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Breathing and temporomandibular joint disease.  


Temporomandibular joint disease (TMD) refers to a collection of pain related conditions in the masticatory muscles and temporomandibular joint. Occlusal factors have been implicated in TMD pathogenesis, yet despite decades of research no causal relationship between occlusion and TMD has been found. The significance of psychosocial factors in both the assessment and the long-term management of patients with TMD is receiving increased recognition. The teaching of relaxation skills and coping strategies are effective, proven TMD therapies. The role of breathing re-education in temporomandibular joint (TMJ) disorders is rarely mentioned. A focus on breathing patterns and their disorders potentially explains how biomechanical factors associated with psychosocial influences might lead to pathophysiological changes within the TMJ as well as in the associated muscles. Attention to factors such as breathing and postural rehabilitation provides health professionals valuable, additional tools to help care for patients with TMD. PMID:21665104

Bartley, Jim



Temporomandibular joint arthritis in sickle cell disease: a case report.  


We report a rare case of aseptic arthritis in the temporomandibular joint of a patient with sickle cell anemia. A 22-year-old woman with sickle cell disease, in the 18th week of gestation, was referred by her hematologist to investigate a sudden mouth opening limitation and severe pain on her left cheek. The patient received a standard pain assessment protocol, clinical examination, and complementary exams (complete blood count, hemoglobin electrophoresis, blood solubility test, panoramic radiograph, and magnetic resonance imaging [MRI]). The blood results were consistent with a sickle cell crisis and the MRI showed an inflammatory process around the left temporomandibular joint. Treatment with opioid analgesics and blood transfusion provided good results. Sickle cell anemia is a disease that can cause arthritis of the temporomandibular joint, and although it is rare, clinicians should be attentive to the differential diagnosis in patients with this disease. PMID:23021926

Caracas, Maíra da Silva; Jales, Sumatra P; Jales Neto, Levi H; da Silva Castro, Joice Carla; Suganuma, Liliana Mitie; Fonseca, Guilherme Henrique Hencklain; Gualandro, Sandra Fatima Menosi; de Siqueira, José Tadeu Tesseroli



Tophaceous calcium pyrophosphate dihydrate deposition disease of the temporomandibular joint.  


Tophaceous pseudogout is a rare manifestation of calcium pyrophosphate dihydrate (CPPD) deposition disease that particularly affects the temporomandibular joint (TMJ). We describe a case of tophaceous pseudogout and review the literature. Thirty-four cases of chronic CPPD deposition disease affecting the TMJ are described. Symptoms usually included pain and swelling. Most patients required surgery because of extensive crystal deposits, usually localized to the joint and adjacent structures but occasionally invasive. For many patients, malignancy was the preoperative diagnosis. Although patients with acute pseudogout of the TMJ may have involvement of other joints, tophaceous pseudogout was predominantly isolated to the TMJ. PMID:18398950

Reynolds, Jennifer L; Matthew, Ian R; Chalmers, Andrew



Synovial fluid cytokines and proteinases as markers of temporomandibular joint disease  

Microsoft Academic Search

Purpose: In this article, biochemical markers in the synovial fluid (SF) for detecting intraarticular inflammation and early cartilage degradation of the temporomandibular joint (TMJ) disease were examined.Patients and Methods: SF was obtained from 25 TMJs in 22 patients with internal derangement (ID) or osteoarthritis (TMJ-OA), 15 asymptomatic TMJs in 11 normal volunteers, and 10 osteoarthritic knee joints (KNEE-OA). Cytokine levels

Eiro Kubota; Takao Kubota; Jun Matsumoto; Takanori Shibata; Ken-Ichiro Murakami



Synovial chondromatosis of the temporomandibular joint with calcium pyrophosphate dihydrate crystal deposition disease (pseudogout).  


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



Imaging the temporomandibular joint  

SciTech Connect

This book encompasses all imaging modalities as they apply to the Temporomandibular Joint and its disorders. The volume employs correlative line drawings to elaborate on diagnostic images. It helps teach methods of TMJ imaging and describes findings identified by different imaging modalities to both radiologists and dental clinicians.

Katzberg, R.W.; Manzione, J.V.; Westesson, P.L.



Tumoral calcium pyrophosphate dihydrate crystal deposition disease of the temporomandibular joint: identification on crystallography.  


This paper reports a case of calcium pyrophosphate dihydrate (CPPD) crystal deposition in the temporomandibular joint (TMJ) of a 59-year-old man with the chief complaint of severe pain in the left TMJ. On CT a radiopaque area was seen around the condylar process of the left TMJ with irregular destructive bony changes. A provisional diagnosis of crystalline-induced arthritis was made on histopathology of a biopsy specimen. Electron probe microanalysis (EPMA), scanning electron microscopy (SEM) and X-ray diffraction showed both CPPD and hydroxyapatite (HA) in the crystalline materials. Identification of these two types of crystal in crystal deposition disease of TMJ, using crystallography, is discussed. PMID:18844939

Mikami, Toshinari; Takeda, Yasunori; Ohira, Akinori; Hoshi, Hideki; Sugiyama, Yoshiki; Yoshida, Yasuo; Ambo, Junichi



Pathogenesis of degenerative temporomandibular joint arthritides.  


Over the past decade, remarkable progress has been made in the study of molecular mechanisms involved in degenerative temporomandibular joint arthritides. Based on recent findings, models of degenerative temporomandibular joint disease predict that mechanical loads trigger a cascade of molecular events leading to disease in susceptible individuals. These events involve the production or release of free radicals, cytokines, fatty acid catabolites, neuropeptides, and matrix-degrading enzymes. Under normal circumstances, these molecules may be involved in the remodeling of articular tissues in response to changing functional demands. However, if functional demands exceed the adaptive capacity of the temporomandibular joint or if the affected individual is susceptible to maladaptive responses, then a disease state will ensue. An individual's susceptibility to degenerative temporomandibular joint disease may be determined by several factors, including genetic backdrop, sex, age, and nutritional status. It is hoped that, by furthering our understanding of the molecular events that underlie degenerative temporomandibular joint diseases, improved diagnostics and effective therapies for these debilitating conditions will be developed. PMID:16170470

Milam, Stephen B



Calcium pyrophosphate dihydrate deposition disease (CPPD)/Pseudogout of the temporomandibular joint - FNA findings and microanalysis.  


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. PMID:18426573

Naqvi, Asghar H; Abraham, Jerrold L; Kellman, Robert M; Khurana, Kamal K



Lubrication of the Temporomandibular Joint  

Microsoft Academic Search

Although tissue engineering of the temporomandibular joint (TMJ) structures is in its infancy, tissue engineering provides\\u000a the revolutionary possibility for treatment of temporomandibular disorders (TMDs). Recently, several reviews have provided\\u000a a summary of knowledge of TMJ structure and function at the biochemical, cellular, or mechanical level for tissue engineering\\u000a of mandibular cartilage, bone and the TMJ disc. As the TMJ

Eiji Tanaka; Michael S. Detamore; Kotaro Tanimoto; Nobuhiko Kawai



Engineering alloplastic temporomandibular joint replacements.  


Temporomandibular disorders (TMD) are part of a heterogeneous group of pathologies that manifest with a constellation of signs and symptoms. They are the most frequent cause of chronic orofacial pain and are prevalent in 12% of the general population. Despite the debilitating nature of these disorders, there is no standardization for treatment of the diseased temporomandibular joint (TMJ). In this review, we present an overview of the functional anatomy of the TMJ and the engineering concepts that must be understood to better understand the indications for surgical management, the types of available treatments and the requirements for reconstruction. A comparison is made of the clinical outcomes with autogenous versus alloplastic reconstruction, including a history of alloplastic materials and the design features of currently available implants. Emphasis is made on material selection, modulus, stiffness, notch sensitivity and modularity. For the treatment of TMD, engineered TMJ alloplastic replacements have had considerable promise with additional room for improvement using new materials and recent design concepts. PMID:22363183

Sinno, Hani; Tahiri, Youssef; Gilardino, Mirko; Bobyn, Dennis



Temporomandibular joint disorders in children.  


A child's difficulty in verbalizing the precise location and nature of facial pain and jaw dysfunction often results in a nondefinitive history, increasing the importance of the dentist's awareness of the early signs and symptoms of temporomandibular joint disorders (TMD). A focused examination of the masticatory musculature, the temporomandibular joints, and associated capsular and ligamentous structures can reveal if a patient's symptoms are TMD in origin. An accurate differential diagnosis enables timely referral to appropriate health care providers and minimizes the use of diagnostic imaging. PMID:23174613

Howard, James A



A case of destructive calcium pyrophosphate dihydrate crystal deposition disease of the temporomandibular joint: a diagnostic challenge.  


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 alone without other joints being affected. A provisional diagnosis of occupying lesion with invasion was made preoperatively, but histologically, the mass contained numerous deposits of rod-shaped or rhomboid crystals, which were positively birefringent under a polarising microscope, suggesting a CPPD deposition disease. The histopathological diagnosis was further supported by scanning electron microscopy with energy dispersive X-ray spectroscopy. The diagnosis, differential diagnosis and treatment of this disease are discussed. PMID:21676588

Meng, J; Guo, C; Luo, H; Chen, S; Ma, X



Temporomandibular joint involvement in ankylosing spondylitis.  


Frequency of temporomandibular joint (TMJ) involvement in patients with ankylosing spondylitis (AS) has varied from 4% to 35%. It is more common in men and produces generalised stiffness in involved joints. Clinician should be suspicious of AS when a patient reports with painful restricted movements of joint, neck or back and with no trauma history. Conventional radiographic methods have allowed the demonstration of TMJ abnormalities in patients with AS, but CT is necessary to establish joint space relations and bony morphology. We describe a case of severe AS with TMJ involvement in a 40-year-old female patient and demonstrated TMJ changes on CT. A CT was able to demonstrate articular cartilage changes, disc- and joint abnormalities. Thus, if conventional radiographs in a symptomatic patient with rheumatic diseases are unable to demonstrate changes, CT can provide valuable additional information of the changes in the TMJ. PMID:23645650

Arora, Pallak; Amarnath, Janardhan; Ravindra, Setru Veerabhadrappa; Rallan, Mandeep



Osteoma of temporomandibular joint: a rarity.  


Osteoma is a benign tumour consisting of mature bone tissue. It is an uncommon lesion that occurs in the bones of the craniofacial complex. Only a few cases involving the temporomandibular joint have been reported. An osteoma of the left temporomandibular joint causing limited mouth opening in a 22-year-old man with CT findings revealing the unusual possibility in differential diagnosis of trismus. PMID:24014334

Misra, Neeta; Srivastava, Saurabh; Bodade, Pankaj R; Rastogi, Vikalp



Tumor necrosis factor-alpha in synovial fluid and plasma from patients with chronic connective tissue disease and its relation to temporomandibular joint pain  

Microsoft Academic Search

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



Chondrocalcinosis of the temporomandibular joint: clinical considerations and case report.  


The calcium pyrophosphate dihydrate crystal deposition disease (CPPD) is a disorder that occasionally affects the temporomandibular joint (TMJ) and is characterized by the presence of crystals in the intra-articular and peri-articular tissues. Diagnosis of CPPD is challenging because clinical symptoms and imaging features are not characteristic and may mimic a chondrosarcoma. A case of a 74-year-old woman with CPPD of the TMJ is reported. This disease rarely involves the TMJ and is not usually considered in the differential diagnosis of temporomandibular disorders (TMD). PMID:19455925

Covani, Ugo; Orlando, Bruno; Galletti, Cesare; Nuterini, Cristiana; Barone, Antonio



Temporomandibular joint arthrocentesis. Review of the literature  

PubMed Central

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



Surgery of temporomandibular joint under local anaesthesia  

PubMed Central

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 devices: Treatment factors and outcomes  

Microsoft Academic Search

TMJ devices have been used for many years in reconstruction of the temporomandibular joint (TMJ). The most common endosseous implant currently used in TMJ reconstruction is a mini-anchor that is placed in the posterior head of the condyle to support artificial ligaments to stabilize the articular disk in the proper position. A 2-year follow-up study shows a success rate of

Larry M Wolford



Radiation dose in temporomandibular joint zonography  

SciTech Connect

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))



Pigmented villonodular synovitis of the temporomandibular joint.  


Pigmented villonodular synovitis (PVNS) is a proliferative disorder that affects synovium-lined joints, bursae, and tendon sheaths. It appears in both diffuse and localized forms, depending on the extent of synovial involvement. PVNS rarely involves the temporomandibular joint (TMJ); when it does, it manifests clinically as a slowly growing and painless preauricular mass that resembles a parotid tumor. TMJ dysfunction, paresthesia, and/or hearing loss can result. We present a case of a large extra-articular PVNS of the TMJ, and we review the literature. PMID:23904309

Giannakopoulos, Helen; Chou, Joli C; Quinn, Peter D



Oral splint for temporomandibular joint disorders with revolutionary fluid system  

PubMed Central

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.

Srivastava, Rahul; Jyoti, Bhuvan; Devi, Parvathi



Management of the temporomandibular joint in rheumatoid disorders.  


This article summarises the rheumatoid diseases that particularly affect the temporomandibular joint (TMJ): psoriatic arthropathy, ankylosing spondylitis, and rheumatoid arthritis. Management is by a joint approach between rheumatologists and maxillofacial surgeons with a specific interest in diseases of the TMJ who give early surgical advice. Steroid injections, whilst useful in the short term, are not useful for long term or repeated treatment, and may lead to collapse of the joint and development of a deformed anterior open bite. These disorders should be managed primarily using standard conservative regimens, and failure to respond should lead to diagnostic or therapeutic arthroscopy and appropriate surgical treatment. When ankylosis develops or the joint collapses, a replacement joint should be considered and patients should be referred to an appropriately trained surgeon. PMID:22658606

Sidebottom, A J; Salha, R



Temporomandibular joint ankylosis fixation technique with ultra thin silicon sheet  

PubMed Central

Background: Temporomandibular joint ankylosis is a highly distressing condition in which the joint space is obliterated by scar tissue and the patient has an inability to open the mouth. Different autogenous and alloplastic interposition materials have been used after the resection of the ankylotic bone to achieve desirable and long lasting results. The recurrence of disease is most distressing for both patients and surgeon. We have been using ultra thin silicon sheet as our preferred material for providing proper fixation and cover to the joint. We have been encouraged by good patient compliance, no implant extrusion and favourable outcome. Materials and Methods: The clinical study included 80 patients with temporomandibular joint ankylosis, treated between April 2001 and March 2009. In all patients, temporomandibular joint ankylosis had resulted following trauma. Diagnosis was based on clinical assessment supplemented by radiographic examination consisting of a panoramic radiograph, axial and coronal computer tomography. The technique of using ultra thin silicon sheet covering whole of the joint space fixed with non-absorbable nylon 3-0 suture both medially to medial pterygoid muscle and laterally to periosteum of zygomatic arch was employed in all patients. Results: A total of 80 patients were in this study (59 males and 21 females). The aetiology of temporomandibular joint ankylosis was post-traumatic in all cases. The patients’ age ranged from 5 to 45 years. The disease was unilateral in 61 cases and bilateral in 19 cases. Twelve patients, who had previous surgery done in the form of gap arthroplasty in 6 cases, costochondral graft in 4 cases and temporalis muscle in 2 cases, presented with recurrence on the same side. The pre-op inter-incisal mouth opening ranged from 4 to 12 mm. The intraoperative inter-incisal mouth opening ranged from 28 to 46 mm. An additional procedure was done in 13 patients, including placement of costochondral graft with coronoidectomy in 4 of these cases. There was no immediate complication and no incidence of facial nerve injury. There was no extrusion of the implant in immediate and follow-up period. Conclusions: The use of alloplastic implants with less volume and proper fixation covering all the raw bone joint space prevents reunion of bone; fixation of the sheet prevents its movement and thus extrusion.

Kalra, G. S.; Kakkar, Vikas



Dislocation of temporomandibular joint: complication of sagittal split ramus osteotomy.  


Sagittal split ramus osteotomy (SSRO) has wide-ranging indications and results in simultaneous improvements in occlusion and facial appearance. Thus, it is the most frequently used osteotomy for jaw deformities. Its main intraoperative and postoperative complications are massive bleeding, atypical fractures, inferior alveolar nerve paralysis, and relapse. This report describes a case of temporomandibular joint dislocation, a rare complication of SSRO. The patient was a 23-year-old man with mandibular prognathism which was treated by bilateral SSRO. Postoperative x-ray showed that the left temporomandibular joint was dislocated anteriorly. Thus, the patient underwent reoperation, including reduction and re-fixation. Subsequently, it was discovered that the patient had a previous history of recurrent dislocation of the temporomandibular joint. This case illustrates the need for practitioners to be mindful of temporomandibular joint dislocation as a rare complication of SSRO. PMID:24036714

Mitsukawa, Nobuyuki; Morishita, Tadashi; Saiga, Atsuomi; Kubota, Yoshitaka; Omori, Naoko; Akita, Shinsuke; Satoh, Kaneshige



Disk repositioning surgery of the temporomandibular joint with bioabsorbable anchor.  


The most common temporomandibular joint (TMJ) pathologic disease is anterior-medial displacement of the articular disk, which can lead to TMJ-related symptoms.The indication for disk repositioning surgery is irreversible TMJ damage associated with temporomandibular pain. We describe a surgical technique using a preauricular approach with a high condylectomy to reshape the condylar head. The disk is anchored with a bioabsorbable microanchor (Mitek Microfix QuickAnchor Plus 1.3) to the lateral aspect of the condylar head. The anchor is linked with a 3.0 Ethibond absorbable suture to fix the posterolateral side of the disk above the condyle.The aims of this surgery were to alleviate temporomandibular pain, headaches, and neck pain and to restore good jaw mobility. In the long term, we achieved these objectives through restoration of the physiological position and function of the disk and the lower articular compartment.In our opinion, the bioabsorbable anchor is the best choice for this type of surgery because it ensures the stability of the restored disk position and leaves no artifacts in the long term that might impede follow-up with magnetic resonance imaging. PMID:24036782

Spallaccia, Fabrizio; Rivaroli, Andrea; Basile, Emanuela; Cascone, Piero



Mandibulofacial Adaptations in a Juvenile Animal Model of Temporomandibular Joint Arthritis  

Microsoft Academic Search

Juvenile rheumatoid arthritis (JRA) is a chronic systemic disease of childhood that affects synovial joints including the temporomandibular joint (TMJ). Individuals with JRA of the TMJ frequently show aberrations in mandibulofacial development. Since the basis for these developmental perturbations is poorly understood, they remain a perplexing clinical problem to manage. To begin dissecting the mechanisms for altered craniofacial development in

M. Tavakkoli-Jou; A. J. Miller; S. Kapila



Neural structures within the sheep temporomandibular joint.  


To better understand pathologic processes associated with arthritis of the temporomandibular joint (TMJ), detailed information on the innervation of TMJ tissues in normal as well as arthritic joints is needed. The aim of this study was to describe the normal innervation of the sheep TMJ in preparation for using this animal as a model for the study of the effects of arthritis on joint innervation. The macroscopic and microscopic appearance plus the distribution of neural structures within the TMJ were examined using fluorescence histochemistry (glyoxylic acid), immunohistochemistry (calcitonin gene-related peptide), silver, and gold chloride techniques. Joints from 10 mature merino sheep were studied. Calcitonin gene-related peptide-immunoreactive nerve fibers were found in the capsule and the synovial membrane, but not in the disc. Nerve bundles and single nerve fibers in the capsule, synovial membrane, and the peripheral 2 to 3 mm of the disc were stained by glyoxylic acid. Ruffini, paciniform-type, and Golgi organ nerve endings plus free nerve endings were located in the capsule, with the highest density of nerve endings occurring at the site of attachment of the disc to the capsule. The highest density of neural structures (using gold chloride) was in the posterior part of the joint. The highest density of autonomic fibers (using glyoxylic acid) was in the anterior capsule. The highest density of sensory fibers (using calcitonin gene-related peptide) was in the synovial and subsynovial tissues of the anterior capsule. These results confirm the existence of autonomic and sensory nerves in the capsule, synovial membrane, and peripheral disc in healthy adult sheep. PMID:9161227

Tahmasebi-Sarvestani, A; Tedman, R A; Goss, A



[The para-clinic investigation of temporo-mandibular joint changes in patients with acromegaly].  


The Acromegaly is an endocrinological disease determined by the hypersecretion of STH in a certain period of the body evolution and it causes the hypertrophy of bones in general and of mandible and cranio-facial bones, determining a disorder due to this development of bones, associated with troubles in the activity of muscles and of the phospho-calcium metabolism. This study was made on a group of 33 acromegaly patients. Their temporo-mandibular joint was investigated by ortopantomography, tomography, computer tomography and scintigraphy. All of these exams shows the changes in temporo-mandibular joint due to the cells hyperactivity determined by the hypersecretion of STH. PMID:12092142

Mor?ra?u, C; Burlui, V; Olaru, C; Boza, C; Bort?, C; Mor?ra?u, G; Brînz?, M


Synovial chondromatosis of the temporomandibular joint with articular eminence extension.  


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



Temporomandibular joint syndrome: diagnostician's dilemma--a review.  


A succinct presentation of the definition, historical notations, etiology, anatomy, physiology, pathology, clinical picture, differential diagnosis, treatment, and prognosis of the temporomandibular joint (TMJ) syndrome is presented. Accentuation is placed upon both the etiology of this distress, as well as the need for accurate diagnosis assisted by an elimination process via differential diagnosis. Diagnosticians can discern only what is known to them, Thus, the diagnosis of TMJ syndrome escapes the examiner too frequently. Misdiagnosis results because of the bizarre symptom-complex that mimics many diseases. Failure to diagnose can lead to erroneous empirical treatment that is ineffective. Whereas definitive scientific therapy, programmed to the patient's needs, can be a rewarding therapeutic experience. Moreover, misdiagnosis is a valid basis for a legal cause of action against physicians of all genre. PMID:1895018

Ficarra, B J; Nassif, N J



Global Body Posture Evaluation in Patients with Temporomandibular Joint Disorder  

PubMed Central

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



Temporomandibular joint computed tomography: development of a direct sagittal technique  

SciTech Connect

Radiology plays an important role in the diagnosis of temporomandibular disorders. Different techniques are used with computed tomography offering simultaneous imaging of bone and soft tissues. It is therefore suited for visualization of the articular disk and may be used in patients with suspected internal derangements and other disorders of the temporomandibular joint. Previous research suggests advantages to direct sagittal scanning, which requires special positioning of the patient and a sophisticated scanning technique. This study describes the development of a new technique of direct sagittal computed tomographic imaging of the temporomandibular joint using a specially designed patient table and internal light visor positioning. No structures other than the patient's head are involved in the imaging process, and misleading artifacts from the arm or the shoulder are eliminated. The use of the scanogram allows precise correction of the condylar axis and selection of exact slice level.

van der Kuijl, B.; Vencken, L.M.; de Bont, L.G.; Boering, G. (Univ. of Groningen, (Netherlands))



Temporomandibular joint dysfunction syndrome: a close association with systemic joint laxity (the hypermobile joint syndrome)  


Sixty-two patients admitted for elective reconstructive surgery of the temporomandibular joint (TMJ) and eight seen as outpatients with a chief complaint of TMJ dysfunction during the same time interval were evaluated for possible etiologic factors contributing to the disease. All hospitalized patients had severe, end-stage degenerative changes within the TMJ, whereas outpatients had less severe disease and did not require surgery. TMJ dysfunction in some patients was said to be a result of established causes including bruxism, malocclusion, and trauma. No patient in this series had evidence of a systemic inflammatory polyarthritis. Of the 70 patients, 38 (54%) met criteria, based on those of Carter and Wilkinson, as modified by Beighton et al., sufficient to warrant a diagnosis of the hypermobile joint syndrome. Five patients had classic Ehlers-Danlos syndrome and therefore were not patients with "benign hypermobility," and an additional two cases were described as "marfanoid" and as possible Ehlers-Danlos syndrome, respectively. Radiographs showed TMJ hyperextensibility in four hypermobile patients. Long-term surgical outcome was identical in the hypermobile and nonhypermobile groups. The incidence of hypermobility in this series is strikingly higher than the expected incidence in an otherwise population. Magnetic resonance images of the TMJs on separate groups of asymptomatic normal and hypermobile women identified excessive anterior movement in the hypermobile group, together with abnormal anterior disk position in some. We hypothesize that hypermobility within the TMJ may cause accelerated disk destruction and degenerative disease. PMID:1745506

Buckingham, R B; Braun, T; Harinstein, D A; Oral, K; Bauman, D; Bartynski, W; Killian, P J; Bidula, L P



Autologous fat grafts placed around temporomandibular joint total joint prostheses to prevent heterotopic bone formation  

Microsoft Academic Search

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


Autologous fat transplantation around temporomandibular joint total joint prostheses: Preliminary treatment outcomes  

Microsoft Academic Search

Purpose: This study evaluated the efficacy of autologous fat grafting to the temporomandibular joint (TMJ) as an adjunct to prosthetic joint reconstruction in preventing fibrosis and heterotopic bone formation and determined its effects on postoperative joint mobility.Patients and Methods: Fifteen patients (2 male, 13 female) underwent TMJ reconstruction with Techmedica (Techmedica, Inc, Camarillo, CA) custom-made total joint prostheses. Seven patients

Larry M Wolford; Spiro C Karras



Groningen temporomandibular joint prosthesis. Development and first clinical application  

Microsoft Academic Search

Patients with a severely degenerated temporomandibular joint (TMJ) may benefit from an alloplastic TMJ replacement. The aim of the study was to develop a safe and properly functioning TMJ prosthesis. The design was based on imitation of anterior condylar translation by an inferiorly located centre of rotation, unrestricted mandibular movements by a double articulation, correct fit to the skull by

J.-P. van Loon; L. G. M. de Bont; B. Stegenga; F. K. L. Spijkervet; G. J. Verkerke



Changes in temporomandibular joint dysfunction after orthognathic surgery  

Microsoft Academic Search

Purpose: We sought to evaluate the effects of orthognathic surgery on temporomandibular joint (TMJ) dysfunction in patients with known presurgical TMJ internal derangement who underwent double-jaw surgery for the treatment of dentofacial deformities. Patients and Methods: Treatment records of 25 patients with magnetic resonance imaging and clinical verification of preoperative TMJ articular disc displacement who underwent double-jaw surgery only were

Larry M. Wolford; Oscar Reiche-Fischel; Pushkar Mehra



Reactive arthritis: Preliminary microbiologic analysis of the human temporomandibular joint  

Microsoft Academic Search

Purpose: The presence of Chlamydia trachomatis has been previously shown in the temporomandibular joint (TMJ). This study investigated whether the presence of other bacteria associated with reactive arthritis (ReA) can be identified in the TMJ. Materials and Methods: Posterior bilaminar tissue removed during TMJ surgery from 26 patients (24 F, 2 M) was evaluated for the presence of C trachomatis,

Charles H. Henry; Christopher V. Hughes; Hervé C. Gérard; Alan P. Hudson; Larry M. Wolford



Biomechanical response of the temporomandibular joint from impacts in boxing  

Microsoft Academic Search

This multi-phase project was the first to explore the biomechanical response of the temporomandibular joint (TMJ) from a straight punch in boxing. During the first phase, a technique was developed that combined the head impact response from a biofidelic anthropometric test device (ATD) with the calculated punch force from an Olympic class boxer throwing straight punches. The results derived from

Timothy J Walilko



Custom CAD\\/CAM total temporomandibular joint reconstruction system  

Microsoft Academic Search

Purpose: The purpose was to test the outcome of a custom computer assisted design\\/computer assisted manufactured (CAD\\/CAM) total temporomandibular joint (TMJ) reconstruction system.Patients and Methods: There were 215 patients (13 males and 202 females); the average age at reconstruction was 40.9 ± 10.3 years (range, 15 to 77 years). There were 363 joints placed, 296 bilateral and 67 unilateral. The

Louis G Mercuri; Larry M Wolford; Bruce Sanders; R. Dean White; Anita Hurder; William Henderson



Reconstruction of the temporomandibular joint autogenous compared with alloplastic  

Microsoft Academic Search

The aims of and indications for temporomandibular joint (TMJ) reconstruction are well-established but the method of reconstruction is controversial. We describe a retrospective, two-centre audit of 49 patients treated with costochondral grafting and 50 patients treated with alloplastic joints. The characteristics of the patients were similar in both centres and the minimum follow-up period was 2 years. For each patient

N. R. Saeed; R. Hensher; N. M. H. McLeod; J. N. Kent



Temporomandibular joint ankylosis: review of thirty-two cases.  


I have reviewed aetiology, sex, age at time of treatment, clinical features, radiographic findings, anaesthetic techniques, surgical treatment, complications, and results in 32 patients with ankylosis of the temporomandibular joint. Trauma and infection were the commonest causes of ankylosis: 50% and 41%, (n = 13), respectively. The 21-30 year age group had the most trauma cases. Twenty (63%) of the patients presented with bilateral ankylosis. Failing to do jaw-opening exercises was the main cause of relapse. PMID:10371317

Chidzonga, M M



Role of Magnetic Resonance Imaging in the Clinical Diagnosis of the Temporomandibular Joint  

Microsoft Academic Search

Temporomandibular joint (TMJ) abnormalities cannot be reliably assessed by a clinical examination. Magnetic resonance imaging (MRI) may depict joint abnormalities not seen with any other imaging method and thus is the best method to make a diagnostic assessment of the TMJ status. In patients with temporomandibular joint disorder (TMD) referred for diagnostic imaging the predominant TMJ finding is internal derangement

Tore A. Larheim



Development and Histologic Characterization of an Animal Model of Antigen-induced Arthritis of the Juvenile Rabbit Temporomandibular Joint  

Microsoft Academic Search

Children with juvenile rheumatoid arthritis or juvenile chronic arthritis often exhibit temporomandibular joint (TMJ) involvement accompanied by pain, dysfunction, and growth abnormalities. Despite the severe functional and developmental consequences of this disease, its pathogenesis remains poorly understood, but important insights may be provided by a suitable animal model of this disease. The purpose of this study was to develop and

S. Kapila; C. Lee; M. R. Tavakkoli Jou; A. J. Miller; D. W. Richards



Comparison of conventional MRI and 3D reconstruction model for evaluation of temporomandibular joint  

Microsoft Academic Search

The aim of this work was to define the diagnostic value of a method for 3D reconstruction of MRI images for the assessment\\u000a of temporomandibular joint. Sixty subjects, 42 diagnosed with unilateral temporomandibular disorders (TMD) with disc displacement\\u000a and 18 without signs or symptoms of TMD (control group) were included. All subjects had both temporomandibular joints scanned\\u000a by MRI. Three-dimensional

André L. F. Costa; Clarissa Lin Yasuda; Simone Appenzeller; Sérgio L. P. C. Lopes; Fernando Cendes



Three-dimensional temporomandibular joint modeling and animation.  


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



Electrosonographic characteristics of sounds from temporomandibular joint disc replacement.  


The purpose of this study was to investigate the waveform and electrosonographic characteristics of sounds emanating from internal derangement of the temporomandibular joint (TMJ). TMJ sounds were recorded from 10 joints of normal people (NP), 10 joints from patients with anterior disc displacement with reduction (DDR) and 20 joints from patients with anterior disc displacement without reduction (DDNR). The sounds were analyzed through fast Fourier transfer methods to observe their waveforms and electrosonographic characteristics. The observations were then used in differentially diagnosing internal derangement. Wave pattern and electrosonography (ESG) differed among the NP, DDR and DDNR groups. There was very little difference in frequency between the sounds from DDR and DDNR, but the amplitude of the DDR sounds was higher than those of DDNR and NP. The sensitivity and specificity of ESG diagnosis for DDR were 77.2% and 93.3%, respectively, while for DDNR they were 81.6% and 64.7%, respectively. PMID:16427252

Deng, M; Long, X; Dong, H; Chen, Y; Li, X



Temporomandibular joints: high-resolution computed tomographic evaluation  

SciTech Connect

High-resolution computed tomography of the temporomandibular joint (TMJ) was performed in 43 patients. Exquisite detail of the face, skull base, and TMJs was obtained with CT using soft tissue and bone algorithms, narrow collimation, and multiplanar images. In 10 patients clinically suspected of joint derangement, CT results were in close agreement with surgical findings and arthrography in 13/15 joints. CT showed indirect signs of disc dislocation, and the dislocated disc itself in 81% of affected joints. In two patients, arthrography with CT proved to be more helpful than conventional arthrography alone. CT without intra-articular contrast material provided information not appreciated on conventional radiogaphs in 28 patients (65%) and was particularly helpful in evaluating patients with disc pathosis and trauma. Early experience with CT of the TMJ shows that it is an excellent method of evaluation at acceptable radiation exposure levels that adds essential information not seen on standard radiographs.

Thompson, J.R.; Christiansen, E.; Hasso, A.N.; Hinshaw, D.B. Jr.



Bilateral temporomandibular joint dislocation in a 29-year-old man: a case report  

PubMed Central

Introduction A dislocation of the temporomandibular joint represents three percent of all reported dislocated joints. The treatment entails reduction of the deformity and this can often be achieved in a ward setting. Case presentation We present the case of a 29-year-old Caucasian man with a non-traumatic bilateral anterior temporomandibular joint dislocation. Following several unsuccessful attempts, due to both inadequate patient analgesia and sedation, joint reduction had to be performed in theatre with the patient under general anesthesia. Conclusion This case highlights the importance of providing the patient with adequate analgesia and sedation when attempting the reduction of temporomandibular joint dislocations.



Total reconstruction of the temporomandibular joint. Up to 8 years of follow-up of patients treated with Biomet ® total joint prostheses  

Microsoft Academic Search

12 patients underwent temporomandibular joint (TMJ) reconstruction with Biomet total joint prostheses. Indications for TMJ reconstruction included ankylosis, rheumatoid arthritis, degenerative joint disease and condylar resorption. Five patients had unilateral procedures, seven had bilateral. The follow-up ranged between 2 and 8 years. Amongst the ankylotic patients the mean jaw-opening capacity increased from 3.8mm preoperatively to 30.2mm 1 year after surgery,

A. Westermark



Bilateral Traumatic Temporomandibular Joint Luxation in a Rat  

PubMed Central

Bilateral temporomandibular joint (TMJ) luxation was diagnosed postmortem in a female, 6-mo-old CD rat (Rattus norvegicus) after probable head entrapment and subsequent disentanglement from a protective jacket. Clinical antemortem signs included inability to close her mouth, prehend food and drink water, anxiety, and linear skin erosions extending down the right and left commissures of the mouth. Radiography revealed rostral displacement of the mandible with concomitant malocclusion. The combination of clinical signs, acute nature of the presentation, and torn appearance of the protective jacket were strongly indicative of a traumatic etiology. To our knowledge, this is the first reported case of TMJ luxation in a rat.

Shientag, Lisa J; Rosenthal, Karen L; Chandler, Heidi K; Wheeler, Suzanne M



Posterior capsulitis of the temporomandibular joint.  


Posterior capsulitis, which is characterized by pain and inflammation localized above and behind the condyle of the mandible, usually develops as a result of premature contacts in dental occlusion. The pain at the affected side is related to the severe spasm of M. Pterygoideus Lateralis or the splinting action of the masticatory muscles. This condition can be readily treated by occlusal grinding of these premature contacts after a definite diagnosis. The amount of grinding on the teeth varies according to the localization of premature contacts and the pain at the joint. This study covers 123 patients diagnosed as having posterior capsulitis and the results are presented. PMID:3088160

Or, S; Yücetas, S



Relationships between geometry and kinematic characteristics in the temporomandibular joint.  


Motions of the temporomandibular joint (TMJ) involve both translation and rotation; however, there may be substantial variations from one human to another, and these variations present significant difficulties when designing TMJ prostheses. The disc-condyle glides along the temporal bone and the condyle centre describe a curve that depends on the individual morphology. This study analyses disc-condyle rotatory and translatory displacements moving all along the temporal bone facets which are mainly composed of two areas: the articular tubercle slope (ATS) and the preglenoid plane separated by the articular tubercle crest. Displacements were quantified using 3D video analysis, and this technique was computer-assisted. From a population of 32 volunteers, we were able to establish a correlation between the kinematic characteristics of the joint and the disc-condyle trajectories. This study quantifies the geometrical characteristics of the ATS and their inter-individual variations, which are useful in TMJ prosthesis design. PMID:21264781

Mesnard, M; Coutant, J C; Aoun, M; Morlier, J; Cid, M; Caix, P



Temporomandibular joints in patients with rheumatoid arthritis using magnetic resonance imaging.  


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?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?joints in the body (P?

Uchiyama, Yuka; Murakami, Shumei; Furukawa, Souhei



Traumatic unilateral temporomandibular joint dislocation overlooked for more than two decades.  


Forward dislocation of the temporomandibular joint commonly can be easily diagnosed and successfully reduced by manual repositioning. In this report, we discuss a rare case of prolonged temporomandibular dislocation that had persisted for more than 20 years because the otolaryngologist and dentist had missed the dislocation. This patient underwent open reduction and mandibular joint plasty with preoperative orthodontic therapy. It is possible that strong pain and mouth-closing disability may gradually remit and only deviated mandibular prognathism like malocclusion may persist. Therefore, abnormal occlusion warrants careful attention to temporomandibular joint dislocation. PMID:17993903

Nakashima, Mitsuko; Yano, Hiroki; Akita, Sadanori; Tokunaga, Kazuyo; Anraku, Kuniaki; Tanaka, Katsumi; Hirano, Akiyoshi



Lateral thigh fascia lata as interpositional graft for temporomandibular joint ankylosis.  


Successful management of temporomandibular joint (TMJ) ankylosis depends on adequate gap arthroplasty and interpositional graft; the objective is to produce a functioning pseudoarthrosis that prevents reankylosis and provides adequate mobility. Several interpositional grafts have been used for the treatment of temporomandibular joint ankylosis such as indigenous pterygomasseteric sling, temporalis muscle/fascia, auricular cartilage, fat and dermis-fat. Lateral thigh fascia lata (LTFL) graft is commonly used in neurosurgical practice and in other surgical specialities. We present a case of lateral thigh fascia lata used as interpositional graft for the treatment of a unilateral fibrous temporomandibular joint ankylosis. PMID:23997493

Alemán, Ramón Manuel; Martínez, María Guadalupe



The arterial blood supply of the temporomandibular joint: an anatomical study and clinical implications  

PubMed Central

Purpose The aim of this study was to analyze three-dimensional images of the arterial supply to the temporomandibular joint. Materials and Methods Ten patients (five men and five women, mean age 36 years) without signs or symptoms of temporomandibular disorders, who underwent contrast-enhanced computed tomographic (CT) scanning with intravenous contrast, were studied. The direct volume rendering technique of CT images was used, and a data set of images to visualize the vasculature of the human temporomandibular joint in three dimensions was created. After elaboration of the data through post-processing, the arterial supply of the temporomandibular joint was studied. Results The analysis revealed the superficial temporal artery, the anterior tympanic artery, the deep temporal artery, the auricular posterior artery, the transverse facial artery, the middle meningeal artery, and the maxillary artery with their branches as the main arterial sources for the lateral and medial temporomandibular joint. Conclusion The direct volume rendering technique was found to be successful in the assessment of the arterial supply to the temporomandibular joint. The superficial temporal artery and maxillary artery ran along the lateral and medial sides of the condylar neck, suggesting that these arteries are at increased risk during soft-tissue procedures such as an elective arthroplasty of the temporomandibular joint.

Caradonna, Carola; Caradonna, Domenico; Anastasi, Giuseppe; Milardi, Demetrio; Favaloro, Angelo; De Pietro, Anita; Angileri, Tommaso Maurizio; Caradonna, Luigi; Cutroneo, Giuseppina



Pseudotumors and tumors of the temporomandibular joint. A review  

PubMed Central

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



Temporomandibular Joint Loading Patterns Related to Joint Morphology: A Theoretical Study  

Microsoft Academic Search

It is unclear which aspects of the temporomandibular joint (TMJ) anatomy and\\/or kinematics determine shape and location of disk-compressive areas (stress field). The aim of this study was a quantitative analysis of TMJ anatomy to predict stress field path direction. Twenty-five asymptomatic TMJs (12 females and 13 males, aged 20–38 years) were tracked during unloaded opening\\/closing cycles. All TMJs were

Vera Colombo; Sandro Palla; Luigi M. Gallo



The ultrasonic value of local muscle hypertrophy in patients with temporomandibular joint disorders.  


Muscle pain and tenderness on palpation are two common symptoms in patients with temporomandibular joint disorders. Examination of the masticatory muscles is largely restricted to the use of electromyography. The technique of ultrasonography in the diagnosis of muscle hypertrophy in patients with temporomandibular joint disorders was investigated. The results of the study indicate that ultrasonography may be beneficial to locate affected muscles that do not exhibit symptoms of tenderness on palpation and thereby give hints for treatment planning. PMID:7783017

Emshoff, R; Bertram, S



Temporomandibular joint herniation into the external ear canal through foramen of Huschke.  


Foramen of Huschke, which is also known as the foramen tympanicum, is an anatomical variation of the tympanic portion of the temporal bone. This foramen is located on the anteroinferior aspect of the external auditory canal, posteromedial to the temporomandibular joint. Herein, a rare case of foramen Huschke with a herniation of the soft tissues around the temporomandibular joint that result in severe otalgia and its treatment are presented. PMID:21316883

Akcam, Timur; Hidir, Yusuf; Ilica, A Turan; Kilic, Erbil; Sencimen, Metin



Changes in the temporomandibular joint caused by the vertical facial pattern. Study on an experimental model.  


An experimental model reproducing open bite or verticalized facial pattern was used to study its effect on the temporomandibular joints. 140 Wistar rats were used, divided into 3 groups: bilateral resection of the masseteric muscle, simulated muscular resection and control group. A series of radiological, morphological and histological tests were analyzed. The posterior rotation of the jaw caused by muscular resection although not producing a degenerative effect, did produce specific articular changes in the temporomandibular joint components. PMID:7884008

Monje, F; Delgado, E; Navarro, M J; Miralles, C; Alonso del Hoyo, J R



Arthroscopic management of septic arthritis of temporomandibular joint.  


This article reports on 7 patients with septic arthritis of the temporomandibular joint (TMJ) who were managed with arthroscopy between 1998 and 2007. The common symptoms were trismus and pain. A series of imaging studies showed widening of joint space in 1 patient with plain film; MRI demonstrated increased joint effusion in 4 patients; accompanying cellulitis in adjacent tissues was discerned by CT in 2 patients. Under the arthroscope, a reddened and swollen synovial membrane was found in 2 patients who were in the acute stage, whereas strong adhesions, destruction of cartilage, and bony defects were discovered in other 5 patients in the chronic stage. Additionally, the disc was ruptured in 3 patients, and fibrosis was confirmed for 2 patients. Lavage, lysis of adhesion, and debridement of articular surface were common procedures for treatments. The average follow-up period was 57.4 months, and no recurrence was found. Arthroscopy has proven to be a useful method for management of septic arthritis of TMJ, especially for patients in the chronic stage. PMID:20123377

Cai, Xie-Yi; Yang, Chi; Chen, Min-Jin; Zhang, Shan-Yong; Yun, Bai



Tensile characterization of porcine temporomandibular joint disc attachments.  


The frequency and impact of temporomandibular joint (TMJ) disorders necessitate research in characterizing the joint's function. The 6 discal attachments have not yet been systematically characterized under tension. Understanding their role in joint function may guide our study of TMJ pathologies, including disc displacement. In the present study, a porcine model was used to characterize the attachments in tension anteroposteriorly and mediolaterally, based on previously identified similarities in the porcine and human masticatory behaviors and discal properties. Tensile stiffness, strength, toughness, and maximum strain were quantified. Collagen alignment was characterized via polarized light and scanning electron microscopy. Anisotropy was demonstrated in all attachments, with the exception of the anterior inferior attachment. Anteroposteriorly, the lateral attachment was stiffest (8.3 MPa) and the anterior superior was least stiff (1.4 MPa). Mediolaterally, the posterior superior attachment was stiffest (16.3 MPa) and the medial was least stiff (1.4 MPa). The greatest strain was observed in the lateral attachment in the mediolateral direction and the posterior superior attachment in the anteroposterior direction. With greatest strains in the most commonly observed directions of disc displacement, it is suggested that compromise in the posterior and lateral attachments contributes to partial lateral and anterior disc displacement. PMID:23783320

Murphy, M K; Arzi, B; Hu, J C; Athanasiou, K A



Absence of the Articular Disc in the Tasmanian Devil Temporomandibular Joint.  


The articular disc of the temporomandibular joint is a constant structure in mammals. According to Parsons' report in 1900, however, it is absent in four animals: the armadillo, two kinds of monotremes and the Tasmanian devil. Thereafter, no research was performed to confirm this observation. The aim of this study was to determine by anatomical and histological examination whether the Tasmanian devil has an articular disc in its temporomandibular joint. Six fresh frozen corpses and one dry skull of Tasmanian devils were obtained from the School of Zoology, University of Tasmania. The corpses were dissected and the morphology of the temporomandibular joint was carefully observed by gross anatomical and histological examination. The structure of the temporomandibular joint of the dry skull was examined macroscopically and by micro-computed tomography. In all cases, absence of the articular disc in the Tasmanian devil temporomandibular joint was morphologically confirmed. The surface layer of both the condyle and the glenoid fossa comprised a thick fibrous tissue. Micro-computed tomography revealed dense and fine trabecular bone in the condyle. The thick fibrous tissue covering the condyle and high-density trabecular bone in the condyle might play a role in absorption against powerful mastication and heavy loading of the Tasmanian devil temporomandibular joint. PMID:23438215

Hayashi, K; Sugisaki, M; Kino, K; Ishikawa, T; Sugisaki, M; Abe, S



Morphological and biomechanical features of the temporomandibular joint disc: An overview of recent findings.  


