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

PubMed Central

Murphy, M. K.; Arzi, B.; Vapniarsky-Arzi, N.; Athanasiou, K. A.

2013-01-01

Summary 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

Association between mandibular retrognathia and TMJ disorders in adult females.

PubMed

Miller, James R; Burgess, Jeffrey A; Critchlow, Cathy W

2004-01-01

This study assesses the association between temporomandibular joint (TMJ) disorders and mandibular retrognathia. We conducted a case-control study among women, aged 18-70 years, recruited from Kaiser Permanente Northwest Division (KPNW, Portland, OR) and Group Health Cooperative of Puget Sound (GHC, Seattle, WA). Cases (N= 160) were women seeking treatment for TMJ disorders at KPNW and GHC clinics. Controls (N=151) were women without TMJ disorders, selected from among adult female dental hygiene patients at KPNW or GHC enrollees. Case status was determined by questionnaire; mandibular sagittal position (orthognathic, mildly retrognathic, severely retrognathic, or prognathic) was measured using digitized facial photographs. Odds ratios (OR) and associated 95 percent confidence intervals (CI) estimated the magnitude of the association between TMJ disorders and mandibular sagittal position. Women with TMJ disorders were 4.0 times (95% CI=1.5, 10.8) more likely than controls to have severe retrognathia; no association with mild retrognathia or prognathia was seen. Results were similar when cases were restricted to those with recent onset of TMJ pain (OR=6.3; 95% CI=1.8, 21.8). We found a strong association between TMJ disorders and severe mandibular retrognathia in adult females. In some women this likely resulted from TMJ disorders influencing mandibular development over time. However, among a subset of women, our data support the reverse hypothesis--that severe mandibular retrognathia may influence the development of TMJ disorders. Despite this strong association, abnormal mandibular position contributed only a small portion to the overall rate at which women sought treatment for TMJ disorders.

Characterization of degenerative changes in the temporomandibular joint of the bengal tiger (Panthera tigris tigris) and siberian tiger (Panthera tigris altaica).

PubMed

Murphy, M K; Arzi, B; Vapniarsky-Arzi, N; Athanasiou, K A

2013-11-01

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. Copyright © 2013 Elsevier Ltd. All rights reserved.

Less Is Often Best in Treating TMJ Disorders

MedlinePlus

... for TMJ. There have been no long- term studies to test the safety and effectiveness of these procedures. Before considering any surgery on the jaw joint, it’s important to get opinions from other doctors and to fully understand the ...

A personalized 3D-printed prosthetic joint replacement for the human temporomandibular joint: From implant design to implantation.

PubMed

Ackland, David C; Robinson, Dale; Redhead, Michael; Lee, Peter Vee Sin; Moskaljuk, Adrian; Dimitroulis, George

2017-05-01

Personalized prosthetic joint replacements have important applications in cases of complex bone and joint conditions where the shape and size of off-the-shelf components may not be adequate. The objective of this study was to design, test and fabricate a personalized 3D-printed prosthesis for a patient requiring total joint replacement surgery of the temporomandibular joint (TMJ). The new 'Melbourne' prosthetic TMJ design featured a condylar component sized specifically to the patient and fixation screw positions that avoid potential intra-operative damage to the mandibular nerve. The Melbourne prosthetic TMJ was developed for a 58-year-old female recipient with end-stage osteoarthritis of the TMJ. The load response of the prosthesis during chewing and a maximum-force bite was quantified using a personalized musculoskeletal model of the patient's masticatory system developed using medical images. The simulations were then repeated after implantation of the Biomet Microfixation prosthetic TMJ, an established stock device. The maximum condylar stresses, screw stress and mandibular stress at the screw-bone interface were lower in the Melbourne prosthetic TMJ (259.6MPa, 312.9MPa and 198.4MPa, respectively) than those in the Biomet Microfixation device (284.0MPa, 416.0MPa and 262.2MPa, respectively) during the maximum-force bite, with similar trends also observed during the chewing bite. After trialing surgical placement and evaluating prosthetic TMJ stability using cadaveric specimens, the prosthesis was fabricated using 3D printing, sterilized, and implanted into the female recipient. Six months post-operatively, the prosthesis recipient had a normal jaw opening distance (40.0 mm), with no complications identified. The new design features and immediate load response of the Melbourne prosthetic TMJ suggests that it may provide improved clinical and biomechanical joint function compared to a commonly used stock device, and reduce risk of intra-operative nerve damage

