Abstract
Psoriatic arthritis is a specific type of inflammatory arthritis that develops in 10% to 30% of patients with psoriasis. It involves peripheral joints and lumbar vertebrae, and is characterized by enthesitis, i.e., inflammation at sites of tendon attachments to bone. In this study, we describe a patient with psoriatic arthritis who had temporomandibular joint ankylosis with markedly limited mouth opening and underwent surgery.
The patient was a 42-year-old man. He was referred to our department by a dermatological clinic because of limited mouth opening. The patient had a reduced mouth opening distance, and temporomandibular arthralgia developed. He also had a past history of psoriatic erythroderma. The maximum mouth opening was 3 mm, suggesting markedly limited mouth opening. Imaging studies showed bilateral narrowing of the joint spaces, frozen joints, and elongated coronoid processes. The patient was given a diagnosis of temporomandibular joint ankylosis, and bilateral condylectomy and aponeurectomy of the masseter muscle with coronoidectomy to release the temporal muscle tendon were performed by Piezosurgery ® with the patient under general anesthesia. The maximum mouth opening increased to 23 mm after condylectomy, 35 mm after right coronoidectomy and aponeurectomy, and 55 mm (final maximum mouth opening) after left coronoidectomy and aponeurectomy. After surgery, mouth opening training was actively performed. Limited mouth opening was improved without complications, and the jaw function was good. The postoperative course was satisfactory.
