes in the proximal tibia of patients with knee osteoarthritis. Osteo Arthritis Cartilage 2007;15:179-86.  Back to cited text no. 10
    
11.
Klaassen Z, Tubbs RS, Apaydin N, Hage R, Jordan R, Loukas M. Vertebral spinal osteophytes. Anat Sci Int 2011;86:1-9.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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