Temporomandibular disorder (TMD) is an inclusive term in which those conditions disturbing the masticatory function are embraced. It has been estimated that 33% of the population have signs of TMD, but less than 5% of the population will require treatment. The objective of this study was to measure the frequency of TMD in rheumatoid arthritis (RA), osteoarthrosis (OA), ankylosing spondylitis (AS) and systemic lupus erythematosus, and to define the limitations in everyday's life that patients perceive when present. A six-month survey of consecutive outpatients in a rheumatology clinic in a teaching hospital in Mexico was carried out. We defined TMD as: 1) the presence of pain; 2) difficulty on mouth opening, chewing or speaking; 3) the presence of non-harmonic movements of the temporomaxilar joints. All three characteristics had to be present. Z test was used to define differences between proportions. We present the results of 171 patients. Overall, 50 patients had TMD according to our operational definition (29.24%). Up to 76% of the sample had symptoms associated with the condition. TMD is more frequent in OA and in AS (29.24% vs 38% OA, P=0.009; 39% AS; P=0.005). We found no association between the severity of TMD and the request for specific attention for the discomfort produced by the condition. Only 8 of 50 (16%) patients with TMD had requested medical help for their symptoms, and they were not the most severe cases. TMD is more frequent in RA and OA. Although it may produce severe impairment, patients seem to adapt easily. PMID:23884028
Aceves-Avila, F J; Chávez-López, M; Chavira-González, J R; Ramos-Remus, C
Calcium pyrophosphate dihydrate deposition disease (CPDD, tophaceous pseudogout) is a rare crystal arthropathy characterized by calcium pyrophosphate crystal deposition in joint spaces, episodes of synovitis, and radiological features of chondrocalcinosis. We present a case of 61-year-old woman who presented with left temporomandibular joint (TMJ) pain, difficulty chewing, left facial numbness, left-sided hearing loss, and left TMJ swelling. Imaging of the temporal fossa revealed a large mass emanating from the temporal bone at the TMJ, extending into the greater wing of the sphenoid and involving the mastoid bone and air cells posteriorly. Fine needle aspiration demonstrated polarizable crystals with giant cells. Intraoperatively, the TMJ was completely eroded by the mass. Final pathology was consistent with tophaceous pseudogout. CPDD has rarely been reported involving the skull base. None of the cases originally described by McCarty had TMJ pseudogout. Symptoms are generally pain, swelling, and hearing loss. Management is nearly always surgical with many patients achieving symptomatic relief with resection. CPDD is associated with many medical problems (including renal failure, gout, and hyperparathyroidism), but our patient had none of these risk factors. This case demonstrates that CPDD can involve the skull base and is best treated with skull base surgical techniques. PMID:23946918
Srinivasan, Vasisht; Wensel, Andrew; Dutcher, Paul; Newlands, Shawn; Johnson, Mahlon; Vates, George Edward
Calcium pyrophosphate dihydrate deposition disease (CPDD, tophaceous pseudogout) is a rare crystal arthropathy characterized by calcium pyrophosphate crystal deposition in joint spaces, episodes of synovitis, and radiological features of chondrocalcinosis. We present a case of 61-year-old woman who presented with left temporomandibular joint (TMJ) pain, difficulty chewing, left facial numbness, left-sided hearing loss, and left TMJ swelling. Imaging of the temporal fossa revealed a large mass emanating from the temporal bone at the TMJ, extending into the greater wing of the sphenoid and involving the mastoid bone and air cells posteriorly. Fine needle aspiration demonstrated polarizable crystals with giant cells. Intraoperatively, the TMJ was completely eroded by the mass. Final pathology was consistent with tophaceous pseudogout. CPDD has rarely been reported involving the skull base. None of the cases originally described by McCarty had TMJ pseudogout. Symptoms are generally pain, swelling, and hearing loss. Management is nearly always surgical with many patients achieving symptomatic relief with resection. CPDD is associated with many medical problems (including renal failure, gout, and hyperparathyroidism), but our patient had none of these risk factors. This case demonstrates that CPDD can involve the skull base and is best treated with skull base surgical techniques.
Srinivasan, Vasisht; Wensel, Andrew; Dutcher, Paul; Newlands, Shawn; Johnson, Mahlon; Vates, George Edward
Nine patients with facial pain were evaluated with limited bone scans. The scintigrams correlated with microscopy in all patients, although radiographs correlated with microscopy in only five patients. The degenerative disease process in the temporomandibular joint was more extensive in the patients with radiographic and scintigraphic abnormalities than in those with scintigraphic abnormalities alone. The limited bone scan appears useful in detecting early degenerative changes in the temporomandibular joint.
Goldstein, H.A.; Bloom, C.Y.
We report a case of a Calcium pyrophosphate dihydrate deposition disease (CPPD) presenting as a mass in the parotid and temporomandibular joint (TMJ) that simulated a parotid tumor. A 35 year-old man presented with pain in the left ear area. A CT Scan of the area showed a large, calcified mass surrounding the left condylar head, and extending into the
Asghar H Naqvi; Jerrold L Abraham; Robert M Kellman; Kamal K Khurana
This report describes a very rare case of synovial chondromatosis with deposition of calcium pyrophosphate dihydrate (CPPD) crystals (pseudogout) in the temporomandibular joint (TMJ) of a 46-year-old male patient. Synovial chondromatosis is a non-neoplastic disease characterized by metaplasia of the connective tissue leading to chondrogenesis in the synovial membrane. Pseudogout is an inflammatory disease of the joints caused by the deposition of CPPD, producing similar symptoms to those observed in gout but not hyperuricaemia. Both diseases commonly affect the knee, hip and elbow joints, but rarely affect the TMJ. PMID:23166363
Matsumura, Y; Nomura, J; Nakanishi, K; Yanase, S; Kato, H; Tagawa, T
This report describes a very rare case of synovial chondromatosis with deposition of calcium pyrophosphate dihydrate (CPPD) crystals (pseudogout) in the temporomandibular joint (TMJ) of a 46-year-old male patient. Synovial chondromatosis is a non-neoplastic disease characterized by metaplasia of the connective tissue leading to chondrogenesis in the synovial membrane. Pseudogout is an inflammatory disease of the joints caused by the deposition of CPPD, producing similar symptoms to those observed in gout but not hyperuricaemia. Both diseases commonly affect the knee, hip and elbow joints, but rarely affect the TMJ.
Matsumura, Y; Nomura, J; Nakanishi, K; Yanase, S; Kato, H; Tagawa, T
Calcium pyrophosphate dihydrate deposition (CPDD) disease is a disorder that occasionally affects the temporomandibular joint (TMJ) and temporal bone, causing pain (66.6% of cases), swelling (50%), trismus (36.8%), and hearing loss (22.2%). Diagnosis of CPDD is challenging because clinical symptoms and imaging features are not characteristic and may mimic a chondrosarcoma. When the diagnosis of CPDD of the TMJ is under consideration, conventional radiographs of the wrist or the knee may contribute to the final diagnosis. Imaging features of CPDD are discussed with a review of the literature. PMID:15140740
Marsot-Dupuch, Kathlyn; Smoker, Wendy R K; Gentry, Lindell R; Cooper, Karen A
The authors present the case of a 64-year-old woman with a destructive calcium pyrophosphate dihydrate (CPPD) crystal deposition disease of the temporomandibular joint. Progressive pain, swelling and a malocclusion were her chief complaints. A few granular calcified masses surrounding the left condylar head and extending to the infratemporal fossa and middle cranial base were presented in CT images. It occurred
J. Meng; C. Guo; H. Luo; S. Chen; X. Ma
We report a case of a Calcium pyrophosphate dihydrate deposition disease (CPPD) presenting as a mass in the parotid and temporomandibular joint (TMJ) that simulated a parotid tumor. A 35 year-old man presented with pain in the left ear area. A CT Scan of the area showed a large, calcified mass surrounding the left condylar head, and extending into the infratemporal fossa. FNA of the mass showed birefringent crystals, most of which were rhomboid with occasional ones being needle shaped, embedded in an amorphous pink substance. Scanning electron microscopy (SEM) with energy dispersive x-ray spectroscopy (EDS) of these crystals showed peaks corresponding to calcium and phosphorus. SEM/EDS is a rapid method of diagnosing calcium pyrophosphate dihydrate deposition disease (CPPD) and an alternative to more commonly used method of special staining of cell block sections coupled with polarizing microscopy.
Naqvi, Asghar H; Abraham, Jerrold L; Kellman, Robert M; Khurana, Kamal K
Temporomandibular Joint disorder (TMD) is a common disorder of mandibular motion system with distinct clinicopathological characteristics. TMD may cause to change in the components of synovial fluid, that affects the functions on lubrication and nutrition of cartilage. Boundary lubrication system contributing to the low friction of joint consists of three parts: lubricin, surface-active phospholipids and hyaluronan (HA). Diminishment of lubrication function is thereby implicated as an adverse contributing factor in degenerative joint diseases such as internal derangement, osteoarthrosis. Moreover, mesenchymal stem cells (MSCs) of synovial membrane can be obtained without irreversible damage, are easily expandable with limited senescence. We postulate that biological active components secreted from MSCs are separated and accumulated by gel permeation chromatography, and then we use the ultra-flirtation of serum and biologically active components to reconstruct the biological synovial fluid in order to rehabilitate the boundary lubrication system and the nutrition of cartilage. Further study investigating the components of biological synovial fluid provides with new treatment strategy for TMD. PMID:18063487
Meng, Qing-Gong; Long, Xing
The aim of this study was to determine whether there are any differences between condylectomy, rib grafts, and prosthetic joints (Biomet TMJ stock prosthesis) with regard to outcomes for patients with end-stage temporomandibular joint (TMJ) disease. Fifty-six of a total 127 patients who presented with category 5 end-stage TMJ disease over 3 years (2010-2013) agreed to participate in this retrospective, comparative, cohort study. Patients were divided into four groups: preoperative (n=16), condylectomy (n=8), rib graft (n=16), and prosthetic joint (n=16). They were assessed for major postoperative complications (i.e., return to theatre) and maximum range of mandibular motion, and all completed a specific quality of life (QOL) questionnaire. Whilst the condylectomy group demonstrated the best mandibular range of motion (P<0.01), rib graft patients were more likely to experience complications (43.8%) necessitating a return to theatre. The prosthesis group recorded the best mean aggregate QOL score, but the difference compared to the rib graft and condylectomy groups was not statistically significant. The results of this study suggest that for dentate patients, prosthetic joints are highly dependable with no returns to theatre and favourable QOL outcomes. For edentulous patients, condylectomies alone also appear to work well. Future TMJ prosthetic designs should focus on improving mandibular range of motion, as the current stock prosthesis allows only a restricted range, no better than that achieved with rib graft (P>0.05) and far less than that achieved with condylectomy (P<0.01). PMID:24629849
Pain in the temporomandibular joint is often the result of internal derangement, other causes are traumatic, functional or inflammatory processes. Conventional radiography is indicated in case of suspected trauma or for specialised preoperative measurements to plan the treatment of various facial dysplasias. MRI and CT should be used in the context with the results of clinical investigation and of axiography to differentiate the various functional and morphological abnormalities of this joint. PMID:11762260
Robinson, S; Peloschek, P; Schmid-Schwab, M; Piehslinger, E; Kainberger, F
Summary: In this article, the CT, three-dimensional CT, and MR findings are reviewed in a 59-year-old woman with tumoral cal- cinosis involving the temporomandibular joint. Index term: Temporomandibular joint, neoplasms Tumoral calcinosis is an uncommon disease characterized by periarticular soft tissue hyper- plasia and calcification. Large joints such as the hip, shoulder, and elbow most frequently are involved. This entity
Kelly Sled; Orlando Ortiz; Mark Wax; Jerry Bouquot
Three cases of pain-only decompression sickness of the temporomandibular joint following altitude chamber exposure are presented. A detailed interview of each individual revealed no other joint involvement or other complaints. A careful neurologic examina...
F. W. Rudge
Temporomandibular joint (TMJ) is a complex, sensitive, and highly mobile joint. Millions of people suffer from temporomandibular disorders (TMD) in USA alone. The TMD treatment options need to be looked at more fully to assess possible improvement of the available options and introduction of novel techniques. As reconstruction with either partial or total joint prosthesis is the potential treatment option in certain TMD conditions, it is essential to study outcomes of the FDA approved TMJ implants in a controlled comparative manner. Evaluating the kinetics and kinematics of the TMJ enables the understanding of structure and function of normal and diseased TMJ to predict changes due to alterations, and to propose more efficient methods of treatment. Although many researchers have conducted biomechanical analysis of the TMJ, many of the methods have certain limitations. Therefore, a more comprehensive analysis is necessary for better understanding of different movements and resulting forces and stresses in the joint components. This article provides the results of a state-of-the-art investigation of the TMJ anatomy, TMD, treatment options, a review of the FDA approved TMJ prosthetic devices, and the TMJ biomechanics. PMID:19252985
Ingawalé, Shirish; Goswami, Tarun
To date, there is no objective or reliable means of assessing the severity of degenerative joint disease (DJD) and need for joint replacement surgery. Hence, it is difficult to know when an individual with DJD has reached a point where total arthroplasty is indicated. The purpose of the present study is to determine whether serum levels of Alpha-2 HS-glycoprotein (AHSG) as well as bone morphogenetic proteins (BMP-2, 4, 7) can be used to predict the presence of severe DJD of the hip and/or temporomandibular joint (TMJ) (specifically: joints that require replacement). A total of 30 patients scheduled for arthroplasty (diseased) (15 HIP, 15 TMJ) and 120 age-matched controls (healthy/non-diseased) were included. Blood samples were collected from all patients ?8 weeks after the last arthroplasty. Concentrations of serum analytes were measured using enzyme-linked immunosorbent assays, and these were compared between the Diseased and Healthy groups, utilizing the Mann-Whitney U-test. Patients with disease had significantly higher levels of BMP-2 and BMP-4 and lower levels of AHSG in serum compared to non-diseased humans (p?0.01). Higher levels of BMP-2, 4 and reduced levels of AHSG appear to characterize patients who have DJD that is severe enough to require total joint replacement. Perhaps measurements of these proteins can be used to make objective decisions regarding the need for total arthroplasty as opposed to the current subjective approaches. PMID:22778059
Albilia, Jonathan B; Tenenbaum, Howard C; Clokie, Cameron M L; Walt, David R; Baker, Gerald I; Psutka, David J; Backstein, David; Peel, Sean A F
Purpose: This study investigated the correlation between temporomandibular joint (TMJ) disease and the composition of glycosaminoglycans (GAGs) components in the synovial fluid (SF).Materials and Methods: Synovial fluid (SF) was obtained from 30 TMJs of 28 female patients diagnosed as having a displaced disc with reduction (WR) (seven joints), a displaced disc without reduction (WOR) (13 joints), osteoarthritis (OA) (five joints),
Takanori Shibata; Ken-Ichiro Murakami; Eiro Kubota; Hiroshi Maeda
Purpose: The purpose of this study was to determine the level of tumor necrosis factor-alpha (TNF-?) in the temporomandibular joint (TMJ) synovial fluid (SF-TNF-?) and blood plasma (P-TNF-?) of patients with chronic inflammatory connective tissue disease and investigate its relation to TMJ pain, hyperalgesia, and allodynia.Patients and Methods: Twenty-four patients with a diagnosis of chronic inflammatory connective tissue disease and
Silvi Nordahl; Per Alstergren; Sigvard Kopp
... A total temporomandibular joint prosthesis is a device that is intended to be implanted in the human jaw to replace the mandibular condyle and augment the glenoid fossa to functionally reconstruct the temporomandibular joint. (b) Classification....
Purpose: The study goal was to evaluate the comparative outcomes of patients treated with temporomandibular joint (TMJ) total joint prostheses, using either the Christensen prosthesis (TMJ Inc, Golden, CO) (CP) or the TMJ Concepts prosthesis (TMJ Concepts Inc, Camarillo, CA; formerly Techmedica Inc) (TP). Patients and Methods: Forty-five consecutive patients treated with either CP or TP total joint prostheses were
Larry M. Wolford; Douglas J. Dingwerth; Reena M. Talwar; Marcos C. Pitta
The temporomandibular joint (TMJ) can be the site of bone, cartilaginous, or synovial tumors. There is no well-defined histological classification. We listed all benign tumors, malignant primitive tumors, and rare pseudo tumors of the TMJ. We provide a list to help for the diagnosis and the differential diagnosis of non-tumoral lesions by far the most frequent. PMID:23711211
Oukabli, M; Chibani, M; Ennouali, H; Hemmaoui, B; Albouzidi, A
Objectives Dislocation of the temporomandibular joint may occur for various reasons. Although different invasive methods have been advocated for its treatment, this study highlights the value of non-invasive treatment options even in chronic cases in a resource-poor environment. Materials and Methods A seven-year retrospective analysis of all patients managed for temporomandibular joint dislocation in our department was undertaken. Patient demographics, risk factors associated with temporomandibular joint dislocation and treatment modalities were retrieved from patient records. Results In all, 26 patients were managed over a seven-year period. Males accounted for 62% of the patients, and yawning was the most frequent etiological factor. Conservative treatment methods were used successfully in 86.4% of the patients managed. Two (66.7%) of the three patients who needed surgical treatment developed complications, while only one (5.3%) patient who was managed conservatively developed complications. Conclusion Temporomandibular joint dislocation appears to be associated with male sex, middle age, yawning, and low socio-economic status, although these observed relationships were not statistically significant. Non-invasive methods remain an effective treatment option in this environment in view of the low socio-economic status of the patients affected.
Fomete, Benjamin; Obiadazie, Athanasius Chukwudi; Idehen, Kelvin; Okeke, Uche
Introduction The anatomy and physiology of the temporomandibular joint can be studied clinically and by diagnostic imaging. Magnetic resonance imaging (MRI), radiography (X-ray) and computed tomography (CT) have thus for many years contributed to the study of the kinetics in the mandibular condyle. However, also duplex Doppler ultrasound (US) examination is widely used in the study of structures during movement, particularly vascular structures. Materials and methods A total of 30 patients were referred by the Department of Orthodontics to the Department of Radiological, Oncological and Pathological Sciences, University of Rome “La Sapienza”. All patients underwent duplex Doppler ultrasound (US) examination of the temporomandibular joint using Toshiba APLIO SSA-770A equipment and duplex Doppler multi-display technique, which allows simultaneous display of US images and color Doppler signals. A linear phased array probe with crystal elements was used operating at a basic frequency of 6 MHz during pulsed Doppler spectral analysis and 7.5 MHz during US imaging. Results In normal patients a regular alternation in the spectral Doppler waveforms was obtained, while in patients with temporomandibular joint meniscus dysfunction there was no regularity in the sum of the Fourier series with an unsteady waveform pattern related to irregular movements of the temporomandibular joint. Conclusions In all cases duplex Doppler US examination proved able to differentiate between normal and pathological patients and among the latter this technique permitted identification of the most significant aspects of the dysfunctional diseases.
Stagnitti, A.; Marini, A.; Impara, L.; Drudi, F.M.; Lo mele, L.; Lillo Odoardi, G.
Loose ligaments are often a predisposing factor of temporomandibular joint (TMJ) disorders. This causal factor was analyzed in 701 subjects presenting at the TMJ and Posture Center of Siena University with TMJ pain or dysfunction. Along with the conventional jaw examination, a Carter and Wilkinson test as modified by Beighton was also done. We found a correlation among the parameters of age, gender, TMJ disorder, joint pain, muscle pain, and loose ligaments. PMID:16933458
Deodato, Francesco; Trusendi, Raffaello; Giorgetti, Roberto; Scalese, Marco U
This paper is a preliminary paper which presents the early findings of an ongoing prospective trial on the use of the TMJ Concepts and Biomet Lorenz total joint replacement systems for the reconstruction of the temporomandibular joint (TMJ). Total alloplastic replacement of the TMJ has become a viable option for many people who suffer from TMJ disease where surgical reconstruction is indicated. Degenerative joint diseases such as osteoarthritis, rheumatoid arthritis, psoriatic arthritis, TMJ ankylosis, malunited condylar fractures and tumours can be successfully treated using this technique. There are a number of TMJ prostheses available. Two of the joint replacement products, which have been found to be most reliable and have FDA approval in the United States, are the TMJ Concepts system and the Biomet Lorenz system, and for this reason they are being investigated in this study. This study presents the findings of seven patients with a total of 12 joint replacements using either the TMJ Concepts system or the Biomet Lorenz joint system. Two patients (3 joints) had the TMJ Concepts system and five patients (9 joints) had the Biomet Lorenz system. Although still early, the results were generally pleasing, with the longest replacement having been in position for three years and the most recent six months. The average postoperative mouth opening was 29.7 mm (range 25-35 mm) with an average pain score of 1.7 (range 0-3, minimum score of 0 and maximum 10). Complications were minimal and related to sensory disturbance to the lip in one patient and joint dislocation in two patients. PMID:21332746
Jones, R H B
The treatment of the temporomandibular joint (TMJ) is still controversial. TMJ arthrocentesis represents a form of minimally invasive surgical treatment in patients suffering from internal derangement of the TMJ, especially closed lock. It consists of washing the joint with the possibility of depositing a drug or other therapeutic substance. Resolution of symptoms is due to the removal of chemical inflammatory mediators and changes in intra-articular pressure. Numerous clinical studies regarding this technique have been published. The goal of this paper is to review all clinical articles that have been published with regard to the critique of this technique. 19 articles with different designs fulfilling selection guidelines were chosen. A series of clinical and procedure variables were analyzed. Although the mean of improvement was higher that 80%, further research is needed to determine more homogeneous indications for TMJ athrocentesis. Key words:Temporomandibular joint, arthrocentesis, minimally invasive surgery.
Nitzan, Dorrit; Gonzalez-Garcia, Raul
Management of temporomandibular joint (TMJ) disorders presenting with pain, restricted mouth opening, or simply asymptomatic clicking can be challenging even to the experienced surgeon. Many conservative and invasive techniques are available, but most cases can be treated by arthrocentesis of the joint locally. A simple process of joint irrigation enables lysis of intra-articular adhesions, change in the joint viscosity, and clearance of various substances in the joint fluid. Classically, arthrocentesis of the TMJ has been performed with 2 needles: an infusion needle and an aspiration needle. Various devices and techniques have been described in the literature, each with its own benefits and drawbacks. We introduce our technique of TMJ lavage using 2 different gauge needles placed in a concentric manner; hence, besides a less traumatic and easier puncture of the joint capsule, the lavage and aspiration of the joint space can be performed efficiently, with minimal morbidity. The use of a concentric-needle cannula system is the least traumatic and perhaps the most cost-effective method for TMJ lavage described to date. We believe that this technique is applicable and can be performed by even the inexperienced surgeon. PMID:21775039
Örero?lu, Ali R?za; Özkaya, Özay; Öztürk, M Be?ir; Bingöl, Derya; Akan, Mithat
Temporomandibular joint ankylosis is a debilitating disorder arising from an inability to open the mouth. This leads to poor nutrition, poor dental hygiene, and stunted growth. Anaesthesia, especially general anaesthesia, is very difficult to administer. There is a lack of direct visualization of the vocal cords, tongue fall following relaxation, and an already narrowed passage due to a small mandible, which makes even the blind nasal intubation difficult. There are various techniques described in literature to overcome these challenges, failing which, one needs to do tracheostomy. All the risks of difficult intubation and general anaesthesia can be avoided if the surgery is done under local anaesthesia. A simple but effective method of successful local anaesthesia is described, which allows successful temporomandibular joint reconstruction. PMID:19753260
Gajiwala, Kalpesh J
Temporomandibular joint ankylosis is a debilitating disorder arising from an inability to open the mouth. This leads to poor nutrition, poor dental hygiene, and stunted growth. Anaesthesia, especially general anaesthesia, is very difficult to administer. There is a lack of direct visualization of the vocal cords, tongue fall following relaxation, and an already narrowed passage due to a small mandible, which makes even the blind nasal intubation difficult. There are various techniques described in literature to overcome these challenges, failing which, one needs to do tracheostomy. All the risks of difficult intubation and general anaesthesia can be avoided if the surgery is done under local anaesthesia. A simple but effective method of successful local anaesthesia is described, which allows successful temporomandibular joint reconstruction.
Gajiwala, Kalpesh J.
Temporomandibular joint morphology and function can be evaluated by panoramic zonography. Thermoluminescent dosimetry was applied to evaluate the radiation dose to predetermined sites on a phantom eye, thyroid, pituitary, and parotid, and the dose distribution on the skin of the head and neck when the TMJ program of the Zonarc panoramic x-ray unit was used. Findings are discussed with reference to similar radiographic techniques.
Coucke, M.E.; Bourgoignie, R.R.; Dermaut, L.R.; Bourgoignie, K.A.; Jacobs, R.J. (Department of Orthodontics, Universitair Ziekenhuis, Ghent (Belgium))
Temporomandibular joint (TMJ) diseases and disorders refer to a complex and poorly understood set of conditions, manifested by pain in the area of the jaw and associated muscles and limitations in the ability to make the normal movements of speech, facial expression, eating, chewing, and swallowing. The conventional soft occlusal splint therapy is a much safer and effective mode of a conservative line of therapy in comparison to the surgical therapy for temporomandibular joint disorders (TMD). The purpose of this article is to review the Aqualizer™, an hydrostatic oral splint, as accurate, effective treatment and differential diagnostic tool in TMD that allow treating the patient's pain quickly and accurately saving valuable treatment time. The review article has been prepared doing a literature review from the world-wide web and pubmed/medline. PMID:24019797
Srivastava, Rahul; Jyoti, Bhuvan; Devi, Parvathi
We report a series of four patients presenting with symptoms of temporomandibular joint pain and dysfunction, and manifesting calcified loose bodies within the temporomandibular joint. Tomographic and arthrotomographic findings are described. Surgical confirmation was obtained in two patients and the histopathology in one demonstrated that the loose body was calcified cartilage surrounded by synovial tissue. The synovial tissue of the
Quentin N. Anderson; Richard W. Katzberg
In experiment on 30 corpses of adult people criteria of an operational wound (depth of a wound, a corner of operational action, an axis of operational action, a corner of an inclination of operational action) were studied at preauricularis, intrauricularis, intrauriculo-temporalis and posterior mandibullaris access to temporo-mandibular joint (TMJ). New surgical intrauriculo-temporalis access to the joint is substantrated. On the basis of the analysis of 289 operations at 268 patients the indications to a choice of surgical access were developed at various diseases and damages of TMJ. PMID:18163061
Sysoliatin, P G; Novikov, A I; Sysoliatin, S P; Bobylev, N G; Brega, I N
Joint mobility was assessed in each member of an epidemiological sample of 96 girls and 97 boys, 17 years old, and graded by means of the hypermobility score of Beighton et al. Twenty two per cent of the girls and 3% of the boys could perform five or more of the nine manoeuvres. The prevalence of symptoms and signs of internal derangement in the temporomandibular joint was higher in adolescents with hypermobility of joints (score greater than or equal to 5/9). In subjects with a high mobility score oral parafunctions (overuse) correlated more strongly with several signs and symptoms of craniomandibular disorder than in those with a low score.
Westling, L; Mattiasson, A
Synovial chondromatosis of the temporomandibular joint is rare. Even less commonly documented is the progression of synovial chondromatosis to a synovial chondrosarcoma. The aim of this paper is to present only the third case of synovial chondrosarcoma of the temporomandibular joint. Distinction between these two entities by histology alone is extremely difficult and even though it is advised that the definitive diagnosis should be based on clinical, radiographic and histological evidence, this has proved not to be so simple. The patient, a 63 year old female presented with a swelling associated with her left temporomandibular joint. CT and MRI scans confirmed the presence of a periauricular chondroid mass. Fine needle aspiration biopsy revealed an atypical chondroid lesion that was supicious for a chondrosarcoma. The left temporomandibular joint and surrounding tissues were resected after further imaging and extensive clinical, radiological and cytologic consultations. A diagnosis of synovial chondrosarcoma arising in synovial chondromatosis was made. PMID:23576196
Coleman, Hedley; Chandraratnam, Edward; Morgan, Gary; Gomes, Lavier; Bonar, Fiona
Synovial chondromatosis (SC) of the temporomandibular joint (TMJ) is a rare disease characterized by the presence of calcified loose bodies within the joint, and few systematically gathered data are available about its epidemiology. The aim of this paper was to describe a case of SC of the TMJ, and to carry out a systematic review of the literature on epidemiology
L. Guarda-Nardini; F. Piccotti; G. Ferronato; D. Manfredini
Synovial chondromatosis of the temporomandibular joint is a disease which occurs rarely. A systematic review of the literature was carried out to identify its demographical, etiological, radiological, and clinical characteristics. A total of 191 case presentations were discovered. The mean age of patients was 47. The disease has been identified more frequently in women than in men. A part from pre-auricular swelling, the most frequently reported clinical characteristics resembled those of temporomandibular disorders. Abnormalities on radiographs were often evident. Insufficient evidence was found that trauma or rheumatoid arthritis plays a role in the development of this disease. Given the similarities with temporomandibular disorders, synovial chondromatosis should be considered in the differential diagnosis of patients suffering from complaints of temporomandibular dysfunction. PMID:21957638
te Veldhuis, A H; Lobbezoo, F; te Veldhuis, E C; Naeije, M; van Selms, M K A
Similarly to humans, healthy, wild-type mice develop osteoarthritis, including of the temporomandibular joint (TMJ), as a result of aging. Pro-inflammatory cytokines, such as IL-1?, IL-6, and TNF?, are known to contribute to the development of osteoarthritis, whereas TGF? has been associated with articular regeneration. We hypothesized that a balance between IL-1? and TGF? underlies the development of TMJ osteoarthritis, whereby IL-1? signaling down-regulates TGF? expression as part of disease pathology. Our studies in wild-type mice, as well as the Col1-IL1?XAT mouse model of osteoarthritis, demonstrated an inverse correlation between IL-1? and TGF? expression in the TMJ. IL-1? etiologically correlated with joint pathology, whereas TGF? expression associated with IL-1? down-regulation and improvement of articular pathology. Better understanding of the underlying inflammatory processes during disease will potentially enable us to harness inflammation for orofacial tissue regeneration.
Lim, W.H.; Toothman, J.; Miller, J.H.; Tallents, R.H.; Brouxhon, S.M.; Olschowka, M.E.; Kyrkanides, S.
Clinical experience of arthroscopy in 12 temporomandibular joints with a clinical diagnosis of closed lock was described. There were 10 patients and all were females with a mean age of 31.2 years (range 20 to 59 years). The antero-lateral approach was used for entry into 11 joints. The clinical findings were adhesions (64%), fibrillation (64%), anterior displacement of disc (36%) and scuffing of the articular surface of the glenoid fossa (9%). Two of the joints that had arthrocentesis prior to arthroscopy did not show any different findings from the rest. Of the 8 patients who had pre-arthroscopy pain, 7 patients (88%) had reduction of the symptom. Three patients (38%) had complete resolution of pain. The range of mouth opening (measured as maximal incisor opening) increased in all patients two weeks following arthroscopy. The average change in maximal incisor opening was 40.3% with a range of 22% to 85%. The mean follow-up was 34 months (range 4 to 68 months). PMID:8924004
Go, W S; Teh, L Y; Peck, R H; Chew, S C; Chua, E K
Analysis of previous data suggested the hypothesis that temporomandibular joint (TMJ) eminence shapes develop ideally to minimize joint loads. Hence, we tested this hypothesis in nine females and eight males in each of two groups, with and without TMJ disc displacement. Participants provided anatomical data used in a joint load minimization numerical model to predict, and jaw-tracking data used to
L. R. Iwasaki; M. J. Crosby; D. B. Marx; Y. Gonzalez; W. D. McCall; R. Ohrbach; J. C. Nickel
Direct measurement of temporomandibular joint (TMJ) tissue deformation requires animal experimentation. Most of the available data pertain to the mechanical strain on the bone surfaces around the joint. However, bone is rarely the first joint tissue to show injury, being affected after damage to collagenous tissues such as the disc or capsule. Capsular ligaments guide or limit movement, while the intra-articular disc may also distribute joint loads. However, these tissues are difficult to visualize dynamically and not suitable for strain gage attachment, so in vivo deformations are poorly understood. Using pigs as the best nonprimate model for human TMJ function, we implanted differential variable reluctance transducers to measure antero-posterior strain in the lateral aspect of the intra-articular disc. The results were compared to previously published data on the TMJ capsule. Passive manipulation in anesthetized animals indicated that opening, protrusion, and contralateral movements caused the disc to elongate. On the contrary, closing, retrusion and ipsilateral movements caused disc shortening. These strains are opposite to those observed in the capsule and are expected on anatomical grounds. Surprisingly, disc strain during mastication differed from that during manipulation. The disc elongated during jaw closure, more on the retruding balancing side (16% +/- 1) than on the working side (8% +/- 2). This anomalous behavior may reflect compressive loading, such that the disc elongates as a result of the Poisson effect rather than condylar movement. Because the capsule also elongates during the power stroke, especially on the balancing side, both disc and capsule are maximally loaded on the same side at the same moment. PMID:16088132
Sindelar, Betty J; Herring, Susan W
Tuberculosis (TB), an infectious disease caused by Mycobacterium tuberculosis, continues to be a major health problem worldwide. Primary TB infection is mostly pulmonary, but it may also occur in the lymph nodes, abdomen, skin, meninges, joints, and central nervous system. TB in the head and neck region usually occurs in the cervical lymph nodes, but is extremely rare in the temporomandibular joint (TMJ). This rarity increases the risk for not considering TB in the differential diagnosis of patients presenting with TMJ pain. This article describes an unusual case of a 53-year-old man with painful swelling in the right preauricular area accompanied by difficulty in mouth opening. After surgical exploration, histopathologic findings revealed TB in the TMJ. The findings of this case highlight the importance of considering TB in the differential diagnosis of TMJ pain, especially for patients from endemic areas, patients who have lived or visited those areas, or patients with a preauricular swelling in the TMJ area. PMID:24822240
Park, Hye Jeong; Kim, Bong Chul; Choi, Eun-Joo; Samayoa, Sara Rebeca Kang; Kim, Hyung-Jun
Bifid mandibular condyle is an uncommon entity described in the literature as having a controversial etiology. Despite the absence of clinical symptomatology, the radiologist must be aware and should have some knowledge of this abnormality, as well its implications regarding functional and morphological changes. TMJ ankylosis is a disabling disease with involvement of the mandibular condyle, articular fossa and base of the skull. The association of bifid condyle with temporomandibular joint ankylosis is rare and must be carefully evaluated. The purpose of this paper is to report a case of simultaneous bifid mandibular condyle and temporomandibular joint ankylosis and to describe its computed tomography imaging findings. PMID:17639206
Sales, Marcelo Augusto Oliveira; Oliveira, Jefferson Xavier; Cavalcanti, Marcelo Gusmão Paraíso
Three orthodontically treated cases with sounds of the temporomandibular joint are presented. Case 1: Eight months after [formula: see text] extraction, bilateral TMJ sounds were noticed. The patient had a history of pre-orthodontic TMJ sounds and locking. A disc recapturing splint was therefore set on the upper arch, then changed into a stabilization splint for 5 months. The TMJ sounds faded away and the active treatment was completed. Case 2: The patient had [formula: see text] missing teeth, severe deep bite, upper and lower spaced arches. She also had mild facial deformity and bilateral TMJ sounds. TMJ arthroscopy showed right side "Anterior disk displacement without reduction" and left side "Anterior disk displacement with reduction". Maxillary spaces were closed following standard splint therapy. Right side TMJ sound diminished considerably while left side sound faded away completely. Finally, prosthodontic treatment was performed. Case 3: The patient had mandibular right side shifting, upper and lower crowding and a right side TMJ sound. Initially, maxillary lateral expansion was performed using a Quad-helix appliance. Simultaneously a positioner-type splint was used on the lower arch for avoiding any occlusal interference. TMJ sound faded away and a standard [formula: see text] extraction treatment was completed for crowding correction and better occlusion. PMID:2133874
Sasaki, M; Tomioka, N; Katsumoto, S; Tokuyama, T; Hasegawa, M; Talass, L S; Talass, M F; Yoneyama, K; Matsumoto, K; Kogai, H
Movement over the surface of the temporomandibular joint (TMJ) disc produces tractional forces. These forces potentially increase the magnitude of shear stresses and contribute to wear and fatigue of the disc. Theoretically, tractional forces in all synovial joints are the result of frictional forces, due to rubbing of the cartilage surfaces, and plowing forces, due to translation of the stress-field
L. M. Gallo; J. C. Nickel; L. R. Iwasaki; S. Palla
Computed tomography represents an effective and highly automated method to display biomedical data from many sources. It has a number of advantages over previous reconstruction methods, particularly the ability to automatically locate object-boundary outlines and produce shaded three-dimensional images of reconstructed data. A three-dimensional reconstruction of the temporomandibular joint was performed successfully on five cadaver heads using the Phillips Tomoscan and IP5000 image processor. The program used in this study of the temporomandibular joint is divided into five distinct steps: data gathering, rotation and projection, filtering, smoothing, and shading. Comparison of this type of data is important in the study of the normal and abnormal anatomy of the temporomandibular joint. Similarly, quantitative data obtained from reconstructed computed tomograms can be used to study normal anatomy in vivo and to examine the effects of various treatment modalities on the size and morphologic characteristics of tumors and other pathologic entities. PMID:3863492
Moaddab, M B; Dumas, A L; Chavoor, A G; Neff, P A; Homayoun, N
Calcium pyrophosphate dihydrate (CPPD) deposition disease (pseudogout) of the temporomandibular joint (TMJ) is rare. It is characterized by the presence of crystal deposits that are birefringent under polarized light. Although these crystals are characteristically weakly birefringent, some other crystals such as those of calcium oxalate, synthetic steroids, and ethylenediaminetetraacetic acid are also birefringent. The differential diagnosis should therefore be based
S. Aoyama; K. Kino; T. Amagasa; T. Kayano; S. Ichinose; Y. Kimijima
Synovial chondromatosis (SC) of the temporomandibular joint is a rare benign lesion that can extend to the adjacent bony tissue. Most studies in the literature reported cases of SC of the temporomandibular joint with extension to the skull base, but there has been no report of intracranial extension through the articular eminence. The current study reports on the case of SC with articular eminence extension that was treated via combined trans-zygomatic tempora and preauricular approach and acquired good effect with 44 months of follow-up. PMID:22565885
Jiang, Bin; Yang, Chi; Chen, Min-Jie; Cai, Xie-Yi
A 26-yr-old AC-130 gunner developed unilateral temporomandibular joint (TMJ) pain while flying a combat support mission. A diagnosis of decompression sickness (DCS) was made based on his symptoms and risk factors that included prolonged exposure to high altitude (60 to 90 min at 18,000 ft), cold temperature (-11 degrees C), and increased inflight activity. His symptoms resolved with 100% oxygen and he was returned to flying status after 72 h. Altitude related DCS is an unusual occurrence and this is the first reported case of inflight DCS affecting the temporomandibular joint. PMID:9591625
Fabian, B G
Introduction: The temporomandibular joint (TMJ) forms the very cornerstone of craniofacial integrity and its ankylosis in a growing child may cause problems in daily food intake, speech, appearance, and oral hygiene is affected to a major extent. It is one of the common acquired pathologies afflicting the skeleton. It is also the most overlooked and under-managed problem in children. Materials and Methods: A house to house survey was conducted between 2010 and 2011 in rural and urban areas of Lucknow. A total of 21,720 children aged between 3-15 years from 9090 houses comprising a representative sample were included. Results: Ten TMJ ankylosis cases were identified in 21,720 children. Of these, six were bilateral and four were unilateral. Male to female ratio was 1:9, with most patients (70.0%) being in the 10-15 years’ age group (mean age was 11.1 years ± 3.34). The most common cause of ankylosis was trauma for 90.0% of cases. The majority of patients (70%) were reporting the condition for the first time, with 30% patients having had previous treatment. Conclusion: TMJ ankylosis is an acquired condition in most of the cases. Birth/childhood trauma would be the major causative factor. Knowledge amongst parents, providers of health about this entity was poor. Initial management of the causative factor was poor. Mere knowledge among the general population and healthcare providers can result in primary prevention and also secondary prevention along with its successful definitive treatment.
Gupta, Vinay Kumar; Mehrotra, Divya; Malhotra, Seema; Kumar, Sandeep; Agarwal, Girdhar Gopal; Pal, Uma Shanker
AIM: To identify the relationship between anterior disc displacement and global posture (plantar arches, lower limbs, shoulder and pelvic girdle, vertebral spine, head and mandibles). Common signs and symptoms of anterior disc displacement were also identified. INTRODUCTION: Global posture deviations cause body adaptation and realignment, which may interfere with the organization and function of the temporomandibular joint. METHODS : Global posture evaluation was performed in a group of 10 female patients (20 to 30 years of age) with temporomandibular joint disc displacement and in a control group of 16 healthy female volunteers matched for age, weight and height. Anterior disc displacement signs, symptoms and the presence of parafunctional habits were also identified through interview. RESULTS: Patients with disc displacement showed a higher incidence of pain in the temporomandibular joint area, but there were no differences in parafunctional habits between the groups. In the disc displacement group, postural deviations were found in the pelvis (posterior rotation), lumbar spine (hyperlordosis), thoracic spine (rectification), head (deviation to the right) and mandibles (deviation to the left with open mouth). There were no differences in the longitudinal plantar arches between the groups. CONCLUSION: Our results suggest a close relationship between body posture and temporomandibular disorder, though it is not possible to determine whether postural deviations are the cause or the result of the disorder. Hence, postural evaluation could be an important component in the overall approach to providing accurate prevention and treatment in the management of patients with temporomandibular disorder.
Saito, Eliza Tiemi; Akashi, Paula Marie Hanai; de Camargo Neves Sacco, Isabel
Synovial chondromatosis is a formation of multiple intrasynovial nodules resembling osteochondromas, resulting from proliferative changes in the synovial linings of joints; as the disorder progresses, nodules increasingly withdraw from the intrasynovial areas for the joint cavities. This is a relatively unusual case that can arise at unilateral large joints, such as knee, hip, and elbow, with the temporomandibular joint being the rarest one of them. Early recognition of the signs and symptoms with resultant accurate diagnosis, as well as proper surgical treatment, offers patients the best hope of recovery and improved quality of life. We report a conventional radiologic film, computed tomography, magnetic resonance imaging, and histopathologic findings of the synovial chondromatosis presenting as a large right preauricular mass arising from the temporomandibular joint without bone destruction. PMID:22801131
Kahraman, Aysegul Sagir; Kahraman, Bayram; Dogan, Metin; Firat, Cemal; Samdanci, Emine; Celik, Tayfun
Large calcified areas were observed in the articular discs of the temporomandibular joint from five patients suffering from articular dysfunctions. The calcified regions were always located inside the fibrous tissue of the discs. They had a woven bone-like morphological pattern and consisted of a compact mineralized tissue containing cells in irregular lacunae. In all the samples the calcified tissue was
Carla Marchetti; Giorgio Bernasconi; Marcella Reguzzoni
This study evaluated 1) the efficacy of packing autologous fat grafts around temporomandibular joint (TMJ) total joint prosthetic reconstruc- tions to prevent fibrosis and heterotopic bone formation and 2) the ef- fects on postsurgical joint mobility and jaw function. One hundred fifteen patients (5 males and 110 females) underwent TMJ reconstruction with total joint prostheses and simultaneous fat grafts (88
Larry M. Wolford; Carlos A. Morales-Ryan; Patricia Garcia Morales; Daniel Serra Cassano
The optimum method of temporomandibular joint (TMJ) reconstruction has not been defined despite numerous surgical treatments and several well controlled clinical trials. Animal models offer an experimental method allowing direct comparison of standardized surgical techniques. Advanced osteoarthrosis was induced bilaterally in 12 mature merino sheep. Three months alter unilateral surgical reconstruction was performed. Four sheep had discectomy alone, four discectomy with fresh TMJ disc grafts, and four discectomy with fresh auricular grafts. All three surgical methods resulted in some reversal and repair of the osteoarthritic process, with the best result being from the auricular graft, next discectomy alone, next the disc graft, with the untreated osteoarthritic joint showing the most advanced pathosis. This study supports the role of surgical reconstruction in advanced degenerative disease of the temporomandibular joint, in particular, auricular graft reconstruction. PMID:9153841
Ogi, N; Ishimaru, J; Kurita, K; Handa, Y; Jones, R H; Goss, A N
Introduction Condylotomy is a surgical procedure that has been used as an option to treat temporomandibular disorder (TMD) patients. This technique has the advantage of avoiding intra-capsular alterations that might be found involving other surgical procedures. Its use, even when unilateral, has positive effect on treatment of both joints. Methods In order to better evaluate the benefits of a clinical-surgical treatment for TMD, the present report describes the case of a psoriatic arthritis patient. The case was clinically characterized by dental malloclusion, and imaging exams showed joint degeneration of the right mandibular condyle. The patient was treated by condylotomy technique after a prosthetic oral rehabilitation. Results No clinical-radiological signs or symptoms of progression of articular disease were observed within a period of 16 months after surgery. Furthermore, there was functional stability of the temporomandibular joint, total absence of local pain and improvement of mouth opening. Conclusion The present study suggests that condylotomy can be considered as a valid option for the management of TMD, since it has low surgical morbidity and favorable clinical outcomes. In this case, the patient had a medical diagnosis of systemic disease presenting general pain and pain at the temporomandibular joint (TMJ), in addition of causal agent of TMD (dental malloclusion). The difficulty of finding a single etiology (malocclusion vs. systemic disease) did not exclude the indication of a clinical-surgical treatment to re-establish the balance of TMJ.
Patients having complete dentures with reduced vertical dimension generally do not manifest Temporomandibular Joint problems. It is not understood as to why the closure of jaws in dentulous individuals can predispose to Temporomandibular Joint problems, while the same etiology in edentulous subjects does not cause any concern. This study was planned to find out the prevalence of various Temporomandibular Joint dysfunction signs in subjects who were edentulous for a period of 6 months to 2 year. The various signs were obtained from a population of 100 healthy asymptomatic edentulous subjects by a questionnaire and then were clinically examined for the presence or absence of signs of Temporomandibular Joint dysfunction. 59% of the subjects exhibited one or more signs of Temporomandibular Joint dysfunction, 41% of the subjects did not show any signs of Temporomandibular Joint dysfunction. 56.6% of males reported signs of Temporomandibular Joint dysfunction when compared with females which was 62.5%. 43.3% of males did not show any signs of Temporomandibular Joint dysfunction when compared with those of the females which was 37.5%. The number of subjects who showed two signs was 29%, subjects who had only one sign was 25%. It was found that dysfunction was prevalent among both men and women in more than half of the asymptomatic subjects examined. 59% had one or as many as three signs of Temporomandibular dysfunction. The most commonly seen Joint dysfunction was the joint sounds which was 47% PMID:21629451
Patients having complete dentures with reduced vertical dimension generally do not manifest Temporomandibular Joint problems.\\u000a It is not understood as to why the closure of jaws in dentulous individuals can predispose to Temporomandibular Joint problems,\\u000a while the same etiology in edentulous subjects does not cause any concern. This study was planned to find out the prevalence\\u000a of various Temporomandibular Joint
Temporomandibular joint arthoscopy is a minimal invasive surgical procedure commonly used to effectively treat some internal derangement of the TMJ. However, this method is not free of complications. Arteriovenous fistula (AVF) is a lesion that communicates the high flow arterial system and the low flow venous network. We describe a new case of preauricular traumatic AVF successfully treated with external carotid embolization, along with a review of the medical literature. PMID:15287315
Martín-Granizo, R; Caniego, J L; de Pedro, M; Domínguez, L
The complexity of structure and functions of the Temporomandibular Joint (TMJ) make the diagnosis of its diseases/disorders difficult. Remarkable progress made in the field of imaging of this joint led us to compare four imaging modalities viz. plain radiographs, CT scan, MRI and ultrasound. We found that MRI was most specific and sensitive for interpretation of soft tissue and inflammatory conditions in the joint, whereas CT examination produced excellent image for osseous morphology and pathology. Plain X-rays are useful for destructive bony changes and sonography is a good in aid in diagnosing disc derangement and is very economical.
Sinha, Vijai P.; Pradhan, Harsha; Gupta, Hemant; Mohammad, Shadab; Singh, R. K.; Mehrotra, Divya; Pant, M. C.; Pradhan, R.
A total of 974 patients with suspected abnormalities of the temporomandibular joint (TMJ) were examined; diseases were detected in 371 patients. The test group consisted of 40 patients, control group of 18 patients. Analysis of the results of graphic recording of mandibular movements and clinical x-ray data in patients of the main and control groups helped develop the strategy for the diagnosis of TMJ dysfunction, based on the functional methods of examination (oral functionography and non-oral axiography). PMID:12666547
Arutiunov, S D; Khvatov, I L; Arutiunov, D S; Nabiev, N V; Tuturov, N S
To investigate the impact of temporomandibular joint (TMJ) pain on daily activities and quality of life in relation to systemic inflammatory activity in patients with rheumatoid arthritis (RA), thirty-three consecutive outpatients with RA were included. TMJ pain intensity at rest, on maximum mouth opening, and on chewing was assessed on a 0–10 numerical rating scale. TMJ palpatory tenderness, degree of anterior open bite, the impact of TMJ pain on daily activities and quality of life were also assessed. The systemic inflammatory activity was estimated by the disease activity score 28 (DAS28), blood levels of inflammatory markers and number of painful musculoskeletal regions. TMJ pain at rest, on maximum mouth opening, and on chewing as well as DAS28 was correlated with the impact of the TMJ pain on daily activities and quality of life. Partial correlations showed a significant interaction between TMJ pain on movement and DAS28 that explained the TMJ pain impact on daily activities and quality of life to a significant degree. This study indicates that both current TMJ pain intensity and systemic inflammatory activity play roles in the impact of TMJ pain on daily living and quality of life in RA.
