A case of temporomandibular joint ankylosis caused by psoriatic arthritis

Abstract

Psoriatic arthritis (PsA) is a common relapsing inflammatory skin disease associated with joint symptoms in patients with psoriasis. Temporomandibular joint (TMJ) disorders are found in 68.8% of affected patients, however most cases of PsA associated with TMJ ankylosis are not reported. We experienced a case of TMJ ankylosis suspected to be caused by PsA. The patient was a 45-year-old male who had developed erythema of the skin and was diagnosed with psoriasis vulgaris at approximately 27 years of age. He was referred to us due to limited range of mouth opening as well as pain in the bilateral TMJ. Panoramic radiography revealed narrowing of the bilateral TMJ space, while computed tomography imaging showed prominent destructive and sclerosing changes in the bilateral mandibular condyle and glenoid fossa. Blood test results indicated a mildly decreased ferritin level and were negative for rheumatoid factor. The patient initially refused surgery and was given mouth opening exercises, though he stopped going to follow-up examinations. A few years later, he returned to our department with the same complaints, and a gap arthroplasty with a temporalis myofascial flap was performed. At a follow-up examination two years later, his maximal mouth opening had been maintained at 34 mm.