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SECTION EDITOR: EDWARD B. STELOW, MD
A 45-year-old man with a history of diabetes and hypertension presented to an outside dentist for extraction of carious tooth No. 20. The extraction was uncomplicated, but 2 months later, the patient began to experience painless jaw stiffness. He presented to an outside institution and was followed up because of his continued inability to open his mouth, which progressed to 1 to 2 mm of maximal incisal opening. Treatment with anti-inflammatory medications, physical therapy, and range-of-motion exercises was unsuccessful. The patient presented to our institution with an 18-kg weight loss and significant dental disease 5 months after the development of his initial symptoms. He denied any previous head or neck trauma.
His vital signs were normal, and he appeared thin but not undernourished. His speech was difficult to understand because of his difficulty in opening his jaw. There was no tenderness of his temporomandibular joint or his muscles of mastication. The maximum incisal opening and excursion were both approximately 1 mm. Manipulation of the jaw with significant pressure could not produce an opening greater than 1 mm. The gingiva was pink, but multiple teeth were carious. Dynamic magnetic resonance imaging demonstrated minimal movement of the temporomandibular join. Computed tomographic images were then obtained (Figures 1, 2, 3, and 4).
What is your diagnosis?
Ebbert TL, Baima JJ, Smoker WRK. Radiology Quiz Case 1. Arch Otolaryngol Head Neck Surg. 2012;138(4):422. doi:10.1001/archoto.2012.62a
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