Ahmed, Neveen; Mustafa, Hamid Masoud; Catrina, Anca Irinel
Twenty-six patients (12 males and 14 females) between two days and 41 years old with temporomandibular joint ankylosis were retrospectively reviewed. Thirty-three joints were involved; 19 unilateral and six bilateral. The aetiologies were trauma, 69.2%; infection, 15.4%; unknown, 11.5% and congenital, 3.9. The majority, 31 were intracapsular while the remaining two joints were extracapsular 51.6% were limited to the condyle, 32.2% extended to the coronoid process and the zygomatic, 9.7% extended to the sigmoid notch while the remaining 6.5% had maxillomandibular fusion. Tracheostomy (48%) was the most common mode of intubation. Gap arthroplasty was carried out in 20 joints while 11 joints had interposition arthroplasty. Postoperative complications were seven anterior open bite, three facial nerve weakness, three infections and two recurrences. PMID:21942122
Ajike, S O; Omisakin, O O
The three-dimensional (3D) temporomandibular joint (TMJ) model derives from a study of the cranium by 3D virtual reality and mandibular function animation. The starting point of the project is high-fidelity digital acquisition of a human dry skull. The cooperation between the maxillofacial surgeon and the cartoonist enables the reconstruction of the fibroconnective components of the TMJ that are the keystone for comprehension of the anatomic and functional features of the mandible. The skeletal model is customized with the apposition of the temporomandibular ligament, the articular disk, the retrodiskal tissue, and the medial and the lateral ligament of the disk. The simulation of TMJ movement is the result of the integration of up-to-date data on the biomechanical restrictions. The 3D TMJ model is an easy-to-use application that may be run on a personal computer for the study of the TMJ and its biomechanics. PMID:19098544
Cascone, Piero; Rinaldi, Fabrizio; Pagnoni, Mario; Marianetti, Tito Matteo; Tedaldi, Massimiliano
Summary Statement of the problem: Drug addiction or substance abuse is an endemic habit globally. At present there is no data available regarding the temporomandibular joint status, Occlusal and cervical tooth wear and facial pain among substance abusers from the Saudi Arabia. Purpose: The aim of the study was to investigate the temporomandibular joint status, occlusal and cervical tooth wear
Khalid Almas; K. Al Wazzan; I. Al Hussaini; K. Y. Al-Ahdal; N. B. Khan
We present a new case of unilateral synovial chondromatosis of the temporomandibular joint, including diagnostic images, the treatment performed, and histologic analysis. In this report, we describe a case of temporomandibular joint synovial chondromatosis treated only through arthroscopy to remove 112 loose bodies completely. PMID:24220430
Zhu, Yaomin; Zheng, Cangshang; Deng, Yongqiang; Zhang, Ying; Hu, Xinxin
Purpose: This study investigated the association between temporomandibular joint pain and bone marrow alterations in the mandibular condyle seen on magnetic resonance (MR) images.Patients and Methods: The study was based on 112 temporomandibular joints in 112 patients with disc displacement without reduction. Thirty-four patients with abnormal bone marrow on MR images were compared with a control group of 78 patients
Tsukasa Sano; Per-Lennart Westesson; Tore A. Larheim; Ritsuo Takagi
We report a rare case of a brain abscess which drained spontaneously in a temporomandibular joint damaged by osteoarthritis. The female patient presented to our hospital with a severe headache and pain in the temporomandibular joint. She showed elevated inflammatory parameters with unknown cause. Magnetic resonance imaging of her whole body revealed a large temporal brain abscess extending into the glenoid fossa of the temporomandibular joint. The brain abscess was incised and drained by neurosurgeons in our hospital and in the same operation we resected the articular disc and the affected part of the right temporomandibular joint. Histological examination confirmed a chronic arthrosis in the resected bone of the temporomandibular joint and an inflammatory abscess in the resected brain tissue. The patient recovered well and the inflammation resolved as seen in postoperative investigations. Magnetic resonance imaging a month later confirmed local consolidation in the brain with no sign of residual inflammation. PMID:22440320
Klatt, J; Heiland, M; Gröbe, A; Westphal, M; Schmelzle, R; Pohlenz, P
The temporomandibular joint is critical for jaw movements and allows for mastication, digestion of food, and speech. Temporomandibular joint osteoarthritis is a degenerative disease that is marked by permanent cartilage destruction and loss of extracellular matrix (ECM). To understand how the ECM regulates mandibular condylar chondrocyte (MCC) differentiation and function, we used a genetic mouse model of temporomandibular joint osteoarthritis that is deficient in two ECM proteins, biglycan and fibromodulin (Bgn?/0Fmod?/?). Given the unavailability of cell lines, we first isolated primary MCCs and found that they were phenotypically unique from hyaline articular chondrocytes isolated from the knee joint. Using Bgn?/0 Fmod?/? MCCs, we discovered the early basis for temporomandibular joint osteoarthritis arises from abnormal and accelerated chondrogenesis. Transforming growth factor (TGF)-?1 is a growth factor that is critical for chondrogenesis and binds to both biglycan and fibromodulin. Our studies revealed the sequestration of TGF-?1 was decreased within the ECM of Bgn?/0 Fmod?/? MCCs, leading to overactive TGF-?1 signal transduction. Using an explant culture system, we found that overactive TGF-?1 signals induced chondrogenesis and ECM turnover in this model. We demonstrated for the first time a comprehensive study revealing the importance of the ECM in maintaining the mandibular condylar cartilage integrity and identified biglycan and fibromodulin as novel key players in regulating chondrogenesis and ECM turnover during temoporomandibular joint osteoarthritis pathology.
Embree, Mildred C.; Kilts, Tina M.; Ono, Mitsuaki; Inkson, Colette A.; Syed-Picard, Fatima; Karsdal, Morten A.; Oldberg, Ake; Bi, Yanming; Young, Marian F.
Introduction Chronic dislocation of temporomandibular joint is usually treated with conservative approaches, but in some cases, surgery\\u000a is needed to avoid recurrencies. The present paper described a case report of a bilateral intervention for articular tubercle\\u000a height augmentation by means of calvaria bone grafts.\\u000a \\u000a \\u000a \\u000a Materials and Methods A 32-year-old woman attended the Department of Maxillofacial Surgery, University of Padova, Italy, in January
Luca Guarda-Nardini; Bernadette Palumbo; Daniele Manfredini; Giuseppe Ferronato
Apoptosis has been shown to be involved in remodeling of organs during development, and derangement of the apoptotic process\\u000a may result in temporomandibular joint (TMJ) dysfunction or congenital malformation. To investigate the relationship between\\u000a the development of the TMJ and apoptosis, rat fetuses at 17.5–20.5 days of gestation (E17.5–20.5, vaginal plug=E0) and rats\\u000a at postnatal days 1, 2, 3, 5,
S. Matsuda; Koichi Mishima; Yasuro Yoshimura; Toshihisa Hatta; Hiroki Otani
The authors report a prospective study involving investigation of the temporo-mandibular joints for algo-dysfunctional syndromes by gaseous arthroscanning. They propose a double articular compartment injection technique using CT scan localization. The CT scan study is performed using fine sagittal sections with the mouth both closed and open, and also Hirtz coronal sections. Early results directly demonstrate menisco-ligamentary structures, the position of the meniscus in the closed position and its displacement on mouth opening, these being of fundamental importance to the practitioner. The authors present normal results and the principal pathological results encountered in the investigation of algodysfunctional syndromes involving this joint (T.M.A.D.S.). CT scan allows more precise localization for joint injection than radioscopy, and while the images obtained are markedly better than those obtained on opaque arthrograms, they offer less dynamic information in view of the lack of radioscopy. PMID:2814320
Bertrand, J L; Rives, J M; Cantaloube, D
Purpose: The purpose of this study was to investigate the relationship between the presence of joint effusion, joint pain, and protein levels in joint lavage fluid (JL) of patients with internal derangement (ID) and osteoarthritis (OA) of the temporomandibular joint (TMJ).Patients and Methods: Thirty-eight joints in 26 patients with ID and OA of the TMJ were studied. Magnetic resonance imaging
Tetsu Takahashi; Hirokazu Nagai; Hiroshi Seki; Masayuki Fukuda
Background: Purpose of this study was to modify the stethoscope which can auscultate the temporomandibular joint (TMJ) sounds more precisely than conventional stethoscope, and fabrication of stethoscope compatible software which analyses the auscultated sound and gives documentary evidence of that analysis in the form of graph. Materials & Methods: The conventional stethoscope was modified by attaching a custom made soundscope with a recording device which can be placed in external auditory meatus (EAM) for auscultation of TMJ sounds. When this small and smooth end of custom made soundscope of modified stethoscope is placed in EAM & connected with specially developed software it records the TMJ sounds & analyzes them in form of graph. Results: Fabrication of modified stethoscope with software records the auscultated sound as a sound wave in form of graph and analyses this sound wave graph to give graphic evidence of prominent intensity at prominent frequency as spectrum analysis graph, and duration of that sound as a sound length graph. Conclusion: The use of modified stethoscope with software increases the accuracy of auscultation of TMJ sounds without any patient’s discomfort and helps in diagnosis of TMJ disorders. The modified stethoscope with software for auscultation of TMJ sounds results in more precise auscultation & analysis of TMJ for sounds even of low intensity & frequency. How to cite the article: Dagar SR, Turakiya V, Pakhan AJ, Jaggi N, Kalra A, Vaidya V. Modified stethoscope for auscultation of temporomandibular joint sounds. J Int Oral Health 2014;6(2):40-4.
Dagar, Sanjiv Rajender Singh; Turakiya, Viral; Pakhan, Ashok J; Jaggi, Nitin; Kalra, Amit; Vaidya, Vidya
The temporomandibular joint is one of the most complicated joints in the human body. Diagnosing its disorders is difficult because the pain is mistakenly taken for toothache, pain in the jaw bones, etc. The paper deals with a post-processing tomographic examination of temporomandibular joint. An interesting post-processing method was used to increase the contrast related to relaxation time T2. Both
O. Liberda; K. Bartusek; Z. Smekal; J. Mikulka
Mucolipidosis Type III, or pseudo-Hurler polydystrophy, is a rare genetic abnormality, the result of a mutation to one of two genes that encode the hexameric protein N-acetylglucosaminyl-1-phosphotransferase (Glc-NAc-PT). The abnormality results in the accumulation of unprocessed macromolecules in cell and tissue compartments throughout the body. In this case report, we describe the clinical and radiographic findings of a 15-year-old male with this disorder. He presented with bilateral ectopically developing mandibular molar teeth with enlarged follicles and multiple joint involvement, including the temporomandibular joints. The patient underwent surgical removal of the molar teeth and curettage of the associated follicles. The subsequent histopathological examination of the tissues revealed hyperplastic follicles suggestive of dentigerous cysts. This report presents the plain film and cone beam CT examinations of the patient.
Khalifa, H; Grubisa, HS; Lee, L; Lam, EWN
The aim of this study was to determine the relationship between the pathogenic duration of rheumatoid arthritis in joints other than the temporomandibular joint and bone and soft tissue involvement of the temporomandibular joint using magnetic resonance imaging. Twenty-six symptomatic patients diagnosed with rheumatoid arthritis were enrolled in this study. All patients were classified according to the duration of rheumatoid arthritis in joints other than the temporomandibular joint. The relationships between the duration of rheumatoid arthritis in these various joints and magnetic resonance findings in the temporomandibular joint were analyzed using the chi-square test. Bony changes in the mandibular condyle were observed in 43 of 52 (82.7 %) temporomandibular joints, but the frequency of such changes was not significantly correlated with the duration of rheumatoid arthritis in other joints. We found a significant correlation between the duration of rheumatoid arthritis in other joints and the type and number of bony changes in the mandibular condyle (P?0.05). Superior disc positions were observed in 27 of 52 (51.9 %) temporomandibular joints. T2-weighted images demonstrated effusion in the joint space in 38 of 52 (73.1 %) temporomandibular joints. A biplanar disc configuration was the most frequent configuration in all groups. The duration of rheumatoid arthritis in other joints was significantly correlated with the mobility of the mandibular condyle (P?0.05). The type and number of bony changes and mobility of the mandibular condyle showed significant relationships with the duration of rheumatoid arthritis in other joints in the body (P?0.05). PMID:23857661
Uchiyama, Yuka; Murakami, Shumei; Furukawa, Souhei
Three hundred and forty-eight cranial remains from Bronze and Iron Age British, Romano-British, Anglo-Saxon, Eastern Coast Australian aborigines, Medieval Christian Norse, Medieval Scarborough, 17--20th century British and German cultures, were examined for the presence of osteoarthritis in the temporomandibular joints. Cultures exposed to more stringent living conditions and with well-worn teeth had about twice the incidence of osteo-arthritis as the more sophisticated cultures. In general, loss of either molar support or occlusal imbalance were potent aetiological factors in this disease. PMID:380538
Griffin, C J; Powers, R; Kruszynski, R
Osteoarthrosis is a disease that affects the temporomandibular joint (TMJ). This case report chronicles the diagnosis and treatment of a patient for whom this pathological condition was accompanied by a rupture of the articular disc. The patient presented with loud sounds in the left TMJ and an irregular mandibular occlusal plane due to condylar intrusion in the glenoid fossa on the ipsilateral side. A noninvasive treatment was selected. A 4-month follow-up revealed remission of the articular sounds, and tissue regeneration was noted. These improvements remained visible at 5-year follow-up. PMID:24598507
Cardinal, Lucas; Porto, Felipe; Agarwal, Sachin; Grossman, Eduardo
Objective: To review the pseudotumors and tumors of the temporomandibular joint (TMJ) published in journals included in Journal Citation Reports (JCR), and to evaluate whether there are clinical and radiological signs capable of differentiating between pseudotumors and tumors and between malignant and benign tumors. Material and Methods: A systematic Medline search was made of clinical cases of tumors and pseudotumors of the TMJ covering a 20-year period and published in journals included in JCR. Only cases with histological confirmation were included. A description is provided of the general characteristics of TMJ tumors, with comparison of the clinical, diagnostic, therapeutic and evolutive variables referred to pseudotumors, benign tumors and malignant tumors. Results: We identified 285 TMJ tumors published in 181 articles of 15 journals. The most frequent lesions were pseudotumors (synovial chondromatosis, pigmented villonodular synovitis, eosinophilic granuloma and osteochondroma). The mean age was 42 years and one month ± 16 years and two months. Tumors were more common in females. The mean time from symptoms onset to consultation was 30 months and 8 days ± 41 months and 9 days, and almost 19.6% of the cases initially had been diagnosed and treated as TMJ dysfunction. The most frequent clinical manifestations were pain, swelling and the limitation of joint movements. The most common radiological findings in the case of benign and malignant lesions were radiopacities and radiotransparencies, respectively. No panoramic X-ray alterations were observed in 14.6% of the benign tumors and in 7.7% of the malignant lesions. Surgery was the usual form of treatment. Sequelae were recorded in 18.2% of the cases, with tumor relapse in 9.1%. The four-year survival rate in the case of malignant tumors was 72.2%. Key words:Tumor, temporomandibular joint, metaplasia, pseudotumor, condyle.
Bagan, Jose V.; Sanchis, Jose M.; Margaix, Maria
Mutation of the human TRPS1 gene leads to trichorhinophalangeal syndrome (TRPS), which is characterized by an abnormal development of various organs including the craniofacial skeleton. Trps1 has recently been shown to be expressed in the jaw joints of zebrafish; however, whether Trps1 is expressed in the mammalian temporomandibular joint (TMJ), or whether it is necessary for TMJ development is unknown. We have analyzed (1) the expression pattern of Trps1 during TMJ development in mice and (2) TMJ development in Trps1 knockout animals. Trps1 is expressed in the maxillo-mandibular junction at embryonic day (E) 11.5. At E15.5, expression is restricted to the developing condylar cartilage and to the surrounding joint disc progenitor cells. In Trps1 knockout mice, the glenoid fossa of the temporal bone forms relatively normally but the condylar process is extremely small and the joint disc and cavities do not develop. The initiation of condyle formation is slightly delayed in the mutants at E14.5; however, at E18.5, the flattened chondrocyte layer is narrowed and most of the condylar chondrocytes exhibit precocious chondrocyte maturation. Expression of Runx2 and its target genes is expanded toward the condylar apex in the mutants. These observations underscore the indispensable role played by Trps1 in normal TMJ development in supporting the differentiation of disc and synoviocyte progenitor cells and in coordinating condylar chondrocyte differentiation. PMID:22427063
Michikami, Ikumi; Fukushi, Toshiya; Honma, Shiho; Yoshioka, Seisuke; Itoh, Shunji; Muragaki, Yasuteru; Kurisu, Kojiro; Ooshima, Takashi; Wakisaka, Satoshi; Abe, Makoto
Tiagabine is an anticonvulsant gamma-aminobutyric acid reuptake inhibitor commonly used as an add-on treatment of refractory partial seizures in persons over 12 years old. Four of the 5 cases reported here indicate that tiagabine might also be remarkably effective in suppressing nocturnal bruxism, trismus, and consequent morning pain in the teeth, masticatory musculature, jaw, and temporomandibular joint areas. Tiagabine has a benign adverse-effect profile, is easily tolerated, and retains effectiveness over time. Bed partners of these patients report that grinding noises have stopped; therefore, the tiagabine effect is probably not simply antinociceptive. The doses used to suppress nocturnal bruxism at bedtime (4–8 mg) are lower than those used to treat seizures.
Kast, R. E.
Mandibular condyle plays an important role in the growth and reconstruction of the temporomandibular joint (TMJ). We aimed to obtain orthotropic elastic parameters of the condyle using a continuous-wave ultrasonic technique and to observe the effects of condylar elastic parameters on stress distribution of the TMJ using finite element analysis (FEA). Using the ultrasonic technique, all nine elastic parameters were obtained, which showed that the mandibular condyle was orthotropic. With the condyle defined as orthotropic, the occlusal stress was transferred fluently and uniformly from the mandible to the TMJ. The stress distribution in the isotropic model showed stepped variation among different anatomical structures with higher stress values in the cartilage and condyle than in the orthotropic model. We conclude that anisotropy has subtle yet significant effects on stress distribution of the TMJ and could improve the reality of simulations.
Zhang, Min; Ono, Takahiro; Chen, Yongjin; Lv, Xin; Wu, Shun; Song, Hong; Zhao, Ruini; Wang, Yibing
Trifid mandibular condyle is an exceedingly rare entity with only 5 cases reported to date. The etiology of the disorder is unknown, though like bifid mandibular condyle, a correlation with prior trauma is usually seen. We present a case of a 6-year-old child who presented with severe restriction of movements at the temporomandibular joint, with a history of trauma 2 years back. Imaging revealed bilateral temporomandibular joint ankylosis with trifid and bifid mandibular condyles. PMID:23524825
Jha, Abhishek; Khalid, Mohd; Sahoo, Biswajit
Microvascular temporomandibular joint (TMJ) and mandibular ramus reconstruction was performed in a 4-year-old hemifacial microsomia patient with multiple craniofacial and extracranial anomalies (Goldenhar syndrome). Her major craniofacial anomalies included bilateral cleft lip and palate, left macrostomia, left microtia, and complete absence of the left vertical mandibular ramus and TMJ. Most of her other anomalies had been corrected surgically before TMJ and vertical mandibular ramus reconstruction, which was accomplished with a metatarsophalangeal (MTP) joint transplantation. The MTP joint was placed in hyperextended position in the skull base inserting the proximal phalanx under the remnants of the zygomatic arch and replacing the vertical mandibular ramus with the metatarsal bone. Straight mouth opening, correction of the midline, and normalized lateral movements of the mandible were accomplished. The graft includes two epiphyseal plates, which should maintain growth of the transplant. During the follow-up period (16 months) the achieved results have been maintained without adverse effects. The present technique appears to be a promising alternative in the treatment of children with Pruzansky type 3 hemifacial microsomia. PMID:12457098
Vilkki, S K; Hukki, J; Nietosvaara, Y; Hurmerinta, K; Suominen, E
In synovial joints, friction between articular surfaces leads to shear stress within the cartilaginous tissue, which might result in tissue rupture and failure. Joint friction depends on synovial lubrication of the articular surfaces, which can be altered due to compressive loading. Therefore, we hypothesized that the frictional coefficient of the temporomandibular joint (TMJ) is affected by the magnitude and duration
E. Tanaka; N. Kawai; M. Tanaka; M. Todoh; T. van Eijden; K. Hanaoka; D. A. Dalla-Bona; T. Takata; K. Tanne
Acute temporomandibular joint dislocation is a common occurrence that is generally treated by conservative therapy. In some patients, this can become a chronic recurrent condition. This recurrent temporomandibular joint dislocation (RTD) can significantly decrease the patient's quality of life and require some form of surgical intervention for correction. The purpose of this study is to present a minimally invasive alternative treatment for RTD using operative arthroscopy. 11 patients treated for recurrent temporomandibular dislocation between 2004 and 2010 were retrospectively analyzed. Electrothermal capsulorrhaphy was performed using a standard double puncture operative arthroscopy with a Hol:YAG laser and/or electrocautery. Postoperatively the patients were monitored for 6 months to 6 years. Of the 11 subjects, 2 suffered a recurrence of temporomandibular dislocation and required open arthrotomy for correction. The other 9 patients had no signs of recurrence or any significant postoperative loss of function. Electrothermal capsulorrhaphy is an effective and minimally invasive method for the treatment of RTD. PMID:22487806
Torres, Daniel E; McCain, Joseph P
Purpose: The purpose of this study was to determine the long-term objective and subjective outcomes of temporomandibular joint (TMJ) implant surgery for the treatment of painful TMJ disc displacement using temporary Silastic (Dow Corning Corporation, Midland, MI), permanent Silastic, or Proplast (Vitek, Houston, TX) implants to replace the disc. These cases were compared with other cases of the same diagnosis
James R. Fricton; John O. Look; Eric Schiffman; James Swift
Temporomandibular disorders (TMD) are common pain problems in the population with uncertain pathophysiology and mechanisms.\\u000a The aim of this experimental study was to: (1) Establish an experimental pain model using electrical stimuli to describe characteristics\\u000a of nociception from the human temporomandibular joint (TMJ) and overlying skin. (2) Test the hypothesis that there would be\\u000a sex-related differences in TMJ sensitivity. Forty-three
E. E. Ayesh; T. S. Jensen; P. Svensson
Abstract.In terms of clinical decision-making in instances of temporomandibular disorders (TMD) and orofacial pain, there is controversy in the literature over the diagnostic significance of the temporomandibular joint (TMJ)-related variable disk-condyle relationship (DCR). The purpose of this study was to investigate whether in patients with TMJ-related pain, the variable of TMJ pain may be linked to magnetic resonance (MR) imaging
Rüdiger Emshoff; Katharina Innerhofer; Ansgar Rudisch; Stefan Bertram
Introduction Juvenile idiopathic arthritis (JIA) may cause damage to the temporomandibular joint (TMJ). In oligoarticular forms of JIA, TMJ involvement is often asymptomatic and consequently overlooked. The aim of this study was to evaluate the presence of TMJ joint effusion (JE) by ultrasonography (US) in patients with early arthritis. Materials and methods We examined 68 children (57 girls, 11 boys, age range 9.1–16.0 years, mean age 11.0 years) recently diagnosed with JIA. None had received any specific treatment for inflammation. Symptomatic TMJ involvement was diagnosed when one or more of the following were present: 1) recurrent pain (spontaneous or on movement of the jaw); 2) crepitation; 3) feeling of stiffness or fatigue of the jaw; 4) intermittent locking. US of the TMJ was performed in static and dynamic phases with a General Electric LOGIQ7 scanner and a linear transducer (8.5 MHz) positioned along the axis of the mandibular ramus. JE was diagnosed when the joint capsule was ?1.5 mm thick. Results Forty-six out (68%) of 68 children had US evidence of TMJ effusions (bilateral in 16 [35%] cases), but only 2/46 were symptomatic. Conclusions These data suggest that children with early stage oligoarticular JIA children are likely to have inflammation of the TMJs even in the absence of symptoms. US is a simple-to-use, noninvasive, radiation-free tool that can provide useful information in the assessment and follow-up of TMJ involvement in children and young adults with JIA.
Melchiorre, D.; Falcini, F.; Kaloudi, O.; Bandinelli, F.; Nacci, F.; Matucci Cerinic, M.
Aim and objectives. The morphology and position of the temporo-mandibular disc are key issues in the diagnosis and treatment of arthrogenous temporo-mandibular disorders. Magnetic resonance imaging and arthroscopy are used today to identify: flattening of the pars posterior of the disc, perforation and/or adhesions in the pars intermedia of the disc and disc displacements. The present study proposes the investigation of the temporo-mandibular joint disc by optical coherence tomography (OCT). Material and methods. 8 human temporo-mandibular joint discs were harvested from dead subjects, under 40 year of age, and conserved in formalin. They had a normal morphology, with a thicker pars posterior (2,6 mm on the average) and a thinner pars intermedia (1mm on the average). We investigated the disc samples using two different OCT systems: an en-face OCT (time domain (TD)-OCT) system, working at 1300 nm (C-scan and B-scan mode) and a spectral OCT system (a Fourier domain (FD)-OCT) system , working at 840 nm (B-scan mode). Results. The OCT investigation of the temporo-mandibular joint discs revealed a homogeneous microstructure. The longer wavelength of the TD-OCT offers a higher penetration depth (2,5 mm in air), which is important for the analysis of the pars posterior, while the FD-OCT is much faster. Conclusions: OCT is a promising imaging method for the microstructural characterization of the temporo-mandibular disc.
M?rc?uteanu, Corina; Demjan, Enikö; Sinescu, Cosmin; Negrutiu, Meda; Motoc, Adrian; Lighezan, Rodica; Vasile, Liliana; Hughes, Mike; Bradu, Adrian; Dobre, George; Podoleanu, Adrian G.
An arthroscopic study on 22 temporomandibular joints in 13 cadavers was undertaken. Dissections were carried out to correlate the arthroscopic with macroscopic findings in the joints. Iatrogenic damage to the temporomandibular joints and their surrounding tissues was also examined. Correlation between arthroscopy and macro findings was 91.0%. There was no damage to the facial nerve and superficial temporal vessels. Iatrogenic damage to the temporomandibular joint included scuffing of the articular surfaces of the glenoid fossa and articular eminence (31.8%), scuffing of the condylar articular surface (9%), one disc perforation (4.5%) and one perforation of the medial capsule (4.5%). Prevention of iatrogenic injuries is discussed. PMID:1295412
Teh, L Y; Peck, R H; Chew, S C; Goh, W S; Chua, E K
Conservative interventions with simple procedures and predictable benefits are expected by patients with recurrent dislocation of the temporomandibular joint (TMJ). We have introduced a modified technique of prolotherapy that comprises injection of lignocaine and 50% dextrose at a single site in the posterior periarticular tissues. We studied the effects in 45 younger patients (age range 17-59 years) with non-neurogenic recurrent dislocation of the TMJ, and confirmed the therapeutic effect after more than a year's follow-up. There were appreciable improvements in the number of episodes of dislocation and clicking after the injection. The overall success rate, defined as the absence of any further dislocation or subluxation for more than 6 months, was 41/45 (91%). Of the 41 rehabilitated patients, 26 (63%) required a single injection, 11 (27%) had 2 treatments, and 4 (10%) needed a third injection. All patients tolerated the injections well. The modified dextrose prolotherapy is simple, safe, and cost-effective for the treatment of recurrent dislocation of the TMJ. PMID:24064304
Zhou, H; Hu, K; Ding, Y
In this study, we tested the compressive stress relaxation behaviors of the mandibular condylar and temporal cartilages in the porcine temporomandibular joint (TMJ). The aim was to determine the quantitative and qualitative similarities and differences of compressive stress relaxation behaviors between the two cartilages. Ten porcine TMJs were used; the articular surface was divided into 5 regions: anterior, central, posterior, lateral and medial. Compressive relaxation test was carried out at a strain level of 5% in each region of the two cartilages. The stress relaxation was monitored over a period of 5min. In all the regions of the two cartilages, the time-dependent stress relaxation curves showed a marked drop in stress within the initial 10s, which can be fitted by a standard linear viscoelastic model. The instantaneous moduli in the temporal cartilage were dominantly larger than those in the condylar cartilage, while the condylar cartilage had slightly larger relaxation moduli than the temporal cartilage except for the medial region. The both cartilages showed the regional differences in the compressive stress relaxation behavior, and in the temporal cartilage the lateral and medial regions revealed the largest values for the instantaneous and relaxation moduli. The present results demonstrate that the viscoelastic properties of compressive stress relaxation in both cartilages are region-specific, which might have an important implication for stress distribution and transmission along with the TMJ disc. PMID:24680920
Tanaka, Eiji; Pelayo, Fernández; Kim, Namhee; Lamela, María Jesús; Kawai, Nobuhiko; Fernández-Canteli, Alfonso
Ankylosis of temporomandibular joint is a condition in which partial or complete immobilization of mandible occurs because of fusion between mandibular condyle and skull base. This condition can be treated orthodontically, surgically, or therapeutically or by prosthodontic rehabilitation. A 10-year-old female patient presented to the Department of Oral and Maxillofacial Surgery, Gazi University Faculty of Dentistry, with limited mouth opening. She got injury in the face when she was 5 years old. Extraoral and intraoral examination findings were facial asymmetry on the left side, micrognathic mandible, and 19-mm mouth opening. After radiographic examination, ankylosis (Shawney type I) on the left side was revealed, and the patient was referred to Department of Orthodontics. After orthodontic clinical examination, we create following multidisciplinary treatment approach: (1) acrylic posterior bite block with spring application, (2) interpositional arthroplasty operation, and (3) physiotherapy (passive mouth-opening exercises). After the follow-up of 9 months, significant improvement (5 mm) was noticed in the opening of the mouth, and we decided to remove appliance and operate on the patient. Surgical procedure was performed under general anesthesia via blinded nasotracheal intubation. To prevent postoperative relapse, temporal fascia was interpositioned and sutured. Passive mouth-opening exercises were started 10 days after the surgery. Thirty-one-millimeter mouth opening was reached after the surgery and passive mouth-opening exercises. Patient's routine controls have been continued for 2 years. PMID:24769608
Ataç, Mustafa Sancar; Cakir, Merve; Yücel, Ergun; Gazio?lu, Ca?ri; Akkaya, Sevil
Synovial chondromatosis of the temporomandibular joint is a rare benign joint disorder that has been reported in only a few studies. However, we recently encountered a pathologically proven case of this disorder. This case also showed the typical imaging findings on panoramic radiographs and on CT and MR images. Therefore, we report this case and the imaging and pathological findings.
Lim, S W; Jeon, S J; Choi, S S; Choi, K H
Synovial chondromatosis of the temporomandibular joint is a rare benign joint disorder that has been reported in only a few studies. However, we recently encountered a pathologically proven case of this disorder. This case also showed the typical imaging findings on panoramic radiographs and on CT and MR images. Therefore, we report this case and the imaging and pathological findings. PMID:22011825
Lim, S W; Jeon, S J; Choi, S S; Choi, K H
Purpose: This study evaluated the objective and subjective changes in a group of rheumatoid arthritic (RA) patients with temporomandibular joint (TMJ) complaints who were subjected to joint lysis and lavage.Patients and Methods: Twelve females with previous documented RA underwent baseline assessment with erythrocyte sedimentation rate, physical examination of TMJ function, and a visual analog pain scale (VAPS). The VAPS and
Norman Trieger; Charles H Hoffman; Eduardo Rodriguez
In this pictorial essay we aim to illustrate the normal temporomandibular joint (TMJ) and the common abnormalities of the osseous, cartilaginous and soft tissue components. These include disc (meniscus) displacement, deformities and perforations, abnormalities of disc and condylar movement, joint effusions, synovial proliferation, condylar deformity and erosions, degenerative change and abnormal retrodiscal enhancement.
C. Styles; A. Whyte
The aim of this study was to analyze whether generalized joint hypermobility (GJH) is a risk factor for temporomandibular disorders (TMD). We examined 895 subjects (20-60 yr of age) in a population-based cross-sectional sample in Germany for GJH according to the Beighton classification and for TMD according to the Research Diagnostic Criteria for TMD (RDC/TMD). After controlling for the effects of age, gender, and general joint diseases using multiple logistic regression analyses, hypermobile subjects (with four or more hypermobile joints on the 0-9 scale) had a higher risk for reproducible reciprocal clicking as an indicator for disk displacement with reduction (Odds Ratio (OR) = 1.68) compared with those subjects without hypermobile joints. Concurrently, subjects with four or more hypermobile joints had a lower risk for limited mouth opening (< 35 mm; OR = 0.26). The associations between GJH and reproducible reciprocal clicking or limited mouth opening were statistically significant in a trend test. No association was observed between hypermobility and myalgia/arthralgia (RDC/TMD Group I/IIIa). In conclusion, GJH was found to be associated with non-painful subtypes of TMD. PMID:19049522
Hirsch, Christian; John, Mike T; Stang, Andreas
A 50-year-old female presented to a chiropractic clinic with left jaw pain consistent with temporomandibular joint disorder. Examination revealed a large ulcerated mass on the posterolateral margin of the tongue which was later diagnosed as squamous cell carcinoma. Squamous cell carcinoma is the most common of the oral cancers. These cancers are often detected late making treatment more complicated and reducing the chance of survival. In the early stages squamous cell carcinoma can be asymptomatic. Symptoms can be similar to that of temporomandibular joint disorder making examination of the patient’s mouth important to rule out oral cancers. Oral cancers should be considered when patients present to a chiropractor with pain in the area of the temporomandibular joint. Risk factors such as chronic tobacco and alcohol use should raise concern in these patients. Suspicious lesions should be referred immediately for further investigation.
Jensen, Andrea; Nolet, Paul S; Diwan, Murtaza A
Synovial chondromatosis of the temporomandibular joint is an uncommon disorder with an indolent clinical course and a slow progression. We report a rare case of unilateral early synovial chondromatosis of the temporomandibular joint with numerous nodules and discuss possible etiologies for the entity of loose bodies and the evolution of this disease. PMID:24739749
Cascone, Piero; Gennaro, Paolo; Gabriele, Guido; Chisci, Glauco; Mitro, Valeria; De Caris, Francesca; Iannetti, Giorgio
Temporomandibular joint dislocation is not frequently encountered, but it is often difficult to reduce the dislocation with conventional methods described in textbooks. The key points to success of reduction depend on the patient's position, route of approach, and timing of reducing each side. We apply a manipulation technique for disk displacement to the reduction that corresponds to these key points. Using our method, temporomandibular joint dislocation can be easily reduced, without using sedative or analgesics. This method is simple, convenient, and worth trying in place of the conventional method. PMID:24621705
Yabe, Tetsuji; Tsuda, Tomoyuki; Hirose, Shunsuke; Ozawa, Toshiyuki; Kawai, Katsuya
Infectious arthritis of the temporomandibular joint (TMJ) is rare, and previous reports have identified malocclusion resulting from condylar deformity and displacement of the condyle as one of the clinical characteristics of the disease. Here we report the case of a 33-year-old man with chronic infectious arthritis of the TMJ without malocclusion associated with osteomyelitis of the right mandible. Based on radiological findings of more prominent inflammation at the TMJ than in other regions and on the observed efficacy of antibiotic administration, we made a diagnosis of suppurative arthritis of the TMJ. Based on our empirical experience, including the present case, we speculate that refusal to cooperate with medical care may be a factor in the development of infectious arthritis of the TMJ.
Kito, Shinji; Hirashima, Souichi; Yoshioka, Izumi; Habu, Manabu; Kodama, Masaaki; Kokuryo, Shinya; Oda, Masafumi; Tanaka, Tatsurou; Wakasugi-Sato, Nao; Matsumoto-Takeda, Shinobu; Seta, Yuji; Tominaga, Kazuhiro; Morimoto, Yasuhiro
Findings in 31 pediatric patients with pain and dysfunction of the temporomandibular joint (TMJ) are reported. The average age was 14 years and the average duration of symptoms was 21.4 months. Internal derangements were found in 29 patients (94%) and degenerative arthritis in 13 (42%). In 12 patients (39%), the problem could be traced to an injury to the jaw. Secondary condylar hypoplasia was associated with the meniscal abnormality in 3 patients (10%). Further awareness of internal derangements of the TMJ in the pediatric population should permit greater recognition of their etiology. It is important that threatment be initiated as soon as possible, not only to minimize the development of osseous disease in young adults but also to prevent facial growth deformities.
Katzberg, R.W.; Tallents, R.H.; Hayakawa, K.; Miller, T.L.; Goske, M.J.; Wood, B.P.
Temporomandibular joint (TMJ) disorders are a heterogeneous group of diseases that cause progressive joint degeneration leading to chronic pain and reduced quality of life. Both effective pain reduction and restoration of TMJ function remain unmet challenges. Intra-articular injections of corticosteroids and hyaluronic acid are currently used to treat chronic pain, but these methods require multiple injections that increase the risk of iatrogenic joint damage and other complications. The small and emerging field of TMJ tissue engineering aims to reduce pain and disability through novel strategies that induce joint tissue regeneration. Development of methods for sustained, intra-articular release of growth factors and other pro-regenerative signals will be critical for the success of TMJ tissue engineering strategies. This review discusses methods of intra-articular drug delivery to the TMJ, as well as emerging injectable controlled release systems with potential to improve TMJ drug delivery, to encourage further research in the development of sustained release systems for both long-term pain management and to enhance tissue engineering strategies for TMJ regeneration.
Mountziaris, Paschalia M.; Kramer, Phillip R.; Mikos, Antonios G.
Inferior joint space arthrograms of the temporomandibular joints of 31 healthy volunteers (62 joints) were obtained to determine normal arthrographic findings. The superior margin of the anterior recess was smooth and flat in 68% of the joints and concave in 32% with the subjects' mouths closed. The concavity was the result of the anterior ridge of the meniscus impinging on the contrast material. The concave impression could be distinguished easily from an anteriorly displaced meniscus on videotaped studies, which demonstrated a smooth transition of contrast material from the anterior to the posterior recess during opening of a subject's mouth. With the mouth open, the anterior recess decreased in size, appearing as a small, crescent-shaped collection of contrast material anterior to the head of the condyle in 52 joints (84%); it remained large in ten joints (16%) at maximal mouth opening. The configuration of the posterior recess was identical to that described previously; however, with the subjects' mouths closed, it was larger than the anterior recess, contrary to most previously reported results.
Kaplan, P.A.; Tu, H.K.; Sleder, P.R.; Lydiatt, D.D.; Laney, T.J.
Pigmented villonodular synovitis (PVNS) is a benign but locally aggressive and destructive disease originating in the synovial membranes. It is a proliferative disorder of unknown etiology. Involvement of the temporomandibular joint (TMJ) is very rare. Computed tomography clearly reveals areas of lytic bone erosion and sclerosis, and also clearly defines the extent of the tumor which is the focal areas of hyperdensity within the soft-tissue mass. Magnetic resonance images invariably show profound hypointensity on both T1- and T2-weighted sequences due to hemosiderin pigmentation. Additionally, high signal intensity on T2-weighted images may indicate cystic loculation of the joint fluid. This case study describes a rare case of PVNS of the TMJ with bone destruction of the mandibular condyle. Complete surgical excision of the lesion was performed through a preauricular approach with temporal extension. During the 10-year follow-up, two more operations were performed due to local recurrence and the fracture of the reconstruction plate. Total joint reconstruction with Biomet was finally performed, and the absence of disease was confirmed with a biopsy report showing fibrosis with hyalinization and mild inflammation of the excised soft tissue from the old lesion. PMID:25045642
Kim, Il-Kyu; Cho, Hyun-Young; Cho, Hyun-Woo; Seo, Ji-Hoon; Lee, Dong-Hwan; Peng, Wang
Pigmented villonodular synovitis (PVNS) is a benign but locally aggressive and destructive disease originating in the synovial membranes. It is a proliferative disorder of unknown etiology. Involvement of the temporomandibular joint (TMJ) is very rare. Computed tomography clearly reveals areas of lytic bone erosion and sclerosis, and also clearly defines the extent of the tumor which is the focal areas of hyperdensity within the soft-tissue mass. Magnetic resonance images invariably show profound hypointensity on both T1- and T2-weighted sequences due to hemosiderin pigmentation. Additionally, high signal intensity on T2-weighted images may indicate cystic loculation of the joint fluid. This case study describes a rare case of PVNS of the TMJ with bone destruction of the mandibular condyle. Complete surgical excision of the lesion was performed through a preauricular approach with temporal extension. During the 10-year follow-up, two more operations were performed due to local recurrence and the fracture of the reconstruction plate. Total joint reconstruction with Biomet was finally performed, and the absence of disease was confirmed with a biopsy report showing fibrosis with hyalinization and mild inflammation of the excised soft tissue from the old lesion.
Cho, Hyun-Young; Cho, Hyun-Woo; Seo, Ji-Hoon; Lee, Dong-Hwan; Peng, Wang
Objectives: The purpose of this study was to investigate the relationship between the presence of temporomandibular joint (TMJ) pain and the magnetic resonance (MR) imaging findings of internal derangement (ID) and effusion. Study Design: The study was comprised of 41 consecutive patients with TMJ pain. Criteria for including a patient were report of unilateral pain near the TMJ, with the
Ansgar Rudisch; Katharina Innerhofer; Stefan Bertram; Rüdiger Emshoff
Randomly assigned 57 patients with chronic temporomandibular joint (TMJ) pain to receive either relaxation or biofeedback therapy. Successful patients in the relaxation condition tended to be younger and had experienced TMJ pain for a shorter period of time than the successful biofeedback patients. (BH)
Funch, Donna P.; Gale, Elliot N.
A new technique for the functional reconstruction of the ankylotic temporomandibular joint (TMJ) is presented. Interposition of a custom-made inverted T-shape silicone implant after osteotomy of the condylar neck has given good results. A case is presented and the advantages of the method are discussed.
C. Karaça; A. Barutçu; A. Atabey; D. Ozaksoy; A. Menderes
Kinematics of the human masticatory system during opening and closing of the jaw have been reported widely. Evidence has been provided that the opening and closing movement of the jaw differ from one another. However, different approaches of movement registration yield divergent expectations with regard to a difference in loading of the temporomandibular joint between these movements. Because of these
Matthijs Tuijt; Jan Harm Koolstra; Frank Lobbezoo; Machiel Naeije
Objective. The purpose of this study was to evaluate the masticatory muscles and the temporomandibular joint (TMJ) by magnetic resonance imaging (MRI) in myotonic dystrophy (MD) patients. Study Design. MRI of the masticatory muscles and TMJ was performed in 15 MD patients, 11 male and 4 female, aged 16 to 53 years (mean, 31 years). Many of them had dental
Edmar Zanoteli; Helio K. Yamashita; Hideo Suzuki; Acary S. B. Oliveira; Alberto A. Gabbai
Establishing a valid animal model to study temporomandibular joint (TMJ) pain has proven extremely difficult. Using complete Freund's adjuvant (CFA) to induce TMJ inflammation, we recently showed that meal pattern analysis could be used as a noninvasive biological marker to study TMJ pain in an animal model. The purpose of this study was to further validate our animal model by
C. A. Kerins; D. S. Carlson; J. E. McIntosh; L. L. Bellinger
Four health outcomes (range of motion, pain, diet, and disability) were measured in six diagnostic categories (internal derangement with closed lock, internal derangement with painful click, osteoarthritis, hypermobility, fibrous ankylosis, and arthralgia) in a 6-year retrospective multicenter study of 4,831 temporomandibular joints having undergone arthroscopic surgery. After arthroscopic surgery, 91.6% of all patients had good or excellent motion; 91.3% had good or excellent pain reduction; 90.6% had good or excellent ability to maintain a normal diet; and 92% had a good or excellent reduction in disability. These health outcomes compare favorably with all other known treatments for these conditions. Also, the surgical technique was relatively free of complications (4.4%). PMID:1506966
McCain, J P; Sanders, B; Koslin, M G; Quinn, J H; Peters, P B; Indresano, A T; Quinn, J D
Although excessive mechanical stress is assumed to be one of the factors contributing to pathogenesis of temporomandibular joint (TMJ) osteoarthritis (OA), no pure mechanical-stress-induced OA model has been developed without surgical manipulation or puncture of the joint cavity. The purpose of this study was to establish a genuine mechanical-stress-induced OA model of the rabbit TMJ. In the experimental rabbits, repetitive,
T. Fujisawa; T. Kuboki; T. Kasai; W. Sonoyama; S. Kojima; J. Uehara; C. Komori; H. Yatani; T. Hattori; M. Takigawa
The authors report their initial conclusions regarding the value of M.R.I. in the investigation of temporo-mandibular joint dysfunction. This examination was performed for all varieties of symptomatology: musculo-ligamentary, menisco-ligamentary or meniscal. A detailed examination technic is given. M.R.I. enables meniscal abnormalities to be demonstrated: morphological and positional abnormalities (reducible and irreducible anterior luxations) and structural abnormalities similar to those seen in meniscal pathology within the knee joint. PMID:2814318
Buthiau, D; Dichamp, J; Goudot, P; Vaillant, J M
Kinematics of the human masticatory system during opening and closing of the jaw have been reported widely. Evidence has been provided that the opening and closing movement of the jaw differ from one another. However, different approaches of movement registration yield divergent expectations with regard to a difference in loading of the temporomandibular joint between these movements. Because of these diverging expectations, it was hypothesized that joint loading is equal during opening and closing. This hypothesis was tested by predicting loading of the temporomandibular joint during an unloaded opening and closing movement of the jaw by means of a three-dimensional biomechanical model of the human masticatory system. Model predictions showed that the joint reaction forces were markedly higher during opening than during closing. The predicted opening trace of the centre of the mandibular condyle was located cranially of the closing trace, with a maximum difference between the traces of 0.45 mm. The hypothesis, postulating similarity of joint loading during unloaded opening and closing of the jaw, therefore, was rejected. Sensitivity analysis showed that the reported differences were not affected in a qualitative sense by muscular activation levels, the thickness of the cartilaginous layers within the temporomandibular joint or the gross morphology of the model. Our predictions indicate that the TMJ is loaded more heavily during unloaded jaw opening than during unloaded jaw closing. PMID:20096414
Tuijt, Matthijs; Koolstra, Jan Harm; Lobbezoo, Frank; Naeije, Machiel
A retrospective comparison was made of tomographic change in the temporomandibular joint (TMJ) of patients who had been treated by either discoplasty or discectomy with polytetrafluoroethylene (PTFE) disc replacement. Fifty-five PTFE- and 18 discoplasty-treated joints were evaluated. More than 60% of the PTFE-treated joints showed severe, destructive osseous change, whereas none of the discoplasty joints showed such change. Histologic examination of the tissues surrounding removed PTFE implants showed a foreign body giant cell reaction. The severity of radiographic change raises questions about the propriety of PTFE as a disc replacement material. PMID:3162520
Florine, B L; Gatto, D J; Wade, M L; Waite, D E
A 28-year-old woman presented with a history of clicking and mandibular clenching. She was studied clinically and with axial and coronal CT. The patient was going through a tense emotional period and reported tightening of her teeth (clenching); she was under psychological and neurological treatment for depression including pharmacological therapy. She presented slight pain only at maximum mouth opening at the right temporomandibular joint (TMJ) and in the lateral pole on palpation; there was no coincidence between initial and maximal interocclusal contacts because of premature dental contacts. She showed occlusal group function in the right side and canine guidance in the left side with a right contact of balance, local muscular pain in the right deep masseter muscle and in the superior and middle portion of the right trapezium on palpation. On CT, a spherical area of 3 mm diameter with an average density of -647 HU (SD+/-4.7) was found in the upper and posterior area of the lower space of the right TMJ, together with a thicker lower synovial tissue. This observation was confirmed by MRI. Like other joints, the TMJ could present vacuum phenomenon images inside synovial tissue in the presence of degenerative disease. It is important for radiologists to recognize this rare entity. PMID:18460579
Moncada, G; Oyarzo, J F; Moncada, M; Marholz, C; Millas, R
Aim: A study was performed on the articular disk and periarticular tissues of the temporo-mandibular joint (TMJ) with immunohistochemical techniques to give evidence to the presence of neuroreceptors (NRec) in these sites. Methods: The study was carried out on tissue samples obtained from 10 subjects without TMJ disease and from 7 patients with severe TMJ arthritis and arthrosis. We use antibodies directed against following antigens: Gliofibrillary Acidic Protein (GFAP), Leu-7, Myelin Basic Protein (MBP), Neurofilaments 68 kD (NF), Neuron Specific Enolase (NSE), S-100 protein (S-100) and Synaptophysin (SYN). Results: This study revealed that Ruffini's-like, Pacini's-like and Golgi's-like receptors can be demonstrated in TMJ periarticular tissues and that free nervous endings are present in the subsynovial tissues but not within the articular disk. We observed elongated cytoplamic processes of chondrocytes that demonstrated strong S-100 immunoreactivity but they were unreactive with all other antibodies. These cytoplamic processes were more abundant and thicker in the samples obtained from patients with disease TMJ. Conclusion: The results of this study confirm that different Nrec are detectable in TMJ periarticular tissues but they are absent within the articular disk. In the latter site, only condrocytic processes are evident, especially in diseased TMJ, and they might have been confused with nervous endings in previous morphological studies. Nevertheless the absence of immunoreactivity for NF, NSE and SYN proves that they are not of neural origin.
Favia, Gianfranco; Corsalini, Massimo; Di Venere, Daniela; Pettini, Francesco; Favia, Giorgio; Capodiferro, Saverio; Maiorano, Eugenio
The experimental setup of this study is focused on the changes in temporomandibular joint tissue after irradiation with an Erbium:YAG laser. Initially, the free-running beam from the laser was focused onto freshly excised porcine tissue samples, indicating an optimum average energy density and pulse duration for the purpose of temporomandibular joint surgery of about 15 - 60 J/cm2 and 120 microsecond(s) - 240 microsecond(s) , respectively. Consecutively, an attempt was made to couple the Erbium:YAG laser beam on the one hand to optical fibers made of infrared-transmitting glasses (fluoride- and chalcogenide-based), on the other hand to a recently developed sapphire and liquid core fiber, respectively. From the preliminary observations of this investigation it appears that both the liquid core and the sapphire fiber are the most promising candidates for delivery of Erbium-YAG laser radiation in arthroscopic surgery of the craniomandibular articulation.
