A 62-year-old man with a persistent snoring problem presented for an oral medicine consultation. The snoring was disrupting his sleep and that of his partner. He had previously consulted with his dentist and his primary care physician. He had no history of complaints related to jaw function, and he was not in pain. There was no history of jaw trauma or jaw fracture.
The patient was healthy, fit, and of normal height and weight. He was taking no medication. A review of systems was unremarkable.
Examination revealed very slight facial asymmetry. Mandibular range of motion (ROM) was 41.5 mm. Lateral movement was normal to the right at 9 mm, and slightly reduced to the left at 7 mm. There was audible crepitus in the left temporomandibular joint (TMJ) when the patient opened his jaw. There was no pain with ROM or joint loading. The patient perceived his bite to be normal, and there was positive occlusal contact on the right and left posterior teeth.
There were no laboratory or biopsy findings to report.
In patients with snoring who do not have a diagnosis of sleep apnea and are candidates for intra-oral appliance therapy, a panoramic radiograph is required to rule out the possibility of TMJ disease. TMJ disease may be aggravated by use of the appliance or could compromise therapy. The crepitus identified in the patient’s left TMJ required the panoramic study to rule out significant TMJ osteoarthrosis.
The panoramic radiograph revealed a large irregularly shaped opacity associated with the left mandibular condyle (Figure 1). At the inferior margin there appeared to be a small oval radiolucency. The anterior margin of the opacity was sharply defined, but the superior margin appeared to include an irregular surface contour. The mandible itself was slightly asymmetric, with the height of the left ramus appearing longer than the left. The dentition and bone otherwise appeared normal.
A lateral head/jaw series in the closed and open views (Figure 2) showed a normal jaw opening associated with the abnormality.