Subcutaneous lipoatrophy and skin depigmentation, secondary to a TMJ intra-articular injection of corticosteroids

Publication date: Available online 5 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Nicolás Patricio Skármeta P, Fernando Ariel Hormazábal N, Juan Alvarado, Ana Maria Rodriguez
BackgroundChronic orofacial pain is a complex multidimensional experience that produces disability and impairment of normal mandibular functions. Overall estimations of chronic orofacial pain prevalence are between 7-11% of the general population. Temporomandibular disorders (TMD) are one of the most prevalent chronic orofacial pain conditions, as temporomandibular joint (TMJ) arthralgia accounted for 30.1% of TMD patients. Interventional procedures are often used in pain and palliative medicine to achieve reasonable and cost-effective pain relief. The use of intra-articular corticosteroids in relieving arthralgia and improving joint function is well documented.Case DescriptionThe authors will present a clinical case of an 84-year-old female patient who was derived to Hospital del Salvador Orofacial Pain service with preauricular pain, limited range of movement, provoked pain at palpation, and function in the preauricular region. The patient was diagnosed, following DC/TMD criteria, with left TMJ arthralgia and degenerative joint disease, which was later corroborated with a CBCT scan. An intra-articular injection of 10mg of methylprednisolone was programmed, and the patient underwent the procedure, according to Hospital del Salvador's intraarticular injection protocol. The intervention underwent without any inconvenience. At the three-week control, the authors noticed that the patient presented a depigmented depression zone adjacent to the site of injection. After doing an echotomography, the authors concluded that the patient presented a skin depigmentation and subcutaneous lipoatrophy that were consecutive to the intra-articular injection of methylprednisolone. To our knowledge, this is the first time that this complication is ever-reported secondary to an interventional procedure in the TMJ.ConclusionsClinicians should be aware and patients must be advised of this rare complication before performing an intra-articular intervention.



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