TMJ Disorders

MedlinePlus

... referred Sally and her parents to a local dentist who specialized in jaw disorders. After examining Sally ... having symptoms of a TMJ disorder, let your dentist know. The earlier a TMJ disorder is diagnosed ...

Orthodontic Residents' Indications for Use of the Lateral TMJ Tomogram and the Posteroanterior Cephalogram.

ERIC Educational Resources Information Center

Luke, Larry S.; And Others

1997-01-01

A study of 144 patients assigned to eight orthodontic residents over two years found residents requested lateral tomograms of the temporomandibular joint (TMJ) 28% of the time, commonly citing TMJ clicking, pain, and medico-legal protection. Posteroanterior cephalograms were ordered 26% of the time, commonly for facial asymmetry and maxillary…

Temporomandibular Joint Regenerative Medicine

PubMed Central

Van Bellinghen, Xavier; Idoux-Gillet, Ysia; Pugliano, Marion; Strub, Marion; Bornert, Fabien; Clauss, Francois; Schwinté, Pascale; Keller, Laetitia; Benkirane-Jessel, Nadia; Lutz, Jean Christophe; Fioretti, Florence

2018-01-01

The temporomandibular joint (TMJ) is an articulation formed between the temporal bone and the mandibular condyle which is commonly affected. These affections are often so painful during fundamental oral activities that patients have lower quality of life. Limitations of therapeutics for severe TMJ diseases have led to increased interest in regenerative strategies combining stem cells, implantable scaffolds and well-targeting bioactive molecules. To succeed in functional and structural regeneration of TMJ is very challenging. Innovative strategies and biomaterials are absolutely crucial because TMJ can be considered as one of the most difficult tissues to regenerate due to its limited healing capacity, its unique histological and structural properties and the necessity for long-term prevention of its ossified or fibrous adhesions. The ideal approach for TMJ regeneration is a unique scaffold functionalized with an osteochondral molecular gradient containing a single stem cell population able to undergo osteogenic and chondrogenic differentiation such as BMSCs, ADSCs or DPSCs. The key for this complex regeneration is the functionalization with active molecules such as IGF-1, TGF-β1 or bFGF. This regeneration can be optimized by nano/micro-assisted functionalization and by spatiotemporal drug delivery systems orchestrating the 3D formation of TMJ tissues. PMID:29393880

Diagnostic index: an open-source tool to classify TMJ OA condyles

NASA Astrophysics Data System (ADS)

Paniagua, Beatriz; Pascal, Laura; Prieto, Juan; Vimort, Jean Baptiste; Gomes, Liliane; Yatabe, Marilia; Ruellas, Antonio Carlos; Budin, Francois; Pieper, Steve; Styner, Martin; Benavides, Erika; Cevidanes, Lucia

2017-03-01

Osteoarthritis (OA) of temporomandibular joints (TMJ) occurs in about 40% of the patients who present TMJ disorders. Despite its prevalence, OA diagnosis and treatment remain controversial since there are no clear symptoms of the disease, especially in early stages. Quantitative tools based on 3D imaging of the TMJ condyle have the potential to help characterize TMJ OA changes. The goals of the tools proposed in this study are to ultimately develop robust imaging markers for diagnosis and assessment of treatment efficacy. This work proposes to identify differences among asymptomatic controls and different clinical phenotypes of TMJ OA by means of Statistical Shape Modeling (SSM), obtained via clinical expert consensus. From three different grouping schemes (with 3, 5 and 7 groups), our best results reveal that that the majority (74.5%) of the classifications occur in agreement with the groups assigned by consensus between our clinical experts. Our findings suggest the existence of different disease-based phenotypic morphologies in TMJ OA. Our preliminary findings with statistical shape modeling based biomarkers may provide a quantitative staging of the disease. The methodology used in this study is included in an open source image analysis toolbox, to ensure reproducibility and appropriate distribution and dissemination of the solution proposed.