Nuebler-Moritz, Michael; Hering, Peter; Niederdellmann, Herbert; Deuerling, Christian; Dammer, Ralf
The focus of this article is diagnostic imaging used for the evaluation of temporomandibular disorders and orofacial pain patients. Imaging modalities discussed include conventional panoramic radiography, panoramic temporomandibular joint imaging mode, cone beam computed tomography, and magnetic resonance imaging. The imaging findings associated with common diseases of the temporomandibular joint are presented and indications for brain imaging are discussed. Advantages and disadvantages of each imaging modality are presented as well as illustrations of the various imaging techniques. PMID:23809300
Hunter, Allison; Kalathingal, Sajitha
Aim This study assessed the patients' and clinicians' perception of the outcome of temporomandibular joint arthroscopy.Method All patients who underwent TMJ arthroscopy for both diagnostic and therapeutic purposes over a 6-year period were sent a questionnaire that asked about various symptoms attributable to the TMJ. Additionally a review of the clinical notes was performed.Results 83 patients underwent arthroscopy to 127
R J M Gray
Recent studies have hypothesized that peripheral glutamate receptors could be implicated in deep craniofacial pain conditions. In this study 18 temporomandibular joint (TMJ) arthralgia patients received intra-articular injections of the N-methyl-d-aspartate (NMDA) receptor antagonist, ketamine, or normal saline to study in a cross-over, double-blinded, placebo-controlled manner the effect on TMJ pain and somatosensory function. Spontaneous pain and pain on jaw
Emad E. Ayesh; Troels S. Jensen; Peter Svensson
Purpose: This article describes the possible role of various peptides in producing pain and inflammation in the temporomandibular joint (TMJ).Material and Methods: Current research findings on the spectrophotometric quantification of TMJ synovial fluid for neuropeptide Y (NPY), serotonin (5HT), and interleukin-1? (IL-1?) are presented.Findings: NPY was found in high levels in the synovial fluid of arthritic TMJs with resting pain,
Eleven patients with long-term pain related to the temporomandibular joint (TMJ) were trained in tension awareness and relaxation using feedback of muscle tension level in the masseter through a digital display. At a follow-up examination 4–15 months after the termination of treatment, 8 of the 11 patients were totally symptom-free or significantly better; 1 patient was slightly better, and there
Sven G. Carlsson; Elliot N. Gale
A retrospective study of 96 cases of temporomandibular joint dislocation was undertaken. Patients’ ages ranged from 9 to 85 years (mean±SD, 35.3±17.4 years) and peak incidence was at 20–29 years. Mean duration was 7.9 weeks (range, 1h to 3 years). Acute, chronic and recurrent dislocations were seen in 46 (47.9%), 29 (30.2%) and 21 (21.9%) patients, respectively. Males dominated in
V. I. Ugboko; F. O. Oginni; S. O. Ajike; H. O. Olasoji; E. T. Adebayo
Bifid mandibular condyle is an uncommon entity with a controversial etiology. It can be developmental or acquired and rarely may be associated with temporomandibular joint (TMJ) ankylosis. Although the patient may be asymptomatic, the radiologist should be aware of this entity and its clinical implications. We report two cases of BMC, one developmental and the other secondary to trauma. Both were diagnosed using computed tomography, which additionally revealed the associated ankylosis of TMJ in both the patients. PMID:19521698
Gulati, Ajay; Virmani, V; Ramanathan, S; Verma, L; Khandelwal, N
This study evaluated serum nutrients in 23 patients who had previous Proplast\\/Teflon implants to their temporomandibular joints (TMJ) and con- tinued to remain in chronic, severe, irresolvable pain despite subsequent surgical reconstruction. All of the patients were women, and their average age was 40.6 years (range, 28-55 years). Standard blood assays were performed for beta-carotene (vitamin A), folate, serum iron,
Pushkar Mehra; Larry M. Wolford
Objective Little is known about the natural progression of the disease process of temporomandibular joint (TMJ) osteoarthritis (OA), which affects approximately 1 % of the US population. The goal of this study was to examine the early microarchitectural and molecular changes in the condylar cartilage and subchondral bone in biglycan/fibromodulin (Bgn/Fmod) double-deficient mice, which develop TMJ-OA at 6 months. Methods TMJs from 3 month old (n=44) and 9 month old (n=52) wild-type (WT n=46) and Bgn/Fmod (n=50) double-deficient mice were evaluated. Micro-CT analysis of the subchondral bone (n=24), transmission electron microscopy for condylar cartilage fibril diameters (n=26), and real time PCR analysis for gene expression for bone and cartilage maturation markers (n=45) was performed. Results A statistically significant increase in collagen fibril diameter of the condylar cartilage and a decrease in expression of Parathyroid related protein in the mandibular condylar head were observed in the 3 month Bgn/Fmod double-deficient mice compared to WT controls. The 9 month Bgn/Fmod double-deficient mouse demonstrated an increase in bone volume and total volume in subchondral bone, and an increase in the expression of Collagen Type X and Aggrecan in the mandibular condylar head compared to the WT controls. Conclusion We found that changes in the microarchitecture of the condylar cartilage preceded changes in the subchondral bone during OA in the TMJ in Bgn/Fmod double-deficient mice.
Chen, J.; Gupta, T.; Barasz, J.A.; Kalajzic, Z.; Yeh, W-C.; Drissi, H.; Hand, A.R.; Wadhwa, S.
Museum skull specimens (n = 1,008) of southern sea otters (Enhydra lutris nereis) were examined macroscopically according to defined criteria for the presence, severity and characteristics of temporomandibular joint osteoarthritis (TMJ-OA). The specimens were from stranded young adult to adult animals. Overall, 4.1% of the specimens had findings consistent with TMJ-OA. Of these, 61.0% were from females and 39.0% were from males. In addition, 85.4% of the affected specimens were from adults and 14.6% were from young adults. However, there was no significant association between age and sex with the presence or severity of TMJ-OA. Lesion severity was mild in 41.5%, moderate in 19.5% and severe in 39.0% of affected specimens. The most prominent changes were the presence of osteophytes and subchondral bone defects and porosity. The mandibular condylar process and fossa were affected equally. The lengths of the right and left mandibular heads were significantly associated with age (P = 0.002 and P = 0.003, respectively) and sex (P = 0.0009 and P = 0.001, respectively), but not with the presence of TMJ-OA. The significance of this disease in sea otters remains elusive, but this condition may play an important role in survival of these animals. PMID:23721871
Arzi, B; Winer, J N; Kass, P H; Verstraete, F J M
Synovial chondromatosis (SC) involving the temporomandibular joint (TMJ) is very rare and can occur in either or both cavities. Differentiation of the affected cavity in SC is therefore as important as making the diagnosis. This report presents a case of SC in which both cavities were thought to be affected, but arthrography using cone beam CT (CBCT) allowed us to see that involvement was limited to the superior joint cavity. In addition, we describe the usefulness of arthrographic CBCT for diagnosis and treatment planning in SC of the TMJ. PMID:22282505
Matsumoto, K; Sato, T; Iwanari, S; Kameoka, S; Oki, H; Komiyama, K; Honda, K
Eminectomy with or without a subsequent discoplasty was performed on 30 patients (36 joints) with internal derangement of the temporomandibular joint (TMJ) confirmed either arthrographically or with magnetic resonance imaging. The importance of the inclination of the TMJ eminence and the therapeutic value of eminectomy are discussed. The TMJs were clinically evaluated before and at least 1 year after surgery in respect to opening function and symptoms. The results were promising (86.8% of the patients felt better). In five patients with a preoperative diagnosis of anterior disc displacement with reduction, only an eminectomy was performed. In these five cases eminectomy alone was sufficient to restore normal TMJ function. PMID:2913249
Kerstens, H C; Tuinzing, D B; van der Kwast, W A
Postsurgical revascularization of the rabbit temporomandibular joint (TMJ) after discoplasty was studied at the gross and microscopic levels. Surgical disruption of the lateral and medial articular blood vessels resulted in revascularization of the joint by the transverse facial artery. Deep branches of the transverse facial artery provided vascular supply to the anterior TMJ until the lateral and medial articular vessels could be re-established. The greatest change in vascularity was observed between the second and third postoperative weeks. It was concluded that discoplasty in the rabbit TMJ is a biologically sound surgical procedure, with the majority of vascularity re-established by three weeks and complete healing at six weeks. PMID:2430082
Satko, C R; Blaustein, D I
Purpose: This study was designed to investigate the efficacy of arthrocentesis with and without injection of sodium hyaluronate (SH) into the upper joint space in the treatment of temporomandibular joint (TMJ) internal derangements. Patients and Methods: Forty-one TMJs in 5 males and 26 females aged 14 to 53 years comprised the study material. The patients' complaints were limited mouth opening,
Gökhan H Alpaslan; Cansu Alpaslan
Summary: Two cases of synovial chondromatosis of the temporomandibular joint (TMJ) are presented, including correlation of CT and MR imaging characteristics with surgical and pathologic findings. The usefulness of CT and MR imaging in the diagnosis of TMJ disorders is discussed. Synovial chondromatosis is a benign tumorlike disorder of the joint characterized by chondrome- taplasia of the synovial membrane, in
Jun-ichi Koyama; Jusuke Ito; Takafumi Hayashi; Fukiko Kobayashi
Objective: Ibuprofen – a non-steroidal anti-inflammatory drug (NSAID)- and glucosamine sulfate – a natural compound and a food supplement- are two therapeutic agents which have been widely used for treatment of patients with temporomandibular joint (TMJ) disorders. This study was aimed to compare the effectiveness and safety of these two medications in the treatment of patients suffering from TMJ disorders. Methods: After obtaining informed consent, 60 patients were randomly allocated to two groups. Patients with painful TMJ, TMJ crepitation or limitation of mouth opening entered the study. Exclusion criteria were history of depressive disorders, cardiovascular disease, musculoskeletal disorders, asthma, gastrointestinal problems, kidney or liver dysfunction or diabetes mellitus, dental diseases needing ongoing treatment; taking aspirin or warfarin, or concomitant treatment of TMJ disorder with other agents or methods. Thirty patients were treated with ibuprofen 400 mg twice a day, (mean age 27.12 ± 10.83 years) and 30 patients (mean age 26.60 ± 10) were treated with glucosamine sulfate 1500 mg daily. Patients were visited 30, 60 and 90 days after starting the treatment, pain and mandibular opening were checked and compared within and between two groups. Findings: Comparing with baseline measures, both groups had significantly improved post-treatment pain (P < 0.0001 for both groups) and mandibular opening (P value: 0.001 for glucosamine sulfate and 0.03 for ibuprofen). Post treatment pain and mandibular opening showed significantly more improvement in the glucosamine treated patients (P < 0.0001 and 0.01 respectively). Rate of adverse events was significantly lower in the P value glucosamine sulfate group (P < 0.0001). Conclusion: This investigation demonstrated that comparing with a commonly prescribed NSAID – ibuprofen-, glucosamine sulfate is a more effective and safer therapeutic agent for treatment of patients with TMJ degenerative join disorder.
Haghighat, Abbas; Behnia, Ali; Kaviani, Naser; Khorami, Behnam
Anthropometric variations in humans make it difficult to replace a temporomandibular joint (TMJ), successfully using a standard “one-size-fits-all” prosthesis. The case report presents a unique concept of total TMJ replacement with customized and modified TMJ prosthesis, which is cost-effective and provides the best fit for the patient. The process involved in designing and modifications over the existing prosthesis are also described. A 12-year- old female who presented for treatment of left unilateral TMJ ankylosis underwent the surgery for total TMJ replacement. A three-dimensional computed tomography (CT) scan suggested features of bony ankylosis of left TMJ. CT images were converted to a sterolithographic model using CAD software and a rapid prototyping machine. A process of rapid manufacturing was then used to manufacture the customized prosthesis. Postoperative recovery was uneventful, with an improvement in mouth opening of 3.5 cm and painless jaw movements. Three years postsurgery, the patient is pain-free, has a mouth opening of about 4.0 cm and enjoys a normal diet. The postoperative radiographs concur with the excellent clinical results. The use of CAD/CAM technique to design the custom-made prosthesis, using orthopaedically proven structural materials, significantly improves the predictability and success rates of TMJ replacement surgery.
Chaware, Suresh M.; Bagaria, Vaibhav; Kuthe, Abhay
Bifid condyle is a rare condition. Most initially reported cases were found in studies conducted on skeletal specimens. While increasing numbers are being reported on living persons, most of them are asymptomatic and have been found on routine dental radiographic examination for other dental complaints. Most of the cases of bifid condyle reported so far have occurred unilaterally and predominantly on the left side. Bifid condyle associated with temporomandibular joint ankylosis is very rare with only 2 cases reported in the English-language literature as far as we know. An additional case of bifid condyle associated with temporomandibular joint ankylosis, involving the right side of mandible, is presented as well as a review of the literature on bifid condyles including those associated with temporomandibular joint ankylosis. PMID:15897854
Daniels, John Spencer M; Ali, Iqbal
Evaluation of the mechanism and principles of management of temporomandibular joint dislocation. Systematic review of literature and a proposed new classification of temporomandibular joint dislocation
Background Virtually all the articles in literature addressed only a specific type of dislocation. The aim of this review was to project a comprehensive understanding of the pathologic processes and management of all types of dislodgement of the head of the mandibular condyle from its normal position in the glenoid fossa. In addition, a new classification of temporomandibular joint dislocation was also proposed. Method and materials A thorough computer literature search was done using the Medline, Cochrane library and Embase database. Key words like temporo-mandibular joint dislocation were used for the search. Additional manual search was done by going through published home-based and foreign articles. Case reports/series, and original articles that documented the type of dislocation, number of cases treated in the series and original articles. Treatment done and outcome of treatment were included in the study. Result A total of 128 articles were reviewed out which 79 were found relevant. Of these, 26 were case reports, 17 were case series and 36 were original articles. 79 cases were acute dislocations, 35 cases were chronic protracted TMJ dislocations and 311 cases were chronic recurrent TMJ dislocations. Etiology was predominantly trauma in 60% of cases and other causes contributed about 40%. Of all the cases reviewed, only 4 were unilateral dislocation. Various treatment modalities are outlined in this report as indicated for each type of dislocation. Conclusion The more complex and invasive method of treatment may not necessarily offer the best option and outcome of treatment, therefore conservative approaches should be exhausted and utilized appropriately before adopting the more invasive surgical techniques.
Ankylosis of the temporomandibular joint following forceps delivery is a rare anomaly. The aetiopathogenesis involves wrongful application of the forceps or forceful closure of the forceps handle against the condyle with haemathrosis, organisation and subsequent ankylosis. Because of the lack of epidemiological data, there is little information about the true incidence and the management of this rare anomaly. The purpose of this presentation is to report the challenges encountered in the airway management of a six-year old female with right temporomandibular joint ankylosis following forceps delivery in a private hospital setting. PMID:21942132
Ajike, S O; Omisakin, O O; Mohammed, R I; Adebayo, E T
For more than 15 years, the maxillo-facial and stomatological center in Lyon has received approximately 100 cases of T.M.A.D.S. per year. The etiological basis of the symptomatology is muscular dysfunction due to malocclusion variable degree and duration. Simple radiological investigations complete the examination. Treatment aims at correcting the malocclusion, either by simple methods: dental occlusion and prosthesis, or by orthognathic orthodontic and surgical techniques. Surgery involving the temporo-mandibular joint is reserved for rare cases of condylar deformation which is often post-traumatic. Favorable results can be obtained in 85% of cases. PMID:2814319
Cros, P; Freidel, M; Borie, J; Henry, B; Bouvier, P; Dumas, P
Long-standing temporomandibular joint (TMJ) dislocation is an uncommon condition, and due to its rarity, no definitive guidelines have been developed for its management. Various reduction techniques ranging from indirect traction techniques to direct exposure of the TMJ have been used. Indirect traction techniques for reduction may fail in long-standing dislocation. Management of two cases of long-standing TMJ dislocation with midline mandibulotomy is discussed in which other indirect reduction techniques had failed. Midline osteotomy of the mandible can be used for reduction in difficult TMJ dislocations. An algorithm for the management of long-standing TMJ dislocation is proposed and related literature is reviewed.
Rattan, Vidya; Rai, Sachin; Sethi, Amit
We report a case of giant cell tumor of the temporal bone invading into the pterygoid muscle through the temporomandibular joint. The patient was a 43-year-old woman who developed left ear fullness 2 years earlier with a mass in the external auditory canal. Radiologic evaluation revealed extension into the infratemporal fossa and confirmed that the tumor was invading into pterygoid muscle. A middle cranial fossa approach along with tympanoplasty was used for total resection of the tumor. Once a tumor invades into muscle tissue, meticulous care is required to remove it because identification of tumor tissue becomes extremely difficult.
Mohamed, Aboshanif; Ishikawa, Kazuo; Omi, Eigo; Honda, Kohei; Suzuki, Shinsuke; Sato, Teruyuki; Fukui, Naoko; Takahasi, Masataka
The paper explains the alterations of the temporomandibular joint (TMJ) visualized by magnetic resonance imaging (MRI) according to the growth and development of schoolchildren. Appearance and disappearance of a "double contour-like structure" (DCLS) of the mandibular condyle on MRI according to the growth and development of schoolchildren were demonstrated. In addition, possible constituents of DCLS and the significance of detection of DCLS on MRI were also speculated. The relationship between red marrow and yellow marrow in the articular eminence of temporal bone, the disappearance of DCLS, and alterations of the mandibular condyle have been elucidated. PMID:23316233
Tanaka, Tatsurou; Konoo, Tetsuro; Habu, Manabu; Oda, Masafumi; Kito, Shinji; Kodama, Masaaki; Kokuryo, Shinya; Wakasugi-Sato, Nao; Matsumoto-Takeda, Shinobu; Nishida, Ikuko; Morikawa, Kazumasa; Saeki, Katsura; Maki, Kenshi; Tominaga, Kazuhiro; Masumi, Shin-Ichi; Terashita, Masamichi; Morimoto, Yasuhiro
Thirty-four temporomandibular joints (TMJ) were examined in 17 normal subjects with two superconductive MR units at 1T and 1.5T. TMJ evaluation was performed with both SE sequences in occlusal position and with "fast" sequences (flash) during the gradual opening of the mouth. Therefore, both the anatomic features of the TMJs and their dynamic behavior during mouth opening were analyzed. The information acquired allowed the complete and non-invasive evaluation of TMJ function. The knowledge of the normal anatomic and functional patterns is of paramount importance for the diagnostic approach to TMJ pathologic conditions. PMID:1857783
Fugazzola, C; Caudana, R; Pregarz, M; Morelli, N; Olivetti, L; Grazioli, L
A total of 107 temporomandibular joints (TMJ) were examined with two superconductive MR units at 1T and 1.5T. In 73 TMJs, MR revealed 55 disk displacements, 7 disk perforations, 10 joint space adhesions, 33 osteoarthrities, 3 avascular necroses of the mandibular condyle, and 25 joint effusions. These abnormalities are described and discussed. In spite of some limitations--e.g., motion artifacts and patients' claustrophobia--MR imaging is the procedure of choice in abnormal TMJs, because it yields useful information as to therapeutic choice (conservative versus surgical). Arthrography can be used as a complementary study technique in the patients with marked disagreement between clinical and MR findings. Arthroscopy should be used as a surgical procedure in abnormal TMJs selected by previous MR studies. PMID:1857784
Olivetti, L; Grazioli, L; Cerri, G; Superti, G; Caudana, R; Fugazzola, C
Subluxation and dislocation of the temporomandibular joint (TMJ) are very unpleasant and distressing conditions to patients; they are not common diseases, but large groups of people in countries such as Yemen and Somalia are affected owing to daily chewing of Qat for several hours every day, but in Iraq, the conditions are not common. These clinical studies were conducted on 133 patients: 87 men and 36 women; their age ranged between 18 and 72 years (mean, 45 y), and their complains were difficulties of chewing food, speech, laughing, or yawning. Patients were divided into 3 groups: the first group included 65 patients (45.53%) who were treated by surgical reconstruction of the TMJ by using a fingerlike fascial flap from the temporal fascia for reconstruction of a lax capsule and reenforcement and a block of corticocancellous bone graft from the iliac crest squeezed and impacted in a gap in front of the eminence of TMJ; the second group included 15 patients with delayed dislocation of TMJ (12.20%) who were treated by surgical release fusion of the capsule and condyle from the infratemporal fascia with reenforcement of the capsule by reverse L-shaped plication technique and eminectomy; and the last group included 45 patients with acute dislocation of the TMJ (34.96%) who were treated by modified manual reduction, and follow-up of the patients was between 1 and 20 years. An experimental study was done on rabbits to support our clinical study by using a temporal fascial flap for the reconstruction of a rabbit TMJ capsule, and the aim was to show that any pathologic changes might occur in the capsule or the condyle. The result was very optimistic, and there were no cellular changes observed in the condyle or surrounding structures. PMID:21119402
Our aim was to investigate the incidence of a hyperintense signal in the joint space of the temporomandibular joint (TMJ) on fat-saturated T2-weighted magnetic resonance images (MRIs). We studied 112 patients (224 joints) with disorders of the TMJ who were examined by T2-weighted MRI, and recorded the association between displacement of the disc and the hyperintense signal using the ? coefficient. A hyperintense signal was found in 4 of 91 joints (4%) when the disc was in the normal position, in all 19 joints with anterior disc displacement with reduction, and in 108 of the 114 joints (95%) with anterior disc displacement without reduction. There was a significant correlation between displacement of the disc and the hyperintense signal (p<0.001). The ? coefficient was 0.91. Such a signal in the joint space of the TMJ on fat-saturated T2-weighted MRI may indicate the presence of synovial fluid in the joint space with displacement of the disc. PMID:19942328
Yura, Shinya; Nobata, Koji; Shima, Tsuyoshi
Over the years, little has changed in the preoperative indications and treatment for these patients. They must have failed a course of nonsurgical care, including physical therapy and medication up to 6 months. They must have had imaging done confirming intra-articular joint pathology (disc displacement, disc immobility for the most part, and joint effusions in some instances). Important technical issues include the use of two cannulas placed approximately 1 cm apart. Cannulas are not routinely placed initially into the anterior recess. Heavy downward pressure applied to the posterior ligament with a blunt obturator is used to assure mobility of the disc, and electrocautery or laser energy is used on the surface of the posterior ligament synovium for hemostasis and denervation (pain control). Corticosteroids are used infrequently. To avoid scuffing or damaging the joint surfaces unnecessarily, lysis is done using triangulation methods. Advanced instrumentation is used as the need arises but not used routinely. These patients can expect a predictably successful outcome with minimal recovery time and complications. PMID:14552050
White, R Dean
The objective of this paper was to study the morphology of the articular disc and analyze the immunohistochemical expression of the marker of type IV collagen in the articular disc of the temporomandibular joint (TMJ) of human fetuses of different gestational ages. Twenty TMJ from human fetuses aging from 21 to 24 weeks of intrauterine life were studied. The TMJ were supplied by the Federal University of Uberaba. The ages of the fetuses were determined by measuring the crown-rump length (CRL). Macroscopically, the fetuses were fixed in a formalin solution at 10% and dissected by removing the skin and the subcutaneous tissue, exposing the deep structures. An immunohistochemical marker of type IV collagen was used in order to characterize the presence of blood vessels in the central region of the temporomandibular joint disc. Analysis of the immunohistochemical marker of type IV collagen showed the presence of blood vessels in the central region of the temporomandibular disc in human fetuses. PMID:18702236
de Moraes, Luís Otávio Carvalho; Lodi, Fábio Redivo; Gomes, Thiago Simão; Marques, Sergio Ricardo; Fernandes Junior, João Antão; Oshima, Celina Tizuko Fijiyama; Alonso, Luís Garcia
Chronic oral and facial pain syndromes are an indication for intervention of physicians of numerous medical specialties, while the complex nature of these complaints warrants interdisciplinary diagnostic and therapeutic approach. Oftentimes, lack of proper differentiation of pain associated with pathological changes of the surrounding tissues, neurogenic pain, vascular pain, or radiating pain from idiopathic facial pain leads to improper treatment. The objective of the paper is to provide detailed characterization of pain developing in the natural history of trigeminal neuralgia and temporomandibular joint dysfunction, with particular focus on similarities accounting for the difficulties in diagnosis and treatment as well as on differences between both types of pain. It might seem that trigeminal neuralgia can be easily differentiated from temporomandibular joint dysfunction due to the acute, piercing, and stabbing nature of neuralgic pain occurring at a single facial location to spread along the course of the nerve on one side, sometimes a dozen or so times a day, without forewarning periods. Both forms differ significantly in the character and intensity of pain. The exact analysis of the nature, intensity, and duration of pain may be crucial for the differential diagnostics of the disorders of our interest.
Pihut, M.; Szuta, M.; Ferendiuk, E.; Zenczak-Wieckiewicz, D.
Among the various treatment options currently indicated to deal with temporomandibular joint disorders (TMD) an important role is played by occlusal devices, which can be used in an individualized or universal manner. A new universal occlusal appliance device was designed and patented at the Clinical Gnathology Service of the Sapienza University of Rome. To assess its validity and efficacy a preliminary study on a sample of 50 patients was carried out. Patients were selected from a cohort of 158 according to the RDC-TMD (SPEC) criteria and randomly assigned to two groups, the patient group (PG), treated with the device, and a control group (CG) without any treatment. The two groups were evaluated by comparing four VAS pain scores: muscular, migraine, cervical and temporomandibular joint (TMJ). On the whole, all VAS pain scores in the PG showed a marked and statistically significant improvement after treatment, decreasing to about 50-80 percent, while the control group remained stable. The best improvement was achieved in muscular pain. Age did not affect neither the initial scores, nor the pain response to the treatment. The pain scores tended to slightly increase with time of application (one, two or three months), but this trend was significant only for cervical pain. Overall the results are favourable to the application of this new occlusion device. However, the data should be considered preliminary and require further verification in time and on a higher sample of patients of both sexes. PMID:24382182
Rampello, A; Saccucci, M; Falisi, G; Panti, F; Polimeni, A; Di Paolo, C
The purpose of this in vitro study was to investigate and compare effects of currently available laser systems at different wavelengths (XeCl excimer laser, Holmium:YAG laser, Erbium:YAG laser) on porcine articulating facets, capsule and meniscus of the temporomandibular joint via photomacroscopy, light and scanning electron microscopy. From a critical review of the relevant literature and the preliminary observations of this investigation, it appears that the Neodymium:YAG laser is inappropriate for TMJ arthroscopic surgery with regard to the huge thermal injury caused to the remaining tissue. The Holmium:YAG laser suffers from remarkable photomechanical and photothermal side effects, whereas the Erbium:YAG laser ablates temporomandibular joint tissue efficiently with minimal adjacent damage--similar to the XeCl excimer laser, without entailing the risk of potential mutagenity. To sum up, it can be concluded that there is a clinical need for laser- assisted arthroscopic surgery of the craniomandibular articulation. Nevertheless, at present none of the available laser systems meet the medical demands completely. Currently, the Erbium:YAG laser seems to be the most suitable for TMJ arthroscopic surgery.
Nuebler-Moritz, Michael; Hering, Peter; Bachmaier, Uli; Schiessl, Robert; Rueschoff, Josef; Meister, Joerg
Objectives This study attempted to validate MR arthrography (MRAr) of the temporomandibular joint (TMJ) in detecting the position, integrity and relations of the articular disc and retrodiscal tissue. Methods A total of 20 TMJs from 10 patients with severe TMJ dysfunction underwent MRI and MRAr. A paramagnetic contrast medium was injected into the upper joint compartment to observe possible adhesions and/or leakage into the lower compartment. 15 TMJs were surgically or arthroscopically explored and restored. Results MRAr was approximately in the same diagnostic value as MRI when locating position, but superior in detecting disc perforations (eight TMJs) and adhesions (seven TMJs) appearing together in four cases. Surgery confirmed radiological findings in all but one case, where arthroscopy and surgery failed to confirm a disc perforation indicated by MRAr. Conclusions TMJ MRAr may simultaneously reveal adhesions and perforations. Sensitivity and the probability of false-positive results require further study.
Venetis, G; Pilavaki, M; Triantafyllidou, K; Papachristodoulou, A; Lazaridis, N; Palladas, P
Objective. To examine the effects of intraarticular induction of interleukin-1 (IL-1) expression in adult mice. Methods. We used somatic mosaic analysis in a novel transgenic mouse with an inducible IL-1 tran- scription unit. Transgene activation was induced by Cre recombinase in the temporomandibular joints (TMJs) of adult transgenic mice (conditional knockin model). The effects of intraarticular IL-1 induction were sub-
Yu-Ching Lai; Solomon S. Shaftel; Jen-nie H. Miller; Ross H. Tallents; Yoon Chang; Carl A. Pinkert; John A. Olschowka; Ian M. Dickerson; J. Edward Puzas; M. Kerry O'Banion; Stephanos Kyrkanides
Objectives: We sought to investigate whether the finding of temporomandibular joint (TMJ)-related pain may be linked to magnetic resonance (MR) imaging findings of TMJ internal derangement and TMJ osteoarthrosis. Study Design: The study consisted of 194 consecutive TMJ patients. Criteria for including a patient with a painful TMJ were as follow: report of orofacial pain in the TMJ, with the
Rüdiger Emshoff; Katharina Innerhofer; Ansgar Rudisch; Stefan Bertram
The understanding of the mastication system motion is essential to maxillofacial surgeons and dentists in the procedures concerning jaw and teeth corrections. The temporomandibular joint (TMJ), despite its complexity, is one of the most frequently used joints of the human body. The incidence of a great number of injuries in this joint is influenced not only by its regular use during the mastication, but also by the strong forces applied by the muscles and the wide range of movements it is capable to perform. In this work, we propose the development of a jaw simulator capable of reproducing the complete mastication movement. Our jaw simulator is basically composed by three triangle meshes representing the 3D model of the cranium, mandible and teeth; and an anatomically-based joint model conceived to represent the TMJ motion. The polygonal meshes describing the bones and teeth are obtained from CT images and the jaw motion is simulated using the joint model guided by a 3D motion curve obtained from the composition of the standard 2D curves available in the medical literature. The scale, height and width of these original curves are modified to simulate different kind and size of food and to represent the movements" variability depending on patient morphology (teeth, bones, joints and muscles). The evaluation of preliminary results involved the comparison of a dynamic MRI of a healthy person with the respective simulation.
Villamil, Marta B.; Nedel, Luciana P.; Freitas, Carla M. D. S.; Maciel, Anderson
Purpose: The aim of this study was to compare the preoperative and 1-year postoperative clinical and radiological findings of the patients after unilateral temporomandibular joint (TMJ) discectomy with inter-positional abdominal dermis-fat graft. Materials and Methods: Fourteen patients underwent unilateral discectomy and dermis-fat grafting between 2008 and 2010. Preoperative and 1-year postoperative clinical parameters such as maximum mouth openings (MMO) and lateral movements (LM) of the mandible were recorded. Additionally, preoperative and postoperative magnetic resonance imagingwas obtained to determine the duration of operated TMJs. Results: All of the 14 patients showed the improvement in mandibular mobility and function. There was a significant increase in the MMO and LM during the follow-up period. Pain levels at follow-up were significantly lower than the preoperative levels. Radiologically, the dermis-fat graft was detected within the joint or surrounding the condyle in all 14 operated joints. The graft material that was found within the joint space was mainly grey in four joints. Ten joints showed heterogeneous material composed of fat interspersed with grey tissue. Conclusion: Discectomy and dermis-fat grafting appears to be a successful surgical option regarding to the clinical parameters. However, summed degenerative changes depending on surgical operation should be retained.
Candirli, Celal; Esen, Alparslan; Taskesen, Fatih; Celik, Salih; Cakir, Banu
We report a case of a 64-year-old patient in whom limitation of mouth opening was the presenting symptom of plasmacytoma. Intra-oral biopsy confirmed a plasma-cell tumour, with no sign of extension on imaging. He was treated with radiotherapy (4000 cGy) and followed up. The diagnosis of solitary plasmacytoma of bone can be confirmed only when the presence of systemic disease has been excluded by clinical, biological, and radiological investigations. We think that the treatment should consist only of radiotherapy. Long-term follow-up is necessary because of the high risk of development of multiple myeloma, which may be delayed. PMID:17698264
Lesmes, Daniel; Laster, Zvi
Our aim was to describe the effects of soft tissue injury to the temporomandibular joint (TMJ), to analyse possible reasons for it, and to evaluate the results of treatment. Eight patients (12 joints) who developed disorders of the TMJ after trauma to the mandible without fracture of the condyle were treated in our department from 2009 to 2010. Magnetic resonance imaging (MRI) and computed tomography (CT) were used to check the condition of the joint. Five patients had their joints explored to relieve pain and improve mouth opening. MRI showed all 12 joints had displaced discs. CT showed that the surface of the condylar bone was "intact" immediately after injury but destroyed later in 8 joints. Exploration showed fibrous ankylosis in 5, osteoarthritis with intra-articular adhesions in 2, and internal derangement in 1. Four were treated by costochondral graft (CCG) with 7 symptomatic joints. The disc was repositioned in 1 case with 1 affected joint. The mean maximal incision opening at follow-up were significantly better than the one before treatment (mean 34 compared with 23 mm, p=0.02). Pain in the TMJ was relieved by operation in all patients so treated. The other 3 patients (4 joints) had no treatment because their symptoms were minor and mouth opening was not restricted. Soft tissue injuries of the TMJ can potentially lead to internal derangement, osteoarthrosis, and possibly fibrous ankylosis, which should be considered during follow-up. Displacement of the disc and damage to the condylar cartilage seem to be the causes of these complications. Surgical management is effective in the short term. PMID:22465223
He, Dongmei; Yang, Chi; Chen, Minjie; Yang, Xiujuan; Li, Lingzhi
The functional disorders of the masticatory organ are the third stomatological disease to be considered a populational disease due to its chronicity and widespread prevalence. Otolaryngological symptoms are a less common group of dysfunction symptoms, including sudden hearing impairment or loss, ear plugging sensation and earache, sore and burning throat, difficulties in swallowing, tinnitus, and vertigo. The diagnostic and therapeutic problems encountered in patients with the functional disorders of the masticatory organ triggered our interest in conducting retrospective studies with the objective of assessing the incidence of otolaryngological symptoms in patients subjected to prosthetic treatment of the functional disorders of masticatory organ on the basis of the analysis of medical documentation containing data collected in medical interviews. Material and Methods. Retrospective study was conducted by analyzing the results of medical interviews of 1208 patients, who had reported for prosthetic treatment at the Functional Disorders Clinic of the Department of Dental Prosthetics of Jagiellonian University Medical College in Cracow between 2008 and March 14, 2014. Results. Otolaryngological symptoms were observed in 141 patients. The most common symptoms in the study group were earache and sudden hearing impairment; no cases of sudden hearing loss were experienced.
Ferendiuk, E.; Zajdel, K.
Objectives The aim of this retrospective study was to characterize MRI findings of synovial chondromatosis in the temporomandibular joint (TMJ) by correlation with their pathological findings. Methods 22 patients with synovial chondromatosis in unilateral TMJ were referred for plain MRI prior to surgical management and pathological examinations. Parasagittal and coronal proton density-weighted imaging and T2 weighted imaging were performed for each case. Results MRI demonstrated multiple chondroid nodules and joint effusion in all patients (100%) and amorphous iso-intensity signal tissues within expanded joint space and capsule in 19 patients (86.4%). On T2 weighted imaging, signs of low signal nodules within amorphous iso-intensity signal tissues were used to determine the presence of attached cartilaginous nodules in pathology, resulting in 100% sensitivity, 60% specificity and 90.9% accuracy. Signs of low and intermediate signal nodules within joint fluids were used to detect loose cartilaginous nodules and resulted in 80% sensitivity, 42.9% specificity and 68.2% accuracy. Conclusions MRI of synovial chondromatosis in TMJ was characterized by multiple chondroid nodules, joint effusion and amorphous iso-intensity signal tissues within the expanded space and capsule. The attached cartilaginous nodules in pathology were better recognized than the loose ones on MRI. Plain MRI was useful for clinical diagnosis of the disorder.
Wang, P; Tian, Z; Yang, J; Yu, Q
Aims The purpose of this study was to assess the biopsychosocial factors associated with acute temporomandibular joint disorders (TMD) based upon the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Methods Participants were assessed in community-based dental clinics, and evaluated by trained clinicians on physical and psychosocial measures. A total of 207 subjects were evaluated. Patients’ high-risk versus low-risk status for potentially developing chronic TMD was also determined. Analyses of variance and chi square analyses were applied to these data. Results Participants’ characteristic pain intensity differed among RDC/TMD Axis I diagnoses. They also significantly varied in their: self-reported graded chronic pain; depression; somatization, pain inclusive; somatization, pain excluded, and physical well-being. In addition, participants with differing RDC/TMD Axis I diagnoses varied in self-reported pain during their chewing performance. Finally, there were also significant differences in chewing performance between high-risk vs. low-risk (for developing chronic TMD) patients. Conclusions Participants with multiple diagnoses reported higher pain, as well as other symptoms, relative to participants without a TMD diagnosis. For chewing performance, participants with mutual diagnoses reported more pain compared to other participants. Finally, the risk-status of patients significantly affected chewing performance.
Dougall, Angela Liegey; Jimenez, Carmen A.; Haggard, Robbie A.; Stowell, Anna W.; Riggs, Richard R.; Gatchel, Robert J.
Ankylosis of the temporomandibular joint (TMJ) is a severe disorder that leads to jaw function impairment and restricted mouth opening. Management of TMJ ankylosis poses a challenge to surgeons concerned because of the high rate of recurrence. The surgical approach to TMJ ankylosis can be performed according to different techniques and modalities. This report presents a case of a bilateral posttraumatic TMJ ankylosis that showed limited mouth opening (27 mm) along with dental occlusion abnormalities, and both TMJs showed severe fibro-osseous ankylosis. Bilateral gap arthroplasty was performed, and passive interincisal mouth opening of at least 47 mm was achieved after 15 days of physiotherapy. Eight months later, bilateral split ramus osteotomy was performed to correct the residual retrognathia and malocclusion. The outcome of the patient's treatment was satisfactory. Wide gap arthroplasty if followed by vigorous physiotherapy may be sufficient in treating TMJ ankylosis and prevent recurrence in adults. PMID:20647844
Abdelrahman, Tarek Ftohy; Takahashi, Katsu; Bessho, Kazuhisa
Since synovial chondromatosis (SC) clinically mimics symptoms of internal derangements of the TMJ, the diagnostic value of MRI and CT, overlooked for years, is discussed in the presented case. Multiple amorphous calcifications in the left infratemporal fossa and upper synovial compartment of the TMJ were detected on the CT and MRI scans. The patient underwent open TMJ arthrotomy and removal of 15 calcified loose bodies. SC may be diagnosed radiographically when sclerosis of the glenoid fossa, soft tissue edema, and intraarticular radio-opaque loose bodies are detected. Advanced imaging of the TMJ, such as MRIs and CTs, are indispensible methods to obtain differential diagnoses for long-standing suspicious pathologies of the temporomandibular joint. PMID:22128672
Varol, Altan; Sencimen, Metin; Gulses, Aydin; Altug, Hasan Ayberk; Dumlu, Asim; Kurt, Bulent
The techniques of conventional discoplasty and the scar producing potential of cryosurgical treatment of the bilaminar region were examined in a study of 17 adult female cynomologous monkeys. Temporomandibular joint (TMJ) tissues were obtained at four and 10 days, four, 20, 52, and 78 weeks after surgery, and compared to TMJ tissues in unoperated control animals. No clinically observable changes in weight, occlusion, or jaw function were identified. All the surgical sites healed normally. At necropsy, lesions of the articular surface of the condyle were apparent in areas that had been surgically "shaved." The anterior, intermediate, and posterior zones of the surgically-treated discs were generally free of change. Two cryosurgically-treated discs showed lesions and perforations. Histologic and autoradiographic observations suggested that the bilaminar area heals quickly with minimal scarring, following both conventional surgical manipulation and cryosurgery. Under the conditions of this experiment the cryosurgical technique was judged not to be superior to the conventional surgical approach. PMID:3480337
Marciani, R D; Traurig, H H; White, D K; Roth, G I
Synovial cysts of the temporomandibular joint (TMJ) are very rare, and to date, only 12 cases of a synovial cyst in the TMJ region have been reported in the literature. In this paper, we present the clinicopathological and immunohistochemical characteristics of one such lesion affecting a 48-year-old woman, presented with a mass in the left preauricular region. We describe the usefulness of immunohistochemical analysis for recognizing the synovial lining, which allowed for clear differentiation between ganglion and synovial cysts. Immunohistochemical analyses can be used to diagnose synovial cysts with certainty; however, using at least two markers is advisable to distinguish the two existing synovial cell subtypes. Our findings indicate that synovial cysts of TMJ possess an internal lining dominated by type B (fibroblast-like) synoviocytes.
Vera-Sirera, B.; Tomas-Amerigo, J. A.; Baquero, C.; Vera-Sempere, F. J.
We present a case involving a late diagnosis of chondroblastoma of the temporal skull base involving the temporomandibular joint (TMJ). Following an initial misdiagnosis and unsuccessful treatment over a period of 5 years, the patient was referred to our department for further evaluation and possible surgical intervention for occlusal abnormalities, trismus, clicking of the TMJ, and hearing impairment. Based on preoperative immunochemical studies showing positive reaction of multinucleated giant cells for S-100 protein, the final diagnosis was chondroblastoma. The surgical approach – postauricular incision and total parotidectomy, with complete removal of the temporal bone, including the TMJ via the extended middle fossa – was successful in preserving facial nerves and diminishing clinical manifestations. This study highlights a misdiagnosed case in an effort to underline the importance of medical examinations and accurate differential diagnosis in cases involving any tumor mass in the temporal bone.
Yokoyama, Junkichi; Yoshimoto, Hitoshi; Ito, Shin; Ohba, Shinichi; Fujimaki, Mitsuhisa; Ikeda, Katsuhisa; Yazawa, Masaki; Fujimiya, Nozomi; Hanaguri, Makoto
Objective The objective of this study was to evaluate the usefulness of bone scan procedures for the diagnosis of temporomandibular joint (TMJ) osteoarthritis. Methods From February 2009 to June 2009, 22 patients (4 males and 18 females) from Seoul National University Bundang Hospital, Republic of Korea, were diagnosed with TMJ disorder. They were examined by clinical examination, plain radiograph and bone scan and were categorized into three groups: normal, internal derangement and osteoarthritis. TMJ uptake ratios and asymmetrical indices were calculated. Results There were no significant differences in uptake ratios associated with pain and bone change. However, significant results were obtained when comparing uptake ratios between the osteoarthritis and non-osteoarthritis groups. Conclusion It was concluded from this study that bone scans may help to diagnose osteoarthritis when increased uptake ratios are observed.
Kim, J-H; Kim, Y-K; Kim, S-G; Yun, P-Y; Kim, J-D; Min, J-H
Proteus syndrome is a rare disorder with progressive asymmetrical and disproportionate overgrowth of various tissues of the body. The syndrome is characterized by a wide range of malformations, including craniofacial deformities. Extraoral examination revealed several of the classical craniofacial features of Proteus syndrome: pronounced hemifacial hypertrophy, macrodactyly and hyperostosis. Intraoral examination revealed a high arched palate and gingival hyperplasia. Other findings were unilateral enlargement of the tongue, alveolar growth and dilaceration of the roots of the teeth. There were severe degenerative changes and deformities in the left temporomandibular joint but the oversized condyle was asymptomatic; there was no pain, limitation and deviation at mouth opening. Treatment was not necessary owing to the asymptomatic situation but periodic follow-up with clinical and radiographic examination was considered. The aim of this article is to describe the radiographic manifestations of an asymptomatic condyle malformation and other craniofacial, oral and dental findings in a 33-year-old female patient with known Proteus syndrome.
Yilmaz, E; Kansu, O; Ozgen, B; Akcicek, G; Kansu, H
Study Objectives: We characterized sleep disorder rates in temporomandibular joint disorder (TMD) and evaluated possible associations between sleep disorders and laboratory measures of pain sensitivity. Design: Research diagnostic examinations were conducted, followed by two consecutive overnight polysomnographic studies with morning and evening assessments of pain threshold. Setting: Orofacial pain clinic and inpatient sleep research facility Participants: Fifty-three patients meeting research diagnostic criteria for myofascial TMD. Interventions: N/A Measurements and Results: We determined sleep disorder diagnostic rates and conducted algometric measures of pressure pain threshold on the masseter and forearm. Heat pain threshold was measured on the forearm; 75% met self-report criteria for sleep bruxism, but only 17% met PSG criteria for active sleep bruxism. Two or more sleep disorders were diagnosed in 43% of patients. Insomnia disorder (36%) and sleep apnea (28.4%) demonstrated the highest frequencies. Primary insomnia (PI) (26%) comprised the largest subcategory of insomnia. Even after controlling for multiple potential confounds, PI was associated with reduced mechanical and thermal pain thresholds at all sites (P < 0.05). Conversely, the respiratory disturbance index was associated with increased mechanical pain thresholds on the forearm (P < 0.05). Conclusions: High rates of PI and sleep apnea highlight the need to refer TMD patients complaining of sleep disturbance for polysomnographic evaluation. The association of PI and hyperalgesia at a non-orofacial site suggests that PI may be linked with central sensitivity and could play an etiologic role in idiopathic pain disorders. The association between sleep disordered breathing and hypoalgesia requires further study and may provide novel insight into the complex interactions between sleep and pain-regulatory processes. Citation: Smith MT; Wickwire EM; Grace EG; Edwards RR; Buenaver LF; Peterson S; Klick B; Haythornthwaite JA. Sleep disorders and their association with laboratory pain sensitivity in temporomandibular joint disorder. SLEEP 2009;32(6):779–790.
Smith, Michael T.; Wickwire, Emerson M.; Grace, Edward G.; Edwards, Robert R.; Buenaver, Luis F.; Peterson, Stephen; Klick, Brendan; Haythornthwaite, Jennifer A.
