Temporomandibular joint pathology in patients with acromegaly: computed tomography and magnetic resonance imaging findings

Relevance. Acromegaly is a systemic disease that commonly involves the musculoskeletal system; however, temporomandibular joint changes in these patients remain insufficiently studied. Excess growth hormone secretion and elevated insulin-like growth factor 1 levels contribute to degenerative, inflammatory, and functional changes in the TMJ, which may lead to pain, impaired masticatory function, and reduced quality of life.

Materials and methods. Twenty patients with acromegaly, comprising 10 women and 10 men, were evaluated at the I. I. Dedov National Medical Research Center for Endocrinology, Ministry of Health of the Russian Federation, and the Russian University of Medicine. Clinical evaluation included symptom assessment, medical history taking, and physical examination. All patients underwent maxillofacial cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI) of both temporomandibular joints. The imaging studies were assessed for changes in the morphology of the mandibular condyles and fossae, osteophytes, erosions, joint space narrowing, articular disc position, signs of synovitis, and masticatory muscle tone.

Results. TMJ osteoarthritis was present in 13 patients (65%): Stage I in 5 patients (25%), Stage II in 7 (35%), and Stage III in 1 (5%). Anterior articular disc displacement was detected in 11 patients (55%), medial displacement in 9 (45%), and lateral displacement in 5 (25%). Synovitis was detected in 13 patients (65%), while condylar osteophytes and erosions and joint space narrowing were each found in 12 (60%). Masticatory muscle hypertonicity was present in 7 patients (35%). Fourteen patients (70%) reported symptoms, most commonly pain at rest and/or during mouth opening (9 patients, 45%), clicking during mouth opening (8, 40%), TMJ discomfort (5, 25%), and restricted mouth opening (1, 5%).

Conclusion. TMJ involvement in patients with acromegaly is characterized by a high prevalence of osteoarthritis, synovitis, osseous remodeling of the mandibular condyle, and articular disc displacement. The complementary use of CBCT and MRI provides a comprehensive assessment of osseous and soft-tissue TMJ abnormalities, facilitating their early detection and informing treatment planning.

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