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Briana Burris, DDS




Clinical Fellow




Endoscopic Maxillofacial Surgery Fellow




Briana Burris, DDS*; Daniel Choi, DDS MD; Joseph McCain, DMD FACS

The Presence of Immune-Mediated Synovial Membrane Disease in Low and High Inflammatory Arthropathies of the Temporomandibular Joint: A Serologic, Arthroscopic, and Histopathologic Study

I am an Oral and Maxillofacial Surgeon who is completing a two year fellowship in Endoscopic Maxillofacial Surgery and Minimally Invasive Temporomandibular Joint (TMJ) Surgery at MGH. This fellowship as a rare opportunity to hone the skills required to perform advanced-arthroscopy to repair and reconstruct TMJs using minimally-invasive approaches. Maxillofacial Surgery is a male-dominated specialty, and participating in the Women’s Science Symposium would be am empowering way for me to start a dialogue about the TMJ with other clinicians, as it is a joint that is incompletely understood and requires continued investigation.

Background: Distinguishing low and high inflammatory arthropathies of the temporomandibular joint (TMJ) and assessing the role of immune-mediation (IMM) in synovial membrane disease poses challenges due to lack of validated diagnostic criteria. The purpose of this study was to describe serologic, arthroscopic, and histopathologic findings suggestive of IMM and distinguishing findings of IMM in inflammatory arthropathies.

Methods: Chart review of 70 TMJ arthroscopy patients, performed at MGH in 2021. 62 women and 3 men met inclusion. Basic statistical analysis was performed on associations between: serology, arthroscopic and synovial biopsy histopathologic findings.

Results: A positive ANA (n=30) was most frequently associated with histopathologic findings of inflammatory infiltrates, synovial hyperplasia, or reactive synovial changes. Higher ANA titers were associated with inflammatory infiltrates (INF). Nearly one-third of patients had histologic findings of INF with lymphocytes, plasma cells, and/or chronic INF. Histologic presence of INF, without plasma cells, occurred in 20% of biopsies and was associated with arthroscopic findings of chondromalacia, adhesions, and joint stenosis.

Conclusions: These preliminary findings may represent an undefined subtype of inflammatory, IMM TMJ synovial disease. We have initiated further studies to identify molecular characteristics and validate diagnostic criteria. Development of targeted immunologic treatments for inflammatory TMJ arthropathies will follow.