Objective. The purpose of this study was to investigate the correlations between the concentrations of pain-related mediators in synovial fluid and the degree of synovitis and between the concentrations of pain-related mediators and the degree of joint pain in patients with internal derangement and osteoarthritis of the temporomandibular joint. Study Design. The concentrations of substance P, serotonin, bradykinin, leukotriene B4
Masaaki Nishimura; Natsuki Segami; Keiseki Kaneyama; Tohikazu Suzuki; Masahisa Miyamaru
A retrospective study of 107 patients (male, n = 13; female, n = 94) with 163 joints previously treated with Proplast-Teflon (PT; Vitek, Inc, Houston, TX) implants was performed. The average time in situ for the PT was 59.8 months (range, 2 to 126 months). Average length of follow-up was 84.6 months (range, 59 to 126 months). Only 12% of joints showed no significant osseous changes radiographically. Forty-five patients (42%) continue to have in situ PT implants and 36% of them experience pain that requires medication; 25% have developed an anterior open bite and malocclusion; 9% have limited vertical opening; and 40% are asymptomatic. Temporomandibular joint (TMJ) reconstruction after PT implant failure was performed with five different autologous tissues or a total joint prosthesis. Autologous tissues used to reconstruct the TMJ and the rates of success were as follows: 1) 31% free temporalis fascia and muscle graft with and 13% without sagittal split ramus osteotomy, 2) 8% dermis, 3) 25% conchal cartilage, 4) 12% costochondral grafts, and 5) 21% sternoclavicular grafts. The success rate decreased in all autologous tissue groups as the number of TMJ surgeries performed before reconstruction increased. Ankylosis was the most common cause of failure. Results of TMJ reconstruction with a total joint prosthesis were as follows: 1) 88% functional and occlusal stability of total joint prosthesis; 2) level of pain reduction was rated as 46% good, 38% fair, and 16% poor; and 3) an average interincisal opening of 27 mm at 24 months or less, and 33 mm at 25 months and beyond.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8450350
Henry, C H; Wolford, L M
Synovial chondromatosis (SC) is a pathologic condition in which mesenchymal tissue rests in a given synovial membrane undergo a metaplastic process, ultimately producing and secreting cartilaginous bodies into the joint space. It is more commonly discussed in the orthopedic literature, since the axial skeleton is the most frequently affected. Although rare, it does occur within the temporomandibular joint (TMJ), with approximately 100 cases previously being described. Within the TMJ, its presentation can be variable, though most cases will show it to be unilateral with fixed and/or loose cartilaginous bodies confined to the superior joint space. Clinically, patients may present with symptoms similar to that of an internal derangement disorder, including pain, clicking, tenderness, functional limitations, and swelling. A thorough history and physical examination, along with proper radiographic examination, are paramount in properly diagnosing SC. Treatment options consist of arthroscopy, arthrotomy with synovectomy, excision of cartilaginous bodies, and possible discectomy. In the current paper, the authors describe the presentation, diagnosis, and surgical management of a SC case involving the right TMJ in a 31-year-old Caucasian female. PMID:24308105
Reed, Lucas S; Foster, Michael D; Hudson, John W
Early temporomandibular joint (TMJ) prostheses articulated on material with poor wear resistance. Wear debris was deposited in the surrounding tissues, causing severe foreign body cell reactions. Recent TMJ prostheses use modern orthopaedic materials, such as ultra high molecular weight polyethylene (UHMWPE) for the fossa component, and cobalt-chromium, or cobalt-chromium-molybdenum for the condylar head. These designs are reliable in long-term follow-up studies. The authors report histological findings in soft tissue samples obtained from around two types of TMJ prostheses after up to 8 years of function. The devices were four Biomet (Biomet Microfixation, Jacksonville, FL, USA), and two TMJ Concepts (TMJ Concepts, Ventura, CA, USA). All joint capsule samples demonstrated dense, fibrous connective tissue with no inflammatory cells or foreign body reactions. The joint disc tissues showed even denser fibrous connective tissue, free from inflammatory reactions. Some samples from the junction between capsule and disk demonstrated synovial-like tissue. The observations reported in this paper indicate that modern TMJ prostheses with Cr-Co-Mb or Cr-Co articular condyles articulating on UHMWPE fossa components appear to function without foreign body reactions in he surrounding tissues. PMID:21044827
Westermark, A; Leiggener, C; Aagaard, E; Lindskog, S
An anatomic and clinical investigation of condylar remodeling; the position of the condyle in centric occlusion; and the relationships of these two factors to each other and to the features of the dentition are reported. Two groups of 100 adult crania were examined. The first group had complete or partially edentulous arches. In the second group, the dentition was complete and there were various degrees of abrasion. In addition, clinical and tomographic data were obtained from 70 patients with temporomandibular joint pain-dysfunction syndrome. Occlusion was also studied by intraoral registration of the gothic arch and by mounting the casts on an articulator in 40 patients. Comparison of the data made it clear that occlusal conditions determine the course of condylar remodeling and lead to marked changes in shape of the joints. Occlusal disorders are also responsible for condylar displacement (noted in 51.4 per cent of patients), which, in turn, may be the cause of typical reshaping of the joint. These findings cast doubt on the proposition that the gnathologic determinants (particularly centric relation) are never changed in the course of time. PMID:269953
The variety of temporomandibular joint (TMJ) prostheses and condylar reconstruction plates available is in contradiction to their rare application. This emphasizes that alloplastic TMJ reconstruction is still evolving. This article reviews the history of TMJ reconstruction. Medline as well as public and private libraries have been searched. Current systems are reviewed. Prosthetic devices can be differentiated into fossa-eminence prostheses, ramus prostheses and condylar reconstruction plates, and total joint prostheses. Fossa and total joint prostheses are recommended when the glenoid fossa is exposed due to excessive stress (degenerative disorders, arthritis, ankylosis, multiply operated pain patients). Singular replacement of the condyle is preferred as a temporary solution in ablative surgery. The use of prosthetic devices for long-term replacement should be restricted to selected cases, taking care to retain the disk, in order to prevent penetration into the middle cranial fossa. The term 'condylar reconstruction plate' reflects this more clearly than 'ramus prosthesis' which suggests permanent reconstruction. Long-term studies comparing the functional and aesthetic results of the various prostheses and condylar reconstruction plates are not available, which leaves the choice to personal experience. PMID:19464145
Driemel, O; Braun, S; Müller-Richter, U D A; Behr, M; Reichert, T E; Kunkel, M; Reich, R
Compared with the joints of the limbs, our understanding of the genes that regulate development and growth in the temporomandibular joint (TMJ) is fairly limited. Because the morphogenesis of the secondary cartilage and other intra-articular structures in the TMJ occurs later and in a different manner than in the limbs, the genetic control of TMJ development might reasonably be assumed to differ from that in the limbs. However, studies of the specific genes regulating TMJ morphogenesis and growth have only begun to appear in the literature within the last decade. This review attempts to survey and interpret the existing knowledge on this topic and to suggest fruitful avenues of investigation for the future. Studies to date using knockout and over-expression of candidate genes suggest that a developmental hierarchy of joint structures exists, with condyle development primary. A hierarchy of gene expression also exists: Runx2 and Sox9 expression is critical for condylar cartilage formation. Several of the other genes discussed in this report may regulate TMJ morphogenesis by affecting Sox9 and Runx2 expression and control the ihh-PTHrP axis by means of these genes. Developmental Dynamics 243:864-874, 2014. © 2014 Wiley Periodicals, Inc. PMID:24668501
Hinton, Robert J
Many different surgical and non-surgical techniques are used for the treatment of temporomandibular joint (TMJ) hypermobility. One of these methods is autologous blood injection into the TMJ. The fate of the autologous blood used for treatment of recurring condylar dislocation is still not completely understood. The authors used 12 pigs (Sus scrota f. domestica) as a model species for autologous blood delivery into the TMJ. Blood injection was followed by histopathological analysis at different times after treatment (1h, 1, 2 and 4 weeks). Samples were examined by magnetic resonance imaging, macroscopic and histological methods. The deposition of the remaining blood was observed in the form of clots in the distal parts of the upper joint cavity 1h and 1 week after treatment. 2 weeks after treatment, small blood clots were still apparent in the distal part of the upper joint cavity. 4 weeks after surgery, no remnants of blood, changes or adhesions were apparent inside the TMJ. No morphological or histological changes were observed in the TMJ after the injection of autologous blood suggesting another mechanism is involved in the hypermobility treatment. PMID:22867740
Stembirek, J; Matalova, E; Buchtova, M; Machon, V; Misek, I
ABSTRACT Background The literature on total alloplastic temporomandibular joint (TMJ) reconstructions is encouraging, and studies on total alloplastic TMJ replacements outcomes showed acceptable improvements in terms of both pain levels and jaw function. Nevertheless, some adverse events, such as heterotopic bone formation around the implanted prosthesis, may occur. In consideration of that, the present manuscript describes a case of heterotopic bone formation around a total temporomandibular joint prosthesis, which occurred several years after the implant. Methods The present manuscript describes a case of heterotopic bone formation around a total TMJ prosthesis, which occurred several years after the implant in patients, who previously underwent multiple failed TMJ surgeries. Results Ten years after the surgical TMJ replacement to solve an ankylotic bone block, the patient came to our attention again referring a progressive limitation in mouth opening. A computerized tomography showed evidence of marked heterotopic bone formation in the medial aspects of the joint, where a new-born ankylotic block occupied most part of the gap created by resecting the coronoid process at the time of the TMJ prosthesis insertion. Conclusions Despite this adverse event has been sometimes described in the literature, this is the first case in which its occurrence happened several years after the temporomandibular joint replacement. It can be suggested that an accurate assessment of pre-operative risk factors for re-ankylosis (e.g., patients with multiple failed temporomandibular joint surgeries) and within-intervention prevention (e.g., strategies to keep the bone interfaces around the implant separated) should be better standardized and define in future studies.
Guarda-Nardini, Luca; Manfredini, Daniele; Ferronato, Giuseppe
The temporomandibular joint plays a crucial role in human mastication acting as a guide of jaw movements. During these movements, the joint is subjected to loads which cause stresses and deformations in its cartilaginous structures. A perfect balance between the two sides of the joint is essential to maintain the physiological stress level within the tissues. Therefore, it has been suggested that a derangement of the joint is a contributing factor in the development of mandibular asymmetry, especially if problems of the temporomandibular joint start in childhood or adolescence. To analyze the movement of the mandible and the stresses undergone by the discs, two finite element models of the human temporomandibular joint including the masticatory system were developed, one corresponding to a healthy joint and the other with a unilateral anterior disc displacement with their movement controlled by muscle activation. A fibre-reinforced porohyperelastic model was used to simulate the behaviour of the articular discs. The stress distribution was analyzed in both models during free opening and closing, and during the introduction of a resistant force between incisors or molars. It was found that a slight unilateral anterior disc displacement does not lead to mandibular asymmetry but to a slight decrease of the maximum gape. With the introduction of a restriction between incisors, the maximum stresses moved to the anterior band in contrast to what happened if the restriction was imposed between molars where maximum stresses were located more posteriorly. Finally, the presence of a unilateral displacement of the disc involved a strong change in the overall behaviour of the joint including also the healthy side, where the maximum stresses moved to the posterior part. PMID:17725577
Pérez del Palomar, A; Doblaré, M
Abstract Objective: Low-level laser therapy (LLLT) is a treatment method commonly used in physiotherapy for musculoskeletal disorders. The aim of this study was to monitor the function of temporomandibular joint (TMJ) and surrounding tissues and compare the objective measurements of the effect of LLLT. Background data: LLLT has been considered effective in reducing pain and muscular tension; thus improving the quality of patients' lives. Materials and Methods: TMJ function was evaluated by cephalometric tracing analysis, orthopantomogram, TMJ tomogram, and computer face-bow record. Interalveolar space between central incisors before and after therapy was measured. Patients evaluated pain on the Visual Analog Scale. LLLT was performed in five treatment sessions (energy density of 15.4?J/cm2) by semiconductive GaAlAs laser with an output of 280?mW, emitting radiation wavelength of 830?mm. The laser supplied a spot of?0.2?cm2. Results: Baseline comparisons between the healthy patients and patients with low-level laser application show that TMJ pain during function is based on anatomical and function changes in TMJ areas. Significant differences were seen in the posterior and anterior face height. The results comparing healthy and impaired TMJ sagittal condyle paths showed that patients with TMJ pain during function had significantly flatter nonanatomical movement during function. After therapy, the unpleasant feeling was reduced from 27.5 to 4.16 on the pain Visual Analog Scale. The pain had reduced the ability to open the mouth from 34 to 42?mm. Conclusions: The laser therapy was effective in the improvement of the range of temporomandibular disorders (TMD) and promoted a significant reduction of pain symptoms.
Hlinakova, Petra; Kasparova, Magdalena; Rehacek, Adam; Vavrickova, Lenka; Navratil, Leos
Healthy articular cartilage is thought to be maintained by the modulation of Cbfa1 expression, although little is currently known about Cbfa1 expression in such tissues. Therefore, we examined in vivo Cbfa1 transcript levels in the temporomandibular (TM) and knee joints of 3- and 10-week-old male ICR mice (weighing 50–70g). A digoxigenin-11-UTP-labeled single-stranded RNA probe (0.6kbp PstI–HindIII fragment of the 3?
Takuo Kuboki; Manabu Kanyama; Tohru Nakanishi; Kentaro Akiyama; Kumiko Nawachi; Hirofumi Yatani; Kazuo Yamashita; Teruko Takano-Yamamoto; Masaharu Takigawa
The purpose of this study was to investigate the radiological fate of the dermis-fat graft within the temporomandibular joint (TMJ) using magnetic resonance imaging (MRI). Fifteen patients with dermis-fat grafts placed in 17 TMJs following discectomy for severe internal derangement were divided into 3 equal groups according to the time lapse between TMJ surgery and the MRI investigation: 0–6 months,
G. Dimitroulis; N. Trost; W. Morrison
Replacements for the temporomandibular joint were developed in the early 1960s. Problems with various prostheses, notably the Kent VK1, led to detailed analysis of their risks and complications. In 1999 one type of prosthesis (the Christensen) was converted from an acrylic condyle on cobalt-chromium fossa to metal-on-metal cobalt-chrome condyle and fossa. This has been popular for the last 15 years
A. J. Sidebottom; B. Speculand; R. Hensher
Total replacement of the temporomandibular joint (TMJ) is increasingly accepted as the gold standard for reconstruction of irreparably damaged or ankylosed joints. The TMJ Concepts system (TMJ Concepts, Ventura, USA) has the longest follow-up of the 2 systems used in the UK. A total of 74 patients had placement of TMJ Concepts prostheses. The primary diagnoses were degenerative disease, multiple previous operations, injury, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and ankylosis. Of these, 12 were revisions of previous replacements (3 after multiple operations). Over the year there was a significant mean (SD) reduction in pain score (10 cm visual analogue scale) from 72 (2.5) to 8 (1.7) (p<0.0001), and mean (SD) improvements in mouth opening from 22.4 mm (9.4) to 33.7 mm (6.2) (p<0.0001), and dietary consistency (10 cm analogue liquid 0 to solid 100) from 38 (23) to 93 (16) (p<0.0001). No patient had worse symptoms postoperatively. Joints in 2 patients failed because of biofilm infections. Two patients required blood transfusion and one required ligation of the external carotid artery. Five had perioperative dislocation, which responded to elastic intermaxillary fixation for one week. A total of 31 patients had partial, and 2 had total weakness of the facial nerve. All resolved fully except weakness of the temporal branch in one patient, which required brow lift. Total TMJ replacement gives good early improvements in function and pain with few complications. Of the 74 patients, 71 were very pleased to have had the procedure. One was dissatisfied despite complete pain relief and improvement in mouth opening from 3 to 30 mm, and 2 were ambivalent (one had infection, revision, and permanent weakness of the temporal branch of the facial nerve). PMID:23618995
A J, Sidebottom; E, Gruber
Background and Aim: The objective of this study was to determine the prevalence of signs and symptoms of temporomandibular joint dysfunction (TMJD) in the Iran/Iraq war veterans suffering from post-traumatic stress disorder. Materials and Methods: A total of 120 subjects in the age range of 27 to 55 years were included; it included case group (30 war veterans with PTSD) and three control groups (30 patients with PTSD who had not participated in the War, 30 healthy war veterans, and 30 healthy subjects who had not participated in the War). All subjects underwent a clinical TMJ examination that involved the clinical assessment of the TMJ signs and symptoms. Results: The groups of veterans had high prevalence of TMJD signs and symptoms vs. other groups; history of Trauma to joint was significantly higher in subjects who had participated in the war compare with subjects who had not participated in the war (P = 0.0006). Furthermore, pain in palpation of masseter, temporal, pterygoideus, digastric, and sternocleidomastoid muscles in the groups of veterans was significantly greater than other groups (P < 0.0001). Clicking noise during mouth chewing was significantly different between groups (P = 0.01). And, there was significant difference in the frequencies of maximum opening of the mouth between groups (P = 0.001). Conclusion: The results of this study showed that subjects’ war veterans with PTSD have significantly poorer TMJ functional status than the control subjects.
Mottaghi, Ahmad; Zamani, Elham
The temporomandibular joint (TMJ) is a specialized synovial joint essential for the function of the mammalian jaw. The main components of the TMJ are the mandibular condyle, the glenoid fossa of the temporal bone, and a fibrocartilagenous disc interposed between them. The genetic program for the development of the TMJ remains poorly understood. Here we show the crucial role of sprouty (Spry) genes in TMJ development. Sprouty genes encode intracellular inhibitors of receptor tyrosine kinase (RTK) signaling pathways, including those triggered by fibroblast growth factors (Fgfs). Using in situ hybridization, we show that Spry1 and Spry2 are highly expressed in muscles attached to the TMJ, including the lateral pterygoid and temporalis muscles. The combined inactivation of Spry1 and Spry2 results in overgrowth of these muscles, which disrupts normal development of the glenoid fossa. Remarkably, condyle and disc formation are not affected in these mutants, demonstrating that the glenoid fossa is not required for development of these structures. Our findings demonstrate the importance of regulated RTK signaling during TMJ development and suggest multiple skeletal origins for the fossa. Notably, our work provides the evidence that the TMJ condyle and disc develop independently of the mandibular fossa. PMID:22328578
Purcell, P; Jheon, A; Vivero, M P; Rahimi, H; Joo, A; Klein, O D
Purpose. We evaluated the efficacy of arthrocentesis in the treatment of temporomandibular joint (TMJ) disorders. Material and Methods. In this prospective clinical case series, 30 consecutive patients with TMJ disorders underwent arthrocentesis using saline and sodium hyaluronate injections. Outcome measures were TMJ pain, maximum mouth opening (MMO), joint noises, and anatomical changes in the TMJ architecture. Patients were evaluated using cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI) at the beginning of treatment and 60 days after the last arthrocentesis. Pretreatment and posttreatment clinical parameters were compared using paired and unpaired t-tests, and McNemar's test was used to evaluate CBCT and MRI changes (P < 0.05). Results. At 1-year follow-up examinations, visual analogue scale scores indicated that pain was reduced significantly and mean postoperative MMO was increased significantly. CBCT findings showed no significant change, and MRI showed only slight reductions in inflammatory signs. Conclusions. Within the limitations of this study, we can conclude that arthrocentesis is a simple, minimally invasive procedure with a relatively low risk of complications and significant clinical benefits in patients with TMJ disorders. This trial is registered with NCT01903512.
De Riu, Giacomo; Soma, Damiano; Pisano, Milena; Sembronio, Salvatore; Tullio, Antonio
To describe the scientific literature about the diagnosis, prevalence, aetiology, natural course and possible treatment modalities of disc displacements within the temporomandibular (TM) joint. PubMed was searched for specific indexing terms. The search yielded 1211 papers. After screening according to title and abstract, 695 papers were excluded, and after full-text reading, 107 papers remained. Hand-searching of the reference lists resulted in an extra 47 papers. Thirteen studies, published since the literature search was carried out, were also included, resulting in 167 papers for this review. A disc displacement is a highly prevalent derangement within the TM joint, with reported prevalence ranging from 18% to 35% in the general population. A disc displacement with reduction is mostly a stable, pain-free and lifelong condition of the joint. In only a small minority of patients, the disc loses its capacity to reduce on opening. Surprisingly, only in rare cases, the loss of disc reduction is accompanied by signs and symptoms of a closed lock (viz. a painful and limited mouth opening). These signs and symptoms have a tendency to reduce and in many cases to resolve within months. The favourable natural course of disc displacements only warrants active treatment for symptomatic disc displacements without reduction. The primary treatment option is a conservative, non-surgical treatment focusing at speeding up the natural process of alleviation of pain and of improvement in mouth opening. For most patients, a disc displacement is just a pain-free, lifelong lasting, 'noisy annoyance' from their TM joint. PMID:23199296
Naeije, M; Te Veldhuis, A H; Te Veldhuis, E C; Visscher, C M; Lobbezoo, F
Background Temporomandibular joint disorders (TMJD) are multifactor, complex clinical problems affecting approximately 60–70% of the general population, with considerable controversy about the most effective treatment. For example, reports claim success rates of 70% and 83% for non-surgical and surgical treatment, whereas other reports claim success rates of 40% to 70% for self-improvement without treatment. Therefore, the purpose of this study was to (1) identify systematic reviews comparing temporomandibular joint disorder surgical and non-surgical treatment, (2) evaluate their methodological quality, and (3) evaluate the evidence grade within the systematic reviews. Methods A search strategy was developed and implemented for MEDLINE, Cochrane Library, LILACS, and Brazilian Dentistry Bibliography databases. Inclusion criteria were: systematic reviews (± meta-analysis) comparing surgical and non-surgical TMJD treatment, published in English, Spanish, Portuguese, Italian, or German between the years 1966 and 2007(up to July). Exclusion criteria were: in vitro or animal studies; narrative reviews or editorials or editorial letters; and articles published in other languages. Two investigators independently selected and evaluated systematic reviews. Three different instruments (AMSTAR, OQAQ and CASP) were used to evaluate methodological quality, and the results averaged. The GRADE instrument was used to evaluate the evidence grade within the reviews. Results The search strategy identified 211 reports; of which 2 were systematic reviews meeting inclusion criteria. The first review met 23.5 ± 6.0% and the second met 77.5 ± 12.8% of the methodological quality criteria (mean ± sd). In these systematic reviews between 9 and 15% of the trials were graded as high quality, and 2 and 8% of the total number of patients were involved in these studies. Conclusion The results indicate that in spite of the widespread impact of TMJD, and the multitude of potential interventions, clinicians have expended sparse attention to systematically implementing clinical trial methodology that would improve validity and reliability of outcome measures. With some 20 years of knowledge of evidence-based healthcare, the meager attention to these issues begins to raise ethical issues about TMJD trial conduct and clinical care.
Bessa-Nogueira, Ricardo V; Vasconcelos, Belmiro CE; Niederman, Richard
Synovial chondromatosis (SC) is a rare metaplastic disease of the larger joints. It is rarely observed in smaller joints, especially in the temporomandibular joint (TMJ). This disease is considered to be metaplastic and shows no malignant tendencies, but can become locally aggressive, erode the cranial base, and even spread intracranially. To date, nine cases of spread into the intracranial space have been reported in the literature; however, the disease remained extradural in all cases. The authors present a review of the literature and report the case of a 70-year-old man with SC of the right TMJ that had eroded the cranial base, reaching the dura mater; a large intracranial mass was not present. The disease was considered to be stage 3 according to Milgram's classification. The patient was treated surgically, the tumour mass was removed, reconstruction of the cranial base was performed using titanium mesh, and the joint was reconstructed with a temporal muscle interposition flap. Diagnostic images and intraoperative photographs are also presented. PMID:24314559
Pau, M; Bicsák, A; Reinbacher, K E; Feichtinger, M; Kärcher, H
The first 25 consecutive patients with high occlusal plane angulation, dysfunction, and pain who were treated with temporomandibular joint (TMJ) total joint prostheses and simultaneous maxillomandibular counterclockwise rotation were evaluated before surgery (T1), immediately after surgery (T2), and at the longest follow-up (T3) for surgical movements and long-term stability. Subjective ratings were used for patients' facial pain/headache, TMJ pain, jaw function, diet, and disability, and objective functional changes were determined by measuring maximum incisal opening and lateral excursive movements. Results showed that the areas of greatest surgical change included an average decrease in the occlusal plane of 13.3 degrees with advancement at point B of 13.4 mm and at the genial tubercles of 16.3 mm. At longest follow-up, relapse was 0.7 degrees, 0.8 mm, and 1.2 mm, respectively, with no statistically significant changes. Significant subjective pain and dysfunction improvements were observed (P ? 0.001). Maximum incisal opening increased, but lateral excursion decreased. Those who had two or more previous TMJ surgeries showed greater levels of dysfunction at T1 and T3 than those who had one or no previous surgeries, but otherwise patients presented similar amounts of absolute changes. In conclusion, end-stage TMJ patients can achieve significant improvement in their pain, dysfunction, dentofacial deformity, and airway problems in one operation with TMJ reconstruction and mandibular advancement using TMJ custom-made total joint prostheses and simultaneous maxillary osteotomies for maxillomandibular counter-clockwise rotation.
Pinto, Lecio P.; Cardenas, Luis E.; Molina, Omar R.
The articulation of the temporomandibular joint (TMJ) is composed of the temporal bone dorsally, the mandibular condyle ventrally and a fibrous articular disc. The TMJ disc plays an essential role in distributing load between the two articular surfaces. Degeneration of the disc in the presence of joint pathology has been shown in man; however, TMJ pathology has not been documented previously in tigers (Panthera tigris). The mandibular condyle and TMJ disc of a Bengal tiger (P. tigris tigris) and a Siberian tiger (P. tigris altaica) were evaluated grossly and the TMJ disc was characterized biochemically and mechanically. Characterization of the TMJ disc verified region- and direction-dependent biochemical and mechanical properties, reflective of the functional demands on the joint. Degenerative joint disease was observed in both cases and this was more severe in the Siberian tiger. Simultaneous evaluation of joint pathology, biochemical composition and mechanical properties of the TMJ disc revealed a loss in functional properties (tensile anisotropy) of the disc as joint pathology advanced from moderate to severe. TMJ degeneration may compromise the ability of the animal to eat and thrive and may be a factor contributing to the endangered status of these species. PMID:23809909
Murphy, M K; Arzi, B; Vapniarsky-Arzi, N; Athanasiou, K A
The objective of this study was to determine the viscoelastic properties present within the intermediate zone of the porcine temporomandibular joint (TMJ) disc using nanoindentation. A 50-microm conospherical indenter tip using a displacement-controlled ramp function with a 600 nm/s loading and unloading rate, a 3000-nm peak displacement with a holding period of 30 s was used to indent the samples. Experimental load-relaxation tests were performed on the TMJ disc to determine the response in three different directions; the mediolateral, anteroposterior, and articular surface directions. The experimental data were analyzed using a generalized Maxwell model to obtain values for short- and long-time relaxation modulus and of material time constants. The short time relaxation modulus E ( I ) values were 180.92, 64.99, and 487.77 kPa for testing done on the articular surface, mediolateral, and anteroposterior directions, respectively. Corresponding values for the long-time relaxation modulus E (infinity) were 45.9, 14.97, and 133.5 kPa. The method confirmed anisotropy present within the central intermediate zone of the porcine TMJ disc due to the directional orientation of the collagen fibers. PMID:20195763
Yuya, P A; Amborn, E K; Beatty, M W; Turner, J A
There is currently no suitable replacement for damaged temporomandibular joint (TMJ) discs after discectomy. In the present study, we fabricated bilayer biodegradable polylactide (PLA) discs comprising a non-woven mat of poly(L/D)lactide (P(L/D)LA) 96/4 and a P(L/DL)LA 70/30 membrane plate. The PLA disc was examined in combination with adipose stem cells (ASCs) for tissue engineering of the fibrocartilaginous TMJ disc in vitro. ASCs were cultured in parallel in control and chondrogenic medium for a maximum of six weeks. Relative expression of the genes, aggrecan, type I collagen and type II collagen present in the TMJ disc extracellular matrix increased in the ASC-seeded PLA discs in the chondrogenic medium. The hypertrophic marker, type X collagen, was moderately induced. Alcian blue staining showed accumulation of sulphated glycosaminoglycans. ASC differentiation in the PLA discs was close to that observed in pellet cultures. Comparison of the mRNA levels revealed that the degree of ASC differentiation was lower than that in TMJ disc-derived cells and tissue. The pellet format supported the phenotype of the TMJ disc-derived cells under chondrogenic conditions and also enhanced their hyalinization potential, which is considered part of the TMJ disc degeneration process. Accordingly, the combination of ASCs and PLA discs has potential for the development of a tissue-engineered TMJ disc replacement.
Maenpaa, Katja; Ella, Ville; Mauno, Jari; Kellomaki, Minna; Suuronen, Riitta; Ylikomi, Timo; Miettinen, Susanna
Background: Temporomandibular joint disorders (TMDs) are chronic, often refractory, pain conditions affecting the jaw and face. Patients least likely to respond to allopathic treatment have the most marked biologic responsiveness to external stressors and concomitant psychosocial and emotional difficulties. From a shamanic healing perspective, this describes individuals who are thought to be “dispirited” and may benefit from this ancient form of spiritual healing. Objective: To report on the long-term quantitative and qualitative outcomes relative to end-of-treatment status of a phase I study that evaluated the feasibility and efficacy of shamanic healing for people with TMDs. Methods/Design: Participants were contacted by telephone at one, three, six, and nine months after treatment and asked to report pain and disability outcomes and qualitative feedback. Setting: Portland, OR. Participants: Twenty-three women aged 25 to 55 years diagnosed with TMD. Primary Outcome Measures: Participants rated their TMD-related pain and disability (on the TMD Research Diagnostic Criteria Axis II Pain Related Disability and Psychological Status Scale) at each follow-up call and were asked to describe their condition qualitatively. Results: Improvements in usual pain, worst pain, and functional impairment reported at end of treatment did not change during the 9 months after treatment ended (p > 0.18). Conclusion: Shamanic healing had lasting effects on TMDs in this small cohort of women.
Vuckovic, Nancy H; Williams, Louise A; Schneider, Jennifer; Ramirez, Michelle; Gullion, Christina M
Background and aims Trauma is one of the major factors associated with temporomandibular joint disorders (TMD). These disorders result from macro-trauma or micro-trauma. Macro-trauma might be iatrogenic; for example, from intuba-tion procedures, third molar extraction procedures, and lengthy dental appointments. The aim of this study was to evaluate the effect of lengthy root canal therapy (more than 2 hours) on TMJ and its supporting structures. Materials and methods Eighty patients whose root canal therapy session lasted more than 2 hours were examined for the status of TMJ and masticatory muscles. After one week the second part of the examination was carried out for TMJ problems and pain and tenderness levels of masticatory muscles. Data was analyzed using Wilcoxon statistical test. Results Women showed more pain compared to men. There was a significant increase in pain in the external acoustic meatus examination one week after root canal therapy. Patients who were treated for their posterior teeth suffered more pain than those who were treated for the anteriors and premolars. Other aspects of the examination were not affected significantly by lengthy root canal therapy. Conclusion Lengthy dental treatments can harm TMJ and masticatory muscles and wide opening of the mouth during such appointments can worsen the situation. Therefore, it is wise to break the appointment into shorter intervals and let the patients rest during treatment to close their mouth to prevent iatrogenic damage to TMJ.
Sahebi, Safoora; Moazami, Fariborz; Afsa, Masoomeh; Nabavi Zade, Mohammad Reza
Objective To describe CT findings in dogs and cats with temporomandibular joint (TMJ) disorders. Design Retrospective case-series. Animals 41 dogs and 17 cats. Procedures Medical records and CT images of the skull were reviewed for dogs and cats that were examined at a dentistry and oral surgery specialty practice between 2006 and 2011. Results Of 142 dogs and 42 cats evaluated, 41 dogs and 17 cats had CT findings consistent with a TMJ disorder. In dogs, the most common TMJ disorder was osteoarthritis; however, in most cases, there were other TMJ disorders present in addition to osteoarthritis. Osteoarthritis was more frequently identified at the medial aspect rather than the lateral aspect of the TMJ, whereas the frequency of osteoarthritic involvement of the dorsal and ventral compartments did not differ significantly. In cats, fractures were the most common TMJ disorder, followed by osteoarthritis. Clinical signs were observed in all dogs and cats with TMJ fractures, dysplasia, ankylosis, luxation, and tumors; however, only 4 of 15 dogs and 2 of 4 cats with osteoarthritis alone had clinical signs. Conclusions and Clinical Relevance Results indicated that TMJ disorders are frequently present in combination. Osteoarthritis was the most common TMJ disorder in dogs and the second most common TMJ disorder in cats. Computed tomography should be considered as a tool for the diagnosis of TMJ disorders in dogs and cats with suspected orofacial disorders and pain.
Arzi, Boaz; Cissell, Derek D.; Verstraete, Frank J. M.; Kass, Philip H.; DuRaine, Grayson D.; Athanasiou, Kyriacos A.
This article presents a patient experiencing several years of pain associated with bilateral failed temporomandibular joint (TMJ) Proplast/Teflon fossa prostheses. Despite surgical removal of the prostheses and comprehensive conservative management, including typical pharmacotherapy approaches for chronic pain, pain was still not relieved, and management was revised to target a putative chronic inflammatory disorder. Methotrexate was prescribed because of its known efficacy for inflammation and pain reduction in rheumatoid arthritis. Titration of methotrexate dosage over 5 months to a weekly dose of 20 mg resulted in reduced pain intensity at rest, increased pain-free maximal jaw opening, and a reduction in the sensory component of the McGill Pain Questionnaire. Maximum assisted jaw opening remained the same, as did the palpation tenderness of both TMJs and of the masseter and temporalis muscles. Methotrexate pharmacotherapy may represent a viable option when conservative treatments have failed to provide significant pain relief in patients who have had Proplast/Teflon TMJ implants. PMID:25047933
Edwards, J Paul; Peterson, Erik J; Durham, Justin; Nixdorf, Donald R
Purpose The objective of this case report was to describe the effects that massage therapy had on a woman with temporomandibular joint dysfunction. Participant The 26-year-old woman’s primary symptoms were pain, decreased range of motion, clicking, and crepitus. These symptoms were reportedly associated with emotional stress and bruxism. Intervention Ten 45-minute massage therapy treatments were administered over a five-week period. The client’s progress was monitored by an initial, midway, and final assessment, using range of motion testing, personal interview, an orthopedic test, and postural analysis. Progress was also evaluated by the use of a daily journal. The client participated in a home care routine consisting of stretches, self-massage, postural training, a proprioception exercise, and hydrotherapy. Results Results include an increase in maximal opening from 3.1 cm to 3.8 cm, an overall increase in neck range of motion, a decrease in muscle hypertonicity using the Wendy Nickel’s Scale, a decrease in pain from 7/10 to 3/10 on a numerical pain scale, and a decline in stress. Conclusion Although the client in this report experienced positive results, more extensive studies are needed to understand the effects of massage on TMD.
Pierson, Melissa Joan
Current diagnostic imaging methods to evaluate internal derangement of the temporomandibular joint (TMJ) include arthrotomography, arthroscopy, computed tomography, and magnetic resonance imaging. Most of these techniques either require ionizing radiation or are invasive, and all are expensive. Electronic thermography (ET) is an alternative diagnostic imaging modality that is inexpensive, nonionizing, and noninvasive. The purpose of this pilot study was to assess ET in the diagnosis of internal derangements of the TMJ. The study population consisted of 11 patients with internal derangement, and 12 normal patients. ET was conducted with an infrared thermographic unit, at 1.0 degrees and 0.5 degrees C sensitivity. Results from subjective blinded interpretations by two experts for the diagnosis of internal derangement of the TMJ were as follows: sensitivity, 86% (+/- 7.8%); specificity, 78% (+/- 7.1%). Results from objective measurements of thermal symmetry of the TMJ region were as follows: normal subjects, 89.3% (+/- 3.0%); internal derangement patients, 66.1% (+/- 16.2%); t21 = -4.89, p less than 0.01. In conclusion, ET appears to have some promise as a diagnostic aid in the evaluation of internal derangement of the TMJ. Additional, more extensive studies are needed before thermographic diagnosis of internal derangement is accepted clinically. PMID:2011363
Gratt, B M; Sickles, E A; Ross, J B
Aims: The aim of the study was to evaluate the role of three-dimensional computed tomography (3D-CT) in the assessment of temporomandibular joint (TMJ) ankylosis and its importance in treatment planning. The objectives of study were to measure and assess the mediolateral extent of ankylosis mass in 3D-CT and to compare the extent with intraoperative assessment. The study was also aimed to measure the coronoid process elongation in 3D-CT and its significance in treatment planning. Materials and Methods: This prospective study included 3D-CT evaluation of 11 patients with TMJ ankylosis during the period of February 2006–October 2007. Results: The 3D-CT assessment provided the length of the coronoid process and the relation of vital structures including maxillary artery to the ankylosed mass. Measurement of ankylosed mass also aids in preoperative measurement of the graft required to reconstruct the defect following removal of the ankylosed mass. Conclusion: Our study concludes that 3D-CT is a useful tool in the diagnosis and treatment planning of TMJ ankylosis.
Kavin, Thangavelu; John, Reena; Venkataraman, Siva Subramaniyam
This article reports the orthodontic treatment of a patient with skeletal mandibular retrusion and an anterior open bite due to temporomandibular joint osteoarthritis (TMJ-OA) using miniscrew anchorage. A 46-year-old woman had a Class II malocclusion with a retropositioned mandible. Her overjet and overbite were 7.0 mm and -1.6 mm, respectively. She had limited mouth opening, TMJ sounds, and pain. Condylar resorption was observed in both TMJs. Her TMJ pain was reduced by splint therapy, and then orthodontic treatment was initiated. Titanium miniscrews were placed at the posterior maxilla to intrude the molars. After 2 years and 7 months of orthodontic treatment, an acceptable occlusion was achieved without any recurrence of TMJ symptoms. The retropositioned mandible was considerably improved, and the lips showed less tension upon lip closure. The maxillary molars were intruded by 1.5 mm, and the mandible was subsequently rotated counterclockwise. Magnetic resonance imaging of both condyles after treatment showed avascular necrosis-like structures. During a 2-year retention period, an acceptable occlusion was maintained without recurrence of the open bite. In conclusion, correction of open bite and clockwise-rotated mandible through molar intrusion using titanium miniscrews is effective for the management of TMJ-OA with jaw deformity.
Yamano, Eizo; Inubushi, Toshihiro; Kuroda, Shingo
Our aim was to explore the incidence of rupture after arthroscopic repositioning of the disc of the temporomandibular joint (TMJ) by reviewing magnetic resonance images (MRI) of the TMJ taken before and after operation, and to investigate correlations retrospectively. We studied 247 patients with anterior disc displacement of the TMJ, and categorised them into 3 groups based on the postoperative MRI. The first group comprised those whose disc ruptured after repositioning, the second those who had a possible rupture of the disc after repositioning, and the third had no rupture of the disc after repositioning. Age, sex, duration of symptoms, maximum incisal mouth opening, whether the anterior disc displacement was unilateral or bilateral, and the Wilkes stage, were included in the analysis. The incidence of rupture (5/247) was 2%. Weak points at the intermediate zone of the disc were found in 4 of the 5 joints. The patients whose discs ruptured were significantly younger than the other 2 groups (p=0.001). There was no statistically significant difference in preoperative duration of symptoms and mouth opening among the groups. The proportions of unilateral and bilateral disc displacement (p=0.047) and Wilkes stage (p=0.027) differed among the 3 groups. The Wilkes stages was significantly more advanced in the ruptured group than in the other 2 groups (p=0.027) with 4/5 being bilateral. The weak point in the intermediate zone of the disc on MRI could be a sign of rupture. Teenagers and young adults with anterior disc displacement without reduction, particularly those in whom it is bilateral, are at a higher risk of a rupture after repositioning of the disc by arthroscopy. PMID:24736122
Li, Hui; Cai, Xieyi; Yang, Chi; Wang, Shaoyi; Huang, Linjian
Background Glial cells have been shown to directly participate to the genesis and maintenance of chronic pain in both the sensory ganglia and the central nervous system (CNS). Indeed, glial cell activation has been reported in both the dorsal root ganglia and the spinal cord following injury or inflammation of the sciatic nerve, but no data are currently available in animal models of trigeminal sensitization. Therefore, in the present study, we evaluated glial cell activation in the trigeminal-spinal system following injection of the Complete Freund's Adjuvant (CFA) into the temporomandibular joint, which generates inflammatory pain and trigeminal hypersensitivity. Results CFA-injected animals showed ipsilateral mechanical allodynia and temporomandibular joint edema, accompanied in the trigeminal ganglion by a strong increase in the number of GFAP-positive satellite glial cells encircling neurons and by the activation of resident macrophages. Seventy-two hours after CFA injection, activated microglial cells were observed in the ipsilateral trigeminal subnucleus caudalis and in the cervical dorsal horn, with a significant up-regulation of Iba1 immunoreactivity, but no signs of reactive astrogliosis were detected in the same areas. Since the purinergic system has been implicated in the activation of microglial cells during neuropathic pain, we have also evaluated the expression of the microglial-specific P2Y12 receptor subtype. No upregulation of this receptor was detected following induction of TMJ inflammation, suggesting that any possible role of P2Y12 in this paradigm of inflammatory pain does not involve changes in receptor expression. Conclusions Our data indicate that specific glial cell populations become activated in both the trigeminal ganglia and the CNS following induction of temporomandibular joint inflammation, and suggest that they might represent innovative targets for controlling pain during trigeminal nerve sensitization.
Congenital infiltrating lipomatosis of the face (CIL-F) is a rare lipomatous lesion with diffuse fatty infiltration of tissues and hyperplasia of underlying bone. We report clinical and CT findings in an unusual case of CIL-F presenting with progressive hemifacial asymmetry, manifesting as severely restricted mouth opening owing to exophytic temporomandibular joint ankylosis. The role of imaging in diagnosis is presented with a review of the literature. Differential diagnosis of CIL-F and its exclusion as a cause of hemifacial hyperplasia are also discussed.
Sahai, S; Rajan, S; Singh, N; Arora, H
Chronic recurrent dislocation of the temporomandibular joint (TMJ) is rare and has many causes. Although it is possible to start treating it conservatively, these treatments are usually unsuccessful. Over the years, many operations have been done including operating on the muscles, the articular capsule, the articular meniscus, and the condyle. At present, the most widely accepted techniques are those used on the articular eminence. It may be reduced (eminectomy), favouring free movement of the condyles, or an obstacle may be interposed to prevent excessive movement of the condyles. These later techniques include Norman's (glenotemporal osteotomy with interpositional bone grafting). Other techniques include Dauterey's procedure, on which onlay bone grafts or bone substitutes are inserted in a subperiosteal pocket inferior to the articular eminences. We report a prospective study of 60 patients who had a bilaterally modified glenotemporal osteotomy, 40 who had chronic dislocations of the temporomandibular joints and the other 20 who had severe hypermobility of the joints. Bone grafts, iliac or calvarial, were inserted at the osteotomy between the zygomatic arch and the articular eminence, and fixed either by wires, mini-plates or microplates, and screws. Stable results were obtained and retained during long-term follow up of 1-8 years. PMID:17935842
Medra, A M; Mahrous, A M
Algo-dysfunctional syndrome (ADS) of the temporo-mandibular joint (TMJ) is frequently encountered and, since its clinical expression is extremely polymorphic, it is often misdiagnosed. As there are many causes for ADS, even in a single patient, in line with the most recent interpretations found in the literature, an attempt was made to determine how important the lack of muscular coordination is in the onset of clinical symptoms. The study was conducted on 48 patients (32 females, 16 males, age range 17-68 years, average age 41.7 years) with ADS, clinically diagnosed according to the criteria defined by Rendell et al. The patients belonged to three distinct groups: -Group 1: patients with ADS of articular origin (9 cases); -Group 2: patients with ADS of dental and/or periodontal origin (18 cases); -Group 3: patients with ADS for which there was no apparent cause (21 cases). All patients were treated with a rehabilitation protocol aimed at eliminating the muscle spasm and restoring correct coordination. The results obtained showed that conservative treatment to resolve the muscle spasm gave positive results in 69% of the cases. The patients with concomitant articular pathology proved the least responsive to treatment. It was, therefore, considered likely that the main cause for clinical expression of this pathology is the muscle spasm itself. On this basis it can be concluded that muscular rehabilitation of the TMJ is valid in the treatment of ADS as it has proved able to break the vicious cycle of symptoms at the base of this pathology. PMID:9844222
de Filippis, C; Osti, L; Osti, R; Marioni, G; Pedace, E
Clinical presentation of temporomandibular joint (TMJ) disorders are more common in women and changes in the female hormone estrogen affect the level of swelling, pro-inflammatory cytokine release and pain in animal models of TMJ arthritis. Estrogen also modulates the expression of the CD16 receptor in vitro. This alters pro-inflammatory cytokine release in monocytes/macrophages when auto-antigens and arthritic factors bind the CD16 receptor. This study investigated the effects of various levels of estrogen on the intensity of inflammation and CD16 expression in a TMJ arthritic animal model. The experiments included rats that were intact or ovariectomized (OVX), eliminating the major source of estrogen output. A portion of the OVX animals had estrogen replaced with 17-beta estradiol (E2) using Alzet pumps. In OVX animals E2 levels were administered for 10 days to create an artificial estrus cycle or to simulate pregnancy. Following E2 treatment the rats were given an intra-articular TMJ injection of saline or complete Freund's adjuvant (CFA). CFA injection significantly increased TMJ swelling, stress induced chromodacryorrhea and attenuated food intake, thus indicating the adjuvant induced TMJ pain/inflammation. Removing endogenous E2 through OVX reduced CFA induced TMJ inflammation, whereas CFA increased the number of TMJ monocytes expressing the CD14 receptor equally in all groups irrespective of plasma E2 levels. Paradoxically, higher levels of E2 reduced the number of TNF-alpha positive, CD16+ and double labeled CD14+/CD16+ cells. The findings indicate that reduced plasma E2 levels attenuated CFA induced TMJ inflammation, whereas increasing E2 levels enhanced TMJ swelling in a dose dependent manner. Estrogenic group differences in CFA induced swelling were independent of TMJ CD14+, CD14+/CD16+ or CD16+ cell numbers suggesting E2 action on the CFA immune response primarily excluded CD16 receptor action. PMID:16153820
Guan, Guoqiang; Kerins, Carolyn C; Bellinger, Larry L; Kramer, Phillip R
Analyzing feeding behavior, and in particular meal duration, can be used as a biological marker for temporomandibular joint (TMJ) inflammation/pain. The present study determined the specificity of meal duration as a measure of TMJ inflammation/pain in a rodent model. The model was also used to test the efficacy of dexamethasone (DEX) as a treatment for TMJ inflammation/pain that was induced by TMJ injection of complete Freund's adjuvant (CFA). In the first study, anesthetized male Sprague-Dawley rats housed in computerized feeding modules received bilateral intra-articular knee injections of CFA or saline. The next day, CFA-injected rats had significant knee swelling and impaired mobility. Food intake in the CFA-injected group was reduced over the next two days and this was due to reduced meal number with no change in meal size. Notably, meal duration was normal in both the CFA and saline knee-injected groups. In the second study, male rats were assigned to one of four groups: Group 1, no CFA and no DEX treatment; Group 2, no CFA and treatment with DEX (0.4 mg/kg i.m. once daily); Group 3, bilateral TMJ CFA injection and no DEX treatment; and Group 4, bilateral TMJ CFA injection and treatment with DEX. CFA significantly increased TMJ swelling and stress-induced chromodacryorrhea in Group 3, but treatment with DEX attenuated these effects in Group 4. Compared to the controls, meal duration was significantly lengthened 24 and 48 h post-CFA injection in Group 3, whereas DEX treatment attenuated TMJ swelling, chromodacryorrhea and normalized meal duration. The data demonstrate that meal pattern analysis, and in particular meal duration, can be used as a non-invasive specific measure of TMJ inflammation/pain and can be used as a marker of DEX treatment efficacy. PMID:16053854
Kerins, C A; Carlson, D S; Hinton, R J; Hutchins, B; Grogan, D M; Marr, K; Kramer, P R; Spears, R D; Bellinger, L L
Establishing a valid animal model to study temporomandibular joint (TMJ) pain has proven extremely difficult. Using complete Freund's adjuvant (CFA) to induce TMJ inflammation, we recently showed that meal pattern analysis could be used as a noninvasive biological marker to study TMJ pain in an animal model. The purpose of this study was to further validate our animal model by determining whether aspects of CFA-induced TMJ inflammation/pain are reversed with ibuprofen (IBU) treatment. In the first trial, 48 male rats were used and in the second trial, 32 female ovariectomized rats, given 17beta-estradiol replacement, were used. The rats were assigned to one of four groups: control (CON-CON); control+IBU (CON+IBU); CFA-CON; and CFA+IBU. In the male trial, CFA injection (P<.01) caused TMJ swelling and chromodacryorrhea (CFA-CON); IBU eliminated these changes in the CFA+IBU group. Meal pattern analysis showed the pertinent CFA-induced change and the IBU effect was that meal duration was increased in the CFA-CON group (P<.01), but normal in the CFA+IBU-treated group on the first, but not second, day postinjection. In the female trial, CFA increased TMJ swelling, but did not cause significant chromodacryorrhea (CFA-CON); IBU eliminated swelling in the CFA+IBU group. Meal duration was increased (P<.01) in the CFA-CON group, but was normal in the CFA+IBU-treated group on both the first and second days postinjection. In both trials, interleukin-1beta (IL-1beta) levels were increased similarly in CFA-CON and CFA+IBU groups (P<.01). This study shows that CFA-induced TMJ inflammation/pain can cause changes in meal patterns (i.e., meal duration), which may be used as a behavioral marker for TMJ inflammation/pain. PMID:12759126
Kerins, C A; Carlson, D S; McIntosh, J E; Bellinger, L L
Objective Dietary loading has been reported to have an effect on temporomandibular joint (TMJ) remodeling via periodontal-muscular reflex. We therefore examined whether reducing dietary loading decreased TMJ degradation induced by the unilateral anterior crossbite prosthesis as we recently reported. Methods Forty 6-week-old female C57BL/6J mice were randomly divided into two experimental and two control groups. One experimental and one control group received small-size diet and the other two groups received large-size diet. Unilateral anterior crossbite prosthesis was created in the two experimental groups. The TMJ samples were collected 3 weeks after experimental operation. Histological changes in condylar cartilage and subchondral bone were assessed by Hematoxylin & Eosin, toluidine blue, Safranin O and tartrate-resistant acid phosphatase staining. Real-time polymerase chain reaction (PCR) and/or immunohistochemistry were performed to evaluate the expression levels of Collagen II, Aggrecan, a disintegrin and metalloproteinase with thrombospondin motifs 5 (ADAMTS-5) and RANKL/RANK/OPG in TMJ condylar cartilage and/or subchondral bone. Results Thinner and degraded cartilage, reduced cartilage cellular density, decreased expression levels of Collagen II and Aggrecan, loss of subchondral bone and enhanced osteoclast activity were observed in TMJs of both experimental groups. However, the cartilage degradation phenotype was less severe and cartilage ADAMTS-5 mRNA was lower while OPG/RANKL ratio in cartilage and subchondral bone was higher in the small-size than large-size diet experimental group. No differences of histomorphology and the tested molecules were found between the two control groups. Conclusions The current findings suggest that a lower level of functional loading by providing small-size diet could reduce TMJ degradation induced by the biomechanical stimulation from abnormal occlusion.
Liu, Y.-D.; Liao, L.-F.; Zhang, H.-Y.; Lu, L.; Jiao, K.; Zhang, M.; Zhang, J.; He, J.-J.; Wu, Y.-P.; Chen, D.; Wang, M.-Q.
Our objective was to compare the accuracy and practicality in use of three available imaging receptors for temporomandibular joint (TMJ) imaging; namely, two computer-assisted and one traditional analog x-ray film system. A standardized tissue-equivalent encased human skull specimen was imaged using lateral and posteroanterior (PA) pantomographic projections with the Orthopantomograph OP 100 (Instrumentarium Imaging, Tuusula, Finland) and three different receptor modalities: (1) Ektavision film with Ektavision screens (Eastman Kodak, Rochester, NY); (2) DenOptix photostimulable phosphor screens (Dentsply/Gendex, Chicago, IL); and (3) the charge-coupled device (CCD) receptor, DigiPan (TREX/Trophy Radiology, Marne-la-Vallée, France). The effective focal trough was found for each receptor using lead resolution grids placed at fractional millimeter distances along empirically determined beam projection angulations. The time to acquire and process images was also established. We found that the CCD system permitted real-time display, whereas the use of traditional film took 2 minutes to load the cassette in a darkroom and perform the exposure, and then a further 2 minutes to unload and process. The storage phosphor took 3 minutes to unload the cassette and process the image and a further 20 seconds to clear the plate following laser scanning. Film produced the greatest maximum resolution followed by the storage phosphor and the CCD. In conclusion, CCD-based TMJ pantomography provided an instant image. The photostimulable phosphor system used was the least satisfactory in terms of the time expended to obtain an image, but provided better spatial resolution than the CCD. Ektavision film/screens provided the best spatial resolution in this investigation. PMID:10342155
Farman, T T; Farman, A G
Purpose This study was performed to determine the prevalence of bifid mandibular condyles (BMCs) in asymptomatic and symptomatic temporomandibular joint (TMJ) subjects with no traumatic history, and to assess their impact on clinical and radiographic manifestations of TMJ. Materials and Methods A total of 3,046 asymptomatic and 4,378 symptomatic patients were included in the study. Cone-beam computed tomography (CBCT) images were reviewed for bifid condyles. T-tests were used to compare the frequency of BMCs when stratified by symptom, gender, and side. In BMC patients, the clinical features of pain and noise, osseous changes, and parasagittal positioning of the condyles were compared between the normally shaped condyle side and the BMC side using chi-squared tests. Results Fifteen (0.49%) asymptomatic and 22 (0.50%) symptomatic patients were found to have BMCs. Among the bilateral cases, the number of condyles were 19 (0.31%) and 25 (0.29%), respectively. No statistically significant differences were found between asymptomatic and symptomatic patients, between female and male patients, or between the right and left sides (p>0.05). Compared with the normally shaped condyle side, the BMC side showed no statistically significant differences in the distribution of pain and noise, parasagittal condylar position, or condylar osseous changes, with the exception of osteophytes. In the symptomatic group, osteophytes were found more frequently on the normally shaped condyle side than the BMC side (p<0.05). Conclusion BMCs tended to be identified as an incidental finding. The presence of BMC would not lead to any TMJ symptoms or cause osseous changes.