The temporomandibular joint is a type of synovial joint with unique structure and function. Between the mandibular condyle and the mandibular fossa there is a dense fibrocartilaginous oval articular disc, temporomandibular joint disc. This disc serves as a nonossified bone, thus permitting the complex movements of the joint, and plays a major role in jaw function by providing stress distribution and lubrication in the temporomandibular joint. Pathological mechanical loads are one of the principal causes of temporomandibular joint disc displacement. There is a high frequency of temporomandibular joint disc disorders and treatment options are very limited. For this reason, it is necessary to examine possible alternatives to current treatment options like physiotherapy, drugs, splints or surgical techniques. Recent discoveries in the field of structure and functions of temporomandibular joint disc have created the need for their particular systematization, all in order to create an implant that would be used to replace the damaged disc and be more similar to the natural one. There is a need to more fully meet the morphology and biomechanical properties of the temporomandibular joint disc, and using tissue engineering, make a substitute for it, as faithful as possible, in a case where the natural TMJ disc is damaged so much that the normal function of the joint can be preserved only through implanted disc. Therefore, the aim of this paper was to describe morphology and structure, as well as biomechanical properties of the TMJ disc, in light of the possible applications of this knowledge for the purposes of tissue engineering. PMID:23871384

Stankovi?, Saša; Vlajkovi?, Slobodan; Boškovi?, Mirjana; Radenkovi?, Goran; Anti?, Vladimir; Jevremovi?, Danimir



Prostaglandin E 2 in temporomandibular joint synovial fluid and its relation to pain and inflammatory disorders  

Microsoft Academic Search

Purpose: The aim of this study was to investigate temporomandibular joint (TMJ) synovial fluid (SF) levels of prostaglandin E2 and its relation to general inflammatory activity and its influence on specific TMJ pain in patients with inflammatory TMJ disorders.Patients and Methods: The study comprised 24 patients (30 joints) with inflammatory TMJ disorders and 4 healthy persons (6 joints). TMJ pain

Per Alstergren; Sigvard Kopp



Proteomic signature of Temporomandibular Joint Disorders (TMD): Toward diagnostically predictive biomarkers  

PubMed Central

The temporomandibular joint (TMJ) articulates the mandible with the maxilla. Temporomandibular joint disorders (TMD) are dysfunctions of this joint, which range from acute to chronic inflammation, trauma and dislocations, developmental anomalies and neoplasia. TMD manifest as signs and symptoms that involve the surrounding muscles, ligaments, bones, synovial capsule, connective tissue, teeth and innervations proximal and distal to this joint. TMD induce proximal and distal, chronic and acute, dull or intense pain and discomfort, muscle spasm, clicking/popping sounds upon opening and closing of the mouth, and chewing or speaking difficulties. The trigeminal cranial nerve V, and its branches provide the primary sensory innervation to the TMJ. Our clinical work suggests that the auriculotemporal (AT) nerve, a branch of the mandibular nerve, the largest of the three divisions of the trigeminal nerve, plays a critical role in TMD sequelae. The AT nerve provides the somatosensory fibers that supply the joint, the middle ear, and the temporal region. By projecting fibers toward the otic ganglion, the AT nerve establishes an important bridge to the sympathetic system. As it courses posteriorly to the condylar head of the TMJ, compression, injury or irritation of the AT nerve can lead to significant neurologic and neuro-muscular disorders, including Tourette's syndrome,Torticolli, gait or balance disorders and Parkinson’s disease. Here, we propose that a proteomic signature of TMD can be obtained by assessing certain biomarkers in local (e.g., synovial fluid at the joint) and distal body fluids (e.g., saliva, cerebrospinal fluid), which can aid TMD diagnosis and prognosis.

Demerjian, Garabed Gary; Sims, Anothony Benjamin; Stack, Brendan Curran



Estrogen receptors in the temporomandibular joint of the baboon (Papio cynocephalus): an autoradiographic study  

SciTech Connect

Using an autoradiographic method, the temporomandibular joint (TMJ) complex of five aged female baboons was studied for the presence of receptors for estradiol-17 beta. The study was performed in an effort to learn more of the pathophysiology of this joint and in an attempt to provide a scientific basis to explain the reported preponderance of women who seek and undergo treatment for signs and symptoms referable to the TMJ. This experiment revealed that the TMJ complex contains numerous cells with receptors for estrogen, particularly the articular surface of the condyle, articular disk, and capsule. Muscles of mastication contained relatively fewer receptors. As a result, one may postulate a role for the sex steroid hormones in the maintenance, repair, and/or pathogenesis of the TMJ. Additional studies are necessary to fully determine the significance of hormone receptors in this site and any correlation between diseases of the TMJ and the endocrine status of affected patients.

Aufdemorte, T.B.; Van Sickels, J.E.; Dolwick, M.F.; Sheridan, P.J.; Holt, G.R.; Aragon, S.B.; Gates, G.A.



Bilateral temporomandibular joint ankylosis as sequel of bilateral fracture of the mandibular condyle and symphysis.  


BACKGROUND: Temporomandibular joint (TMJ) ankylosis is an extremely disabling affliction that causes problems in mastication, digestion, speech, appearance, and hygiene. The disease also has an impact on the psychological development of the patients. CASE REPORT: A 49-year-old male patient came to our unit with complaint of restriction in his alimentation and of mouth opening. In the anamnesis, the patient reported that this limitation began 11 years ago, soon after a serious car accident that caused trauma on the face. In the clinical examination, the patient's mouth opening was 1 mm, and there was satisfactory occlusion. He was diagnosed with bilateral temporomandibular joint (TMJ) ankylosis after an imaging examination. DISCUSSION: In order to confirm the post-traumatic etiology of the anquilose, we got the medical records from the hospital where the patient received the first treatment. The records, at that time, reported facial trauma with bilateral condylar fracture and comminuted symphyseal fracture which was reduced and fixed followed by maxillomandibular fixation that remained for 45 days. After collecting all the information needed for diagnosis, surgical treatment was proposed through arthroplasty. The patient was placed on immediate post-operative jaw physiotherapy, and 12 months after surgery, his mouth opening improved to 35 mm. Thus, in our case, ankylosis may have been developed as a sequel of the mandibular fractures. PMID:23306946

Benaglia, Matheus B; Gaetti-Jardim, Ellen Cristina; Oliveira, Janayna G Paiva; Mendonça, Jose Carlos Garcia



Relationship between temporomandibular joint pain and magnetic resonance imaging findings of internal derangement  

Microsoft Academic Search

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



Occlusal effects on longitudinal bone alterations of the temporomandibular joint.  


The pathological changes of subchondral bone during osteoarthritis (OA) development in the temporomandibular joint (TMJ) are poorly understood. In the present study, we investigated the longitudinal alterations of subchondral bone using a rat TMJ-OA model developed in our laboratory. Changes in bone mass were examined by micro-CT, and changes in osteoblast and osteoclast activities were analyzed by real-time PCR, immunohistochemistry, and TRAP staining. Subchondral bone loss was detected from 8 weeks after dental occlusion alteration and reached the maximum at 12 weeks, followed by a repair phase until 32 weeks. Although bone mass increased at late stages, poor mechanical structure and lower bone mineral density (BMD) were found in these rats. The numbers of TRAP-positive cells were increased at 12 weeks, while the numbers of osteocalcin-expressing cells were increased at both 12 and 32 weeks. Levels of mRNA expression of TRAP and cathepsin K were increased at 12 weeks, while levels of ALP and osteocalcin were increased at both 12 and 32 weeks. These findings demonstrated that there is an active bone remodeling in subchondral bone in TMJs in response to alteration in occlusion, although new bone was formed with lower BMD and poor mechanical properties. PMID:23340211

Zhang, J; Jiao, K; Zhang, M; Zhou, T; Liu, X-D; Yu, S-B; Lu, L; Jing, L; Yang, T; Zhang, Y; Chen, D; Wang, M-Q



Pigmented villonodular synovitis of the temporomandibular joint: case report and review of the literature.  


Pigmented villonodular synovitis (PVNS) is an aggressive proliferative lesion that usually involves the synovial tissues of big joints. To date, there are ?52 cases of PVNS affecting the temporomandibular joint reported in the English-language literature, about one-third of them exhibiting intracranial involvement. We herein describe an additional case of PVNS of the temporomandibular joint with skull base invasion affecting a 26-year-old male patient and discuss its clinicopathologic features considering previously published cases. Histopathology and imaging evaluation are important for the diagnosis of PVNS, which should be included in the differential diagnosis of preauricular aggressive swellings. PMID:21310347

Romañach, Mário José; Brasileiro, Bernardo Ferreira; León, Jorge Esquiche; Alves, Daniel Berreta; de Almeida, Oslei Paes; Vargas, Pablo Agustin



Subjective and objective assessment of the temporalis myofascial flap in previously operated temporomandibular joints  

Microsoft Academic Search

Purpose: This study evaluated the subjective and objective findings in patients who had undergone temporomandibular joint (TMJ) reconstruction with a temporalis myofascial flap. All joints had previously been reconstructed with alloplastic, allogeneic, or autogenous material.Patients and Methods: Twenty-three consecutive patients who underwent 28 temporalis myofascial flap procedures were assessed subjectively and objectively preoperatively and at an average of 36 months

Julie Ann Smith; Noah A Sandler; Wayne H Ozaki; Thomas W Braun



Reconstruction of ankylosed temporomandibular joint: Sternoclavicular grafting as an approach to management  

Microsoft Academic Search

A retrospective analysis of 15 cases of ankylosed temporomandibular joint (TMJ) reconstructed, with sternoclavicular joint graft (SCG), during the period 2002–2007 was undertaken. All cases were analyzed for functional adaptation of the graft, considering maximum interincisal opening, and protrusive and laterotrusive movement of the jaw. Significant improvement was noticed in all cases except one, although maximum improvement was seen 3–6

V. Singh; A. Verma; I. Kumar; A. Bhagol



The use of TMJ Concepts prostheses to reconstruct patients with major temporomandibular joint and mandibular defects  

Microsoft Academic Search

Temporomandibular joint (TMJ) reconstruction may be required in complex cases in which there are additional mandibular or zygomatic arch defects. The reconstructive options include autogenous tissue, alloplastic material, or combinations of these. The authors describe 4 cases in which TMJ reconstruction was performed with TMJ Concepts customized joint prostheses. The prosthetic components were designed to restore major defects in the

A. Westermark; P. Hedén; E. Aagaard; C.-P. Cornelius



Long-term follow-up of the CAD\\/CAM patient fitted total temporomandibular joint reconstruction system  

Microsoft Academic Search

Purpose: The purpose of this study was the assessment of the long-term safety and effectiveness of the Techmedica (Camarillo, CA) CAD\\/CAM Total Temporomandibular Joint Reconstruction System (now called the TMJ Concepts Patient Fitted Total Temporomandibular Joint Reconstruction System, Ventura, CA). Patients and Methods: A survey was mailed to the available addresses of 170 (79%) of the 215 patients who had

Louis G. Mercuri; Larry M. Wolford; Bruce Sanders; R. Dean White; Anita Giobbie-Hurder



Current status of temporomandibular joint arthroscopy in the United Kingdom.  


In an era during which minimally invasive procedures are increasingly becoming the norm, arthroscopy of the temporomandibular joint (TMJ) seems to be infrequently used for diagnosis and treatment of disorders of the TMJ. The reasons for this are not clear. The purpose of this study was to find out the current state of arthroscopy of the TMJ in the UK and, more specifically, how often it is used, the indications for its use, the level of experience of practising surgeons, and the reasons for not using it. Information was gathered between 2009 and 2010 from a postal and e-mail questionnaire to all oral and maxillofacial consultants in the UK. Of the 346 consultants, 215 (60%) responded to the questionnaire. Forty-two said that they currently used arthroscopy of the TMJ, and 33 of those (81%) have more than 5 years' experience. During the past year, a total of 8 consultants nationally have done 20 arthroscopies or more. Thirty-three of the procedures (81%) were done for both diagnosis and treatment. Lack of perceived need of patients and lack of interest in this specialty were the main reasons given for not doing arthroscopy, lack of training being a key secondary reason. The Storz and Olympus systems were the most commonly used within the UK. Results seem to support the opinion that arthroscopy of the TMJ is under-used, and consideration should be given to ensuring that trainees are instructed in its use, which is important in the diagnosis and treatment of disorders of the TMJ. PMID:22206716

Thomas, Sangeetha M; Matthews, N Shaun



Fluroscopic assisted airway intubation in temporomandibular joint ankylosis: A novel technique  

PubMed Central

Airway management is considered one of the most difficult and challenging procedures among the various anesthetic procedures. It becomes tougher when there is a diseased temporomandibular joint (TMJ) due to inadequate mouth opening. In the current scenario there are only a few methods that ensure a safe, uneventful intubation in a TMJ ankylosis patient with a difficult airway. These include techniques ranging from minimally invasive techniques like blind nasal intubation, retrograde intubation using a guide wire, the latest technique of intubating with the help of a fiberoptic laryngoscope and the time tested tracheostomy. All these techniques have got their own disadvantages. So we report a case series of five patients with TMJ ankylosis who underwent fluoroscopic-assisted intubation for airway management. We found that this technique is 100% successful in managing the airway in these patients. To the best of our knowledge, this is the first case series detailing this novel technique in the entire English medical literature.

Varughese, Ibin; Varughese, Parekkara I; Soman, Thomas; Mathew, James



Internal derangements of the temporomandibular joint: findings in the pediatric age group  

SciTech Connect

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.



Emerging Intra-Articular Drug Delivery Systems for the Temporomandibular Joint  

PubMed Central

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.



Synovial chondromatosis of the temporomandibular joint: report of 2 patients whose joints were reconstructed with costochondral graft and alloplastic prosthesis  

Microsoft Academic Search

Synovial chondromatosis of the temporomandibular joint (TMJ) is rare, and only about 100 cases have been reported. Among these, intracranial extension was reported in only 9. Although some patterns of clinical presentation and evolution, synovial histological changes, and diagnosis by computed tomography and magnetic resonance imaging have been described, there is little information about surgical treatment. We report two new

Carlos C. Goizueta-Adame; Raúl González-García



Magnetic resonance imaging features of the temporomandibular joint in normal dogs  

Microsoft Academic Search

Evaluation of the canine temporomandibular joint (TMJ) is important in the clinical diagnosis of animals presenting with dysphagia, malocclusion and jaw pain. In humans, magnetic resonance imaging (MRI) is the modality of choice for evaluation of the TMJ. The objectives of this study were to establish a technical protocol for performing MRI of the canine TMJ and describe the MRI

D M Macready; Silke Hecht; Linden E Craig; G A Conklin



Aetiology and presentation of ankylosis of the temporomandibular joint: report of 23 cases from Abuja, Nigeria  

Microsoft Academic Search

Several studies have reviewed the management of ankylosis of the temporomandibular joint (TMJ), but only a few focused on the aetiology and clinical features. We retrospectively studied the aetiology and clinical features of patients with ankylosis of the TMJ who presented to the Maxillofacial Unit, National Hospital, Abuja, Nigeria, between 2004 and 2009. There were 13 male and 10 female

Seidu Adebayo Bello; Bayo Aluko Olokun; Abayomi Ademola Olaitan; Sunday O. Ajike


Rapid prototyping assisted fabrication of the customised temporomandibular joint implant: a case report  

Microsoft Academic Search

Purpose – The purpose of this paper was to find a successful treatment modality for patients suffering from temporomandibular joint (TMJ) ankylosis who could not be treated through traditional surgeries. Design\\/methodology\\/approach – This work integrated the unique capabilities of the imaging technique, the rapid prototyping (RP) technology and the advanced manufacturing technique to develop the customised TMJ implant. The patient

T. R. Deshmukh; A. M. Kuthe; S. M. Chaware; B. Vaibhav; D. S. Ingole



Comparison of different methods of temporomandibular joint disc reconstruction - An animal model  

Microsoft Academic Search

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 later unilateral surgical reconstruction was performed. Four sheep had discectomy alone, four discectomy

Nobumi Ogi; Jun-Ichi Ishimaru; Kenichi Kurita; Yujiro Handa; Robert H. B. Jones; Alastair N. Goss



Computer-assisted condylar reconstruction in bilateral ankylosis of the temporomandibular joint using autogenous coronoid process  

Microsoft Academic Search

During the past 10 years, more than 20 patients a year have been treated at our centre for bilateral ankylosis of the temporomandibular joint (TMJ). Here we describe the use of computer-assisted three-dimensional surgical planning and its clinical effects in condylar reconstruction for such patients using autogenous coronoid process. Sixteen patients with bilateral bony ankylosis of the TMJ from March

Xiaoqin Yang; Jing Hu; Guozhu Yin; Jian Hu; En Luo


Guidelines for the replacement of temporomandibular joints in the United Kingdom  

Microsoft Academic Search

BAOMS has requested that guidelines be formulated for the replacement of the temporomandibular joint (TMJ). This is an expensive and technique sensitive method of TMJ reconstruction and in the current climate warrants an agreed approach. The following document states the indications and contraindications for this technique as discussed and agreed amongst surgeons currently carrying out this procedure in the UK.

Andrew J. Sidebottom



Reconstruction of the temporomandibular joint by the transfer of the free vascularised second metatarsal  

Microsoft Academic Search

We present our experience of a series of patients who presented for salvage reconstruction of the temporomandibular joint (TMJ) for relief of pain. Reconstruction was achieved by transfer of the free vascularised second metatarsal. This technique has been used for a total of seven TMJ reconstructions in five patients.We describe the surgical anatomy, technique and results during the last 18

S. E. Bond; N. R. Saeed; P. D. Cussons; S. R. Watt-Smith



Historical development of alloplastic temporomandibular joint replacement after 1945 and state of the art  

Microsoft Academic Search

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

O. Driemel; S. Braun; U. D. A. Müller-Richter; M. Behr; T. E. Reichert; M. Kunkel; R. Reich



Initial Investigation of the Relation between Extended Computer Use and Temporomandibular Joint Disorders  

Microsoft Academic Search

Aim: ? To determine if temporomandibular joint disorders (TMDs) are associated with extended computer use. MaterialsandMethods: ? People with chronic pain and extensive computer use were recruited by means of a newspaper advertisement. Those who responded to the ad were asked to complete an online survey, which included questions on computer use, medical history, pain symptoms, lifestyle and mood. Results:

Romina Perri; Veronika Huta; Leonard Pinchuk; Cindy Pinchuk; David J. Ostry; James P. Lund



Temporomandibular joint: role of direct sagittal CT air-contrast arthrogram and MRI.  


Direct sagittal CT air-contrast arthrography can provide useful diagnostic information in the evaluation of disorders of the temporomandibular joint. The technique for the performance of this examination is practical and efficient, using a specifically designed head-holder, which is described. This technique effectively complements the clinical and imaging work-up of jaw dysfunction. PMID:3399277

Mafee, M F; Heffez, L; Campos, M; Backus, P; Kahen, H L; Langer, B G; Spigos, D G; Sadighi, S; Kriz, R J



Psoriatic arthritis of the temporomandibular joints with ankylosis. Literature review and case reports.  


Psoriatic arthritis is currently defined as psoriasis associated with chronic, erosive inflammatory arthritis, which is seronegative for rheumatoid factor. A review of the etiology, pathogenesis, diagnosis, and treatment is accompanied by two unusual case reports of psoriatic arthritis affecting the temporomandibular joints with ankylosis. PMID:2011347

Koorbusch, G F; Zeitler, D L; Fotos, P G; Doss, J B



Late extrusion of a temporomandibular joint prosthesis masquerading as a sebaceous cyst.  


Complications of temporomandibular joint prostheses are not uncommon and have been well documented. We report a very late and rare complication following silastic TMJ replacement, believed to be the first implant extrusion through healthy skin. We are reminded that these implants can still cause problems to patients many years after initial surgery. PMID:23664576

Hogan, K; Herman, A; Nicholson, S; Matteucci, P



Arthroscopic surgery of the temporomandibular joint: comparison of two successful techniques  

Microsoft Academic Search

We have compared two techniques of arthroscopic surgery for advanced internal derangement of the temporomandibular joint (TMJ). Patients with stage III or above TMJ internal derangement, who had not responded to three months of non-surgical treatment, were prospectively and randomly assigned to one of two types of treatment. One group had arthroscopic lysis and lavage (ALL) and the other had

H. Miyamoto; H. Sakashita; M. Miyata; A. N. Goss



Viscoelastic properties of the human temporomandibular joint disc in patients with internal derangement  

Microsoft Academic Search

Purpose: This study investigated the viscoelastic properties of human temporomandibular joint (TMJ) discs in patients with severe internal derangement (ID). Patients and Methods: TMJ discs obtained from 5 patients with severe TMJ internal derangement were analyzed. Normal discs derived from 2 fresh cadavers and 4 patients without ID served as the controls. The viscoelastic responses of the discs to tensile

Eiji Tanaka; Tatsuya Shibaguchi; Masao Tanaka; Kazuo Tanne



Biofeedback and Relaxation Therapy for Chronic Temporomandibular Joint Pain: Predicting Successful Outcomes.  

ERIC Educational Resources Information Center

|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.



Magnetic resonance imaging findings of internal derangement and effusion in patients with unilateral temporomandibular joint pain  

Microsoft Academic Search

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



Treatment of recurrent temporomandibular joint dislocation with intramuscular botulinum toxin injection  

Microsoft Academic Search

Recurrent dislocation of the mandibular condyle poses a difficult problem for affected patients. In the course of time, dislocations often become more frequent and more difficult to avoid. Even with good patient compliance, conservative treatment is often not sufficient. Operative procedures have also been described for the treatment of temporomandibular joint dislocation. However, these interventions are invasive, involving open arthrotomy

Christoph M. Ziegler; C. Haag; J. Mühling



The relationship between the temporomandibular joint capsule, articular disc and jaw muscles.  

PubMed Central

The anatomy of the temporomandibular joint capsule and its possible relationships to other structures near the joint are not fully understood. A 3-dimensional analysis based on sagittal, frontal and horizontal serial sections through the human temporomandibular joint region was therefore undertaken. Capsular elements which directly connect the temporal bone with the mandible were seen only on the lateral side of the joint. In the posterior, anterior and medial regions of the joint the upper and lower laminae of the articular disc are attached separately either to the temporal bone or to the mandibular condyle. The shaping of the articular cavities and the texture of the joint capsule permit movements of the articular disc predominantly in the anteromedial direction. On the entire medial side of the joint the articular disc and its capsular attachments are in close contact with the fascia of the lateral pterygoid muscle whereby a small portion of the upper head of this muscle inserts directly into the anteromedial part of the articular disc. Thus both the upper and the lower heads of the lateral pterygoid muscle are likely to influence the position of the articular disc directly during temporomandibular joint movements. Laterally, the articular disc is attached to the fascia of the masseter muscle, and part of the lateral ligament inserts into the temporalis fascia. Since these attachments are relatively weak, neither the temporalis nor the masseter muscles are considered to act directly on the articular disc; instead, via afferents from muscle spindles, they may take part in signalling the position of the temporomandibular joint components, including that of the articular disc. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5

Schmolke, C



MRI Slice Segmentation and 3D Modelling of Temporomandibular Joint Measured by Microscopic Coil  

NASA Astrophysics Data System (ADS)

The paper focuses on the segmentation of magnetic resonance imaging (MRI) slices and 3D modelling of the temporomandibular joint disc in order to help physicians diagnose patients with dysfunction of the temporomandibular joint (TMJ). The TMJ is one of the most complex joints in the human body. The most common joint dysfunction is due to the disc. The disc is a soft tissue, which in principle cannot be diagnosed by the CT method. Therefore, a 3D model is made from the MRI slices, which can image soft tissues. For the segmentation of the disc in individual slices a new method is developed based on spatial distribution and anatomical TMJ structure with automatic thresholding. The thresholding is controlled by a genetic algorithm. The 3D model is realized using the marching cube method.

Smirg, O.; Liberda, O.; Smekal, Z.; Sprlakova-Pukova, A.



Subjective and objective outcomes in patients reconstructed with a custom-fitted alloplastic temporomandibular joint prothesis  

Microsoft Academic Search

Purpose: This study looked at prospective subjective and objective preoperative and postoperative outcome data from a set of multiply operated, anatomically mutilated, functionless, chronic temporomandibular joint (TMJ) pain patients who have undergone TMJ reconstruction with a custom-fitted prosthetic system.Patients and Methods: Two hundred fifteen patients (363 joints: 296 bilateral, 67 unilateral) who had undergone total TMJ reconstruction with a custom-fitted

Louis G Mercuri



Two-stage total prosthetic reconstruction of temporomandibular joint in severe and recurrent ankylosis.  


Temporomandibular joint ankylosis is a devastating condition for the patient associated with both functional disability and aesthetic deformities. Various techniques have been described in the literature to overcome this problem; however, there is still a high risk of reankylosis in patients undergoing multiple temporomandibular joint operations, severe heterotopic ossification, and fibrosis of the soft tissues. This study includes 5 patients with severe and recurrent ankylosis. Two-stage reconstruction with excision of the bony mass and placement of a distraction device in the first stage, followed by gradual distraction of soft tissues, and placement of a total joint prosthesis in the second stage were performed in all patients. The 2-step approach helps to overcome the fibrosis and adhesions in the soft tissues and allows placing an implant with a higher ramus component. This approach seems to be a useful and effective technique for the management of such patients with high risk of reankylosis. PMID:22976729

Egemen, Onur; Ozkaya, Ozay; Filinte, Gaye Taylan; Uscetin, Ilker; Akan, Mithat



Vacuum phenomenon in the temporomandibular joint: a clinical, computed tomography and magnetic resonance case report.  


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



Navigation-guided resection for a tenosynovial giant cell tumor involving the temporomandibular joint and skull base.  


Tenosynovial giant cell tumor is a very rare, benign lesion from the synovium. It seldom happens in the temporomandibular joint area and skull base that is difficult to resect and reconstruct. We present a case treated with computer-assisted navigation to help mark the tumor boundaries, protect vital structures, and facilitate the reconstruction process. Follow-up at 6 months after surgery showed no tumor recurrent and good temporomandibular joint function. PMID:22421861

He, Dongmei; Yang, Chi; Shen, Guofang; Chen, Minjie; Yang, Xiujuan; Huang, Dong; Zhou, Qin; Guo, Zhilin; Wang, Peihua; Ye, Ming



Immunohistochemical evaluation of neuroreceptors in healthy and pathological temporo-mandibular joint.  


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. PMID:24151441

Favia, Gianfranco; Corsalini, Massimo; Di Venere, Daniela; Pettini, Francesco; Favia, Giorgio; Capodiferro, Saverio; Maiorano, Eugenio



Immunohistochemical Evaluation of Neuroreceptors in Healthy and Pathological Temporo-Mandibular Joint  

PubMed Central

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



Assessment of five oblique radiographic projections of the canine temporomandibular joint.  


Investigation of temporomandibular joint (TMJ) disease requires a clear diagnostic image, which can be challenging to obtain using conventional radiography. The aim of this study was to compare five different oblique radiographic views with the head in lateral recumbency, assessing the clarity of visualization of the normal TMJ anatomy. The views under investigation were the laterorostral-laterocaudal oblique at a 10° and 20° rotation of the head ("nose-up" view), laterorostral-laterocaudal oblique with a rostrocaudal X-ray beam angulation of 10° and 20°, and a parallax view with the beam centered over C2 and collimated to include the TMJ region, using the divergence of the X-ray beam to project the TMJs separately on the radiograph. The views were performed on both TMJs of thirty canine cadavers and were graded independently by experienced and inexperienced observers. Grading was performed on the mandibular fossa, condylar process, joint space, retroarticular process, and the overall TMJ, and was based on a four-point scale. Mean grades for each component and for the overall joint were compared for each observer and each projection. Mean grades were significantly (P < 0.05) higher for the "Nose-up" projections than the angled beam or parallax projections, as was interobserver agreement, and both observers showed significantly higher (P < 0.05) mean grades for the 20(o) "Nose-up" angulation than the 10(o) "Nose-up" angulation. These results suggest that a latero 20(o) rostral-laterocaudal oblique gives the best representation of the anatomy of the TMJ of the dog of the projections assessed, and should be considered when investigating clinical cases of TMJ disease. PMID:22703026

Hammond, Gawain; King, Alison; Lapaglia, John



Long-term outcomes after total alloplastic temporomandibular joint reconstruction following exposure to failed materials  

Microsoft Academic Search

PurposeTotal alloplastic temporomandibular joint (TMJ) reconstruction is often necessary because of the significant bony destruction resulting from failed Proplast-Teflon (Vitek, Houston, TX) and\\/or Silastic (Dow Corning, Arlington, TX) foreign body inflammatory reactions. Multiply operated and functionless, TMJ patients likewise have undergone total alloplastic reconstruction. Many of these patients were also exposed to failed TMJ implant materials. It was the purpose

Louis G. Mercuri; Anita Giobbie-Hurder



Experimental study of reconstruction of the temporomandibular joint using a bone transport technique  

Microsoft Academic Search

Purpose: This study investigated the applicability of transport distraction osteogenesis with an internal appliance for reconstruction of the temporomandibular joint (TMJ). Materials and Methods: Fifteen millimeters of the ascending ramus, including the condyle and intra-articular disc, was extirpated in 42 white rabbits (3.0 kg weight). After an L-osteotomy was performed from the anterior border of the coronoid process to the

Hisako Hikiji; Tsuyoshi Takato; Shigeyuki Matsumoto; Yoshiyuki Mori



Technique of temporomandibular joint replacement using a patient-specific reconstruction system in the edentulous patient.  


The dental occlusion sets the intermaxillary relation during planning, construction of a prosthesis, and surgery for total replacement of the temporomandibular joint (TMJ), and enables accurate placement of the prosthesis. However, in edentulous patients this no longer exists. We describe techniques to overcome the problems encountered in such patients having TMJ replacement using the patient-specific TMJ Concepts(®) system (Ventura, California, USA). PMID:21144629

Dhanda, Jagtar; Cooper, Claire; Ellis, David; Speculand, Bernard



Temporomandibular joint reconstruction after failed teflon-proplast implant: case report and literature review  

Microsoft Academic Search

Multiple reports document that a foreign-body giant cell reaction forms around Proplast-Teflon temporomandibular joint (TMJ) implants. This results in destruction of surrounding bone and instability of the implants. This case presents a patient whose Proplast-Teflon TMJ implants became displaced into her middle cranial fossa. The staged reconstruction of this patient is described, including removal of the TMJ implants, reconstruction of

S. Abramowicz; M. F. Dolwick; S. B. Lewis; C. Dolce



Culture of cells gained from temporomandibular joint cartilage on non-absorbable scaffolds  

Microsoft Academic Search

The objective of this study was to investigate the adhesion, spreading and extracellular matrix synthesis of temporomandibular joint (TMJ) derived cells on non-absorbable scaffold materials to ultimately provide a durable stress-absorbent framework within tissue-engineered disc transplants. Scaffolds were prepared by polyamide monofilaments, expanded polytetrafluoroethylene (ePTFE) monofilaments, polyglycolic acid monofilaments (control) or natural bone mineral blocks (control). These scaffolds were incubated

Ingo N. G. Springer; Bernd Fleiner; Søren Jepsen; Yahya Açil



The temporomandibular joint in juvenile idiopathic arthritis: frequently used and frequently arthritic  

PubMed Central

Recent recognition of the markedly high prevalence of temporomandibular joint (TMJ) arthritis in children with juvenile idiopathic arthritis (JIA) coupled with the significant morbidity associated with TMJ damage has prompted increased interest in both the clinical and pathological aspects of TMJ arthritis. This review focuses on the prevalence of TMJ arthritis in JIA, the imaging modalities used to detect TMJ arthritis, and the treatment of TMJ arthritis in children with JIA.

Ringold, Sarah; Cron, Randy Q



Development of nerve fibres in the temporomandibular joint of the human fetus  

Microsoft Academic Search

The development of nerve fibres in the temporomandibular joint (TMJ) in relation to the development of bone, muscle and fibre components was investigated in human fetuses ranging from 9 weeks of gestation to birth. Immunohistochemistry for the glia-associated protein S-100 and for the neuro-specific marker protein gene product 9.5 (PGP 9.5) were used; specimens were compared to specimens of adult

G. Ramieri; G. Bonardi; V. Morani; G. Preti; G. C. Panzica; F. Tetto; R. Arisio



False-Positive 131I Uptake by the Temporomandibular Joint Effusion.  


A 59-year-old man with papillary thyroid carcinoma underwent total thyroidectomy and received 2 separate 100-mCi doses of I about 5 months apart. A whole-body scan 4 days after the second dose revealed a focal uptake in the left temporomandibular joint (TMJ). The subsequent MRI examination demonstrated that the site of elevated iodine activity was caused by a TMJ effusion. PMID:24107815

Zhang, Min; Zhang, Yifan; Huang, Wei; Li, Biao



Static and Dynamic Loading Effects on Temporomandibular Joint Disc Tractional Forces  

Microsoft Academic Search

Mechanical fatigue-related degeneration of the temporomandibular joint (TMJ) disc may be promoted by tractional forces. This study tested the hypotheses that tractional forces following static loading of the TMJ disc: (1) increase with compressive strain at the start of movement, and (2) are velocity-dependent during movement. Sixty-four porcine discs received a 10-N static load via an acrylic indenter for 1

J. C. Nickel; L. R. Iwasaki; M. W. Beatty; M. A. Moss; D. B. Marx



Signs and Symptoms of Temporomandibular Joint Disorders Related to the Degree of Mouth Opening and Hearing Loss  

Microsoft Academic Search

Background  The temporomandibular joint is a unique bi-condylar joint involved in mastication and speech. Temporomandibular joint disorders\\u000a (TMD) have a range of symptoms, including aural symptoms, and are present in approximately 75% of normal populations. The\\u000a present study examined the relationship between signs and symptoms of TMD and mouth opening, gender, joint and aural symptoms,\\u000a and hearing loss.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  The study involved

Panagiotis Kitsoulis; Aikaterini Marini; Kalliopi Iliou; Vasiliki Galani; Aristides Zimpis; Panagiotis Kanavaros; Georgios Paraskevas



Influence of temporomandibular joint pain on sleep patterns: role of nitric oxide.  


Since nitric oxide is related to nociception and the sleep-wake cycle, this study sought to determine its involvement in the altered sleep pattern in a temporomandibular joint pain model by investigating the effect of the inhibitor of nitric oxide synthase (L-NAME) and that of its precursor (L-arginine). The temporomandibular joints of test animals were injected with Freund's adjuvant or saline, and their sleep was recorded. The procedure was repeated after the administration of L-NAME and L-arginine. L-NAME increased rapid eye movement (REM) sleep in the control group. The orofacial pain group showed a reduction in total sleep time and an increase in sleep latency compared with the SHAM group. L-NAME increased sleep time, non-rapid eye movement (NREM), and REM sleep and reduced sleep latency in the orofacial pain group. L-arginine did not alter sleep parameters. Thus, L-NAME improved sleep efficiency, whereas L-arginine did not modify it, suggesting the involvement of nitric oxide in painful temporomandibular joint conditions. PMID:15329374

Schütz, T C B; Andersen, M L; Tufik, S



Management of temporomandibular joint arthritis in adult rheumatology practices: a survey of adult rheumatologists  

PubMed Central

Background The temporomandibular (TMJ) is frequently involved in juvenile idiopathic arthritis (JIA), however little is known about management of this joint once a patient transitions from pediatric to adult care and about how rheumatologists approach TMJ involvement in rheumatoid arthritis (RA). The objective of this project was to describe adult rheumatologists’ approaches to the diagnosis and treatment of TMJ arthritis in adults with JIA or RA. Findings One hundred and eighteen rheumatologists responded to an online survey of adult rheumatologists in the United States and Canada. Respondents estimated that 1-25% of their patients with RA or JIA had TMJ arthritis. Respondents reported lower rates of MRI use (19%) and higher rates of use of splinting/functional devices (50%) than anticipated. Approximately 80% of respondents reported that their practice had a standardized approach to the evaluation of patients with TMJ arthritis. The most commonly used medical therapies were non-steroid anti-inflammatory drugs, anti-tumor necrosis factor alpha medications, and methotrexate. Conclusions Despite the majority of respondents stating that their practices had a standardized approach to the diagnosis and treatment of TMJ disease, there nevertheless appeared to be a range of practices reported. Standardizing the evaluation and treatment of TMJ arthritis across practices may benefit both adult and pediatric patients.



Osteoarthritis of the Temporomandibular Joint in Southern Sea Otters (Enhydra lutris nereis).  


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



The use of arthrography in the diagnosis of temporomandibular joint synovial chondromatosis.  


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



A classification system for occlusions that relates maximal intercuspation to the position and condition of the temporomandibular joints  

Microsoft Academic Search

Interarch occlusal relationships are defined by temporomandibular joint (TMJ) position. Determination of the most physiologic joint position is a logical prerequisite for occlusal analysis. Existing classification systems for occlusion do not consider TMJ position or condition when relating the mandibular arch to the maxillary arch or the range of adaptive changes that can affect the position of the condyles or

Peter E Dawson



Clinical and Magnetic Resonance Imaging Findings of the Temporomandibular Joint in Patients With Rheumatoid Arthritis  

PubMed Central

Background The aim of this study is to evaluate temporomandibular joint (TMJ) involvement in patients with rheumatoid arthritis by magnetic resonance imaging (MRI), jaw clenching force, mouth opening, and Fonseca’s questionnaire, and to establish the relationship between these findings and clinical, radiologic, and laboratory activity parameters that are unique to rheumatoid arthritis. Methods Included in the study were 30 RA patients and 30 healthy volunteers. Jaw clenching force of the entire cases was measured with Istanbul Bite Force Recorder (kg) and the mouth opening was measured with a ruler (cm). Additionally, hand grip forces of patients with rheumatoid arthritis were measured with hand dynamometer (kg). Hand and feet graphs and TMJ MRIs of patients were obtained. MRI findings were classified as normal, mild, medium, and severe. DAS28 and sharp scores of patients were estimated. Sedimentation rate (ESR), C-Reactive protein (CRP) and rheumatoid factor (RF) were checked in the patient group and Fonseca’s questionnaires were filled in. Results A significant difference was not observed between age, gender, and level of education of the groups. Jaw clenching force and mouth opening were established as significantly low in RA group compared to the control group (P < 0.001). A significant correlation was found between jaw clenching force, hand grip force, mouth opening, questionnaire, and MRI findings with the disease duration sharp score, DAS28, and hand grip force of the RA group (P < 0.05). However, a significant correlation was not established with ESR, CRP, and RF (P < 0.001). Conclusions Jaw clenching force, mouth opening, and Fonseca’s questionnaire can be used as parameters pointing to TMJ involvement in patients with RA. Yet, further studies in which TMJ involvement is followed up since the onset of the disease are of necessity.

Hiz, Ozcan; Ediz, Levent; Ozkan, Yasemin; Bora, Aydin



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  

PubMed Central

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.



Fine needle aspiration of pigmented villonodular synovitis of the temporomandibular joint.  


Temporomandibular joint (TMJ) problems are usually the result of functional disorders. Tumors of the TMJ are rarer entities, the diagnosis of which may be delayed due to a clinical impression of a functional ailment. We report a case of a patient with a recurrent TMJ area lesion diagnosed cytologically as pigmented villonodular synovitis (PVNS), an entity that very rarely involves the TMJ and is usually diagnosed by histology. The differential diagnosis of PVNS in the context of its location in and around the TMJ is also discussed. PMID:21162093

Lu, David Y; Zhang, Liping; Apple, Sophia K; Dry, Sarah M; Moatamed, Neda A



[The theoretical substantiation of myofunctional correction of sagittal occlusion abnormalities and temporomandibular joint dysfunction].  


Simulation in 3D-model of skeletal forms of sagittal malocclusion revealed tendency in tonus' modification of muscles of mastication in formation of distal and mesial occlusion. It's shown that distal occlusion is characterized by hypotonic condition of muscles of mastication, except posterior fibers of temporal muscle. Mesial occlusion is characterized by complex combination of muscle tone with prevalence of hypotonic condition of anterior fibers of temporal muscle, superficial portion of masseter muscle and medial pterygoid muscle. We have detected that using of myofunctional devices in treatment of sagittal malocclusion, temporomandibular joint dysfunction promotes of tone increasing of muscles of mastication. PMID:22968618

Danilova, M A; Ishmurzin, P V; Zakharov, S V



Alterations of the Temporomandibular Joint on Magnetic Resonance Imaging according to Growth and Development in Schoolchildren  

PubMed Central

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.

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



Treatment of temporomandibular joint ankylosis: gap and interpositional arthroplasty with temporalis muscle flap  

Microsoft Academic Search

Purpose  The purpose of this study was to examine the effectiveness of gap and interpositional arthroplasty with temporalis muscle\\u000a flap in the treatment of the temporomandibular joint (TMJ) ankylosis.\\u000a \\u000a \\u000a \\u000a Materials and methods  This retrospective study was evaluated on 34 patients who were treated from February 2003 to July 2007. Diagnosis of TMJ ankylosis\\u000a was based upon the clinical examination and plain radiography

Mohammad Bayat; Amirali Badri; Nima Moharamnejad



The Middle Cranial Fossa Approach in Managing Lesions of the Temporomandibular Joint  

PubMed Central

The temporomandibular joint (TMS) lies at the skull base. Its bony roof forins part of the floor of the middle cranial fossa. It is bounded by the infratemporal fossa, external auditory canal, middle ear, and eustachian tube. When wide resection of tumors arising within the TMJ is necessary, skull base approaches permit complete resection with oncologically sound margins. Precise pathologic diagnosis can be difficult and extra care should be taken to ensure diagnostic accuracy. Outcomes are improved if attention and effort is directed to rehabilitation of the TMJ. Five such cases are presented and the literature is reviewed. ImagesFigure 1Figure 2Figure 3Figure 4

Roland, Peter S.; Marple, Bradley F.



Full-thickness skin graft interposition after temporomandibular joint ankylosis surgery. A study of 31 cases.  


Recurrence is a major problem after release of temporomandibular joint ankylosis. Early physiotherapy and choice of interpositional material are important in preventing recurrence. Currently, the most used technique is gap arthroplasty associated with coronoidectomy, temporalis muscle flap interposition and reconstruction of the condylar unit with a costochondral graft. Full-thickness skin graft interposition, using the technique described by Popescu & Vasiliu, can also be used. This retrospective review of 31 patients confirms the reliability of full-thickness skin graft interposition. Results were successful in 90% of the 20 patients with follow-up longer than one year. PMID:10535529

Chossegros, C; Guyot, L; Cheynet, F; Blanc, J L; Cannoni, P



Pigmented villonodular synovitis of the temporomandibular joint: a case report and the literature review.  


Pigmented villonodular synovitis (PVNS) is an uncommon benign proliferative disorder of synovium that may involve joints, tendon sheaths, and bursae. It most often affects the knees, and less frequently involves other joints. It presents in the temporomandibular joints (TMJs) extremely rarely. The authors report an elderly female patient with PVNS of the TMJ with skull base extension, who had traumatic history in the same site. It was diagnosed through core-needle biopsy, which was not documented in the literature. Radical excision and follow-up for 7-8 years was recommended because of the reported malignant transformation and high recurrence rate. This case and previously reported cases in the literature are reviewed and discussed. PMID:21474285

Cai, J; Cai, Z; Gao, Y



Radiographic diagnosis of synovial chondromatosis of the temporomandibular joint: a case report.  


Synovial chondromatosis is a rare, benign condition that usually affects the larger diarthroidal joints of the axial skeleton. Approximately 120 cases of synovial chondromatosis involving the temporomandibular joint (TMJ) have been reported. People with this condition may present with swelling, pain, intracapsular sounds and limitation of mandibular movement. Because it is important to differentiate synovial chondromatosis from other joint pathologies, a thorough history and appreciation of clinical features of these conditions are necessary. Radiographs are an important component of the diagnostic armamentarium for discerning conditions that mimic synovial chondromatosis. A case of synovial chondromatosis diagnosed radiographically with the aid of volumetric computed tomography is described, followed by a discussion of potential causative factors and management strategies. A brief review of the differential diagnosis of synovial chondromatosis involving the TMJ is also provided. PMID:20003756

Balasundaram, Ashok; Geist, James R; Gordon, Sara C; Klasser, Gary D



Dislocation of the temporomandibular joint meniscus: contrast arthrography vs. computed tomography  

SciTech Connect

A prospective study to determine the accuracy of computed tomography (CT) for the diagnosis of dislocation of the temporomandibular joint (TMJ) meniscus was made by performing both CT and contrast arthrography on 18 joints suspected of meniscus dislocation. Arthography rather than surgery was chosen as the quality standard for comparing CT findings, as not all patients undergoing the studies underwent surgery. The results of each test were reported independently by the radiologist who obtained either all of the arthograms or all of the CT scans. For dislocation of the meniscus, there were excellent agreement between the two methods. CT seems to be nearly as accurate as arthrography for showing meniscus dislocation, is performed with lower x-ray exposure, and is noninvasive. Arthrograpy discloses more detailed information about the joint meniscus, such as perforation and maceration, and should continue to be used when this kind of information is clinically important.

Thompson, J.R.; Christiansen, E.; Sauser, D.; Hasso, A.N.; Hinshaw, D.B. Jr.



Surgical managements of subluxation and dislocation of the temporomandibular joint: clinical and experimental studies.  


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

Kummoona, Raja



Pigmented villonodular synovitis of the temporomandibular joint with intracranial extension: a case and literature review.  