Structure and function of the temporomandibular joint disc: implications for tissue engineering.

PubMed

Detamore, Michael S; Athanasiou, Kyriacos A

2003-04-01

The temporomandibular joint (TMJ) disc is a little understood structure that, unfortunately, exhibits a plethora of pathologic disorders. Tissue engineering approaches may be warranted to address TMJ disc pathophysiology, but first a clear understanding of structure-function relationships needs to be developed, especially as they relate to the regenerative potential of the tissue. In this review, we correlate the biochemical content of the TMJ disc to its mechanical behavior and discuss what this correlation infers for tissue engineering studies of the TMJ disc. The disc of the TMJ exhibits a somewhat biconcave shape, being thicker in the anterior and posterior bands and thinner in the intermediate zone. The disc, which is certainly an anisotropic and nonhomogeneous tissue, consists almost entirely of type I collagen with trace amounts of type II and other types. In general, collagen fibers in the intermediate zone appear to run primarily in an anteroposterior direction and in a ringlike fashion around the periphery. Collagen orientation is reflected in higher tensile stiffness and strength in the center anteroposteriorly than mediolaterally and in the anterior and posterior bands than the intermediate zone mediolaterally. Tensile tests have shown the disc is stiffer and stronger in the direction of the collagen fibers. Elastin fibers in general appear along the collagen fibers and most likely function in restoring and retaining disc form after loading. The 2 primary glycosaminoglycans of the disc by far are chondroitin sulfate and dermatan sulfate, although their distribution is not clear. Compression studies are conflicting, but evidence suggests the disc is compressively stiffest in the center. Only a few tissue engineering studies of the TMJ disc have been performed to date. Tissue engineering studies must take advantage of existing information for experimental design and construct validation, and more research is necessary to characterize the disc to create a

Validation of TMJ osteoarthritis synthetic defect database via non-rigid registration

NASA Astrophysics Data System (ADS)

Paniagua, Beatriz; Pera, Juliette; Budin, Francois; Gomes, Liliane; Styner, Martin; Lucia, Cevidanes; Nguyen, Tung

2015-03-01

Temporomandibular joint (TMJ) disorders are a group of conditions that cause pain and dysfunction in the jaw joint and the muscles controlling jaw movement. However, diagnosis and treatment of these conditions remain controversial. To date, there is no single sign, symptom, or test that can clearly diagnose early stages of osteoarthritis (OA). Instead, the diagnosis is based on a consideration of several factors, including radiological evaluation. The current radiological diagnosis scores of TMJ pathology are subject to misdiagnosis. We believe these scores are limited by the acquisition procedures, such as oblique cuts of the CT and head positioning errors, and can lead to incorrect diagnoses of flattening of the head of the condyle, formation of osteophytes, or condylar pitting. This study consists of creating and validating a methodological framework to simulate defects in CBCT scans of known location and size, in order to create synthetic TMJ OA database. User-generated defects were created using a non-rigid deformation protocol in CBCT. All segmentation evaluation, surface distances and linear distances from the user-generated to the simulated defects showed our methodological framework to be very precise and within a voxel (0.5 mm) of magnitude. A TMJ OA synthetic database will be created next, and evaluated by expert radiologists, and this will serve to evaluate how sensitive the current radiological diagnosis tools are.

Temporomandibular joint formation requires two distinct hedgehog-dependent steps.