Patients with juvenile idiopathic arthritis (JIA) can have alterations in bone metabolism and skeletal growth, as well as damage to the temporomandibular joint (TMJ), which can generate extra and/or intraoral alterations, resulting in craniofacial disorders. Our goal is to carry out a review of the literature on orofacial alterations in patients with JIA. Among the orofacial disorders in patients with JIA, alterations in mandibular growth, caused by dysfunctions in the TMJ region, seem highly prevalent in these patients. The most often found alterations are: retrognathia, micrognathia, anterior open bite, dental crowding, facial asymmetry and mouth opening limitation. Thus, the rheumatologist becomes a key agent in the early detection of these disorders, helping with patient referral to a dentist. The diagnosis, in turn, should be performed by the orthodontist, using clinical examination and imaging methods, allowing early treatment and a favorable prognosis. TMJ disorders should be treated by a multidisciplinary team, including pharmacological treatment for pain control and dental care through functional appliance and/or orthodontic therapy, physical therapy and sometimes, speech therapy. We conclude that among the orofacial disorders in patients with JIA, alterations in mandibular growth generated by dysfunctions in the TMJ region seem highly prevalent. Such dysfunctions can cause mainly open bite, mandibular retrusion, micrognathia, dental crowding and facial asymmetry. The rheumatologist can detect these alterations at an early stage, with immediate patient referral to a team that should preferably be a multidisciplinary one, consisting of an orthodontist, physical therapist and speech therapist, to reduce future occlusal and mandibular growth complications. PMID:23223701
Carvalho, Renata Teixeira de; Braga, Flávia Silva Farah Ferreira; Brito, Fernanda; Capelli Junior, Jonas; Figueredo, Carlos Marcelo; Sztajnbok, Flávio Roberto
The choice of approach for diagnosing temporomandibular joint (TMJ) anterior disc displacement with reduction (ADDR), viz. functional examination or TMJ imaging, is debatable and complicated by findings of low agreement between these approaches. Our aim was to investigate the validity of functional ADDR diagnostics using clinical examination and opto-electronic mandibular movement recordings versus magnetic resonance imaging (MRI). 53 participants (32 women and 21 men, mean age ± s.d. of 28.7 ± 10.1 years) underwent a clinical examination, mandibular movement recording and MRI of their TMJs within 1 month. All were performed and analysed in a single-blind design by different experienced examiners for each technique. The sensitivity and specificity of each functional diagnostic method was calculated, with MRI as the gold standard. Anterior disc displacement with reduction was diagnosed in 27.6% of the TMJs clinically, in 15.2% using the movement recordings and in 44.8% on MRI. The specificity of the clinical examination for diagnosing ADDR was 81.0%, and of the movement recordings, 96.6%. The sensitivity was 38.3% and 29.8%, respectively. The chance of having a false-positive functional diagnosis of ADDR compared with MRI is low, and disagreement between the functional methods and MRI is mainly due to the high number of MRI diagnoses in asymptomatic subjects. In view of the fact that ADDR becomes clinically relevant only when it interferes with TMJ function, the functional diagnostic approach can be considered benchmark in ADDR recognition. PMID:24533784
Marpaung, C M; Kalaykova, S I; Lobbezoo, F; Naeije, M
Accurate measurement and analysis of 3D kinematics of temporomandibular joint (TMJ) is very important for assisting clinical diagnosis and treatment of prosthodontics and orthodontics, and oral surgery. This study presents a new 3D kinematic measurement technique of the TMJ using X-ray fluoroscopic images, which can easily obtain the TMJ kinematic data in natural motion. In vivo kinematics of the TMJ (maxilla and mandibular bone) is determined using a feature-based 2D/3D registration, which uses beads silhouette on fluoroscopic images and 3D surface bone models with beads. The 3D surface models of maxilla and mandibular bone with beads were created from CT scans data of the subject using the mouthpiece with the seven strategically placed beads. In order to validate the accuracy of pose estimation for the maxilla and mandibular bone, computer simulation test was performed using five patterns of synthetic tantalum beads silhouette images. In the clinical applications, dynamic movement during jaw opening and closing was conducted, and the relative pose of the mandibular bone with respect to the maxilla bone was determined. The results of computer simulation test showed that the root mean square errors were sufficiently smaller than 1.0 mm and 1.0 degree. In the results of clinical application, during jaw opening from 0.0 to 36.8 degree of rotation, mandibular condyle exhibited 19.8 mm of anterior sliding relative to maxillary articular fossa, and these measurement values were clinically similar to the previous reports. Consequently, present technique was thought to be suitable for the 3D TMJ kinematic analysis.
Yamazaki, Takaharu; Matsumoto, Akiko; Sugamoto, Kazuomi; Matsumoto, Ken; Kakimoto, Naoya; Yura, Yoshiaki
Low-level laser therapy (LLLT) has been commonly used for the treatment of painful musculoskeletal conditions, but the results of previous studies on this subject are controversial. The aim of this study was to evaluate the efficacy of LLLT in the management of patients with myogenic temporomandibular joint disorders (TMDs). In this randomized, double-blind clinical trial, 20 patients with myogenic TMD were randomly divided into laser and placebo groups. In the laser group, a pulsed 810-nm low-level laser (average power 50 mW, peak power 80 W, 1,500 Hz, 120 s, 6 J, and 3.4 J/cm(2) per point) was used on painful muscles three times a week for 4 weeks. In the placebo group, the treatment was the same as that in the laser group, but without energy output. The patients were evaluated before laser therapy (T1), after six sessions of laser application (T2), at the end of treatment (T3), and 1 month after the last application (T4), and the level of pain and the amount of mouth opening were measured. There was a significant increase in mouth opening and a significant reduction of pain symptoms in the laser group (p?0.05). A similar improvement was not observed in the placebo group (p?>?0.05). Between-group comparisons revealed no significant difference in pain intensity and mouth opening measurement at any of the evaluation time points (p?>?0.05). LLLT can produce a significant improvement in pain level and mouth opening in patients affected with myogenic TMD. PMID:23318917
Ahrari, Farzaneh; Madani, Azam S; Ghafouri, Zahra S; Tunér, Jan
The aim was to describe the appearance of the calcified cartilage zone (CCZ) and to determine its dimensional relationship to the articular cartilage thickness in the normal human temporomandibular joint. An autopsy material comprising 21 joints from 12 elderly individuals was examined microscopically. The appearance of the CCZ was examined, and the thickness of the CCZ and of the total articular cartilage was measured in 18 different positions in each joint. The CCZ was outlined by a flat or gently undulating tidemark and an irregular osteochondral junction. The cellularity of the CCZ varied extensively. The cells were numerous in the CCZ when the overlying articular cartilage displayed high cellularity. Statistical analysis of the measurements demonstrated a relationship (p < 0.001) between the thickness of the CCZ and of the articular cartilage. Our findings, both qualitative and quantitative, indicate a close relationship between the physiology of the CCZ and of the overlying articular cartilage. PMID:8342409
Flygare, L; Klinge, B; Rohlin, M; Akerman, S; Lanke, J
Background Temporomandibular joint (TMJ) involvement occurs in up to 80% of patients with juvenile idiopathic arthritis (JIA). Currently there are no standardized procedures regarding diagnosis and treatment of this common complication of JIA. The aim of the study was to assess the current clinical practices in many countries regarding diagnosis and treatment of TMJ involvement in JIA. Pediatric rheumatologists were asked to fill out a survey with 8 items regarding diagnosis and treatment of TMJ involvement. The survey was distributed over the worldwide pediatric rheumatology electronic list-serve. Data was collected in an Excel spread sheet and analyzed using Excel software. Findings Eighty-seven centers responded to the survey between December 2009 and April 2010. All responding centers were actively screening for TMJ involvement. All centers were screening by physical exam, 85 (97%) by history, and 2 (3%) by imaging. Seventy-seven (88%) centers were screening at the first visit and 76 (87%) at each follow-up visit. If imaging was requested, 77% of the centers reported that they asked for MRI, 10% for ultrasound, 9% for CT and 33% for X-ray. The first line treatment of TMJ arthritis was a non-biologic DMARD in 36%, an NSAID in 33%, an intraarticular corticosteroid injection in 26%, and an anti-TNF agent in 5%. Overall, 57 (65%) of the centers were using intraarticular corticosteroid injections as treatment. Conclusions TMJ arthritis is common among children with JIA. This survey shows that a wide array of diagnostic and therapeutic approaches is being employed for TMJ disease in 87 international centers. Due to this lack of agreement in how to diagnose and treat this JIA complication, we believe that an expert opinion/consensus statement regarding TMJ arthritis in JIA will likely benefit patients worldwide.
The role of nuclear medicine in the diagnosis and management of the major arthropathies is critically reviewed, with particular reference to osteoarthritis, rheumatoid and similar forms of arthritis, ankylosing spondylitis, non-specific back pain, gout, the neuropathic joint, avascular necrosis, infection and the consequences of prosthetic joint insertion. Attention is drawn both to practical applications and deficiencies in current techniques and
M. V. Merrick
Objectives: The main purpose of this study was to determine the prognosis and outcomes of the patients with bilateral temporomandibular disorder which underwent bilateral temporomandibular joint surgery in a consecutive number of patients in a retrospective study. Study Design: Sixty five patients with 130 bilateral TMJ were included the study with the selection from consecutive 256 TMJ patients who were treated with open surgery who do not respond to conservative treatment. 65 patients were divided in to 3 main groups according to the clinical diagnosis of bilateral TMJ site. In the first group comprised 29 patients with 48 TMJ, the clinical diagnosis was bilaterally presence of anterior disc displacement with reduction (ADDR). In the second group comprised 19 patients with 26 TMJ, bilateral presence of TMD consisted of anterior disc displacement without reduction (ADDNR) on both site. In the third group comprised 27 patients with 46 TMJ, bilaterally presence of TMD consist of ADDR on one site and ADDNR on another site. The patients in three different groups were operated either high condylectomy alone or high condylectomy with additional surgical procedures. Results: In the evaluation of pain relief, clicking, crepitation, headache, marked improvement was determined in all groups, but it was statistically insignificant in the comparison of 3 groups. Slight increase in maximal mouth opening was determined in the mean values of the 3 groups and also in the comparison of 3 groups it was not statistically significant. Conclusions: These similar succesfull outcomes of bilateral TMD with the respect of TMJ surgical procedures were obtained in 3 main groups although different diagnosis on the patients’ groups waspresent. Key words:Temporomandibular joint, prognosis, retrospective studies.
Pernu, Hannu; Oikarinen, Kyosti; Raustia, Aune
Objectives: We sought to study the long-term outcome of juvenile chronic arthritis (JCA) in the temporomandibular joint (TMJ). Study Design: Temporomandibular disorders, including TMJ involvement, were assessed in 42 women with pauciarticular or polyarticular JCA—on average 25.8 years from disease onset—and compared with those found in matched control subjects. Disease-related parameters associated with temporomandibular disorders were identified. Results: The TMJ
Merete Bakke; Marek Zak; Birgit Leth Jensen; Freddy Karup Pedersen; Sven Kreiborg
Varieties of injuries have been reported as a result of the deployment of the airbag/s following road traffic accidents. The purpose of this case-report is to present a physiotherapist's perspective of a patient who was diagnosed as having temporomandibular pain and dysfunction following the deployment of the airbag on the face and its implications for the dental profession. The patient was assessed using a modified Maitland assessment procedure to establish the diagnosis and the treatment consisted of Maitland mobilisation techniques, pulsed short wave diathermy and ultrasound as and when indicated directed to the upper cervical spine. The outcome of this case-report suggests that the temporomandibular symptoms presented by this patient were of cervical origin. Therefore, it is suggested that the cervical spine should be routinely examined in patients presenting with temporomandibular pain and dysfunction following trauma and early referral to physiotherapy may facilitate early recovery. PMID:15311239
Mohammad Ali, H
Background: This study evaluated the prevalence of the signs and symptoms of temporomandibular joint disorder (TMD) among patients with TMD symptoms. Methods: Between September 2011 and December 2011, 243 consecutive patients (171 females, 72 males, mean age 41 years) who were referred to the Department of Prosthodontics, Faculty of Dentistry, Karadeniz Technical University, Trabzon were examined physically and completed a questionnaire regarding age, gender, social status, general health, antidepressant drug usage, dental status, limited mouth opening, temporomandibular joint (TMJ) sounds, and parafunctions (bruxism, clenching). The data were analyzed using the chi-square test and binary logistic regression model (alpha = 0.05). Results: With a frequency of 92%, pain in the temporal muscle was the most common symptom, followed by pain during mouth opening (89%) in both genders. TMJ pain at rest, pain in the masseter muscle, clicking, grinding, and anti-depressant use were significantly more frequent in females than males. Age (p=0.006; odds ratio 0.954; 95% CI 0.922-0.987) and missing teeth (p=0.003; odds ratio 3.753; 95% CI 1.589-8.863) had significant effects on the prevalence of TMD. Conclusion: Females had TMD signs and symptoms more frequently than males in the study population. The most common problem in both genders was pain.
Bagis, Bora; Ayaz, Elif Aydogan; Turgut, Sedanur; Durkan, Rukiye; Ozcan, Mutlu
Objective: To analyze the steps used in evaluation of sports- related temporomandibular dysfunctions and make recommendation for treatment and referral based upon the evaluation findings. Data Sources: This review searched Cinahl (1982 to 1995) and Medline (1986 to 1995). Key words searched included “sports related temporomandibular dysfunction,” “temporomandibular dysfunction,” and “temporomandibular joint.” Data Synthesis: This paper provides an introduction to the anatomy and biomechanics of the temporomandibular joint (TMJ) as well as causes of temporomandibular disorders in athletes. An analysis of the evaluative steps used for the temporomandibular joint is also given. Findings that suggest specific temporomandibular dysfunctions are discussed. Conclusions/Recommendations: Recommendations about when dental consultation is most appropriate or if conservative treatment is indicated are included. Hopefully, this will provide the sports medicine practitioner with a better understanding of the joint and its dysfunctions, as well as eliminate some unnecessary and costly dental referrals for our athletes. ImagesFig 2.Fig 3.Fig 4.
Sailors, Matthew E.
Anxiolytic agents, mainly benzodiazepines, have been used to treat symptomatic disorders of the temporomandibular joint (TMJ). Our aim was to evaluate the effect of diazepam on the TMJ of rats with increased occlusal vertical dimension (iOVD). Forty male rats were randomly assigned to 4 groups: control rats were given sham iOVD plus saline solution daily for 7 days. The first experimental group was given sham iOVD plus diazepam 2.5mg/kg/intramuscularly daily for 7 days (diazepam alone group); the second had iOVD induced in molars for 7 days plus saline daily for 7 days (iOVD alone group); and the third had iOVD induced in molars for 7 days plus diazepam 2.5mg/kg/intramuscularly daily for 7 days (iOVD plus diazepam group). At the end of each experiment the animals were killed and their bilateral TMJs were removed, randomly stained with haematoxylin and eosin and sirius-red, and immunoassayed. The thickness of condylar cartilage and of fibrous, proliferating, mature, and hypertrophic layers, number of collagen fibres, and the articular area were measured. Proinflammatory cytokines (interleukin (IL)-1?, IL-1?, IL-6, and tumour necrosis factor (TNF)-?) were also measured. ANOVA and Tukey's tests or the Kruskal-Wallis test were used to compare data among groups (?=5%). Condylar cartilage was thicker in the control group than in the other groups, the diazepam alone group being thicker than the other 2 experimental groups. There were fewer collagen fibres in the 2 groups given diazepam than in the other 2 groups, and there were no significant differences in the area of cartilage among groups. The controls had lower concentrations of all cytokines (p<0.05) than the 3 experimental groups, except for IL-6. Both iOVD groups had higher concentrations of IL-1?, IL-1?, and IL-6 than the diazepam alone group. Diazepam alone was associated with increased concentrations of all cytokines except IL-6. We conclude that both iOVD and diazepam induced significant changes in rats' articular cartilage. PMID:24629451
Figueroba, S R; Desjardins, M P; Nani, B D; Ferreira, L E N; Rossi, A C; Santos, F A; Venâncio, P C; Aguiar, F H B; Groppo, F C
The purpose of this study was to evaluate changes in stress on the temporomandibular joint (TMJ) in 80 Japanese subjects (21 males and 59 females, mean age 23.7 years) with mandibular prognathism, with and without asymmetry after orthognathic surgery using the rigid bodies spring model (RBSM). The asymmetric group consisted of 40 subjects whose Mx-Md midline was more than 3 degrees. The remaining 40 subjects formed the symmetric group. The geometry of the stress analysis model was based on frontal cephalograms of the subjects. Menton (Me), the centre point of occlusal force on a line connecting the bilateral buccal cusps of the second molars, and the most lateral, superior, and medial points on the condyle were plotted on a computer display and stress on the condyle was calculated with the two-dimensional RBSM program, Fortran. The degree (force partition) of the resultant force, the direction (angulation), and the displacement (X, Y) of each condyle were calculated and the horizontal displacement (u), the vertical displacement (v), and rotation displacement (theta) of the mandibular body at Me were calculated pre- and post-operatively. The data was analysed using paired and unpaired t-tests. For the vertical (v) and rotational (theta) displacement, the post-operative value was smaller than the pre-operative value (v: P < 0.001, theta: P = 0.0063) in the asymmetric group. For angulation and the X-component, the post-operative value was smaller than that pre-operatively on the deviated (angulation: P = 0.0074, X-component: P = 0.0003) and non-deviated (angulation: P = 0.0024, X-component: P = 0.001) side in the asymmetric group. However, there was no significant difference between the pre- and post-operative value for any parameter in the symmetric group. These findings suggest that surgical correction of mandibular prognathism, with and without asymmetry, could induce an improvement in stress balance on the TMJ in the frontal aspect. PMID:20798211
Ueki, Koichiro; Nakagawa, Kiyomasa; Marukawa, Kohei; Yamamoto, Etsuhide; Takeuchi, Norio
Background Hydrogen sulfide (H2S), an endogenous gaseotransmitter/modulator, is becoming appreciated that it may be involved in a wide variety of processes including inflammation and nociception. However, the role for H2S in nociceptive processing in trigeminal ganglion (TG) neuron remains unknown. The aim of this study was designed to investigate whether endogenous H2S synthesizing enzyme cystathionine-?-synthetase (CBS) plays a role in inflammatory pain in temporomandibular joint (TMJ). Methods TMJ inflammatory pain was induced by injection of complete Freund’s adjuvant (CFA) into TMJ of adult male rats. Von Frey filaments were used to examine pain behavioral responses in rats following injection of CFA or normal saline (NS). Whole cell patch clamp recordings were employed on acutely isolated TG neurons from rats 2 days after CFA injection. Western blot analysis was carried out to measure protein expression in TGs. Results Injection of CFA into TMJ produced a time dependent hyperalgesia as evidenced by reduced escape threshold in rats responding to VFF stimulation. The reduced escape threshold was partially reversed by injection of O-(Carboxymethyl) hydroxylamine hemihydrochloride (AOAA), an inhibitor for CBS, in a dose-dependent manner. CFA injection led to a marked upregulation of CBS expression when compared with age-matched controls. CFA injection enhanced neuronal excitability as evidenced by depolarization of resting membrane potentials, reduction in rheobase, and an increase in number of action potentials evoked by 2 and 3 times rheobase current stimulation and by a ramp current stimulation of TG neurons innervating the TMJ area. CFA injection also led to a reduction of IK but not IA current density of TG neurons. Application of AOAA in TMJ area reduced the production of H2S in TGs and reversed the enhanced neural hyperexcitability and increased the IK currents of TG neurons. Conclusion These data together with our previous report indicate that endogenous H2S generating enzyme CBS plays an important role in TMJ inflammation, which is likely mediated by inhibition of IK currents, thus identifying a specific molecular mechanism underlying pain and sensitization in TMJ inflammation.
A case of burn injury to lips and cheek mucosa is reported who developed severe contracture of cheek mucosa leading to inability to open mouth. Patient was misdiagnosed as a case of temporomandibular ankylosis and was managed on those lines to no relief. When the contracture was released and soft tissue defect repaired with nasolabial flap, patient gained near normal mouth opening. PMID:16499819
Cheema, Saeed Ashraf; Amin, Farhat
A cow, presented after being struck by a motor vehicle, continued to have difficulty eating after mandibular fracture repair. Imaging showed a temporomandibular luxation and a mandibular condylectomy was performed. Mastication improved greatly but the cow was euthanized due to infection. This is the first report of mandibular condylectomy in cattle. PMID:24891643
Sparks, Holly D; Roquet, Imma; MacKay, Angela; Barber, Spencer
Temporomandibular joint (TMJ) disorders are divided by the American Academy of Orofacial Pain into five categories. The most common ones are joint pain, as arthralgia and joint disorders, as disc displacements. An important clinical presentation of arthralgia is the painful tenderness to manual palpation or decreased pressure pain threshold (PPT). The authors conducted a study to determine the appropriate PPT value to discriminate asymptomatic TMJ individuals from those with moderate to severe arthralgia. Forty-nine individuals was evaluated and divided into groups: TMJ arthralgia, asymptomatic disc displacement and control group. Magnetic resonance images were obtained for all the groups, and algometry was performed on the TMJ lateral pole. Patients with arthralgia filled out a visual analogue scale (VAS). anova test with 1% of significance analysed the data. Specificity, sensitivity and ROC curve were also determined. Arthralgia group had significant lower PPT (mean of 1·07 kgf cm(-2) ) than the others. Asymptomatic disc displacement group (mean of 1·64 kgf cm(-2) ) has shown significant lower PPT than the control (mean of 2·35 kgf cm(-2) ). 89·66% of specificity and 70% of sensitivity were obtained when 1·36 kgf cm(-2) was applied to the TMJ (ROC area = 0·90). This value was considered to be the most appropriate to detected moderate to severe TMJ arthralgia. Indeed, the presence of disc displacement seems to significantly decrease PPT levels in asymptomatic subjects. The PPT value of 1·36 kgf cm(-2) can be used in the calibration procedures of the professionals involved with temporomandibular disorders and orofacial pain. PMID:24612404
Cunha, C O; Pinto-Fiamengui, L M S; Castro, A C P C; Lauris, J R P; Conti, P C R
Discoidin domain receptor 1 (DDR-1)-deficient mice exhibited a high incidence of osteoarthritis (OA) in the temporomandibular joint (TMJ) as early as 9 weeks of age. They showed typical histological signs of OA, including surface fissures, loss of proteoglycans, chondrocyte cluster formation, collagen type I upregulation, and atypical collagen fibril arrangements. Chondrocytes isolated from the TMJs of DDR-1-deficient mice maintained their osteoarthritic characteristics when placed in culture. They expressed high levels of runx-2 and collagen type I, as well as low levels of sox-9 and aggrecan. The expression of DDR-2, a key factor in OA, was increased. DDR-1-deficient chondrocytes from the TMJ were positively influenced towards chondrogenesis by a three-dimensional matrix combined with a runx-2 knockdown or stimulation with extracellular matrix components, such as nidogen-2. Therefore, the DDR-1 knock-out mouse can serve as a novel model for temporomandibular disorders, such as OA of the TMJ, and will help to develop new treatment options, particularly those involving tissue regeneration. PMID:23912900
Schminke, Boris; Muhammad, Hayat; Bode, Christa; Sadowski, Boguslawa; Gerter, Regina; Gersdorff, Nikolaus; Bürgers, Ralf; Monsonego-Ornan, Efrat; Rosen, Vicki; Miosge, Nicolai
The authors report the results of cephalographic studies in 65 cases of temporo-mandibular algo-dysfunctional syndromes. Cephalometric analysis according to the method described by Delaire allows specific cranio-facial morphotypic criteria to be defined. These results warrant presentation since they are frequently encountered but do not constitute a pathognomonic presentation. Statistical analysis of dento-maxillo-facial orthopedic abnormalities underlines their very frequent occurrence. The indications for maxillo-facial orthopedic surgery should therefore be widened. PMID:2130435
Blanchard, P; Scheffer, P; Lerondeau, J C; Nurit, Y
Healthy articular cartilage is thought to be maintained by the modulation of Cbfa1 expression, although little is currently known about Cbfa1 expression in such tissues. Therefore, we examined in vivo Cbfa1 transcript levels in the temporomandibular (TM) and knee joints of 3- and 10-week-old male ICR mice (weighing 50-70 g). A digoxigenin-11-UTP-labeled single-stranded RNA probe (0.6 kbp PstI-HindIII fragment of the 3' of untranslated region in exon 8 of mouse Cbfa1 cDNA) was prepared and in situ hybridization was performed on paraffin-embedded TM and knee joint sections. The antisense probe detected Cbfa1 transcripts in prehypertrophic chondrocytes, but not in the articular surface layer chondrocytes of 3- and 10-week-old mice TMJs. Despite the intense Cbfa1 expression in prehypertrophic chondrocytes, articular surface layer chondrocytes of the knee joints expressed low and undetectable level of Cbfa1 in the 3- and 10-week-old mice, respectively. These results indicate that Cbfa1 are highly expressed in the prehypertrophic chondrocytes presumably for articular tissue remodeling during the entire lifespan of the mouse, whereas Cbfa1 expression is suppressed in the articular surface chondrocytes in the adult mouse TM and knee joints to obtain the permanent cartilage phenotype. PMID:12798155
Kuboki, Takuo; Kanyama, Manabu; Nakanishi, Tohru; Akiyama, Kentaro; Nawachi, Kumiko; Yatani, Hirofumi; Yamashita, Kazuo; Takano-Yamamoto, Teruko; Takigawa, Masaharu
The high condylar shave has the disadvantage of removing the articular soft tissue cover together with the underlying condylar bone. In an attempt to overcome this disadvantage, we elevated the articular soft tissue cover, shaved the condylar head, and replaced the articular soft tissue cover in its original position in nine adult rabbit temporomandibular joints. On the contralateral joints, the same amount of bone was shaved together with the articular soft tissue cover. The rabbits were killed after 3 months, and the condyles were macroscopically and histologically evaluated. All condyles were covered with an articular soft tissue layer in the area operated on. This surface was smoother when the articular soft tissue cover was preserved. Histologically, the subarticular layer of cartilage cells was continuous in the joints with preservation of the articular soft tissue cover but was frequently interrupted in the joints where this cover was removed. The incision made in the posterior part of the articular surface for elevating the articular soft tissue cover frequently caused a deformity of the condyle and an interruption of the subarticular layer of cartilage. The results suggest that preservation of the articular soft tissue cover on the mandibular condyle might be one way to improve the postoperative morphology after high condylar shave. The technique in its present state has obvious drawbacks and should be further refined before it is considered for clinical application. PMID:2296439
Kurita, K; Westesson, P L; Eriksson, L; Sternby, N H
Synovial chondromatosis (SC) of the temporomandibular joint (TMJ) is a rare disorder with an indolent clinical course that leads to nonspecific symptoms, dysfunction, and anatomic distortion of the TMJ. We describe a case of SC in an 82-year-old male that presented as an incidental 2 cm cystic tumor of the left TMJ, during diagnostic work-up for unrelated symptoms. A fine needle aspiration of the lesion yielded fragments of abnormal mature cartilage and myxoid fluid. The diagnosis of SC was suggested after correlating the clinical and pathologic findings. Open TMJ surgery was performed for definitive diagnosis and therapy. This manuscript describes the clinical, radiologic, cytologic, and pathologic features of this entity, and relates the differential diagnosis to other cartilaginous lesions and neoplasms of the TMJ. Awareness of this disorder is important to provide adequate care and avoid overtreatment. PMID:23850367
Sink, Jill; Bell, Brian; Mesa, Hector
The aim of this study was to evaluate the use of splint treatment for therapy of osteoarthritis of temporomandibular joint, and to compare the level of anxiety (State-Trait Anxiety Inventory, STAI) and clinical characteristics between 16 patients and 20 asymptomatic dental school students. Magnetic resonance imaging (MRI) was used for all subjects. Dental students showed a statistically significant higher capacity of mouth opening (p < 0.05), and lower level of anxiety (p < 0.05 for STAI 1, and p < 0.001 for STAI 2) than patients. Patients who had suffered chronic pain before splint treatment had a higher value of anxiety by STAI 1 test (p < 0.05). PMID:21263397
Badel, Tomislav; Lovko, Sandra Kocijan; Podoreski, Dijana; Pavcin, Ivana Savi?; Kern, Josipa
Replacements for the temporomandibular joint were developed in the early 1960s. Problems with various prostheses, notably the Kent VK1, led to detailed analysis of their risks and complications. In 1999 one type of prosthesis (the Christensen) was converted from an acrylic condyle on cobalt-chromium fossa to metal-on-metal cobalt-chrome condyle and fossa. This has been popular for the last 15 years in the UK, but since it was converted to the metal-on-metal variant there have been several cases of foreign body giant-cell reactions to the prosthesis. Of the 9 cases seen (out of 106 placed), 4 were found retrospectively to be sensitive to one of the metal components of the prosthesis; the others have not been tested to date. Other potential causes of this reaction are point contact, micromovement, or a lymphocyte-mediated response to the prosthesis. PMID:18242801
Sidebottom, A J; Speculand, B; Hensher, R
The objective was to study the morphology of the articular disc and analyse the immunohistochemical expression of types I and III collagen markers in the temporomandibular joint (TMJ) disc of human foetuses of different gestational ages. Twenty TMJ from human foetuses supplied by Universidade Federal de Uberaba with gestational ages from 17 to 24 weeks were studied. The gestational age of the foetuses was determined by measuring the crown-rump (CR) length. Macroscopically, the foetuses were fixed in 10% formalin solution and dissected by removing the skin and subcutaneous tissue and exposing the deep structures. Immunohistochemical markers of type I and III were used to characterize the existence of collagen fibres. Analysis of the immunohistochemical markers of types I and III collagen revealed the presence of heterotypical fibril networks.
de Moraes, L.O.C.; Lodi, F.R.; Gomes, T.S.; Marques, S.R.; Oshima, C.T.F.; Lancellotti, C.L.P.; Rodriguez-Vazquez, J.F.; Merida-Velasco, J.R.; Alonso, L.G.
Temporomandibular joint disorders affect a big portion of the population. There are a variety of treatment methods currently in use. Conservative treatment modalities are followed by more invasive approaches like arthrocentesis or arthroscopy. The aim of the study is to compare the effects of intra-articular tenoxicam injection and arthrocentesis plus viscosupplementation on patients in which a previous arthrocentesis plus viscosupplementation has failed to relieve pain and restore function. The study group consists of 18 TMJs in 16 patients (15 female and 1 male) and the patients were randomly divided into two groups as the arthrocentesis plus viscosupplementation group (n: 8) and tenoxicam injection (n: 10). 20 mg of tenoxicam was injected to the upper compartments of 10 joints without arthrocentesis. The other 8 joints were treated with a second arthrocentesis and sodium hyaluronate injection. VAS scores and maximum mouth opening with and without assistance were recorded in the post operative first week, first month and third month. The results show that there is little benefit in using relatively conservative methods once an arthrocentesis together with viscosupplementation has failed to relieve the patients pain. It is concluded that more invasive procedures should be considered for the patients who do not benefit from arthrocentesis. PMID:23932198
Emes, Y; Arp?nar, I ?; Oncü, B; Aybar, B; Akta?, I; Al Badri, N; Atalay, B; I?sever, H; Yalç?n, S
Temporomandibular disorders are recognized as the most common nontooth-related chronic orofacial pain conditions. This article reviews the recent temporomandibular disorders literature and summarizes the temporomandibular disorders seen in rheumatology practices. Arthritis is a common condition affecting the temporomandibular joint. Although degenerative and rheumatoid arthritis are the most frequently encountered infectious arthritis, metabolic arthritis, spondyloarthropathies and the traumatic arthritis have also
Saadet Sa?lam Atsü; Figen Ayhan-Ardic
Propofol Bolus Facilitates Reduction of Luxed Temporomandibular Joints 1 1 Pharmacology in Emergency Medicine is coordinated by Richard F. Clark, MD, of the University of California, San Diego Medical Center, and the San Diego Regional Poison Center, San Diego, California
Abstract\\\\“Locked” or dislocated temporomandibular joint (TMJ) is a common problem in emergency medicine. Like many other joint dislocations, the repositioning of the joint can be facilitated by conscious sedation and muscular relaxation. Propofol is a useful agent for use in the emergency department because of its extremely short half-life, its antiemetic properties, and its safety record. We report two cases
Vicken Y Totten; Raymond F Zambito
Background Osteoarthritis (OA) is an important subtype of temporomandibular disorders. A simple and reproducible animal model that mimics the histopathologic changes, both in the cartilage and subchondral bone, and clinical symptoms of temporomandibular joint osteoarthritis (TMJOA) would help in our understanding of its process and underlying mechanism. Objective To explore whether injection of monosodium iodoacetate (MIA) into the upper compartment of rat TMJ could induce OA-like lesions. Methods Female rats were injected with varied doses of MIA into the upper compartment and observed for up to 12 weeks. Histologic, radiographic, behavioral, and molecular changes in the TMJ were evaluated by light and electron microscopy, MicroCT scanning, head withdrawal threshold test, real-time PCR, immunohistochemistry, and TUNEL assay. Results The intermediate zone of the disc loosened by 1 day post-MIA injection and thinned thereafter. Injection of an MIA dose of 0.5 mg or higher induced typical OA-like lesions in the TMJ within 4 weeks. Condylar destruction presented in a time-dependent manner, including chondrocyte apoptosis in the early stages, subsequent cartilage matrix disorganization and subchondral bone erosion, fibrosis, subchondral bone sclerosis, and osteophyte formation in the late stages. Nociceptive responses increased in the early stages, corresponding to severe synovitis. Furthermore, chondrocyte apoptosis and an imbalance between anabolism and catabolism of cartilage and subchondral bone might account for the condylar destruction. Conclusions Multi-level data demonstrated a reliable and convenient rat model of TMJOA could be induced by MIA injection into the upper compartment. The model might facilitate TMJOA related researches.
Wang, Xue-Dong; Kou, Xiao-Xing; He, Dan-Qing; Zeng, Min-Min; Meng, Zhen; Bi, Rui-Yun; Liu, Yan; Zhang, Jie-Ni; Gan, Ye-Hua; Zhou, Yan-Heng
Arthroscopic lavage and arthrocentesis, performed with different inner-diameter lavage needles, are the current minimally invasive techniques used in temporomandibular joint disc displacement (TMJ-DD) for pain reduction and functional improvement. In the current study, we aimed to explore the biomechanical influence and explain the diverse clinical outcomes of these two approaches with computational fluid dynamics. Data was retrospectively analyzed from 78 cases that had undergone arthroscopic lavage or arthrocentesis for TMJ-DD from 2002 to 2010. Four types of finite volume models, featuring irrigation needles of different diameters, were constructed based on computed tomography images. We investigated the flow pattern and pressure distribution of lavage fluid secondary to caliber-varying needles. Our results demonstrated that the size of outflow portal was the critical factor in determining irrigated flow rate, with a larger inflow portal and a smaller outflow portal leading to higher intra-articular pressure. This was consistent with clinical data suggesting that increasing the mouth opening and maximal contra-lateral movement led to better outcomes following arthroscopic lavage. The findings of this study could be useful for choosing the lavage apparatus according to the main complaint of pain, or limited mouth opening, and examination of joint movements.
Zhu, Ping; Zhou, Wenyan; Han, Yi; Zheng, Youhua; Zhang, Zhiguang
This retrospective study was designed to analyze the relationships between temporomandibular joint (TMJ) disk displacement and skeletal deformities in orthodontic patients. Subjects consisted of 460 adult patients. Before treatment, lateral cephalograms and TMJ magnetic resonance imaging (MRI) were recorded. Subjects were divided into six groups based on TMJ MRI according to increasing severity of TMJ disk displacement, in the following order: bilateral normal TMJs, unilateral disk displacement with reduction (DDR) and contralateral normal, bilateral DDR, unilateral disk displacement without reduction (DDNR) and contralateral normal, unilateral DDR and contralateral DDNR, and bilateral DDNR. Subjects were subdivided sagittally into skeletal Class I, II, and III deformities based on the ANB (point A, nasion, point B) angle and subdivided vertically into hypodivergent, normodivergent, and hyperdivergent deformities based on the facial height ratio. Linear trends between severity of TMJ disk displacement and sagittal or vertical deformities were analyzed by Cochran-Mantel-Haenszel test. The severity of TMJ disk displacement increased as the sagittal skeletal classification changed from skeletal Class III to skeletal Class II and the vertical skeletal classification changed from hypodivergent to hyperdivergent. There were no significant differences in the linear trend of TMJ disk displacement severity between the sexes according to the skeletal deformities. This study suggests that subjects with skeletal Class II and/or hyperdivergent deformities have a high possibility of severe TMJ disk displacement, regardless of sex. PMID:23618835
Jung, W-S; Kim, H; Jeon, D-M; Mah, S-J; Ahn, S-J
Finite element analysis is a useful analytical tool for the design of biomedical implants. The aim of this study was to investigate the behavior of temporomandibular joint implants with multiple design variables of the screws used for fixation of the implant. A commercially available implant with full mandible was analyzed using a finite element software package. The effects of different design variables such as orientation, diameter and stem length of the screws on the stress distribution in bone for two different surgical procedures were investigated. Considering the microstrain in bone as a principal factor, the acceptable ranges for screw diameter and length were determined. Parallel orientation of the screws performed better from a stress point of view when compared to the zig-zag orientation. Sufficient contact between the implant collar and mandibular condyle was shown to reduce the peak stresses which may lead to long term success. The distance between screw holes in the parallel orientation was much closer when compared to the zig-zag orientation. However, the stresses in bone near the screw hole area for the parallel orientation were within acceptable limits. PMID:21816398
Chowdhury, Amit Roy; Kashi, Ajay; Saha, Subrata
[Purpose] This study investigated the effects of stomatognathic alignment exercise on temporomandibular joint function and swallowing function of stroke patients presenting limited mouth opening. [Subjects] Fourteen subjects with post-stroke hemiparesis presenting limited mouth opening were randomly assigned to either the experimental group or the control group, with 7 subjects in each group. [Methods] Subjects in the experimental group participated in a stomatognathic alignment exercise program that consisted of mobility exercises of the TMJ and neck and postural correction. Main outcome measures were neck mobility, the active maximum range of mouth opening, the craniomandibular index (CMI), and the Mann assessment of swallowing ability (MASA) score. [Results] The changes in the values of the range of mouth opening, CMI, MASA, and all the parameters of neck mobility were significantly different between the groups. Furthermore, post-test values appeared to be significantly different for the range of mouth opening, the craniomandibular index, and the MASA scores between the groups (p>0.05). [Conclusion] Stomatognathic alignment exercise may improve TMJ function and swallowing function of patients with post-stroke hemiparesis.
Oh, Duck-Won; Kang, Tae-Woo; Kim, Sun-Ju
Aims To quantify short T2* properties of a disc from human temporomandibular joint (TMJ) using ultrashort time-to-echo magnetic resonance imaging (UTE MRI) technique, and to corroborate regional T2* values with biomechanical properties and histologic appearance. Methods A cadaveric human TMJ was sliced sagittally and imaged using conventional and UTE MRI techniques. The slices were then subjected to either biomechanical indentation testing or histologic evaluation for comparison to T2* maps obtained from UTE MRI data, using linear regression. Feasibility of in vivo UTE MRI was assessed in two volunteers. Results UTE MRI technique of specimens provided images of TMJ disc with greater signal-to-noise ratio (~3 fold) and contrast against surrounding tissues compared to conventional techniques. Higher T2* values correlated with lower indentation stiffness (softer) and less collagen organization as indicated by polarized light microscopy. T2* values were also obtained from volunteers. Conclusion UTE MRI facilitates quantitative characterization of TMJ discs, which may reflect structural and functional properties related to TMJ dysfunction.
Sanal, Hatice T.; Bae, Won C.; Pauli, Chantal; Du, Jiang; Statum, Sheronda; Znamirowski, Richard; Sah, Robert L.; Chung, Christine B.
We investigated the in vivo therapeutic efficacy of an intra-articular controlled release system consisting of biodegradable poly(DL-lactic-co-glycolic acid) (PLGA) microparticles (MPs) encapsulating anti-inflammatory small interfering RNA (siRNA), together with branched poly(ethylenimine) (PEI) as a transfecting agent, in a rat model of painful temporomandibular joint (TMJ) inflammation. The in vivo effects of PLGA MP dose and siRNA-PEI polyplex delivery were examined via non-invasive meal pattern analysis and by quantifying the protein level of the siRNA target as well as of several downstream inflammatory cytokines. Controlled release of siRNA-PEI from PLGA MPs significantly reduced inflammation-induced changes in meal patterns compared to untreated rats with inflamed TMJs. These changes correlated to decreases in tissue-level protein expression of the siRNA target to 20–50% of the amount present in the corresponding control groups. Similar reductions were also observed in the expression of downstream inflammatory cytokines, e.g., interleukin-6 (IL-6), whose tissue levels in the siRNA-PEI PLGA MP groups were 50% of the values for the corresponding controls. This intra-articular sustained release system has significant implications for the treatment of severe TMJ pain, and also has the potential to be readily adapted and applied to mitigate painful, chronic inflammation in a variety of conditions.
Mountziaris, Paschalia M.; Tzouanas, Stephanie N.; Sing, David C.; Kramer, Phillip R.; Kasper, F. Kurtis; Mikos, Antonios G.
While India boasts the largest collective experience in the surgical management of TMJ ankylosis, times are changing and Indian Surgeons will need to begin thinking about other TMJ disorders that have previously gone under the radar. A growing Indian middle class with greater access to health facilities will demand treatment for TMJ disorders like myofacial pain and dysfunction, internal derangement and osteoarthrosis which Oral & Maxillofacial Surgeons must be prepared to manage. The aim of this paper is to review the role of TMJ surgery and its place in the treatment armamentarium of temporomandibular disorders. Indications, rationale for surgery, risks vs benefits are discussed and complemented with examples of clinical cases treated by the author. As India moves up the economic ladder of success, TMJ disorders that have largely been confined to Western nations will begin to appear in the rising middle classes of India. Indian Oral & Maxillofacial Surgeons must be prepared to recognize and manage disorders which present with more complex symptomatology where the role of TMJ surgery is less clear cut. PMID:23997473
Minimally invasive arthroscopic surgery of the temporomandibular joint (TMJ) is more technically demanding than procedures in Larger joints. The acquisition of adequate arthroscopic skills for TMJ surgery requires extensive specialized training that can hardly be obtained from patients. In order to introduce a proper animal model for TMJ arthroscopy, this study focuses on the morphology of the upper joint cavity of pigs at different ages. Plastic casts of the upper joint cavity were obtained from a mixed-sex sample of eight unfixed juvenile pig heads. The morphometric evaluation of these plastic casts revealed that the TMJ of pigs with a body weight of about 30 kg resemble the situation of the human TMJ best, and thus may serve as a model for arthroscopic exercises and examinations of the TMJ. PMID:17695994
Kaduk, W M H; Koppe, Th
Background Open joint procedures using bone anchors have shown clinical and radiograph good success, but post surgical disc position has not been documented with MRI imaging. We have designed a modified technique of using two bone anchors and 2 sutures to reposition the articular discs. This MRI study evaluates the post surgical success of this technique to reposition and stabilize the TMJ articular discs. Methods Consecutive 81 patients with unilateral TMJ internal derangement (ID) (81 TMJs) were treated between December 1, 2003, and December 1, 2006, at the Department of Oral and Maxillofacial Surgery, Ninth Peoples Hospital, Shanghai, Jiao Tong University School of Medicine. All patients were subjected to magnetic resonance imaging before and one to seven days post surgery to determine disc position using the modified bone anchor technique. Results Postoperative MRIs (one to seven days) confirm that 77 of 81 joints were identified as excellent results and one joint was considered good for an overall effective rate of 96.3% (78 of 81 joints). Only 3.7% (3 of 81) of the joints were designated as poor results requiring a second open surgery. Conclusions This procedure has provided successful repositioning of the articular discs in unilateral TMJ ID at one to seven days post surgery.
Prospective comparison study of one-year outcomes for all titanium total temporomandibular joint replacements in patients allergic to metal and cobalt-chromium replacement joints in patients not allergic to metal.
We aimed to ascertain whether there are any early differences in outcome between all titanium temporomandibular joint (TMJ) prostheses in patients allergic to metal and standard cobalt-chromium prostheses in patients not allergic to metal. All patients who had primary TMJ prostheses placed with one-year follow-up between March 2003 and February 2011 were included. We reviewed the basic characteristics of patients. The outcome variables measured included disease, pain, mouth opening, and diet. A total of 55 patients with 77 joint replacements fulfilled the inclusion criteria. Forty patients had standard cobalt-chromium alloy (Co-Cr-Mo) prostheses (20 unilateral and 20 bilateral), and 15 had all titanium prostheses (13 unilateral and 2 bilateral). Osteoarthritis was the most common disease in both groups. There was significant improvement in pain score at reviews at 6 weeks (p=0.001) and 12 months (p=0.03). Values between groups were not significant (p=0.48 at 6 weeks, and p=0.10 at 1 year). Mouth opening in each group improved significantly with continued gains between assessments at 6 weeks and 12 months (p=0.001) but there were no significant differences between groups. Diet scores were significantly improved one year postoperatively in both groups (p=0.001), but differences between groups were not significant (p=0.90). At one year, outcomes for all titanium prostheses in patients allergic to metal were similarly favourable to those in patients who had no hypersensitivity to metal and had standard prostheses. No patient developed a hypersensitivity reaction, and no all titanium prosthesis failed during the one-year follow-up period. PMID:23522619
Hussain, O T; Sah, S; Sidebottom, A J
The purpose of this study was to evaluate biomechanical loading of the temporomandibular joint when using a biodegradable laminate implant to replace the articular disc and to test the hypothesis that the use of the implant reduces stress distribution in the condyle, implant, and glenoid fossa. A finite element model of a female human mandible, including the temporomandibular joint, which had two standard endosseous implants inserted bilaterally in the premolar region, was constructed from computed tomography scan images using a commercially available finite element software. The disc, condyle, and glenoid fossa were arbitrarily divided into five regions: the anterior, posterior, medial, lateral, and central. The disc was then replaced with a poly-L/DL-lactide biodegradable laminate. The finite element model was then used to predict principal and Von Mises stresses. The use of poly-L/DL-lactide implant resulted in remarkable reduction in Von Mises stresses (approximately threefold) in the anterior, central, and medial regions of the mandibular condyle in comparison with slight to moderate stress reductions in the corresponding regions of the implant and glenoid fossa. The mandibular condyle also demonstrated the largest total displacement in all directions followed by the implant and glenoid fossa. The use of an alloplastic implant such as the bioresorbable, poly-L/DL-lactide laminate to replace the articular disc reduces loading of the mandibular condyle rather than the implant and glenoid fossa. These findings lead to support the hypothesis that the mandibular condyle more likely functions as a shock absorber than the disc. The use of bioresorbable laminate implants might prove an efficient technique to replace the articular disc and promote normal function of the temporomandibular joint. PMID:17667665
Al-Sukhun, Jehad; Ashammakhi, Nureddin; Penttila, Heikki
The development of a traumatic arteriovenous fistula after arthroscopic surgery of the temporomandibular joint (TMJ) is an unusual event that has been limited to a few case reports. These have generally involved the superficial temporal artery and surrounding venous outlets. No cases of either postoperative or post-traumatic arteriovenous fistulas involving the extracranial middle meningeal artery (MMA), which is located on the medial surface of the TMJ, have been previously reported. We report, to our knowledge, the first case of this unusual complication and describe its successful endovascular management. PMID:24768419
Sacho, Raphael H; Kryshtalskyj, Bohdan; Krings, Timo
Purpose As the next step in the development of an intra-articular controlled release system to treat painful temporomandibular joint\\u000a (TMJ) inflammation, we developed several biodegradable poly(DL-lactic-co-glycolic acid) (PLGA)-based microparticle (MP) formulations\\u000a encapsulating a model anti-inflammatory small interfering RNA (siRNA) together with branched poly(ethylenimine) (PEI) as a\\u000a transfecting agent. The effect of siRNA loading and N:P ratio on the release kinetics of
Paschalia M. Mountziaris; David C. Sing; Sue Anne Chew; Stephanie N. Tzouanas; E. Dennis Lehman; F. Kurtis Kasper; Antonios G. Mikos
Autophagy is a cell protective mechanism for maintaining cellular homeostasis. The present study aimed to investigate whether autophagy is enhanced in the biomechanically induced degenerative cartilage of the temporomandibular joint (TMJ) and the potential role of mitogen-activated protein kinase kinase kinase kinase 3 (MAP4K3) and mammalian Target of rapamycin (mTOR) in this observation. To induce degenerative changes in the TMJs, rats were subjected to biomechanical dental stimulation by moving 4 molars away from their original position as we previously reported. The ultrastructure of autophagosome was observed by transmission electron microscopy. The number of lysosomes was analyzed by flow cytometry. The expression levels of Beclin1 and LC3 and the involvement of MAP4K3 activity were detected by immunohistochemistry, real-time PCR and western blot. The activity of the mTOR pathway indicated by p-mTOR and p-p70S6 K was assayed by western blot. TMJ degeneration, characterized by irregular cell arrangement and cell-free area, was induced in the experimental groups. Under transmission electron microscopy, we observed the presence of autophagosomes, small patches of condensed chromatin, abundant rough endoplasmic reticulum and Golgi apparatus. The number of lysosomes and the expression levels of Beclin1 and LC3 increased, while the activity of mTOR and the expression level of MAP4K3 decreased in the experimental groups. Cartilage in TMJ which was induced to be degenerative biomechanically exhibited autophagy accompanied by reduced mTOR and MAP4K3 activity. PMID:23386193
Zhang, Mian; Zhang, Jing; Lu, Lei; Qiu, Zhong-Ying; Zhang, Xu; Yu, Shi-Bin; Wu, Yao-Ping; Wang, Mei-Qing
The retrospective study was based on 36 open joint surgeries done in 33 consecutive patients with anterior disc dislocation without reduction with severe signs and symptoms and unsuccessful nonsurgical treatment lasting at least 6 months. The patients underwent either discoplasty or discectomy followed by auricular cartilage graft implantation and were evaluated for amount of interincisal mouth opening, severity of pain on VAS scores preoperatively and as well as 12 months postsurgically. The minimum pain levels were preoperatively 50 on VAS for the discoplasty group and 60 on VAS for the discectomy group. After the surgery, the VAS values lower than 20 were reported on 69.4% of 25 sides (72.7% in the discoplasty group, 68.0% in the discectomy group). Using the cutoff point for maximal interincisal opening of more than 35 mm, only 6 patients (16.6%) fulfilled the criterion at the baseline. Interincisal distance measured vertically 12 months after the operation increased in all but five patients. In three of the five subjects, the opening was at the same level as before the surgery. Almost ninety-one percent of the patients (90.9%) in discoplasty group and 81.8% in discectomy group, respectively reached 35 mm or more of vertical opening after the operation. Applying the 1984 Criteria for classification of postoperative results (AAOMS), 12 months after surgery, 24 patients (72.7%) displayed good results, 6 patients (18.2%) were evaluated with acceptable results, and in 3 cases (9.1%) we observed bad results. Although only short-term evaluation is presented, our findings show that both discoplasty and discectomy are effective methods for surgical treatment of patients suffering from severe temporomandibular pain and limited mouth opening. Discoplasty should be reserved only for patients without severe changes of the disc. PMID:15168882
Krug, Jirí; Jirousek, Zdenek; Suchmová, Helena; Cermáková, Eva
Background Previous studies have shown 17?-estradiol will reduce temporomandibular joint (TMJ) inflammation and hypersensitivity in female rats. Although, male rats contain significant amounts of estradiol it was unknown whether a physiological concentration of 17?-estradiol would attenuate male TMJ inflammation and nociception. Methods Intact and castrated rats were given a physiological concentration of estradiol to examine first, if estradiol will affect male TMJ nociception/inflammation and second, if administration of estradiol would act synergistically with endogenous male hormones to attenuate TMJ nociception. The hormonally treated rats were given TMJ injections of complete Freund’s adjuvant (CFA) and then nociception was measured using a validated method in which a lengthening in meal duration is directly correlated to the intensity of deep TMJ nociception. Inflammation was assayed by quantitating pro-inflammatory gene expression. Results Meal duration was significantly lengthened after TMJ CFA injection and this lengthening was significantly attenuated in the castrated but not intact males after administering a physiological concentration estradiol. A physiological concentration of 17?-estradiol also significantly increased IL-6 expression in the inflamed TMJ of castrated males while 17?-estradiol did not alter IL-1?, CXCL2 and CCL20 expression. Castration increased pro-inflammatory mediators IL-6, IL-1? and CXCL2 suggesting male sex hormones were anti-inflammatory. CGRP in the trigeminal ganglia was unchanged. Conclusions Similar to females, male rats with TMJ inflammation showed a reduced nociceptive response after treatment with a physiological concentration of estradiol suggesting the effects of estradiol treatment were not constrained by organizational processes in the males.