Pigmented villonodular synovitis (PVNS) is a benign, yet locally aggressive proliferative lesion most commonly found in joints of the long bones; it rarely presents in the temporomandibular joint (TMJ). The authors report a case of PVNS involving the TMJ and review similar cases reported in the English literature. This is the first case of PVNS with long-term follow-up of 11 years to include imaging studies. A 36-year-old male with symptoms suggestive of a temporomandibular disorder (TMD) presented with a progressive preauricular/parotid swelling and restricted mandibular range of motion. Imaging suggested a lesion with an aggressive course due to tissue displacement and destruction proximal to the lesion. A multidisciplinary team performed complete excision of the lesion with immediate reconstruction. PVNS often presents with similar symptoms to a TMD, but must be distinguished from symptomatic TMD as it can be highly destructive. Owing to its aggressive nature and potential for recurrence, complete and early extirpation and long-term follow-up with advanced imaging is indicated. PMID:19303255

Herman, C R; Swift, J Q; Schiffman, E L



Degenerative joint disease. Part I: Diagnosis and management considerations.  


Degenerative joint disease, primarily in the form of osteoarthrosis, affects the temporomandibular joints (TMJs) with symptoms similar to those found in other body joints. These symptoms include stiffness, pain, restriction of movement, inflammation, crepitus and radiographic changes. Symptoms can occur in both males and females at any age, starting with pre-adolescent, but most often occur in females age 30 and over. Most symptoms will last nine to 18 months (followed by remission) and are managed using anti-inflammatory medications, physical therapy, occlusal splints and dietary changes. Major areas for consideration in this article include epidemiology, signs and symptoms, radiography, etiopathology and symptom management. PMID:8118899

Bates, R E; Gremillion, H A; Stewart, C M



Simultaneous custom-made replacement of the temporomandibular joint and cranioplasty.  


A 23-year-old man presented with a history of fibrous ankylosis of the left temporomandibular joint (TMJ), scarring and shortening of the left temporalis muscle secondary to transection, and surgically-induced neuropathic pain after previous decompression of the temporal bone. There was evident hollowing of the left temporal fossa, and mouth opening was limited to 5mm. The aims of the operation were to treat the ankylosis, improve cosmesis, and reduce his medication. His left TMJ was reconstructed with a custom-made alloplastic joint, and a simultaneous custom-made cranioplasty. At follow-up after 2 years he was free of pain and taking no drugs. He had no obvious cranial deformity, and his mouth opening had increased to 35 mm. To our knowledge this is the first reported case of simultaneous custom-made cranioplasty and reconstruction of the TMJ. PMID:22578706

Kirchheimer, S; Sainuddin, S; Bojanic, S; Saeed, N R



Temporomandibular joint arthrography: a comparison between a fluoroscopic and a nonfluoroscopic technique  

SciTech Connect

A nonfluoroscopic temporomandibular joint arthrographic technique is contrasted with a more widely employed fluoroscopically guided technique. The nonfluoroscopic technique uses a posterior approach to joint injection, as contrasted with the lateral injection approach of the fluoroscopically guided technique. The advantages of the nonfluoroscopic technique are less radiation dose to the patient, less expensive and less sophisticated imaging equipment, and less potential for neurovascular trauma. The fluoroscopic technique offers greater control of the procedure, less patient and operator time, and the capability for a dynamic videofluoroscopic study. Both techniques appear to be safe and efficacious. Differences in anatomy, imaging modalities, patient radiation exposure, and potential complications are also discussed as part of this comparison.48 references.

Benson, B.W.; Langlais, R.P.; Abramovitch, K.



Naturalistic changes in insomnia symptoms and pain in temporomandibular joint disorder: A cross-lagged panel analysis  

Microsoft Academic Search

An increasing number of prospective studies suggest a bi-directional association between the pain and sleep quality. Few of these investigations have controlled for synchronous correlations, an important source of extraneous variance in lagged associations, which may have confounded conclusions of prior investigations. Despite high rates of insomnia in temporomandibular joint disorders (TMD), no studies have examined temporal associations between naturalistic

Phillip J. Quartana; Emerson M. Wickwire; Brendan Klick; Edward Grace; Michael T. Smith



Narrative representations of chronic illness experience: cultural models of illness, mind, and body in stories concerning the Temporomandibular Joint (TMJ)  

Microsoft Academic Search

The narratives individuals told about their experiences with an illness they have come to understand as TMJ, a problem linked to the temporomandibular joints of the jaw, are complex. Each is embedded within a unique set of life circumstances and guided by individual schemas and explanatory models. Each recounts how persons have come to make sense of perplexing symptoms that

Linda C. Garro



2-stage treatment protocol for management of temporomandibular joint ankylosis with secondary deformities in adults: our institution’s experience  

Microsoft Academic Search

PurposeTreatment of adult patients with temporomandibular joint (TMJ) ankylosis and secondary deformities is a challenging problem. Although various techniques including arthroplasties, orthognathic surgery, autogenous bone graft and distraction osteogeneis (DO), have been described for the management of the patient with this condition, an appropriate treatment protocol has not been established. The purpose of the present report is to describe a

Songsong Zhu; Jihua Li; En Luo; Ge Feng; Yongqing Ma; Jing Hu


Magnetic resonance imaging findings and clinical symptoms in the temporomandibular joint in patients with mandibular continuity defects  

Microsoft Academic Search

Purpose: This study explored the morphologic changes and clinical symptoms related to the temporomandibular joint (TMJ) associated with long-term lack of mandibular continuity.Patients and Methods: The subjects were 20 patients (40 TMJs) who underwent mandibulectomy including the condyle or segmental mandibulectomy without mandibular reconstruction more than 6 months previous to the study. The 40 TMJs were classified into the following

Yoshiki Hamada; Toshirou Kondoh; Kazutoshi Nakaoka; Kanichi Seto



Massage therapy decreases frequency and intensity of symptoms related to temporomandibular joint syndrome in one case study  

Microsoft Academic Search

Summary Objective: This study investigated the ability of massage therapy to mitigate the frequency and intensity of headaches, jaw clicking and masticatory pain associated with temporomandibular joint syndrome (TMJ). Methods: The subject reported 3 years of masticatory pain, clicking, teeth grinding, reduced jaw opening and headaches prior to the study. A log was kept documenting frequency, intensity and type of

Lindsay Phipps Eisensmith



Association of metalloproteinases, tissue inhibitors of matrix metalloproteinases, and proteoglycans with development, aging, and osteoarthritis processes in mouse temporomandibular joint  

Microsoft Academic Search

The temporomandibular joint (TMJ) is an important growth and articulation center in the craniofacial complex. In aging it develops spontaneous degenerative osteoarthritic (OA) lesions. Metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPS) play key roles in extracellular matrix remodeling and degradation. Gelatinase activities and immunohistochemical localization of MMP-2, -3, -8, -9, and -13 and TIMP-1 and -2 were examined in

Amira Gepstein; Gil Arbel; Israel Blumenfeld; Micha Peled; Erella Livne



The biological concept of “internal derangement and osteoarthrosis”: A diagnostic approach in patients with temporomandibular joint pain?  

Microsoft Academic Search

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



Interleukin 1? and stromelysin (MMP3) activity of synovial fluid as possible markers of osteoarthritis in the temporomandibular joint  

Microsoft Academic Search

Purpose: This study investigated the early signs of synovitis and cartilage degradation by means of synovial fluid analysis in temporomandibular joints (TMJs) with internal derangement (closed lock) or osteoarthritis (OA).Patients and Methods: Synovial fluid was obtained from 25 TMJs in 22 patients diagnosed with closed lock and from 15 asymptomatic TMJs of 12 normal controls. IL-1? concentrations were measured using

Eiro Kubota; Hideo Imamura; Takao Kubota; Takanori Shibata; Ken-Ichiro Murakami



Hard and soft tissue imaging of the temporomandibular joint 30 years after diagnosis of osteoarthrosis and internal derangement  

Microsoft Academic Search

Purpose: This article describes the clinical and imaging findings in the temporomandibular joints (TMJs) of patients 30 years after the initial diagnosis of osteoarthrosis and internal derangement.Patients and Methods: Fifty-five TMJs with a history of osteoarthrosis and internal derangement and 37 contralateral TMJs that were asymptomatic 30 years ago were examined in 46 former patients. To visualize degenerative changes of

Reny de Leeuw; Geert Boering; Bart van der Kuijl; Boudewijn Stegenga



Osteoarthritis and synovitis as major pathoses of the temporomandibular joint: Comparison of clinical diagnosis with arthroscopic morphology  

Microsoft Academic Search

Purpose: The purposes of this investigation were to determine how common osteoarthritis and synovitis are in patients with severe, recalcitrant temporomandibular joint (TMJ) symptoms using clinical diagnostic criteria as well as arthroscopic examination, and to compare the accuracy of the clinical and arthroscopic diagnoses with respect to specificity and sensitivity.Patients and Methods: Clinical and arthroscopic diagnoses were established in 126

Howard A Israel; Beverly Diamond; Fatemah Saed-Nejad; Anthony Ratcliffe



Outcomes of open temporomandibular joint surgery following failure to improve after arthroscopy: is there an algorithm for success?  


We reviewed the results of one surgeon's experience of open surgical management of the temporomandibular joint (TMJ) in patients who fail to respond to arthroscopy and aimed to identify groups of patients that may or may not benefit from the intervention. Over a 7-year period (2005-2012) we retrospectively collected data from the medical notes of patients who underwent discectomy, disc plication, eminectomy, eminoplasty, and adhesiolysis, according to the clinical findings for joint pain, restriction, and locking. A total of 22 patients (71%) reported improvement in pain score and 19 (61%) reported an improvement in mouth opening 12 months postoperatively. Overall, 12 patients (39%) ultimately needed TMJ replacement. This group included 5/6 patients in Wilkes' stage IV and 6/15 in stage V, 5/7 patients with a preoperative pain score of 90-100, and half of those with preoperative mouth opening of 20-29mm (7/14). Open surgical management of the TMJ can benefit patients despite the previous failure of arthroscopy to manage pain, restriction, and locking. Arthroscopy seems to reduce the percentage of patients that need open TMJ surgery, but also the success of subsequent operations compared with previous studies. TMJ replacement is increasingly being done successfully to treat end-stage disease. These results may be used when obtaining a patient's consent for open TMJ surgery, particularly if they are in the groups considered to have a high risk of subsequently requiring a replacement joint. PMID:23701829

Tzanidakis, Konstantinos; Sidebottom, Andrew J



Radiologic Techniques Used to Evaluate the Temporomandibular Joint; I. Conventional Methods  

PubMed Central

Symptoms of temporomandibular joint pathology are present in a relatively high proportion of the population. Conventional radiographic techniques used to evaluate the morphology of the joint provide data which may be difficult to interpret. These techniques are reviewed briefly and their interpretational shortcomings are noted. Computed tomography is currently being used by some clinicians to evaluate the joint. This technique may also yield data which are difficult to interpret. Extended processing of CT data to provide three-dimensional images of the joint enhances the technique as a means of diagnosing hard tissue pathology, but despite reports in the literature detailing its use in diagnosing soft tissue pathology, CT is not optimal for this purpose. The introduction of nuclear magnetic resonance imaging provides a means of examining the soft tissues of the joint in either two- or three-dimensional images and has the advantage over all previous techniques in that the patient is not subjected to ionizing radiation during the scan process. ImagesFig. 2Fig. 3Fig. 4Fig. 5Fig. 6Fig. 7Fig. 8Fig. 9

Roberts, David; Pettigrew, James; Ram, Carol; Joseph, Peter M.



Finite element analysis of the temporomandibular joint during lateral excursions of the mandible.  


One of the most significant characteristics of the temporomandibular joint (TMJ) is that it is in fact composed of two joints. Several finite element simulations of the TMJ have been developed but none of them analysed the different responses of its two sides during nonsymmetrical movement. In this paper, a lateral excursion of the mandible was introduced and the biomechanical behaviour of both sides was studied. A three-dimensional finite element model of the joint comprising the bone components, both articular discs, and the temporomandibular ligaments was used. A fibre-reinforced porohyperelastic model was introduced to simulate the behaviour of the articular discs, taking into account the orientation of the fibres in each zone of these cartilage components. The mandible movement during its lateral excursion was introduced as the loading condition in the analysis. As a consequence of the movement asymmetry, the discs were subjected to different load distributions. It was observed that the maximal shear stresses were located in the lateral zone of both discs and that the lateral attachment of the ipsilateral condyle-disc complex suffered a large distortion, due to the compression of this disc against the inferior surface of the temporal bone. These results may be related with possible consequences of a common disorder called bruxism. Although it would be necessary to perform an exhaustive analysis of this disorder, including the contact forces between the teeth during grinding, it could be suggested that a continuous lateral movement of the jaw may lead to perforations of both discs in their lateral part and may damage the lateral attachments of the disc to the condyle. PMID:16125714

Pérez Del Palomar, A; Doblaré, M



Osteoarthritic changes and condylar positioning of the temporomandibular joint in Korean children and adolescents  

PubMed Central

Purpose To investigate the prevalence of osteoarthritic changes and condylar positioning of the temporomandibular joint (TMJ) in Korean children and adolescents with or without temporomandibular disorders (TMDs). Materials and Methods A total of 101 asymptomatic and 181 symptomatic children and adolescents aged 10 to 18 years old were included in the study. Osteoarthritic changes such as flattening, sclerosis, osteophytes, or erosion, and the parasagittal positioning of the condyle were assessed using cone-beam computed tomography (CBCT) images. Results The overall prevalence of osteoarthritic changes was higher in symptomatic (26.8%) than in asymptomatic adolescents (9.9%) (p<0.05). In the symptomatic group, the frequency was higher in males (33.3%) than in females (23.0%) (p<0.05). Erosion was the most common change for the symptomatic group (15.6%), whereas sclerosis was the most common change for the asymptomatic group (5.4%). Posterior condylar position was more frequently observed in the symptomatic group (p<0.05). Erosion was more common in the samples with TMJ pain or mouth opening limitations as compared to those without them (p<0.05). Conclusion This study showed that osteoarthritic changes in TMJ were common in children and adolescents, with a much higher prevalence in symptomatic patients.

Cho, Bong-Hae



Temporomandibular joint development and functional disorders related to clinical otologic symptomatology.  


Temporomandibular disorders (TMDs) are a form of musculoskeletal pain of the temporomandibular joint (TMJ) and/or masticatory muscles of nonspecific etiology. In this study, the relationship between embryonic and anatomic-topographic similarities of the TMJ and the ear was analyzed, i.e. secondary otologic symptoms that can be closely connected to TMJ disorder. Nonspecific otologic symptoms are not primary diagnostic symptoms of TMD, but may cause diagnostic confusion due to patients' inability to correctly locate the origin of pain. The most common otologic symptoms that can be related to TMDs are otalgia, tinnitus and vertigo. Otorhinolaryngologists have to differentiate between primary otologic symptoms and those caused by TMJ disorders. In TMD diagnosis, manual techniques are used to determine the arthrogenic or myogenic form, whereas in the diagnosis of arthrogenic disorders magnetic resonance imaging is indicated as the highly specific imaging method ofjoint disk and osteoarthritic changes. Symptomatic treatments for TMD as well as the etiologic diagnosis of the pain require multidisciplinary cooperation between dentists and medical specialists. PMID:22034784

Badel, Tomislav; Savi?-Pavicin, Ivana; Zadravec, Dijana; Marotti, Miljenko; Krolo, Ivan; Grbesa, Durdica



Biological reconstruction of the temporomandibular joint by chondro-osseous graft: clinical and experimental study.  


This study includes 35 children treated by reconstruction of the temporomandibular joint (TMJ) by chondro-osseous graft harvested from iliac crest for management of 2 diseases; the first one was ankylosis of the TMJ. There were 25 cases of 9 girls and 16 boys, and there were 10 cases of hypoplasia of the TMJ of first-arch dysplasia syndrome or hemifacial microsomia, of which 4 were females and 6 were males. Their ages ranged between 4 and 13 years (mean, 8.5 years); follow-up of the patients ranged from 3 to 5 years. All patients showed good result and without recurrence of ankylosis or restriction of mouth opening, and growth of the face was acceptable and without using osteotomies for correction of jaw relationship or distraction techniques.Experimental studies on rabbits were performed to prove the condyle as growth center and after excision of the head of condyle and disk in newly growing rabbits of 3 months of age; after 3 months of follow-up, we observed severe deformity of the rabbits' mandible, and the mandible deviated to the affected side on the first experiment. In the second experiment, reconstruction of the TMJ and condyle of the rabbits by chondro-osseous graft harvested from iliac crest of the same rabbit was carried out in 8 animals to assess the viability and value of chondro-osseous graft to replace the TMJ. After 3 months, all animals were killed. Postmortem studies were done to assess the healing process of the graft or any resorption of the graft. Histological studies of the graft showed 4 layers: the first articular layer was thick because of functional demand of masticatory process for hard food of rabbits; the second layer was the granular mesenchymal stem cells layer, very active and multiple layers that represent the proliferative layer; the third layer showed conversion of cartilage cells to osteoid cells, and the fourth layer was the osteoid layer. On follow-up of clinical cases, the graft was continued for functional demand of growth, repair, and remodeling of the condyle. PMID:23714882

Kummoona, Raja K



Simultaneous pigmented villonodular synovitis and synovial chondromatosis of the temporomandibular joint: case report.  


Pigmented villonodular synovitis and synovial chondromatosis are benign nonneoplastic proliferations originating in the synovium of unknown cause. Involvement of the temporomandibular joint (TMJ) is rare. Only 3 cases of simultaneous pigmented villonodular synovitis and synovial chondromatosis involving the TMJ have been reported. The authors report the case of a 21-year-old female with simultaneous involvement of pigmented villonodular synovitis and synovial chondromatosis in the left TMJ. Clinical examination and magnetic resonance imaging did not reveal the synovial lesions, and the diagnosis was made by arthroscopy and histological examination. The lesions were removed with arthroscopy, and the displaced disc was repositioned. The patient has been symptom-free for 13 months postoperatively. PMID:19608385

Cai, Xie-Yi; Yang, Chi; Chen, Min-Jie; Yun, Bai



Functional outcomes in bilateral temporomandibular joint ankylosis treated with stock prosthesis.  


The purpose of this study was to evaluate the functional outcomes in patients affected by bilateral temporomandibular joint (TMJ) ankylosis treated with TMJ total alloplastic reconstruction with stock prosthesis. As a matter of fact, ankylosis of the TMJ may produce the narrowing of the oropharyngeal airway space resulting in the obstructive sleep apnea syndrome, a pathological condition characterized by repetitive upper airway obstructions during sleep, resulting in arousal from sleep, sleep fragmentation, arterial oxygen desaturation. and daytime hypersomnolence.Clinical results demonstrate that total TMJ reconstruction with prosthesis is the surgical modality of choice to obtain the counterclockwise rotation and the advancement of the maxillomandibular complex, which significantly increase the volume of the oropharyngeal airway space in this kind of patients. PMID:23524813

Cascone, Piero; Gennaro, Paolo; Gabriele, Guido; Ramieri, Valerio



Synovial Cysts of the Temporomandibular Joint: An Immunohistochemical Characterization and Literature Review  

PubMed Central

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.



Radiographic manifestations of the temporomandibular joint in a case of Proteus syndrome.  


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. PMID:22241876

Yilmaz, E; Kansu, O; Ozgen, B; Akçiçek, G; Kansu, H



Merging the computed tomography and magnetic resonance imaging images for the visualization of temporomandibular joint disk.  


Computed tomography (CT) depicts intricate bony details well, whereas magnetic resonance imaging (MRI) offers excellent contrast to the anatomy of soft tissues. This technical report offers a method to merge the CT and MRI images using Photoshop software and yield hybrid images that combine the key features of both CT and MRI. In this hybrid image, the temporomandibular joint (TMJ) disk was clearly displayed, and the relationship between the TMJ disk and surrounding skeleton structures, including glenoid fossa and condyle, also was finely demonstrated. Although the merging process is not absolutely accurate, the method presented in this article can be applied as a supplementary way to help the physicians to read the image of TMJ in an even better fashion and also may offer a useful method to help the junior physicians to quickly identify the TMJ disk. PMID:23172513

Dai, Jiewen; Dong, Yuefu; Shen, Steve Guofang



Association Between Stress, Sleep Quality and Temporomandibular Joint Dysfunction: Simulated Mars Mission  

PubMed Central

Objectives The aim of this study was to test the association between quality of sleep and stress in individuals with TMD (temporomandibular joint dysfunction) in simulated Mars mission. Methods The 24 healthy crew members were recruited. The physiological measures of systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded. The Symptom Checklist-90-revised was used which was based on nine dimensions of psychological functioning. The Multidimensional Pain Inventory was pain severity, social and physical activities, affective distress, social support, and feelings of life control. The Pittsburgh Sleep Quality Index was used to measure the number of hours spent in bed and during asleep, frequency and reasons for awakening, and difficulty returning to sleep after awakening. The orofacial pain questionnaire was applied to measure pain experience using descriptors from the McGill Pain Questionnaire. Salivary cortisol and melatonin were measured. Results The 15 crew members reported temporomandibular joint pain after 6 days of mission. On dental examination, 5 crew members reported simple muscle pain (SM) and other 10 crew members with TMD. The TMD group endorsed more affective descriptors of their pain experience. Compared to the TMD group, the SM group also reported significantly poorer sleep duration. The TMD group reported nonsignificantly more daytime dysfunction than the control. Higher levels of salivary cortisol and salivary melatonin were reported in the TMD group as compared to other group. Conclusion This study concludes that both quality of sleep and stress levels due to extreme condition (simulated Mars mission) were associated with TMD in simulated Mars mission.

Rai, Balwant; Kaur, Jasdeep



Use of autologous conditioned serum (Orthokine(R)) for the treatment of the dege-nerative osteoarthritis of the temporomandibular joint. Review of the literature  

PubMed Central

Objectives: Treatment of osteoarthritis (OA) using autologous conditioned serum (ACS) has become in recent years an alternative to consider in the approach of the degenerative joint disease of the knee. There is no support in the literature for the use of ACS for the treatment of OA of the temporomandibular joint (TMJ), although the promising results obtained in human patients with knee joint disease as well as in animal studies are opening the way for its use at the TMJ. The aim of this paper is to conduct a review of the published literature regarding the use of the ACS for the treatment of OA in humans, considering the level of scientific evidence, and following the principles of the evidence-based medicine and dentistry. Material and Methods: A PubMed-MEDLINE search was carried out of articles published between 1980 and 2011. After an initial search, a total of 102 articles were obtained, followed by a selection of the most relevant articles according to the topic; a total of 8 articles were selected, which were stratified according to their level of scientific evidence using SORT criteria (Strength of Recommendation Taxonomy). Results: At the time of this review, there is no available literature referring the use of ACS at the TMJ. However, the use of the ACS in other joints is well documented, both experimentally and clinically, in humans and animals. The reviewed articles, with a level of evidence 1 and 2 according to the SORT criteria, have generally promising results. Discussion and Conclusions: The use of ACS in the treatment of OA in joints other than the TMJ, is endorsed by the level of evidence found in the literature, which opens the door to future studies to determine the feasibility of the use of the ACS in the treatment of degenerative OA that affects TMJ. Key words:Osteoarthritis, temporomandibular joint, autologous conditioned serum.

Alvarez-Camino, Juan C.; Vazquez-Delgado, Eduardo



Temporomandibular joint ankylosis: Is hypercoagulable state of blood a predisposing factor?  


Temporomandibular joint (TMJ) ankylosis is a significant problem in Asian countries and the most common etiology is trauma to the mandibular condyle. Other less common etiologies are infection, forceps delivery trauma and rheumatoid arthritis. Many hypotheses are given to explain the pathogenesis. All the proposed hypotheses revolve around trauma to the joint and subsequent healing causing ankylosis. This is however true for only few patients, most of the others do not progress to ankylosis after trauma to TMJ irrespective of seeking treatment or not. In this paper, we try to answer the question that why only a minor subset of condylar injuries progress to ankylosis and why others do not? The hypothesis follows a report of 4 cases that had bilateral TMJ ankylosis with extrahepatic portal venous obstruction (EHPVO) secondary to protein C deficiency. It is postulated that hypercoagulability/reduced fibrinolytic activity in these as well as non-EHPVO patients with TMJ ankylosis cases may have predisposed them to the development of joint ankylosis. The possible mechanism is explained and correlated with other causes of TMJ ankylosis and known facts of protein C deficiency/activated protein C resistance. PMID:23910558

Bhatt, Krushna; Roychoudhury, Ajoy; Balakrishnan, Prahlad



Shox2-deficiency leads to dysplasia and ankylosis of the temporomandibular joint in Mice  

PubMed Central

The temporomandibular joint (TMJ) is a unique synovial joint whose development differs from the formation of other synovial joints. Mutations have been associated with the developmental defects of the TMJ only in a few genes. In this study, we report the expression of the homeobox gene Shox2 in the cranial neural crest derived mesenchymal cells of the maxilla-mandibular junction and later in the progenitor cells and undifferentiated chondrocytes of the condyle as well as the glenoid fossa of the developing TMJ. A conditional inactivation of Shox2 in the cranial neural crest-derived cells causes developmental abnormalities in the TMJ, including dysplasia of the condyle and glenoid fossa. The articulating disc forms but fuses with the fibrous layers of the condyle and glenoid fossa, clinically known as TMJ ankylosis. Histological examination indicates a delay in development in the mutant TMJ, accompanied by a significantly reduced rate of cell proliferation. In situ hybridization further demonstrates an altered expression of several key osteogenic genes and a delayed expression of the osteogenic differentiation markers. Shox2 appears to regulate the expression of osteogenic genes and is essential for the development and function of the TMJ. The Shox2 conditional mutant thus provides a unique animal model of TMJ ankylosis.

Gu, Shuping; Wei, Na; Yu, Ling; Fei, Jian; Chen, YiPing



Morphologic and histologic changes in canine temporomandibular joint tissues following arthroscopic guided neodymium:YAG laser exposure  

SciTech Connect

A neodymium:yttrium aluminum garnet (Nd:YAG) laser beam was introduced by a quartz fiber passed arthroscopically into the superior joint space of the temporomandibular joints (TMJ) of five mongrel dogs, with one joint serving as a control without laser wounds. Immediate postoperative death and examination of the disc grossly and histologically revealed different patterns for contact and noncontact burn wounds. The wounds exhibited signs of thermal coagulation necrosis similar to those reported in other tissues. The potential implications of the adaptation of the Nd:YAG laser to TMJ arthroscopic surgery are discussed.

Bradrick, J.P.; Eckhauser, M.L.; Indresano, A.T. (Case Western Reserve Univ. College of Medicine, OH (USA))



Correlating cone beam CT results with temporomandibular joint pain of osteoarthritic origin  

PubMed Central

Objectives The purpose of this study was to determine whether bony changes in temporomandibular joint (TMJ) osteoarthritis (OA) is correlated with pain and other clinical signs and symptoms. Methods Clinical data and cone beam CT (CBCT) images of 30 patients with TMJ OA were analysed. The criteria of Koyama et al (Koyama J, Nishiyama H, Hayashi T. Follow-up study of condylar bony changes using helical computed tomography in patients with temporomandibular disorder. Dentomaxillofac Radiol 2007; 36: 472–477.) and Ahmad et al [Ahmad M, Hollender L, Anderson Q, Kartha K, Ohrbach R, Truelove EL, et al. Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107: 844–860.] were used to classify the condyles observed on the CBCT. Clinical measures included self-reported pain, mandibular range of motion, TMJ sound, pain on palpation of the TMJ and masticatory muscles, and pain on jaw function. Generalized linear modelling was used to correlate the clinical and radiographic findings and Spearman's rho was used to correlate the two classification systems. Results There was poor correlation between the maximum condyle change and pain rating (Koyama: r2 = 0.1443, p = 0.3995; Ahmad: r2 = 0.0273, p = 0.9490), maximum mouth opening (Koyama: r2 = 0.2910, p = 0.0629; Ahmad: r2 = 0.2626, p = 0.0951), protrusion (Koyama: r2 = 0.0875, p = 0.7001; Ahmad: r2 = 0.1658, p = 0.3612), right lateral motion (Koyama: r2 = 0.0394, p = 0.9093; Ahmad: r2 = 0.0866, p = 0.6877) and left lateral motion (Koyama: r2 = 0.0943, p = 0.6494; Ahmad: r2 = 0.1704, p = 0.3236). Strong correlation was observed between Koyama et al's and Ahmad et al's classifications for average (r = 0.9216, p < 0.001) and maximum (r = 0.7694; p < 0.0001) bony change. Conclusions There was poor correlation between condylar changes (as observed on CBCT images), pain and other clinical signs and symptoms in TMJ OA.

Palconet, G; Ludlow, JB; Tyndall, DA; Lim, PF



Evidence of reactive oxygen species generation in synovial fluid from patients with temporomandibular disease by electron spin resonance spectroscopy.  


Reactive oxygen species (ROS) have been implicated in the pathogenesis of temporomandibular disorders. In the present study, we provide the first evidence of ROS generation in the synovial fluid from human temporomandibular disorder patients, as shown by electron spin resonance (ESR) and spin trapping. Three distinct ESR spectra of DMPO spin adducts were observed in the synovial fluid. They corresponded to three free radical species: hydroxyl radical (HO(*)), hydrogen radical (H(*)), and carbon-center radical (R(*)). Among them, the 5,5-dimethyl-1-pyrroline-N-oxide (DMPO)-OH spectrum was the most prominent, suggesting that HO(*) was dominantly generated in the synovial fluid from temporomandibular disorder patients. Desferrioxamine (DFO), an iron chelator, strongly depressed the DMPO-OH signal intensity in the synovial fluid from patients with temporomandibular disorders. We successfully demonstrated ROS-induced oxidative stress in the synovial fluid from temporomandibular disorder patients. ROS generation in the temporomandibular joint could lead to exacerbation of inflammation and activation of cartilage matrix degrading enzymes that proceed to degenerative change of the temporomandibular joint. Thus, iron-dependent generation of HO( *) might have a crucial role in the pathogenesis of temporomandibular disorders. PMID:15720828

Lee, Masaichi-Chang-Il; Kawai, Yoshiaki; Shoji, Hirofumi; Yoshino, Fumihiko; Miyazaki, Hiroyuki; Kato, Hiroharu; Suga, Masako; Kubota, Eiro



Clinical and magnetic resonance imaging findings of the temporomandibular joint and masticatory muscles in patients with rheumatoid arthritis  

Microsoft Academic Search

The aim of this study was to investigate the clinical, radiographic, and magnetic resonance imaging (MRI) findings of temporomandibular\\u000a joint (TMJ) and masticatory muscles in rheumatoid arthritis (RA) patients. Twenty-eight RA patients and 29 healthy subjects\\u000a were participated in the study. The patient underwent clinical and laboratory investigation. DAS28 scores were calculated.\\u000a Lateral panoramic radiography was performed to evaluate condylar

Hasan Huseyin YilmazDerya Yildirim; Derya Yildirim; Yunus Ugan; Sevket Ercan Tunc; Ahmet Yesildag; Hikmet Orhan; Cevriye Akdag


Interleukin1? in synovial fluid from the arthritic temporomandibular joint and its relation to pain, mobility, and anterior open bite  

Microsoft Academic Search

Purpose: The purpose of this study was to investigate whether interleukin-1? in synovial fluid or blood plasma is involved in the development of pain or hyperalgesia of the temporomandibular joint (TMJ), as well as reduced mandibular mobility and anterior open bite.Patients and Methods: Twenty-nine patients with TMJ arthritis and seven healthy subjects were studied. VAS measurement of TMJ tenderness on

Per Alstergren; Malin Ernberg; Maria Kvarnström; Sigvard Kopp



Pathology of the temporomandibular joint of patients with rheumatoid arthritis–case reports of secondary amyloidosis and macrophage populations  

Microsoft Academic Search

Introduction: The pathogenetic features of rheumatoid arthritis of the temporomandibular joint (TMJ) are not well defined. In this paper the histological features of TMJs affected by rheumatoid arthritis, and the detection of secondary amyloidosis and macrophage populations in the TMJs of two patients with progressive rheumatoid arthritis are described.Methods: In two patients (64-year-old man and 61-year-old woman) with rheumatoid arthritis

Takaaki Ueno; Toshimasa Kagawa; Miwa Kanou; Nobuhisa Ishida; Takashi Fujii; Joji Fukunaga; Nobuyoshi Mizukawa; Toshio Sugahara



Arthroscopic management of intra-articular pigmented villonodular synovitis of temporomandibular joint.  


This retrospective study reports on four patients with intra-articular pigmented villonodular synovitis (PVNS) of the temporomandibular joint (TMJ) who were managed with arthroscopy between 2002 and 2009. There were three females and one male, with a mean age of 46 years at diagnosis. The common symptoms were trismus and pain. No pre-auricular swelling or mass was detected. Magnetic resonance imaging (MRI) and arthrography showed an anteriorly displaced disc, disc perforation, osteophyte of the condyle, or increased joint effusion. No neoplasm was suspected radiologically. Under arthroscopy, a yellow nodule and loose bodies were found in one patient, and a yellow or brown hyperplasia of the synovial membrane was noted in the other three patients. Degeneration of the articular cartilage was detected in two patients. The arthroscopic procedures used for every patient were partial synovectomy and debridement of articular surfaces with electric shaving and coblation. Arthroscopic disc repositioning was performed for the two young patients. Postoperative histological examination verified the diagnosis of PVNS of the TMJ. The average follow-up period was 57.4 months, and no recurrence was found. Arthroscopy has proved to be a useful method for the management of intra-articular PVNS of the TMJ. PMID:20961736

Cai, X-Y; Yang, C; Chen, M-J; Jiang, B; Yun, B; Fang, B



Total alloplastic temporomandibular joint replacement: the Czech-Slovak initial experience.  


In 2004, total alloplastic temporomandibular joint (TMJ) replacement began in the Czech Republic and Slovakia. This paper presents initial subjective and objective data compiled between 2005 and 2009 from those cases. Data were collected from 27 patients (38 joints) reconstructed with the Biomet-Lorenz stock and custom TMJ prostheses during a mean follow-up period of 24 months. The variables of pain and mouth opening were evaluated pre- and postoperatively. Patients classified pain on a scale of 0-5 (none - unbearable). The extent of opening was investigated by a physician (the distance between the points of the incisors on the upper and lower jaw was measured). The most common indication for replacement was ankylosis. There was an improvement in pain score in 15 patients. 4 patients reported worsening of pain and 8 patients did not complain of pre- or postoperative pain. Mandibular opening increased from a mean of 17.7 mm preoperatively to a mean of 29.1mm postoperatively. There were complications related to the surgery, but no significant complications related to the devices. Total alloplastic TMJ replacement appears to be a safe and effective method of reconstruction in the patients in this initial study. PMID:22285011

Machon, V; Hirjak, D; Beno, M; Foltan, R



Spry1 and Spry2 Are Essential for Development of the Temporomandibular Joint  

PubMed Central

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.

Purcell, P.; Jheon, A.; Vivero, M.P.; Rahimi, H.; Joo, A.; Klein, O.D.



One-year prospective outcome analysis and complications following total replacement of the temporomandibular joint with the TMJ Concepts system.  


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



Characterization of Degenerative Changes in the Temporomandibular Joint of the Bengal Tiger (Panthera tigris tigris) and Siberian Tiger (Panthera tigris altaica).  


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



Computer-assisted condylar reconstruction in bilateral ankylosis of the temporomandibular joint using autogenous coronoid process.  


During the past 10 years, more than 20 patients a year have been treated at our centre for bilateral ankylosis of the temporomandibular joint (TMJ). Here we describe the use of computer-assisted three-dimensional surgical planning and its clinical effects in condylar reconstruction for such patients using autogenous coronoid process. Sixteen patients with bilateral bony ankylosis of the TMJ from March 2006 to March 2009 were randomly divided into 2 groups and treated by bilateral osteoarthrectomy and condylar reconstruction by free grafting of autogenous coronoid process with and without three-dimensional simulation using Surgicase CMF™ (Materialise, Belgium) software. Clinical examination, radiographs, photographs, and details of the operation and its outcome were used postoperatively to evaluate the clinical effects of the technique. Satisfactory mouth opening was achieved in all cases. There were fewer postoperative malocclusions among patients who had three-dimensional simulation. The combination of computer-assisted three-dimensional surgical planning and simulation and free grafting of autogenous coronoid process is a sound and predictable method for the reconstruction of condyles in patients with bilateral ankylosis of the TMJ as it makes the operation easier and more accurate. PMID:21084137

Yang, Xiaoqin; Hu, Jing; Yin, Guozhu; Hu, Jian; Luo, En



Use of adipose stem cells and polylactide discs for tissue engineering of the temporomandibular joint disc  

PubMed Central

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



Lateral impingements of the temporomandibular joint: a classification system and MRI imaging characteristics.  


Finite element analysis of dynamic temporomandibular joint (TMJ) loading reveals a predominance of localization of loading laterally towards the collateral ligament regions and disc/capsule attachments to the mandibular condyle. A previous publication (Kirk, Kirk. OMS Clin North Am 2006;18:345-68) introduced biomechanical principles for surgeons to consider in the diagnostic phase of management as well as initial surgical procedure selection. The concept of impingements and their impact with development of derangement is presented in this paper with an expanded collection of imaging characteristics. Diagnostic coronal imaging using a dual photon imaging technique is presented. This technique is superior to traditional T1 and T2 weighted imaging sequences when sagittal imaging is employed. Coronal imaging using this technique adds a new dimension to preoperative imaging. Impingement presence and the discernment of early lateral disc/capsule rupture from the condyle of the mandible is superior with the dual photon technique. Images and a classification of degrees of impingement are presented. The biomechanical importance of diagnosis of impingement is discussed. PMID:23218512

Kirk, W S



Impact of temporomandibular joint pain on activities of daily living in patients with rheumatoid arthritis.  


The aim of this study was to investigate the impact of temporomandibular joint (TMJ) pain on daily living in patients with rheumatoid arthritis (RA) involving the TMJ. Nineteen patients (17 F, 2 M) with a median (IQR) age of 44 (23) years were included. A scale for the influence of TMJ pain/discomfort on the activities of daily living was used. TMJ resting pain and pain upon maximum mouth opening according to a visual analog scale as well as pressure pain threshold and tenderness to digital palpation of the TMJ were assessed. Blood samples were collected to measure the level of acute phase proteins. Activities of daily living were influenced in all patients at different levels. The impact on daily living by TMJ pain/discomfort was greatest on the performance of physical exercises and jaw movements, while it was smallest on the performance of hobbies and eating. Pain during maximum mouth opening and tenderness to digital palpation were correlated to difficulties with several activities such as to yawn and open the mouth wide, while pressure pain threshold was correlated with difficulties during eating, which confirms that the pain was located in the TMJ. In conclusion, this study indicates that pain/discomfort from the TMJ in patients with RA has a significant negative impact on activities of daily living. PMID:14763779

Voog, Ulle; Alstergren, Per; Leibur, Edvitar; Kallikorm, Riina; Kopp, Sigvard



Management of acquired open bite associated with temporomandibular joint osteoarthritis using miniscrew anchorage.  


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. PMID:23112945

Tanaka, Eiji; Yamano, Eizo; Inubushi, Toshihiro; Kuroda, Shingo



Dynamic compressive properties of articular cartilages in the porcine temporomandibular joint.  


The mandibular condylar and temporal cartilages in the temporomandibular joint (TMJ) play an important role as a stress absorber during function. However, relatively little information is available on its viscoelastic properties in dynamic compression, particularly in a physiological range of frequencies. We hypothesized that these properties are region-specific and depend on loading frequency. To characterize the viscoelastic properties of both cartilages, we performed dynamic indentation tests over a wide range of loading frequencies. Nine porcine TMJs were used; the articular surface was divided into five regions: anterior; central; posterior; medial and lateral. Sinusoidal compressive strain was applied with an amplitude of 1.0% and a frequency range between 0.01 and 10 Hz. In both cartilages, the dynamic storage modulus increased with frequency, and the value was the highest in the lateral region. These values of E' in the temporal cartilage were smaller than those in the mandibular condylar cartilage in all five regions except the lateral region. The Loss tangent values were higher in the temporal cartilage (0.35-0.65) than in the mandibular condylar one (0.2-0.45), which means that the temporal cartilage presents higher viscosity. The present results suggest that the dynamic compressive moduli in both cartilages are region-specific and dependent on the loading frequency, which might have important implications for the transmission of load in the TMJ. PMID:23660305

Lamela, María Jesús; Fernández, Pelayo; Ramos, Alberto; Fernández-Canteli, Alfonso; Tanaka, Eiji



The role of three-dimensional computed tomography in the evaluation of temporomandibular joint ankylosis  

PubMed Central

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



Stress analysis in human temporomandibular joint affected by anterior disc displacement during prolonged clenching.  


Parafunctional habits, such as prolonged clenching and bruxism, have been associated with dysfunctional overloading in the temporomandibular joint (TMJ). In this study, stress distributions in the TMJ were analysed during prolonged clenching, using three-dimensional finite element (FE) models of the TMJ with and without disc displacement. The aim of this study was to investigate stress distribution of the cartilaginous tissues in the TMJ with and without disc displacement. Finite element models were developed on the basis of magnetic resonance images from two subjects with and without anterior disc displacement. Condylar movements recorded during a 5-min clenching were used as the loading condition for stress analysis. In the asymptomatic model, the highest von Mises stresses were located in the lateral area (4·91 MPa) of the disc surfaces, and after 5-min clenching, the higher stresses were still located at the lateral area (3·65 MPa). In all the cartilaginous tissues, 30-50% of stress reduction occurred during 5-min clenching. In contrast, the von Mises stress in the cartilaginous tissues of the symptomatic model with disc displacement was markedly lower, compared with the asymptomatic model. However, in the condylar cartilage, stress relaxation during clenching was not recognised. Furthermore, relatively high stresses were observed in the retrodiscal tissues throughout clenching. The present results indicate that disc position could be involved in the stress distribution of the TMJ components during prolonged clenching. PMID:23398635

Abe, S; Kawano, F; Kohge, K; Kawaoka, T; Ueda, K; Hattori-Hara, E; Mori, H; Kuroda, S; Tanaka, E



A mechanical evaluation of three decellularization methods in the design of a xenogeneic scaffold for tissue engineering the temporomandibular joint disc  

Microsoft Academic Search

Tissue-engineered temporomandibular joint (TMJ) discs offer a viable treatment option for patients with severe joint internal derangement. To date, only a handful of TMJ tissue engineering studies have been carried out and all have incorporated the use of synthetic scaffold materials. These current scaffolds have shown limited success in recapitulating morphological and functional aspects of the native disc tissue. The

Sarah B. Lumpkins; Nicolas Pierre; Peter S. McFetridge



Clinical and magnetic resonance imaging findings of the temporomandibular joint and masticatory muscles in patients with rheumatoid arthritis.  


The aim of this study was to investigate the clinical, radiographic, and magnetic resonance imaging (MRI) findings of temporomandibular joint (TMJ) and masticatory muscles in rheumatoid arthritis (RA) patients. Twenty-eight RA patients and 29 healthy subjects were participated in the study. The patient underwent clinical and laboratory investigation. DAS28 scores were calculated. Lateral panoramic radiography was performed to evaluate condylar erosion and condylar movement. Craniofacial MRI was performed to evaluate TMJ and masseter, medial and lateral pterygoid muscles' thickness, and cross-sectional area. It was found that the mean maximal interincisal distance, range of lateral, retrusive (P < 0.05) and protrusive motion were all lesser in RA group. Lateral panoramic radiography revealed a distinct erosion in 10.7% (3/28) and restricted condylar movement in 53.6% (15/28) of RA patients. Two RA patients demonstrating marked condylar erosion in lateral panoramic radiographs were RF negative and had DAS28 scores 3.41 and 4.61. MRI findings revealed condylar erosion and effusion in one RA patient and atrophic changes of masticatory muscles in another patient. There was no statistical significance between RA and healthy groups for the thickness and cross-sectional areas of the masticatory muscles. RA group revealed a strong linear relationship for the right and left muscle thickness and cross-sectional areas in regression analysis. TMJ symptoms are frequent findings and thought to be affected from mean disease duration in RA. Laboratory findings should be considered for disease activity-related TMJ involvement. RA patients did not present muscular atrophy or hypertrophy. PMID:21253736

Yilmaz, Hasan Huseyin; Yildirim, Derya; Ugan, Yunus; Tunc, Sevket Ercan; Yesildag, Ahmet; Orhan, Hikmet; Akdag, Cevriye



Preliminary optical coherence tomography investigation of the temporo-mandibular joint disc  

Microsoft Academic Search

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

Corina Marcauteanu; Enikö Demjan; Cosmin Sinescu; Meda Negrutiu; Adrian Motoc; Rodica Lighezan; Liliana Vasile; Mike Hughes; Adrian Bradu; George Dobre; Adrian G. Podoleanu



Nontraumatic bifid mandibular condyles in asymptomatic and symptomatic temporomandibular joint subjects  

PubMed Central

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.

Cho, Bong-Hae



Impact of tobacco use on the symptoms of painful temporomandibular joint disorders.  