PubMed

Purcell, Patricia; Joo, Brian W; Hu, Jimmy K; Tran, Pamela V; Calicchio, Monica L; O'Connell, Daniel J; Maas, Richard L; Tabin, Clifford J

2009-10-27

We conducted a genetic analysis of the developing temporo-mandibular or temporomandi-bular joint (TMJ), a highly specialized synovial joint that permits movement and function of the mammalian jaw. First, we used laser capture microdissection to perform a genome-wide expression analysis of each of its developing components. The expression patterns of genes identified in this screen were examined in the TMJ and compared with those of other synovial joints, including the shoulder and the hip joints. Striking differences were noted, indicating that the TMJ forms via a distinct molecular program. Several components of the hedgehog (Hh) signaling pathway are among the genes identified in the screen, including Gli2, which is expressed specifically in the condyle and in the disk of the developing TMJ. We found that mice deficient in Gli2 display aberrant TMJ development such that the condyle loses its growth-plate-like cellular organization and no disk is formed. In addition, we used a conditional strategy to remove Smo, a positive effector of the Hh signaling pathway, from chondrocyte progenitors. This cell autonomous loss of Hh signaling allows for disk formation, but the resulting structure fails to separate from the condyle. Thus, these experiments establish that Hh signaling acts at two distinct steps in disk morphogenesis, condyle initiation, and disk-condyle separation and provide a molecular framework for future studies of the TMJ.

Temporomandibular joint formation requires two distinct hedgehog-dependent steps

PubMed Central

Purcell, Patricia; Joo, Brian W.; Hu, Jimmy K.; Tran, Pamela V.; Calicchio, Monica L.; O'Connell, Daniel J.; Maas, Richard L.; Tabin, Clifford J.

2009-01-01

We conducted a genetic analysis of the developing temporo-mandibular or temporomandi-bular joint (TMJ), a highly specialized synovial joint that permits movement and function of the mammalian jaw. First, we used laser capture microdissection to perform a genome-wide expression analysis of each of its developing components. The expression patterns of genes identified in this screen were examined in the TMJ and compared with those of other synovial joints, including the shoulder and the hip joints. Striking differences were noted, indicating that the TMJ forms via a distinct molecular program. Several components of the hedgehog (Hh) signaling pathway are among the genes identified in the screen, including Gli2, which is expressed specifically in the condyle and in the disk of the developing TMJ. We found that mice deficient in Gli2 display aberrant TMJ development such that the condyle loses its growth-plate-like cellular organization and no disk is formed. In addition, we used a conditional strategy to remove Smo, a positive effector of the Hh signaling pathway, from chondrocyte progenitors. This cell autonomous loss of Hh signaling allows for disk formation, but the resulting structure fails to separate from the condyle. Thus, these experiments establish that Hh signaling acts at two distinct steps in disk morphogenesis, condyle initiation, and disk–condyle separation and provide a molecular framework for future studies of the TMJ. PMID:19815519

BMPRIA Mediated Signaling Is Essential for Temporomandibular Joint Development in Mice

PubMed Central

Liu, Chao; Yang, Ling; Sun, Cheng; Ye, Wenduo; Li, Xihai; Chen, Jianquan; Long, Fanxin; Chen, YiPing