Kramer, P.R.; Bellinger, L.L.
The aim of this study was to determine whether peripheral N-methyl-D-aspartate (NMDA) receptors are involved in inflammation-induced mechanical hypersensitivity of the temporomandibular joint (TMJ) region. We developed a rat model of mechanical sensitivity to Complete Freund’s Adjuvant (CFA; 2?l containing 1?g Mycobacterium tuberculosis)-induced inflammation of the TMJ and examined changes in sensitivity following injection of NMDA receptor antagonists (DL-2-amino-5-phosphonovaleric acid (AP5) or Ifenprodil) with CFA. CFA injected into the TMJ resulted in an increase in mechanical sensitivity relative to pre-injection that peaked at day 1 and lasted for up to 3 days (n=8, P<0.05). There was no change in mechanical sensitivity in vehicle-injected rats at any time-point (n=9). At day 1, there was a significant increase in mechanical sensitivity in animals injected with CFA+vehicle (n=7) relative to those injected with vehicle alone (n=7; P<0.05), and co-injection of AP5 (n=6) or Ifenprodil (n=7) with CFA blocked this hypersensitivity. Subcutaneous injection of AP5 (n=7) and Ifenprodil (n=5) instead of into the TMJ had no significant effect on CFA-induced hypersensitivity of the TMJ region. Western blot analysis revealed constitutive expression of the NR1 and NR2B subunits in trigeminal ganglion lysates. Immunohistochemical studies showed that 99% and 28% of trigeminal ganglion neurons that innervated the TMJ contained the NR1 and NR2B subunits respectively. Our findings suggest a role for peripheral NMDA receptors in inflammation-induced pain of the TMJ region. Targeting peripheral NMDA receptors with peripheral application of NMDA receptor antagonists could provide therapeutic benefit and avoid side effects associated with blockade of NMDA receptors in the central nervous system.
Ivanusic, JJ; Beaini, D; Hatch, RJ; Staikopoulos, V; Sessle, BJ; Jennings, EA
Purpose A device composed of extracellular matrix (ECM) was investigated as an inductive template in vivo for reconstruction of the TMJ disk following discectomy. Methods A scaffold material composed of porcine derived ECM was configured to mimic the shape and size of the TMJ. This device was implanted in a canine model of bilateral TMJ discectomy. Following discectomy, one side was repaired with an ECM scaffold material and the contralateral side was left empty as a control. At 6 months post-implantation the joint space was opened, the joints evaluated for signs of gross pathologic degenerative changes, and newly formed tissue was excised for histologic, biochemical, and biomechanical analysis. Results The results show that implantation of an initially acellular material supported the formation of site-appropriate, functional host tissue which resembled that of the native TMJ disk. Further, this prevented gross degenerative changes in the temporal fossa and mandibular condyle. No tissue formation and mild to severe gross pathologic changes were observed in the contralateral controls. Conclusion These results suggest that an ECM based bioscaffold may represent an off-the-shelf solution for TMJ disk replacement.
Brown, Bryan N.; Chung, William L.; Almarza, Alejandro J.; Pavlick, Matthew; Reppas, Serafim; Ochs, Mark W.; Russell, Alan J.; Badylak, Stephen F.
The authors evaluate the possible use of osteodistraction techniques to restore the vertical dimension of the mandibular ramus after reduction during surgical treatment of TMJ ankylosis. They report the case of a fully grown female patient with monolateral right TMJ ankylosis following previous fracture injury who was treated at the Maxillofacial Surgery Unit of George Eastman Hospital in Rome. The patient underwent removal of the ankylotic block and the concomitant restoration of the vertical dimension of the mandibular ramus achieved using subperiosteal osteodistraction. Bichat's bubble flap was used as the interarticular interposition material. The distractor was activated one week after surgery with daily increments of 1 mm for a total of 7 days. Clinical and instrumental tests performed after the removal of the distractor and after a cycle of physiotherapy confirmed the good functional recovery of the joint and the restored vertical dimension of the mandibular ramus. The authors affirm that the method used represents a valid alternative for correcting loss of height after extensive resection of ankylotic joint processes in fully-grown patients. PMID:11887078
Pelo, S; Quagliero, A; Mosca, R; Boniello, R; Moro, A
The long-term results achieved in 31 joints by means of discoplasty or (temporary) implantation of silastic for treatment of internal derangements are presented. These data support the philosophy of preserving the disc whenever possible. If, however, discectomy is inevitable this fibrous plate should be replaced. Interposition of a sheet of silastic for a period of 3-6 months has proven very useful as it has in surgery for ankylosis. Silastic induces formation of a scar located between fossa and condyle which is necessary for the preservation of both rotational and translatory movements. Our postoperative results have been stable for many years and the disadvantages noted by other authors have not been found in these patients. PMID:2201699
Gundlach, K K
The articular disc in the temporomandibular joint (TMJ) that serves in load relief and stabilizing in jaw movements is a dense collagenous tissue consisting of extracellular matrices and disc cells. The various morphological configurations of the disc cells have given us diverse names, such as fibroblasts, chondrocyte-like cells and fibrochondrocytes; however, the characteristics of these cells have remained to be elucidated in detail. The disc cells have been reported to exhibit heterogeneous immunoreaction patterns for intermediate filaments including glial fibrillary acidic protein (GFAP), nestin and vimentin in the adult rat TMJ. Because these intermediate filaments accumulate in the disc cells as tooth eruption proceeds during postnatal development, it might be surmised that the expression of these intermediate filaments in the disc cells closely relates to mechanical stress. The present study was therefore undertaken to examine the effect of a continuous compressive force on the immunoexpression of these intermediate filaments and an additional intermediate filament – muscle-specific desmin – in the disc cells of the TMJ disc using a rat experimental model. The rats wore an appliance that exerts a continuous compressive load on the TMJ. The experimental period with the appliance was 5 days as determined by previous studies, after which some experimental animals were allowed to survive another 5 days after removal of the appliance. Histological observations demonstrated that the compressive force provoked a remarkable acellular region and a decrease in the thickness of the condylar cartilage of the mandible, and a sparse collagen fiber distribution in the articular disc. The articular disc showed a significant increase in the number of desmin-positive cells as compared with the controls. In contrast, immunopositive cells for GFAP, nestin and vimentin remained unchanged in number as well as intensity. At 5 days after removal of the appliance, both the disc and cartilage exhibited immunohistological and histological features in a recovery process. These findings indicate that the mature articular cells are capable of producing desmin instead of the other intermediate filaments against mechanical stress. The desmin-positive disc cells lacked ?-smooth muscle actin (?-SMA) in this study, even though desmin usually co-exists with ?-SMA in the vascular smooth muscle cells or pericytes. Because the precursor of a pericyte has such an immunoexpression pattern during angiogenesis, there is a further possibility that the formation of new vessels commenced in response to the extraordinary compressive force.
Magara, Jin; Nozawa-Inoue, Kayoko; Suzuki, Akiko; Kawano, Yoshiro; Ono, Kazuhiro; Nomura, Shuichi; Maeda, Takeyasu
Experimental subjects (n = 29) were patients who had undergone orthodontic treatment in combination with extraction of maxillary or mandibular premolar teeth, or both. Control subjects (n = 29) were healthy dental students with no orthodontic or extraction experience. Sagittal (corrected axis) tomograms of the TMJs were used to determine the narrowest linear distances between the anterior and posterior outlines of the TMJ condyle and the TMJ fossa, expressed as the joint space ratio. There were no significant (p greater than 0.05) differences between the control and experimental ratios. Bipolar surface electromyograms of the masseter and anterior temporalis muscles were used to determine the isometric contraction velocities of these muscles until 50% and 100% voluntary isometric contraction effort (teeth clenching) was achieved. There were no significant (p greater than 0.05) differences between the control and experimental subjects. Electromyograms were also used to determine the relative contribution of the masseter and anterior temporalis muscles to the bite force developed during brief maximum voluntary tooth clenching, expressed as the activity index. There were no significant (p greater than 0.05) differences between the control and experimental subjects. PMID:1867161
Kundinger, K K; Austin, B P; Christensen, L V; Donegan, S J; Ferguson, D J
Temporomandibular disorders (TMD) are loosely defined as an assorted set of clinical conditions, characterized by pain and dysfunction of the masticatory system. Pain in the masticatory muscles, in the temporomandibular joint (TMJ), and in associated hard and soft tissues, limitation in jaw function, and sounds in the TMJ are common symptoms. That women make up the majority of patients treated
Michelle P. Warren; Joanna L. Fried
Temporomandibular disorders (TMD) encompass a group of musculoskeletal conditions that involve the temporomandibular joint (TMJ) or joints, the masticatory musculature, or both. These conditions are typically characterized by pain in the pre-auricular area that is usually aggravated by chewing or other jaw function and is often accompanied, either singly or in combination, by limitation of jaw movement, joint sounds, palpable
N. D. Mohl
The aim of this study was to investigate the analgesic and anti-inflammatory activity of low-level laser therapy (LLLT) on the nociceptive behavioral as well as histomorphological aspects induced by injection of formalin and carrageenan into the rat temporomandibular joint. The 2.5% formalin injection (FRG group) induced behavioral responses characterized by rubbing the orofacial region and flinching the head quickly, which were quantified for 45 min. The pretreatment with systemic administration of diclofenac sodium-DFN group (10 mg/kg i.p.) as well as the irradiation with LLLT infrared (LST group, 780 nm, 70 mW, 30 s, 2.1 J, 52.5 J/cm(2), GaAlAs) significantly reduced the formalin-induced nociceptive responses. The 1% carrageenan injection (CRG group) induced inflammatory responses over the time-course of the study (24 h, and 3 and 7 days) characterized by the presence of intense inflammatory infiltrate rich in neutrophils, scanty areas of liquefactive necrosis and intense interstitial edema, extensive hemorrhagic areas, and enlargement of the joint space on the region. The DFN and LST groups showed an intensity of inflammatory response that was significantly lower than in CRG group over the time-course of the study, especially in the LST group, which showed exuberant granulation tissue with intense vascularization, and deposition of newly formed collagen fibers (3 and 7 days). It was concluded that the LLLT presented an anti-nociceptive and anti-inflammatory response on the inflammation induced in the temporomandibular joint of rodents. PMID:24231378
Barretto, S R; de Melo, G C; dos Santos, J C; de Oliveira, M G B; Pereira-Filho, R N; Alves, A V F; Ribeiro, M A G; Lima-Verde, I B; Quintans Júnior, L J; de Albuquerque-Júnior, R L C; Bonjardim, L R
Comparison of cytokine level in synovial fluid between successful and unsuccessful cases in arthrocentesis of the temporomandibular joint 1 1 A grant for Specially Promoted Research from Kanazawa Medical University and a grant for Scientific Research (13672129) from the ministry of Education, Culture, Sports, Science and Technology of Japan supported this work
PurposeThe aim of this study was to compare proinflammatory cytokine levels between successful cases and unsuccessful cases of arthrocentesis in patients with internal derangement of the temporomandibular joint (TMJ).
Masaaki Nishimura; Natsuki Segami; Keiseki Kaneyama; Jun Sato; Kazumza Fujimura
The purpose of this study was to evaluate the effects of intra-articular temporomandibular joint (TMJ) treatment in patients with juvenile idiopathic arthritis (JIA). The inclusion criteria were met by 21 patients (38 joints). Joints were randomly selected for either arthrocentesis alone (n=17) or arthrocentesis with the additional use of triamcinolone hexacetonide (n=21) using a closed single-needle system. Measurements of pain and function were performed at baseline and at follow-up after 3 and 8 months. Pain on opening and lateral excursion improved significantly after injections. Pain decreased significantly from baseline to first and second control on a visual analogue scale (VAS) for overall pain (49-18-8) and overall function (41-19-4). Significant improvement was recorded for pain on palpation of muscles and joints. There was no statistically significant difference between the treatment modalities, with or without glucocorticoid injection. Arthrocentesis in the TMJ treatment of patients with JIA may be beneficial and steroids had no additional effect. Further studies are needed to evaluate the long-term effects on the TMJ structures and on condylar growth from arthrocentesis and intra-articular steroid injections. PMID:24794763
Olsen-Bergem, H; Bjørnland, T
Stellate ganglion blocks have been shown to provide effective pain relief in a number of different conditions involving the upper body. This was demonstrated in a 65-year-old woman who had experienced severe debilitating pain in her left temporomandibular joint (TMJ) and the surrounding area of her face for over 10?years. The pain was unresponsive to indomethacin, carbamazepine, sodium valproate, gabapentin, lithium, melatonin and amitriptyline. She had also had four surgical procedures to the TMJ without success. The pain was partially responsive to Syndol tablets and pregabalin, although the use of pregabalin was limited by its adverse effects. The patient underwent 13 ultrasound guided stellate ganglion blocks over a 24-month period which demonstrated 90% pain relief for up to 10?weeks. Pulsed radio frequency lesioning showed no benefit over stellate ganglion block. More recently, tapentadol was found to be effective and this replaced the stellate ganglion blocks. PMID:24849638
Jones, Gareth Peter; Tripathi, Shiva Shankar
Mesenchymal stem cells have the capacity to differentiate into a variety of connective tissue cells including bone, cartilage, tendon, muscle and adipose tissue. These multipotent cells have been isolated from bone marrow and from other adult tissues including skeletal muscle, fat and synovium. Because of their multipotentiality and capacity for self renewal adult stem cells may represent units of active regeneration of tissues damaged as a result of trauma or disease. In certain degenerative diseases such as osteoarthritis (OA) stem cells are depleted, and have reduced proliferative capacity and reduced ability to differentiate. The delivery of stem cells to these individuals may therefore enhance repair or inhibit the progressive destruction of the joint. We have developed methods for the delivery of mesenchymal stem cell preparations taken from bone marrow to the injured knee joint. This treatment has the potential to stimulate regeneration of cartilage and retard the progressive destruction of the joint that typically occurs following injury. PMID:12708651
Barry, Frank P
Background Temporomandibular disorders (TMDs) are characterized by persistent orofacial pain and have diverse etiologic factors that are not well understood. It is thought that central sensitization leads to neuronal hyperexcitability and contributes to hyperalgesia and spontaneous pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) are currently the first choice of drug to relieve TMD pain. NSAIDS were shown to exhibit anticonvulsant properties and suppress cortical neuron activities by enhancing neuronal voltage-gated potassium KCNQ/Kv7 channels (M-current), suggesting that specific activation of M-current might be beneficial for TMD pain. Results In this study, we selected a new anticonvulsant drug retigabine that specifically activates M-current, and investigated the effect of retigabine on inflammation of the temporomandibular joint (TMJ) induced by complete Freund's adjuvant (CFA) in rats. The results show that the head withdrawal threshold for escape from mechanical stimulation applied to facial skin over the TMJ in inflamed rats was significantly lower than that in control rats. Administration of centrally acting M-channel opener retigabine (2.5 and 7.5 mg/kg) can dose-dependently raise the head withdrawal threshold of mechanical allodynia, and this analgesic effect can be reversed by the specific KCNQ channel blocker XE991 (3 mg/kg). Food intake is known to be negatively associated with TMJ inflammation. Food intake was increased significantly by the administration of retigabine (2.5 and 7.5 mg/kg), and this effect was reversed by XE991 (3 mg/kg). Furthermore, intracerebralventricular injection of retigabine further confirmed the analgesic effect of central retigabine on inflammatory TMJ. Conclusions Our findings indicate that central sensitization is involved in inflammatory TMJ pain and pharmacological intervention for controlling central hyperexcitability by activation of neuronal KCNQ/M-channels may have therapeutic potential for TMDs.
The present study was undertaken to test a hypothesis that the addition of articular fibrocartilage in the condyle of the temporomandibular joint reduces three-dimensional stress distribution in the condyle, the disc and articular eminence. A three-dimensional, nonlinear finite-element model was developed for analysis of joint loading before and after the addition of condylar fibrocartilage to the osseous mandibular condyle reconstructed from spiral computer topography data. In the model, each of the disc, condyle and articular eminence was arbitrarily divided into five regions: the anterior, posterior, medial, lateral and central. Von Mises stresses that in virtually all regions of the disc, condyle and articular eminence became lower after the addition of condylar fibrocartilage. Especially remarkable was the approximately four-fold reduction in von Mises stresses in the anterior, central and medial regions of the mandibular condyle. In comparison, only slight to moderate stress reductions occurred in the disc and articular eminence, suggesting that condylar fibrocartilage absorbs considerable stresses and likely dampens more loads than the disc and articular eminence. The mandibular condyle demonstrated the largest total displacement in all directions after the addition of articular fibrocartilage, followed by the disc and articular eminence. We conclude that the addition of articular fibrocartilage primarily reduces loading of the mandibular condyle, rather than the disc and articular eminence. These findings lead to a hypothesis that the mandibular condyle more likely functions as a shock absorber than the disc. PMID:12538065
Hu, Kai; Qiguo, Rong; Fang, Jing; Mao, Jeremy J
Little information is available regarding the long-term effects, if any, of running on the musculoskeletal system. The authors compared the prevalence of degenerative joint disease among 17 male runners with 18 male nonrunners. Running subjects (53% marathoners) ran a mean of 44.8 km (28 miles)/wk for 12 years. Pain and swelling of hips, knees, ankles and feet and other musculoskeletal complaints among runners were comparable with those among nonrunners. Radiologic examinations (for osteophytes, cartilage thickness, and grade of degeneration) also were without notable differences among groups. They did not find an increased prevalence of osteoarthritis among the runners. Our observations suggest that long-duration, high-mileage running need to be associated with premature degenerative joint disease in the lower extremities.
Panush, R.S.; Schmidt, C.; Caldwell, J.R.; Edwards, N.L.; Longley, S.; Yonker, R.; Webster, E.; Nauman, J.; Stork, J.; Pettersson, H.
Headache and temporomandibular disorders should be treated together but separately. If there is marked limitation of opening, imaging of the joint may be necessary. The treatment should then include education regarding limiting jaw function, appliance therapy, instruction in jaw posture, and stretching exercises, as well as medications to reduce inflammation and relax the muscles. The use of physical therapies, such as spray and stretch and trigger point injections, is helpful if there is myofascial pain. Tricyclic antidepressants and the new-generation antiepileptic drugs are effective in muscle pain conditions. Arthrocentesis and/or arthroscopy may help to restore range of motion. PMID:24703543
Graff-Radford, Steven B; Bassiur, Jennifer P
Our aim was to explore important inflammatory mediators for synovial chondromatosis in the temporomandibular joints (TMJs) by analysing synovial fluid. Samples were collected from 10 patients with unilateral synovial chondromatosis of the TMJ. Control samples were obtained from 11 subjects with no symptoms in the TMJ. Concentrations of aggrecan, interleukin (IL)-2, IL-4, IL-5, IL-6, IL-8 (CXCL8), IL-10, interferon (IFN)-?, tumour necrosis factor (TNF)-? and vascular endothelial growth factor (VEGF)-A were measured in the samples of synovial fluid, and the results in the two groups compared. The tissues from the affected TMJ were examined histologically and immunohistochemically. Of the proteins evaluated, the concentrations of aggrecan, IL-6, and VEGF-A were significantly higher in the group with synovial chondromatosis. The immunohistochemical analysis showed that the synovial cells around the osteocartilaginous nodules were vigorously expressing VEGF-A. IL-6 and VEGF-A are thought to have important roles in the pathology of synovial chondromatosis of the TMJ. PMID:22475366
Wake, Masahiro; Hamada, Yoshiki; Kumagai, Kenichi; Tanaka, Nobuho; Ikeda, Yasuko; Nakatani, Yasunori; Suzuki, Ryuji; Fukui, Naoshi
Background This survey characterized the strategies used by general dentists to manage temporomandibular muscle joint disorders (TMJD) pain, and assessed the feasibility of doing a randomized clinical trial (RCT) of the effectiveness of these strategies. Methods Dentists from three Practice-Based Research Networks (PBRNs) specifically, DPBRN, PEARL, NWPRECEDENT) accepted to participate in this survey. Results Out of 862 dentists surveyed, 654 were general dentists who treat TMJD; among these, 80.3 percent stated they would participate in a RCT. Dentists treated an average of three pain-related TMJD patients per month. Splints (97.6 percent), self-care (85.9 percent) and over-the-counter or prescribed medications (84.6 percent) were the treatments most frequently used. The preferred treatments to compare in a RCT were splint therapy (35.8 percent), self-care (27.4 percent) and medications (16.9 percent). Conclusions Most general dentists treat TMJD pain, and reversible initial care is typically provided. Finally, it is feasible to conduct a RCT in the PBRNs to assess the effectiveness of splint therapy, medications and/or self-care, for the initial management of painful TMJD. Clinical Implications There is an opportunity to do a RCT in PBRNs leading to the development of evidence-based treatment guidelines for the initial treatment of pain-related TMJD by primary care dentists.
Velly, Ana M.; Schiffman, Eric L.; Rindal, D. Brad; Cunha-Cruz, Joana; Gilbert, Gregg H.; Lehmann, Maryann; Horowitz, Allan; Fricton, James
The rehabilitation of children affected by early traumatic facial deformity is a challenge for both the craniofacial team and the child's family. Although the immediate goals of surgery are to restore both form and function, the psychological needs of the growing child must also be addressed. Early surgery may be required to assist integration of the child into the community and thereby avert both social isolation and stigmatization of the child. Timed correctly, such surgery has the potential to harness the patient's own growth to assist in correction of the deformity and to maintain some of the surgical gains. The use of autogenous tissue rather than nondegradable implants to facilitate craniofacial reconstruction in the growing child avoids some of the concerns associated with permanent implants. These include both their potential to adversely affect growth and to migrate. The purpose of this article is to illustrate how advances in tissue adhesion using protein polymers (BioGlue(®); CryoLife, Inc., Kennesaw, GA) and bone regeneration techniques (distraction osteogenesis) have been used to correct the disfiguring and functional problems associated with unilateral temporomandibular joint ankylosis acquired in early childhood. PMID:24436736
Muhammad, Joseph Kamal; Al Hashimi, Bader Abdulla; Al Mansoor, Abu Bakr; Ali, Iqbal
The rehabilitation of children affected by early traumatic facial deformity is a challenge for both the craniofacial team and the child's family. Although the immediate goals of surgery are to restore both form and function, the psychological needs of the growing child must also be addressed. Early surgery may be required to assist integration of the child into the community and thereby avert both social isolation and stigmatization of the child. Timed correctly, such surgery has the potential to harness the patient's own growth to assist in correction of the deformity and to maintain some of the surgical gains. The use of autogenous tissue rather than nondegradable implants to facilitate craniofacial reconstruction in the growing child avoids some of the concerns associated with permanent implants. These include both their potential to adversely affect growth and to migrate. The purpose of this article is to illustrate how advances in tissue adhesion using protein polymers (BioGlue®; CryoLife, Inc., Kennesaw, GA) and bone regeneration techniques (distraction osteogenesis) have been used to correct the disfiguring and functional problems associated with unilateral temporomandibular joint ankylosis acquired in early childhood.
Muhammad, Joseph Kamal; Al Hashimi, Bader Abdulla; Al Mansoor, Abu Bakr; Ali, Iqbal
Seventy-six patients including 27 females and 49 males, with ages ranging between 4 and 35 years (mean, 19.5 y), all experienced loss of weight, stiff temporomandibular joints and inability to chew food, and facial deformities. These patients were treated in the Maxillofacial Unit, Surgical Specialties Hospital, Medical City, Baghdad, Iraq, using 4 different techniques according to the requirement of each case and the facilities available. These patients were divided into 4 groups: the first group consists of 16 children (21.06%) treated with a chondro-osseous graft; the second group, 10 children (13.16%) treated with a 2-part chrome-cobalt prosthesis; the third group, 32 children (42.11%) treated with a Sialastic rubber silicone implant (Koken Co, Tokyo, Japan); and the fourth group, 18 children (23.69%) treated with interposition arthroplasty with a temporalis muscle flap. The follow-up period of the cases ranged between 3 and 15 years. Experimental studies were done on using rabbits to assess the viability of the chondro-osseous graft and on monkeys to demonstrate the biological acceptability of the 2-part chrome-cobalt prosthesis. The aim of this clinical and experimental study was to show our experience in managing difficult tasks that craniofacial or maxillofacial surgeons may face and to share these experiences with other colleagues all over the world. PMID:19884846
Up to a quarter of the general population has experienced temporomandibular joint disorder (TMD) at some point in time. Physiotherapy has been used in the management of TMD for many years, but evidence supporting its clinical effectiveness is limited. We investigated the perceived effectiveness of physiotherapy for patients with TMD among consultants in oral and maxillofacial surgery (OMFS) and the accessibility of these services in the United Kingdom (UK). Information was gathered from a postal or electronic questionnaire sent to the 356 OMFS consultants listed on the British Association of Oral and Maxillofacial Surgeons' website. A total of 208 responded (58%) and 72% considered physiotherapy to be effective. Amongst these respondents, jaw exercises (79%), ultrasound (52%), manual therapy (48%), acupuncture (41%) and laser therapy (15%) were considered to be effective. Twenty-eight percent of respondents did not consider physiotherapy to be effective. Reasons for this included lack of knowledge or expertise of the physiotherapist (41%) and lack of awareness of the benefits of physiotherapy (28%). In relation to access to physiotherapy services, 10% of respondents had a designated physiotherapist for patients with TMD, 89% could refer directly to physiotherapy and 7% worked in an environment that provided training for physiotherapists. Patients were prescribed jaw exercises by 69% of respondents. Despite limited evidence to support its effectiveness, approximately three-quarters of OMFS consultants in the UK regard physiotherapy to be beneficial in the management of TMD. PMID:22541647
Rashid, Arif; Matthews, Nigel Shaun; Cowgill, Helen
The collagen fiber organization in the anterior band (AB), intermediate zone (IZ) and posterior band (PB) of the disk of the human jaw joint disk and in its attachments was studied under the polarizing microscope. Observations were made on serially sectioned joints (n = 6) and three sets of disk samples sectioned along mutually perpendicular planes (n = 21). The
Robert P. Scapino; Ales Obrez; Daniel Greising
Treatment of chronic recurrent dislocation of the temporomandibular joint with injection of autologous blood alone, intermaxillary fixation alone, or both together: a prospective, randomised, controlled clinical trial.
Our aim was to evaluate the efficacy of autologous blood injection in the treatment of chronic recurrent dislocation of the temporomandibular joint (TMJ) in a prospective randomised controlled clinical study. Forty-eight patients (11 men and 37 women) with chronic recurrent dislocation of the TMJ were randomly assigned to 1 of 3 equally sized groups. Patients in the first group were treated with injection of autologous blood (ABI) alone into the superior joint space and the pericapsular tissues. Those in the second group were treated with intramaxillary fixation (IMF) alone for 4 weeks, and those in the third group were treated with ABI and IMF for 4 weeks. Interincisal distance, digital panoramic radiograph, incidence of recurrent dislocation, and pain in the TMJ were assessed postoperatively at 2 weeks and at 1, 3, 6, and 12 months. The mean (SD) reduction in interincisal distance in the group treated with both techniques was 11.0 (1.9), which was significantly higher than in either the group treated with ABI, which was 8.5 (2.4) or IMF, which was 9.1 (2.1). The results in the ABI group and the IMF group did not differ significantly. The combined group showed the biggest decrease. The ABI alone group had the most recurrences (n=8, which were treated by repeated injections with no recurrence after the third). The IMF alone group had only 3 and there were none in the combined group. We conclude that ABI is a simple and safe technique for the treatment of dislocation of the TMJ in the outpatient clinic. Recurrence can be overcome by multiple injections. However, the best clinical results are given by a combination of ABI and IMF. PMID:23684013
Hegab, Ayman F
This study investigated the effects of intra-articular injection of alendronate on the mandibular condyle in ovariectomized rats. Sixty rats were divided into five groups: ovariectomy with vehicle treatment alone, early alendronate treatment at ovariectomy, late alendronate treatment at 4 weeks after ovariectomy, sham-operation with vehicle treatment, and normal controls. The changes in cartilage and subchondral bone were evaluated by micro-computed tomography, histology, tartrate-resistant acid phosphatase (TRAP) staining, immunohistochemistry, and real-time quantitative polymerase chain reaction. Compared with late alendronate treatment, early alendronate treatment completely inhibited cartilage thickening (727.6±39.3 vs. 1013.3±51.6; P=0.017) and improved microstructural properties of the subchondral bone, with a higher bone volume ratio (46.4±2.5 vs. 37.5±2.1; P=0.038), trabecular thickness (47.3±1.7 vs. 34.6±1.4; P=0.029), and trabecular number (8.5±0.6 vs. 6.2±0.3; P=0.041) and lower trabecular separation (30.2±1.6 vs. 37.7±2.6; P=0.034). Fewer TRAP-positive cells (4.2±0.2 vs. 6.8±0.4; P=0.019) and a higher OPG/RANKL ratio (0.38±0.01 vs. 0.25±0.03; P=0.043) in the subchondral bone were observed in the animals with early treatment compared to late treatment or ovariectomy/vehicle treatment. In addition, early alendronate treatment blocked the up-regulation of matrix metalloproteinase (MMP)-13 expression in the chondrocytes, whereas late alendronate treatment attenuated the up-regulation of MMP-13 expression. Our results suggest the therapeutic potential of intra-articular alendronate injection in the treatment of osteoporosis-associated temporomandibular disorders. PMID:24811289
Chen, K; Zhang, N; Ding, L; Zhang, W; Hu, J; Zhu, S
This article describes the arthroscopic surgical treatment of disc perforations by discoplasty to mobilize the disc and reduce joint friction. Grade IV chondromalacia with exposed bone was treated by abrasion arthroplasty with the goal of resurfacing the bone with fibrocartilage. Preliminary data on the results of these procedures are presented. PMID:8040731
Quinn, J H
Temporomandibular joint (TMJ) arthritis is a common cause of orofacial pain. In the present study, the modulatory effects of N-methyl-d-aspartate receptors (NMDA-Rs) and magnesium were investigated in TMJ arthritis hypernociception. Male Wistar rats received an intra-articular injection of carrageenan (Cg) in the TMJ, and mechanical hypernociception was measured. The NMDA-R antagonist, MK-801, and magnesium chloride (MgCl? ) were administered before arthritis induction. Magnesium deficiency was promoted by feeding rats a synthetic magnesium-free diet for 9 d before injection of Cg. The Cg induced mechanical hypernociception that lasted for 120 h. MK-801 inhibited this hypernociceptive state. MgCl? pretreatment prevented Cg-induced hypernociception and altered the nociceptive threshold in the absence of Cg. Magnesium deficiency increased hypernociception and induced spontaneous hypernociceptive behavior. TMJ arthritis increased the expression of mRNA for all NMDA-R subunits and immunostaining of phosphorylated NR1 (phospho-NR1). MgCl? inhibited expression of NR2B mRNA and phospho-NR1 immunostaining and increased expression of NR3 mRNA. Magnesium deficiency increased expression of both NR1 and NR3 mRNAs and phospho-NR1 immunostaining in the trigeminal subnucleus caudalis. We found that magnesium modulates nociceptive behavior and induces NMDA-R subunit rearrangement in the subnucleus caudalis. The present results may lead to a better understanding of central processing in the nociceptive trigeminal pathway and the development of new approaches to treat orofacial pain with a TMJ origin. PMID:24206074
Cavalcante, André L C; Siqueira, Rafaelly M P; Araujo, Joana C B; Gondim, Delane V; Ribeiro, Ronaldo A; Quetz, Josiane S; Havt, Alexandre; Lima, Aldo A M; Vale, Mariana L
Brain neuroimaging has been widely used to investigate the bran signature of chronic orofacial pain, including trigeminal neuropathic pain (TNP) and pain related to temporomandibular joint disorders (TMD). We here systematically reviewed the neuroimaging literature regarding the functional and structural changes in the brain of TNP and TMD pain patients, using a computerized search of journal articles via PubMed. Ten TNP studies and 14 TMD studies were reviewed. Study quality and risk of bias were assessed based on the criteria of patient selection, the history of medication, the use of standardized pain/psychological assessments, and the model and statistics of imaging analyses. Qualitative meta-analysis was performed by examining the brain regions which showed significant changes in either brain functions (including the blood-oxygen-level dependent signal, cerebral blood flow and the magnetic resonance spectroscopy signal) or brain structure (including gray matter and white matter anatomy). We hypothesized that the neuroimaging findings would display a common pattern as well as distinct patterns of brain signature in the disorders. This major hypothesis was supported by the following findings: (1) TNP and TMD patients showed consistent functional/structural changes in the thalamus and the primary somatosensory cortex, indicating the thalamocortical pathway as the major site of plasticity. (2) The TNP patients showed more alterations at the thalamocortical pathway, and the two disorders showed distinct patterns of thalamic and insular connectivity. Additionally, functional and structural changes were frequently reported in the prefrontal cortex and the basal ganglia, suggesting the role of cognitive modulation and reward processing in chronic orofacial pain. The findings highlight the potential for brain neuroimaging as an investigating tool for understanding chronic orofacial pain.
Seaweed lectins have been widely investigated as anti-nociceptive and anti-inflammatory agents. This study analyzed the anti-nociceptive and anti-inflammatory responses of a lectin from the green seaweed Caulerpa cupressoides (CcL) on zymosan-induced arthritis of the rat temporomandibular joint (TMJ). Rats received i.v. CcL 30min prior to injection of zymosan (2mg/art.) or 0.9% saline into the left TMJ. Mechanical hyper-nociception was measured by the electronic von Frey method at baseline and 4h after zymosan injection. Animals were euthanized 6h after zymosan injection and the synovial fluid was collected for leukocyte counting and myeloperoxidase activity assessment. Other animals were treated with ZnPP-IX (3mg/kg; s.c.), a specific heme oxygenase-1 pathway inhibitor, and naloxone (10?g/art.), a nonselective opioid receptor antagonist. TMJ tissues were excised to perform histopathological and immunohistochemistry analyses. CcL (0.1, 1 or 10mg/kg) significantly reduced zymosan-induced hyper-nociception (81, 83 and 89.5%, respectively) and inhibited the leukocyte influx (77.3, 80.7 and 98.5%, respectively) compared with the zymosan-only group, as confirmed by myeloperoxidase activity; however, treatment with naloxone or ZnPP-IX did not revert the effects of CcL (10mg/kg), suggesting that the naloxone-sensitive opioid and heme oxygenase-1 pathways are not involved. CcL also reduced the leukocyte influx and the expression of IL-1? and TNF-? in the TMJ, based on histopathological and immunohistochemistry analyses, respectively. Therefore, CcL reduces TMJ hyper-nociception and inflammation with a mechanism that is partially dependent on TNF-? and IL-1? inhibition. CcL reveals a potentially valuable alternative tool for future studies of TMJ disorders. PMID:24768528
da Conceição Rivanor, Renata Line; Chaves, Hellíada Vasconcelos; do Val, Danielle Rocha; de Freitas, Alice Ramos; Lemos, Jonas Cavalcante; Rodrigues, José Ariévilo Gurgel; Pereira, Karuza Maria Alves; de Araújo, Ianna Wivianne Fernandes; Bezerra, Mirna Marques; Benevides, Norma Maria Barros
Background Interleukin-1? (IL-1?) and tumor necrosis factor-? (TNF-?) are key mediators of the intracapsular pathological conditions of the temporomandibular joint (TMJ). Therefore, the gene expression profiles in synovial fibroblast-like cells (SFCs) from patients with internal derangement of the TMJ were examined after they were stimulated with IL-1? or TNF-? to determine which genes were altered. Methods Ribonucleic acid was isolated from SFCs after IL-1? or TNF-? treatment. Gene expression profiling was performed using oligonucleotide microarray analysis. On the basis of the results of this assay, we investigated the kinetics of macrophage inflammatory protein-3? (MIP-3?) gene expression using PCR, and protein production in TMJ SFCs stimulated by IL-1? or TNF-? using an ELISA. Inhibition experiments were performed with MAPK and NF?B inhibitors. SFCs were stimulated with IL-1? or TNF-? after treatment with inhibitors. The MIP-3? levels were measured using an ELISA. Results Macrophage inflammatory protein-3? was the gene most upregulated by IL-1?- or TNF-? stimulation. The mRNA and protein levels of MIP-3? increased in response to IL-1? in a time-dependent manner. In contrast, during TNF-? stimulation, the MIP-3? mRNA levels peaked at 4 h, and the protein levels peaked at 8 h. In addition, the IL-1?- and TNF-?-stimulated MIP-3? production was potently reduced by the MAPK and NF?B signaling pathway inhibitors. Conclusion Interleukin-1? and TNF-? increased the MIP-3? production in SFCs via the MAPK and NF?B pathways. These results suggest that the production of MIP-3? from stimulation with IL-1? or TNF-? is one factor associated with the inflammatory progression of the internal derangement of the TMJ.
Akutsu, Miwa; Ogura, Naomi; Ito, Ko; Kawashima, Mutsumi; Kishida, Tsuyoshi; Kondoh, Toshirou
The radiological and tomographic aspects of the sternoclavicular joint were examined in 10 patients with psoriatic arthritis to evaluate better how this joint was affected using different radiological techniques. Imaging of the sternoclavicular joint showed that computed tomography provides a better visualisation of erosions, subchondral cysts, and sclerosis than standard radiography and conventional linear tomography. Images
Taccari, E; Spadaro, A; Riccieri, V; Guerrisi, R; Guerrisi, V; Zoppini, A
\\u000a Musculoskeletal pain affecting the orofacial region is quite prevalent and has frequently been reported throughout the developed\\u000a world (Dworkin and Ohrbach 2001). Common TMD symptoms include spontaneous pain in the area of the ear, the temporomandibular joint, or the muscles of mastication,\\u000a physical limitations or irregularities in jaw movement, and clicking and popping noises in the temporomandibular joint during\\u000a jaw
Gary B. Rollman; Joanne M. Gillespie
This study evaluated the use of behavior therapy to reduce teeth clenching and grinding as a treatment for temporomandibular disorders (TMD). Habit reversal was used to treat three adults with TMD using a multiple baseline across subjects design. The results indicated significant improvement for two of the three subjects including decreased self-reported pain, decreased pain upon muscle palpation, and increased maximum mandibular opening. However, temporomandibular joint sounds were increased. Habit reversal appears to be more effective in reducing the myofascial pain symptoms of TMD than in improving temporomandibular joint functioning. PMID:8370797
Peterson, A L; Dixon, D C; Talcott, G W; Kelleher, W J
Objective Temporomandibular dysfunction involves osteoarthritis of the TMJ, including degeneration and morphologic changes of the mandibular condyle. Purpose of this study was to determine accuracy of novel 3D-UTE MRI versus micro-CT (?CT) for quantitative evaluation of mandibular condyle morphology. Material & Methods Nine TMJ condyle specimens were harvested from cadavers (2M, 3F; Age 85 ± 10 yrs., mean±SD). 3D-UTE MRI (TR=50ms, TE=0.05 ms, 104 ?m isotropic-voxel) was performed using a 3-T MR scanner and ?CT (18 ?m isotropic-voxel) was performed. MR datasets were spatially-registered with ?CT dataset. Two observers segmented bony contours of the condyles. Fibrocartilage was segmented on MR dataset. Using a custom program, bone and fibrocartilage surface coordinates, Gaussian curvature, volume of segmented regions and fibrocartilage thickness were determined for quantitative evaluation of joint morphology. Agreement between techniques (MRI vs. ?CT) and observers (MRI vs. MRI) for Gaussian curvature, mean curvature and segmented volume of the bone were determined using intraclass correlation correlation (ICC) analyses. Results Between MRI and ?CT, the average deviation of surface coordinates was 0.19±0.15 mm, slightly higher than spatial resolution of MRI. Average deviation of the Gaussian curvature and volume of segmented regions, from MRI to ?CT, was 5.7±6.5% and 6.6±6.2%, respectively. ICC coefficients (MRI vs. ?CT) for Gaussian curvature, mean curvature and segmented volumes were respectively 0.892, 0.893 and 0.972. Between observers (MRI vs. MRI), the ICC coefficients were 0.998, 0.999 and 0.997 respectively. Fibrocartilage thickness was 0.55±0.11 mm, as previously described in literature for grossly normal TMJ samples. Conclusion 3D-UTE MR quantitative evaluation of TMJ condyle morphology ex-vivo, including surface, curvature and segmented volume, shows high correlation against ?CT and between observers. In addition, UTE MRI allows quantitative evaluation of the fibrocartilaginous condylar component.
Geiger, Daniel; Bae, Won C.; Statum, Sheronda; Du, Jiang; Chung, Christine B.
The relationship between long-term ballet dancing and eventual arthrosis of the hip, ankle, subtalar, and first metatarsophalangeal joint was examined in 19 former professional female dancers, aged 50 to 70 years. The dancers were compared with pair-matched controls. All 38 women underwent medical history taking, clinical ex amination, and roentgenography of the joints studied. The roentgenographs were independently judged by
C. Niek van Dijk; Liesbeth S. L. Lim; Alina Poortman; Ernst H. Strübbe; Rene K. Marti
Temporomandibular Disorders (TMD) is a collective term embracing a number of clinical problems that involve the muscles of mastication, the temporomandibular joint (TMJ) and associated structures or both. This group of disorders has been identified as the chief cause of pain, which is not of dental origin, in the orofacial area, and is defined as a subgroup in the category of musculoskeletal disorders. These disorders impair the quality of life of those suffering from them due to the extent of the pain and the chronic nature of its symptoms. It is known that chronic pain causes the development of psychological disturbances (anxiety, depression, etc.). The most common symptoms of TMD are the pain that usually appears as the result of mandibular activity (speaking or chewing), and is usually located in the masticulatory muscles, in the preauricular area and the temporomandibular joint (TMJ). Additional common symptoms are: a. restriction in jaw movement; b. asymmetry in jaw movement; c. noises from the joint. Patients suffering from TMD are likely to exhibit additional symptoms: hypertrophy of the muscles of mastication (an adaptive and asymptomatic phenomenon), abnormal occlusar erosion due to nighttime or daytime bruxism, or teeth grinding. Most functional temporomandibular disorders have similar signs and symptoms. As a result, diagnosis of the various disorders presents a serious problem. Functional temporomandibular disorders are often accompanied by mental symptoms such as depression, anxiety and/or somatization on various levels. One of today's accepted methods of classification also refers to the mental aspect and thus enables, for the first time, a suitable scientific comparison of the epidemiological, diagnostic and treatment data in the various studies. This method, initiated by Dworkin and LeResche (1992) is known as Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The purpose of this method is to classify every subgroup of TMD according to agreed upon, clear and measurable diagnostic criteria, both from the physical (AXIS I) and the mental (AXIS II) aspect. The method includes a scale which grades the extent of severity, damage and limitations caused by the illness, in a manner which now can make scientific comparisons between the various studies and between the population of patients and the general population. Temporomandibular disorders are very common and affect between 30%-50% of the population, and appear to be more prevalent among women than among men. Studies conducted on youth revealed significant relationships between oral parafunctions (especially chewing gum and "jaw playing"), and functional temporomandibular disorders. The significance of this finding is in the need to warn young people of the possible risks of engaging in intensive oral practices. The high prevalence of signs and symptoms among the Israeli population obligates us, in our opinion, to change the physical examination for identification of these disorders, to a routine procedure in all dental clinics in Israel. PMID:12674926
Winocur, E; Emodi-Perlman, A; Finkelstein, T; Sharabi-Ventura, Y; Gavish, A
TMJ disc related diseases are difficult to be cured due to the poor repair ability of the disc. TMJ-SDSCs were ideal cell sources for cartilage tissue engineering which have been widely used in hyaline cartilage regeneration. Fibrin gel has been demonstrated as a potential scaffold for neocartilage formation. The aim of this study was to repair the TMJ disc perforation using fibrin/chitosan hybrid scaffold combined with TMJ-SDSCs. Rat TMJ-SDSCs were cultured on hybrid scaffold or pure chitosan scaffolds. The cell seeding efficiency, distribution, proliferation, and chondrogenic differentiation capacity were investigated. To evaluate the in vivo repair ability of cell/scaffold construct, rat TMJ disc explants were punched with a defect to mimic TMJ disc perforation. Cell seeded scaffolds were inserted into the defect of TMJ disc explants and then were implanted subcutaneously in nude mice for 4 weeks. Results demonstrated that fibrin may improve cell seeding, proliferation, and chondrogenic induction in vitro. The in vivo experiments showed more cartilage ECM deposition in fibrin/chitosan scaffold, which suggested an enhanced reparative ability. This pilot study demonstrated that the regenerative ability of TMJ-SDSCs seeded in fibrin/chitosan scaffold could be applied for repairing TMJ disc perforation.
Gong, Zhongcheng; Li, Jian; Meng, Qinggong; Fang, Wei; Long, Xing
Comparing proton density and turbo spin echo T2 weighted static sequences with dynamic half-Fourier single-shot TSE pulse sequence at 3.0?T in diagnosis of temporomandibular joint disorders: a prospective study.
