Arnold-Chiari Syndrome : interdisciplinary valutation of strumental diagnosis in dental field

Aim: The use of strumental diagnosis on patients suffering from Juvenile Idiopathic Arthritis (JIA) permits to discover diseases which aren’t within competence of dentistry subject, making possible to do a early diagnosis, even without any symptoms. Material and Methods: The JIA can lead in children to temporomandibular joint damage with facial development and growth alterations. JIA of the mandibular condyle produces morphological and surface changes, including cortical erosion, flattening, sclerosis, osteophyte formation, and reduced inter-articular space. The Arnold-Chiari Syndrome can cause headaches, fatigue, muscle weakness in the head and face, difficulty swallowing, dizziness, nausea, impaired coordination, and, in severe cases, paralysis. We present a case report about a 20 years old patient with previous JIA for a exacerbation of articular pains. It has been requested a cranium TC, by means of we noticed a central erosion of both condyles, so much that they acquired a forked profile. As usual to evaluate the condition of the articular meniscus, we requested the execution of RMN exam. Results: The radiological survery reported, in addition to an articular meniscus erosion, a 14 mm prolapse of cerebellum tonsils under occipital foramen. This is a characteristic sign of the Arnold-Chiari Syndrome. The patient even being asymptomatic, has been sent to the Neurosurgery Department for a more accurate investigations and evaluate the chance for a surgical operation. Conclusions: It results to be necessary to have an interdisciplinary approach to instrumental analyses that could permit an early diagnosis which is not other wise possible in asymptomatic forms.