Condylar Asymmetry in Children with Juvenile Idiopathic Arthritis Assessed by Cone-beam Computed Tomography

The purpose of this study was to determine the degree of condylar asymmetry in children with juvenile idiopathic arthritis (JIA) using cone-beam computed tomography (CBCT) and analysis software. For 20 patients (14 girls and six boys; mean age 11.21 +/- 3.54 years), resultant cross-sectional images of the left and right temporomandibular joints (TMJs) were semi-automatically segmented, and exact registration of the right, with respect to the flipped left grey-level condyle, was obtained. Visual inspection of the volume images in 360 degree rotation showed a wide variety of condylar destruction patterns, ranging from small erosions within the cortex to almost complete deformation of the condylar head. Because segmentation was restricted to the delineation of the cortical region, possible changes in the deeper zones were not reproduced. Descriptive statistics [median and interquartile range (IQR)] and diagrams (frequency distribution) were used to assess the results. Initial analysis of condylar volume (including both flipped left and right) showed a median value for volume of 0.844 cm(3) (IQR 0.323), while the median value for volume difference between both condyles was 0.051 cm(3) (IQR 0.098). Analysis of the degree of asymmetry showed a median value of 26.18 per cent (IQR 14.46). Using the CBCT-based method, it was shown that condylar asymmetry was a common feature in children with JIA. The degree of asymmetry was variable, but significant in the majority of the subjects.