Objectives: The aim of this prospective study was to compare dynamic and static sequences in the evaluation of temporomandibular joint disorders using a 3.0?-T imaging unit. Methods: 194 patients were evaluated by static (double echo proton density weighted/turbo spin echo T2 weighted sequences) and dynamic (half-Fourier single-shot turbo spin echo sequences)imaging. Two radiologists evaluated in consensus the quality of images, the disc position and morphological alterations. The Kendall rank correlation coefficient (?-b) was used to compare the qualitative rating between static and dynamic sequences. Cohen's kappa coefficient (k) was used to assess the agreement of disc position and morphological alterations between both sequences. The intraclass correlation coefficient was used to calculate the intraobserver variability. The significance was set at p???0.05. Results: The correlation between both sequences in the qualitative evaluation was ?-b?=?0.632. The agreement between both techniques in the evaluation of disc position was k?=?0.856. The agreement between both techniques in assessing the morphological alterations was k?=?0.487. In the static sequences, the intraclass correlation coefficient was 0.915 in the qualitative evaluation, 0.873 in the evaluation of disc position and 0.934 in the assessment of morphological alterations. In the dynamic sequences, the intraclass correlation coefficient was 0.785 in the qualitative evaluation, 0.935 in the evaluation of disc position and 0.826 in the assessment of morphological alterations. Conclusions: Static imaging remains the gold standard in the evaluation of the temporomandibular joint. Dynamic imaging is a valuable tool that can provide additional information about topographic changes in the disc-condyle relationship. PMID:24720606
Cassetta, M; Barchetti, F; Pranno, N; Marini, M
This update develops the actual therapeutic options in the management of the joint involvement of calcium pyrophosphate deposition disease (CPPD), basic calcium phosphate (BCP) deposition disease, hemochromatosis (HH), ochronosis, oxalosis, and Wilson's disease. Conventional pharmaceutical treatment provides benefits for most diseases. Anti-interleukine-1 (IL-1) treatment could provide similar results in CPPD than in gout flares. There is only limited evidence about the efficacy of preventive long-term colchicine intake, methotrexate, and hydroxychloroquine in chronic CPPD. Needle aspiration and lavage have satisfactory short and midterm results in BCP. Extracorporeal shockwave therapy has also proved its efficacy for high-doses regimes. Phlebotomy does not seem to have shown real efficacy on joint involvement in HH so far. Iron chelators' effects have not been assessed on joint involvement either, while IL-1 blockade may prove useful. NSAIDs have limited efficacy on joint involvement of oxalosis, while colchicine and steroids have not been assessed either. The use of nitisinone for ochronotic arthropathy is still much debated, but it could provide beneficial effects on joint involvement. The effects of copper chelators have not been assessed either in the joint involvement of Wilson's disease. NSAIDs should be avoided because of the liver affection they may worsen.
Richette, Pascal; Flipo, Rene-Marc
This update develops the actual therapeutic options in the management of the joint involvement of calcium pyrophosphate deposition disease (CPPD), basic calcium phosphate (BCP) deposition disease, hemochromatosis (HH), ochronosis, oxalosis, and Wilson's disease. Conventional pharmaceutical treatment provides benefits for most diseases. Anti-interleukine-1 (IL-1) treatment could provide similar results in CPPD than in gout flares. There is only limited evidence about the efficacy of preventive long-term colchicine intake, methotrexate, and hydroxychloroquine in chronic CPPD. Needle aspiration and lavage have satisfactory short and midterm results in BCP. Extracorporeal shockwave therapy has also proved its efficacy for high-doses regimes. Phlebotomy does not seem to have shown real efficacy on joint involvement in HH so far. Iron chelators' effects have not been assessed on joint involvement either, while IL-1 blockade may prove useful. NSAIDs have limited efficacy on joint involvement of oxalosis, while colchicine and steroids have not been assessed either. The use of nitisinone for ochronotic arthropathy is still much debated, but it could provide beneficial effects on joint involvement. The effects of copper chelators have not been assessed either in the joint involvement of Wilson's disease. NSAIDs should be avoided because of the liver affection they may worsen. PMID:24895535
Pascart, Tristan; Richette, Pascal; Flipo, René-Marc
Basic calcium phosphate (BCP) crystals include partially carbonate-substituted hydroxyapatite, octacalcium phosphate, and\\u000a tricalcium phosphate. They may form deposits, which are frequently asymptomatic but may give rise to a number of clinical\\u000a syndromes including calcific periarthritis, Milwaukee shoulder syndrome, and osteoarthritis, in and around joints. Recent\\u000a data suggest that magnesium whitlockite, another form of BCP, may play a pathologic role in
Eamonn S. Molloy; Geraldine M. McCarthy
Alzheimer's disease (AD) is a neurodegenerative disease concomitant with grey and white matter damages. However, the interrelationship of volumetric changes between grey and white matter remains poorly understood in AD. Using joint independent component analysis, this study identified joint grey and white matter volume reductions based on structural magnetic resonance imaging data to construct the covariant networks in twelve AD patients and fourteen normal controls (NC). We found that three networks showed significant volume reductions in joint grey–white matter sources in AD patients, including (1) frontal/parietal/temporal-superior longitudinal fasciculus/corpus callosum, (2) temporal/parietal/occipital-frontal/occipital, and (3) temporal-precentral/postcentral. The corresponding expression scores distinguished AD patients from NC with 85.7%, 100% and 85.7% sensitivity for joint sources 1, 2 and 3, respectively; 75.0%, 66.7% and 75.0% specificity for joint sources 1, 2 and 3, respectively. Furthermore, the combined source of three significant joint sources best predicted the AD/NC group membership with 92.9% sensitivity and 83.3% specificity. Our findings revealed joint grey and white matter loss in AD patients, and these results can help elucidate the mechanism of grey and white matter reductions in the development of AD.
Guo, Xiaojuan; Han, Yuan; Chen, Kewei; Wang, Yan; Yao, Li
Temporomandibular disorders (TMD) are a class of degenerative musculoskeletal conditions associated with morphologic and functional deformities that affect up to 25% of the population, but their etiology and progression are poorly understood and, as a result, treatment options are limited. In up to 70% of cases, TMD are accompanied by malpositioning of the temporomandibular joint (TMJ) disc, termed "internal derangement." Although the onset is not well characterized, correlations between internal derangement and osteoarthritic change have been identified. Because of the complex and unique nature of each TMD case, diagnosis requires patient-specific analysis accompanied by various diagnostic modalities. Likewise, treatment requires customized plans to address the specific characteristics of each patient's disease. In the mechanically demanding and biochemically active environment of the TMJ, therapeutic approaches that can restore joint functionality while responding to changes in the joint have become a necessity. One such approach, tissue engineering, which may be capable of integration and adaptation in the TMJ, carries significant potential for the development of repair and replacement tissues. The following review presents a synopsis of etiology, current treatment methods, and the future of tissue engineering for repairing and/or replacing diseased joint components, specifically the mandibular condyle and TMJ disc. An analysis of native tissue characterization to assist clinicians in identifying tissue engineering objectives and validation metrics for restoring healthy and functional structures of the TMJ is followed by a discussion of current trends in tissue engineering. PMID:24278954
Murphy, Meghan K; MacBarb, Regina F; Wong, Mark E; Athanasiou, Kyriacos A
Freedom of the manducatory apparatus is critical to economical and accurate vocal production. Two types of dysfunction will be discussed: global muscular hypertonia of the muscular manducatory system and dysfunction of the temporomandibular joint (TMJ). Hypertonia occurs in a high number of dysphonic patients. It impairs mandibular mobility and also induces chronic hypertonia of the tongue muscles, hyoid apparatus and occipitocervical joint through the neuromuscular facilitation process. TMJ can be a major source of mandibular kinetics impairment. Its pathogenic effects are most deeply felt in singers, who often have their mouths wide open, especially when singing notes in the upper register. Affected singers generally use an avoidance or compensation strategy which is detrimental to optimal use of resonance cavities and vocal sound articulation. It is consequently vital to understand TMJ pathophysiology and to include an examination of the manducatory apparatus in any clinical evaluation of dysphonia. PMID:21077413
Piron, A; Roch, J B
We analyze a bioeconomic model of a multiple-host disease problem involving wildlife and livestock. The social planner’s choices\\u000a include targeted (i.e., infectious versus healthy) livestock harvests, non-targeted wildlife harvests, environmental habitat\\u000a variables, and on-farm biosecurity to prevent cross-species contacts. The model is applied to bovine tuberculosis among Michigan\\u000a white-tailed deer and cattle. We find optimal controls may target the livestock
Richard D. Horan; Christopher A. Wolf; Eli P. Fenichel; Kenneth H. Mathews Jr
The joint capsule is vital to the function of synovial joints. It seals the joint space, provides passive stability by limiting movements, provides active stability via its proprioceptive nerve endings and may form articular surfaces for the joint. It is a dense fibrous connective tissue that is attached to the bones via specialised attachment zones and forms a sleeve around the joint. It varies in thickness according to the stresses to which it is subject, is locally thickened to form capsular ligaments, and may also incorporate tendons. The capsule is often injured, leading to laxity, constriction and/or adhesion to surrounding structures. It is also important in rheumatic disease, including rheumatoid arthritis and osteoarthritis, crystal deposition disorders, bony spur formation and ankylosing spondylitis. This article concentrates on the specialised structures of the capsule--where capsular tissues attach to bone or form part of the articulation of the joint. It focuses on 2 joints: the rat knee and the proximal interphalangeal (PIP) joint of the human finger. The attachments to bone contain fibrocartilage, derived from the cartilage of the embryonic bone rudiment and rich in type II collagen and glycosaminoglycans. The attachment changes with age, when type II collagen spreads into the capsular ligament or tendon, or pathology--type II collagen is lost from PIP capsular attachments in rheumatoid arthritis. Parts of the capsule that are compressed during movement adapt by becoming fibrocartilaginous. Such regions accumulate cartilage-like glycosaminoglycans and may contain type II collagen, especially in aged material.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7928639
Ralphs, J R; Benjamin, M
About 30% of individuals in the Swedish population will at some stage during life have treatment with orthodontic appliances. In more severe cases, when orthodontic treatment is not considered sufficient enough to correct the malocclusion, the orthodontic treatment is combined with orthognathic surgery. For these cases, a satisfying jaw relation is achieved by surgically moving the maxilla and/or the mandible into a pre-planned position. Patients due to be treated with orthognathic surgery often suffer from an impaired masticatory function, symptoms from the masticatory muscles or temporomandibular joints (temporomandibular disorders), headaches as well as dissatisfaction with their facial aesthetics. Since orthognathic treatment is expensive, in many cases arduous to the patient and not without complications, it is important to assess the treatment outcome and if this is satisfying for the patients. Previous studies that have examined the outcome after orthognathic treatment have had diverging study designs and have come to different conclusions with regard to both temporomandibular disorders and masticatory function. The overall aim of this thesis was to assess and compare the frequencies of temporomandibular disorders and the masticatory function in patients with dentofacial deformities before and after orthognathic treatment. THE THESIS IS BASED ON THE FOLLOWING STUDIES: Paper I is a systematic literature review aiming to, in an evidence-based approach, answer the question whether orthognathic treatment affects the prevalence of signs and symptoms of temporomandibular disorders. The review encompasses the period from January 1966 to April 2006 and was further extended to May 2013 in the frame story of this thesis. CONCLUSIONS IN PAPER I AND THE COMPLEMENTARY SURVEY: There is insufficient scientific evidence for a decrease of sub diagnoses of temporomandibular disorders after orthognathic treatment. There is limited scientific evidence for a reduction of masticatory muscle pain on palpation after orthognathic treatment. There is insufficient scientific evidence for an effect on temporomandibular joint pain on palpation and temporomandibular joint sounds from orthognathic surgery. Further controlled, well-designed studies assessing temporomandibular disorders before and after orthognathic treatment are needed to consolidate strong evidence considering treatment outcomes. Papers II and III are studies comparing frequencies of temporomandibular disorders in patients with dentofacial deformities with a control group. The patients were referred for a combined orthodontic and orthognathic treatment to correct their malocclusion. The control group comprised individuals with normal occlusion or minor malocclusion traits not in need of orthodontic treatment. In Paper III, temporomandibular disorders were longitudinally analysed by assessing and comparing frequencies before and after orthognathic treatment. All individuals in the studies were diagnosed according to the research diagnostic criteria for temporomandibular disorders. CONCLUSIONS IN PAPERS II AND III: Patients due to be treated with orthognathic surgery had more signs and symptoms of temporomandibular disorders and a higher frequency of diagnosed temporomandibular disorders compared with the age- and gender matched control group. Patients with dentofacial deformities, corrected by orthodontic treatment in conjunction with orthognathic surgery, had a positive treatment outcome in respect of myofascial pain and arthralgia. After treatment the frequency of temporomandibular disorders . in the treatment group was low and at an equivalent level of that in the control group. Paper IV evaluates the self-estimated masticatory ability and the masticatory performance before and after orthognathic treatment in the same individuals as in Paper II and III. CONCLUSIONS IN PAPER IV: Masticatory ability and performance increased after orthognathic treatment. The number of occlusal contacts and severity of overall symptoms of TMD influenced both the masticatory ability and performan
Temporomandibular disorder (TMD) is a collective term used to characterize a heterogeneous group of conditions involving the temporomandibular joint (TMJ) and its contiguous tissues. Although the pathologies behind TMDs have not been completely explained, the symptoms associated with these disorders are similar and are most commonly manifest as pain in the orofacial region. In preliminary studies, botulinum toxin has been used successfully to treat various pain syndromes, including TMDs. Because of the complex nature of TMDs and proximity of affected muscles to facial nerves, correct injection technique and appropriate dosing guidelines are very important for successful results. This article describes common TMDs and their treatment with botulinum toxin. Dosing guidelines and illustrations of affected muscles and target injection sites are provided. PMID:12569969
Schwartz, Marvin; Freund, Brian
Dermal grafts have been described for a variety of applications, including preprosthetic surgery, reconstructive surgery, and temporomandibular joint surgery. Several reports have described the procedural techniques for acquiring a dermal graft. The surgical technique for harvesting a dermal graft with the use of the dermabrading diamond fraise bur is described. The use of the diamond fraise bur offers many unique
Faisal A Quereshy; Michael S Hauser
The use of interactive computer-based simulation of cases of chronic orofacial pain and temporomandibular joint disfunction patients for clinical dental education is described. Its application as a voluntary study aid in a third-year dental course is evaluated for effectiveness and for time factors in case completion. (MSE)
Clark, Glenn T.; And Others
For a better definition of diagnostic subgroups of patients with temporomandibular disorders (TMD), clinical orthopedic tests have been developed for the masticatory system, for use together with the commonly used active movement tests and palpation. In the present study, the characteristics and additional diagnostic value of four orthopedic tests-namely, passive opening, the joint play test, compression, and the static pain
A. M. Lobbezoo-Scholte; M. H. Steenks; J. A. J. Faber; F. Bosman
Symptomatic sacroiliac (SI) joint disease is poorly understood. The literature provides no clear aetiology for SI joint pathology, making evaluation and diagnosis challenging. We hypothesised that patients with documented sacroiliac pain might provide insight into the aetiology of these symptoms. Specifically, we questioned whether SI joint symptoms might be associated with abnormal hip radiographs. We reviewed the pelvic and hip radiographs of a prospectively collected cohort of 30 consecutive patients with SI joint pathology. This database included 33 hips from 30 patients. Radiographic analysis included measurements of the lateral centre edge angle, Tönnis angle, and the triangular index, of the ipsilateral hip. Evidence for retrotorsion of the hemipelvis was recorded. Hips were graded on the Tönnis grading system for hip arthrosis. In this cohort 14/33 (42%) of hips had evidence of significant osteoarthrosis indicated by Tönnis grade 2 or greater and 15/33 (45%) displayed subchondral cyst formation around the hip or head neck junction. In assessing acetabular anatomy, 21% (7/33) had retroversion, 12% (4/33) had a lateral centre edge angle >40° with 3% (1/33) >45°. Tönnis angle was <0° in 27% (9/33). Coxa profunda and acetabuli protrusio were present in 47% (17/33) and 3% (1/33), respectively. When femoral head morphology was assessed, 33% (11/33) showed evidence of cam impingement. Overall, 76% (25/33) had at least one abnormality on their hip radiograph. A significant number of patients meeting strict diagnostic criteria for SI joint pain had radiographic evidence of femoroacetabular impingement (FAI) and hip arthrosis. The clinician should maintain FAI in the differential diagnosis when investigating patients with buttock pain. PMID:23417531
Morgan, Patrick M; Anderson, Anthony W; Swiontkowski, Marc F
Background Temporomandibular disorders are the most common cause of chronic orofacial pain, but, except where they occur subsequent to trauma, their cause remains unknown. This cross-sectional study assessed chewing function (habitual chewing side) and the differences of the chewing side and condylar path and lateral anterior guidance angles in participants with chronic unilateral temporomandibular disorder. This is the preliminary report of a randomized trial that aimed to test the effect of a new occlusal adjustment therapy. Methods The masticatory function of 21 randomly selected completely dentate participants with chronic temporomandibular disorders (all but one with unilateral symptoms) was assessed by observing them eat almonds, inspecting the lateral horizontal movement of the jaw, with kinesiography, and by means of interview. The condylar path in the sagittal plane and the lateral anterior guidance angles with respect to the Frankfort horizontal plane in the frontal plane were measured on both sides in each individual. Results Sixteen of 20 participants with unilateral symptoms chewed on the affected side; the concordance (Fisher’s exact test, P?=?.003) and the concordance-symmetry level (Kappa coefficient ??=?0.689; 95% confidence interval [CI], 0.38 to 0.99; P?=?.002) were significant. The mean condylar path angle was steeper (53.47(10.88) degrees versus 46.16(7.25) degrees; P?=?.001), and the mean lateral anterior guidance angle was flatter (41.63(13.35) degrees versus 48.32(9.53) degrees P?=?.036) on the symptomatic side. Discussion The results of this study support the use of a new term based on etiology, “habitual chewing side syndrome”, instead of the nonspecific symptom-based “temporomandibular joint disorders”; this denomination is characterized in adults by a steeper condylar path, flatter lateral anterior guidance, and habitual chewing on the symptomatic side.
Santana-Mora, Urbano; Lopez-Cedrun, Jose; Mora, Maria J.; Otero, Xose L.; Santana-Penin, Urbano
Two cases of Charcot-like joints in patients with pseudogout who were otherwise neurologically intact are presented. The arthropathy of pseudogout should include Charcot-like joints and it is emphasized that an apparent Charcot joint should raise the question of pseudogout.
Helms, C.A.; Chapman, G.S.; Wild, J.H.
Objectives: To analyze the influence of socioeconomic and demographic factors (gender, economic class, age and marital status) on the occurrence of temporomandibular disorder. Study Design: One hundred individuals from urban areas in the city of Recife (Brazil) registered at Family Health Units was examined using Axis I of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) which addresses myofascial pain and joint problems (disc displacement, arthralgia, osteoarthritis and oesteoarthrosis). The Brazilian Economic Classification Criteria (CCEB) was used for the collection of socioeconomic and demographic data. Then, it was categorized as Class A (high social class), Classes B/C (middle class) and Classes D/E (very poor social class). The results were analyzed using Pearson’s chi-square test for proportions, Fisher’s exact test, nonparametric Mann-Whitney test and Binary logistic regression analysis. Results: None of the participants belonged to Class A, 72% belonged to Classes B/C and 28% belonged to Classes D/E. The multivariate analysis revealed that participants from Classes D/E had a 4.35-fold greater chance of exhibiting myofascial pain and 11.3-fold greater chance of exhibiting joint problems. Conclusions: Poverty is a important condition to exhibit myofascial pain and joint problems. Key words:Temporomandibular joint disorders, risk factors, prevalence.
Magalhaes, Bruno G.; de-Sousa, Stephanie T.; de Mello, Victor V C.; da-Silva-Barbosa, Andre C.; de-Assis-Morais, Mariana P L.; Barbosa-Vasconcelos, Marcia M V.
Multipotent mesenchymal stem cells (MSCs) found in the synovial fluid (SFMSCs) of the tempromandibular joint (TMJ) remain poorly understood. During TMJ arthrocentesis, we discovered that synovial fluid collected from some patients with TMJ disorders contained not only SFMSCs but also synovium fragments (SFs). In this study, we attempted to characterize both the SFMSCs and SF-derived cells (SFCs) in order to further understand the role of MSCs in the synovial fluid of the TMJ. The SFs were membranous and translucent and consisted of several cell layers, indicating that their origin was only from the intima. SFCs were obtained by digestion of the SFs and subsequently expanded in vitro. SFMSCs were enriched by centrifugation of the synovial fluid and expanded in vitro. SFCs and SFMSCs displayed a similar fibroblast-like, spindle-shaped morphology, and we observed that some SFMSCs grew out of small tissue masses in culture. Flow cytometric analysis showed that both groups of cells expressed similar surface markers, including CD90, CD44, CD105, and CD73. However, both were negative for Stro-1, CD146, CD45, CD34, CD11b, CD19, and HLA-DR. Immunofluorescent staining showed that both SFs and SFMSCs expressed vascular cell adhesion molecule 1. Both SFCs and SFMSCs could be induced to differentiate down osteogenic, chondrogenic, adipogenic, and neurogenic lineages in vitro. Together, our results indicate that the intima is the most likely tissue origin of SFMSCs in the TMJ. Moreover, the SFs are composed of only intima and thus offer an improved source of synovium-derived MSCs compared to synovium specimens obtained by surgery, which contain both intima and subintima.
Sun, Yang-peng; Zheng, You-hua; Liu, Wen-jing; Zheng, Yu-liang; Zhang, Zhi-guang
The first joint replacement surgery was performed in 1919. Since then, joint replacement surgery has undergone tremendous development in terms of surgical technique and anesthetic management. In this era of nuclear family and independent survival, physical mobility is of paramount importance. In recent years, with an increase in life expectancy, advances in geriatric medicine and better insurance coverage, the scenario of joint replacement surgery has changed significantly. Increasing number of young patients are undergoing joint replacement for pathologies like rheumatoid arthritis and ankylosing spondylitis. The diverse pathologies and wide range of patient population brings unique challenges for the anesthesiologist. This article deals with anesthetic issues in joint replacement surgery in patients with comorbidities.
Kakar, P N; Roy, Preety Mittal; Pant, Vijaya; Das, Jyotirmoy
Objective: To compare the risk factors and clinical manifestations of patients with temporomandibular disorders (TMDs) diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) (axis I) versus an age and gender matched control group. Study Design: A total of 162 patients explored according to the RDC/TMD (mean age 40.6±18.8 years, range 7-90; 11.1% males and 88.9% females) were compared with 119 controls, measuring differences in TMD risk factors (sleep disturbances, stress, psychoactive medication, parafunctions, loss of posterior support, ligament hyperlaxity) and clinical variables (joint sounds, painful muscle and joint palpation, maximum aperture). Results: Myofascial pain (MFP) (single or multiple diagnoses) was the most frequent diagnosis (42%). The most common diagnostic combination was MFP plus arthralgia (16.0%). Statistically significant differences were observed in clenching (OR 2.3; 95%CI: 1.4-3.8) and in maximum active aperture (MAA) on comparing the two groups both globally (TMD vs. controls) (patients 36.7±8.6 mm, controls 43.1±5.8 mm; F=45.41, p = 0.000) and on comparing according to diagnostic categories. MFP explained most of the observed differences in the risk factors: stress perception (OR=1.98;I.C.:1.01-3.89), psychoactive medication (OR=2.21; I.C.:1.12-4.37), parafunctions (OR=2.14;I.C.:1.12-4.11), and ligament laxity (OR=2.6;I.C.:1.01-6.68). Joint sounds were more frequent in patients with MFP (39.7% vs. 24.0%; ?2=4.66; p=0.03), and painful joint palpation was more common in patients with disc displacement with reduction (DDWR)(15.9% vs. 5.0%; ?2 = 5.2; p = 0.02) and osteoarthrosis (20.8% vs. 5.0%; ?2 = 7.0; p = 0.008). Conclusions: There is a high prevalence of signs and symptoms of TMDs in the general population. Significant differences are observed in clenching and MAA between patients and controls considered both globally and for each diagnostic category individually. The analyzed risk factors (except loss of posterior support) show a statistically significant OR for the diagnosis of MFP. Key words:Disorder, dysfunction, temporomandibular, myofascial, osteoarthrosis, TMJ, disc displacement.
Bagan, Jose V.; Sanchis, Jose M.; Carbonell, Enrique
Release of the patellar retinaculum and tibial tubercle elevation have both been advocated for the treatment of patellofemoral degeneration. Questions remain, however, regarding the magnitude and predictability of such effects in diseased joints. Using cadaver knee joints exhibiting a range of patellofemoral cartilage degeneration, we investigated the effects on joint contact pressures on release of the patellar retinaculum, followed by tibial tubercle elevations of 1.25 and 2.5 cm. Retinacular release failed to alter the joint-loading parameters significantly. Tibial tubercle elevation reduced the patello-femoral joint contact area and contact force, but failed to cause a consistent change in contact pressure. Tibial tubercle elevation also caused a migration of the joint contact area superolaterally on the retropatellar surface. This migration occurred in conjunction with ventral tilting of the inferior pole of the patella as the tubercle was elevated, suggesting that significant changes in joint kinematics may result from this procedure. PMID:2213343
Lewallen, D G; Riegger, C L; Myers, E R; Hayes, W C
The term TMD refers to a collection of medical and dental conditions affecting the temporomandibular joint (TMJ) and/or muscles of mastication, as well as contiguous tissue components. Symptoms range from occasional discomfort to debilitating pain and sev...
Thirty-eight osteoarthrotic knees were examined to assess the widths of the femorotibial joint spaces. Radiographs were exposed with the patient lying, in a standing position, and with an adduction and abduction force. Forced compression of the osteoarthrotic joint compartment caused, on average, 18% greater narrowing than when loading it in the standing position. Compared to the joint space at rest, the non-weight-bearing compartment widened by 16% in the standing position and narrowed by 20% when stress was applied. Furthermore, the results showed an increase in laxity proportional to the degree of arthrosis. Stress radiographs significantly display the real cartilage width of both joint compartments. Knowledge of the condition of the articular cartilage in the non-weight-bearing compartment is important when considering a transfer of loading stresses by means of osteotomy. PMID:3423831
Tallroth, K; Lindholm, T S
Shotgun injuries to the maxillofacial region may have minor or, more often, devastating consequences. The most important factor in determining the extent of injury is the distance of the victim from the muzzle of the gun: usually, the longer the distance, the less severe the damage. Here is reported a case of shotgun injury sustained from a distance of approximately
C. Taglialatela Scafati; S. Taglialatela Scafati; M. Gargiulo; M. Cassese; S. Parascandolo
Data sourcesThe Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline Embase, Lilacs, Allied and Complementary Medicine Database (AMED) and CINAHL databases were searched. In addition the reference lists of the included articles were checked and 14 journals hand searched.Study selectionRandomised controlled clinical trials (RCT) of arthroscopy for treating TMDs were included. There were
The synovial joint contains synovial fluid (SF) within a cavity bounded by articular cartilage and synovium. SF is a viscous fluid that has lubrication, metabolic, and regulatory functions within synovial joints. SF contains lubricant molecules, including proteoglycan-4 and hyaluronan. SF is an ultrafiltrate of plasma with secreted contributions from cell populations lining and within the synovial joint space, including chondrocytes and synoviocytes. Maintenance of normal SF lubricant composition and function are important for joint homeostasis. In osteoarthritis, rheumatoid arthritis, and joint injury, changes in lubricant composition and function accompany alterations in the cytokine and growth factor environment and increased fluid and molecular transport through joint tissues. Thus, understanding the synovial joint lubrication system requires a multi-faceted study of the various parts of the synovial joint and their interactions. Systems biology approaches at multiple scales are being used to describe the molecular, cellular, and tissue components and their interactions that comprise the functioning synovial joint. Analyses of the transcriptome and proteome of SF, cartilage, and synovium suggest that particular molecules and pathways play important roles in joint homeostasis and disease. Such information may be integrated with physicochemical tissue descriptions to construct integrative models of the synovial joint that ultimately may explain maintenance of health, recovery from injury, or development and progression of arthritis.
Hui, Alexander Y.; McCarty, William J.; Masuda, Koichi; Firestein, Gary S.; Sah, Robert L.
Objectives: The present study was designed to evaluate the usefulness of deep dry needling in the treatment of temporomandibular myofascial pain. Study Design: We selected 36 patients with myofascial pain located in the external pterygoid muscle (30 women/6 men, mean age=27 years with SD±6,5). We studied differences in pain with a visual analog scale and range of mandibular movements before and after intervention. Results: We found a statistically significant relationship (p<0,01) between therapeutic intervention and the improvement of pain and jaw movements, which continued up to 6 months after treatment. Pain reduction was greater the higher was the intensity of pain at baseline. Conclusions: Although further studies are needed, our findings suggest that deep dry needling in the trigger point in the external pterygoid muscle can be effective in the management of patients with myofascial pain located in that muscle. Key words:Temporomandibular joint, myofascial pain, external pterygoid muscle, trigger point, deep dry needling.
Gonzalez-Perez, Luis M.; Granados-Nunez, Mercedes; Urresti-Lopez, Francisco J.
Arthroscopy of the hip joint was performed in 19 children with Legg-Calvé-Perthes' disease. Proliferation of the synovium was pronounced both in the acetabular fossa and over the inner wall of the capsule. Hypervascularity was seen on the acetabular labrum in every stage of the disease. Microscopically, hyperplasia of the synovial lining cells was observed, but inflammatory changes in the synovial tissue were inconspicuous in the early stage of the disease. Although hypertrophy of the endothelial cells of the vessels was seen in the late stage of the disease, it was not distinct in the initial or fragmentation stages. Joint pain improved after irrigation during arthroscopy. PMID:7839839
Suzuki, S; Kasahara, Y; Seto, Y; Futami, T; Furukawa, K; Nishino, Y
\\u000a Joint tissues, including cartilage, bone, meniscus, tendon, ligament and synovial membrane, are exposed to high mechanical\\u000a stimulation. The response of these tissues to mechanical strains is a key factor of the OA onset and progression. Any little\\u000a failure in this mechanical function may lead to cell phenotype alteration and tissue damages. While mechanical responses of\\u000a cartilage are well known, very
Christelle Sanchez; Marianne Mathy-Hartert; Yves Henrotin
A comparative study of the distribution of immunoglobulins G, M, and A and C3 in the synovium and inside synovial fluid leucocytes and of the relative levels of IgG, IgM, AND C3 in paired samples of serum and synovial fluid from both seropositive and seronegative patients with rheumatoid arthritis and other types of non-infective synovitis shows that although there is no distinctive immunopathological feature of rheumatoid arthritis, the incidence of immune complexes containing IgG and IgM with and without detectable C3 in the affected synovium or inside synovial fluid granulocytes is higher in rheumatoid arthritis and especially so in seropositive cases. The mean level of C3 in synovial fluid from patients with rheumatoid arthritis is lower than that from the group without rheumatoid arthritis. In contrast to previous reports, extracellular clumps of IgA could be detected in the affected synovium of a number of affected patients. Aggretated human IgG could be bound by some of the synovial biopsies and synovial fluid leucocytes from both seropositive and seronegative rheumatoid arthritis patients. Antinuclear factor and rheumatoid factor could be detected in the synovial fluid but not in the serum of several patients suggesting either selective sequestration or local synthesis of antinuclear and rheumatoid factors in the affected joints. Images
Ghose, T; Woodbury, J F; Ahmad, S; Stevenson, B
A total of 329 children with hip pain were examined by ultrasound, which indicated transient synovitis (n = 161), rheumatoid arthritis (n = 16), tuberculoid arthritis (n = 3), septic arthritis (n = 16), Legg-Calvé-Perthes disease (n = 102), and slipped capital femoral epiphysis (n = 31). Using the standard planes described by DEGUM and DGOOC, it is possible to analyze the joint capsule, the surface of the femoral head, and the periarticular structures. In cases of synovitis or joint effusion, a capsular distension can be diagnosed by ultrasound. This distension is typical in transient synovitis, septic and tuberculoid arthritis, juvenile rheumatoid arthritis, and the onset phase of Perthes disease. Because capsular distension exhibits no significant differences in the various diseases, differentiation is not possible with ultrasound in the absence of osseous abnormalities. In cases with both capsular distension and osseous abnormalities, ultrasound usually allows a differentiation between slipped capital femoral epiphysis and Perthes disease as well as septic and unspecific arthritis. PMID:12017857
Konermann, W; Gruber, G
Behcet's disease (BD) is a polysymptomatic and recurrent systemic vasculitis with a chronic course and unknown cause. Erosive arthropathy is extremely rare. We report a 52-year-old female patient with BD demonstrating bone erosion of the sternocostal joint. PMID:19564715
Nanke, Yuki; Kobashigawa, Tsuyoshi; Yago, Toru; Ichikawa, Naomi; Yamanaka, Hisashi; Kotake, Shigeru
Calcium pyrophosphate crystal deposition disease (CPPD), previously pseudogout, is the second most common crystal arthropathy after gout. There is increased radiographic prevalence associated with age, trauma and several metabolic disorders. Tophaceous CPPD (T-CPPD) is a rare form of CPPD which, though non-neoplastic, mimics a bone or soft tissue malignancy. T-CPPD usually presents as a mass in the temporomandibular joint and occasionally in the paraspinal tissues, but rarely in the joints of the extremities. We present an exceptionally rare case of T-CPPD that was subtle on plain radiography, presenting as a soft tissue mass in the knee joint. PMID:24916978
Watura, Christopher; Saifuddin, Asif
Moyamoya disease is a rare cerebrovascular disorder which, according to a few literature reports, can coexist with hypothalamic-pituitary dysfunction. We report a 16 year-old boy referred to our Department because of short stature and headaches. He additionally, at admission, presented dis- crete facial dysmorphy, bruxism, luxation of temporomandibular joint and cryptorchidism. The height was 146 cm (-4.3 SDS); the sexual
Maria Kalina; Barbara Kalina-Faska; Katarzyna Wojaczynska-Stanek; Ewa Malecka-Tender; Elzbieta Marszal
Temporomandibular disorders (TMD) are characterized by the presence of temporomandibular joint (TMJ) and/or masticatory muscle pain and dysfunction. Low-level laser is presented as an adjuvant therapeutic modality for the treatment of TMD, especially when the presence of inflammatory pain is suspected. Objective To systematically review studies that investigated the effect of low level laser therapy (LLLT) on the pain levels in individuals with TMD. Material and Methods The databases Scopus, embase, ebsco and PubMed were reviewed from January/2003 to October/2010 with the following keywords: laser therapy, low-level laser therapy, temporomandibular joint disorders, temporomandibular joint dysfunction syndrome, temporomandibular joint, temporomandibular, facial pain and arthralgia, with the inclusion criteria for intervention studies in humans. exclusion criteria adopted were intervention studies in animals, studies that were not written in english, Spanish or Portuguese, theses, monographs, and abstracts presented in scientific events. Results After a careful review, 14 studies fit the criteria for inclusion, of which, 12 used a placebo group. As for the protocol for laser application, the energy density used ranged from 0.9 to 105 J/cm2, while the power density ranged from 9.8 to 500 mW. The number of sessions varied from 1 to 20 and the frequency of applications ranged from daily for 10 days to 1 time per week for 4 weeks. A reduction in pain levels was reported in 13 studies, with 9 of these occurring only in the experimental group, and 4 studies reporting pain relief for both the experimental group and for the placebo. Conclusion Most papers showed that LLLT seemed to be effective in reducing pain from TMD. However, the heterogeneity of the standardization regarding the parameters of laser calls for caution in interpretation of these results. Thus, it is necessary to conduct further research in order to obtain a consensus regarding the best application protocol for pain relief in patients with TMD.
MAIA, Mila Leite de Moraes; BONJARDIM, Leonardo Rigoldi; QUINTANS, Jullyana de Souza Siqueira; RIBEIRO, Maria Amalia Gonzaga; MAIA, Luiz Guilherme Martins; CONTI, Paulo Cesar Rodrigues
Background Patients suffering from a pathological fracture or painful bony lesion because of metastatic bone disease often benefit from a total joint replacement. However, these are large operations in patients who are often weak. We examined the patient survival and complication rates after total joint replacement as the treatment for bone metastasis or hematological diseases of the extremities. Patients and methods 130 patients (mean age 64 (30–85) years, 76 females) received 140 joint replacements due to skeletal metastases (n = 114) or hematological disease (n = 16) during the period 2003–2008. 21 replaced joints were located in the upper extremities and 119 in the lower extremities. Clinical and survival data were extracted from patient files and various registers. Results The probability of patient survival was 51% (95% CI: 42–59) after 6 months, 39% (CI: 31–48) after 12 months, and 29% (CI: 21–37) after 24 months. The following surgical complications were seen (8 of which led to additional surgery): 2–5 hip dislocations (n = 8), deep infection (n = 3), peroneal palsy (n = 2), a shoulder prosthesis penetrating the skin (n = 1), and disassembly of an elbow prosthesis (n = 1). The probability of avoiding all kinds of surgery related to the implanted prosthesis was 94% (CI: 89–99) after 1 year and 92% (CI: 85–98) after 2 years. Conclusion Joint replacement operations because of metastatic bone disease do not appear to have given a poorer rate of patient survival than other types of surgical treatment, and the reoperation rate was low.
Tooth grinding and tooth clenching are unvoluntary mainly nocturnal habits that result in an hypertrophy of masseter and temporalis muscles with an unbalance between opening and closing muscles of the jaw and lead to an alteration of mandibular condyles movements and to hyper pressure in the temporo-mandibular joints (TMJ) which can generate severe pain. Intra muscular injections of botulinum toxin permit to restablish the balance between closing and opening muscles, to relieve pain, to treat masseteric hypertrophy with improvement of face outline and to recover a normal cinetic of temporo-mandibular joints. Moreover, botulinum toxin injections permit to quit habits of tooth grinding and clenching and one single session of injections is curative for 2/3 of the patients. There are no side effects apart from slight diffusion to superficial muscles of the face resulting in a "fixed" smile for about 6 to 8 weeks. So injections of botulinum toxin in masseter and temporalis muscles are an efficient treatment of bruxism and TMJ dysfunction, cheap with no lasting side effect. PMID:12928140
Chikhani, L; Dichamp, J
The objective of this study was to evaluate prospectively the outcome of 21 clinical patients treated with triple pelvic osteotomies during the year following surgery. Specific aims included documenting the time of and extent of improved limb function as measured by force plate analysis, evaluating the progression of degenerative joint disease (DJD) in the treated and untreated coxofemoral joints, and determining whether or not triple pelvic osteotomy resulted in degenerative joint changes in the ipsilateral stifle and hock. Twelve dogs were treated unilaterally and nine dogs were treated bilaterally with triple pelvic osteotomies. There were no differences in mean anteversion angles, angles of inclination, or preoperative DJD between treated hips and untreated hips. Degenerative joint disease progressed significantly in all hips regardless of treatment. Two cases developed hyperextension of their hocks after the triple pelvic osteotomies. However, no radiographic evidence of DJD was observed for any of the stifles or hocks at any observation time. A significant increase in vertical peak force (VPF) scores was noted for treated legs by two-to-three months after surgery, which continued over time. Untreated legs did not show a significant change in VPF scores over time. No differences were found in progression to higher scores when unilaterally treated legs, first-side treated legs, and second-side treated legs were compared. PMID:9590455
Johnson, A L; Smith, C W; Pijanowski, G J; Hungerford, L L
A key step for Alzheimer's disease (AD) study is to identify associations between genetic variations and intermediate phenotypes (e.g., brain structures). At the same time, it is crucial to develop a noninvasive means for AD diagnosis. Although these two tasks-association discovery and disease diagnosis-have been treated separately by a variety of approaches, they are tightly coupled due to their common biological basis. We hypothesize that the two tasks can potentially benefit each other by a joint analysis, because (i) the association study discovers correlated biomarkers from different data sources, which may help improve diagnosis accuracy, and (ii) the disease status may help identify disease-sensitive associations between genetic variations and MRI features. Based on this hypothesis, we present a new sparse Bayesian approach for joint association study and disease diagnosis. In this approach, common latent features are extracted from different data sources based on sparse projection matrices and used to predict multiple disease severity levels based on Gaussian process ordinal regression; in return, the disease status is used to guide the discovery of relationships between the data sources. The sparse projection matrices not only reveal the associations but also select groups of biomarkers related to AD. To learn the model from data, we develop an efficient variational expectation maximization algorithm. Simulation results demonstrate that our approach achieves higher accuracy in both predicting ordinal labels and discovering associations between data sources than alternative methods. We apply our approach to an imaging genetics dataset of AD. Our joint analysis approach not only identifies meaningful and interesting associations between genetic variations, brain structures, and AD status, but also achieves significantly higher accuracy for predicting ordinal AD stages than the competing methods. PMID:24297556
Zhe, Shandian; Xu, Zenglin; Qi, Yuan; Yu, Peng
Reported here is the case of a 29-year-old male with cervical lymphadenopathy, fever and weight loss, followed by acute painful osteomyelitis of the left hip joint due to cat-scratch disease. The diagnosis was established by detection of IgG antibodies to Bartonella henselae in serum and histologic examination of a lymph node including a positive polymerase chain reaction test. Treatment consisted of clarithromycin and cefotiam for 2 weeks. Four weeks after discharge, all of the patient's symptoms had completely resolved. Magnetic resonance imaging of the left hip joint showed marked regression of bone inflammation 4 months later and normalization after 8 months. Cat-scratch disease should be considered in the differential diagnosis of osteomyelitis in an adult, especially when lymphadenitis is present. PMID:11117643
Krause, R; Wenisch, C; Fladerer, P; Daxböck, F; Krejs, G J; Reisinger, E C
Most MRI studies of Alzheimer's disease (AD) and frontotemporal dementia (FTD) have assessed structural, perfusion and diffusion abnormalities separately while ignoring the relationships across imaging modalities. This paper aimed to assess brain gray (GM) and white matter (WM) abnormalities jointly to elucidate differences in abnormal MRI patterns between the diseases. Twenty AD, 20 FTD patients, and 21 healthy control subjects were imaged using a 4?Tesla MRI. GM loss and GM hypoperfusion were measured using high-resolution T1 and arterial spin labeling MRI (ASL-MRI). WM degradation was measured with diffusion tensor imaging (DTI). Using a new analytical approach, the study found greater WM degenerations in FTD than AD at mild abnormality levels. Furthermore, the GM loss and WM degeneration exceeded the reduced perfusion in FTD whereas, in AD, structural and functional damages were similar. Joint assessments of multimodal MRI have potential value to provide new imaging markers for improved differential diagnoses between FTD and AD.
Zhang, Yu; Schuff, Norbert; Ching, Christopher; Tosun, Duygu; Zhan, Wang; Nezamzadeh, Marzieh; Rosen, Howard J.; Kramer, Joel H.; Gorno-Tempini, Maria Luisa; Miller, Bruce L.; Weiner, Michael W.
We assessed the impact of various forms of spinal degenerative joint disease (DJD) on bone mineral density (BMD) measured by quantitative computed tomography (QCT) and dual X-ray absorptiometry (DXA) in a group of postmenopausal women. Lateral (T4-L4) and AP (L1-L4) spinal radiographs were reviewed for fracture and DJD in 209 women (mean age 62.6±6.7). The severity of DJD findings was
W. Yu; C.-C. Glüer; T. Fuerst; S. Grampp; J. Li; Y. Lu; H. K. Genant
Hip joints (280) from 140 human fetuses, obtained from abortions and deaths in the perinatal period, were studied. The fetuses ranged from 8.7 to 40 cm in crown-rump length and are believed to be between 12 and 42 weeks in age. The joints were dissected, morphology inspected, and measurements taken of the depth and diameter of the acetabulum, the diameter of the femoral head, length and width of the ligament of the head, the neck-shaft, and torsion angles of the proximal femur. Regression models were fitted to determine which would best predict the growth pattern. Multivariate analysis of variance showed no significant differences between males and females or between the right and left sides. Acetabular depth was shown to be the slowest-growing hip variable, increasing less than fourfold in the period studied. Acetabular indices less than 50 percent indicate a shallow socket at term. Femoral head and acetabular diameter demonstrated a strong relationship (r = 0.860) and in many joints the femoral head diameter exceeded that of the acetabulum. Considerable variability was demonstrated in both femoral angles. The femoral angles showed only low correlation with the other hip variables. These observations indicate that soft tissue structures about the joint must play an important role in neonatal joint stability. The explanation of greater female and left side involvement in congenital hip disease must lie in factors other than growth changes of hip dimensions. Neither angle appears to be a useful indicator of normal joint development. Images FIG. 2 FIG. 3 FIG. 4 FIG. 10 FIG. 11 FIG. 13
Walker, J. M.; Goldsmith, C. H.
This case report presents a patient with tardive dyskinesia who also suffered from masticatory muscle pain and temporomandibular joint osteoarthrosis. The patient was treated with clozapine in gradually increasing doses and two injections of botulinum toxin type A one year apart. Involuntary movements of mandibular clenching and bruxing disappeared and pain was relieved to a great extent. Reappearances of dyskinetic movements and pain were observed during the follow-up period of 1.5 years. PMID:20401360
Pekkan, Gurel; Kilicoglu, Alev; Algin, Demet Ilhan
Regenerative therapeutic strategies for joint diseases usually employ either enriched concentrates of bone marrow-derived stem cells, chondrogenic preparations such as platelet-rich plasma, or irritant solutions such as hyperosmotic dextrose. In this case series, we describe our experience with a simple, cost-effective regenerative treatment using direct injection of unfractionated whole bone marrow (WBM) into osteoarthritic joints in combination with hyperosmotic dextrose. Seven patients with hip, knee or ankle osteoarthritis (OA) received two to seven treatments over a period of two to twelve months. Patient-reported assessments were collected in interviews and by questionnaire. All patients reported improvements with respect to pain, as well as gains in functionality and quality of life. Three patients, including two whose progress under other therapy had plateaued or reversed, achieved complete or near-complete symptomatic relief, and two additional patients achieved resumption of vigorous exercise. These preliminary findings suggest that OA treatment with WBM injection merits further investigation. PMID:24046512
Hauser, Ross A; Orlofsky, Amos
Regenerative therapeutic strategies for joint diseases usually employ either enriched concentrates of bone marrow-derived stem cells, chondrogenic preparations such as platelet-rich plasma, or irritant solutions such as hyperosmotic dextrose. In this case series, we describe our experience with a simple, cost-effective regenerative treatment using direct injection of unfractionated whole bone marrow (WBM) into osteoarthritic joints in combination with hyperosmotic dextrose. Seven patients with hip, knee or ankle osteoarthritis (OA) received two to seven treatments over a period of two to twelve months. Patient-reported assessments were collected in interviews and by questionnaire. All patients reported improvements with respect to pain, as well as gains in functionality and quality of life. Three patients, including two whose progress under other therapy had plateaued or reversed, achieved complete or near-complete symptomatic relief, and two additional patients achieved resumption of vigorous exercise. These preliminary findings suggest that OA treatment with WBM injection merits further investigation.
Hauser, Ross A.; Orlofsky, Amos
Temporomandibular disorder (TMD) is an umbrella term for a collection of disorders affecting the temporomandibular joint (TMJ) and associated tissues. TMD is not a rare pathology for the dentist. The most common presenting symptom is pain, which causes the patient seek immediate treatment. Management is dictated by the cause. The most 'famed' causes include trauma, inflammation, aging, parafunctional habits, infections, neoplasms, and stress; and these are always considered in the differential diagnosis of TMJ pain. There are some less 'famed' causes of TMD, which are characterized by increased pain sensitivity due to psychosocial factors; these include myofascial pain syndrome and functional somatic syndromes (FSS) such as fibromyalgia and chronic fatigue syndrome. They present with chronic pain, fatigue, disability, and impairment in ability to perform daily activities. A non-systematic search in the English literature revealed numerous studies describing the occurrence of TMD in these conditions, along with few other oral manifestations. TMD has been even considered to be a part of the FSS by some. In these patients, TMD remains a recurring problem, and adequate management cannot be achieved by traditional treatment protocols. Awareness of these conditions, with correct diagnosis and modification of management protocols accordingly, may resolve this problem. PMID:23257491
Suma, S; Veerendra Kumar, B
There is a need to expand the current temporomandibular disorders' (TMDs) classification to include less common but clinically important disorders. The immediate aim was to develop a consensus-based classification system and associated diagnostic criteria that have clinical and research utility for less common TMDs. The long-term aim was to establish a foundation, vis-à-vis this classification system, that will stimulate data collection, validity testing and further criteria refinement. A working group [members of the International RDC/TMD Consortium Network of the International Association for Dental Research (IADR), members of the Orofacial Pain Special Interest Group (SIG) of the International Association for the Study of Pain (IASP), and members from other professional societies] reviewed disorders for inclusion based on clinical significance, the availability of plausible diagnostic criteria and the ability to operationalise and study the criteria. The disorders were derived from the literature when possible and based on expert opinion as necessary. The expanded TMDs taxonomy was presented for feedback at international meetings. Of 56 disorders considered, 37 were included in the expanded taxonomy and were placed into the following four categories: temporomandibular joint disorders, masticatory muscle disorders, headache disorders and disorders affecting associated structures. Those excluded were extremely uncommon, lacking operationalised diagnostic criteria, not clearly related to TMDs, or not sufficiently distinct from disorders already included within the taxonomy. The expanded TMDs taxonomy offers an integrated approach to clinical diagnosis and provides a framework for further research to operationalise and test the proposed taxonomy and diagnostic criteria. PMID:24443898
Peck, C C; Goulet, J-P; Lobbezoo, F; Schiffman, E L; Alstergren, P; Anderson, G C; de Leeuw, R; Jensen, R; Michelotti, A; Ohrbach, R; Petersson, A; List, T
Arthroscopy of the hip joint has developed into a useful tool for the hip surgeon. Hip joint anatomy, however, makes special demands of the arthroscopist. He needs to be familiar with the arthroscopic anatomy of the hip and its variations. Moreover, he should have practical training in the technique of hip arthroscopy prior to his first intraoperative experience in order to avoid complications. A complete arthroscopic inspection of the hip can be achieved by using a combined procedure: whereas the central hip compartment can be scoped only by distraction of the joint, the periphery can be better seen without traction. Whether to place the patient supine or lateral is dependent on personal experience. No matter which position is used, the positioning technique has to be exact. The literature has shown that most complications are related to traction. Before the first portal is placed, the joint vacuum force should be broken by distension of air or fluid. This leads to maximum distraction of the joint and reduces the risks of damage to labrum and cartilage during first access to the joint. For a diagnostic round through the central compartment, at least two portals have to be placed. The use of a 3-portal technique increases the range of inspection. Due to the relatively thin soft tissue mantle and greater distance to neurovascular structures, the anterolateral or lateral portal should be used as the first portals to the central compartment. In addition, the anterolateral portal is the standard portal to the periphery of the hip. The posterolateral or anterior portal should be used as a supplementary portal. The following indications have been described for an arthroscopic procedure of the hip: loose bodies, labral lesions, synovial diseases such as chondromatosis and pigmented villonodular synovitis, associated lesions in underlying osteoarthritis, ruptures of the teres ligament, malorientation of the acetabulum and proximal femur and, last but not least, "idiopathic" hip pain. The use of hip arthroscopy in infectious arthritis, avascular necrosis of the femoral head, Perthes' disease, osteochondrosis dissecans and complications after total hip replacement is less frequent. Here, in addition to its diagnostic value, operative arthroscopy of the hip offers removal of loose bodies, resection of the labrum and ligaments, synovial biopsy, partial synovectomy, microfracturing, lavage and placement of intraarticular drainage. The first results of arthroscopic procedures in the hip are promising. In addition to its diagnostic value and contribution to the understanding of intraarticular anatomy and pathology, recent studies have demonstrated the advantages of the arthroscopic treatment of the hip. PMID:11381758
Dienst, M; Kohn, D
Chikungunya virus (CHIKV) is a reemerging mosquito-borne pathogen that causes incapacitating disease in humans characterized by intense joint pain that can persist for weeks, months, or even years. Although there is some evidence of persistent CHIKV infection in humans suffering from chronic rheumatologic disease symptoms, little is known about chronic disease pathogenesis, and no specific therapies exist for acute or chronic CHIKV disease. To investigate mechanisms of chronic CHIKV-induced disease, we utilized a mouse model and defined the duration of CHIKV infection in tissues and the associated histopathological changes. Although CHIKV RNA was readily detectable in a variety of tissues very early after infection, CHIKV RNA persisted specifically in joint-associated tissues for at least 16 weeks. Inoculation of Rag1?/? mice, which lack T and B cells, resulted in higher viral levels in a variety of tissues, suggesting that adaptive immunity controls the tissue specificity and persistence of CHIKV infection. The presence of CHIKV RNA in tissues of wild-type and Rag1?/? mice was associated with histopathological evidence of synovitis, arthritis, and tendonitis; thus, CHIKV-induced persistent arthritis is not mediated primarily by adaptive immune responses. Finally, we show that prophylactic administration of CHIKV-specific monoclonal antibodies prevented the establishment of CHIKV persistence, whereas therapeutic administration had tissue-specific efficacy. These findings suggest that chronic musculoskeletal tissue pathology is caused by persistent CHIKV infection and controlled by adaptive immune responses. Our results have significant implications for the development of strategies to mitigate the disease burden associated with CHIKV infection in humans.