2014-01-01

The central importance of BMP signaling in the development and homeostasis of synovial joint of appendicular skeleton has been well documented, but its role in the development of temporomandibular joint (TMJ), also classified as a synovial joint, remains completely unknown. In this study, we investigated the function of BMPRIA mediated signaling in TMJ development in mice by transgenic loss-of- and gain-of-function approaches. We found that BMPRIA is expressed in the cranial neural crest (CNC)-derived developing condyle and glenoid fossa, major components of TMJ, as well as the interzone mesenchymal cells. Wnt1-Cre mediated tissue specific inactivation of BmprIa in CNC lineage led to defective TMJ development, including failure of articular disc separation from a hypoplastic condyle, persistence of interzone cells, and failed formation of a functional fibrocartilage layer on the articular surface of the glenoid fossa and condyle, which could be at least partially attributed to the down-regulation of Ihh in the developing condyle and inhibition of apoptosis in the interzone. On the other hand, augmented BMPRIA signaling by Wnt1-Cre driven expression of a constitutively active form of BmprIa (caBmprIa) inhibited osteogenesis of the glenoid fossa and converted the condylar primordium from secondary cartilage to primary cartilage associated with ectopic activation of Smad-dependent pathway but inhibition of JNK pathway, leading to TMJ agenesis. Our results present unambiguous evidence for an essential role of finely tuned BMPRIA mediated signaling in TMJ development. PMID:25093411

Dose-dependent sustained local release of dexamethasone from biodegradable thermosensitive hydrogel of PEG-PLGA-PEG triblock copolymers in the possible prevention of TMJ re-ankylosis (Arakeri's TMJ release technique).

PubMed

Arakeri, Gururaj; Brennan, Peter A

2012-05-01

Temporomandibular joint (TMJ) ankylosis is a devastating anatomico-pathological condition which severely affects the quality of human health. Over the last 70 years various treatments have been described to treat this distressing condition. But no single method has uniformly produced successful results. Although various surgical techniques have been improved periodically, the treatment results remain inefficient due to its recurrence as TMJ re-adhesion. Since recurrence remains as a problem in many cases, the TMJ ankylosis presents a major therapeutic challenge in head and neck surgery. The re-ankylosis is a unique phenomenon that so far has defied a full and logical explanation, based upon biological and mechanical factors that are linked together in a coherent fashion. Many factors have been implicated in the development of re-adhesion following TMJ surgery. But still the mechanism by which the TMJ re-adhesion develops is unclear. Hence, TMJ ankylosis demands an alternative effective treatment modality to prevent its recurrence as re-ankylosis. This paper postulates some critical biological factors responsible for re-ankylosis based on which a novel treatment modality is also proposed. Copyright © 2012 Elsevier Ltd. All rights reserved.

[Changes in ingestive behavior during growth affects the functional maturation of temporomandibular joint nociceptive neurons of rats].

PubMed

Hiranuma, Maya

2013-03-01

Temporomandibular joint (TMJ) loading during development promotes its growth and maintains normal structure/function. Continuous change in diet consistency is related to development and maturation of the peripheral nervous system, including the nociceptive system. However, the functional modulation of TMJ-nociceptive neurons under different ingestive behavior is unclear. We fed growing rats a liquid diet to investigate the effects of low TMJ loading on the response properties of neurons in the trigeminal spinal tract subnucleus caudalis (Sp5C). Forty 2-week-old male rats were used. They were fed chow pellets (n = 20, C group) or a liquid diet (n = 20, LD group) soon after weaning. Firing activities of single sensory units in response to TMJ pressure stimuli were recorded at 4, 5, 7 and 9 weeks. In TMJ-nociceptive neurons, the firing threshold (FT) in the LD group was significantly lower than that in the C group at each recording age. The FT in the C group remained unchanged throughout the recording period, whereas that in the LD group was the highest at 4 weeks, and gradually decreased. On the other hand, the initial firing frequency (IFF) was significantly higher in the LD group than in the C group at each recording age. The IFF in the C group remained unchanged throughout the experimental period, whereas that in the LD group was at its lowest at 4 weeks, and gradually increased. Based on these findings, ingestive behavior that results from continuous changes in the physical consistency of the diet during growth may affect the functional maturation of TMJ-nociceptive neurons.

A new three-dimensional, print-on-demand temporomandibular prosthetic total joint replacement system: Preliminary outcomes.