This study examines the relationship between the severity of painful temporomandibular joint disorders (TMD) symptoms and current tobacco use in patients evaluated at a specialized orofacial pain clinic. Medical records, including responses to the Chronic Pain Grading Scale (CPGS), from 606 consecutive patients evaluated at the Mayo Clinic orofacial pain clinic with TMD by RDC-TMD criteria were retrospectively reviewed. Univariate analyses were performed comparing tobacco users and non-users. Analysis of covariance and multiple logistic regression models were used to adjust for demographic variables. A p value

Weingarten, Toby N; Iverson, Barton C; Shi, Yu; Schroeder, Darrell R; Warner, David O; Reid, Kevin I



Indirect measurement of the temporomandibular joint disc elasticity with magnetic resonance imaging  

PubMed Central

Objectives The radiological evaluation of the temporomandibular joint (TMJ) consists of demonstrating the morphological features of the disc and the condyle in closed and open mouth positions using MRI. We aimed to determine elasticity of the disc by measuring the amount of elongation during mouth opening. Methods The study population included 49 patients. Coronal T1 and multiplane oblique T2 weighted gradient recalled echo sequences were acquired in open and closed mouth positions. Biconcave TMJ disc lengths were measured on sagittal oblique images in both positions. Elongation ratio (ER) was calculated for each patient. According to the findings, TMJs are classified into subgroups: normal (N), dislocated with reduction (DWR), pure DWR (p-DWR), DWR with additional findings (DWR-a) and dislocated without reduction (DWOR). Statistical analysis was performed using the ?2 test and receiver operating characteristic analysis. Results Out of 98 discs, 22 of them were evaluated as N, 60 as DWR (28 p-DWR, 32 DWR-a) and 16 as DWOR. There was no significant difference among the disc lengths in three subgroups at the closed mouth position (P = 0.15), whereas there was significant difference in the open mouth position (P = 0.0001). There was significant difference among subgroups as far as ER is concerned (P < 0.05). Conclusions ER is a strong indicator of elasticity. Compared with the N group, elasticity of the disc was not significantly different in the p-DWR group but the disc elasticity was very degraded in DWR-a and in DWOR. A negative conversion or one smaller than 1.4 mm means a compromised disc, although sometimes it will possess normal anatomical configurations or signal characteristics.

Yildirim, D; Dergin, G; Tamam, C; Moroglu, S; Gurses, B



An adult case of temporomandibular joint osteoarthritis treated with splint therapy and the subsequent orthodontic occlusal reconstruction.  


Herein we report treatment for a 19-year-old female patient with severe osteoarthritis of the temporomandibular joint. The patient had severe open bite with a Class II molar relationship. She had limited mouth opening and pain. Clinical examination and magnetic resonance imaging revealed that she had anterior disc displacement without reduction. By splint therapy, limited mouth opening and pain was eliminated, but an anterior open bite developed after the treatment. By orthodontic treatment, an acceptable occlusion was achieved with a Class I molar relationship. PMID:22346169

Kurt, Hanefi; Ozta?, Evren; Gençel, Burç; Ta?an, Demet Ataman; Ozta?, Derya



Use and accuracy of US guidance for image-guided injections of the temporomandibular joints in children with arthritis  

Microsoft Academic Search

Background  Juvenile idiopathic arthritis (JIA) has an incidence that ranges from 1 to 22 per 100,000 children worldwide, with involvement\\u000a of the temporomandibular joint (TMJ) in 17–87% of patients. Intraarticular corticosteroid injections are beneficial in the\\u000a local treatment of JIA and of other types of arthritis.\\u000a \\u000a \\u000a \\u000a \\u000a Objective  To describe and assess the accuracy of an US-guided technique for visualization of needle placement

Dimitri A. Parra; Melissa Chan; Ganesh Krishnamurthy; Lynn Spiegel; Joao G. Amaral; Michael J. Temple; Philip R. John; Bairbre L. Connolly



The comparison of outcomes of surgically treated bilateral temporomandibular joint disorder in different groups: A retrospective study  

PubMed Central

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



Changes in urinary bone resorption markers (pyridinoline, deoxypyridinoline) resulting from experimentally-induced osteoarthritis in the temporomandibular joint of rats.  


The purpose of this study was to quantify the urinary bone resorption markers, pyridinoline (Pyr) and deoxypyridinoline (Dpyr), excreted from experimentally-induced osteoarthritis (OA) in the temporomandibular joint (TMJ) of rats. Osteoarthritic lesions were induced by intra-articular injection of collagenase into the right TMJs of 16-week-old male rats. The whole day's urine was collected from each animal one day before the injection and 5, 7, 11 and 14 days after the injection. Urine samples were analyzed by high-perfomance liquid chromatography and fluorescence spectroscopy. Histological changes in condyle were examined by using paraffin sections with toluidine blue staining. Degenerative changes were observed in the articular cartilage of the experimental group on day 7 and day 14 after the injection of collagenase. The concentration of Pyr was remarkably high in the experimental group, and consequently the Pyr to Dpyr ratio was significantly higher (p<0.05) in the experimental group than in the control group from 7-14 days after the injection. These findings suggest that a urinary Pyr/Dpyr ratio would be available for the detection of degenerative changes in condyle relevant to temporomandibular joint osteoarthritis (TMJ OA). PMID:12555930

Imada, Masae; Tanimoto, Kotaro; Ohno, Shigeru; Sasaki, Akiko; Sugiyama, Hiroki; Tanne, Kazuo



[Substantiation of psychosomatic nature of temporomandibular joint disorders complicated by parafunctions of masticatory muscles and their combined treatment].  


The nature and origin of disorders of masticatory muscles and temporomandibular joint are discussed. Their psychosomatic origin is suggested. Methods of direct and indirect psychotherapy as well as psychopharmacotherapy were included in complex rehabilitation. Computer videoautotraining with biological adaptive feedback was used. 105 patients (31 men and 74 women) at the age of 16-70 years (mean age 34,9+/-1,3 years) were examined. For the first time dysfunction computer arthrophonography of joint sound was used. Combined therapy of this patients was carried out including: psychological correction (suggestion, placebo-therapy, computer videoautotraining), pharmacotherapy (psychotropic, myorelaxative, analgetic drugs preparations), physiotherapy (electrophoresis, phonotherapy, vibroacustic massage), use of orthopaedic apparatuses. Complete recovery or significant improvement of health was observed in 92% of patients, insufficient effect - in 8%. PMID:17310953

Bulycheva, E A



Operation with a single-channel thin-fibre arthroscope in patients with internal derangement of the temporomandibular joint.  


We evaluated the use of operation by single-puncture arthroscopy in 55 patients (62 joints) with locked temporomandibular joints (TMJ). We used a single-channel thin-fibre arthroscope (M & M Co., Tokyo, Japan) and a holuminium yttrium aluminium garnet (Ho:YAG) laser (Lumenis Co., Tokyo, Japan). The preoperative mean (SD) maximum interincisal measurement (distance between the edge of the lower and upper incisor) was 26.0 (4.9) mm, and it was increased by 15.0mm 12 weeks after operation. The preoperative mean (SD) visual analogue score (VAS) was 6.3(2.0), and after 12 weeks it had been reduced to 1.6 (1.1). There were no other complaints. Single-puncture arthroscopy with the Ho:YAG laser is simple and useful. There were no other complications, and the results obtained were satisfactory. PMID:17658200

Yoshida, H; Fukumura, Y; Tojyo, I; Yamaguchi, A; Tsuji, K; Sako, J; Yamada, K; Morita, S



Poly (glycerol sebacate): a novel scaffold material for temporomandibular joint disc engineering.  


The preponderance of temporomandibular joint (TMJ) disorders involving TMJ disc injury inspires the need to further explore tissue engineering strategies. The objective of this study was to examine the potential of poly (glycerol sebacate) (PGS), a biocompatible, biodegradable elastomer, as a porous scaffold material for the TMJ disc. Goat fibrochondrocytes were seeded on PGS at three seeding densities (25, 50, 100 million cells/mL scaffold), respectively, and cultured for 24?h, 2 weeks, and 4 weeks. The resulting histological, biochemical, and biomechanical properties were determined. Histological staining revealed an abundance of both collagen and glycosaminoglycans (GAG) throughout the high seeding density scaffolds at 4 weeks. There was also a significant increase in the cellular content in all groups over the four-week period, showing that the scaffolds promoted cell attachment and proliferation. The PGS scaffolds supported the deposition of large quantities of extracellular matrix, with differences noted between seeding density groups. At 4 weeks, the medium and high seeding density groups had significantly more collagen per scaffold (181±46??g and 218±24??g, respectively) than the low seeding density group (105±28??g) (p<0.001). At 4 weeks, the medium and high seeding density groups also had a significantly higher GAG content per scaffold (702±253??g and 773±187??g, respectively), than the low seeding density group (324±73??g) (p<0.001). The compression tangent modulus was significantly greater at 4 weeks than 24?h (123.6±86?kPa and 26.2±5?kPa, respectively) (seeding density groups combined) (p<0.001), with no differences between seeding groups at each time point. After 4 weeks, the tangent modulus of the low seeding density group was in a similar range of the goat TMJ disc (180±127?kPa compared to 304±141?kPa, respectively). The results show that cell seeding density and culture time do have an effect on both the biochemical and biomechanical properties of PGS scaffolds. These findings demonstrate that PGS has great potential as a scaffold material for TMJ disc engineering. PMID:23157344

Hagandora, Catherine K; Gao, Jin; Wang, Yadong; Almarza, Alejandro J



Measuring persistent temporomandibular joint nociception in rats and two mice strains.  


Temporomandibular joint (TMJ) pain has been reported to last for prolonged periods in humans. In rodents a variety of methods have been used to measure TMJ nociception, but for most of these methods the period of measurement has been minutes to a couple of hours. In addition, most measurement protocols required restraint or training of the animal. Previous studies from our laboratory demonstrated that feeding behavior, particularly meal duration, was an indicator of TMJ nociception in unrestrained and untrained male and female Sprague-Dawley rats for up to two days. In this study, we first found that injection of complete Freund's adjuvant (CFA) into the TMJ of rats significantly lengthened meal duration for 19 days and also decreased meal frequency for 42 days. Interestingly, the meal duration varied significantly from day to day within the 19 day period. TMJ interleukin-1 beta (IL-1 beta) and calcitonin gene-related peptide (CGRP) were significantly elevated in the TMJ tissues of CFA-injected animals and the level of these markers was attenuated as the meal duration decreased with time. Control animals injected with saline into the TMJ or CFA into the knee did not show a significant lengthening in meal duration but did show a decrease in meal frequency. In a second study, DBA/1LacJ mice given TMJ CFA injections showed a significantly lengthened meal duration on four of the seven days measured using end-of-the meal definition of 5 or 10 min. No other meal pattern changed significantly. Two days post-CFA injection, the DBA/1LacJ mice showed significantly elevated interleukin-6 (IL-6), but not elevated IL-1 beta. Seven days post-injection, both IL-6 and IL-1 beta were significantly elevated. No change in CGRP was detected. In this study C57Bl/6 mice also received TMJ CFA injections, but they did not show a lengthening in any meal pattern or significant increases in IL-1 beta, IL-6 or CGRP. Our data show, for the first time, that meal duration can be used to measure CFA-induced nociception in the TMJ over the course of several weeks in unrestrained rats and for up to seven days in the DBA/1LacJ mouse strain. In addition, C57Bl/6 mice are resistant to CFA-induced TMJ nociception at the same dose used in the DBA/1LacJ mice. PMID:20152846

Kramer, Phillip R; Kerins, Carolyn A; Schneiderman, Emet; Bellinger, Larry L



New arthroscopic disc repositioning and suturing technique for treating an anteriorly displaced disc of the temporomandibular joint: part I--technique introduction.  


Anterior disc displacement is one of the most frequent types of temporomandibular joint disorders. Various arthroscopic disc repositioning and suturing techniques were reported to treat patients with disc displacement in the 1990s, but the success rate and long-term stability was not satisfactory. This report describes a new repositioning and suturing technique and discusses its advantages and disadvantages. PMID:22771167

Yang, C; Cai, X-Y; Chen, M-J; Zhang, S-Y



Relative odds of temporomandibular joint pain as a function of magnetic resonance imaging findings of internal derangement, osteoarthrosis, effusion, and bone marrow edema  

Microsoft Academic Search

Objective. The purpose of this study was to evaluate whether common magnetic resonance (MR) imaging variables such as temporomandibular joint (TMJ) internal derangement, osteoarthrosis, effusion, and bone marrow edema are predictive of the presence of TMJ pain. Study Design. The relationship between TMJ pain and TMJ internal derangement, osteoarthrosis, effusion, and bone marrow edema was analyzed in MR images of

Rüdiger Emshoff; Iris Brandlmaier; Stefan Bertram; Ansgar Rudisch



Orofacial pain, jaw function, and temporomandibular disorders in women with a history of juvenile chronic arthritis or persistent juvenile chronic arthritis  

Microsoft Academic Search

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



Interleukin1?, interleukin-1 receptor antagonist, and interleukin-1 soluble receptor II in temporomandibular joint synovial fluid from patients with chronic polyarthritides  

Microsoft Academic Search

Purpose: The aim of this study was to investigate whether interleukin-1? (IL-1?), interleukin-1 receptor antagonist (IL-1ra), or soluble IL-1 receptor II (sIL-1RII) in synovial fluid or plasma is associated with joint pain or signs of tissue destruction in patients with temporomandibular joint (TMJ) involvement of polyarthritides.Patients and Methods: Forty-three patients with TMJ involvement of polyarthritides were included. TMJ resting pain,

Per Alstergren; Claudia Benavente; Sigvard Kopp



Peripheral metabotropic glutamate receptor subtype 5 contributes to inflammation-induced hypersensitivity of the rat temporomandibular joint.  


Temporomandibular disorders (TMD) comprise an assortment of clinical conditions characterized by pain in the temporomandibular joint (TMJ). TMD patients have a variety of symptoms, including jaw movement disorder and TMJ pain. Metabotropic glutamate receptor subtype 5 (mGluR5) was reported to be involved in pain processing in several animal models of neuropathic and inflammatory pain. In this study, the head withdrawal threshold and mGluR5 expression were investigated in rats with complete Freund's adjuvant (CFA)-induced TMJ inflammatory pain. CFA injection into the TMJ significantly decreased the mechanical head withdrawal thresholds relative to vehicle injection, and the effects were blocked by pre-injection of 2-methyl-6-(phenylethynyl)-pyridine (MPEP). mGluR5 expression in the trigeminal ganglion was predominantly increased in the CFA-injected group compared with the normal control group. Pretreatment with MPEP, a selective mGluR5 antagonist, reduced mGluR5 expression in the trigeminal ganglion compared with the CFA group, as measured by immunohistochemistry, western blotting, and RT-PCR. Significant differences in the proportion or intensity of mGluR5 expression were found in animals with inflammation versus control animals at the examined time point. These findings indicate a role for peripheral mGluR5 in CFA-induced nociceptive behavior and TMJ inflammation. Peripheral application of mGluR5 antagonists could provide therapeutic benefits for inflammatory TMJ pain. PMID:23807708

Li, Bo; Lu, Li; Tan, Xuexin; Zhong, Ming; Guo, Yan; Yi, Xin



Signs and Symptoms of Temporomandibular Joint Disorders Related to the Degree of Mouth Opening and Hearing Loss  

PubMed Central

Background The temporomandibular joint is a unique bi-condylar joint involved in mastication and speech. Temporomandibular joint disorders (TMD) have a range of symptoms, including aural symptoms, and are present in approximately 75% of normal populations. The present study examined the relationship between signs and symptoms of TMD and mouth opening, gender, joint and aural symptoms, and hearing loss. Methods The study involved 464 healthy Greek university students (156 men and 308 women) with a mean age of 19.6 years. Age, gender and maximum mouth opening was recorded. Mouth opening was measured using Vernier calipers. An anamnestic questionnaire was used to stratify the subjects into four groups based on TMD severity. Aural symptoms and an audiogram were recorded for each subject too. Data were analyzed using multifactor ANOVA, chi-square, t-test, Mann-Whitney and Kruskal-Wallis tests. Results The overall incidence of TMD signs and symptoms was 73.3%. The incidence and severity was greater in females than males (p-value 0.0001 < 0.05). The number of aural symptoms was associated to the TMD severity (p-value 0.0001 < 0.05) as well as maximum mouth opening (p-value 0.004 < 0.05). Audiometry showed that moderate and severe TMD was associated with hearing loss of median and low tones respectively (p-value 0.0001 < 0.05). TMJ pain (p-value 0.0001 < 0.05), TMJ ankylosis (p-value 0.0001 < 0.05), bruxism (p-value 0.0001 < 0.05) and ear itching (p-value 0.0001 < 0.05) were also found to be statistically different between TMD and non-TMD subjects. Conclusions TMD signs and symptoms were more common and severe in females than males. TMD severity is correlated with the degree of mouth opening and the number of aural symptoms. The absence or presence of mild TMD are associated with normal audiograms while moderate and severe TMD are related to hearing loss in median and low tones respectively. Bruxism, joint ankylosis, joint pain and ear itching were more common in TMD than non-TMD patients.



Image-Based Biomimetic Approach to Reconstruction of the Temporomandibular Joint  

Microsoft Academic Search

This article will present an image-based approach to the designing and manufacturing of biomimetic tissue engineered temporomandibular (TMJ) condylar prosthesis. Our vision of a tissue-engineered TMJ prosthesis utilizes a 3-D designed and manufactured biodegradable scaffold shaped similar to a condylar head and neck, i.e. a condylar-ramus unit (CRU). The fabricated CRU scaffold can be constructed with a specific intra-architectural design

Stephen E. Feinberg; Scott J. Hollister; John W. Halloran; T. M. Gabe Chu; Paul H. Krebsbach



[Indirect testimony of stress conduction from mandible to skull in maxillofacial trauma: morphological changes of temporomandibular joint disc  


There were cerebral injuries accompanied in maxillofacial high velocity projectile wound.Owing to the special anatomic relationship between skull and facial bones,the stress conduction of bone was an important factor of cerebral injury in maxillofacial wound.In this experiment,the canine mandibular regions were wounded by steel spheres,which weight 1.03g,impacting velocity at 1400m/s,to produce severely maxillofacial firearm wounds.The morphological and pathological changes of temporomandibular joint disc of wounded side were observed with light and electron microscopes.The microscopic injuries of disc,including arrangement disorder of figre,spotty edema and some fibrous dissolution,etc,were found.These results have provided an indirect evidence of injurous mechanism of the cerebral injury accompaning maxillofacial high enery misslle wound. PMID:15159877

Tan, Y H; Liu, Y Q; Zhou, S X; Jiang, H T; Zhang, X F; Ya, Z M; Liu, Y Q; Lai, X N



Immunohistochemical expression of types I and III collagen antibodies in the temporomandibular joint disc of human foetuses  

PubMed Central

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.



Computed tomography evaluation of temporomandibular joint alterations in patients with class II division 1 subdivision malocclusions: condyle-fossa relationship.  


Thirty persons with Class II Division 1 subdivision malocclusions, ranging in age from 12 years 8 months to 42 years, underwent computed tomography of the temporomandibular joints. The images obtained from sagittal slices were used to assess the depth of the mandibular fossa, the angulation of the posterior wall of the articular tubercle, the condyle-fossa relationship, and the concentric position of the condyles associated with this malocclusion. Paired Student t tests were applied, and Pearson product moment correlations (r) were determined after measurements on both Class I and Class II sides were obtained. No statistically significant asymmetries were found in the depth of the mandibular fossa, the angulation of the posterior wall of the articular tubercle, or the condyle-fossa relationship. However, a statistically significant (P <.05) anterior positioning of the condyles was observed. PMID:15224058

Vitral, Robert Willer Farinazzo; Telles, Carlos de Souza; Fraga, Marcelo Reis; de Oliveira, Roberto Sotto Maior Fortes; Tanaka, Orlando Motohiro



[Endo-prosthetics of the temporomandibular joint: results of using different methods based on data of Central Institute of Dentistry clinic].  


Results of using different types of endoprostheses for repair of the temporomandibular joint (TMJ) are discussed. The main advantages and drawbacks of the method of endoprosthetic treatment of the mandibular condylar process, detected during the immediate and remote postoperative periods, are described. The biomechanics of mandibular movements in prostheses of the joint is presented. Results of using complete endoprosthesis of the TMJ, designed with consideration for mandibular movements biomechanics and experience gained in the use of various types of the joint endoprostheses are presented. PMID:14671591

Liashev, I N; Semkin, V A; Rabukhina, N A



Progression of Cartilage Degradation, Bone Resorption and Pain in Rat Temporomandibular Joint Osteoarthritis Induced by Injection of Iodoacetate  

PubMed Central

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



Long-term effect of mandibular midline distraction osteogenesis on the status of the temporomandibular joint, teeth, periodontal structures, and neurosensory function  

Microsoft Academic Search

Purpose: This study retrospectively evaluated the long-term effects of transverse symphyseal distraction osteogenesis (DO) on the temporomandibular joint (TMJ) symptoms, periodontal health, tooth vitality, and nerve injury after surgery.Patients and Methods: Twenty-three patients were treated with symphyseal DO during a 4-year period. Fifteen patients were available for follow-up from 7 to 45 months postoperatively (ave, 24.5 months). The patients were

Greg F Kewitt; Joseph E Van Sickels



Involvement of NMDA receptor mechanisms in jaw electromyographic activity and plasma extravasation induced by inflammatory irritant application to temporomandibular joint region of rats  

Microsoft Academic Search

The aim of this study was to examine the possible role of N-methyl- d-aspartate (NMDA) receptor mechanisms in responses induced by the small-fibre excitant and inflammatory irritant mustard oil injected into the temporomandibular joint (TMJ) region of rats. The effects of the non-competitive NMDA antagonist MK-801 were tested on the mustard oil-evoked increases in electromyographic (EMG) activity of the masseter

X.-M Yu; B. J Sessle; D. A Haas; A Izzo; H Vernon; J. W Hu



Persistent monoarthritis of the temporomandibular joint region enhances nocifensive behavior and lumbar spinal Fos expression after noxious stimulation to the hindpaw in rats  

Microsoft Academic Search

Effects of persistent temporomandibular joint (TMJ) inflammation on nociceptive responses of remote bodily areas of the rat\\u000a were investigated. Monoarthritis of the TMJ region was evoked by the injection of complete Freund’s adjuvant (CFA) into the\\u000a left TMJ region. Rats without injection of CFA into the TMJ region served as controls (non-CFA group). Time spent on licking\\u000a behavior evoked by

Keiichiro Okamoto; Akihisa Kimura; Tomohiro Donishi; Hiroki Imbe; Kyosuke Goda; Koki Kawanishi; Yasuhiko Tamai; Emiko Senba



Application of a cephalometric method to the temporomandibular joint in patients with or without alteration in the orientation of the mandibular condyle axis.  


In a prior study, the spatial relationship of the mandibular condyle was studied through a cephalogram based on laminographies of the temporomandibular joint (TMJ). The present method was developed with the aim of analyzing TMJ morphology and the spatial relationship of the mandibular head within the mandibular fossa, considering references far from these structures, as they may suffer shape alterations. This study was conducted in view of the importance of the study of morphology and the hard structures relationship, which constitutes the temporomandibular joint. Its purpose is to validate a new TMJ cephalogram method by analyzing joints with and without alterations in the orientation of the condylar axis growth. Sixty joints were studied through laminographies in maximal occlusion, examining those joints with and without alterations in the orientation of the axis during condylar growth for subsequent analysis. Results showed that those joints were in a posterior position and rotation of the mandibular head, and that they presented a greater inclination in the articular eminence compared to joints without alterations in the axis orientation. Moreover, a new cephalometric method could be validated, demonstrating that changes in the condylar axis orientation imply pathology; they could also be correlated with changes in the condylar position and in the glenoid fossa morphology. PMID:23461262

Learreta, Jorge A; Barrientos, Esteban E



Short-term outcomes using the Christensen patient-specific temporomandibular joint implant system: a prospective study.  


Thirty-one patients were assessed for changes in pain and maximal mouth opening (MMO) before and after total temporomandibular joint (TMJ) replacement. All prosthetic joint replacements used the Christensen fossa-eminence prosthesis system; 18 were unilateral and 13 bilateral. There were more women (n=22) than men (n=9), and their mean age was 45 years (women 46, range 18-74, and men 42, range 28-69). Indications for replacement included osteoarthritis, ankylosis, and "other". There were overall significant improvements in pain scores for the whole group at one year (95% CI 6.3-8.5 compared with 0.2-3.0) and for women alone (6.5 to 9.2 compared with -0.5 to 2.0). There were also significant improvements in pain scores in both those with osteoarthritis (95% CI 8.1 to 8.9 compared with -0.8 to 3.8) and the group with "other" diagnoses at the 12-month follow-up (95% CI 4.4 to 10.7 compared with -0.2 to 0.5). Finally, there was a significant improvement in MMO in the whole group at the time of 12-month follow-up (95% CI 15.8-23.5 compared with 24.0-32.3). PMID:21459496

Kanatas, A N; Needs, C; Smith, A B; Moran, A; Jenkins, G; Worrall, S F



Temporomandibular disorders seen in rheumatology practices: a review  

Microsoft Academic Search

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



Numerical simulation of a relaxation test designed to fit a quasi-linear viscoelastic model for temporomandibular joint discs.  


The main objectives of this work are: (a) to introduce an algorithm for adjusting the quasi-linear viscoelastic model to fit a material using a stress relaxation test and (b) to validate a protocol for performing such tests in temporomandibular joint discs. This algorithm is intended for fitting the Prony series coefficients and the hyperelastic constants of the quasi-linear viscoelastic model by considering that the relaxation test is performed with an initial ramp loading at a certain rate. This algorithm was validated before being applied to achieve the second objective. Generally, the complete three-dimensional formulation of the quasi-linear viscoelastic model is very complex. Therefore, it is necessary to design an experimental test to ensure a simple stress state, such as uniaxial compression to facilitate obtaining the viscoelastic properties. This work provides some recommendations about the experimental setup, which are important to follow, as an inadequate setup could produce a stress state far from uniaxial, thus, distorting the material constants determined from the experiment. The test considered is a stress relaxation test using unconfined compression performed in cylindrical specimens extracted from temporomandibular joint discs. To validate the experimental protocol, the test was numerically simulated using finite-element modelling. The disc was arbitrarily assigned a set of quasi-linear viscoelastic constants (c1) in the finite-element model. Another set of constants (c2) was obtained by fitting the results of the simulated test with the proposed algorithm. The deviation of constants c2 from constants c1 measures how far the stresses are from the uniaxial state. The effects of the following features of the experimental setup on this deviation have been analysed: (a) the friction coefficient between the compression plates and the specimen (which should be as low as possible); (b) the portion of the specimen glued to the compression plates (smaller areas glued are better); and (c) the variation in the thickness of the specimen. The specimen's faces should be parallel to ensure a uniaxial stress state. However, this is not possible in real specimens, and a criterion must be defined to accept the specimen in terms of the specimen's thickness variation and the deviation of the fitted constants arising from such a variation. PMID:23513990

Commisso, Maria S; Martínez-Reina, Javier; Mayo, Juana; Domínguez, Jaime



Degenerative joint disease in captive waterfowl  

Microsoft Academic Search

A retrospective study was conducted to evaluate degenerative joint disease (DJD) in captive waterfowl that died or were euthanized at Fresno's Chaffee Zoo in Fresno, California, USA from 2001 to 2005. Of these, 16 out of 33 birds (48%) had DJD in one or both stifle (femoral–tibiotarsal joint; n = 13), hock (tibiotarsal–tarsometatarsal joint; n = 4), or toe joints

L. A. Degernes; P. S. Lynch; H. L. Shivaprasad



Phenotypic alterations of neuropeptide Y and calcitonin gene-related peptide-containing neurons innervating the rat temporomandibular joint during carrageenan-induced arthritis  

PubMed Central

The aim of this study was to identify immunoreactive neuropeptide Y (NPY) and calcitonin gene-related peptide (CGRP) neurons in the autonomic and sensory ganglia, specifically neurons that innervate the rat temporomandibular joint (TMJ). A possible variation between the percentages of these neurons in acute and chronic phases of carrageenan-induced arthritis was examined. Retrograde neuronal tracing was combined with indirect immunofluorescence to identify NPY-immunoreactive (NPY-IR) and CGRP- immunoreactive (CGRP-IR) neurons that send nerve fibers to the normal and arthritic temporomandibular joint. In normal joints, NPY-IR neurons constitute 78±3%, 77±6% and 10±4% of double-labeled nucleated neuronal profile originated from the superior cervical, stellate and otic ganglia, respectively. These percentages in the sympathetic ganglia were significantly decreased in acute (58±2% for superior cervical ganglion and 58±8% for stellate ganglion) and chronic (60±2% for superior cervical ganglion and 59±15% for stellate ganglion) phases of arthritis, while in the otic ganglion these percentages were significantly increased to 19±5% and 13±3%, respectively. In the trigeminal ganglion, CGRP-IR neurons innervating the joint significantly increased from 31±3% in normal animals to 54±2% and 49±3% in the acute and chronic phases of arthritis, respectively. It can be concluded that NPY neurons that send nerve fibers to the rat temporomandibular joint are located mainly in the superior cervical, stellate and otic ganglia. Acute and chronic phases of carrageenan-induced arthritis lead to an increase in the percentage of NPY-IR parasympathetic and CGRP-IR sensory neurons and to a decrease in the percentage of NPY-IR sympathetic neurons related to TMJ innervation.

Damico, J.P.; Ervolino, E.; Torres, K.R.; Batagello, D.S.; Cruz-Rizzolo, R.J.; Casatti, C.A.; Bauer, J.A.



MRI analysis of the relationship between bone changes in the temporomandibular joint and articular disc position in symptomatic patients  

PubMed Central

Objectives The aim of this study was to investigate bone changes in the condyle, articular eminence and glenoid fossa in relation to the position of the articular disc. Methods 148 temporomandibular joints (TMJs) of 74 symptomatic patients who underwent MRI were evaluated. The position of the disc was classified as either normal (N), disc displacement with reduction (DDwR), disc displacement without reduction (DDwoR) and posterior displacement (PD). Bone changes were investigated in the condyle and temporal components of the TMJ and classified as osteophytosis, sclerosis or erosion. Results There were no bone changes in the glenoid fossa of the temporal bone. Of the total number of TMJs studied, 94 (63.5%) were N, 34 (23%) presented DDwoR, 19 (12.8%) presented DDwR and 1 (0.7%) presented PD. The bone changes in the condyle and posterior aspect of the articular eminence were associated with the position of the disc. The bone changes in the anterior aspect of the articular eminence were not associated with the position of the disc. Conclusion In cases of DDwoR, bone changes in the condyles were more common. The combination of erosion and osteophytosis in the condyle and the bone changes of the posterior aspect of the articular eminence were associated with disc position.

Gil, C; Santos, KCP; Dutra, MEP; Kodaira, SK; Oliveira, JX



Malignant pigmented villonodular synovitis of the temporomandibular joint with lung metastasis: a case report and review of the literature.  


Malignant pigmented villonodular synovitis (PVNS) is an extremely rare lesion. Approximately 30 cases of malignant PVNS have been reported to date and of these, only 1 case involved the temporomandibular joint. Owing to the rarity of well-documented cases and the heterogeneous histologic features of this group of tumors, there has been some confusion regarding its diagnosis. The heterogeneous features of the sarcomatous areas contain fibrosarcomatous, myxosarcomatous, malignant fibrous histiocytomalike or giant cell tumorlike patterns. However, despite the absence of frank sarcomatous change in the histopathogy of PVNS, there have been 3 reported cases of metastatic lesions in the lung or lymph nodes. Here we present an additional case of clinically malignant PVNS with pulmonary metastasis after recurrence. A 29-year-old man presented in our hospital with a recurrent swelling and pain in the right preauricular area, where benign tumor had been previously resected. MRI demonstrated a large mass with a low signal intensity that seemed to demonstrate a ferromagnetic effect. Surgical resection of the lesion was performed and the diagnosis of PVNS with focal atypical cells was made. Unfortunately, at 30 months post surgery, a thoracic CT found a metastatic nodule in the left lower lobe of the lung. PMID:21444225

Yoon, Hye-Jung; Cho, Young-Ah; Lee, Jae-Il; Hong, Sam-Pyo; Hong, Seong-Doo



Naturalistic changes in insomnia symptoms and pain in temporomandibular joint disorder: a cross-lagged panel analysis.  


An increasing number of prospective studies suggest a bi-directional association between the pain and sleep quality. Few of these investigations have controlled for synchronous correlations, an important source of extraneous variance in lagged associations, which may have confounded conclusions of prior investigations. Despite high rates of insomnia in temporomandibular joint disorders (TMD), no studies have examined temporal associations between naturalistic fluctuations in insomnia and pain in TMD. We conducted cross-lagged panel analysis to examine reciprocal temporal associations between 1-month changes in insomnia symptom severity and self-reported pain over 3 months among 53 TMD patients. This rigorous analytic strategy represents a comprehensive method to explore possible reciprocal temporal associations between insomnia and pain that controls for both auto- and synchronous correlations. Analyses revealed that initial-month increases in insomnia were associated with next-month increases in average daily pain, but not vice versa. The direction of the effect was such that initial-month increases in insomnia symptom severity were associated with next-month increases in average daily pain. These data suggest that naturally occurring fluctuations in insomnia symptom severity are prospectively associated with fluctuations in daily pain experience for persons with TMD. Potential mechanisms by which insomnia might influence pain in TMD and therapeutic implications of these findings are discussed. PMID:20359824

Quartana, Phillip J; Wickwire, Emerson M; Klick, Brendan; Grace, Edward; Smith, Michael T



Intra-Articular Controlled Release of Anti-Inflammatory siRNA with Biodegradable Polymer Microparticles Ameliorates Temporomandibular Joint Inflammation  

PubMed Central

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.



A pilot trial on the molecular pathophysiology of traumatic temporomandibular joint bony ankylosis in a sheep model. Part I: Expression of Wnt signaling.  


OBJECTIVE: To preliminarily investigate the temporal patterns of the endogenous mRNA expression for members of the Wnt signaling and a series of genes regulating bone formation during the development of traumatic temporomandibular joint (TMJ) bony ankylosis in a sheep model. METHODS: Six sheep were used for the induction of bony ankylosis of TMJ. We performed a condylar fracture, excision of the lateral 2/3 disc and serious injury to the glenoid fossa to induce bony ankylosis on the right TMJ. An isolated condylar fracture was performed on the left side. Two sheep were sacrificed at 1 month, 3 months, and 6 months after surgery, respectively. The specimens from the ankylosed joint and the condylar fracture were harvested for RNA extraction respectively. In this report (Part I), only the bony ankylosed samples were used for analysis of gene expressions. The specimens 1 month postoperatively were taken as the control, and the changes of expression of target genes over time were examined by real-time PCR. RESULTS: mRNA expression of Wnt1, Wnt2b, Wnt3a, ?-catenin, Sfrp1, Lrp6, Lef1, CyclinD1, and Runx2 was up-regulated at 3 and 6 months compared with 1 month. The expression of Wnt5a, Sox9, and Osterix was up-regulated with a peak at 3 months, and then fell back to the basal levels at 6 months. The expression of Ocn began to up-regulate until 6 month postoperatively. CONCLUSION: Our findings suggested that Wnt signaling was involved in the formation of traumatic TMJ bony ankylosis and thus may be a potential therapeutic target for the treatment of the disease in the future. PMID:23707780

Yan, Ying-Bin; Li, Jiang-Ming; Xiao, E; An, Jin-Gang; Gan, Ye-Hua; Zhang, Yi



Differential metabolic responses to local administration of TGF-? and IGF-1 in temporomandibular joint cartilage of aged mice  

Microsoft Academic Search

Osteoarthritis is a degenerative joint disease characterized by destruction of the articular cartilage in aging and senescence. The aim of this study was to study the possible treatment of this disease by intraarticular injection of growth factors to osteoarthritic joints of aged animals. 20-month-old female ICR mice were injected with insulin-like growth factor (IGF-1), transforming growth factor-? (TGF-?) or TGF-?+IGF-1

Gil E Sviri; Israel Blumenfeld; Erella Livne



Is aggressive gap arthroplasty essential in the management of temporomandibular joint ankylosis?-a prospective clinical study of 15 cases.  


The purpose of this three-year, prospective, follow-up study was to evaluate whether aggressive gap arthroplasty is essential in the management of ankylosis of the temporomandibular joint (TMJ). Fifteen patients were treated by the creation of a minimal gap of 5-8mm and insertion of an interpositional gap arthroplasty using the temporalis fascia. Eleven patients had unilateral coronoidectomy and 4 bilateral coronoidectomy based on Kaban's protocol. Preoperative assessment included recording of history, clinical and radiological examinations, personal variables, the aetiology of the ankylosis, the side affected, and any other relevant findings. Patients were assessed postoperatively by a surgeon unaware of the treatment given for a minimum of 3 years, which included measurement of the maximal incisal opening, presence of facial nerve paralysis, recurrence, and any other relevant findings. Of the 15 patients (17 joints), 12 had unilateral and three had bilateral involvement, with trauma being the most common cause. The patients were aged between 7 and 29 years (mean (SD) age 20 (8) years). Preoperative maximal incisal opening was 0-2mm in 8 cases and 2-9mm in 9. Postoperatively adequate mouth opening of 30-40mm was achieved in all cases, with no recurrence or relevant malocclusion during 3-year follow up. However, patients will be followed up for 10 years. Aggressive gap arthroplasty is not essential in the management of ankylosis of the TMJ. Minimal gap interpositional arthroplasty with complete removal of the mediolateral ankylotic mass is a feasible and effective method of preventing recurrence. PMID:23219020

Babu, Lokesh; Jain, Manoj Kumar; Ramesh, C; Vinayaka, N



[Total alloplastic temporomandibular joint reconstruction combined with orthodontic treatment in a patient with idiopathic condylar resorption].  


This case report describes the successful treatment of an adult patient with skeletal Class II open-bite malocclusion secondary to idiopathic condylar resorption. Total alloplastic joint reconstruction and counterclockwise rotation of the maxillomandibular complex combined with orthodontic treatment provided a satisfying outcome with maximum functional and esthetic improvement. PMID:22944016

Chung, Chooryung J; Choi, Yoon-Jeong; Kim, In-Sil; Huh, Jong-Ki; Kim, Hyung-Gon; Kim, Kyung-Ho




PubMed Central

We have previously shown that injection of the excitatory amino glutamate into the rat temporomandibular joint (TMJ) evokes reflex activity in both anterior digastric (DIG) and masseter (MASS) muscles that can be attenuated by prior TMJ injection of a N-methyl-D-aspartate (NMDA) receptor antagonist. The aim of the present study was to test if jaw muscle activity could also be evoked by P2X receptor agonist injection into the rat TMJ region and if the reflex activity could be modulated by TMJ injection of P2X receptor antagonist or NMDA receptor antagonist. The selective P2X subtype agonist ?,?-methylene adenosine 5?-triphosphate (?,?-me ATP) and vehicle (phosphate-buffered saline) or the selective P2X antagonist, 2?-(or-3?)-O-(2,4,6-trinitrophenyl) adenosine 5?-triphosphate (TNP-ATP) or selective NMDA antagonist (±)-D-2-amino-5-phosphonovalerate(APV) were injected into the rat TMJ region. Electromyographic (EMG) reflex activity was recorded in both DIG and MASS muscles. Compared with the baseline EMG activity, ?,?-me-ATP injection into the TMJ (but not its systemic administration) following pre-injection of the vehicle significantly increased the magnitude and the duration of ipsilateral DIG and MASS EMG activity in a dose-dependent manner. The ?,?-me-ATP-evoked responses could be antagonized by pre-injection of TNP-ATP into the same TMJ site but contralateral TMJ injection of TNP-ATP proved ineffective. Furthermore, the ?,?-me-ATP-evoked responses could also be antagonized by APV injected into the same TMJ site but not by its systemic injection. These results indicate the interaction of peripheral purinergic as well as glutamatergic receptor mechanisms in the processing of TMJ nociceptive afferent inputs that evoke reflex activity in jaw muscles.

Watanabe, T.; Tsuboi, Y.; Sessle, B.J.; Iwata, K.; Hu, J.W.



A long-term follow-up study of radiographically evident degenerative changes in the temporomandibular joint with different conditions of disk displacement.  


The purpose of this retrospective study is to assess the relationship between an initial and persisting condition of disk displacement (DD) and the long-term course of radiographically evident degenerative changes of the temporomandibular joint (TMJ). Nineteen patients agreed to a radiographic follow-up examination of 29 joints and were included in this study. The joints were radiographically assessed at the first visit and at least 46 months after the first visit (mean 89.3 months). At the time of the follow-up, all subjects had a good clinical course after a favorable response to the treatments. There were significant relationships between the initial diagnosis of DD and the interval change in the morphology of the articular eminence. The articular eminence became flattened or deformed only in the joints with persistent DD without reduction. And there was a tendency that the condyle became smaller in the joints initially with permanent DD and in the joints which show a progression in the disk-condylar relationship. The results of this study suggested that, in the joints with persisting non-reducing disk displacement, flattening and deformation of the articular eminence and regression of the condylar size were likely to happen even after symptoms and signs of TMJ disorders were resolved or reduced. PMID:15961278

Kurita, H; Uehara, S; Yokochi, M; Nakatsuka, A; Kobayashi, H; Kurashina, K



[Syringomyelia and associated bone and joint diseases].  


Syringomyelia can occur in patients presenting bone and joint diseases of various origins. When joint destruction of the shoulder or elbow produces little pain, a neurological cause might be involved. In this case, the disease history can be of utmost importance because an initial diagnosis of rheumatoid polyarthritis, polyosteoarthritis, or destructive joint disease can be misleading before the syringomyelic origin of the bone and joint disease becomes patent. We report two cases illustrating this association and the diagnostic pitfalls which can delay recognition of the syringomyelia. Better awareness of the prevalence of this condition should be helpful in establishing the diagnosis and in selecting patients who can benefit from neurosurgical treatment. The two cases presented here suggest that syringomyelia could be underdiagnosed in certain patients with an initially atypical presentation. A review of the current knowledge of syringomyelia suggests that arthroplasty is generally not advisable for destroyed dislocated syringomyelic joints. PMID:17534210

Alnot, J-Y; Rossarie, R; Welby, F



Degenerative joint disease. Part II: Symptoms and examination findings.  


From a pool of 1,279 consecutive patients referred to the Parker E. Mahan Facial Pain Center for complaints of head/neck pain, a subset of 215 patients with the diagnosis of osteoarthrosis of the temporomandibular joint (TMJ-DJD) have been identified. Data regarding patient age and sex, reported symptoms and examination results are presented from this subset of TMJ-DJD patients. From this data, common signs and symptoms of TMJ-DJD are proposed. PMID:8055593

Bates, R E; Gremillion, H A; Stewart, C M



Joint Involvement Associated with Inflammatory Bowel Disease  

Microsoft Academic Search

Joint involvement associated with inflammatory bowel disease (IBD) belongs to the concept of spondyloarthritis (SpA) and includes two types of arthritis: a peripheral arthritis characterized by the presence of pauciarticular asymmetrical arthritis affecting preferentially joints of lower extremities and an axial arthropathy including inflammatory back pain, sacroiliitis and ankylosing spondylitis (AS). Treatment of arthritis includes a short-term use of NSAIDs

M. De Vos



Temporomandibular disorders. Part 3. Surgical treatment.  


Surgery of the temporomandibular joint has a small but nonetheless important role in the overall management of temporomandibular disorders. Appropriate case selection is the mandatory requirement for successful surgical intervention in order to achieve the desired outcome of treatment, such as relief of symptoms and improved function. In this, the third article in the series, a general overview of the current surgical treatment modalities for temporomandibular disorders will be presented. PMID:8639109

Dimitroulis, G; Dolwick, M F



[Interposition of a full-thickness skin graft in the surgery of temporomandibular joint ankylosis. A study of 31 cases of which 20 had long-term follow-up].  


Recurrence is the main problem in temporo-mandibular joint ankylosis treatment. Two therapy are used against this, physiotherapy and surgical joint interposition. Following ankylosis removal, many materials can be interposed but, for us, fullthickness skin graft using Popescu and Vasiliu technique seems to be the best and simplest one. This retrospective study of 31 cases, 20 with long-term follow-up, shows that good results are obtained using this skin graft, with 90% successful rate. PMID:8650497

Guyot, L; Chossegros, C; Cheynet, F; Gola, R; Lachard, J; Blanc, J L



The evaluation of lateral pterygoid muscle pathologic changes and insertion patterns in temporomandibular joints with or without disc displacement using magnetic resonance imaging.  


Temporomandibular joint (TMJ) disc displacement is a common disorder in patients with internal derangement. Certain anatomic features of TMJ may make the patient prone to this condition, namely lateral pterygoid muscle (LPM) insertion variations. The aim of this study was to investigate LPM attachments and their relationships with disc displacement and subsequent pathologic changes. A total of 26 patients with clinical temporomandibular disorders (TMDs) and a control group of 14 unaffected individuals were studied. Magnetic resonance images (MRIs) were taken to evaluate LPM insertion patterns, superior LPM head pathologic changes, and relative disc to condyle position. Data registration and analysis were done using SPSS v. 16.0. The most common variation (type I) was shown to be the superior head with two bundles, one attached to the disc and another to the condyle. No significant relationship between LPM insertion type and disc displacement or pathologic changes of the muscle was found. However, a link between disc displacement and muscle pathologic changes was established (P=0.001). PMID:23746672

Imanimoghaddam, M; Madani, A S; Hashemi, E M



Bone and joint symptoms in Paget's disease.  

