Traumatic myositis chondro-ossificans of masseter muscle associated with TGF-ß1, Indian Hegdehog, BMP2, osteopontin and osteocalcin upregulation: Case report.

Masseter traumatic myositis chondro-ossificans (TMCO) is a rare pathological condition that causes severe mandibular function restriction. The aim of the present study is to report a TMCO case after direct masseter muscle injury and correlate it to bone and cartilage biomarkers up-regulation. Caucasian male patient, 38 years old, seeks treatment nine days after trauma with severe mouth opening limitation. Physical examination revealed a circumscribed hardened area connected to masseter muscle on the left side. Cone beam tomography and ultrasonography of masseter region were requested. There was incomplete fracture between the posterior board of inferior jaw and coronoid process as well as calcification within masseter muscle. The proposed treatment was excisional biopsy of calcification, coronoid process removal to enhance mouth opening as well as incomplete condyle fracture monitoring. Material removed was sent for histological analysis in order to confirm diagnosis. Immuhistochemistry was conducted and it was found that chondro-ossification biomarkers such as TGF-b1, Indian Hegdehog (IHH), BMP2, osteopontin (OP) and osteocalcin (OC) were up-regulated. One-year follow-up showed that the patient is stable with increased mouth opening and satisfactory jaw movements. Pathologists and maxillofacial surgeons must be aware of differential diagnosis of TMCO. Understanding cellular mechanisms of muscle tissue after trauma is also important once cellular pathway modifications leads to clinical features that differ from previously described in literature.

Polymorphisms in FGF3, FGF10, and FGF13 May Contribute to the Presence of Temporomandibular Disorders in Patients Who Required Orthognathic Surgery.

BACKGROUND: To evaluate whether genetic polymorphisms in FGF3, FGF10, and FGF13 are associated with temporomandibular disorders (TMD) in patients that presented dentofacial deformities requiring orthognathic surgery. MATERIAL AND METHODS: The sample comprised a total of 113 patients of both sexes. The diagnosis of TMD was performed before orthognathic surgery between Research Diagnostic Criteria for Temporomandibular Disorders (RDC-TMD). According to the TMD assessment, the patients were divided into 3 major groups: myofascial pain, articular disc displacements and other TMD conditions (arthralgia, arthritis, and arthrosis). Genomic DNA was collected from saliva samples and genetic polymorphisms in FGF3 (rs1893047 and rs7932320), FGF10 (rs900379) and FGF13 (rs5931572 and rs5974804) were analyzed by real-time polymerase chain reactions. The association between the TMD conditions and the genetic polymorphisms assessed were analyzed by Poisson Regression. The model was calculated on bivariate and adjusted by sex. The established alpha was 5%. Data were analyzed by using SPSS software (IBM, Armonk, NY). RESULTS: The genetic polymorphisms rs7932320 in FGF3 (P < 0.001) and rs900379 in FGF10 (P < 0.05) were associated with the presence of muscle disorder. The genetic polymorphisms rs1893047 in FGF3, rs900379 in FGF10, and rs5974804 and rs5931572 in FGF13, were associated with the presence of disk displacement (P < 0.05). The genetic polymorphisms rs1893047 and rs7932320 in FGF3, rs900379 in FGF10, and rs900379 in FGF10 were associated with other TMD conditions (P < 0.05). CONCLUSION: Genetic polymorphisms in FGF3, FGF10, and FGF13 genes were associated with temporomandibular disorders in a population with dentofacial deformities.

Treatment of Atypical Bifid Mandibular Condyle Associated with Ankylosis of the Temporomandibular Joint.

INTRODUCTION: The bifid mandibular condyle (BMC) is an unusual temporomandibular joint (TMJ) disorder with controversial etiology. The association of this entity with ankylosis is rare. OBJECTIVE: The objective of the present study is to report a case of BMC with associated TMJ ankylosis in a patient with no history of trauma and/or infection. CASE REPORT: A 17-year-old male patient sought care reporting pain on the right TMJ region and mastication difficulty due to a severe limitation of mouth opening. In the clinic and imaging examinations, a 15 mm mouth opening and BMC associated with ankylotic mass of the right TMJ were observed, besides a facial asymmetry with chin deviation to the right. The proposed treatment plan was condylectomy on the right side, bilateral coronectomy, and genioplasty, so the chin lateral deviation could be corrected, under general anesthesia. The patient remains under clinical and imaging follow-up of two years with functional stability and no signs of relapse of the ankylosis. CONCLUSION: The association of BMC with ankylosis is an atypical entity which must be diagnosed and treated early to prevent aesthetic and functional damages to the patient.