PubMed

Dimitroulis, George; Austin, Stephen; Sin Lee, Peter Vee; Ackland, David

2018-05-16

The aim of this study is to present the preliminary clinical data on the OMX Temporomandibular Joint (TMJ) Prosthetic total joint replacement system. A prospective, cohort, clinical study was undertaken of consecutive adult patients with Category 5 end-stage joint disease who were implanted with the OMX TMJ prosthesis between May 2015 and April 2017. A total of 50 devices were implanted in 38 patients, with 12 patients receiving bilateral prosthetic joints. There were 31 females and 7 males in this cohort, who ranged in age from 20 to 66 years, with a mean of 43.8 years (±14.0 years). Ten of the 50 prosthetic joints (20%) were fully customized, while the remaining were patient matched using virtual planning software. Based on a mean follow-up period of 15.3 months (range 12-24 months) following the TMJ total joint replacement, preliminary results suggest the OMX TMJ prosthesis has made a positive impact on clinical outcomes, with a mean 74.4% reduction in joint pain levels and significant improvements (p < 0.05) in jaw function as measured by the visual analogue scales for mouth opening (30.8%), diet (77.1%), and function (59.2%). No device failures were reported during the study period. This study suggests that the print-on-demand OMX TMJ prosthesis, designed for rapid delivery of both patient-matched and fully customize devices, represents a safe, reliable and versatile implantable joint replacement system for the treatment of category 5 end-stage TMJ disease. Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Temporo-mandibular joint kinetics and chewing cycles in children. A 3-year follow-up.

PubMed

Bodin, C; Lodetti, G; Marinone, M G

2002-01-01

To report the temporo-mandibular joint (TMJ) kinetics and masticatory function in healthy children. Temporo-mandibular joint palpation and electrognathographic registrations of chewing cycles were repeated for 3 years in order to evaluate changes. Healthy children without systemic pathologies, decayed cavities and previous dental treatment. Electrognathographic (EGN) registration of masticatory cycles and TMJ palpation were carried out on 52 patients (mean age: 5 years 8 months, range: 5 years 1 month, 6 years 8 months), by two university researchers, once a year for 3 consecutive years. TMJ palpation, differentiated TMJ synchronism (simultaneous bilateral opening movement) and TMJ asynchronism (not simultaneous bilateral opening movement), TMJ subluxation and click were observed. Electrognathographic registrations differentiated normal and abnormal jaw chewing cycles, and narrow and large cycles. Temporo-mandibular joint asynchronism was evident in 34 of 52 patients in the primary dentition, in 42 of 52 patients after the eruption of the first permanent molar, and in 31 of 52 patients after the eruption of the permanent incisors. TMJ subluxation increased during the full period of observation. Three temporomandibular clicks appeared after the eruption of the permanent incisors. Altered mastication was not always associated with TMJ disorders. In children, normal chewing cycles can coexist with occlusal discrepancies, cranio-facial growth and TMJ alterations.

On the analysis of condylar path versus real motion of the temporomandibular joint: application for Sicat Function.

PubMed

Kordaß, Bernd; Ruge, Sebastian

2015-01-01

Analysis of temporomandibular joint (TMJ) function using condylar path tracings is a challenge in functionally oriented dentistry. In most cases, reference points on the skin surface over the TMJ region are defined as "arbitrary", "individual" or "kinematic" condylar hinge axis points, which are displayed as "condylar paths" in motion. To what extent these reference points represent the actual condylar paths in each individual patient is ultimately unclear because the geometric relationship of the actual condyle to the selected reference point is usually unknown. Depending on the location of the point on the condyle and the centers of rotation of mandibular movement, these trajectories can vary greatly during combined rotational and sliding movements (eg, opening and closing movements of the mandible); this represents a grid of points located in the vicinity of the TMJ. To record the actual condylar path as the movement trajectory of a given point (eg, the condylar center), technological solutions are needed with which to link the tracing technology with the appropriate imaging technology capable of scanning the condyle, including the points of interest, and displaying them in real dynamic motion. Sicat Function (Sicat, D-Bonn) is such a solution. Sicat Function links cone beam computed tomography (CBCT) scans (made using the Galileos CBCT scanner; Sirona, Bensheim, Germany) with ultrasound-based, three-dimensional (3D) functional jaw movement recordings of the mandible (made using the JMT+ Jaw Motion Tracker; Sicat, Bonn, Germany). Digital images of the dental arches acquired with the intraoral scanner Cerec system (Sirona) can also be superimposed. This results in the generation of a 3D model of the bony mandible, including the TMJ, which reproduces the 3D real dynamic movement of the condyles simultaneously with that of the condylar paths at defined points (with the condylar centers being a particular point of interest). Sicat Function is an integrated, digital