PubMed Central

Fifty patients with Paget's disease of bone were reviewed with regard to the basis of their symptoms and the long-term results of treatment. Twenty-four patients (48%) presented with pain localised within bone, while 17 (34%) presented with symptoms of degenerative joint disease. Three patients presented with bone pain and arthritis and the remaining six with fractures, ataxia, or painless deformity. Symptomatic osteoarthritis of the hip (OA) developed in 25 patients (50%) with approximately half developing radiological changes identical to those of idiopathic OA. Among the other patients those with coxa vara tended to show medial (rather than superior) joint space narrowing and severe Paget's disease on both sides of the joint. Arthritic pain, stiffness, and reduced mobility in other joints (knee, ankle, and wrist) were associated clinically with bone deformity adjacent to the affected joint and radiologically with distorted articular surfaces and narrowed joint spaces; sclerosis, subarticular cyst formation, and osteophytosis were usually absent. Fifteen patients were treated with calcitonin for bone pain alone; all claimed long-term 'good to complete' relief. By contrast, none of the 14 with arthritic symptoms responded to calcitonin when assessed retrospectively. Results of surgical and other medical treatment were analysed. Careful clinical evaluation is a prerequisite for optimal treatment in Paget's disease. Images

Winfield, J; Stamp, T C



Temporomandibular Joint, Open  


... and craniofacial health of our nation. Grants & Funding Funding Opportunity Announcements By Topic RFAs PAs See All Grants & Funding Application Forms and Deadlines Grant Application Forms Application ...


Temporomandibular Joint, Closed  


... and craniofacial health of our nation. Grants & Funding Funding Opportunity Announcements By Topic RFAs PAs See All Grants & Funding Application Forms and Deadlines Grant Application Forms Application ...


Functional states of mandibular movements and synovial pumps of the temporomandibular joint. Is it possible to provide a biomechanically correct replacement for the TMJ?  


Due to its complexity, there is currently an incomplete understanding of temporomandibular joint (TMJ) function, especially in relation to the morphological interplay of the condyle and the disc as well as the disc, the Os temporale and the lateral pterygoid muscle. This also holds true for synovial flow and synovial pumps, the existence of which we postulate and for which we present a theory of their mechanism. In view of the complexity of mandibular movements and the morphology and function of the TMJ, we need to know how precisely a reconstruction of the TMJ, if necessary, must be adapted to nature. An analysis of the morphology of the functional states of the mandible, as well as the synovial pump system, should at least provide a basis for moulding reconstructions. PMID:22079779

Kubein-Meesenburg, D; Nägerl, H; Fialka-Fricke, J; Hahn, W; Weber, S; Hönig, J; Hansen, C; Fanghänel, J; Thieme, K M; Ihlow, D



A comparative study of accuracy of detection of surface osseous changes in the temporomandibular joint using multidetector CT and cone beam CT  

PubMed Central

Objective The aim of this study was to assess the accuracy and reliability of cone beam CT (CBCT) images compared with multidetector CT (MDCT) images for the detection of surface osseous changes in temporomandibular joints (TMJs). Methods Naked-eye inspection of 110 sites in 10 TMJs from 5 dry human skulls provided the gold standard. Two radiologists interpreted the images. Sensitivity, specificity and kappa statistics were used for analysis. Results The sensitivities of both modalities were low and comparable whereas the specificities were high and comparable. Intraobserver reliabilities for CBCT (p=0.0005) and for MDCT (p=0.0001) showed significant agreement. Interobserver reliability was higher for CBCT than for MDCT. Conclusion CBCT and MDCT accuracy was comparable in detecting surface osseous changes with comparable intraobserver reliabilities. However, since CBCT requires less radiation exposure, it should be encouraged for imaging TMJ with suspected surface osseous changes.

Zain-Alabdeen, EH; Alsadhan, RI



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  

Microsoft Academic Search

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



A serial study on the development of the temporomandibular joint in the fetal mouse--in particular on the fibrous component in the condylar cartilage.  


The development of the temporomandibular joint of 400 fetal mice at stages ranging from the 13th to the 20th day after insemination was investigated under the light, scanning (SEM) and transmission electron (TEM) microscopes. The differentiation and development of a cartilaginous tissue were observed at the supero-posterior end of the mandible at the 13 days after insemination. This tissue grew backward, upward and lateralward continuously and maintained a constant articulation with the squamosal part of the temporal bone. Seventeen days after insemination, cell layers in the condylar process and articular disc were arranged regularly. An supero- and inferno-directional cellular differentiation initiated from the subfibrous (SF) layer toward the articular spaces and cartilaginous layer was observed. The perichondrial ossification had taken place with the invasion of capillaries and the differentiation of osteoblasts in the SF layer, and was followed with a hypertrophic degeneration and endochondral ossification in the condylar process. Such a bi-directional growth of collagen and elastic fibers starting from the SF layer was also observed. Observation under SEM and TEM on the autoclaved condylar process revealed a complicated network consisted of main elastic fibers running in the sagittal direction. These fibers as well as the proteoglycan which contributes to the resilient property of the condylar cartilage and the ability to endure tensile or compressive stress from surrounding tissues during the growth and development of the mandibular condyle. The developing cartilaginous tissue was stimulated with the pressure from the masticatory muscles to initiate an active differentiation of the fibrous layer, which was invaded by the blood capillary system closely related with the subsequent endochondral ossification. These results elucidate that the development of the temporomandibular joint has closely kept relations with the functional influences from surrounding tissues, which also play an important role in regulating postnatal growth of the mandible. PMID:2133877

Kagawa, M



Central serotonin 3 receptors play an important role in the modulation of nociceptive neural activity of trigeminal subnucleus caudalis and nocifensive orofacial behavior in rats with persistent temporomandibular joint inflammation  

Microsoft Academic Search

The role of central serotonin 3 receptors on neural activities recorded from superficial laminae of trigeminal subnucleus caudalis\\/upper cervical spinal cord junction region was investigated using rats with (Complete Freund’s Adjuvant day 7 group) or without (non-Complete Freund’s Adjuvant group) persistent temporomandibular joint inflammation evoked by Complete Freund’s Adjuvant for 7 days. We identified two types of units, Deep-wide dynamic

K. Okamoto; A. Kimura; T. Donishi; H. Imbe; E. Senba; Y. Tamai



Contribution of peripheral 5HT2A or 5HT3 receptors to Fos expression in the trigeminal spinal nucleus produced by acute injury to the masseter muscle during persistent temporomandibular joint inflammation in rats  

Microsoft Academic Search

We investigated the contribution of peripheral 5-HT2A or 5-HT3 receptors to Fos expression in the trigeminal spinal nucleus (VSP) following acute masseter muscle injury in male rats with or without temporomandibular joint (TMJ) inflammation persisting for 7 days. TMJ inflammation was evoked by an injection of complete Freund’s adjuvant (CFA). Two hours after formalin injection into the masseter muscle produced

K. Okamoto; A. Kimura; T. Donishi; H. Imbe; Y. Nishie; H. Matsushita; Y. Tamai; E. Senba



A study of factors for successful splint capture of anteriorly displaced temporomandibular joint disc with disc repositioning appliance.  


The purpose of this study was to analyse the factors which influenced the success of disc recapture by the insertion of a disc repositioning appliance. Fifty-one joints with joint clicking that occurred at both middle to late opening and late closing (near maximum cuspation) of the mandible were splinted with a mandibular full-coverage repositioning appliance. The clinical and MR findings were compared between the joints with successful and unsuccessful splint disc capture. Thirty-two clicking joints with reducibly displaced discs (DDWR) had successful disc recapture, while six of 19 joints with displaced disc without reduction (DDWOR). Unsuccessful joints with DDWOR had significantly higher prevalence of deformed disc and joint effusion, higher VAS quantitative pain score, and severe disc displacement especially in medial part of the joint (P < 0.05). From the results of this study joints with DDWR can be expected to have successful disc recapture with the insertion of the appliance. In joints with DDWOR, presence of inflammatory conditions, changed disc morphology and extensive disc displacement in medial part of the joint are negative factors. PMID:11422698

Kurita, H; Ohtsuka, A; Kurashina, K; Kopp, S



Chondroprotective drugs in degenerative joint diseases.  


Catabolic cytokine and anabolic growth factor pathways control destruction and repair in osteoarthritis (OA). A unidirectional TNF-alpha/IL-1-driven cytokine cascade disturbs the homeostasis of the extracellular matrix of articular cartilage in OA. Although chondrocytes in OA cartilage overexpress anabolic insulin-like growth factor (IGF) and its specific receptor (IGFRI) autocrine TNF-alpha released by apoptotic articular cartilage cells sets off an auto/paracrine IL-1-driven cascade that overrules the growth factor activities that sustain repair in degenerative joint disease. Chondroprotection with reappearance of a joint space that had disappeared has been documented unmistakably in peripheral joints of patients suffering from spondyloarthropathy when treated with TNF-alpha-blocking agents that repressed the unidirectional TNF-alpha/IL-1-driven cytokine cascade. A series of connective tissue structure-modifying agents (CTSMAs) that directly affect IL-1 synthesis and release in vitro and down-modulate downstream IL-1 features, e.g. collagenase, proteoglycanase and matrix metalloproteinase activities, the expression of inducible nitric oxide synthase, the increased release of nitric oxide, and the secretion of prostaglandin E(2), IL-6 and IL-8, have been shown to possess disease-modifying OA drug (DMOAD) activities in experimental models of OA and in human subjects with finger joint and knee OA. Examples are corticosteroids, some sulphated polysaccharides, chemically modified tetracyclines, diacetylrhein/rhein, glucosamine and avocado/soybean unsaponifiables. PMID:16278282

Verbruggen, G



Is running associated with degenerative joint disease  

SciTech Connect

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.



Reduction of temporomandibular joint pain after treatment with a combination of methotrexate and infliximab is associated with changes in synovial fluid and plasma cytokines in rheumatoid arthritis.  


The aims were to investigate the effect of intravenous infusions of the tumor necrosis factor-alpha (TNF-alpha) antibody infliximab on symptoms and signs of temporomandibular joint (TMJ) involvement in relation to effects on synovial fluid and plasma proinflammatory TNF-alpha, interleukin-1beta (IL-1beta) and interleukin-6 as well as antiinflam matory soluble TNF receptor II (TNF-sRII), interleukin-1 receptor antagonist (IL-1ra), soluble IL-1 receptor II (IL-1sRII) and interleukin-10 (IL-10) in patients with active rheumatoid arthritis (RA). Nineteen patients with TMJ involvement taking methotrexate were included in the study. TMJ and general joint pain intensity as well as pain on mandibular movements, tenderness to digital palpation, pressure pain threshold and maximum mouth-opening capacity were assessed in a clinical examination. The effect of infliximab was assessed after 2 and 14 or 22 weeks. TMJ synovial fluid and venous blood were collected for cytokine analysis at all occasions while determination of erythrocyte sedimentation rate and C-reactive protein were performed at baseline and at long-term follow-up only. Reduction of TMJ pain was associated with raised levels of synovial fluid TNF-sRII and IL-1sRII as well as raised plasma levels of IL-1ra and IL-10. Decreased erythrocyte sedimentation rate was associated with decreased tenderness to digital palpation. Reduced general joint pain intensity was associated with reduced plasma levels of IL-6 and C-reactive protein. In conclusion, systemic treatment with a combination of infliximab and methotrexate reduces TMJ pain in RA in association with an increase in anti-inflammatory cytokines and receptors in synovial fluid and plasma. PMID:16088130

Kopp, Sigvard; Alstergren, Per; Ernestam, Sofia; Nordahl, Silvi; Morin, Par; Bratt, Johan



Is running associated with degenerative joint disease  

Microsoft Academic Search

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

R. S. Panush; C. Schmidt; J. R. Caldwell; N. L. Edwards; S. Longley; R. Yonker; E. Webster; J. Nauman; J. Stork; H. Pettersson



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



Clinical and experimental aspects of temporomandibular disorders  

Microsoft Academic Search

Temporomandibular disorders (TMDs) are currently viewed as a family of related pain conditions in the craniofacial muscles,\\u000a temporomandibular joint, and associated structures. The etiology and pathophysiology of pain is still far from being known,\\u000a but several important neurobiological aspects have emerged in the last decade. This article reviews the present knowledge\\u000a on three clinically relevant topics in TMD: referred pain

Peter Svensson; Lars Arendt-Nielson



The effect of interocclusal appliances on temporomandibular joints as assessed by 3D reconstruction of MRI scans  

Microsoft Academic Search

Magnetic resonance imaging (MRI) enables simultaneous visualization of hard and soft tissues. The aims of the present study were to computer generate three-dimensional (3D) images, reconstructed from MRI scans of normal temporo- mandibular joints (TMJ), to assess the relative positions of the disc, condyle and articular surface of the temporal bone and to study the effect of two mandibular group

Sandra A. Chu; Tuija I. Suvinen; John G. Clement; Peter C. Reade



Differential ascending projections of temporomandibular joint-responsive brainstem neurons to periaqueductal gray and posterior thalamus of male and female rats  

PubMed Central

Several craniofacial pain conditions including temporomandibular joint disorders (TMJD) are more prevalent in women than men. The basis for sex differences in deep craniofacial pain is not known. The present study compared the magnitude of ascending projections from TMJ-responsive neurons in trigeminal brainstem to the ventrolateral periaqueductal gray (vlPAG) or posterior nucleus of the thalamus (Po) in males and female rats. Fluorogold (FG) was injected into vlPAG or Po and TMJ-responsive neurons were identified by Fos-like immunoreactivity (Fos-LI) after mustard oil injection. TMJ-evoked Fos-LI was similar in males and females; however, significant differences in cell counts were seen for FG single-labeled and Fos/FG double-labeled neurons in trigeminal brainstem. After vlPAG injections, the number of FG-labeled neurons in trigeminal subnucleus interpolaris (Vi), ventral interpolaris/caudalis transition (vl-Vi/Vc) and dorsal paratrigeminal region (dPa5) was greater in females than males. The percentage of Fos/FG double-labeled neurons in vl-Vi/Vc and dPa5 after vlPAG injection also were greater in females than males. By contrast after Po injections, males displayed a greater number of FG-labeled neurons in superficial laminae of Vc and C1–2 and deeper laminae at C1–2 than females. The percentage of Fos/FG double-labeled neurons in superficial laminae of Vc after Po injection also was greater in males than females. These data revealed significant sex differences in ascending projections from TMJ-responsive neurons in trigeminal brainstem. Such differences may influence the ability of males and females to recruit autonomic reflexes and endogenous pain control circuits relevant for TMJ nociception.

Chang, Z.; Okamoto, K.; Bereiter, D.A.



Differences in suprathreshold heat pain responses and self-reported sleep quality between patients with temporomandibular joint disorder and healthy controls  

PubMed Central

The purpose of this study was to examine differences in heat pain threshold (HPTh) and heat pain tolerance (HPTo) between temporomandibular joint disorder (TMJD) patients and healthy controls. Using suprathreshold heat pain, this study also examined between-group (i.e. TMJD vs. healthy controls) differences in hyperalgesia and temporal summation (TS) of heat pain. Lastly, whether between-group differences in these heat pain outcomes were mediated by self-reported sleep quality was also tested. A total of 119 participants (41% TMJD) completed the current study. HPTh and HPTo responses were assessed at the ventral forearm with an ascending method of limits, while hyperalgesia and TS responses were assessed at the dorsal forearm at temperatures of 46, 48 and 50 °C. Prior to completion of heat pain procedures, participants completed the Pittsburgh Sleep Quality Index. Significant between-group differences in HPTh and HPTo were not observed. TMJD patients demonstrated significantly greater hyperalgesia than healthy controls at 46 °C only, but there were no differences for TS. Furthermore, TMJD patients reported significantly poorer sleep quality compared with healthy controls. Data analysis revealed a significant simple mediation effect whereby the presence of TMJD was strongly associated with poorer self-reported sleep quality, which, in turn, was related to enhanced hyperalgesia at 46 °C. These findings support the hypothesis that the thermal hyperalgesia demonstrated by TMJD patients may be related to poor quality of their self-reported sleep. The ability of interventions that improve sleep quality to also affect pain sensitivity is currently the topic of ongoing investigation.

Ribeiro-Dasilva, M.C.; Goodin, B.R.; Fillingim, R.B.



Congenital cheek teratoma with temporo-mandibular joint ankylosis managed with ultra-thin silicone sheet interpositional arthroplasty  

PubMed Central

Primary cheek teratomas are rare with < 5 reported cases. None had associated temporo mandibular joint ankylosis (TMJA). The fundamental aim in the treatment of TMJA is the successful surgical resection of ankylotic bone, prevention of recurrence, and aesthetic improvement by ensuring functional occlusion. Early treatment is necessary to promote proper growth and function of mandible and to facilitate the positive psychological development of child. Inter-positional arthroplasty with ultra-thin silicone sheet was performed. Advantages include short operative time, less foreign material in the joint space leading to negligible foreign body reactions and least chances of implant extrusion. Instead of excising a large bony segment, a thin silicone sheet was interposed and then sutured ensuring preservation of mandibular height. Aggressive post-operative physiotherapy with custom made dynamic jaw exerciser was used to prevent recurrence.

Bhatnagar, Ankur; Verma, Vinay Kumar; Purohit, Vishal



Joint Leveling for Advanced Kienbock's Disease  

PubMed Central

PURPOSE The use of joint leveling procedures to treat Kienbock’s disease has been limited by the degree of disease advancement. This study was designed to compare clinical and radiographic outcomes of wrists with more advanced Kienbock’s disease (stage IIIB) to wrists with less advanced disease (stage II/IIIA) following radius shortening osteotomy. METHODS This retrospective study enrolled 31 adult wrists (30 patients, mean age 39 years), treated by radius shortening osteotomy between two institutions for either stage IIIB (n=14) or stage II/IIIA (n=17) disease. Evaluation was carried out at a mean of 74 months (IIIB, 77 months; II/IIIA, 72 months). Radiographic assessment determined disease progression. Clinical outcomes were determined by validated patient-based and objective measures. RESULTS Patient-based outcome ratings of wrists treated for stage IIIB were similar to those with stage II/IIIA [QuickDASH (15 vs 12:p=.63), MMWS (84 vs 87:p=.59), VAS pain (1.2 vs 1.7:p=.45), VAS function (2.6 vs 2.1:p=.59)]. The average flexion/extension arc was 102° for wrists with stage IIIB and 106° for wrists with stage II/IIIA Kienbock’s (p=.70). Grip strength was 77% of the opposite side for stage IIIB wrists versus 85% for stage II/IIIA (p=.25). Postoperative carpal height ratio and radioscaphoid angle were worse (p<.05) for wrists treated for stage IIIB (0.46:65°) than stage II/IIIA (0.53:53°) disease. Radiographic disease progression occurred in 7 wrists (6 stage II/IIIA: 1 stage IIIB). The one stage IIIB wrist that progressed underwent wrist arthrodesis. CONCLUSIONS In this limited series, clinical outcomes of radius shortening using validated, patient-based assessment instruments and objective measures failed to demonstrate predicted “clinically relevant” differences between stage II/IIIA and IIIB Kienbock’s. Provided the high percentage successful clinical outcomes in this case series of 14 stage IIIB wrists, we believe that static carpal malalignment does not preclude radius shortening osteotomy. Level of Evidence IV; retrospective case series

Calfee, Ryan P.; Van Steyn, Marlo O.; Gyuricza, Cassie; Adams, Amelia; Weiland, Andrew J.; Gelberman, Richard H.



Temporomandibular arthritis in familial Mediterranean fever.  


Temporomandibular joint arthritis is a rare manifestation of familial Mediterranean fever and should be considered in patients of Mediterranean origin. Recently we treated four patients suffering from this condition, and intra-articular corticosteroid injection resulted in rapid resolution of the pain and disability in two. Computed tomography confirmed the usefulness of this therapeutic modality. PMID:1468924

Tovi, F; Gatot, A; Fliss, D


Oral surgery: part 3. Temporomandibular disorders.  


Temporomandibular disorders (TMDs) are a collection of conditions affecting the temporomandibular joint (TMJ), the muscles of mastication and/or associated structures. They are probably one of the most commonly presenting chronic orofacial pain complaints to the dental profession. TMDs are recognised as a chronic illness and exert biopsychosocial effects on the patient and should therefore be managed in a biopsychosocial manner. This chapter will firstly cover the basic anatomy of the TMJ and its associated structures and then go on to discuss the signs and symptoms, aetiology, diagnosis, and broad management options for TMDs. PMID:24113949

Durham, J



Temporomandibular disorders and tension-type headache.  


Pathologies currently defined as temporomandibular disorders may be different in nature. Temporomandibular joint (TMJ) disorders and craniofacial and cervical myogenous pain (MP) are distinct pathologies but may be superimposed and share some etiologic factors. Tension-type headache (TTH) may often be associated with craniofacial and cervical pain, and the same pharmacologic and nonpharmacologic treatment may be efficacious for both. Psychiatric comorbidity (depression and/or anxiety disorder) is less frequent in sheer TMJ disorders, compared with MP and TTH. A screening for the presence of an underlying psychiatric disorder should be part of the clinical evaluation in patients suffering from headache and facial pain. PMID:18173983

Mongini, Franco



Mapping joint grey and white matter reductions in Alzheimer's disease using joint independent component analysis.  


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. PMID:23123779

Guo, Xiaojuan; Han, Yuan; Chen, Kewei; Wang, Yan; Yao, Li



Characterization of joint disease in mucopolysaccharidosis type I mice.  


Mucopolysaccharidoses (MPS) are lysosomal storage disorders characterized by mutations in enzymes that degrade glycosaminoglycans (GAGs). Joint disease is present in most forms of MPS, including MPS I. This work aimed to describe the joint disease progression in the murine model of MPS I. Normal (wild-type) and MPS I mice were sacrificed at different time points (from 2 to 12 months). The knee joints were collected, and haematoxylin-eosin staining was used to evaluate the articular architecture. Safranin-O and Sirius Red staining was used to analyse the proteoglycan and collagen content. Additionally, we analysed the expression of the matrix-degrading metalloproteinases (MMPs), MMP-2 and MMP-9, using immunohistochemistry. We observed progressive joint alterations from 6 months, including the presence of synovial inflammatory infiltrate, the destruction and thickening of the cartilage extracellular matrix, as well as proteoglycan and collagen depletion. Furthermore, we observed an increase in the expression of MMP-2 and MMP-9, which could conceivably explain the degenerative changes. Our results suggest that the joint disease in MPS I mice may be caused by a degenerative process due to increase in proteases expression, leading to loss of collagen and proteoglycans. These results may guide the development of ancillary therapies for joint disease in MPS I. PMID:23786352

de Oliveira, Patricia G; Baldo, Guilherme; Mayer, Fabiana Q; Martinelli, Barbara; Meurer, Luise; Giugliani, Roberto; Matte, Ursula; Xavier, Ricardo M



Analgesic effect of etidronate on degenerative joint disease  

Microsoft Academic Search

In the present study, 80 patients with degenerative joint disease, spondylosis deformans, and\\/or osteoarthritis of the knee\\u000a with back or joint pain, especially on movement and strain, were randomly divided into four groups. Group A received no etidronate,\\u000a while groups B, C and D received 66, 133 and 200 mg\\/day etidronate, respectively, for 12 months. Every 3 months, after evaluating

Takuo Fujita; Yoshio Fujii; Seiko F. Okada; Akimitsu Miyauchi; Yasuyuki Takagi



Femoral neck erosions: sign of hip joint synovial disease  

SciTech Connect

Pathologic synovial processes in the hip joint can cause characteristic extrinsic erosions of the femoral neck, which in extreme cases produce an ''apple core'' appearance. Nine such cases of synovial diseases, including synovial osteochondromatosis, pigmented villonodular synovitis, rheumatoid arthritis, and amyloidosis, that demonstrate this radiographic finding are presented. The anatomic relations of the hip joint that result in theis appearance, differential diagnosis, and radiographic techniques useful in diagnosis are discussed.

Goldberg, R.P.; Weissman, B.N.; Naimark, A.



Reactive oxygen species and superoxide dismutases: Role in joint diseases  

Microsoft Academic Search

Reactive oxygen species (ROS) are produced in many normal and abnormal processes in humans, including atheroma, asthma, joint diseases, aging, and cancer. The superoxide anion O2? is the main ROS. Increased ROS production leads to tissue damage associated with inflammation. Superoxide dismutases (SODs) convert superoxide to hydrogen peroxide, which is then removed by glutathione peroxidase or catalase. Thus, SODs prevent

Valéry Afonso; Romuald Champy; Dragoslav Mitrovic; Pascal Collin; Abderrahim Lomri



Hemophilic joint disease – current perspective and potential future strategies  

Microsoft Academic Search

Recurrent hemarthroses can lead to hemophilic joint disease (HJD), which is one of the most disabling complications of these X-linked recessive disorders characterized by a deficiency of clotting factors VIII\\/IX. The pathogenesis of HJD is not well understood and there is evidence to suggest that iron may play a central role in the pathogenetic process causing changes at the molecular

Suchitra S. Acharya




Microsoft Academic Search

This presentation describes an approach to modeling the spread of contagious diseases across a population-at-risk represented by the LandScan database used by the Joint Effects Model (JEM). We are implementing two models of disease transmission for this effort: 1) a cohort-based Susceptible-Exposed-Infectious-Removed (SEIR) model that uses historical epidemics and simulated outbreaks as the basis for its time-dependent transmission functions and

Brian Adams; Jaideep Ray




NSDL National Science Digital Library

Hinge joints move only in one direction, ball-and-socket joints are free to rotate in all directions, and gliding joints are able to move forward, backward, and side to side, but do not rotate freely.

Olivia Worland (Purdue University;Biological Sciences)



Non-invasive investigation in patients with inflammatory joint disease  

PubMed Central

Gut inflammation can occur in 30%-60% of patients with spondyloarthropathies. However, the presence of such gut inflammation is underestimated, only 27% of patients with histological evidence of gut inflammation have intestinal symptoms, but subclinical gut inflammation is documented in two-thirds of patients with inflammatory joint disease. There are common genetic and immunological mechanisms behind concomitant inflammation in the joints and intestinal tract. A number of blood tests, e.g. erythrocyte sedimentation rate, orosomucoid, C-reactive protein, and white cell and platelet counts, are probably the most commonly used laboratory markers of inflammatory disease, however, these tests are difficult to interpret in arthropathies associated with gut inflammation, since any increases in their blood levels might be attributable to either the joint disease or to gut inflammation. Consequently, it would be useful to have a marker capable of separately identifying gut inflammation. Fecal proteins, which are indirect markers of neutrophil migration in the gut wall, and intestinal permeability, seem to be ideal for monitoring intestinal inflammation: they are easy to measure non-invasively and are specific for intestinal disease in the absence of gastrointestinal infections. Alongside the traditional markers for characterizing intestinal inflammation, there are also antibodies, in all probability generated by the immune response to microbial antigens and auto-antigens, which have proved useful in establishing the diagnosis and assessing the severity of the condition, as well as the prognosis and the risk of complications. In short, non-invasive investigations on the gut in patients with rheumatic disease may be useful in clinical practice for a preliminary assessment of patients with suspected intestinal disease.

Dal Pont, Elisabetta; D'Inca, Renata; Caruso, Antonino; Sturniolo, Giacomo Carlo



Sensitivity of patients with painful temporomandibular disorders to experimentally evoked pain  

Microsoft Academic Search

Temporomandibular disorders (TMD) represent a group of chronic painful conditions involving the muscles of mastication and the temporomandibular joint. We determined whether patients with painful TMD are more sensitive to noxious stimuli than age-matched control subjects. Fifty-two TMD patients (16 with muscle pain and 36 with combined muscle and joint pain) and 23 age-matched and gender-matched volunteers participated. Forearm thermal

William Maixner; Roger Fillingim; Donna Booker; Asgeir Sigurdsson



Mesenchymal stem cells in joint disease and repair.  


Osteoarthritis (OA), a prevalent chronic condition with a striking impact on quality of life, represents an enormous societal burden that increases greatly as populations age. Yet no approved pharmacological intervention, biologic therapy or procedure prevents the progressive destruction of the OA joint. Mesenchymal stem cells (MSCs)-multipotent precursors of connective tissue cells that can be isolated from many adult tissues, including those of the diarthrodial joint-have emerged as a potential therapy. Endogenous MSCs contribute to maintenance of healthy tissues by acting as reservoirs of repair cells or as immunomodulatory sentinels to reduce inflammation. The onset of degenerative changes in the joint is associated with aberrant activity or depletion of these cell reservoirs, leading to loss of chondrogenic potential and preponderance of a fibrogenic phenotype. Local delivery of ex vivo cultures of MSCs has produced promising outcomes in preclinical models of joint disease. Mechanistically, paracrine signalling by MSCs might be more important than differentiation in stimulating repair responses; thus, paracrine factors must be assessed as measures of MSC therapeutic potency, to replace traditional assays based on cell-surface markers and differentiation. Several early-stage clinical trials, initiated or underway in 2013, are testing the delivery of MSCs as an intra-articular injection into the knee, but optimal dose and vehicle are yet to be established. PMID:23881068

Barry, Frank; Murphy, Mary



Feline degenerative joint disease: a genomic and proteomic approach.  


The underlying disease mechanisms for feline degenerative joint disease (DJD) are mostly unidentified. Today, most of what is published on mammalian arthritis is based on human clinical findings or on mammalian models of human arthritis. However, DJD is a common occurrence in the millions of domestic felines worldwide. To get a better understanding of the changes in biological pathways that are associated with feline DJD, this study employed a custom-designed feline GeneChip, and the institution's unique access to large sample populations to investigate genes and proteins from whole blood and serum that may be up- or down-regulated in DJD cats. The GeneChip results centered around three main pathways that were affected in DJD cats: immune function, apoptosis and oxidative phosphorylation. By identifying these key disease-associated pathways it will then be possible to better understand disease pathogenesis and diagnose it more easily, and to better target it with pharmaceutical and nutritional intervention. PMID:23295270

Gao, Xiangming; Lee, Junyu; Malladi, Sukhaswami; Melendez, Lynda; Lascelles, B Duncan X; Al-Murrani, Samer



Whipple's disease with axial and peripheral joint destruction.  


A seropositive white man had follow-up for 16 years with a diagnosis of palindromic rheumatism. Treatment had included parenteral gold, methotrexate, prednisone, hydroxychloroquine sulfate, and penicillamine before diarrhea led to a biopsy-proven diagnosis of Whipple's disease. Clinical and radiographic criteria for ankylosing spondylitis were met. In addition to classic Whipple's arthropathy, he had the combined but singular findings of pancarpal destruction and cervical apophyseal fusion. HLA typing revealed the B7 antigen. This case illustrates the pitfalls in diagnosis of a chronic polyarthritis that has, as a typical feature, a long latency before manifesting its more specific signs and symptoms (ie, diarrhea, malabsorption, and hyperpigmentation). Care should be taken during evaluation of any disease with atypical and nonspecific features (eg, positive rheumatoid factor in a patient with polyarthritis) and one should continue to reevaluate the original impression while confirmatory evidence is lacking. Moreover, the roentgenographic findings of pancarpal narrowing, apophyseal fusion, and advanced iliofemoral joint disease, in addition to sacroiliitis and syndesmophyte formation, challenge the generally held notion that Whipple's arthropathy is a nondestructive joint disease. PMID:1694047

Scheib, J S; Quinet, R J



Case-Based Learning for Orofacial Pain and Temporomandibular Disorders.  

ERIC Educational Resources Information Center

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



Sensitivity of patients with painful temporomandibular disorders to experimentally evoked pain: evidence for altered temporal summation of pain  

Microsoft Academic Search

Temporomandibular disorders (TMD) represent a group of chronic painful conditions involving the muscles of mastication and the temporomandibular joint. Several studies have reported that TMD is associated with enhanced sensitivity to experimental pain. Twenty-three TMD subjects and 24 pain-free matched control subjects participated in a set of studies which were designed to evaluate whether the temporal integrative aspects of thermal

William Maixner; Roger Fillingim; Asgeir Sigurdsson; Shelley Kincaid; Stefanie Silva



The radiology of joint disease. 3rd Ed  

SciTech Connect

The book is a systematic radiographic approach to the arthritides. Part one deals with hand abnormalities ''to facilitate the teaching of basic principles and to dramatize the differences between radiographic features of various arthritides,'' as stated in the forward of the first edition. Part two, ''Arthritis from Head to Foot,'' illustrates the same diseases as they affect other joints. The ABCs (alignment, bone mineralization, cartilage space, soft tissue) approach is followed throughout the book. For example, reflex sympathetic dystrophy syndrome is dealt with in six different locations, and metatarsal stress fractures are mentioned in a chapter on erosions in rheumatoid arthritis.

Forrester, D.M.; Brown, J.C.



[Relations between orthognathic surgery and temporomandibular disorders: a systematic review].  


A painful and dysfunctional temporomandibular joint can be associated with a musculoskeletal anomaly. The multifactorial character of the etiology is now recognized. Among the etiologies, the role of orthognathic surgery is still debated. The analysis of the literature from 2000 to 2011 reveals for most authors a decrease in the frequency and intensity of signs and symptoms after surgery, especially pain and clicking. Risk factors may influence post-surgical results. Studies on patient risk factors such as age, sex, type of dysmorphia are inconclusive. Surgical techniques and the procedure used may have an influence on the development of post-surgical clinical signs and symptoms of temporomandibular disorders. PMID:23719245

Chauvel-Lebret, Dominique; Leroux, Agathe; Sorel, Olivier



Joint Modeling of Transitional Patterns of Alzheimer's Disease  

PubMed Central

While the experimental Alzheimer's drugs recently developed by pharmaceutical companies failed to stop the progression of Alzheimer's disease, clinicians strive to seek clues on how the patients would be when they visit back next year, based upon the patients' current clinical and neuropathologic diagnosis results. This is related to how to precisely identify the transitional patterns of Alzheimer's disease. Due to the complexities of the diagnosis of Alzheimer's disease, the condition of the disease is usually characterized by multiple clinical and neuropathologic measurements, including Clinical Dementia Rating (CDRGLOB), Mini-Mental State Examination (MMSE), a score derived from the clinician judgement on neuropsychological tests (COGSTAT), and Functional Activities Questionnaire (FAQ). In this research article, we investigate a class of novel joint random-effects transition models that are used to simultaneously analyze the transitional patterns of multiple primary measurements of Alzheimer's disease and, at the same time, account for the association between the measurements. The proposed methodology can avoid the bias introduced by ignoring the correlation between primary measurements and can predict subject-specific transitional patterns.

Liu, Wei; Zhang, Bo; Zhang, Zhiwei; Zhou, Xiao-Hua



Vascular Disease is Associated with Facet Joint Osteoarthritis  

PubMed Central

Objective Epidemologic studies have demonstrated associations between vascular disease and spinal degeneration. We sought to examine whether vascular disease was associated with lumbar spine facet joint osteoarthritis (OA) in a community-based population. Design 441 participants from the Framingham Heart Study multi-detector computed tomography (MDCT) Study were included in this ancillary study. We used a quantitative summary measure of abdominal aortic calcification (AAC) from the parent study as a marker for vascular disease. AAC was categorized into tertiles of ‘no’ (reference), ‘low’, and ‘high’ calcification. Facet joint (FJ) OA was evaluated on CT scans using a 4-grade scale. For analytic purposes, FJ OA was dichotomized as moderate FJ OA of at least one joint from L2-S1 vs. no moderate FJ OA. We examined the association of AAC and FJ OA using logistic regression before and after adjusting for age, sex and BMI. Furthermore, we examined the independent effect of AAC on FJ OA after including the known cardiovascular risk factors diabetes, hypertension, hypercholesterolemia, and smoking. Results Low AAC (OR 3.84 [2.33-6.34]; p=<0.0001) and high AAC (9.84 [5.29-18.3]; =<0.0001) were strongly associated with FJ OA, compared with the reference group. After adjusting for age, sex, and BMI, the association with FJ OA was attenuated for both low AAC (1.81 [1.01-3.27]; p=0.05) and high AAC (2.63 [0.99-5.23]; p=0.05). BMI and age were independently and significantly associated with FJ OA. The addition of cardiovascular risk factors to the model did not substantially change parameter estimates for either AAC tertile. Conclusions Abdominal aortic calcifications were associated with FJ OA in this community-based population, when adjusting for epidemiologic factors associated with spinal degeneration, and cardiovascular risk factors. Potentially modifiable risk factors for facet degeneration unrelated to conventional biomechanical paradigms may exist. This study is limited by cross-sectional design; longitudinal studies are needed.

Suri, Pradeep; Katz, Jeffrey N.; Rainville, James; Kalichman, Leonid; Guermazi, Ali; Hunter, David J



Joint infection, with consideration of underlying disease and sources of bacteremia in hematogenous infection.  


Joint infection commonly results from hematogenous spread of infection from a distant site. Pre-existing joint disease increases the risk of joint infection during bacteremia. Most patients present with pain, swelling, heat, and limitation of motion of the affected joint, often with fever, but presentation may be atypical, especially in patients with rheumatoid arthritis, systemic corticosteroid therapy, or infected prosthetic joints. Diagnosis is best made by analysis and culture of synovial fluid. The infecting microorganism often provides a clue to remote infection or underlying disease, which may require special attention. Therapy consists of high-dose parenteral antibiotics and adequate drainage. Outcome depends on early diagnosis and appropriate therapy. PMID:3288326

Klein, R S



Role of panoramic radiographis in differential diagnosis of patients with temporomandibular dysfunction  

Microsoft Academic Search

We reviewed the records for 4 patients with temporomandibular disorders (TMD), in all of whom temporomandibular joint (TMJ)\\u000a arthrosis was initially suspected because of the clinical symptoms such as limited mouth opening and pain at the TMJ region.\\u000a However, careful observation of the panoramic radiographs disclosed abnormalities other than TMJ arthrosis, including, obliteration\\u000a of the posterior maxillary sinus wall (caused

Yoshikazu Suei; Akira Taguchi; Keiji Tanimoto



Anesthesia for joint replacement surgery: Issues with coexisting diseases  

PubMed Central

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



Somatomedin activity in synovial fluid from patients with joint diseases.  

PubMed Central

The somatomedin activity in synovial fluids from 50 patients with a variety of joint diseases has been studied and compared with the activity in each of the patient's own serum and a standard reference serum (SRS). The porcine costal cartilage bioassay of Van den Brande and Du Caju (1974a) has been used with the isotopes 3H-thymidine and 35S-sulphate. Synovial fluids from most patients with post-traumatic and post-operative effusions, osteoarthritis and arthritis associated with psoriasis, Reiter's disease, and ankylosing spondylitis stimulated the synthesis of DNA and proteoglycans in cartilage. Synovial fluids from patients with rheumatoid arthritis either had impaired capacity to stimulate DNA synthesis, or they inhibited it; a similar, but less evident pattern was observed for proteoglycan synthesis. Some synovial fluids from patients with miscellaneous synovitides stimulated, while others inhibited cartilage metabolism. It is concluded that the synovial fluid from patients with rheumatoid arthritis and from some patients with miscellaneous synovitides contained an inhibitor(s) to DNA and possibly proteoglycan synthesis. The sera from nearly all the patients stimulated both DNA and proteoglycan synthesis, but the somatomedin potency ratios for serum in terms of SRS were generally less than 1.0. There was a significant inverse correlation between the serum somatomedin potency ratio and the age of the patient.

Coates, C L; Burwell, R G; Lloyd-Jones, K; Swannell, A J; Walker, G; Selby, C



Presenting a successful stroke education model to meet the Joint Commission's Disease-Specific Care Certification.  


Obtaining Joint Commission Disease-Specific Care Certification can be challenging for healthcare organizations. This article outlines the methodology for developing and implementing a comprehensive educational plan for a 560-bed academic teaching hospital. This information is valuable to any staff development educator who is leading the way to achieve Joint Commission Disease-Specific Care Certification. PMID:21430478

Daniels, Christine S; Johnson, Jennifer Ray; Mackovjak, Jennifer


A Systems Biology Approach to Synovial Joint Lubrication in Health, Injury, and Disease  

PubMed Central

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.



Temporomandibular joint involvement in familial mediterranean fever  

Microsoft Academic Search

Case 2. A 15-year-old girl of Jewish Sephardi origin had a history of recurrent cellulitis on the medial aspect of the ankles since 7 years of age. At age 12, she had recurrent episodes of chest pain and\\/or abdominal pain with fever. At age 14 years she underwent laparotomy and appendectomy because of signs of peritonitis. Histologically her appendix was

M. Mukamel; M. Mimouni



Temporomandibular disorders. 1. Clinical evaluation.  


The treatment of temporomandibular disorders continues to provide dental practitioners with a difficult challenge that has yet to overcome numerous major obstacles. In this, the first of a series of three articles, an overview of the current understanding of the diagnosis of temporomandibular disorders will be presented. The subsequent two articles will present an overview of the management strategies that have appeared in the literature in recent years. PMID:8629958

Dimitroulis, G; Dolwick, M F; Gremillion, H A



Joint-specific disruption of control during arm movements in Parkinson's disease.  


The leading joint hypothesis (LJH) suggests distinct types of control (leading and subordinate) at different joints during multi-joint movements. Taking into account specific features of movements in Parkinson's disease (PD), the LJH predicts distinct effect of PD on control of leading and subordinate joints: impaired interaction torque (INT) regulation should be emphasized at the subordinate joints, and impaired generation of muscle torque (MUS) magnitude should be more pronounced at the leading joint. This prediction was tested by studying three tasks of horizontal shoulder-elbow movements in PD patients and age-matched controls: cyclic line drawing, cyclic point-to-point, and discrete pointing movements. Each task included movements in different directions, providing both shoulder-lead and elbow-lead control patterns. Torque analysis supported the prediction, specifically for Tasks 2 and 3 in which movement targets were chosen to emphasize the shoulder- and elbow-lead control patterns. Patients did not exploit INT for motion generation as successfully as controls did, but only at the subordinate joint. Underproduction of MUS by PD patients was more apparent at the leading than subordinate joint. The results support joint-specific effect of PD on movement control. They also suggest that dyscoordination of joint motions in PD stems predominantly from impaired control of subordinate joints, while bradykinesia is associated more with control of the leading than subordinate joint. Possible contribution of the revealed impairments in joint control to some other movement features in PD is discussed. The study demonstrates the efficiency of the LJH application for revealing changes in joint control caused by motor disorders. PMID:19277617

Fradet, Laetitia; Lee, Gyusung; Stelmach, George; Dounskaia, Natalia



Nutraceutical Therapies for Degenerative Joint Diseases: A Critical Review  

Microsoft Academic Search

There is growing recognition of the importance of nutritional factors in the maintenance of bone and joint health, and that nutritional imbalance combined with endocrine abnormalities may be involved in the pathogenesis of osteoarthritis (OA) and osteochondritis dissecans (OCD). Despite this, dietary programs have played a secondary role in the management of these connective tissue disorders. Articular cartilage is critically

Robert Goggs; Anne Vaughan-Thomas; Peter D. Clegg; Stuart D. Carter; John F. Innes; Ali Mobasheri; Mehdi Shakibaei; Wolfgang Schwab; Carolyn A. Bondy



Bone Morphogenetic Protein signaling in joint homeostasis and disease  

Microsoft Academic Search

Despite advances in therapies that target inflammation and tissue destruction in chronic arthritis, stimulation of tissue repair and restoration of joint function, the ultimate goal of treatment, is far from achieved. We introduce a new paradigm that may help to improve our understanding and management of chronic arthritis. The presence or absence of tissue responses distinguishes destructive arthritis, steady-state arthritis

Rik J. U. Lories; Frank P. Luyten



Relationships of hip joint volume ratios with degrees of joint laxity and degenerative disease from youth to maturity in a canine population predisposed to hip joint osteoarthritis  

PubMed Central

Objective To assess relationships of acetabular volume (AV), femoral head volume (FV), and portion of the femoral head within in the acetabulum (FVIA) with each other and with degrees of hip joint laxity and degenerative joint disease from youth to maturity in dogs predisposed to developing hip joint osteoarthritis (OA). Animals 46 mixed-breed half- or full-sibling hound-type dogs. Procedures The distraction index (DI), AV, FV, FVIA, and degree of osteoarthritis (OA score) were quantified in 1 hip joint at 16, 32, and 104 weeks of age. Relationships among variables were evaluated within and between ages. Ratios corresponding to OA scores were compared within ages. Differences among 16-week ratios corresponding to 32-week OA scores and among 16- and 32-week ratios corresponding to 104-week OA scores were evaluated. Results Significant positive relationships existed between FV and AV across ages as well as between FVIA/FV and FVIA/AV and between DI and OA score across and within most ages. Such relationships also existed within these variables across most ages. Negative relationships of DI and OA scores with FVIA/FV and FVIA/AV within and among all ages were significant. Sixteen-week AVs, FVs, and FVIAs were greater and FV/AVs and OA scores were less than 32- and 104-week values. The 32-week FVIA/FV was less than 16- and 104-week values, and the 32-week FVIA/AV was less than the 104-week value. The FVIA/FV and FVIA/AV were lower and the DI was higher with higher OA scores within and among most ages. Conclusions and Clinical Relevance Structural volumes in lax canine hip joints changed predictably relative to each other during growth, despite degenerative changes. Measures developed in this study may augment current diagnosis and treatment strategies for hip dysplasia in dogs.

D'Amico, Laura L.; Xie, Lin; Abell, Lindsey K.; Brown, Katherine T.; Lopez, Mandi J.



Treatment of advanced carpometacarpal joint disease: trapeziectomy and hematoma arthroplasty.  


Some surgical treatment options of painful basal joint arthritis do not require complex arthroplasty or suspensionplasty techniques. Simple trapeziectomy with temporary pinning of a slightly overdistracted thumb metacarpal can provide reliable pain relief, good motion, and functional stability. Recent literature supports alternative options when compared with formal ligament reconstruction or suspensionplasty procedures. Simple trapeziectomy is associated with less morbidity due to shorter operative times and the lack of need for graft harvest and ligament reconstruction. PMID:18675718

Fitzgerald, Brian T; Hofmeister, Eric P



Treatment of temporomandibular myofascial pain with deep dry needling  

PubMed Central

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.



