Infections and cancers mimicking temporomandibular disorders

Abstract

Background: Jaw pain and trismus are common clinical symptoms among temporomandibular disorders (TMD) patients. These symptoms by a reason other than TMD may puzzle clinicians. Chronic dental infection can provoke the symptoms. Cancer is a rare cause but serious scenario. This report analysed 4 cases presenting TMD-like symptoms: two with chronic dental infections and two with malignancies. Objectives: This report stresses the importance of differential diagnoses of TMD with imaging diagnostics. Methods: The four patients were initially diagnosed with TMD and referred to TMJ clinic.Chronic dental infections: Case 1 and Case 2 with jaw pain and trismus without response to TMD treatment.Malignancies: Case 3 and Case 4 with progressive symptoms in spite of TMD treatment. Findings: Chronic dental infections -computed tomography (CT) scan revealed infection of dental origin into the infratemporal space in Case 1, and postsurgical infection of infra-masseteric space secondary to maxillary dental extraction in Case 2. Surgical drainage and antibiotics successfully resolved the symptoms in both cases.Malignancies -magnetic resonance imaging and/or CT scan disclosed a destructive mass in the condyle in Case 3, and in Case 4 a large cancer mass occupied the sinus and spreading into the adjacent structures. Pathologic examination confirmed lung metastatic adenocarcinoma in Case 3 and squamous cell carcinoma in Case 4. Both patients underwent chemoradiation, but passed away after four and six months, respectively. Conclusion: It is indispensable that oral surgeons be on the alert to symptoms mimicking TMD. Once any underlying disease is suspected, advanced imaging diagnostics should be considered immediately.