An underrecognized aspect of oncology care: temporomandibular joint evaluation in patients with head and neck cancer

Aims: This study aimed to evaluate and compare temporomandibular joint (TMJ) disc position and condylar morphology on magnetic resonance imaging (MRI) and computed tomography (CT) images of patients with head and neck cancer (HNC) and healthy controls, to determine the prevalence and coexistence of soft-tissue and osseous alterations and to explore their potential clinical relevance. Methods: In this retrospective case-control study, 145 HNC patients and 147 controls that underwent standardized maxillofacial CT and MRI. Anterior disc displacement (ADD) was defined on mid-sagittal MRI; condylar morphology (normal, flattening, erosion, osteophyte) was classified on sagittal CT. Results: Two hundred ninety-two individuals were analyzed (HNC 49.7%). Age was similar (mean difference -3.11 years; p=0.097; Mann-Whitney p=0.0737). ADD prevalence was higher in HNC: right 49.0% vs 37.4% (RD +11.6 percentage points [pp]; RR 1.31; χ² p=0.046), left 52.4% vs 32.7% (RD +19.8 pp; RR 1.61; χ² p=0.00064), and any ADD 60.7% vs 46.9% (RD +13.8 pp; RR 1.29; χ² p=0.018); significance was retained after Holm–Bonferroni adjustment. Condylar morphology distributions differed on both sides (right χ² p=9.6×10-⁵; left p=8.1×10-¹⁰), driven by more erosion in HNC (right 26.9% vs 11.6%; left 27.6% vs 13.6%). “Any condylar pathology” was more frequent in HNC (93.8% vs 85.7%; RD +8.1 pp; OR 2.52; χ² p=0.023; Fisher p=0.033). ADD showed no lateral preference within groups (McNemar p>0.30). Controls, but not HNC patients, exhibited right-greater-than-left discordance for “any condylar pathology” (McNemar p=2.5×10-⁵ vs 1.000). Conclusion: HNC is associated with a high burden of TMJ abnormalities; particularly ADD and an erosive change in condyle; consistent with treatment- and disease-related vulnerability of joint tissues. Providing TMJ assessment into HNC imaging, coupled with early jaw-mobilization and masticatory-muscle–sparing strategies, may help preserve function.