Adenoid cystic carcinoma of the skull base mimicking temporomandibular disorder.  


BACKGROUND: Temporomandibular disorder (TMD) involves problems of the temporomandibular joint and its adjacent muscular system. Because TMD prevalence is high among Western populations, complaints in these regions are generally attributed to TMD. However, in rare cases, TMD symptoms are mimicked by malignant tumors of the head. CASE REPORT: Upon first presentation, an 18-year-old female complained about typical symptoms of TMD. After an initial splint therapy and physiotherapy, painful symptoms increased significantly. Twelve weeks after initial diagnosis, further diagnostic imaging revealed a tumor formation at the skull base with infiltration of the infratemporal fossa. Histological evaluation confirmed the diagnosis of adenoid cystic carcinoma. Two years after resection of the tumor, lung metastases were detected with no option of curative treatment. CONCLUSION: TMD symptoms, which are refractory to treatment or exhibit significant worsening during therapy, should be regarded as warning signals and as an indication that early further diagnostic imaging is warranted. PMID:23636713

Sari-Rieger, Aynur; Hassfeld, Stefan; Junker, Klaus; Rustemeyer, Jan



Temporomandibular disorders in scuba divers-an increased risk during diving certification training.  


The design of a diving regulator's mouthpiece increases the risk of a temporomandibular disorder (TMD) in scuba divers. The total weight of a diving regulator is reflected directly on the temporomandibular joint, causing articular and periarticular disorders. In the current study, the prevalence of TMD in scuba divers triggered during diving certification training is investigated. We also aimed to determine the factors that lead to TMD during diving training and clarify the observation that there is an increased incidence of TMD in inexperienced divers. The study was held between 2006 and 2011. Ninety-seven divers were referred with the complaint of pain around temporomandibular area. The divers were classified according to their diving experience. Symptoms and signs of TMD were graded. Fourteen divers were diagnosed with TMD. Temporomandibular disorder was seen more frequently in inexperienced divers than in experienced divers (P = 0.0434). The most prevalent symptom was an increased effort for mouthpiece gripping. Temporomandibular joint tenderness and trigger point activation were the mostly seen physical signs. Thirteen divers had an improvement with therapy. The increased effort for stabilizing the mouthpiece is a recognized factor in TMD development. Attention must be paid to an association of scuba diving with TMDs, especially in inexperienced divers having a scuba certification training. PMID:23147349

Oztürk, Ozmen; Tek, Mustafa; Seven, Hüseyin



How antibodies to a ubiquitous cytoplasmic enzyme may provoke joint-specific autoimmune disease  

Microsoft Academic Search

Arthritis in the K\\/BxN mouse model results from pathogenic immunoglobulins (Igs) that recognize the ubiquitous cytoplasmic enzyme glucose-6-phosphate isomerase (GPI). But how is a joint-specific disease of autoimmune and inflammatory nature induced by systemic self-reactivity? No unusual amounts or sequence, splice or modification variants of GPI expression were found in joints. Instead, immunohistological examination revealed the accumulation of extracellular GPI

Isao Matsumoto; Mariana Maccioni; David M. Lee; Madelon Maurice; Barry Simmons; Michael Brenner; Diane Mathis; Christophe Benoist



Management of temporomandibular ankylosis - compromise or individualization - a literature review  

PubMed Central

Summary Temporomandibular joint ankylosis is defined as bony or fibrous adhesion of the anatomic joint components accompanied by a limitation in opening the mouth, causing difficulties with mastication, speaking and oral hygiene as well as inadvertently influencing mandibular growth. Surgical treatment procedures include arthroplasty of the joint cavity with or without a reconstruction and a coronoidectomy, an autogenous costochondral rib graft, distraction osteogenesis and intensive mouth-opening exercise, corrective orthognathic surgery or alloplastic joint prostheses. The authors of this study would like to provide the reader with an evidence-based review of the literature in order to determine the most efficient way to manage TMJ ankylosis and re-ankylosis. The authors have concluded that in order to achieve a satisfactory and durable effective treatment, an individualized approach is necessary in each case.

Sporniak-Tutak, Katarzyna; Janiszewska-Olszowska, Joanna; Kowalczyk, Robert



Non-invasive investigation in patients with inflammatory joint disease  

Microsoft Academic Search

have proved useful in establishing the diagnosis and assessing the severity of the condition, as well as the prognosis and the risk of complications. In short, non- invasive investigations on the gut in patients with rheumatic disease may be useful in clinical practice for a preliminary assessment of patients with suspected intestinal disease.

Elisabetta Dal Pont; Renata D'Incà; Antonino Caruso; Carlo Sturniolo



Treatment of advanced CMC joint disease: trapeziectomy and implant arthroplasty (silastic-metal-synthetic allograft).  


Osteoarthritis of the basal joint of the thumb is a common and frequently debilitating condition, most often affecting middle-aged women. Nonoperative treatment with activity modification, splinting, oral anti-inflammatory medication, and intraarticular steroid injection frequently leads to acceptable control of symptoms. If nonoperative treatment fails, many surgical techniques have been described for management of symptomatic advanced degenerative joint changes. This article reviews the literature related to various arthroplasty options for advanced disease. Treatment decisions must clearly be tempered by the surgeon's experience, the patient's goals and expectations, and the extent of degenerative disease. PMID:18675719

Earp, Brandon E



Temporomandibular disorders in headache patients  

PubMed Central

Objective: To identify the frequency of signs and symptoms of temporomandibular disorder (TMD) and its seve-rity in individuals with headache. Study Design: 60 adults divided into three groups of 20 individuals: chronic daily headache (CDH), episodic headache (EH) and a control group without headache (WH). Headache diagnosis was performed according to the criteria of International Headache Society and the signs and symptoms of TMD were achieved by using a clinical exam and an anamnestic questionnaire. The severity of TMD was defined by the temporomandibular index (TMI). Results: The TMD signs and symptoms were always more frequent in individuals with headache, especially report of pain in TMJ area (CDH, n=16; EH, n=12; WH, n=6), pain to palpation on masseter (CDH, n=19; EH, n=16; WH, n=11) which are significantly more frequent in episodic and chronic daily headache. The mean values of temporomandibular and articular index (CDH patients) and muscular index (CDH and EH patients) were statistically higher than in patients of the control group, notably the articular (CDH=0.38; EH=0.25;WH=0.19) and muscular (CDH=0.46; EH=0.51; WH=0.26) indices. Conclusions: These findings allow us to speculate that masticatory and TMJ pain are more common in headache subjects. Besides, it seems that the TMD is more severe in headache patients. Key words:Temporomandibular dysfunction, headache disorders.

Mello, Christiane-Espinola-Bandeira; Oliveira, Jose-Luiz-Goes; Jesus, Alan-Chester-Feitosa; Maia, Mila-Leite-de Moraes; de Santana, Jonielly-Costa-Vasconcelos; Andrade, Loren-Suyane-Oliveira; Siqueira Quintans, Jullyana-de Souza; Quintans-Junior, Lucindo-Jose; Conti, Paulo-Cesar-Rodrigues



Relationship of orthopedic examination, goniometric measurements, and radiographic signs of degenerative joint disease in cats  

PubMed Central

Background Available information suggests a mismatch between radiographic and orthopedic examination findings in cats with DJD. However, the extent of the discrepancy between clinical and radiographic signs of OA in companion animals has not been described in detail. This study aimed to evaluate the relationship between orthopedic examination findings, joint goniometry, and radiographic signs of DJD in 100 cats, in a prospective observational design. Cat temperament, pain response to palpation, joint crepitus, effusion and thickening were graded. Radiographs of appendicular joints and the axial skeleton were made under sedation. Joint motion was measured by use of a plastic goniometer before and after sedation. Associations between radiographic degenerative joint disease (DJD) and examination findings were assessed to determine sensitivity, specificity and likelihood estimations. Results Pain response to palpation was elicited in 0-67% of the joints with DJD, with a specificity ranging from 62-99%; crepitus was detected in 0-56% of the joints and its specificity varied between 87 and 99%; for effusion, values ranged between 6 and 38% (specificity, 82-100%), and thickening, 0-59% (specificity, 74-99%). Joints with DJD tended to have a decreased range of motion. The presence of pain increased the odds of having DJD in the elbow (right: 5.5; left: 4.5); the presence of pain in the lower back increased the odds of spinal DJD being present (2.97 for lumbar; 4.67 for lumbo-sacral). Conclusions Radiographic DJD cannot be diagnosed with certainty using palpation or goniometry. However, negative findings tend to predict radiographically normal joints. Palpation and goniometry may be used as a tool to help to screen cats, mostly to rule out DJD.



Temporomandibular disorders. 2. Non-surgical treatment.  


There are many treatment modalities for temporomandibular disorders (TMD), most of which are effective in controlling symptoms, at least in the short term. The non-surgical treatment of temporomandibular disorders continues to be the most effective way of managing over 80 per cent of patients who present with symptoms of temporomandibular pain and dysfunction. In this, the second article in the series, a general overview of the current non-surgical treatment strategies for TMD will be presented. PMID:8615742

Dimitroulis, G; Gremillion, H A; Dolwick, M F; Walter, J H



Therapy Insight: how the gut talks to the joints—inflammatory bowel disease and the spondyloarthropathies  

Microsoft Academic Search

Axial and peripheral arthritis can occur in up to 30% of patients with inflammatory bowel disease. Likewise, the presence of gut inflammation in primary spondyloarthropathies is underappreciated, with subclinical gut inflammation documented in up to two-thirds of patients with this group of inflammatory disorders. Common genetic and immunologic mechanisms underlie the coincidence of inflammation in the joints and the intestine.

Carmen Meier; Scott Plevy



Segment-specific association between cervical pillar hyperplasia (CPH) and degenerative joint disease (DJD)  

Microsoft Academic Search

BACKGROUND: Cervical pillar hyperplasia (CPH) is a recently described phenomenon of unknown etiology and clinical significance. Global assessment of pillar hyperplasia of the cervical spine as a unit has not shown a relationship with degenerative joint disease, but a more sensible explanation of the architectural influence of CPH on cervical spine biomechanics may be segment-specific. OBJECTIVE: The objective of this

Maja Stupar; Cynthia K Peterson



Risk management in clinical practice. Part 8. Temporomandibular disorders.  


Temporomandibular disorders can arise apparently idiopathically, as a result of macro-trauma or micro-trauma such as parafunction, as a result of a separate disease process or as a consequence of dental treatment. The objectives of this chapter are to make the practitioner aware of his/her responsibilities in any of these situations. Precise record keeping and careful risk management are essential. Guidelines are given to protect not only the practitioner but also the patient. PMID:21072093

Gray, R; Al-Ani, Z



Patient and implant survival following joint replacement because of metastatic bone disease  

PubMed Central

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.



Lessons from a non-domestic canid: joint disease in captive raccoon dogs (Nyctereutes procyonoides).  


The purpose of this study was to describe pathological changes of the shoulder, elbow, hip and stifle joints of 16 museum skeletons of the raccoon dog (Nyctereutes procyonoides). The subjects had been held in long-term captivity and were probably used for fur farming or research, thus allowing sufficient longevity for joint disease to become recognisable. The prevalence of disorders that include osteochondrosis, osteoarthritis and changes compatible with hip dysplasia, was surprisingly high. Other changes that reflect near-normal or mild pathological conditions, including prominent articular margins and mild bony periarticular rim, were also prevalent. Our data form a basis for comparing joint pathology of captive raccoon dogs with other mammals and also suggest that contributing roles of captivity and genetic predisposition should be explored further in non-domestic canids. PMID:23277118

Lawler, Dennis F; Evans, Richard H; Nieminen, Petteri; Mustonen, Anne-Mari; Smith, Gail K


Relationship of angiogenesis factor in synovial fluid to various joint diseases.  

PubMed Central

A low-molecular-weight freely dialysable angiogenesis factor has been isolated from 49 synovial fluids obtained from patients with various joint diseases. An analysis of disease type and incidence of freely dialysable angiogenesis activity showed that the osteoarthrotic group had a significantly higher incidence than all the other groups (p = 0.0332). Angiogenesis factor has also been detected in a bound form in the retentates of fluids which gave positive results for dialysable factor. The possibility that an imbalance between carrier-bound and free factor may have a causative role in disease is discussed.

Brown, R A; Tomlinson, I W; Hill, C R; Weiss, J B; Phillips, P; Kumar, S



Prosthetic rehabilitation in patients with temporomandibular disorders  

Microsoft Academic Search

Decision-making in prosthetic dentistry and in the management of patients suffering from temporomandibular disorders is strongly influenced by the clinical and educational background of the dentist. The prosthetic rehabilitation of patients affected by one of the various subsets of temporomandibular disorders is a particularly challenging task, and the literature about this topic is limited. This article reviews the current situation

Jens C Türp; Jörg R Strub



[Bruxism, temporo-mandibular dysfunction and botulinum toxin].  


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



Inflammatory synovial fluid microenvironment drives primary human chondrocytes to actively take part in inflammatory joint diseases.  


The role of human chondrocytes in the pathogenesis of cartilage degradation in rheumatic joint diseases has presently gained increasing interest. An active chondrocyte participation in local inflammation may play a role in the initiation and progression of inflammatory joint diseases and in a disruption of cartilage repair mechanisms resulting in cartilage degradation. In the present study, we hypothesized that inflammatory synovial fluid triggers human chondrocytes to actively take part in inflammatory processes in rheumatic joint diseases. Primary human chondrocytes were incubated in synovial fluids gained from patients with rheumatoid arthritis, psoriasis arthritis and reactive arthritis. The detection of vital cell numbers was determined by using Casy Cell Counter System. Apoptosis was measured by Annexin-V and 7AAD staining. Cytokine and chemokine secretion was determined by a multiplex suspension array. Detection of vital cells showed a highly significant decrease in chondrocyte numbers. Flow cytometry demonstrated a significant increase in apoptotic chondrocytes after the incubation. An active secretion of cytokines such as MCP-1 and MIF by chondrocytes was observed. The inflammatory synovial fluid microenvironment mediates apoptosis and cell death of chondrocytes. Moreover, in terms of cytokine secretion, it also induces an active participation of chondrocytes in ongoing inflammation. PMID:21979468

Röhner, Eric; Matziolis, Georg; Perka, Carsten; Füchtmeier, Bernd; Gaber, Timo; Burmester, Gerd-Rüdiger; Buttgereit, Frank; Hoff, Paula




Microsoft Academic Search

Summary Effectiveness of the treatment of degenerative joint disease by Zeel injections was assessed on the basis of published work and our own experience, including the results of a study carried out in a group of 523 patients. The solution was injected into the affected joints, periarticularly and intramuscularly. We also assessed the product's tolerability. Women were predominant (71%) in

Andrzej Lesiak; Rainer Gottwald; Michael Weiser


Host and parasite diversity jointly control disease risk in complex communities.  


Host-parasite interactions are embedded within complex communities composed of multiple host species and a cryptic assemblage of other parasites. To date, however, surprisingly few studies have explored the joint effects of host and parasite richness on disease risk, despite growing interest in the diversity-disease relationship. Here, we combined field surveys and mechanistic experiments to test how transmission of the virulent trematode Ribeiroia ondatrae was affected by the diversity of both amphibian hosts and coinfecting parasites. Within natural wetlands, host and parasite species richness correlated positively, consistent with theoretical predictions. Among sites that supported Ribeiroia, however, host and parasite richness interacted to negatively affect Ribeiroia transmission between its snail and amphibian hosts, particularly in species-poor assemblages. In laboratory and outdoor experiments designed to decouple the relative contributions of host and parasite diversity, increases in host richness decreased Ribeiroia infection by 11-65%. Host richness also tended to decrease total infections by other parasite species (four of six instances), such that more diverse host assemblages exhibited ?40% fewer infections overall. Importantly, parasite richness further reduced both per capita and total Ribeiroia infection by 15-20%, possibly owing to intrahost competition among coinfecting species. These findings provide evidence that parasitic and free-living diversity jointly regulate disease risk, help to resolve apparent contradictions in the diversity-disease relationship, and emphasize the challenges of integrating research on coinfection and host heterogeneity to develop a community ecology-based approach to infectious diseases. PMID:24082092

Johnson, Pieter T J; Preston, Daniel L; Hoverman, Jason T; Lafonte, Bryan E



Regenerative Injection Therapy with Whole Bone Marrow Aspirate for Degenerative Joint Disease: A Case Series  

PubMed Central

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



Regenerative injection therapy with whole bone marrow aspirate for degenerative joint disease: a case series.  


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



Muscle diseases with prominent joint contractures: Main entities and diagnostic strategy.  


Muscle diseases may have various clinical manifestations including muscle weakness, atrophy or hypertrophy and joint contractures. A spectrum of non-muscular manifestations (cardiac, respiratory, cutaneous, central and peripheral nervous system…) may be associated. Few of these features are specific. Limb joint contractures or spine rigidity, when prevailing over muscle weakness in ambulant patients, are of high diagnostic value for diagnosis orientation. Within this context, among several disorders, four groups of diseases should systematically come to mind including the collagen VI-related myopathies, the Emery-Dreifuss muscular dystrophies, the SEPN1 and FHL1 related myopathies. More rarely other genetic or acquired myopathies may present with marked contractures. Diagnostic work-up should include a comprehensive assessment including family history, neurological, cardiologic and respiratory evaluations. Paraclinical investigations should minimally include muscle imaging and electromyography. Muscle and skin biopsies as well as protein and molecular analyses usually help to reach a precise diagnosis. We will first describe the main muscle and neuromuscular junction diseases where contractures are typically a prominent symptom of high diagnostic value for diagnosis orientation. In the following chapters, we will present clues for the diagnostic strategy and the main measures to be taken when, at the end of the diagnostic work-up, no definite muscular disease has been identified. PMID:24021317

Eymard, B; Ferreiro, A; Ben Yaou, R; Stojkovic, T



Joint modeling of multivariate longitudinal measurements and survival data with applications to Parkinson's disease.  


In many clinical trials, studying neurodegenerative diseases including Parkinson's disease (PD), multiple longitudinal outcomes are collected in order to fully explore the multidimensional impairment caused by these diseases. The follow-up of some patients can be stopped by some outcome-dependent terminal event, e.g. death and dropout. In this article, we develop a joint model that consists of a multilevel item response theory (MLIRT) model for the multiple longitudinal outcomes, and a Cox's proportional hazard model with piecewise constant baseline hazards for the event time data. Shared random effects are used to link together two models. The model inference is conducted using a Bayesian framework via Markov Chain Monte Carlo simulation implemented in BUGS language. Our proposed model is evaluated by simulation studies and is applied to the DATATOP study, a motivating clinical trial assessing the effect of tocopherol on PD among patients with early PD. PMID:23592717

He, Bo; Luo, Sheng



Age-related differences in temporomandibular disorder diagnoses.  


The purpose of the current study was to evaluate the pattern of age distribution of temporomandibular disorders (TMD) and to identify prevalence peaks for the different diagnoses. The study sample (N = 383; F:M ratio = 3.9; mean age range 41.7 +/- 17 years) consisted of patients seeking treatment for TMD and who were assessed in accordance with the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) version 1.0 guidelines. The sample was divided into four age groups on the basis of percentile-derived intervals to compare prevalence of different diagnoses in relation to age. The pattern of clinical diagnoses changed with increasing age. The peculiar distribution of RDC/TMD axis I diagnoses, with relation to age, mainly affected the disorders trend of groups II and III, with the former decreasing with age from about 62% to 40% and the latter increasing from 75% to almost 95%. Two distinct age peaks were identified for the prevalence of the main clinical marker of group III diagnosis of arthrosis/arthritis, viz., joint crepitus sounds (N = 104, mean age range 51.9 +/- 14.5), and for the prevalence of all other diagnoses in patients without joint crepitus (N = 279, mean age range 37.9 +/- 16.4). The hypothesis that TMD patient populations may be composed of at least two diagnostic subgroups in relation to age, and that the presence of clinically diagnosed degenerative joint disorders may be a key discriminating factor, was supported. The external validity of the results from this investigation needs to be confirmed by multicenter and cross-cultural studies. PMID:22606853

Guarda-Nardini, Luca; Piccotti, Fabio; Mogno, Giorgia; Favero, Lorenzo; Manfredini, Daniele



Mood spectrum in patients with different painful temporomandibular disorders.  


The purpose of this study was to investigate for difference in the prevalence of mood disorders between patients with different painful temporomandibular disorders (TMD). After a sample size necessary for the study was calculated, 60 patients with a painful TMD were selected and divided into the following groups: myofascial pain (n=20), temporomandibular joint (TMJ) pain (n=18), combined myofascial and TMJ pain (n=22). Two distinct comparison groups were selected: subjects with a nonpainful TMD (n=25) and TMD-free subjects (n=29). All participants filled out a self-report validated instrument (MOODS-SR) to evaluate psychopathological symptoms related to mood disturbances. A one-way analysis of variance (ANOVA) with Bonferroni's post hoc test for multiple comparisons was performed to investigate for significant differences among the groups. The three groups of patients with painful TMD scored significantly higher than comparison groups in all MOODS-SR domains investigating depression, but no difference was shown between subjects with myofascial pain and those with TMJ pain. No significant differences among the groups emerged for the presence of manic symptoms, indicating that depressive disorders associated with TMD are not an expression of a more complex manic depressive illness. The study concluded that the presence of depressive symptoms in TMD patients seems to be related to the presence of a painful condition and seems to be unrelated to the location of pain. Furthermore, depressive disturbances in painful TMD patients affect the whole spectrum of depressive psychopathology. PMID:15293779

Manfredini, Daniele; di Poggio, Adolfo Bandettini; Romagnoli, Mario; Dell'Osso, Liliana; Bosco, Mario



Nuclear medicine in diagnosis and therapy of bone and joint diseases.  


Concerning bone and joint diseases therapy of rheumatic synovitis (= radiosynoviorthesis) was introduced in 1952 before clinically relevant diagnostic procedures were developed. Radionuclides of Sr and later on 99mTc phosphonates then started the wide use of bone scintigraphy since > 30 years. The diagnostic methods have an excellent sensitivity for detection of local abnormalities of bone metabolism, the specificity of such studies, however, is low. Modifications of the technique (3-phase-bone-scintigraphy, pinhole collimators, ROI-technique), increasing knowledge of pathological scan patterns and introduction of other radionuclide studies (67Ga, 201Tl, inflammation scans with 99mTc-leukocytes or 99mTc-HIG) as well as 18FDG-PET have increased the specificity significantly in recent years and improvements of imaging systems (SPECT) also increased the accuracy of diagnostic methods in diseases of bone and joints. Therapy of such diseases has made considerable progress: inflamed, swollen joints can effectively be treated with 90Y-, 186Re, 169Er-colloids or with 165Dy-particles by radiosynoviorthesis. Severe pain due to disseminated bone metastases of cancer or polyarthritis can be controlled by radionuclide therapy with 89Sr, 153Sm-EDTMP, 186Re- or 188Re-HEDP and possibly 117mSn-DTPA with an acceptable risk of myelodepression. Possibilities, technical details and limitations of radionuclide applications for diagnostic and therapeutic purposes must be considered if optimal benefit for individual patients should be achieved. Overall Nuclear Medicine can become an essential element in management of bone and joint diseases. The relationship of Nuclear Medicine to bone and joint pathology is peculiar: In 1952 treatment of rheumatic synovitis by radiosynoviorthesis with 198Au Colloid was started by Fellinger and Schmid before diagnostic approaches to bone pathology existed. Bone scintigraphy was introduced only in 1961 using 85Sr but obviously the unfavourable radiation characteristics of this radionuclide limited it's broad application and 87mSr did not improve this situation. Only when 99mTc phosphonates were developed by Subramanian the importance of bone scintigraphy became apparent: The excellent imaging properties of these radiotracers showed, that abnormal bone metabolism could be visualized even before morphological alterations in the skeleton become visible on radiographies or even CT-scans. Moreover, proposals made earlier to use 32P or 89Sr for palliation of pain in patients with disseminated skeletal metastases were picked up again and led also to other radiopharmaceuticals (186Re-HEDP, 153Sm-EDTMP, 117mSn-DTPA) which are applied today for the same purpose with very good success. Therefore Nuclear Medicine today has a broad program for diagnostic and therapeutic approaches to diseases of bone and joints. In bone scanning the high sensitivity led to inclusion of this method for routine staging and re-staging programs in a variety of cancer forms which have a trend to develop bone metastases (e.g. breast, lung, prostate, melanoma) but the low specificity of abnormal patterns on such scans can impair the diagnostic value of the technique. To increase specificity and to define inflammatory lesions, radiotracers used for "inflammation scanning" were introduced such as labeled granulocytes, 99mTc Human Immunoglobulin and others but also a simple modification of bone scanning--triple phase bone scintigraphy--was used. Recently the excellent properties of 18F for PET of the skeleton were rediscovered again and emission CT scanning--possibly with overlay with transmission CT or MRT pictures--can enhance the diagnostic impact of radionuclide bone studies. PMID:14601000

Riccabona, G



Effect of treatment of temporomandibular disorders (TMD) in patients with cervicogenic headache: a single-blind, randomized controlled study.  


The present study was comprised of 43 patients (16 men) with cervicogenic headaches for over three months, diagnosed according to the International Classification of Diagnostic Criteria of Headaches (ICDH-II). The patients were randomly assigned to receive either manual therapy for the cervical region (usual care group) or additional manual therapy techniques to the temporomandibular region to additionally influence temporomandibular disorders (TMD). All patients were assessed prior to treatment, after six sessions of treatment, and at a six-month follow-up. The outcome criteria were: intensity of headaches measured on a colored analog scale, the Neck Disability Index (Dutch version), the Conti Anamnestic Questionnaire, noise registration at the mandibular joint using a stethoscope, the Graded Chronic Pain Status (Dutch version), mandibular deviation, range of mouth opening, and pressure/pain threshold of the masticatory muscles. The results indicate in the studied sample of cervicogenic headache patients, 44.1% had TMD. The group that received additional temporomandibular manual therapy techniques showed significantly decreased headache intensities and increased neck function after the treatment period. These improvements persisted during the treatment-free period (follow-up) and were not observed in the usual care group. This trend was also reflected on the questionnaires and the clinical temporomandibular signs. Based on these observations, we strongly believe that treatment of the temporomandibular region has beneficial effects for patients with cervicogenic headaches, even in the long-term. PMID:21370769

von Piekartz, Harry; Lüdtke, Kerstin



Preliminary results of automated removal of degenerative joint disease in bone scan lesion segmentation  

NASA Astrophysics Data System (ADS)

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.



Post-traumatic disorders of the jaw joint.  

PubMed Central

A group of 165 patients with surgical diseases of the temporomandibular joint treated in 3 Australian university hospitals is reviewed. A facial trauma is relatively common patients have been included in the post-traumatic group only if there was an undisputed history of injury requiring medical or dental treatment or admission to hospital. In 38.3% of patients with histologically proven osteoarthritis there was an undisputed history of trauma. In a further group with recurrent mandibular dislocation 62.6% were post-traumatic. Trauma was the cause of 62.5% of cases of mandibular ankylosis. There is a general tendency to underdiagnose degenerative joint disease and to perpetuate conservative treatment when it is crystal clear that these measures are not being successful. It is probable that intracapsular fractures of the jaw joint are frequently undiagnosed and a higher index of suspicion is required. Mandibular ankylosis continues to pose some difficulty of management and a critical review confirms that wide surgical exposure of the joint is essential; the importance of long-term review is stressed. The outcome of the surgical treatment of recurrent luxation is excellent and an operation of commendable simplicity is advocated. Images fig. 5 p34-a

Norman, J. E.



Total knee arthroplasty for neuropathic joint disease after severe bone destruction eroded the tibial tuberosity.  


This article describes a patient in whom total knee arthroplasty was performed for neuropathic joint disease secondary to diabetes mellitus after severe bone destruction eroded the tibial tuberosity. At initial examination, radiographs of the knee showed bone destruction in the medial and anterior regions of the tibia, and fine bone fragments were seen in the joint. Conservative therapy was performed using a brace. However, bone destruction gradually advanced, and 10 months after the initial examination, radiographs of the knee showed bone destruction in the lateral condyle of the femur and advanced bone destruction of the anterior tibia; the tibial tuberosity was missing. It is rare for the tibial tuberosity in the anterior tibia to disappear. If this happens, reconstruction is difficult and total knee arthroplasty becomes complicated. For the bone defect in the tibia, cement was used to recreate the shape of the anterior surface of the tibia. It was possible to minimize the volume of bone resection and morphologically reconstruct the tibial tuberosity. The patient recovered quickly. At postoperative week 5, the patient was able to walk using a cane. Thirty-six months after total knee arthroplasty, knee extension was 0°, flexion was 120°, extension lag was 5°, knee score improved from 40 points to 94 points, and functional score improved from 20 points to 75 points. However, long-term implant stability needs to be carefully monitored. PMID:22784910

Sugitani, Kazuya; Arai, Yuji; Takamiya, Hisatake; Minami, Ginjiro; Higuchi, Tetsuo; Kubo, Toshikazu



Joint action of disease control measures: a case study of alternaria leaf blight of carrot.  


ABSTRACT The efficacy of chemical (i.e., foliar fungicide sprays), genetic (i.e., moderately resistant cultivars), and cultural (i.e., drip-irrigation system) control measures was quantified individually and in combination in the management of Alternaria dauci, the causal agent of Alternaria leaf blight of carrot. Whereas host resistance and drip irrigation affected both the time of disease onset and the rate of disease progression, chemical control affected only the latter. In all cases, a single control measure did not provide an acceptable level of disease suppression. Control efficacy values (based on the relative area under the disease progress curve) for chemical, genetic, and cultural control were 58 +/- 11, 39 +/- 20, and 60 +/- 22%, respectively (values are means +/- standard error). By contrast, implementing two control measures concurrently always improved disease suppression significantly compared with the individual measures. Control efficacy values were 91 +/- 8% for the integration of chemical and genetic measures and 82 +/- 23% for the integration of chemical and cultural measures. Moreover, yields in plots protected by two control measures simultaneously were higher by 10.1 to 28.6 t/ha than those in the respective plots protected by single measures. The joint effect of chemical control and host resistance was additive, whereas that of chemical control and drip irrigation was synergistic in most cases. A literature review was performed to determine if these findings represent a general relationship between chemical and genetic, and chemical and cultural measures. Based on 19 reviewed cases, it was concluded that additive effects are the rule and synergistic or antagonistic effects are the exception. Synergistic effects of two control measures were observed when one control measure improved the efficacy of the other directly or when one control measure induced host resistance or predisposed the pathogen to increased susceptibility. These results may enable a more effective selection of candidate control measures for integration in the future. PMID:18944332

Ben-Noon, E; Shtienberg, D; Shlevin, E; Dinoor, A



Matrix metalloproteinases-3, -8, -9 as markers of disease activity and joint damage progression in early rheumatoid arthritis  

PubMed Central

Objective: To analyse the relation between systemic levels of pro-MMP-3, -8, and -9 matrix metalloproteinase (MMP) activity in ?2 macroglobulin (?2M)/MMP complexes and the progression of joint destruction in patients with recent onset rheumatoid arthritis (RA). Methods: 109 patients with RA of recent onset were entered into this longitudinal study. Patients were followed up for two years; clinical data, blood samples, and radiographs were obtained at baseline and at 1 and 2 years. Serum levels of MMPs were measured by sandwich ELISA and MMP activity assays. Results: During the two years joint damage progressed from 0 to 10 (median Sharp score, p<0.001). Stable levels of pro-MMP-3 and a significant decrease in the levels of pro-MMP-8 and -9 and ?2M/MMP complexes were seen throughout the two years. Regression analysis showed that serum pro-MMP-3 levels at disease onset were independently associated with the progression of joint damage (B=0.7, 95% CI 0.3 to 1.1, p=0.001). Based on the rate of joint destruction, patients were divided into two subgroups: patients with mild and severe joint damage progression. The pro-MMP-3 levels were significantly higher in the group with severe compared with mild disease at all times. Levels of pro-MMP-8 and -9 were decreased in both groups, whereas ?2M/MMP complex levels decreased in the group with mild disease only. Conclusion: Serum levels of the MMPs studied are associated with disease activity, but serum pro-MMP-3 levels at the onset of disease are also predictive of joint damage progression.

Tchetverikov, I; Lard, L; DeGroot, J; Verzijl, N; TeKoppele, J; Breedveld, F; Huizinga, T; Hanemaaijer, R



The germfree state prevents development of gut and joint inflammatory disease in HLA-B27 transgenic rats  

PubMed Central

A number of inflammatory disease states occur with greatly increased frequency in individuals inheriting the human major histocompatibility complex class I allele HLA-B27. In a minority of cases, namely those with B27-associated reactive arthritis, there is good evidence that the disease state is triggered by infection with an enteric or genitourinary bacterial pathogen. For the majority of B27-associated disease, no definite pathogenetic role for bacteria has been established. However, in these latter cases intestinal inflammation can often be demonstrated, and it sometimes occupies a major part of the clinical picture. Rats transgenic for B27 are known to develop a disorder resembling B27-associated human disease, with prominent intestinal, joint, skin, and male genital inflammatory lesions. We report here that B27 transgenic rats raised in a germfree environment do not develop inflammatory intestinal or peripheral joint disease, whereas the skin and genital inflammatory lesions are unaffected by the germfree state. These findings support the concept that gut and joint inflammation are pathogenetically closely related, and they provide direct evidence that the commensal gut flora play an important role in the pathogenesis of B27-associated gut and joint inflammation.



Lipoproteins and their subfractions in psoriatic arthritis: identification of an atherogenic profile with active joint disease  

PubMed Central

OBJECTIVES—(a) To characterise the lipid profile in psoriatic arthritis and investigate whether there are similarities to the dyslipoproteinaemia reported in rheumatoid arthritis and other inflammatory forms of joint disease; (b) to investigate whether there is an atherogenic lipid profile in psoriatic arthritis, which may have a bearing on mortality.?METHODS—Fasting lipids, lipoproteins, and their subfractions were measured in 50 patients with psoriatic arthritis and their age and sex matched controls.?RESULTS—High density lipoprotein cholesterol (HDL cholesterol) and its third subfraction, HDL3 cholesterol, were significantly reduced and the most dense subfraction of low density lipoprotein (LDL), LDL3, was significantly increased in the patients with psoriatic arthritis. Twenty patients with active synovitis had significantly lower total cholesterol, LDL cholesterol, and HDL3 cholesterol than their controls. 25% of the patients with psoriatic arthritis had raised Lp(a) lipoprotein levels (>300 mg/l) compared with 19% of controls, but this was not statistically significant.?CONCLUSION—Raised levels of LDL3 and low levels of HDL cholesterol are associated with coronary artery disease. Such an atherogenic profile in a chronic inflammatory form of arthritis is reported, which may be associated with accelerated mortality.??

Jones, S; Harris, C; Lloyd, J; Stirling, C; Reckless, J; McHugh, N



A digital-signal-processor-based optical tomographic system for dynamic imaging of joint diseases  

NASA Astrophysics Data System (ADS)

Over the last decade, optical tomography (OT) has emerged as viable biomedical imaging modality. Various imaging systems have been developed that are employed in preclinical as well as clinical studies, mostly targeting breast imaging, brain imaging, and cancer related studies. Of particular interest are so-called dynamic imaging studies where one attempts to image changes in optical properties and/or physiological parameters as they occur during a system perturbation. To successfully perform dynamic imaging studies, great effort is put towards system development that offers increasingly enhanced signal-to-noise performance at ever shorter data acquisition times, thus capturing high fidelity tomographic data within narrower time periods. Towards this goal, I have developed in this thesis a dynamic optical tomography system that is, unlike currently available analog instrumentation, based on digital data acquisition and filtering techniques. At the core of this instrument is a digital signal processor (DSP) that collects, collates, and processes the digitized data set. Complementary protocols between the DSP and a complex programmable logic device synchronizes the sampling process and organizes data flow. Instrument control is implemented through a comprehensive graphical user interface which integrates automated calibration, data acquisition, and signal post-processing. Real-time data is generated at frame rates as high as 140 Hz. An extensive dynamic range (˜190 dB) accommodates a wide scope of measurement geometries and tissue types. Performance analysis demonstrates very low system noise (˜1 pW rms noise equivalent power), excellent signal precision (˜0.04%--0.2%) and long term system stability (˜1% over 40 min). Experiments on tissue phantoms validate spatial and temporal accuracy of the system. As a potential new application of dynamic optical imaging I present the first application of this method to use vascular hemodynamics as a means of characterizing joint diseases, especially effects of rheumatoid arthritis (RA) in the proximal interphalangeal finger joints. Using a dual-wavelength tomographic imaging system and previously implemented reconstruction scheme, I have performed initial dynamic imaging case studies on healthy volunteers and patients diagnosed with RA. These studies support our hypothesis that differences in the vascular and metabolic reactivity exist between affected and unaffected joints and can be used for diagnostic purposes.

Lasker, Joseph M.


Joint Prevalence of Diabetes, Impaired Glucose Regulation, Cardiovascular Disease Risk and Chronic Kidney Disease in South Asians and White Europeans  

PubMed Central

Background Multiple vascular risk factors may confer very high risk, but the degree of commonality between risk factors is unclear, particularly among ethnic minorities. Furthermore, it is unknown what impact this commonality will have on the UK-based NHS Health Check Programme; a vascular disease prevention programme that screens individuals aged 40–74 years. We estimated the joint prevalence of diabetes, impaired glucose regulation (IGR), high cardiovascular disease (CVD) risk and chronic kidney disease (CKD) among White Europeans and South Asians who would be eligible for the Programme. Methods Cross-sectional data were analysed for 3707 participants (23.6% South Asian) in a screening study set in Leicestershire, UK. Diabetes and IGR were screen-detected. CKD may have been diagnosed previously. IGR was defined as impaired fasting glucose and/or impaired glucose tolerance, and high CVD risk as 10 year risk greater than 20%. Results Among males, South Asians had higher prevalence than White Europeans of diabetes (9.0% vs. 3.9%, respectively, p<0.001), IGR (12.5% vs. 9.2%, p?=?0.06), and high CVD risk (39.1% vs. 33.1%, p?=?0.03), but lower prevalence of CKD (1.5% vs. 4.6%, p<0.01). Among females, South Asians had higher prevalence than White Europeans of diabetes (7.4% vs. 3.3%, p<0.001), but lower prevalence of CKD (3.7% vs. 13.0%, p <0.001) and CVD risk (2.4% vs. 4.6%, p?=?0.03), and a non-significant difference in IGR prevalence. At least one risk factor was diagnosed in 34% of participants, and all of them in 0.4%, suggesting that 723,589–734,589 more individuals each year will require monitoring following implementation of the Health Check Programme. Conclusions The collective prevalence of risk factors for vascular disease in this population was high, but there was little overlap between the risk factors, and prevalence differed by ethnicity. This has implications for service delivery and resources, and should be considered when planning screening and intervention programmes.

Khunti, Kamlesh; Morris, Danielle H.; Weston, Claire L.; Gray, Laura J.; Webb, David R.; Davies, Melanie J.



Stomatognathic adaptive motor syndrome is the correct diagnosis for temporomandibular disorders.  


Temporomandibular disorder is a generic and inadequate conception to be used as a diagnosis. It fails to express the etiology or the pathophysiology and it is mainly associated with the anatomical site. Moreover, the clinical condition presents a mandibular motor problem and not a joint problem. The hypothesis presents the new diagnosis stomatognathic motor adaptive syndrome, which comprehend a motor response and the adaptive processes it induces. Inadequate occlusal contacts cause the mandible to shift in order to reach an ideal intercuspal position. The condylar displacements are proportional to such movements. Temporomandibular joint (TMJ) receptors respond to the capsular mechanical stress and the information reaches the trigeminal sensory nuclei. The mandibular modified position seems to be relevant information and may interfere with catecholaminergic neurotransmission in basal ganglia. The main motor responses comprise increased jaw muscle tone, decreased velocity of movements and incoordination. The overload of muscle function will produce adaptive responses on many stomatognathic structures. The muscle adaptive responses are hypertonia, pain, fatigue and weakness. Temporomandibular joint presents tissue modification, disc alteration and cracking noise. Periodontium show increased periodontal membrane, bone height loss and gingival recession. Teeth manifest increased wear facets, abfraction and non-accidental fractures. The periodontal and teeth adaptive processes are usually identified as occlusal trauma. The altered stomatognathic functions will show loss of velocity during mastication and speech. Fatigue, weakness in jaw muscle and difficulties to chew hard food are related to hypertonia. Incoordination between stomatognathic muscles groups is found, causing involuntary tongue/cheek biting and lateral jaw movements on speech. Otologic complaints, as aural fullness and tinnitus, are related to the tensor tympani muscle, innervated by the trigeminal nerve. PMID:19910127

Douglas, Carlos Roberto; Avoglio, José Luiz Villaça; de Oliveira, Heloisa



[Experimental research on temporomandibular joint function in dysgnathic patients].  


In an experimental study we examined the function of the TMJ of patients with a considerable aberration from ideal dynamic occlusion and with obvious symptoms of frontal dysgnathia. Using a measuring seat for the simultaneous recording of opening and closing movements without occlusal interference and the sounds produced by the TMJ, we could not find any significantly impaired TMJ function compared with an orthognathic control group of similar age. PMID:2262179

Hensel, S



Absorbed radiation doses in transcranial temporomandibular joint radiography  

SciTech Connect

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.



Partial Antiviral Activities Detection of Chicken Mx Jointing with Neuraminidase Gene (NA) against Newcastle Disease Virus  

PubMed Central

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



Maxillo-mandibular counter-clockwise rotation and mandibular advancement with TMJ Concepts ® total joint prostheses  

Microsoft Academic Search

The purpose of this study was to evaluate skeletal and dental stability in patients who had temporomandibular joint (TMJ) reconstruction and mandibular counterclockwise advancement using TMJ Concepts total joint prostheses (TMJ Concepts Inc. Ventura, CA) with maxillary osteotomies being performed at the same operation. All patients were operated at Baylor University Medical Center, Dallas TX, USA, by one surgeon (Wolford).

K. E. Dela Coleta; L. M. Wolford; J. R. Gonçalves; A. dos Santos Pinto; L. P. Pinto; D. S. Cassano



Executive summary: diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America.  


These guidelines are intended for use by infectious disease specialists, orthopedists, and other healthcare professionals who care for patients with prosthetic joint infection (PJI). They include evidence-based and opinion-based recommendations for the diagnosis and management of patients with PJI treated with debridement and retention of the prosthesis, resection arthroplasty with or without subsequent staged reimplantation, 1-stage reimplantation, and amputation. PMID:23230301

Osmon, Douglas R; Berbari, Elie F; Berendt, Anthony R; Lew, Daniel; Zimmerli, Werner; Steckelberg, James M; Rao, Nalini; Hanssen, Arlen; Wilson, Walter R



Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America.  


These guidelines are intended for use by infectious disease specialists, orthopedists, and other healthcare professionals who care for patients with prosthetic joint infection (PJI). They include evidence-based and opinion-based recommendations for the diagnosis and management of patients with PJI treated with debridement and retention of the prosthesis, resection arthroplasty with or without subsequent staged reimplantation, 1-stage reimplantation, and amputation. PMID:23223583

Osmon, Douglas R; Berbari, Elie F; Berendt, Anthony R; Lew, Daniel; Zimmerli, Werner; Steckelberg, James M; Rao, Nalini; Hanssen, Arlen; Wilson, Walter R



Prognostic factors affecting survival of 507 horses with joint disease: (1983 to 1990).  

PubMed Central

Between July 1, 1983 and December 31, 1990, risk factors were determined for all horses with joint disease presented to a referral center, of being discharged, of ever becoming sound, or of being alive at 3 mo follow-up. Logistic multiple-regression models were done separately for foals (< or = 4 mo), yearlings (> 4-24 mo) and racing or nonracing adult horses (> 24 mo). The breakdown in this study was 53 foals, 87 yearlings, 141 nonracing adults, and 226 racing adults. Thirty-one foals (58%), 68 yearlings (78%), 119 non-racing adults (84%), and 213 racing adults (94%) were discharged. Foals with a less severe lameness, duration of illness of > 1 d, and infectious arthritis had increased odds of discharge. At follow-up, 12 of 18 (67%) were alive, 10 (56%) of which were sound. Yearlings with osteochondrosis had higher odds of discharge; at follow-up, 38 of 49 (78%) were alive, 32 (65%) of which were sound. For non-racing adults, horses with less severe lameness, without a miscellaneous diagnosis, or intended for pleasure use had increased odds of discharge. At follow-up, 55 of 78 (70%) were alive and 33 of 58 (57%) with soundness data became sound. Risk factors for higher odds of being alive at follow-up were carpal lameness, arthroscopic surgery, a prognosis other than poor, became sound, above-median hospitalization costs, and duration of follow-up. The 161 racing adults (76% of discharges), with follow-up, were more likely to have had osteoarthritis, higher hospital costs, hospitalization > 1 d, and arthroscopy. Sixty-four (60%) of these became sound; the odds increased if the horse was not severely lame at admission or was hospitalized for > 1 d. Risk factors and prognosis differed by age-use group among horses seen at our hospital.

Fubini, S L; Erb, H N; Freeman, K P; Todhunter, R J



Otalgia and aversive symptoms in temporomandibular disorders.  