Hawman, David W.; Stoermer, Kristina A.; Montgomery, Stephanie A.; Pal, Pankaj; Oko, Lauren; Diamond, Michael S.
Whole-body bone scintigraphy (or bone scan) is a highly sensitive method for visualizing bone metastases and is the accepted standard imaging modality for detection of metastases and assessment of treatment outcomes. The development of a quantitative biomarker using computer-aided detection on bone scans for treatment response assessment may have a significant impact on the evaluation of novel oncologic drugs directed at bone metastases. One of the challenges to lesion segmentation on bone scans is the non-specificity of the radiotracer, manifesting as high activity related to non-malignant processes like degenerative joint disease, sinuses, kidneys, thyroid and bladder. In this paper, we developed an automated bone scan lesion segmentation method that implements intensity normalization, a two-threshold model, and automated detection and removal of areas consistent with non-malignant processes from the segmentation. The two-threshold model serves to account for outlier bone scans with elevated and diffuse intensity distributions. Parameters to remove degenerative joint disease were trained using a multi-start Nelder-Mead simplex optimization scheme. The segmentation reference standard was constructed manually by a panel of physicians. We compared the performance of the proposed method against a previously published method. The results of a two-fold cross validation show that the overlap ratio improved in 67.0% of scans, with an average improvement of 5.1% points.
Chu, Gregory H.; Lo, Pechin; Kim, Hyun J.; Auerbach, Martin; Goldin, Jonathan; Henkel, Keith; Banola, Ashley; Morris, Darren; Coy, Heidi; Brown, Matthew S.
Multi-modality imaging provides complementary information for diagnosis of neurodegenerative disorders such as Alzheimer’s disease (AD) and its prodrome, mild cognitive impairment (MCI). In this paper, we propose a kernel-based multi-task sparse representation model to combine the strengths of MRI and PET imaging features for improved classification of AD. Sparse representation based classification seeks to represent the testing data with a sparse linear combination of training data. Here, our approach allows information from different imaging modalities to be used for enforcing class level joint sparsity via multi-task learning. Thus the common most representative classes in the training samples for all modalities are jointly selected to reconstruct the testing sample. We further improve the discriminatory power by extending the framework to the reproducing kernel Hilbert space (RKHS) so that nonlinearity in the features can be captured for better classification. Experiments on Alzheimer’s Disease Neuroimaging Initiative database shows that our proposed method can achieve 93.3% and 78.9% accuracy for classification of AD and MCI from healthy controls, respectively, demonstrating promising performance in AD study.
Wang, Yaping; Liu, Manhua; Guo, Lei; Shen, Dinggang
We report a case of closed rupture of the flexor tendons of the little finger caused by calcium pyrophosphate dihydrate crystal deposition disease of the pisotriquetrum joint. The patient could not flex the little finger and did not have wrist pain. Plain radiographs of the affected wrist joint showed severe arthritic changes of the pisotriquetrum joint and calcification around the joint. At operation, the pisotriquetrum joint capsule was ruptured and involved the flexor tendon of the little finger. The distal stump of the flexor tendon was transferred to the flexor tendon of the ring finger, and the pisiform was resected. Histological examination with polarized light microscopy revealed crystals showing weakly positive birefringence in the calcification. PMID:24156589
Wakasugi, Takuma; Shirasaka, Ritsuro; Kimura, Hiroaki; Wakabayashi, Yoshiaki
The loss of anterior teeth leads to extreme psychological trauma, along with functional and esthetic debilitations. Healthy anterior teeth play an important role of protecting the posterior teeth during excursive mandibular movement. Loss of anterior teeth induces posterior interference with extended disocclusion time. Posterior disocclusion is critical to remove the harmful force on the teeth temporomandibular joint and eliminate muscle hypertonicity. Occlusal interference is considered as contributing factor to temporomandibular disorder (TMD) symptoms. Prosthesis design should eliminate deleterious tooth contacts. Establishing optimum anterior guidance is a key to establishing harmonious functional occlusion in addition to the correction of the esthetic and phonetic disabilities. This case report explains the steps involved in the rehabilitation of the TMD patient with loss of maxillary anterior teeth.
Haralur, Satheesh B.; Saeed Al-Shahrani, Omar
For the treatment of myogenous temporomandibular pain, a clinician can choose from among a wide variety of possibilities. Unfortunately, a paper summarizing the effectiveness of all these forms of treatment does not yet exist. The aim of this paper is to provide specific advice for dentists concerning the treatment of patients with myogenous temporomandibular pain by means of a systematic review of the relevant literature. The results of this review of the literature suggest that all forms of treatment selected, including treatment with placeboes, are equally effective in reducing myogenous temporomandibular pain. In order to avoid liability issues, it is advisable to choose for a restrained, reversible form of treatment. The dentist and the patient must, in this respect, be aware that the pain can continue after treatment (albeit at a reduced level) or can return after a period of time. PMID:19507420
van Selms, M K A; Naeije, M; van der Zaag, J; Lobbezoo, F
A large body of evidence suggests that temporomandibular joint disorders (TMJD) are much more prevalent in women than in men. The purpose of this systematic review was to examine whether hormone levels during the menstrual cycle influence TMJD when painful symptoms are present. A data extraction search strategy was performed in the Medline, Embase, Scielo and CINAHL databases from 1970
R. La Touche; J. Fernández-Carnero; J. Pesquera Velasco; J. Mesa
\\u000a Abstract\\u000a \\u000a \\u000a Objective:\\u000a The etiology of temporomandibular disorders (TMD) remains unclear. The aim of this study was, by comparing the prevalence\\u000a of TMD between adolescents of different ethnic origin, to examine whether certain genetic factors may play a role in causing\\u000a TMD.\\u000a \\u000a \\u000a \\u000a \\u000a \\u000a Subjects and Methods:\\u000a We assessed the prevalence of TMD according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC\\/TMD)
Ning Wu; Christian Hirsch
The purpose of this study was to compare the serum interleukin (IL)-23 levels between rheumatoid arthritis (RA) patients and healthy controls and to determine the correlation of IL-23 levels with disease activity, joint damage and functional disability in RA. Serum samples were obtained from 45 patients with RA and 45 healthy controls. The enzyme-linked immunosorbent assay method was used for quantitative analysis of IL-23. All the RA patients were assessed for disease activity based on the 28-joint disease activity score, joint damage based on modified Sharp score, and functional ability using the Health Assessment Questionnaire-Disability Index. The mean serum IL-23 level was much higher among the RA patients (24.50 ± 13.98 pg/mL) compared to the controls (5.98 ± 3.40 pg/mL; p < 0.01). There was a significant positive relationship between IL-23 levels and disease activity and questionnaire scores (p = 0.003 and 0.020, respectively). On logistic regression analysis, IL-23 levels were significantly higher in patients with moderate to high disease activity (p = 0.008, odds ratio = 1.073, 95% confidence interval = 1.019-1.130) and patients with significant functional disability (p = 0.008, odds ratio = 1.085, 95% confidence interval = 1.021-1.153). RA patients have significantly higher levels of serum IL-23. The IL-23 levels correlate well with disease activity and functional disability but not with radiographic joint damage. PMID:24924839
Dalila, Adnan Siti; Mohd Said, Mohd Shahrir; Shaharir, Syahrul Sazliyana; Asrul, Abdul Wahab; Low, Soo Fin; Shamsul, Azhar Shah; Sakthiswary, Rajalingham
The aim of this study was to determine the value of scaphoidtrapezium osteoarthritis (ST osteoarthritis) as an early sign of calcium pyrophosphate dihydrate disease (CPDD) in a cohort of patients undergoing surgery for osteoarthritis of the first carpometacarpal joint. We examined whether patients with cartilage calcification of the wrist at the time of operation had ST osteoarthritis, indicating CPDD at an earlier time (retrospective study), and whether patients with ST osteoarthritis but without cartilage calcification at the time of surgery develop radiological or clinical signs of CPDD at a later time (prospective study). From 1 January 1989 to 31 December 1995 a total of 169 patients (from an orthopaedic clinic) with a diagnosis of osteoarthritis of the first carpometacarpal joint were included in the study; 167 underwent surgery and two were treated without. Of the 16 patients showing calcification on surgery and therefore included in the retrospective study, 12 had prior radiographs, of which eight showed ST osteoarthritis. Among these, four had no concomitant cartilage calcification in the prior radiographs. Of the 32 patients in the prospective group having ST osteoarthritis but no calcifications at the time of surgery, 27 could be clinically examined. Of these, two showed cartilage calcifications on the follow-up radiographs of the hands. The presence of ST osteoarthritis is a helpful diagnostic finding for the diagnosis of CPDD, especially in cases without radiographic cartilage or fibrocartilage calcification of the wrist. ST osteoarthritis may then point to the correct diagnosis. PMID:11254235
Peter, A; Simmen, B R; Brühlmann, P; Michel, B A; Stucki, G
Objectives To investigate whether normal variation of adult height is associated with clinical characteristics in rheumatoid arthritis (RA), including disease activity (DAS28), impairment of joint function (mechanical joint score, MJS) and overall disability (health assessment questionnaire, HAQ). Methods A cohort (134 males, 287 females) of consecutively recruited RA patients of Northern European origin was studied. Height, weight and demographic information were obtained. A core set of disease measurements, including DAS28, MJS and HAQ, were recorded at baseline, 12 and 24 months. Other clinical variables (e.g. disease duration, IgM rheumatoid factor, antibodies to cyclic citrullinated peptide, C-reactive protein, erythrocyte sedimentation rate) were recorded at baseline. Socioeconomic status, smoking status, comorbid condition, other autoimmune conditions and drug therapy were also recorded. Associations were analyzed using univariate statistics and multivariate linear regression models. Mediation tests were also carried out for evaluating the relationship between gender, height and disease measures. Results In males, height was inversely associated with DAS28, MJS and HAQ (at baseline and over 24 months) independent of other factors (e.g. weight, body mass index, age, disease duration, osteoporosis, autoantibodies, erosive disease, joint replacement, steroid use, smoking status, socioeconomic status and comorbid disease). In females, a similar trend was seen but the relationships were non significant. In the whole population, the association of female gender with more active disease and poor function disappeared after adjustment for height. Mediation analysis indicated that height served as a full mediator in the relationship of gender with disease activity and overall disability. Confirmation of these findings was demonstrated in a second RA population (n?=?288). Conclusion Adult height is inversely associated with disease activity, impairment of joint function and overall disability in RA, particularly in males. The association of female sex with more severe disease activity and disability appears to be mediated by smaller stature.
Chen, Ying; Yu, Zanzhe; Packham, Jonathan C.; Mattey, Derek L.
High-dimensional biomarker data are often collected in epidemiological studies when assessing the association between biomarkers and human disease is of interest. We develop a latent class modeling approach for joint analysis of high-dimensional semicontinuous biomarker data and a binary disease outcome. To model the relationship between complex biomarker expression patterns and disease risk, we use latent risk classes to link the 2 modeling components. We characterize complex biomarker-specific differences through biomarker-specific random effects, so that different biomarkers can have different baseline (low-risk) values as well as different between-class differences. The proposed approach also accommodates data features that are common in environmental toxicology and other biomarker exposure data, including a large number of biomarkers, numerous zero values, and complex mean–variance relationship in the biomarkers levels. A Monte Carlo EM (MCEM) algorithm is proposed for parameter estimation. Both the MCEM algorithm and model selection procedures are shown to work well in simulations and applications. In applying the proposed approach to an epidemiological study that examined the relationship between environmental polychlorinated biphenyl (PCB) exposure and the risk of endometriosis, we identified a highly significant overall effect of PCB concentrations on the risk of endometriosis.
Zhang, Bo; Chen, Zhen; Albert, Paul S.
When a lumbar nucleus pulposus deteriorates, instability and abnormal apophyseal joint motion ensues. Cadaver experiments showed abnormal apophyseal joint motion immediately after incision of the corresponding disc. In a retrospective study there was a high positive correlation between abnormal apophyseal joint motion and surgically demonstrated abnormal discs, demonstrated as early as one week following injury. Criteria for abnormal motion include
Martin S. Abel
An enzyme linked immunoassay (ELISA) for the collagen cross link, pyridinoline, has been developed using affinity purified antibodies, with a sensitivity down to about 0.1 ng of cross link. Measurements of urinary pyridinoline were made in patients with rheumatoid arthritis (RA), osteoarthritis (OA), and a control group showing no signs of joint disease. Expressed relative to creatinine values, pyridinoline was
S P Robins; P Stewart; C Astbury; H A Bird
One hundred and eighteen elbows in 59 patients who started treatment using disease-modifying antirheumatic drugs (DMARDs)\\u000a in the first year of the disease were followed-up for more than 10 years without biologic agents. Using annual radiographs\\u000a of the elbow joint, Larsen grade (LG) was determined, and bone absorption ratio (BAR), cortical thickness ratio (CTR) in the\\u000a humerus, and olecranon thickness ratio
Asami Abe; Hajime Ishikawa; Akira Murasawa; Kiyoshi Nakazono
Purpose Diagnosis of osteoarthritis most commonly depends on clinical and radiographic findings. The present study attempted to observe the bony changes in temporomandibular joint (TMJ) patients from all age groups. Materials and Methods The first-visit clinical records and cone beam computed tomography (CBCT) data of 440 TMJs from 220 consecutive TMJ patients were reviewed retrospectively. Results The most frequent condylar bony change observed was sclerosis (133 joints, 30.2%) followed by surface erosion (129 joints, 29.3%), flattening of the articular surface (112 joints, 25.5%), and deviation in form (58 joints, 13.2%), which included 33 TMJs in a cane-shape, 16 with a lateral or medial pole depression, 6 with posterior condylar surface flattening, and 3 with a bifid-shaped condyle. Fifty-three joints (12.0%) showed hypoplastic condyles but only 1 joint showed hyperplasia. Osteophyte was found in 35 joints (8.0%) and subcortical cyst in 24 joints (5.5%), 5 of which had surface erosion as well. One hundred nineteen joints (27.0%) had only one kind of condylar bony change, 66 joints (15.0%) had two, 52 joints (11.8%) had three, 12 joints (5.0%) had four, and 6 joints (1.4%) had five kinds of condylar bony changes at the same time. Eighty-five (65.9%) of 129 joints with surface erosion had pain recorded at the chief complaint. Conclusion With more widespread use of CBCT, more specific or detailed guidelines for osteoarthritis are needed.
The objectives of this study were to evaluate the course of radiographic deterioration of the wrist joint with rheumatoid arthritis (RA), and to determine the influence of disease activity on its deterioration. A retrospective study was performed on 122 wrists in 66 patients, who started treatment using disease-modifying antirheumatic drugs within the first year of the disease and followed for more than 10 years without surgical intervention. The mean disease activity score (DAS28-CRP) was high during the first 2 years, followed by a decrease and a flattening of the curve of disease activity. Generally, carpal collapse progressed more in the early stage and decreased linearly over 10 years. Individually, continuous high disease activity and progression in radiographic damage were observed in carpal collapsed groups from early stage of the disease. The cut-off values of the mean DAS28-CRP(3) during year 0-2, which indicated progression to Larsen grade III or more and Schulthess type I (ankylosis) or III (disintegration) at year 10 were 3.34 (sensitivity: 70.9% and specificity: 72.1%) and 3.63 (sensitivity: 74.3% and specificity: 77.0%), respectively. In patients with RA, deterioration of the wrist joint was influenced by disease activity. Identifying this activity and the course of wrist progression may be useful in predicting wrist deterioration. PMID:18758892
Toyohara, Issaku; Ishikawa, Hajime; Abe, Asami; Nakazono, Kiyoshi; Murasawa, Akira
The aim of this work is to determine the effect of this type of treatment on the shape of the femoral head, the range of motion (ROM), radiological changes in the femoral head, and the prognosis of Perthes disease at skeletal maturity. From 1998 to 2007, 53 patients with Perthes disease were treated with a combination of soft tissue release and joint distraction with a hinged monolateral external fixator in 32 patients and by Ilizarov external fixator in 21 patients. Nineteen of our 53 patients attained skeletal maturity and were evaluated in our study. This study included 15 boys and four girls, mean age at surgery 9.3 years (range 7.2-13.1), and mean age at the last follow-up 17.4 years (range 14.9-21.3). The duration of symptoms varied from a period of 6 to 60 months before the operation. Radiographs taken during the fragmentation stage of the disease were classified by the lateral pillar classification of Herring; 19 of our patients attained skeletal maturity and were evaluated. Clinical assessment included the Harris hip score, hip ROM, and limb length discrepancy. Radiographic assessment included sharp transverse acetabular inclination, the uncoverage percentage, the epiphyseal index before surgery (modified Eyre-Brook), at frame removal, and at the last follow-up, the epiphyseal quotient (of Sjovall), and the Stulberg classification. The mean follow-up was 7.2 years (range 4.1-11.3). The mean Harris hip score was 87.1/100 (range 49.2-94.8). An improvement in hip (ROM) of 83.3% of the normal range was restored. There was a marked improvement in the degree of pain and limp postoperatively. The hip ROM was slightly limited in most patients, and seven patients had limb shortening of between 1 and 3 cm. The mean sharp transverse acetabular inclination of the affected side was 44° (range 35-51) compared with 37° for the unaffected side (P=0.042). The mean uncoverage percentage was 36% (range 24-45) compared with 21% for the unaffected side (P=0.027). The mean epiphyseal index was 0.74 (range 0.36-0.94) before surgery, 0.78 (range 0.49-0.89) at frame removal (P=0.017), and 0.80 (range 0.54-0.91) at the last follow-up (P=0.701). The epiphyseal quotient was 0.74 (range 0.51-0.94) and the Stulberg classifications were type II in eight patients, type III in seven patients, type IV in three patients, and type V in one patient. Arthrodiastasis of the hip joint with soft tissue release may represent a good contribution toward the treatment of Legg-Calvé-Perthes disease. This method of treatment has many advantages such as easy technique, minimal rate of complications, a short hospitalization period, correction of shortening because it adds to the length of the limb, and a higher rate of acceptable results than would be expected compared with other methods. It also improves the ROM, reduces superior and lateral subluxation, and provides better radiographic sphericity of the femoral head. In addition, it does not distort the anatomy of the pelvis or the proximal femur; it can be used with equal success in older children who are typically expected to have a poor prognosis. Distraction treatment is not limited by hip stiffness, degree of femoral head deformity, or subluxation, and can be used when other methods of treatment are contraindicated. PMID:22713742
Laklouk, Mohamed Abdel-Rehim; Hosny, Gamal Ahmed
The Joint Health and Disease Management Program in the Toronto Central Local Health Integration Network (TC LHIN) is envisioned as a comprehensive model of care for patients with hip and knee arthritis. It includes access to assessment services, education, self-management programs and other treatment programs, including specialist care as needed. As the first phase of this program, the hospitals in TC LHIN implemented a Hip and Knee Replacement Program to focus on improving access and quality of care, coordinating services and measuring wait times for patients waiting for hip or knee replacement surgery. The program involves healthcare providers, consumers and constituent hospitals within TC LHIN. The approach used for this program involved a definition of governance structure, broad stakeholder engagement to design program elements and plans for implementation and communication to ensure sustainability. The program and approach were designed to provide a model that is transferrable in its elements or its entirety to other patient populations and programs. Success has been achieved in creating a single wait list, developing technology to support referral management and wait time reporting, contributing to significant reductions in waits for timely assessment and treatment, building human resource capacity and improving patient and referring physician satisfaction with coordination of care. PMID:19369812
Macleod, Anne Marie; Gollish, Jeffrey; Kennedy, Deborah; McGlasson, Rhona; Waddell, James
Alleviation of pain and inhibition of inflammation are the primary goals of pharmacotherapy of osteoarthritis (OA). These therapeutic goals can almost always be accomplished by the use of analgesics and nonsteroidal anti-inflammatory drugs (NSAID). One of the main problems of NSAIDs is their gastrointestinal toxicity, for which a prophylactic medication should be considered particularly amongst risk groups. Recent studies have shown that COX-2-selective and maybe also non-selective NSAIDs increase the cardiovascular risk so that their application is getting now drastically restricted. Pharmacological results published until now suggest that a clinically relevant minor analgesic and/or anti-inflammatory effect can be attained with the use of some of the SYmptomatic Slow Acting Drugs in OA (SYSADOAs). However, no clinical studies exist, which can positively confirm prevention, slowing down or reversal of any advanced joint cartilage destruction by any individual medication. Disease modifying therapy is still in its infancy; discovery and development of novel therapeutic targets and agents are an extremely difficult task, currently challenging many pharmaceutical companies and academic institutions. PMID:16616797
Steinmeyer, Jürgen; Konttinen, Yrjö T
We report 7 cases of sigmoid colon infection in patients taking TNF? antagonist therapy to treat chronic inflammatory joint disease. There were 5 women and 2 men with a mean age of 57.5years (range, 21-77years). The presenting symptoms were abdominal pain, bowel habit changes, and a fever. These symptoms developed within 6months after starting TNF? antagonist therapy in 5 of the 7 patients. Empirical antibiotic therapy was used in all 7 patients. Surgical colectomy was performed in 4 patients, including 1 who required a temporary Hartmann's procedure. The risk of infection associated with TNF? antagonist therapy is well documented. However, few cases of colon infection have been reported and little is known about this potentially severe complication. Glucocorticoids or non-steroidal anti-inflammatory drugs may worsen the infection, particularly as they can attenuate the clinical symptoms, thereby delaying the diagnosis. A history of sigmoid colon infection, diverticulosis, and/or diverticulitis must be sought before starting treatment with a biological agent. Prophylactic treatment may be considered if such a history is found. Diagnostic investigations are in order to develop a standardized management strategy in patients with a history of intestinal tract infection. PMID:24176737
Moyano, Chantal; Beldjerd, Mounir; Pécourneau, Virginie; Billey, Thierry; Lassoued, Slim
Samples of home-grown maize and groundnuts from the endemic area of Mseleni joint disease (MJD) during four seasons (1980-1983) were examined mycologically. The mycoflora of these dietary staples included Fusarium poae and F. oxysporum, which have been implicated in the aetiology of Kashin-Beck or Urov disease, another osteo-arthrosis endemic in Siberia and China. Two other species of Fusarium, i.e. F. moniliforme and F. equiseti, implicated in syndromes of abnormal bone development in animals, were also present. The predominant fungus associated with maize kernels was F. moniliforme; two other fungi relatively frequently isolated from Mseleni maize, i.e. F. compactum and Lasiodiplodia theobromae, have not previously been reported in maize in southern Africa. The predominant fungi associated with groundnut kernels were Penicillium spp., L. theobromae, Macrophomina phaseolina and F. oxysporum. The incidence of certain fungi, particularly F. compactum, F. oxysporum and L. theobromae, appeared to be higher in dietary staples from households affected by MJD than from non-affected ones. The numbers of samples examined were, however, small and these findings need to be confirmed. Cultures of 120/322 isolates of fungi from Mseleni dietary staples proved toxic to ducklings, the most toxic species being F. compactum, F. moniliforme, F. oxysporum and Phomopsis sp. The characteristic pathological changes of MJD have, however, not been induced in experimental animals with cultures of any of these fungi. A diet containing maize and groundnuts from households affected by MJD also failed to induce the characteristic osteo-arthritic changes of MJD in rats. The dietary staples used in this experiment were, however, collected during seasons of abnormally low rainfall at Mseleni.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3961620
Marasas, W F; Van Rensburg, S J
OBJECTIVE--To assess the nature of T cell receptor (TCR) utilisation by CD4 T cells in the rheumatoid joint. METHODS--Sequencing of the joining (NDJ) region of TCR beta chain mRNA isolated from synovial fluid CD4 T cells was performed in three patients in order to determine if oligoclonal expansion of particular sequences was present. Two patients were studied longitudinally to determine if these sequences changed over time. RESULTS--A number of dominant clonotypes were found within the TCR transcripts sequenced in each patient. In the two patients who were studied longitudinally, different dominant clonotypes were detected over time. No single clonotype was persistently dominant during the period of study. CONCLUSIONS--The pattern of TCR usage showed multiple oligoclonally expanded CD4 T cells within the rheumatoid joint. The change in clonotypes within the joint over time suggests that different antigens may be able to elicit synovial inflammation during the course of rheumatoid disease.
Khazaei, H A; Lunardi, C; So, A K
Lateral transcranial radiographs are commonly used to evaluate TMJ morphology and function. This study evaluated the use of four TMJ positioners in controlling the amount of radiation absorbed at predetermined sites on a phantom head. Use of positioners and collimators can reduce the amount of radiation exposure.
Saini, T.S.; Fischer, W.G.; Verbin, R.S.
In an attempt to decrease central side effects associated with the use of opioids, some strategies have been developed by\\u000a targeting peripheral opioid receptors. In this context, kappa receptors are of major interest, since, in contrast to other\\u000a opioid receptors, their activation is not associated with potent peripheral side effects. We have recently demonstrated that\\u000a local activation of kappa opioid
Tânia C. Chicre-Alcântara; Karla E. Torres-Chávez; Luana Fischer; Juliana T. Clemente-Napimoga; Vilma Melo; Carlos Amílcar Parada; Claudia Herrera Tambeli
As an attempt to increase the resistance to Newcastle Disease Virus (NDV) and so further reduction of its risk on the poultry industry. This work aimed to build the eukaryotic gene co-expression plasmid of neuraminidase (NA) gene and myxo-virus resistance (Mx) and detect the gene expression in transfected mouse fibroblasts (NIH-3T3) cells, it is most important to investigate the influence of the recombinant plasmid on the chicken embryonic fibroblasts (CEF) cells. cDNA fragment of NA and mutant Mx gene were derived from pcDNA3.0-NA and pcDNA3.0-Mx plasmid via PCR, respectively, then NA and Mx cDNA fragment were inserted into the multiple cloning sites of pVITRO2 to generate the eukaryotic co-expression plasmid pVITRO2-Mx-NA. The recombinant plasmid was confirmed by restriction endonuclease treatment and sequencing, and it was transfected into the mouse fibroblasts (NIH-3T3) cells. The expression of genes in pVITRO2-Mx-NA were measured by RT-PCR and indirect immunofluorescence assay (IFA). The recombinant plasmid was transfected into CEF cells then RT-PCR and the micro-cell inhibition tests were used to test the antiviral activity for NDV. Our results showed that co-expression vector pVITRO2-Mx-NA was constructed successfully; the expression of Mx and NA could be detected in both NIH-3T3 and CEF cells. The recombinant proteins of Mx and NA protect CEF cells from NDV infection until after 72 h of incubation but the individually mutagenic Mx protein or NA protein protects CEF cells from NDV infection till 48 h post-infection, and co-transfection group decreased significantly NDV infection compared with single-gene transfection group (P<0. 05), indicating that Mx-NA jointing contributed to delaying the infection of NDV in single-cell level and the co-transfection of the jointed genes was more powerful than single one due to their synergistic effects.
Zhang, Yani; Fu, Dezhi; Chen, Hao; Zhang, Zhentao; Shi, Qingqing; Elsayed, Ahmed Kamel; Li, Bichun
As an attempt to increase the resistance to Newcastle Disease Virus (NDV) and so further reduction of its risk on the poultry industry. This work aimed to build the eukaryotic gene co-expression plasmid of neuraminidase (NA) gene and myxo-virus resistance (Mx) and detect the gene expression in transfected mouse fibroblasts (NIH-3T3) cells, it is most important to investigate the influence of the recombinant plasmid on the chicken embryonic fibroblasts (CEF) cells. cDNA fragment of NA and mutant Mx gene were derived from pcDNA3.0-NA and pcDNA3.0-Mx plasmid via PCR, respectively, then NA and Mx cDNA fragment were inserted into the multiple cloning sites of pVITRO2 to generate the eukaryotic co-expression plasmid pVITRO2-Mx-NA. The recombinant plasmid was confirmed by restriction endonuclease treatment and sequencing, and it was transfected into the mouse fibroblasts (NIH-3T3) cells. The expression of genes in pVITRO2-Mx-NA were measured by RT-PCR and indirect immunofluorescence assay (IFA). The recombinant plasmid was transfected into CEF cells then RT-PCR and the micro-cell inhibition tests were used to test the antiviral activity for NDV. Our results showed that co-expression vector pVITRO2-Mx-NA was constructed successfully; the expression of Mx and NA could be detected in both NIH-3T3 and CEF cells. The recombinant proteins of Mx and NA protect CEF cells from NDV infection until after 72 h of incubation but the individually mutagenic Mx protein or NA protein protects CEF cells from NDV infection till 48 h post-infection, and co-transfection group decreased significantly NDV infection compared with single-gene transfection group (P<0. 05), indicating that Mx-NA jointing contributed to delaying the infection of NDV in single-cell level and the co-transfection of the jointed genes was more powerful than single one due to their synergistic effects. PMID:23977111
Zhang, Yani; Fu, Dezhi; Chen, Hao; Zhang, Zhentao; Shi, Qingqing; Elsayed, Ahmed Kamel; Li, Bichun
Chromosomal aberrations were comparatively assessed in nuclei extracted from synovial tissue, primary-culture (P-0) synovial cells, and early-passage synovial fibroblasts (SFB; 98% enrichment; P-1, P-4 [passage 1, passage 4]) from patients with rheumatoid arthritis (RA; n = 21), osteoarthritis (OA; n = 24), and other rheumatic diseases. Peripheral blood lymphocytes (PBL) and skin fibroblasts (FB) (P-1, P-4) from the same patients, as well as SFB from normal joints and patients with joint trauma (JT) (n = 4), were used as controls. Analyses proceeded by standard GTG-banding and interphase centromere fluorescence in situ hybridization. Structural chromosomal aberrations were observed in SFB (P-1 or P-4) from 4 of 21 RA patients (19%), with involvement of chromosome 1 [e.g. del(1)(q12)] in 3 of 4 cases. In 10 of the 21 RA cases (48%), polysomy 7 was observed in P-1 SFB. In addition, aneusomies of chromosomes 4, 6, 8, 9, 12, 18, and Y were present. The percentage of polysomies was increased in P-4. Similar chromosomal aberrations were detected in SFB of OA and spondylarthropathy patients. No aberrations were detected in i) PBL or skin FB from the same patients (except for one OA patient with a karyotype 45,X/46,XX in PBL and variable polysomies in long-term culture skin FB); or ii) synovial tissue and/or P-1 SFB of normal joints or of patients with joint trauma. In conclusion, qualitatively comparable chromosomal aberrations were observed in synovial tissue and early-passage SFB of patients with RA, OA, and other inflammatory joint diseases. Thus, although of possible functional relevance for the pathologic role of SFB in RA, these alterations probably reflect a common response to chronic inflammatory stress in rheumatic diseases.
Kinne, Raimund W; Liehr, Thomas; Beensen, Volkmar; Kunisch, Elke; Zimmermann, Thomas; Holland, Heidrun; Pfeiffer, Robert; Stahl, Hans-Detlev; Lungershausen, Wolfgang; Hein, Gert; Roth, Andreas; Emmrich, Frank; Claussen, Uwe; Froster, Ursula G
Seronegative spondyloarthropathies are a unique group of disorders sharing similar clinical characteristics (e.g., inflammatory back pain, spondylitis, sacroiliitis, uveitis, inflammatory bowel disease, skin rashes, and enthesitis). Clinical and genetic similarities suggest that they also share similar causes or pathophysiologies. Rheumatoid factor (RF) is characteristically negative in this group of disorders, hence collectively termed seronegative spondyloarthropathies (SpA). They include psoriatic arthritis, ankylosing spondylitis, reactive arthritis, ulcerative colitis, and Crohn's disease. "Enthesitis", the term used to describe inflammation at tendon, ligament, or joint capsule insertions, is considered a common feature in this domain and was included in the European Spondyloarthropathy Study Group criteria for the classification of SpA. Evaluation of entheseal-related changes at different joints by MRI became an important item on the research agenda in both differentiated and undifferentiated arthritis. Most of the research focused on MRI findings in the hand and wrist joints among patients with RA and SpA and support two patterns of inflammation "RA" phenotype where synovial involvement is the primary target of inflammation and "SpA" pattern where enthesitis comes first followed by synovitis. In this review, we summarize the literature on enthesitis in SpA and focus on MRI findings in the knee joint in the SpA group of disorders and subclinical synovitis among patients with skin psoriasis. PMID:21210292
Yasser, Ragab; Yasser, Emad; Hanan, Darweesh; Nashwa, El Shaarawy; Rasker, Johannes J
The purposes of the study were to evaluate the utility of diagnosing degenerative joint disease (DJD) by the clinical finding of coarse crepitus alone, without supporting imaging studies, as defined by the RDC/TMD, and to evaluate the contribution of panoramic radiography as an aid in the diagnosis of DJD. A retrospective analysis of 372 consecutive patients with TMD was conducted. Their panoramic radiographs were evaluated for the extent of their contribution to the final diagnosis. Panoramic radiography was of no diagnostic value in 94.4% of the cases when the group was considered as a whole. When patients diagnosed with DJD were considered separately, panoramic radiography was completely sufficient for reaching the final diagnosis in 20.0% of the cases. In almost 90% of these patients, however, the clinical examination did not support the diagnosis of DJD (no coarse crepitus was found). This raises some doubts about the effectiveness of the clinical examination according to the RDC/TMD and about the utility of panoramic radiography in the definitive diagnosis of DJD, because both techniques have low accuracy (11.1% and 20%, respectively). The present study supports the current recommendations that panoramic radiography should not be ordered routinely to assess DJD, but still it is first choice when any dental problem is suspected. Further additional imaging (computerized tomography, magnetic resonance imaging) should be considered only if there is reason to expect that the findings might affect diagnosis and management. This study adds to recent criticisms of the clinical validity of the RDC/TMD, with regard to DJD. PMID:20002532
Winocur, E; Reiter, S; Krichmer, M; Kaffe, I
BackgroundThe modified Lapidus procedure has been used to treat hallux abducto valgus and degenerative joint disease of the first metatarsocuneiform joint for many years. Historically, the Lapidus has been associated with poor satisfaction due to complications such as non-union. The aim of this study was to review the surgical outcomes of 18 patients using the validated Foot Health Status Questionnaire
Natalie G Taylor; Stuart A Metcalfe
Background Genome-wide association studies (GWAS) have provided a large set of genetic loci influencing the risk for many common diseases. Association studies typically analyze one specific trait in single populations in an isolated fashion without taking into account the potential phenotypic and genetic correlation between traits. However, GWA data can be efficiently used to identify overlapping loci with analogous or contrasting effects on different diseases. Results Here, we describe a new approach to systematically prioritize and interpret available GWA data. We focus on the analysis of joint and disjoint genetic determinants across diseases. Using network analysis, we show that variant-based approaches are superior to locus-based analyses. In addition, we provide a prioritization of disease loci based on network properties and discuss the roles of hub loci across several diseases. We demonstrate that, in general, agonistic associations appear to reflect current disease classifications, and present the potential use of effect sizes in refining and revising these agonistic signals. We further identify potential branching points in disease etiologies based on antagonistic variants and describe plausible small-scale models of the underlying molecular switches. Conclusions The observation that a surprisingly high fraction (>15%) of the SNPs considered in our study are associated both agonistically and antagonistically with related as well as unrelated disorders indicates that the molecular mechanisms influencing causes and progress of human diseases are in part interrelated. Genetic overlaps between two diseases also suggest the importance of the affected entities in the specific pathogenic pathways and should be investigated further.
In the present paper the current clinical knowledge about proprioception is given for the shoulder, knee, ankle, elbow and the radiocarpal joint. Proprioceptive capabilities are decreased after joint injuries such as ACL or meniscus tears, shoulder dislocation, ankle sprain and in joints with degenerative joint disease. Some surgical procedures seem to restore the proprioceptive abilities; others do not. Elastic knee
J. Jerosch; M. Prymka
Nonhuman primates are a valuable model for osteoarthritis. Osteoarthritis has been extensively studied in nonhuman primates in both naturally occurring and induced disease states. However, little published information describes naturally occurring osteoarthritis of the coxofemoral joints of nonhuman primates. We report a case of naturally occurring coxofemoral joint osteoarthritis in a rhesus macaque. This case radiographically resembled hip dysplasia reported in other species and demonstrated a rapid progression in severity of lameness, with accompanying loss of muscle mass in the affected limb. We excised the femoral head and neck to alleviate the pain that accompanied the osteoarthritis. Physical therapy was initiated, and dual-energy X-ray absorptiometry and video recordings were performed to evaluate the macaque's response to surgical intervention. By 3 mo postoperatively, the macaque had regained full use of the affected limb.
Dufour, Jason P; Phillippi-Falkenstein, Kathrine; Bohm, Rudolf P; Veazey, Ronald S; Carnal, Jean
Introduction The influence of the neuromuscular system on the cervical region and mastication is directly associated with mandibular movements and neck posture. Normal occlusal homeostasis depends on complex sensory feedback mechanisms of the periodontal ligament, temporomandibular joint and other structures of the stomatognathic system. This feedback serves as a regulatory mechanism that helps determine the force and nature of muscle contractions. Alterations in the muscles of mastication, neck muscles, and occlusal characteristics constitute causal factors of imbalances in the postural muscle chains, leading to alterations in the center of pressure (CoP) of the feet. Thus, therapies that seek occlusal reestablishment, such as muscle relaxation techniques, may lead to a restructuring of the global equilibrium of the neuromuscular system and an improvement in body posture. Purpose The aim of the present pilot study was to investigate the immediate effect of facial massage on the CoP in the anteroposterior (CoPAP) and mediolateral (CoPML) directions in individuals with temporomandibular disorder (TMD). Methods Twenty individuals with a diagnosis of TMD based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were submitted to a facial massage technique. CoPAP and CoPML were evaluated using a force plate. Evaluations were performed under two visual conditions (eyes open and eyes closed) prior to resting in dorsal decubitus (baseline), after 10 minutes of rest (premassage) and after the administration of the massage technique (postmassage). Results No significant differences were found regarding CoPAP velocity with eyes open or the following aspects under either visual condition (eyes open or closed): CoPML velocity, RMS of CoPAP, RMS of CoPML, and sway area. The only significant difference was found for mean CoPAP velocity with eyes closed. Conclusions While the results of the present study demonstrate the reliability of the reproduction of the data, facial massage had no immediate influence on postural control in individuals with TMD.
El Hage, Yasmin; Politti, Fabiano; Herpich, Carolina Marciela; de Souza, Dowglas Fernando Magalhaes; de Paula Gomes, Cid Andre Fidelis; Amorim, Cesar Ferreira; de Oliveira Gonzalez, Tabajara; Biasotto-Gonzalez, Daniela Aparecida
Venous cystic adventitial disease (CAD) is an extremely rare entity, and so far less than 20 cases have been described in the literature. Herein, we describe the imaging findings of CAD of iliofemoral vein in a 51-year-old woman who presented with leg swelling with special emphasis on high spatial resolution MRI, which demonstrated communication of the cyst with the hip joint. To our knowledge, this is the first description of high spatial resolution MRI findings in venous CAD supporting a new theory about the pathogenesis of venous CAD. PMID:23670571
Michaelides, Michael; Papas, Stylianos; Pantziara, Maria; Ioannidis, Kleanthis
One hundred and eighteen elbows in 59 patients who started treatment using disease-modifying antirheumatic drugs (DMARDs) in the first year of the disease were followed-up for more than 10 years without biologic agents. Using annual radiographs of the elbow joint, Larsen grade (LG) was determined, and bone absorption ratio (BAR), cortical thickness ratio (CTR) in the humerus, and olecranon thickness ratio (OTR) were calculated. Disease activity was determined by disease activity score (DAS)28-C-reactive protein (CRP)(3) at 3- or 4-month interval throughout the follow-up period. At 10 years, 30 elbows were in LG III or more, the more deteriorated (MD) group, and 88 elbows were in LG II or less, the less deteriorated (LD) group. In the radiological assessment, the mean LG, BAR, CTR, and OTR progressed with time linearly during 10 years. In the comparison between the MD group and the LD group, there was a significant difference in the magnitude of change in CTR (DeltaCTR; P = 0.0064), BAR (DeltaBAR; P = 0.0100), and OTR (DeltaOTR; P = 0.0051). There was a significant difference in the mean DAS28-CRP(3) (0-2 and 0-10 years) between the two groups (P = 0.0017 and 0.00002). The cut-off value of mean DAS28-CRP(3) (0-2 years), which indicated further progress to the MD group at 10 years, was 3.15. It is important to keep disease activity in low level to prevent progression of the elbow joint deterioration in the patients with RA. PMID:18157680
Abe, Asami; Ishikawa, Hajime; Murasawa, Akira; Nakazono, Kiyoshi
In 2012, the recognition of the specialty of Temporomandibular Disorders and Orofacial Pain completed ten years. Given this scenario, it is extremely important to track the current situation of this field of knowledge in Brazil, specifically in the area of research and training. We hope to discuss the importance of the recognition of this specialty and the inclusion of these subjects in undergraduate programs in Dentistry. Objective The objective of this study is to perform a bibliometric survey of researches regarding Temporomandibular Disorders and Orofacial Pain conducted in the country, determine the number of specialization courses in Orofacial Pain and the number of specialists in the field. Methods The bibliometric survey was conducted based on the Dissertations Portal of Coordination for the Improvement of Higher education Personnel (CAPES) and on PubMed. The panorama of the field of Orofacial Pain and Temporomandibular disorders in Brazil was determined by searching on the website of the Brazilian Council of Dentistry. Results We found 731 theses and dissertations with Temporomandibular Disorders and Orofacial Pain as the main subjects; 81 accredited/recognized Courses on Orofacial Pain and Temporomandibular Dysfunction completed; 8 accredited/recognized Specialization Courses on Orofacial Pain and Temporomandibular Dysfunction still in progress, and 1,064 registered specialists in Orofacial Pain and Temporomandibular Dysfunction in the Brazilian Council of Dentistry. Search in the PUBMED database yielded 576 articles published with the participation of Brazilian researchers as first authors and/or co-authors in the period from 2000 to 2013. From this amount, only 5 were published in Portuguese, while all the others were published in english. We can also notice that the number of published articles increases over time. Conclusion The number of researches related to temporomandibular disorders has increased over the last ten years, as well as the number of specialization courses and the number of specialists, which represents a major breakthrough for this field of knowledge.
MACHADO, Naila Aparecida de Godoi; LIMA, Fernanda Ferruzzi; CONTI, Paulo Cesar Rodrigues
The aim of this review was to investigate the effectiveness of counselling and other self-management-based therapies on muscle and temporomandibular joint (TMJ) pain relief and increasing the functional abilities of patients with temporomandibular disorders (TMD). A systematic literature review was conducted by three independent reviewers and included articles published up to 2012. PubMed and Cochrane Library electronic databases were used in addition to hand-searching to assess clinical outcomes for counselling and self-management approaches for TMD treatment. The review yielded 581 records that were narrowed down to 7. All included studies were classified as blind-randomized controlled clinical trials. The selected articles analysed revealed that counselling was able to improve tenderness upon masticatory muscle palpation and maximum mouth opening with and without pain in patients with TMD, with similar results to those of interocclusal appliances approaches. Thus, counselling- and self-management-based therapies could be considered a conservative low-cost and beneficial treatment alternative for treating TMD to potentially improve psychological domains and remove harmful behaviours for the control of the signs and symptoms of TMD. PMID:24102692
de Freitas, R F C P; Ferreira, M Â F; Barbosa, G A S; Calderon, P S
A quantitative study of the elastic fibres found in the human temporomandibular disc and its attachments was performed. Seven left discs from 57- to 82-year-old subjects, without macroscopic evidence of a TMJ disorder, were analysed and prepared in parasagittal sections. The surface amount was measured, thresholded and expressed from 0 to 1, using microscopic digitized views after Weigert's resorcin-fuchsin staining of elastic fibres. Fibre density rates ranged from 0 to 0.687. The mean density was 0.1532 (sigma=0.1150) in the upper bilaminary zone, 0.1097 (sigma=0.1159) in the lower bilaminary zone, 0.0474 (sigma=0.0782) in the anterior band, 0.0180 (sigma=0.0603) in the posterior band and null in the intermediate zone. The difference in density rate between the structures was significant, except for the posterior band and the intermediate zone. The elastic fibre density rates in central and medial locations of the upper and lower bilaminary zones were twice as big as in the lateral locations. In the anterior band, the elastic fibre density was less abundant medially than in its lateral part. These quantitative results support the current elastic fibre distribution scheme, and confirm the necessity of studying their orientation, taking into account age and temporomandibular joint health parameters. PMID:17011753
Clément, C; Bravetti, P; Plénat, F; Foliguet, B; Haddioui, A El; Gaudy, J-F; Weissenbach, M
The aim of this research was to evaluate, within a controlled clinical study, the effects of a Delaire-type facemask or a modified Jasper Jumper (JJ) used in the treatment of children with Class III malocclusions due to maxillary retrognathia on temporomandibular disorders (TMDs). Forty-six patients with Class III malocclusions referred for orthodontic treatment were divided into two groups, a test and a control. The test group comprised 33 randomly chosen patients (15 females, 18 males) aged 8-11 years. The control group included 13 patients (eight females, five males) with similar features. TMD assessment was performed before and after treatment using a two-axis questionnaire, the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMDs). Qualitative data were evaluated using chi-square and McNemar tests. No statistically significant differences related to the presence of TMD were observed pre- or post-treatment (P > 0.05). The most commonly encountered diagnosis was arthralgia in the JJ group both before and after treatment. Evaluation of joint and muscle regions showed decreased symptoms, apart from the diagnosed discomforts, in the JJ group (P < 0.05). Reduced symptoms were observed in the Delaire group; however, this reduction was not statistically significant. An increase, not considered to be statistically significant, was observed in the control group. The Delaire-type facemask and modified JJ used in the early phase of Class III malocclusion treatment did not result in TMD. PMID:21187525
Kurt, Hanefi; Alio?lu, Ceylan; Karayazgan, Banu; Tuncer, Necat; K?l?ço?lu, Hülya
OBJECTIVETo determine the value of HLA DR ?1 disease associated epitope (DAE) and erythrocyte sedimentation (ESR) in predicting the need for major joint replacement in rheumatoid arthritis (RA).METHODSSixty five RA patients who had undergone hip, knee or shoulder arthroplasty within 15 years of disease onset and 65 who had not. HLA DR ?1 genotype was determined by polymerase chain reaction.
Anne Crilly; Nicola Maiden; Hilary A Capell; Rajan Madhok
This study examined the association between limited joint mobility (LJM) and diabetic control, atherosclerotic vascular disease and other diabetic complications in non–insulin-dependent diabetic (NIDDM) patients. LJM was studied in 139 [age (mean ± SD) 61.3 ± 12.3 years] NIDDM patients. Limitation of several joints was examined with a goniometer and LJM was classified by the Rosenbloom method. The NIDDM patients
Perttu E. T. Arkkila; Ilkka M. Kantola; Jorma S. A. Viikari
Background: Rheumatic joint pain is a common extra-intestinal complication of inflammatory bowel disease (IBD). Because the high ratio of n-6 to n-3 fatty acids (FAs) of the Western diet might promote rheumatic disorders, we sought to compare the effects of short-term duodenal administration of n-3-rich seal oil and n-6-rich soy oil on IBD-related joint pain. Methods: Nineteen patients with IBD-related
Tormod Bjørkkjær; Linn Anne Brunborg; Gülen Arslan; Ragna Anne Lind; Johan Gorgas Brun; Merete Valen; Beate Klementsen; Arnold Berstad; L. Frøyland