Temporomandibular joint involvement in nodulosis-arthropathy-osteolysis syndrome without TMJ-directed treatment: An eight-year imaging follow-up case report

BACKGROUND: Nodulosis-arthropathy-osteolysis (NAO) syndrome is an MMP2-related disorder within the multicentric osteolysis, nodulosis, and arthropathy spectrum. Temporomandibular joint (TMJ) involvement is rarely characterized. CLINICAL PRESENTATION: A woman with genetically confirmed NAO syndrome underwent TMJ imaging from 2018 to 2026 while receiving annual intravenous zoledronic acid for systemic skeletal disease. Baseline panoramic and cone-beam computed tomography imaging showed bilateral condylar flattening, cortical thinning, surface irregularity, altered trabecular architecture, and temporal-component involvement. Serial panoramic radiographs demonstrated progressive bilateral remodeling, including erosive changes, articular-eminence flattening, and shallow glenoid fossae. She reported occasional joint sounds without pain, locking, or interference with daily function. Examination showed mild left crepitus, no tenderness or deviation, and maximum comfortable, unassisted, and assisted openings of 36, 37, and 38 mm, respectively. No TMJ-directed treatment was undertaken. CONCLUSION: Progressive TMJ osseous change may occur in NAO syndrome despite minimal symptoms. Imaging should be interpreted with pain, function, examination, and differential diagnosis rather than used alone to establish a temporomandibular disorder or justify treatment.