The term Costen's syndrome has been used in the dentomedical literature to describe a constellation of craniofacial symptoms. Since some of the same complaints have been reported in patients with "generalized" psychological distress, symptoms associated with the syndrome may not be useful in differential diagnosis of temporomandibular disorders. The present study investigated whether some somatic complaints, particularly tinnitus and dizziness, were pathognomonic in patients with chronic temporomandibular pain. Illness behavior and personality factors were studied for possible interrelationships with these symptoms. Factor analysis revealed that tinnitus and dizziness loaded on separate factors. Tinnitus loaded with nasal stuffiness, tearing, and itching of the eyelids and nose, while dizziness loaded with complaints of altered taste and smell and blurred vision. Neither was consistently related to measures of pain or to indices of illness behavior or somatic focus. PMID:10527281

Bush, F M; Harkins, S W; Harrington, W G



Articular Chondrocytes from Animals with a Dermatan Sulfate Storage Disease Undergo a High Rate of Apoptosis and Release Nitric Oxide and Inflammatory Cytokines: A Possible Mechanism Underlying Degenerative Joint Disease in the Mucopolysaccharidoses  

Microsoft Academic Search

Mucopolysaccharidosis (MPS) Type VI (Maroteaux-Lamy Disease) is the lysosomal storage disease characterized by deficient arylsulfatase B activity and the resultant accumulation of dermatan sulfate-containing glycosaminoglycans (GAGs). A major feature of this and other MPS disorders is abnormal cartilage and bone development leading to short stature, dysostosis multiplex, and degenerative joint disease. To investigate the underlying cause(s) of degenerative joint disease

Calogera M. Simonaro; Mark E. Haskins; Edward H. Schuchman



Virtual restoration of anatomic jaw relationship to obtain a precise 3D model for total joint prosthesis construction for treatment of TMJ ankylosis with open bite  

Microsoft Academic Search

Temporomandibular joint (TMJ) reconstruction with a TMJ Concepts total joint prosthesis (TMJ Concepts, Ventura, USA) requires a precise 3D model of the jaws in centric occlusion. The authors present a virtual procedure for repositioning the lower jaw in centric occlusion to obtain a precise stereolithographic model for TMJ reconstruction using a custom-made total joint prosthesis in a case of TMJ

C. Zizelmann; P. Bucher; D. Rohner; N.-C. Gellrich; H. Kokemueller; B. Hammer



Network-based SNP meta-analysis identifies joint and disjoint genetic features across common human diseases  

PubMed Central

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.



[The effect of magnetotherapy on the immunobiochemical indices of subjects with diseases of the periodontal tissues and joints].  


Kept under medical surveillance in a health resort setting were 52 patients with disorders of the parodontium and large joints. All patients were given a complex therapy involving dietotherapy, therapeutic exercise, hydrotherapy, mud-treatment. Those patients having parodontium diseases were also prescribed topical treatment (chloride-sodium mouth baths and mud applications to the gingiva area). The main group subjects were also exposed to VMF using the unit for low-frequency therapy "Gradient-1". Laboratory means were also made use of, as a complex of biochemical tests characterizing changes in lipid metabolism. The level of the natural bodily resistance was determined by nitroblue tetrazolium test (NBT-test). The condition of the parodontium was evaluated by the Loë-Silness index. Adaptive reactions were studied by the lymphocytes-to-segmented neutrophils ratio. Adoption of therapy involving physiobalneofactors in patients with afflictions of the parodontium tissues and large joints makes for development of favourable in prognostic respect adaptive reactions. PMID:10424014

Samo?lovich, V A


[Rapid and high-resolution 3D-imaging in MR tomographic diagnosis of diseases of the knee joint].  


A new technique was developed for MR imaging of diseases of the knee joint to shorten the time required for examination. The acquisition of an isotropic 3D-dataset using a FLASH- or a FISP-sequence is the base for secondary reconstructions of planar high-resolution images (spatial resolution less than or equal to 1 mm) in free orientations. Acquisition time of the 3D-dataset is 16 minutes, additional one up to five minutes are needed for image calculation. The method can image structures of the knee joint such as the cartilage, the menisci or the ligament. The advantage of the decreased examination time of about 30 minutes has been proved, but further comparative clinical studies are needed to establish the diagnostic equivalence of this method and conventional techniques. PMID:2173057

Skalej, M; Bongers, H



Efficacy of ultrasound-guided steroid injections for pain management of midfoot joint degenerative disease  

Microsoft Academic Search

Objective  To examine the efficacy of ultrasound (US)-guided injections for midfoot joint degenerative changes.\\u000a \\u000a \\u000a \\u000a Materials and methods  The US images and radiographs of 63 patients with midfoot joint degenerative changes were retrospectively reviewed. In those\\u000a patients who had US-guided intra-articular steroid injection, the response to the injection was recorded by reviewing the\\u000a 2-week pain diaries and clinical notes. Partial or complete pain

Eleni E. Drakonaki; James S. B. Kho; Robert J. Sharp; Simon J. Ostlere



Temporomandibular disorder in a patient with pseudoxanthoma elasticum: a case report and review.  


Pseudoxanthoma elasticum (PXE) is a disorder characterized by progressive degeneration of elastic fibers and ectopic mineralization. Cutaneous manifestations are a hallmark of this disease and organs that may be affected by the disease process include cardiovascular, central nervous system, ocular and gastrointestinal systems. Oral manifestations of PXE have been previously reported as intramucosal nodules observed on various intraoral surfaces. We present a case of a 46-year-old female with PXE diagnosed with temporomandibular disorder (TMD). To our knowledge, this is the first report of a patient with TMD coexisting with PXE in the scientific literature. PMID:23980559

Nadeau, Christine; Kuperstein, Arthur S; Mupparapu, Muralidhar; Stoopler, Eric T



Prophylaxis versus Episodic Treatment to Prevent Joint Disease in Boys with Severe Hemophilia  

Microsoft Academic Search

Sixty-five boys younger than 30 months of age were randomly assigned to prophylaxis (32 boys) or enhanced episodic therapy (33 boys). When the boys reached 6 years of age, 93% of those in the prophylaxis group and 55% of those in the episodic-ther- apy group were considered to have normal index-joint structure on MRI (P = 0.006). The relative risk

Marilyn J. Manco-Johnson; Thomas C. Abshire; Amy D. Shapiro; Brenda Riske; Michele R. Hacker; Ray Kilcoyne; J. David Ingram; Michael L. Manco-Johnson; Sharon Funk; Linda Jacobson; Leonard A. Valentino; W. Keith Hoots; George R. Buchanan; Donna DiMichele; Michael Recht; Deborah Brown; Cindy Leissinger; Shirley Bleak; Alan Cohen; Prasad Mathew; Alison Matsunaga; Desiree Medeiros; Diane Nugent; Gregory A. Thomas; Alexis A. Thompson; Kevin McRedmond; J. Michael Soucie; Harlan Austin; Bruce L. Evatt



Obesity and increased burden of hip and knee joint disease in Australia: Results from a national survey  

PubMed Central

Background Research involving more representative samples is needed to extend our understanding of the broader impact of obesity in hip or knee joint disease (arthritis and OA) beyond clinical settings. Although population-based research has been conducted in the United States, how these findings translate to other countries is unclear. Using a national approach, this study explored associations between obesity and the burden of hip and knee joint disease in Australia (in terms of prevalence, pain, stiffness, function, Health-Related Quality of Life (HRQoL) and disease severity). Methods A random sample of 5000 Australians (?39 years) from the federal electoral roll was invited to complete a mailed questionnaire to identify doctor-diagnosed hip arthritis, hip OA, knee arthritis and knee OA and evaluate the burden of these conditions. Validated questionnaires included the WOMAC Index, Assessment of Quality of Life instrument and Multi-Attribute Prioritisation Tool. Body Mass Index (BMI) was classified into underweight/normal weight (?24.99 kg/m2), overweight (25–29.99) or obese (?30). Multiple logistic regression was used to estimate odds of arthritis and OA, with demographic and socioeconomic variables included in the models. Associations between BMI and other variables were investigated using analysis of covariance, with adjustment for age and sex. Results Data were available from 1,157 participants (23%). Overweight participants had increased odds of knee arthritis (adjusted OR (AOR) 1.87, 95%CI 1.14-3.07) and knee OA (AOR 2.11, 95%CI 1.07-4.15). Obesity was associated with higher prevalence of hip arthritis (AOR 2.18, 95%CI 1.17-4.06), knee arthritis (AOR 5.47, 95%CI 3.35-8.95) and knee OA (AOR 7.35, 95%CI 3.85-14.02). Of those with arthritis or OA, obese individuals reported more pain (for hip arthritis, hip OA and knee OA), greater stiffness (for hip arthritis, knee arthritis and knee OA), worse function (all diagnoses), lower HRQoL (for hip arthritis and hip OA) and greater disease severity (all diagnoses). Conclusions This national study has demonstrated that the odds of arthritis and OA was up to 7 times higher for obese individuals, compared with those classified as underweight/normal weight. Concurrent obesity and joint disease had a marked impact on several key aspects of wellbeing, highlighting the need for public health interventions.



The association between hepatitis B virus infection and disease activity, synovitis, or joint destruction in rheumatoid arthritis.  


The prevalence of chronic hepatitis B virus (HBV) infection in China is high. Four percent of patients with HBV infection can present with polyarthritis and positive rheumatic factor similar to rheumatoid arthritis (RA). Here, we investigated the association between HBV infection and serological, radiological, or histological disease status in RA. According to HBV infection status, 223 consecutive hospitalized Chinese patients with RA were divided into the groups of chronic HBV infection, past HBV infection, and no HBV infection. Clinical data and hand radiographs were collected. Synovium was obtained by closed-needle biopsy, and serial tissue sections were stained immunohistochemically for HBV surface antigen (HBsAg) and cluster of differentiation (CD) markers. (1) The prevalence of HBsAg positivity and chronic hepatitis B in RA was consistent with the age-matched general Chinese population (11.2 vs. 8.7 %, 1.7 vs. 1.0 %, respectively, P?>?0.05). (2) Clinical parameters, disease activity score in 28 joints, or Sharp scores showed no significant difference among the three groups in 206 RA or 140 treatment-naïve patients, both with active disease (all P?>?0.05). (3) Synovial immunohistochemical staining showed negative HBsAg in ten RA patients with HBV carrier status and ten RA patients with past HBV infection. Except for higher subintimal CD3+ cell density in the past HBV infection group, Krenn's synovitis score, mean densities of subintima positive-staining cells (CD20, CD38, CD79a, and CD68), and CD34+ microvessel counts showed no significant difference among RA patients with HBV carrier status, past HBV infection, or no HBV infection (all P?>?0.05). Chronic HBV infection may have no significant effect on disease activity, synovitis, or joint destruction in RA. PMID:23340833

Zou, Chan-Juan; Zhu, Lang-Jing; Li, Yan-Hua; Mo, Ying-Qian; Zheng, Dong-Hui; Ma, Jian-Da; Ou-Yang, Xia; Pessler, Frank; Dai, Lie



Reduced Joint Pain after Short-term Duodenal Administration of Seal Oil in Patients with Inflammatory Bowel Disease: Comparison with Soy Oil  

Microsoft Academic Search

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



Obstructive Sleep Apnea and Autoimmune Rheumatic Disease: Is there Any Link?  


The association between autoimmune rheumatic diseases and obstructive sleep apnea (OSA) is complex. Systemic inflammation secondary to OSA may underlie this association. It is possible that OSA-related inflammation may trigger the occurrence of autoimmune rheumatic disease in genetically susceptible individuals. On the other hand, autoimmune rheumatic diseases can lead to OSA or worsen preexisting OSA. Temporomandibular joint destruction, cervical spine subluxation and brainstem compression are the factors responsible for the above observation. Future studies are needed to clarify whether OSA is an independent risk factor for the development of autoimmune disease and whether OSA management will lead to a reduction in the incidence of autoimmune disease. On the other hand, it is important to treat autoimmune rheumatic disease promptly, to reduce the risk of complications, with OSA being one of these. PMID:23859748

Mirrakhimov, Aibek E



Development of temporomandibular disorder symptoms: a 3-year cohort study of university students.  


The aims of this study were to examine the incidence of temporomandibular disorders (TMDs) over a 3-year period and to evaluate the risk of self-reported TMDs among university students in Japan. The study population comprised 2374 university students examined at the start of their undergraduate course and 492 students re-examined after 3 years using questionnaires on symptoms of TMD and experiences of jaw injury, stress, orthodontic treatment and parafunctional habits. Cumulative incidence (%) and relative risks were calculated overall. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to determine the degree of risks of these variables for symptoms of TMDs using logistic regression. Results of logistic regression analysis showed that male subjects with experience of jaw injury had a 3·54 (CI=1·45-8·68, P<0·01)-fold higher risk of temporomandibular joint (TMJ) pain than that for those who did not. Female subjects who reported experiencing stress and bruxism had 10·56 (CI=1·28-87·54, P<0·05)- and 5·00 (CI=1·21-20·71, P<0·05)-fold higher risks of TMJ sound, respectively, than the risk for female subjects who had not experienced stress or bruxism. The results indicated that experiences of jaw injury, stress and bruxism were significantly associated with increased risks of development of TMJ disorders in a 3-year cohort. PMID:21294762

Akhter, R; Morita, M; Esaki, M; Nakamura, K; Kanehira, T



Correlation between the Condyle Position and Intra-Extraarticular Clinical Findings of Temporomandibular Dysfunction  

PubMed Central

Objectives: To investigate the relationship between different clinical findings and condyle position. Methods: Tenderness on masseter (MM), temporal (TM), lateral pyterigoid (LPM), medial pyterigoid (MPM) and posterior cervical (PSM) muscles, limitation, deviation and deflection in opening of mouth, clicking, crepitating, tenderness on lateral palpation of temporomandibular joint (TMJ) area for each side of 85 patients were evaluated. Each side of patients was categorized into the clinical findings: no sign and/or symptom of temporomandibular dysfunctions (TMDs), only extraarticular findings and only intraarticular findings, extra and intraarticular findings. Condyle positions of 170 TMJs were determined the narrowest anterior (a) and posterior interarticular distance (p) on mid-sagittal MRIs of condyles and expressed as p/a ratio and these ratio were transformed into logarithmic base e. Spearman’s Correlation was used to investigate the relationship between the condyle position and the clinical findings. The difference between the condyle positions of different groups was tested by T test. Reliability statistic was used to determine intra-observer concordance of two measurements of condylar position. Results: A significant relationship was found between the condyle position and tenderness of PSM. There was no significant difference between the groups in aspect of the condyle position. Occlusion and condyle position correlated with significantly. Conclusions: The inclination of the upper cervical spine and craniocervical angulations can cause the signs and symptoms of TMD and condyle position is not main cause of TMDs alone but it may be effective together with other possible etiological factors synergistically.

Sener, Sevgi; Akgunlu, Faruk



Chewing ability as a parameter for evaluating the disability of patients with temporomandibular disorders.  


Restoration of chewing ability is an important aspect of the treatment for temporomandibular disorders (TMDs). However, too little attention has been paid to it. We have used a questionnaire to evaluate and score the chewing ability of TMD patients. The questionnaire includes 19 kinds of food and a chewing task. The patient was asked if she/he experiences difficulty in enjoying eating. The aim of this study was to evaluate correlations between score of chewing ability (SCA) and other symptoms/signs of TMD. Four hundred and seventy-three consecutive TMD patients were evaluated for SCA and other symptoms/signs including temporomandibular joint (TMJ) pain, TMJ and muscle tenderness, TMJ noise (clicking and crepitus), and maximum mouth opening. The relationship between SCA and other symptoms/signs were analysed by multiple regression analysis. Score of chewing ability correlated significantly with TMJ pain and mouth opening capacity but not with TMJ noise and muscle tenderness. Age was a background factor but sex was not. The result of this study suggests that SCA correlated with dysfunction of the TMD patients. This method could be used to evaluate the ability of chewing in assessment of TMD. PMID:11380787

Kurita, H; Ohtsuka, A; Kurashina, K; Kopp, S



Counselling and self-management therapies for temporomandibular disorders: a systematic review.  


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



Otologic symptoms of temporomandibular disorder and effect of orofacial myofunctional therapy.  


The aim of this study was to investigate the frequency of otologic symptoms and their relationship to orofacial signs and symptoms of temporomandibular disorder (TMD), and the effect of orofacial myofunctional therapy. The study was conducted on eight asymptomatic subjects (Group C) and 20 subjects with articular TMD, randomly distributed over two groups: one treated using orofacial myofunctional therapy (OMT Group) and a control group with TMD (Group CTMD). Patient selection was based upon the Research Diagnostic Criteria for TMD (RDC/TMD). All subjects submitted to a clinical examination with self-reporting of symptom severity, and to orofacial myofunctional and electromyographic evaluation at diagnosis and again, at the end of the study. Correlations were calculated using the Pearson test and inter- and intragroup comparisons were made (p < 0.05). In the diagnosis phase, subjects with TMD reported earache (65%), tinnitus (60%), ear fullness (90%), and 25% of the asymptomatic subjects reported tinnitus. The otologic symptoms were correlated with tenderness to palpation of the temporomandibular muscles and joints and with orofacial symptoms. Only the OMT group showed a reduction of otologic and orofacial symptoms, of tenderness to palpation and of the asymmetric index between muscles. OMT may help with muscle coordination and a remission of TMD symptoms. PMID:18468271

de Felício, Cláudia Maria; Melchior, Melissa de Oliveira; Ferreira, Clãudia Lúcia Pimenta; Da Silva, Marco Antonio M Rodrigues



Thoracolumbar spinal cord compression due to vertebral process degenerative joint disease in a family of Shiloh Shepherd dogs.  


Five young Shiloh Shepherd Dogs (4 males and 1 female) related by a common sire were studied because of progressive pelvic limb weakness and incoordination. All dogs had a spastic paraparesis and pelvic limb ataxia consistent with an upper motor neuron and general proprioceptive lesion between spinal cord segments T3 and L3. Proliferative lesions involving one or more of the articular processes from the 11th thoracic vertebrae to the 2nd lumbar vertebra were observed on radiographs of the thoracolumbar vertebrae. Dorsal compression of the spinal cord was identified during imaging studies at these sites. Abnormalities of the synovial joints and bony proliferation of the involved articular processes were identified at postmortem examination in 2 dogs. The articular processes and associated vertebral arches protruded into the vertebral canal, indenting the dorsal surface of the spinalcord. Degenerative joint disease (DJD) was identified histologically. A compressive myelopathy was diagnosed in the spinal cord. These dogs were affected by a compressive myelopathy as a consequence of vertebral process DJD that likely has a geneticcomponent. The DJD could have been caused by a primary vertebral malformation or an injury to the processes at a young age causing malarticulation. PMID:12892304

McDonnell, John J; Knowles, Kim E; deLahunta, Alexander; Bell, Jerold S; Lowrie, Charles T; Todhunter, Rory J


The retinoic acid binding protein CRABP2 is increased in murine models of degenerative joint disease  

Microsoft Academic Search

INTRODUCTION: Osteoarthritis (OA) is a debilitating disease with poorly defined aetiology. Multiple signals are involved in directing the formation of cartilage during development and the vitamin A derivatives, the retinoids, figure prominently in embryonic cartilage formation. In the present study, we examined the expression of a retinoid-regulated gene in murine models of OA. METHODS: Mild and moderate forms of an

Ian D. Welch; Matthew F. Cowan; Frank Beier; Tully M. Underhill



How can calcium pyrophosphate crystals induce inflammation in hypophosphatasia or chronic inflammatory joint diseases?  


Hypophosphatasia (HP) is a rare inborn error of bone and mineral metabolism characterized by a defect in the tissue non-specific alkaline phosphatase (TNSALP) gene. Calcium pyrophosphate dihydrate (CPPD) crystals are known to accumulate as substrates of TNSALP in tissues and joints of patients with HP. In CPPD-induced arthritis these crystals are known to induce an inflammatory response. HP patients do suffer from pain in their lower extremities. However, it is not clear whether CPPD crystals contribute to these musculoskeletal complaints in HP. As long as there is no curative treatment of HP, symptomatic treatment in order to improve clinical features, especially with regard to pain and physical activity, is of major interest to the patients. Knowledge of the mechanisms underlying crystal-induced cell activation, however, is limited. Here we describe recent advances in elucidating the signal transduction pathways activated by CPPD crystals as endogenous "danger signals". Recent investigations provided evidence that Toll/interleukin-1 receptor (TIR) domain containing receptors including Toll-like receptors (TLRs) and interleukin-1 receptor (IL-1R), as well as the triggering receptor expressed on myeloid cells 1 (TREM-1) and the NACHT-leucin rich repeat and pyrin-domain-containing protein (NALP3) containing inflammasome are essentially involved in acute CPPD crystal-induced inflammation. These receptors are considered in part as components of the innate immune system. Further studies are needed to improve our understanding of the pathophysiological mechanisms leading to inflammation and tissue destruction associated with deposition of microcrystals. They might support the development of new therapeutic strategies for crystal-induced inflammation. Eventually, patients with HP might as well profit from such strategies addressing these metabolic disorders secondary to the gene defect. PMID:18821074

Beck, C; Morbach, H; Richl, P; Stenzel, M; Girschick, H J



Guidelines for diagnosis and management of chronic obstructive pulmonary disease: Joint ICS/NCCP (I) recommendations  

PubMed Central

Chronic obstructive pulmonary disease (COPD) is a major public health problem in India. Although several International guidelines for diagnosis and management of COPD are available, yet there are lot of gaps in recognition and management of COPD in India due to vast differences in availability and affordability of healthcare facilities across the country. The Indian Chest Society (ICS) and the National College of Chest Physicians (NCCP) of India have joined hands to come out with these evidence-based guidelines to help the physicians at all levels of healthcare to diagnose and manage COPD in a scientific manner. Besides the International literature, the Indian studies were specifically analyzed to arrive at simple and practical recommendations. The evidence is presented under these five headings: (a) definitions, epidemiology, and disease burden; (b) disease assessment and diagnosis; (c) pharmacologic management of stable COPD; (d) management of acute exacerbations; and (e) nonpharmacologic and preventive measures. The modified grade system was used for classifying the quality of evidence as 1, 2, 3, or usual practice point (UPP). The strength of recommendation was graded as A or B depending upon the level of evidence.

Gupta, Dheeraj; Agarwal, Ritesh; Aggarwal, Ashutosh Nath; Maturu, V. N.; Dhooria, Sahajal; Prasad, K. T.; Sehgal, Inderpaul S.; Yenge, Lakshmikant B.; Jindal, Aditya; Singh, Navneet; Ghoshal, A. G.; Khilnani, G. C.; Samaria, J. K.; Gaur, S. N.; Behera, D.



Guidelines for diagnosis and management of chronic obstructive pulmonary disease: Joint ICS/NCCP (I) recommendations.  


Chronic obstructive pulmonary disease (COPD) is a major public health problem in India. Although several International guidelines for diagnosis and management of COPD are available, yet there are lot of gaps in recognition and management of COPD in India due to vast differences in availability and affordability of healthcare facilities across the country. The Indian Chest Society (ICS) and the National College of Chest Physicians (NCCP) of India have joined hands to come out with these evidence-based guidelines to help the physicians at all levels of healthcare to diagnose and manage COPD in a scientific manner. Besides the International literature, the Indian studies were specifically analyzed to arrive at simple and practical recommendations. The evidence is presented under these five headings: (a) definitions, epidemiology, and disease burden; (b) disease assessment and diagnosis; (c) pharmacologic management of stable COPD; (d) management of acute exacerbations; and (e) nonpharmacologic and preventive measures. The modified grade system was used for classifying the quality of evidence as 1, 2, 3, or usual practice point (UPP). The strength of recommendation was graded as A or B depending upon the level of evidence. PMID:24049265

Gupta, Dheeraj; Agarwal, Ritesh; Aggarwal, Ashutosh Nath; Maturu, V N; Dhooria, Sahajal; Prasad, K T; Sehgal, Inderpaul S; Yenge, Lakshmikant B; Jindal, Aditya; Singh, Navneet; Ghoshal, A G; Khilnani, G C; Samaria, J K; Gaur, S N; Behera, D



Local Massage with Topical Analgesic, a Novel Treatment Modality for Temporomandibular Muscular Pain, a Case Study Report of 5 Consecutive Cases  

PubMed Central

Introduction: Temporomandibular disorders (TMDs) represent a group of painful conditions involving the muscles of mastication and the temporomandibular joint. Ping On Ointment has been used in the Chinese Orthopedics as a soothing massage balm for muscular aches, strain and sprain. If topical application of the ointment can be effective for the treatment of TMD muscular pain, it may be the long-sought-after method for safe, simple, cheap, non-invasive, and effective treatment modality of TMD muscular pain. Purpose: This report documented a case study of the first five consecutive cases using this treatment modality. Results: All cases resulted in complete remission of pain within one month of topical massage. Conclusion: This treatment method has high potential to benefit a significant number of people and randomized control trials should be performed.

Wong, R.W.K; Rabie, A.B.M



A randomized controlled clinical trial evaluating the effectiveness of an external mandibular support device during dental care for patients with temporomandibular disorders.  


This study tested a jaw support device for patients receiving dental care while suffering from temporomandibular joint pain. This crossover randomized trial used 31 subjects with jaw pain. Subjects underwent 2 consecutive dental scaling sessions of 30 minutes each. For each subject, the device was used for 1 of the sessions. Subjects completed questionnaires regarding jaw pain and jaw fatigue before and after each session. Multivariate analyses were performed to assess the device's effectiveness in preventing the aggravation of pain and fatigue during dental treatment. Statistically significant differences were found for jaw pain (P = 0.001), and fatigue (P = 0.04), indicating the effectiveness of the device. Based on the results, supporting the mandible of patients with temporomandibular disorders during dental treatments may prevent further pain. PMID:24064159

Fernandes, Patricia; Velly, Ana Miriam; Anderson, Gary C


Treatment to lipid targets in patients with inflammatory joint diseases in a preventive cardio-rheuma clinic.  


OBJECTIVES: To perform cardiovascular risk stratification in patients with inflammatory joint diseases (IJD) and treat to lipid targets according to recommendations. METHODS: We initiated a preventive cardio-rheuma clinic based on the unmet need of adequate cardiovascular prevention in IJD patients. A full cardiovascular risk stratification was performed at the first consultation (history of conventional risk factors and of cardiovascular disease, lipid measurement, blood pressure and ultrasound examination of both carotid arteries), and the patient was classified to either a primary or secondary cardiovascular prevention regime, or to have a low risk (no intervention). Lipid-lowering treatment was adjusted until at least two lipid targets were achieved. RESULTS: Of the 426 patients referred, 36.6% had a systematic coronary risk evaluation less than 5% (no lipid-lowering intervention). The remaining 270 patients ((rheumatoid arthritis (RA), n=165; ankylosing spondylitis (AS), n=70; and psoriatic arthritis (PsA), n=35) were assigned to either primary (n=63) or secondary prevention (n=207). There were significant differences between the patient groups regarding age (p<0.001), sex (p<0.001) and disease duration (p<0.001). Lipid changes in IJD patients were: total cholesterol -1.86±1.20 mmol/l (p<0.001); low-density lipoprotein cholesterol -1.74±1.11 (p<0.001); high-density lipoprotein cholesterol 0.01±0.30 (p=0.61); triglycerides -0.28±0.72 (p<0.001). The proportions of patients reaching at least two lipid targets were for RA 92.1%, AS 90.0% and PsA 82.9%. No serious adverse events were observed. CONCLUSIONS: There was indication for cardiovascular prevention in a high proportion of IJD patients referred for cardiovascular risk stratification. Treatment to lipid targets was successful in approximately 90% of patients with IJD. PMID:23264359

Rollefstad, Silvia; Kvien, Tore K; Holme, Ingar; Eirheim, Anne S; Pedersen, Terje R; Semb, Anne Grete P



Joint recognition-expression impairment of facial emotions in Huntington's disease despite intact understanding of feelings.  


Patients with Huntington's disease (HD), a neurodegenerative disorder that causes major motor impairments, also show cognitive and emotional deficits. While their deficit in recognising emotions has been explored in depth, little is known about their ability to express emotions and understand their feelings. If these faculties were impaired, patients might not only mis-read emotion expressions in others but their own emotions might be mis-interpreted by others as well, or thirdly, they might have difficulties understanding and describing their feelings. We compared the performance of recognition and expression of facial emotions in 13 HD patients with mild motor impairments but without significant bucco-facial abnormalities, and 13 controls matched for age and education. Emotion recognition was investigated in a forced-choice recognition test (FCR), and emotion expression by filming participants while they mimed the six basic emotional facial expressions (anger, disgust, fear, surprise, sadness and joy) to the experimenter. The films were then segmented into 60 stimuli per participant and four external raters performed a FCR on this material. Further, we tested understanding of feelings in self (alexithymia) and others (empathy) using questionnaires. Both recognition and expression were impaired across different emotions in HD compared to controls and recognition and expression scores were correlated. By contrast, alexithymia and empathy scores were very similar in HD and controls. This might suggest that emotion deficits in HD might be tied to the expression itself. Because similar emotion recognition-expression deficits are also found in Parkinson's Disease and vascular lesions of the striatum, our results further confirm the importance of the striatum for emotion recognition and expression, while access to the meaning of feelings relies on a different brain network, and is spared in HD. PMID:22244587

Trinkler, Iris; Cleret de Langavant, Laurent; Bachoud-Lévi, Anne-Catherine



A Comparison of the Polytomous Logistic Regression and Joint Cox Proportional Hazards Models for Evaluating Multiple Disease Subtypes in Prospective Cohort Studies  

PubMed Central

Background Polytomous logistic regression models are commonly used in case-control studies of cancer to directly compare the risks associated with an exposure variable across multiple cancer subtypes. However, the validity, accuracy and efficiency of this approach for prospective cohort studies have not been formally evaluated. Methods We investigated the performance of the polytomous logistic regression model and compared it to an alternative approach based on a joint Cox proportional hazards model using simulation studies. We then applied both methods to a prospective cohort study to assess whether the association of breast cancer with body size differs according to estrogen and progesterone receptor-defined subtypes. Results Our simulations showed that the polytomous logistic regression model but not the joint Cox regression model yielded biased results in comparing exposure and disease subtype associations when the baseline hazards for different disease subtypes are non-proportional. For this reason, an analysis of a real data set was based on the joint Cox proportional hazards model and showed that body size has a significantly greater association with estrogen and progesterone positive breast cancer than with other subtypes. Conclusions Because of the limitations of the polytomous logistic regression model for the comparison of exposure-disease associations across disease subtypes, the joint Cox proportional hazards model is recommended over the polytomous logistic regression model in prospective cohort studies. Impact The paper will promote the use of the joint Cox model in a prospective cohort study. Examples of SAS and S-plus programming codes are provided to facilitate use by non-statisticians.

Xue, Xiaonan; Kim, Mimi Y.; Gaudet, Mia M.; Park, Yikyung; Heo, Moonseong; Hollenbeck, Albert R.; Strickler, Howard D.; Gunter, Marc J.



Detection and classification of interstitial lung diseases and emphysema using a joint morphological-fuzzy approach  

NASA Astrophysics Data System (ADS)

Multi-detector computed tomography (MDCT) has high accuracy and specificity on volumetrically capturing serial images of the lung. It increases the capability of computerized classification for lung tissue in medical research. This paper proposes a three-dimensional (3D) automated approach based on mathematical morphology and fuzzy logic for quantifying and classifying interstitial lung diseases (ILDs) and emphysema. The proposed methodology is composed of several stages: (1) an image multi-resolution decomposition scheme based on a 3D morphological filter is used to detect and analyze the different density patterns of the lung texture. Then, (2) for each pattern in the multi-resolution decomposition, six features are computed, for which fuzzy membership functions define a probability of association with a pathology class. Finally, (3) for each pathology class, the probabilities are combined up according to the weight assigned to each membership function and two threshold values are used to decide the final class of the pattern. The proposed approach was tested on 10 MDCT cases and the classification accuracy was: emphysema: 95%, fibrosis/honeycombing: 84% and ground glass: 97%.

Chang Chien, Kuang-Che; Fetita, Catalin; Brillet, Pierre-Yves; Prêteux, Françoise; Chang, Ruey-Feng



The Revised Research Diagnostic Criteria for Temporomandibular Disorders: Methods used to Establish and Validate Revised Axis I Diagnostic Algorithms  

PubMed Central

AIMS To derive reliable and valid revised Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms for clinical TMD diagnoses. METHODS The multi-site RDC/TMD Validation Project’s dataset (614 TMD community and clinic cases, and 91 controls) was used to derive revised algorithms for Axis I TMD diagnoses. Validity of diagnostic algorithms was assessed relative to reference standards, the latter based on consensus diagnoses rendered by 2 TMD experts using criterion examination data, including temporomandibular joint imaging. Cut-offs for target validity were sensitivity ? 0.70 and specificity ? 0.95. Reliability of revised algorithms was assessed in 27 study participants. RESULTS Revised algorithm sensitivity and specificity exceeded the target levels for myofascial pain (0.82, 0.99, respectively) and myofascial pain with limited opening (0.93, 0.97). Combining diagnoses for any myofascial pain showed sensitivity of 0.91 and specificity of 1.00. For joint pain, target sensitivity and specificity were observed (0.92, 0.96) when arthralgia and osteoarthritis were combined as “any joint pain.” Disc displacement without reduction with limited opening demonstrated target sensitivity and specificity (0.80, 0.97). For the other Group II disc displacements and Group III osteoarthritis and osteoarthrosis, sensitivity was below target (0.35 to 0.53), and specificity ranged from 0.80 to meeting target. Kappa for revised algorithm diagnostic reliability was ? 0.63. CONCLUSION Revised RDC/TMD Axis I TMD diagnostic algorithms are recommended for myofascial pain and joint pain as reliable and valid. However, revised clinical criteria alone, without recourse to imaging, are inadequate for valid diagnosis of two of the three disc displacements and osteoarthritis/osteoarthrosis.

Schiffman, Eric L.; Ohrbach, Richard; Truelove, Edmond L.; Feng, Tai; Anderson, Gary C.; Pan, Wei; Gonzalez, Yoly M.; John, Mike T.; Sommers, Earl; List, Thomas; Velly, Ana M.; Kang, Wenjun; Look, John O.



The effects on knowledge of the systematic education of patients with joint diseases treated with NSAIDs and diuretics.  


In a randomised, controlled trial, patients with joint diseases and concomitant treatment with NSAIDs and diuretics received systematic education. The intervention group was given information by a self-conducted, interactive Kodak Photo-CD program in addition to personal drug information and non-commercial drug leaflets. Awareness of drug interactions and encouragement of self-adjustment of treatment was focused on. Control patients received conventional information. Three months after randomisation, knowledge was tested by means of a questionnaire. At 3 months there was a significant difference in attained score between the intervention group and the control group. Greater knowledge was achieved, especially on drug interaction, in the intervention group. In conclusion, less than 1 h of systematic education significantly improved patients' knowledge on essential issues of concomitant treatment with NSAIDs and diuretics. Knowledge of effects, side-effects and interactions of drugs is essential for self-adjustment of treatment. The method employed, which is standardised and produces a reproducible quantity of education, might be applicable to several other medical conditions. PMID:11118782

Linné, A B; Liedholm, H; Jacobsson, L



Differential major histocompatibility complex class I chain-related A allele associations with skin and joint manifestations of psoriatic disease.  


About 30% of patients with psoriasis have psoriatic arthritis (PsA), an inflammatory arthritis that can affect both axial and peripheral joints. Major histocompatibility complex class I chain-related A (MICA) alleles have previously been shown to be associated with PsA; however it is unclear whether there is a differential association of MICA alleles with skin and joint manifestations of PsA. Here, we describe a case-control study that aims to validate previously reported MICA allele associations with PsA and determine whether MICA alleles differentiate patients with PsA from those with psoriasis without PsA. Two hundred forty-nine unrelated Caucasian PsA patients, 243 psoriasis patients without arthritis, and 248 healthy controls were genotyped for 55 MICA alleles using PCR-SSP, and for human leucocyte antigen (HLA)-B and HLA-C alleles by PCR-SSO reverse line blot. Allele frequencies were calculated and logistic regressions were performed, adjusting for HLA-B and HLA-C alleles previously shown to be associated with psoriasis and/or PsA. Several MICA alleles were associated with psoriatic disease, PsA, and psoriasis compared with controls, and PsA compared with psoriasis in univariate analyses. Haplotype analysis showed evidence of strong linkage disequilibrium (LD) between PsA and psoriasis risk alleles of HLA-C, HLA-B, and MICA. After adjusting for significant HLA-B and HLA-C alleles in multivariate analyses, MICA*016 remained significantly associated with psoriasis [odds ratio (OR) = 5.5, P = 0.008]. MICA*00801 homozygosity was associated with susceptibility to PsA when compared with patients with psoriasis alone (OR = 2.26, P = 0.009). We conclude that most MICA allele associations with psoriasis and PsA are dependent on LD with HLA-B and HLA-C risk alleles. Independent of HLA, only MICA*016 influences the risk of developing psoriasis without arthritis, and homozygosity for MICA*00801 increases the risk of developing PsA in patients with psoriasis. PMID:21457151

Pollock, R; Chandran, V; Barrett, J; Eder, L; Pellett, F; Yao, C; Lino, M; Shanmugarajah, S; Farewell, V T; Gladman, D D



Importance of intestinal mucosal immunity and luminal bacterial cell wall polymers in the aetiology of inflammatory joint diseases.  


The distal intestine contains bacterial cell wall polymers capable of inducing acute and chronic polyarthritis if systemically distributed. Parenteral injection of peptidoglycan-polysaccharide (PG-PS) polymers from certain bacterial species produces spontaneously relapsing erosive synovitis in susceptible rat strains, and normally subarthropathic amounts of PG-PS and lipopolysaccharide (endotoxin) can reactivate arthritis initially induced by PG-PS. These experimental results illustrate the inflammatory potential of luminal bacterial products and the importance of genetically determined host susceptibility factors in the pathogenesis of arthritis. Normally, luminal complexing by secretory IgA and an intact epithelial barrier limits uptake of luminal antigen; however, intestinal inflammation enhances mucosal uptake and systemic distribution of potentially injurious macromolecules, including PG-PS and lipopolysaccharide. Occult intestinal inflammation, which may be related to non-steroidal anti-inflammatory drugs or may be disease-associated, occurs in approximately two thirds of patients with rheumatoid arthritis, idiopathic reactive arthritis and ankylosing spondylitis. Enhanced mucosal permeability to macromolecules occurs in rheumatoid arthritis, enteric infections and idiopathic inflammatory bowel disease. Intestinal inflammation is associated with increased mucosal IgG production and circulating immune complexes. Hyperactive IgA synthesis occurs in many types of inflammatory joint disease. Polyclonal IgA is increased in rheumatoid arthritis, Sjögren's syndrome, ankylosing spondylitis, Reiter's syndrome, and reactive arthritis following Yersinia infection. Anti-Klebsiella IgA cross-reacts with HLA-B27 antigen, and antibodies to enteric bacteria are able to lyse lymphocytes from HLA-B27 patients with ankylosing spondylitis. Anti-Yersinia IgA is produced at the mucosa in increased quantities in patients who develop arthritis following Yersinia enteritis, possibly as a consequence of defective cellular immunity. Serum concentrations of IgA correlate with activity of rheumatoid arthritis and ankylosing spondylitis, and serum IgA immune complexes are associated with rheumatoid vasculitis, suggesting that IgA contributes to the pathogenesis of arthritis. We speculate that intestinal injury may also induce or perpetuate arthritis by systemic distribution of inflammatory mediators produced by intestinal immune effector cells. PMID:2670253

Sartor, R B



Direct Toll-like receptor 2 mediated co-stimulation of T cells in the mouse system as a basis for chronic inflammatory joint disease  

Microsoft Academic Search

The pathogenesis of chronic inflammatory joint diseases such as adult and juvenile rheumatoid arthritis and Lyme arthritis is still poorly understood. Central to the various hypotheses in this respect is the notable involvement of T and B cells. Here we develop the premise that the nominal antigen-independent, polyclonal activation of preactivated T cells via Toll-like receptor (TLR)-2 has a pivotal

Vera Sobek; Nico Birkner; Ingrid Falk; Andreas Würch; Carsten J Kirschning; Hermann Wagner; Reinhard Wallich; Marinus C Lamers; Markus M Simon



Reconstruction of the trapeziometacarpal joint in inflammatory joint disease using interposition of autologous tendon or poly-L-D-lactic acid implants: a prospective clinical trial.  


Interposition arthroplasty with bioreplaceable poly-L-D-lactic acid (PLDLA) implants has yielded promising results in reconstruction of rheumatoid hands. In this prospective clinical study we compared the PLDLA implant arthroplasty (n = 17) with that of tendon interposition (n = 12) for destruction of the trapeziometacarpal joint in arthritic patients. There was no significant difference between the two groups preoperatively. At one-year follow-up, the mean pain and function scores were 5 and 13 in the PLDLA group, and 19 and 43 in the tendon interposition group, respectively. At one-year follow-up the visual analogue scale (VAS) for function of the PLDLA group differed significantly from that of the tendon interposition group (p = 0.03). This difference was not found at three months postoperatively, and disappeared again at two-year follow-up. Otherwise, no significant difference was found between the groups in the pain or function scores, functional tests, or range of movement. Bioreplaceable interposition arthroplasty works at least as well as tendon interposition. The operation is easier. PMID:22471260

Tiihonen, Raine P; Skyttä, Eerik T; Kaarela, Kalevi; Ikävalko, Mikko; Belt, Eero A



[Dentofacial Orthopedics to treat facial asymmetries before six years of age. How to balance craniofacial growth and enhance temporomandibular function].  


Minor facial asymmetries that can be detected in newborn infants indicate that facial growth for this child will also be asymmetric. When practitioners observe a displacement of the mandible in temporary dentition it probably indicates the presence of asymmetric masticatory function and they should look for an inter-temporal axial asymmetry by tracing cutaneous landmarks in the vicinity of the external ears. If they find the possible presence of asymmetric remodeling of glenoid fossas, they have to anticipate future temporo-mandibular disorders. By using a measurement grid (Orthogrille type) placed on the teeth of the upper plaster cast, they can assess sagittal and transverse status of the temporary teeth. If indicated, they can use acrylic plates fitted with sectional distalizing or expansion screws designed for full or partial arch correction. They can also modify the upper occlusal plane inclination by using acrylic bite blocks that keep all of the teeth from occluding and thus allow the displaced mandible to return to symmetrical movements during mastication and at the same time allow the temporal bones to remodel symmetrically. Finally, they can re-center the two dental arches and their midlines with a Frankel re-centering device that will also restore harmony to respiratory and vocalization functions. Thanks to this type of orthopedic treatment carried out for patients before they reach the age of six the asymmetric direction of their facial growth will become normal and the functioning of their temporo-mandibular joints will become optimal. PMID:20712975

Deshayes, Marie-Josèphe



Treatment of patients with temporomandibular disorders – a retrospective treatment comparison  

Microsoft Academic Search

Summary  PURPOSE: Effectiveness of splint therapy or exercise therapy has been discussed controversially in literature. This retrospective\\u000a study was intended to compare effectiveness of splint therapy or exercise therapy alone or with a combination of both methods.\\u000a MATERIAL OR PATIENTS AND METHODS: The study evaluated 97 patients from the Clinic of Temporomandibular Dysfunction. Pain sensation,\\u000a muscle pain on palpation, mouth opening

M. Schmid-Schwap; M. Bristela; M. Kundi; E. Piehslinger



Nonpharmacologic approaches to the management of myofascial temporomandibular disorders  

Microsoft Academic Search

The temporomandibular disorders (TMDs) are a heterogeneous group of painful musculoskeletal conditions that include masticatory\\u000a muscle pain. TMD is a common condition but its etiology is, as yet, poorly understood. Although TMD can be quite disabling,\\u000a most patients presenting with symptoms improve regardless of treatment type. This article focuses on nonpharmacologic treatments\\u000a for TMD; recent articles on etiology, assessment, and

Jeffrey J. Sherman; Dennis C. Turk



The time-averaged inflammatory disease activity estimates the progression of erosions in MRI of the sacroiliac joints in ankylosing spondylitis.  


A method to estimate the individual ankylosing spondylitis (AS) patient radiological progression of semi-quantitative magnetic resonance imaging (MRI) changes in the sacroiliac joints has not been described yet, which this study examines. Inflammatory disease activity and MRIs of the sacroiliac joints of 38 patients with recent onset established AS were analyzed at baseline and during follow-up. Sacroiliac MRIs were semi-quantitatively assessed using a modification of the "Spondylarthritis Research Consortium of Canada" (SPARCC) method. In each patient, the annual inflammatory disease activity was estimated by the time-averaged C-reactive protein (CRP; mg/l), calculated as the area under the curve. The mean (SD) CRP decreased from 1.3 (1.8) at baseline to 0.5 (0.6) at follow-up MRI (p < 0.04), which has been performed after a mean (SD) disease course of 2.8 (1.5) years. The mean (SD) annual increase (?) of SPARCC score from baseline to follow-up MRI was 0.4 (0.4). Baseline individual SPARCC sub-score for bone marrow edema did not statistically significantly correlate with individual ?SPARCC sub-score for erosions (p = N.S.). The individual AS patient correlation between annual time-averaged inflammatory disease activity and each annual ?SPARCC sub-scores was only statistically significant for erosions (p < 0.01; r = 0.71). Our results show that bone marrow edema and contrast-medium enhancement at baseline do not relate to the progression of erosions but the calculation of the individual patient annual time-averaged inflammatory disease activity allows to estimate the annual progression of erosions in sacroiliac MRIs of patients with AS. PMID:22422197

Wick, Marius C; Grundtman, Cecilia; Weiss, Rüdiger J; Gruber, Johann; Kastlunger, Martin; Jaschke, Werner; Klauser, Andrea S



Autogeneous coronoid process as free graft for reconstruction of mandibular condyle in patients with temporomandibular ankylosis.  


OBJECTIVE: This study was conducted to determine the efficacy of using the autogeneous coronoid process as free graft for reconstruction of mandibular condyle and to achieve structural, functional, as well as esthetic rehabilitation of patients with temporomandibular joint (TMJ) ankylosis. MATERIALS AND METHODS: This article presents the clinical results of an evaluation of ten cases of TMJ ankylosis treated by using autogeneous coronoid process as free graft for reconstruction of mandibular condyle after resection of ankylotic mass. RESULTS: Satisfactory mouth opening were obtained in all ten cases. No patient showed signs of re-ankylosis at 12 months follow-up. Preoperative mouth opening ranged from 0 to 15 mm with mean being 4.8 mm. As a result of successful procedure, the immediate postoperative mouth opening increased ranging from 24 to 31 mm (mean, 26.5 mm). Follow up of patients at the first and 12th month showed good results with increase in mouth opening from a range of 24 to 31 mm (mean, 27.8 mm ) to 26 to 36 mm (mean, 33.13 mm). CONCLUSION: The results of this study suggest that the autogeneous coronoid process as free graft is a suitable graft material for reconstruction of mandibular condyle after resection of ankylotic mass. PMID:23686355

Hu, Weihsin; Thadani, Sandeep; Mukul, Sailesh Kumar; Sood, Ramita



Qualitative study of young, adult, and aged Wistar rats temporomandibular synovial membrane employing light, scanning, and transmission electron microscopy.  


The aim of this study was to analyze the rat temporomandibular joint (TMJ) synovial membrane at different ages using light, scanning, and transmission electron microscopy. Under light microscopic analysis, the TMJ structures were observed such as condyle, capsule, disk, the synovial membrane collagen type, and cells distribution. In the scanning electron microscopy, the synovial membrane surface exhibited a smooth aspect in young animals and there was an increase with ageing in the number of folds. The transmission electron microscopic analysis showed more synoviocytes in the synovial layer in the young group and still a great number of vesicles and cisterns dilation of rough endoplasmic reticulum in the aged group. In the three groups, a dense layer of collagen fibers in the synovial layer and cytoplasmic extensions were clearly seen. It was possible to conclude that synovial membrane structures in aged group showed alterations contributing to the decrease in joint lubrication and in the sliding between disk and joint surfaces. These characteristic will reflect in biomechanics of chewing, and may cause the TMJ disorders, currently observed in clinical processes. PMID:22791633

Duro, Christiano Cony; Ciena, Adriano Polican; De Almeida, Sonia Regina Yokomizo; Righetti, Marta Maria Da Silva; Grisolia, Débora De Freitas; Issa, João Paulo Mardegan; Da Silva, Marcelo Cavenaghi Pereira; Watanabe, Ii-Sei



Validity of the Research Diagnostic Criteria for Temporomandibular Disorders Axis I in clinical and research settings.  


The lack of standardized diagnostic criteria for defining clinical subtypes of temporomandibular disorders (TMD) was the main motive to create the Research Diagnostic Criteria for TMD (RDC/TMD), which were provided to allow standardization and replication of research into the most common forms of muscle- and joint-related TMD. The RDC/TMD offered improvement compared to the older literature: the use of one system classifying TMD subgroups and the introduction of a dual-axis classification. The aim of this Focus Article is to appraise the RDC/TMD Axis I (physical findings). Since the original publication in 1992, no modification of the RDC/TMD has taken place, although research has yielded important new findings. The article outlines several concerns, including diagnostic issues in Axis I, classification criteria, feasibility of palpation sites, the myofascial diagnostic algorithm, the lack of joint tests (compression, traction), and missing subgroups. Using a gold standard examiner may improve calibration and offer better reliability; it does not improve any of the diagnostic validity issues. It is also noted that in the 2004 mission statement of the International Consortium For RDC/TMD-Based Research, the RDC/TMD are also advocated for clinical settings. Clinicians may eagerly embrace the RDC/TMD, believing that the clinical use of the RDC/TMD as a diagnostic procedure is already supported by evidence, but its application is not indicated in clinical settings. The article concludes that given the research developments, there is a need to update the RDC/TMD Axis I in the clinical research setting. PMID:19264032

Steenks, Michel H; de Wijer, Anton



Joint aspiration and injection.  


Joint aspiration/injection is an invaluable procedure for the diagnosis and treatment of joint disease. The knee is the commonest site to require aspiration although any non-axial joint is accessible for obtaining synovial fluid. Septic arthritis and crystal arthritis can be readily diagnosed by aspirating synovial fluid. Intra-articular injection of long-acting insoluble corticosteroids produces rapid resolution of inflammation in most injected joints and is a well established procedure in rheumatological practice. The technique involves only a knowledge of basic anatomy and should not be unduly painful for the patient. Provided sterile equipment and a sensible, aseptic approach are used it is a safe procedure. This chapter addresses the indications, technical principals, expected benefits and risks of intra-articular corticosteroid injection. The use of other intra-articular injections including osmic acid, radioisotopes and hyaluronic acid, which are less universally utilised than intra-articular corticosteroid, will also be addressed. PMID:15939363

Courtney, Philip; Doherty, Michael



Ceramic joints  


Butt joints between materials having different coefficients of thermal expansion are prepared having a reduced probability of failure of stress facture. This is accomplished by narrowing/tapering the material having the lower coefficient of thermal expansion in a direction away from the joint interface and not joining the narrow-tapered surface to the material having the higher coefficient of thermal expansion.

Miller, Bradley J. (Worcester, MA); Patten, Jr., Donald O. (Sterling, MA)



Influenza delle infiltrazioni intra-articolari con acido ialuronico sugli indici clinici e sui livelli di ossido nitrico nell'artrosi temporomandibolare Influence of intra-articular injections of sodium hyaluronate on clinical features and synovial fluid nitric oxide levels of temporomandibular osteoarthritis  

Microsoft Academic Search

SUMMARY Objective: This study was designed to assess the effect of intra-articular injection of sodium hyaluronate (SH) on clin- ical findings of temporomandibular osteoarthritis (OA) and on synovial fluid (SF) levels of nitric oxide (NO). Methods: Twenty seven patients (7 men, 20 women, mean (SD) age 53.9 (11.8) years) with OA of the temporo- mandibular joint were randomly allocated to

L. Guarda Nardini; F. Oliviero; R. Ramonda; G. Ferronato


Orofacial manual therapy improves cervical movement impairment associated with headache and features of temporomandibular dysfunction: a randomized controlled trial.  


There is evidence that temporomandibular disorder (TMD) may be a contributing factor to cervicogenic headache (CGH), in part because of the influence of dysfunction of the temporomandibular joint on the cervical spine. The purpose of this randomized controlled trial was to determine whether orofacial treatment in addition to cervical manual therapy, was more effective than cervical manual therapy alone on measures of cervical movement impairment in patients with features of CGH and signs of TMD. In this study, 43 patients (27 women) with headache for more than 3-months and with some features of CGH and signs of TMD were randomly assigned to receive either cervical manual therapy (usual care) or orofacial manual therapy to address TMD in addition to usual care. Subjects were assessed at baseline, after 6 treatment sessions (3-months), and at 6-months follow-up. 38 subjects (25 female) completed all analysis at 6-months follow-up. The outcome criteria were: cervical range of movement (including the C1-2 flexion-rotation test) and manual examination of the upper 3 cervical vertebra. The group that received orofacial treatment in addition to usual care showed significant reduction in all aspects of cervical impairment after the treatment period. These improvements persisted to the 6-month follow-up, but were not observed in the usual care group at any point. These observations together with previous reports indicate that manual therapists should look for features of TMD when examining patients with headache, particularly if treatment fails when directed to the cervical spine. PMID:23415640

von Piekartz, Harry; Hall, Toby



A Case Report of the Symptom-Relieving Action of an Anterior Flat Plane Bite Plate for Temporomandibular Disorder  

PubMed Central

Splint therapy is a widely used modality for temporomandibular disorders (TMDs). However, questions remain regarding the mechanism of symptom relief. Recently, a relation between TMD and a discrepancy between the habitual occlusal position (HOP) and the anterior flat plane bite plate-induced occlusal position (BPOP) has been reported. Therefore, to understand the mechanism of the symptom relief associated with the use of a bite plate, the changes in both the HOP and BPOP values were observed during anterior bite plate treatment in a patient with TMD. Case presentation Anterior bite plate treatment was started in a patient complaining of arthralgia. A discrepancy between the HOP and BPOP values was recorded three days after the first visit; this discrepancy disappeared on day 6, and the disappearance was maintained between days 6 and 12. The disappearance was associated with a decrease in the severity of the patient’s symptoms; however, the discrepancy reappeared after 15 days, coinciding with the complete disappearance of the patient’s symptoms. Therefore, the effect of the bite plate on the resolution of the discrepancy between the HOP and BPOP values was interpreted as being unsustainable and occlusal equilibration for the BPOP was performed at 17 days. Thereafter, neither a discrepancy in the HOP and BPOP values nor any symptoms of TMD (right temporomandibular joint pain or limited jaw opening) reoccurred during a two-year follow-up period. Conclusion Within the limitations of the present study, the symptom-relieving action of an anterior flat plane bite plate on the resolution of occlusal discrepancy appeared to be temporary. This outcome supports previously reported conclusions that the effectiveness of stabilization splint therapy for reducing symptoms in patients with pain dysfunction syndrome does not differ significantly from that of other conservative therapies or of no treatment at all.

Torii, Kengo; Chiwata, Ichiro



Chronic disease projections in heterogeneous ageing populations: approximating multi-state models of joint distributions by modelling marginal distributions.  


To quantify the effects of changes in risk factors for chronic diseases on morbidity and mortality, Markov-type multi-state models are used. However, with multiple risk factors and many diseases relating to these risk factors, these models contain a large number of states. In this paper, we present an alternative modelling methodology implemented in the National Institute for Public Health and the Environment chronic disease model. This model includes multiple states based on risk factor levels and disease stages but only keeps track of the marginal probability values. Starting from the multi-state model, differential equations are derived that describe the change of the marginal distribution for each risk factor class and disease stage, taking into account population heterogeneity and competing mortality risks. The model is illustrated by presenting results of a scenario affecting disease incidence by altering the risk factor distribution of the population. To show the strength of the approximating model, we compare its results to those of the multi-state Markov model. PMID:19516046

Hoogenveen, Rudolf T; van Baal, Pieter H M; Boshuizen, Hendriek C



Temporomandibular disorders, otologic symptoms and depression levels in tinnitus patients.  


The aim of this study was to determine the prevalence of signs and symptoms of temporomandibular disorders (TMD) and otologic symptoms in patients with and without tinnitus. The influence of the level of depression was also addressed. The tinnitus group was comprised of 100 patients with tinnitus, and control group was comprised of 100 individuals without tinnitus. All subjects were evaluated using the research diagnostic criteria for temporomandibular disorders (RDC/TMD) to determine the presence of TMD and depression level. Chi-square, Spearman Correlation and Mann-Whitney tests were used in statistical analysis, with a 5% significance level. TMD signs and symptoms were detected in 85% of patients with tinnitus and in 55% of controls (P?0·001). The severity of pain and higher depression levels were positively associated with tinnitus (P?0·001). It was concluded that tinnitus is associated with TMD and with otalgia, dizziness/vertigo, stuffy sensations, hypoacusis sensation and hyperacusis, as well as with higher depression levels. PMID:22035253

Hilgenberg, P B; Saldanha, A D D; Cunha, C O; Rubo, J H; Conti, P C R



Joint Replacement (Finger and Wrist Joints)  


... mean to have a “joint replacement” or an “artificial joint”? The abnormal bone and lining structures of ... When should joint replacement surgery NOT be done? Artificial joints should not be done when: There is ...


The joint modeling of a longitudinal disease progression marker and the failure time process in the presence of cure  

Microsoft Academic Search

SUMMARY In this paper we present an extension of cure models: to incorporate a longitudinal disease progression marker. The model is motivated by studies of patients with prostate cancer undergoing radiation therapy. The patients are followed until recurrence of the prostate cancer or censoring, with the PSA marker measured intermittently. Some patients are cured by the treatment and are immune




A Painless and Constraint-free Method to Estimate Viscoelastic Passive Dynamics of Limbs' Joints to Support Diagnosis of Neuromuscular Diseases  

Microsoft Academic Search

Though seldom identified, the human joints dynamics is important in the fields of medical robotics and medical research. We present a general solution to estimate in-vivo and simultaneously the passive dynamics of the human limbs' joints. It is based on the use of the multi-body description of the human body and its kinematics and dynamics computations. The linear passive joint

Gentiane Venture; Yoshihiko Nakamura; Katsu Yamane; Masaya Hirashima



Septic arthritis of the acromioclavicular joint  

Microsoft Academic Search

A patient with isolated pyogenous arthritis of the acromioclavicular joint (A-C joint) caused by Streptococcus viridans is described. The patient had no underlying disease. Minor trauma preceded shortly the development of the septic process. The patient was treated successfully with surgical drainage and antibiotics. To our knowledge this is the first case report of septic arthritis of the A-C joint

A. Blankstein; J. L. Amsallem; E. Rubinstein; H. Horoszowski; I. Farin



The Germfree State Prevents Development of Gut and Joint Inflammatory Disease in HLA-B27 Transgenic Rats  

Microsoft Academic Search

Summary A number of inflammatory disease states occur with greatly increased frequency in individuals inheriting the human major histocompatibility complex class I allele HLA-B2Z In a minority of cases, namely those with B27-associated reactive arthritis, there is good evidence that the dis- ease state is triggered by infection with an enteric or genitourinary bacterial pathogen. For the majority of B27-associated

Joel D. Tautog; James A. Richardson; JoAnne T. Croft; William A. Simmons; S Ming Zhou


Citrullinated proteins have increased immunogenicity and arthritogenicity and their presence in arthritic joints correlates with disease severity  

Microsoft Academic Search

Autoantibodies directed against citrulline-containing proteins have an impressive specificity of nearly 100% in patients with rheumatoid arthritis and have been suggested to be involved in the disease pathogenesis. The targeted epitopes are generated by a post-translational modification catalysed by the calcium-dependent enzyme peptidyl arginine deiminase (PAD), which converts positively charged arginine to polar but uncharged citrulline. The aim of this

Karin Lundberg; Suzanne Nijenhuis; Erik R Vossenaar; Karin Palmblad; Walter J van Venrooij; Lars Klareskog; A. J. W. Zendman; Helena Erlandsson Harris



High resolution ultrasound investigation of the temporomandibular joint in patients with chronic polyarthritis  

Microsoft Academic Search

40 patients with chronic polyarthritis were investigated prospectively. The TMJ was investigated to detect clicking, crepitation, and pain. High resolution ultrasound (HR-US) assessed destructive changes, effusion, and disc dislocation. The results of the clinical investigation and the HR-US investigation were compared using the ?2 test. The statistical calculation of the correlation between the HR-US results and the clinical TMJ investigation

S. Jank; A. Zangerl; F. R. Kloss; K. Laimer; M. Missmann; D. Schroeder; E. Mur



The regional difference of viscoelastic property of bovine temporomandibular joint disc in compressive stress-relaxation  

Microsoft Academic Search

An in vitro experimental technique was performed to measure the viscoelastic properties of the bovine disc. Thirteen TMJ discs from young cattle (3-year-old) were used. Each disc was divided into five specimens of anterior, central, posterior, lateral and medial regions, and they were used for compression tests. A series of stress-relaxation tests was conducted for each specimen from 5% strain

R. del Pozo; E. Tanaka; M. Tanaka; M. Okazaki; K. Tanne



Consequences of fiducial marker error on three-dimensional computer animation of the temporomandibular joint  

NASA Astrophysics Data System (ADS)

Jaw motion has been used to diagnose jaw pain patients, and we have developed a 3D computer animation technique to study jaw motion. A customized dental clutch was worn during motion, and its consistent and rigid placement was a concern. The experimental protocol involved mandibular movements (vertical opening) and MR imaging. The clutch contained three motion markers used to collect kinematic data and four MR markers used as fiducial markers in the MR images. Fiducial marker misplacement was mimicked by analytically perturbing the position of the MR markers +/- 2, +/- 4, and +/- 6 degrees in the three anatomical planes. The percent difference between the original and perturbed MR marker position was calculated for kinematic parameters. The maximum difference across all perturbations for axial rotation, coronal rotation, sagittal rotation, axial translation, coronal translation, and sagittal translation were 176.85%, 191.84%, 0.64%, 9.76%, 80.75%, and 8.30%, respectively, for perturbing all MR markers, and 86.47%, 93.44%, 0.23%, 7.08%, 42.64%, and 13.64%, respectively, for perturbing one MR marker. The parameters representing movement in the sagittal plane, the dominant plane in vertical opening, were determined to be reasonably robust, while secondary movements in the axial and coronal planes were not considered robust.

Leader, J. Ken; Boston, J. Robert; Rudy, Thomas E.; Greco, Carol M.; Zaki, Hussein S.



Consequences of fiducial marker error on three-dimensional computer animation of the temporomandibular joint  

Microsoft Academic Search

Jaw motion has been used to diagnose jaw pain patients, and we have developed a 3D computer animation technique to study jaw motion. A customized dental clutch was worn during motion, and its consistent and rigid placement was a concern. The experimental protocol involved mandibular movements (vertical opening) and MR imaging. The clutch contained three motion markers used to collect

J. Ken Leader; J. Robert Boston; Thomas E. Rudy; Carol M. Greco; Hussein S. Zaki



P2X(7) receptor-mediated release of cathepsins from macrophages is a cytokine-independent mechanism potentially involved in joint diseases.  


The ATP-gated P2X(7) receptor (P2X(7)R) is a promising therapeutic target in chronic inflammatory diseases with highly specific antagonists currently under clinical trials for rheumatoid arthritis. Anti-inflammatory actions of P2X(7)R antagonists are considered to result from inhibition of P2X(7)R-induced release of proinflammatory cytokines from activated macrophages. However, P2X(7)Rs are also expressed in resting macrophages, suggesting that P2X(7)R may also signal via cytokine-independent mechanisms involved in joint disease. In this study, we examined P2X(7)R function in resting human lung macrophages and mouse bone marrow-derived macrophages and found that ATP induced rapid release of the lysosomal cysteine proteases cathepsin B, K, L, and S and that was independent of the presence of the proinflammatory cytokines IL-1beta and IL-18. Cathepsins released into the medium were effective to degrade collagen extracellular matrix. ATP-induced cathepsin release was abolished by P2X(7)R antagonists, absent from P2X(7)R(-/-) mouse macrophages, and not associated with cell death. Our results suggest P2X(7)R activation may play a novel and direct role in tissue damage through release of cathepsins independently of its proinflammatory actions via IL-1 cytokines. PMID:20639492

Lopez-Castejon, Gloria; Theaker, Jill; Pelegrin, Pablo; Clifton, Andrew D; Braddock, Martin; Surprenant, Annmarie



Tumor necrosis factor receptor-associated periodic syndrome (TRAPS): definition, semiology, prognosis, pathogenesis, treatment, and place relative to other periodic joint diseases.  


Tumor necrosis factor receptor-associated periodic syndrome (TRAPS) is an autosomal dominant inherited condition of periodic fever and pain. Most patients are of northern European descent. The attacks manifest as fever and pain in the joints, abdomen, muscles, skin, or eyes, with variations across patients. An acute-phase response occurs during the attacks. Patients with TRAPS are at risk for AA amyloidosis, the most common targets being the kidneys and liver. Soluble TNFRSF1A is usually low between the attacks and may be normal during the attacks, when TNF levels are high. TNFRSF1A is found in abnormally high numbers on leukocyte cell membranes. TRAPS is the first condition for which naturally occurring mutations in a TNF receptor were found; the mutations affect the soluble TNFRSF1A gene in the 12p13 region. In some patients, the pathogenesis involves defective TNFRSF1A shedding from cell membranes in response to a given stimulus. Thus, TRAPS is a model for a novel pathogenic concept characterized by failure to shed a cytokine receptor. This review compares TRAPS to other inherited periodic febrile conditions, namely, familial Mediterranean fever, Muckle-Wells syndrome, cold urticaria, and hyper-IgD syndrome. The place of TRAPS relative to other intermittent systemic joint diseases is discussed. Colchicine neither relieves nor prevents the attacks, whereas oral glucocorticoid therapy is effective when used in dosages greater than 20 mg/day. The pathogenic hypothesis involving defective TNFRSF1A shedding suggests that medications targeting TNF may be effective in TRAPS. PMID:15288852

Masson, Charles; Simon, Virginie; Hoppé, Emmanuel; Insalaco, Paolo; Cissé, Idrissa; Audran, Maurice



Research Diagnostic Criteria for Temporomandibular Disorders: Reliability of Axis I Diagnoses and Selected Clinical Measures  

PubMed Central

AIM To estimate inter-examiner reliability of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) protocol. METHODS Kappa (k), computed by generalized estimate equation procedures, was selected as the primary estimate of inter-examiner reliability. Intersite reliability of six examiners from 3 study sites was assessed annually over the 5-year period of the RDC/TMD Validation Project. Intrasite reliability was monitored throughout the validation study by comparing RDC/TMD data collections performed on the same day by the test examiner and a criterion examiner. RESULTS Intersite calibrations included a total of 180 subjects. Intersite reliability of RDC/TMD diagnoses was excellent (k > 0.75) when myofascial pain diagnoses (Ia or Ib) were grouped. Good reliability was observed for discrete myofascial pain diagnoses, Ia (k = 0.62) and Ib (k = 0.58), for disc displacement with reduction (k = 0.63), disc displacement without reduction with limited opening (k = 0.62), arthralgia (k = 0.55), and when joint pain (IIIa or IIIb) was grouped (k = 0.59). Reliability of less frequently observed diagnoses such as disc displacements without reduction without limited opening, and osteoarthrosis (IIIb, IIIc), was poor to marginally fair (k = 0.31- 0.43). Intrasite monitoring results (n = 705) approximated well intersite reliability estimates. The greatest difference in paired estimates was 0.18 (IIc). CONCLUSION Reliability of the RDC/TMD protocol was good to excellent for myofascial pain, arthralgia, disc displacement with reduction, and disc displacement without reduction with limited opening. Reliability was poor to marginally fair for disc displacement without reduction without limited opening and osteoarthrosis.

Look, John O.; John, Mike T.; Tai, Feng; Huggins, Kimberly H.; Lenton, Patricia A.; Truelove, Edmond L.; Ohrbach, Richard; Anderson, Gary C.; Schiffman, Eric L.



Jacob's disease: report of a rare case and literature review.  


Jacob's disease is a rare condition consisting of pseudojoint formation between enlarged coronoid process and the inner surface of the zygoma. The authors report a 45-year-old female patient who presented with limited mouth opening (5 mm) and swelling of the left zygoma. No temporomandibular joint disease was diagnosed. 3D computed tomography images showed a mushroom-shaped coronoid growth with pseudojoint formation medial and superior to the zygomatic arch. Under general anaesthesia, coronoidectomy was carried out through a combined extraoral and intraoral approach. Histopathological examination revealed normal trabecular bone covered with hyaline cartilage. To the best of the authors' knowledge this case is the fifth typical mushroom-shaped Jacob's disease; only four similar cases have been reported. A review of the literature revealed only 39 histologically proved cases of Jacob's disease cases up to 2010. Aggressive physical treatment was given to improve function and maximum mouth opening, which had increased to 40 mm at 3 months follow-up. The literature concerning this condition's aetiology, pathogenesis, clinical characteristics, diagnosis, and treatment is reviewed. PMID:21411289

Sreeramaneni, Sumanth K; Chakravarthi, P S; Krishna Prasad, L; Raja Satish, P; Beeram, Ratna K



Oral appliances in the management of temporomandibular disorders.  


Various types of oral appliances (OAs) have been used for over half a century to treat temporomandibular disorders (TMDs), but there has been considerable debate about how OAs should be designed, how they should be used, and what they actually do therapeutically. However, there is enough information in the scientific literature at this time to reach some evidence-based conclusions about these issues. The main focus of this review is on the materials and designs of various OAs in terms of their proposed mechanisms of action and their claimed clinical objectives. Based on current scientific evidence, an analysis is presented regarding the role that OAs can or cannot play in the management of TMDs. Finally, the concept that OAs may be an effective treatment modality for some TMDs owing to their potential for acting as an elaborate placebo rather than any specific therapeutic mechanism is considered. PMID:19138639

Klasser, Gary D; Greene, Charles S



Management and Treatment of Temporomandibular Disorders: A Clinical Perspective  

PubMed Central

A temporomandibular disorder (TMD) is a very common problem affecting up to 33% of individuals within their lifetime. TMD is often viewed as a repetitive motion disorder of the masticatory structures and has many similarities to musculoskeletal disorders of other parts of the body. Treatment often involves similar principles as other regions as well. However, patients with TMD and concurrent cervical pain exhibit a complex symptomatic behavior that is more challenging than isolated TMD symptoms. Although routinely managed by medical and dental practitioners, TMD may be more effectively cared for when physical therapists are involved in the treatment process. Hence, a listing of situations when practitioners should consider referring TMD patients to a physical therapist can be provided to the practitioners in each physical therapist's region. This paper should assist physical therapists with evaluating, treating, insurance billing, and obtaining referrals for TMD patients.

Wright, Edward F.; North, Sarah L.



Alexithymia partly predicts pain, poor health and social difficulties in patients with temporomandibular disorders.  


Temporomandibular disorders (TMD) are functional diseases of the masticatory system; their symptoms are clicking, difficulty opening the mouth wide, ear pain, facial pain and headaches. The relationships among distress, emotional factors and TMD are well known. It was shown that patients with TMD have little awareness of their inner states and emotions, and it was found that those reporting oro-facial pain presented higher alexithymia than did asymptomatic people. Other authors confirmed that alexithymia was higher in the painful TMD group than controls. This study was aimed to evaluate whether alexithymia and its components can be considered as predisposing factors for pain severity, poor health and greater social difficulties in patients with TMD. One hundred thirty-three patients received a diagnosis of TMD and completed the 20-item Toronto Alexithymia Scale. Multiple stepwise regressions showed that alexithymia and age explained 10% of the pain and 31% of poor health and also that alexithymia explained 7% of social difficulty. A direct comparison of patients with TMD based on alexithymia revealed a higher presence of pain in alexithymic patients with TMD than in those characterised by moderate or no alexithymia. In conclusion, alexithymia partly predicts pain, poor health and social difficulties in patients with TMD. Furthermore, alexithymic patients have more pain than those with moderate or low alexithymia. PMID:23869944

Mingarelli, A; Casagrande, M; Di Pirchio, R; Nizzi, S; Parisi, C; Loy, B C; Solano, L; Rampello, A; Di Paolo, C



A pilot study comparing the efficacy of hard and soft stabilizing appliances in treating patients with temporomandibular disorders  

Microsoft Academic Search

Statement of problem. Soft and hard stabilizing appliances have been used to treat temporomandibular disorders. No data exist to suggest whether a hard or soft appliance is beneficial. Purpose. This study compared soft and hard acrylic resin stabilizing appliances in the reduction of masticatory muscle pain in patients with temporomandibular disorders. Materials and methods. Twenty-three patients with at least one

Craig A. Pettengill; Maurice R. Growney; Robert Schoff; Christian R. Kenworthy



Joint position statement by Spanish Society of Gastroenterology and Spanish Society of Pharmacology on biosimilar therapy for inflammatory bowel disease.  


Biological drugs or biopharmaceutical products, manufactured with or from living organisms using biotechnology, have represented a therapeutic revolution for the control of inflammatory bowel disease (IBD). At present, in this indication and in our country, only two biological are approved, infliximab (IFX) and adalimumab (ADA), both of them monoclonal antibodies against tumor necrosis factor alpha. Effectiveness data are strong for both therapies, with maximum levels of scientific evidence.The upcoming expiry date for these biologicals´ patents has allowed the potential marketing of so-called biosimilar agents for the IBD indication. While biosimilars are conceptually for biological what generics are for chemical drugs, the structural complexity of biosimilars and their biological and manufacturing variability lead to consider validation processes for these two types in humans as highly differential. Thus, in our setting, under the coverage of "Agencia Española del Medicamento y Productos Sanitarios (AEMPS)" (Spanish Agency of Medicines and Medical Devices), guidelines issued by the European Medicines Agency (EMA) are to be applied, which states that a number of stages or steps must be overcome in order to obtain approval for a biosimilar agent.However, despite the presence of these recommendations by EMA, which must be met by a biosimilar in order to be licensed in our marketplace, relevant uncertainties persist that only future decisions by EMA and AEMPS may clarify. The present stance by our task force is that biosimilar development should be undertaken according to established regulations, thus certifying their efficacy and safety. Similarly, this task force considers that results obtained from studies in rheumatoid arthritis (RA) should not be extrapolated to IBD since the biological variability of these complex structures will not ensure a lack of noticeable changes in efficacy and safety. PMID:23548008

Argüelles-Arias, F; Barreiro-de-Acosta, M; Carballo, F; Hinojosa, J; Tejerina, T



Reliability and discriminatory testing of a client-based metrology instrument, feline musculoskeletal pain index (FMPI) for the evaluation of degenerative joint disease-associated pain in cats.  


The objective of this study was to test the readability, reliability, repeatability and discriminatory ability of an owner-completed instrument to assess feline degenerative joint disease (DJD)-associated pain (feline musculoskeletal pain index, FMPI). Readability was explored using four different formulas (Flesch, Fry, SMOG and FOG) and the final FMPI instrument was produced. To assess the instrument, client-owned cats that were defined as normal (normal group) or as having DJD-associated pain and mobility impairment (pain-DJD group) were recruited. A total of 32 client-owned cats were enrolled in the study (normal, n=13; pain-DJD, n=19). Owners completed the FMPI on two occasions, 14days apart. Internal consistency (reliability) and repeatability (test-retest) were explored using Cronbach's ? and weighted ? statistic, respectively. Data from the two groups were compared using analysis of covariance (controlling for age) to evaluate discriminatory ability. The FMPI was constructed with 21 questions covering activity, pain intensity and overall quality of life. It had a 6th grade readability score. Reliability of the FMPI was excellent (Cronbach's ?>0.8 for all groupings of questions in normal and pain-DJD cats) and repeatability was good (weighted ? statistic >0.74) for normal and pain-DJD cats. All components of the FMPI were able to distinguish between normal cats and cats with DJD (P<0.001 for all components). This initial evaluation of the FMPI suggests that this instrument is worthy of continued investigation. PMID:23369382

Benito, J; Depuy, V; Hardie, E; Zamprogno, H; Thomson, A; Simpson, W; Roe, S; Hansen, B; Lascelles, B D X



The functional MICA-129 polymorphism is associated with skin but not joint manifestations of psoriatic disease independently of HLA-B and HLA-C.  


A methionine/valine polymorphism at amino acid 129 of the major histocompatibility complex class I chain-related gene A (MICA-129) categorizes alleles into strong and weak binders of the natural killer (NK) and T-cell receptor NKG2D. We investigated whether MICA-129 is differentially associated with skin and joint manifestations of psoriatic disease (PsD) independently of human leukocyte antigen (HLA)-C and HLA-B in patients and controls from Toronto and St. John's. The MICA-129 methionine (Met) allele, particularly Met/Met homozygosity, was strongly associated with both cutaneous psoriasis (PsC) and psoriatic arthritis (PsA) independently of HLA-B and HLA-C in Toronto patients, and was also associated with PsA in St. John's patients, but with no additional effect of Met/Met homozygosity. No association remained after adjustment for HLA alleles in St. John's patients. MICA-129 was not associated with PsA when compared with PsC. We conclude that MICA-129 is a marker of skin manifestations of PsD that is independent of HLA class I in Toronto patients. PMID:23611695

Pollock, R A; Chandran, V; Pellett, F J; Thavaneswaran, A; Eder, L; Barrett, J; Rahman, P; Farewell, V; Gladman, D D



Metacarpophalangeal joint arthritis.  


Arthritis of the metacarpophalangeal joint can result in considerable disability and pain. Inflammatory, posttraumatic, crystalline, and osteoarthritis are common etiologies of joint disease. A variety of nonsurgical treatment options have been shown to be effective, including activity modification, anti-inflammatory medications, splinting, and cortisone injections. In addition, newer generation disease-modifying antirheumatic drugs geared toward the treatment of rheumatoid arthritis have shown promise in retarding the inflammatory process. Another, relatively newer, conservative treatment option includes topical anti-inflammatories such as diclofenac sodium that are now approved by the Federal Drug Administration. Surgical treatment options most commonly include arthroplasty and arthrodesis. In the treatment of thumb metacarpophalangeal arthritis, arthrodesis is a popular and generally reliable surgical solution. In the fingers, arthroplasty remains the most common treatment option. Traditional constrained silicone joint replacements remain the most commonly used. Newer generation, unconstrained, surface replacement arthroplasties have shown promise in the treatment of osteoarthritis and select cases of inflammatory arthritis in which there is good bone stock, no or minimal deformity, adequate supporting soft tissues, and good disease control. PMID:21276901

Rizzo, Marco



Positive anti-citrullinated protein antibody status and small joint arthritis are consistent predictors of chronic disease in patients with very early arthritis: results from the NOR-VEAC cohort  

PubMed Central

Introduction The current 1987 American College of Rheumatology (ACR) classification criteria for rheumatoid arthritis (RA) have proven less useful in early arthritis. The objective of this study was to identify and compare predictors of three relevant outcomes of chronic arthritis in a cohort of very early arthritis patients. Methods The Norwegian Very Early Arthritis Cohort (NOR-VEAC) includes adult patients with at least one swollen joint of ?16 weeks' duration. Patients are followed for 2 years with comprehensive clinical and laboratory examinations. Logistic regression analyses were performed to determine independent predictors of three outcomes: persistent synovitis, prescription of disease-modifying anti-rheumatic drugs (DMARDs), and established clinical RA diagnosis within one year. Results Of 384 patients eligible for one year follow-up (56.3% females, mean (SD) age 45.8 (14.7) years, median (IQR) duration of arthritis 31 (10-62) days), 14.4% were anti-CCP2 positive, and 11.2% were IgM RF positive. 98 patients (25.5%) had persistent synovitis, 106 (27.6%) had received DMARD treatment during follow-up, while 68 (17.7%) were diagnosed with RA. Consistent independent predictors across all three outcomes were positive anti-citrullinated protein antibody (ACPA) status (odds ratio (OR) 3.2, 5.6 and 19.3), respectively, and small joint arthritis (proximal interphalangeal joint (PIP), metacarpo-phalangeal joint (MCP), and/or metatarso-phalangeal joint (MTP) joint swelling) (OR 1.9, 3.5, and 3.5, respectively). Conclusions Positive ACPA status and small joint arthritis were consistent predictors of three relevant outcomes of chronic arthritis in very early arthritis patients. This consistency supports DMARD prescription as a valid surrogate endpoint for chronic arthritis. Importantly, this surrogate is used in ongoing efforts to develop new diagnostic criteria for early RA.



[Recommendations for the diagnosis and treatment of latent and active tuberculosis in patients with inflammatory joint diseases treated with tumour necrosis factor alpha inhibitors].  


The Portuguese Society of Rheumatology (SPR) and the Portuguese Society of Pulmonology (SPP) have developed guidelines for the diagnosis and treatment of latent tuberculosis infection (LTBI) and active tuberculosis (AT) in patients with inflammatory joint diseases (IJD), namely rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis, treated with tumour necrosis factor alpha (TNF-alpha) antagonists. Due to the high risk of tuberculosis (TB) in patients with IJD, LTBI and AT screening should be performed as soon as possible, ideally at the moment of IJD diagnosis. Even if TB screening was performed at the beginning of the disease, the evaluation should be repeated before starting anti-TNF-alpha therapy. When TB (LTBI orAT) treatment is indicated, it should be performed before the beginning of anti-TNF-alpha therapy. If the IJD activity requires urgent anti-TNF-alpha therapy, these drugs can be started after two months of antituberculosis therapy in AT cases, or after one month in LTBI cases. Chest X-ray is mandatory for all patients. If abnormal, e.g. Gohn complex, the patient should be treated as LTBI; residual lesions require the exclusion of AT and patients with history of untreated or incomplete TB treatment should be treated as LTBI. In cases of suspected active lesions, AT diagnosis should be confirmed and adequate therapy initiated. Tuberculin skin test (TST), with two units of RT23, should be performed in all patients. If induration is less than 5 mm, the test should be repeated after 1 to 2 weeks, on the opposite forearm, and should be considered negative if the result is again inferior to 5 mm. Positive TST implicates LTBI treatment. IfTST is performed in immunosupressed IJD patients, LTBI treatment should be offered to the patient before starting anti-TNFalpha therapy, even in the presence of a negative test. PMID:17094335

Fonseca, João Eurico; Lucas, Helena; Canhão, Helena; Duarte, Raquel; Santos, Maria José; Villar, Miguel; Faustino, Augusto; Raymundo, Elena


Molecular monitoring of equine joint homeostasis  

Microsoft Academic Search

Diseases affecting synovial joints are a major cause of chronic disability both in humans and in companion animal species, most notably dogs and horses. As progressive deterioration of the articular cartilage is the hallmark of degenerative joint disease or osteoarthritis, research efforts traditionally tended to focus primarily on cartilage pathology. However, in recent years it has become clear that synovial

Janny C. de Grauw



Osteoarthritis accelerates and exacerbates Alzheimer's disease pathology in mice  

PubMed Central

Background The purpose of this study was to investigate whether localized peripheral inflammation, such as osteoarthritis, contributes to neuroinflammation and neurodegenerative disease in vivo. Methods We employed the inducible Col1-IL1?XAT mouse model of osteoarthritis, in which induction of osteoarthritis in the knees and temporomandibular joints resulted in astrocyte and microglial activation in the brain, accompanied by upregulation of inflammation-related gene expression. The biological significance of the link between peripheral and brain inflammation was explored in the APP/PS1 mouse model of Alzheimer's disease (AD) whereby osteoarthritis resulted in neuroinflammation as well as exacerbation and acceleration of AD pathology. Results Induction of osteoarthritis exacerbated and accelerated the development of neuroinflammation, as assessed by glial cell activation and quantification of inflammation-related mRNAs, as well as A? pathology, assessed by the number and size of amyloid plaques, in the APP/PS1; Col1-IL1?XAT compound transgenic mouse. Conclusion This work supports a model by which peripheral inflammation triggers the development of neuroinflammation and subsequently the induction of AD pathology. Better understanding of the link between peripheral localized inflammation, whether in the form of osteoarthritis, atherosclerosis or other conditions, and brain inflammation, may prove critical to our understanding of the pathophysiology of disorders such as Alzheimer's, Parkinson's and other neurodegenerative diseases.



Effect of Five Genetic Variants Associated with Lung Function on the Risk of Chronic Obstructive Lung Disease, and Their Joint Effects on Lung Function  

PubMed Central

Rationale: Genomic loci are associated with FEV1 or the ratio of FEV1 to FVC in population samples, but their association with chronic obstructive pulmonary disease (COPD) has not yet been proven, nor have their combined effects on lung function and COPD been studied. Objectives: To test association with COPD of variants at five loci (TNS1, GSTCD, HTR4, AGER, and THSD4) and to evaluate joint effects on lung function and COPD of these single-nucleotide polymorphisms (SNPs), and variants at the previously reported locus near HHIP. Methods: By sampling from 12 population-based studies (n = 31,422), we obtained genotype data on 3,284 COPD case subjects and 17,538 control subjects for sentinel SNPs in TNS1, GSTCD, HTR4, AGER, and THSD4. In 24,648 individuals (including 2,890 COPD case subjects and 13,862 control subjects), we additionally obtained genotypes for rs12504628 near HHIP. Each allele associated with lung function decline at these six SNPs contributed to a risk score. We studied the association of the risk score to lung function and COPD. Measurements and Main Results: Association with COPD was significant for three loci (TNS1, GSTCD, and HTR4) and the previously reported HHIP locus, and suggestive and directionally consistent for AGER and TSHD4. Compared with the baseline group (7 risk alleles), carrying 10–12 risk alleles was associated with a reduction in FEV1 (? = –72.21 ml, P = 3.90 × 10?4) and FEV1/FVC (? = –1.53%, P = 6.35 × 10?6), and with COPD (odds ratio = 1.63, P = 1.46 × 10?5). Conclusions: Variants in TNS1, GSTCD, and HTR4 are associated with COPD. Our highest risk score category was associated with a 1.6-fold higher COPD risk than the population average score.

Soler Artigas, Maria; Wain, Louise V.; Repapi, Emmanouela; Obeidat, Ma'en; Sayers, Ian; Burton, Paul R.; Johnson, Toby; Zhao, Jing Hua; Albrecht, Eva; Dominiczak, Anna F.; Kerr, Shona M.; Smith, Blair H.; Cadby, Gemma; Hui, Jennie; Palmer, Lyle J.; Hingorani, Aroon D.; Wannamethee, S. Goya; Whincup, Peter H.; Ebrahim, Shah; Smith, George Davey; Barroso, Ines; Loos, Ruth J. F.; Wareham, Nicholas J.; Cooper, Cyrus; Dennison, Elaine; Shaheen, Seif O.; Liu, Jason Z.; Marchini, Jonathan; Dahgam, Santosh; Naluai, Asa Torinsson; Olin, Anna-Carin; Karrasch, Stefan; Heinrich, Joachim; Schulz, Holger; McKeever, Tricia M.; Pavord, Ian D.; Heliovaara, Markku; Ripatti, Samuli; Surakka, Ida; Blakey, John D.; Kahonen, Mika; Britton, John R.; Nyberg, Fredrik; Holloway, John W.; Lawlor, Debbie A.; Morris, Richard W.; James, Alan L.; Jackson, Cathy M.; Hall, Ian P.



Recommendations for the diagnosis and treatment of latent and active tuberculosis in inflammatory joint diseases candidates for therapy with tumor necrosis factor alpha inhibitors: March 2008 update.  


The Portuguese Society of Rheumatology and the Portuguese Society of Pulmonology have updated the guidelines for the diagnosis and treatment of latent tuberculosis infection (LTBI) and active tuberculosis (ATB) in patients with inflammatory joint diseases (IJD) that are candidates to therapy with tumour necrosis factor alpha (TNFalpha) antagonists. In order to reduce the risk of tuberculosis (TB) reactivation and the incidence of new infections, TB screening is recommended to be done as soon as possible, ideally at the moment of IJD diagnosis, and patient assessment repeated before starting anti-TNFalpha therapy. Treatment for ATB and LTBI must be done under the care of a TB specialist. When TB treatment is indicated, it should be completed prior to starting anti-TNFalpha therapy. If the IJD activity justifies the need for immediate treatment, anti-TNFalpha therapy can be started two months after antituberculous therapy has been initiated, in the case of ATB, and one month after in the case of LTBI. Chest X-ray is mandatory for all patients. If Gohn s complex is present, the patient should be treated for LTBI; healed lesions require the exclusion of ATB. In cases of suspected active lesions ATB should be excluded/confirmed and adequate therapy initiated. Tuberculin skin test, with two units of RT23, should be performed in all patients. If the induration is <5 mm, the test should be repeated within 1 to 2 weeks, on the opposite forearm, and will be considered negative only if the result is again <5 mm. Positive TST implicates LTBI treatment, unless previous proper treatment was provided. If TST is performed in immunossuppressed IJD patients, LTBI treatment should be offered to the patient before starting anti-TNFalpha therapy, even in the presence of a negative test, after risk/benefit assessment. PMID:18344925

Fonseca, João Eurico; Lucas, Helena; Canhão, Helena; Duarte, Raquel; Santos, Maria José; Villar, Miguel; Faustino, Augusto; Raymundo, Elena


Mobilization with movement, thoracic spine manipulation, and dry needling for the management of temporomandibular disorder: A prospective case series.  


The purpose of this case series was to describe the outcomes of patients with temporomandibular disorder (TMD) treated with mobilization with movement (MWM) directed at the temporomandibular joint (TMJ) and the cervical spine, thoracic manipulation, and trigger point (TrP) dry needling. Fifteen patients with TMD completed the Steigerwald/Maher TMD disability questionnaire, the Visual Analog Scale (VAS), and maximal mouth opening (MMO) at baseline. The VAS and MMO were also collected at 15 days posttreatment and at a 2-month follow-up, and the Steigerwald/Maher TMD disability questionnaire was completed at the 2-month follow-up. Repeated measure ANOVAs were used to determine the effects of the intervention on each outcome. Within-group effect sizes were calculated in order to assess clinical effectiveness. Fifteen patients participated in this case series. The ANOVA revealed significant decreases (all, p ?? 1.0) for all outcomes at both follow-up periods. Patients with TMD treated with a multimodal treatment exhibited significant and clinical improvements in pain intensity, disability, and MMO. PMID:23687913

González-Iglesias, Javier; Cleland, Joshua A; Neto, Francisco; Hall, Toby; Fernández-de-Las-Peñas, César



Temporal Summation of Heat Pain in Temporomandibular Disorder Patients  

PubMed Central

Aims One possible mechanism underlying myofascial temporomandibular disorders (TMD) is altered central nervous system processing of painful stimuli. The current study aimed to compare TMD cases to controls on two measures of central processing, i.e., temporal summation of heat pain and decay of subsequent aftersensations, following thermal stimulation in both a trigeminal and extratrigeminal area. Methods Using a “wind-up” (WU) protocol, 19 female TMD patients and 17 controls were exposed to 15 heat stimuli at a rate of 0.3 Hz. Numeric pain ratings were elicited after the 1st, 5th, 10th and 15th stimu