Gait changes after using a temporomandibular joint exerciser in patients who underwent lower limb joint surgery

PubMed Central

Chung, Gu-Young; Choi, Geun-Seok; Shin, Ki-Young; Park, Joon-Soo

2016-01-01

[Purpose] The improvements in gait of the patients with lower limb disease who used a temporomandibular joint (TMJ) exerciser were verified. [Subjects and Methods] Eleven subjects were included. Their mean age was 53.2 years. The lower limb joint angles before and after using the TMJ exerciser were measured using a gait analyzer. Before the gait experiment, the TMJ exerciser setting process and one-leg stance balance test (OLST) were repeated until the balance maintenance time improved. [Results] Because of the OLST, the mean change in the body center point after the subjects used the exerciser improved from 5.76 mm to 4.20 mm. When the TMJ exerciser was used, the joint angle range of the subjects approached that of the normal individuals. [Conclusion] According to the gait experiments, the angles of the subjects’ hips, knees, and ankle joints approached to those of the normal individuals after the subjects used the TMJ exerciser; however, the results did not completely match. The changes in the hip, knee, and ankle joint angles were statistically significant, which confirm the usefulness of the TMJ exerciser. PMID:27313377

Reduced GABAA receptor α6 expression in the trigeminal ganglion alters inflammatory TMJ hypersensitivity

PubMed Central

Puri, Jyoti; Vinothini, Priya; Reuben, Jayne; Bellinger, Larry L.; Ailing, Li; Peng, Yuan B.; Kramer, Phillip R.

2012-01-01

Trigeminal ganglia neurons express the GABAA receptor subunit alpha 6 (Gabrα6) but the role of this particular subunit in orofacial hypersensitivity is unknown. In this report the function of Gabrα6 was tested by reducing its expression in the trigeminal ganglia and measuring the effect of this reduction on inflammatory temporomandibular joint (TMJ) hypersensitivity. Gabrα6 expression was reduced by infusing the trigeminal ganglia of male Sprague Dawley rats with small interfering RNA (siRNA) having homology to either the Gabrα6 gene (Gabrα6 siRNA) or no known gene (control siRNA). Sixty hours after siRNA infusion the rats received a bilateral TMJ injection of complete Freund’s adjuvant to induce an inflammatory response. Hypersensitivity was then quantitated by measuring meal duration, which lengthens when hypersensitivity increases. Neuronal activity in the trigeminal ganglia was also measured by quantitating the amount of phosphorylated ERK. Rats in a different group that did not have TMJ inflammation had an electrode placed in the spinal cord at the level of C1 sixty hours after siRNA infusion to record extracellular electrical activity of neurons that responded to TMJ stimulation. Our results show that Gabrα6 was expressed in both neurons and satellite glia of the trigeminal ganglia and that Gabrα6 positive neurons within the trigeminal ganglia have afferents in the TMJ. Gabrα6 siRNA infusion reduced Gabrα6 gene expression by 30% and significantly lengthened meal duration in rats with TMJ inflammation. Gabrα6 siRNA infusion also significantly increased p-ERK expression in the trigeminal ganglia of rats with TMJ inflammation and increased electrical activity in the spinal cord of rats without TMJ inflammation. These results suggest that maintaining Gabrα6 expression was necessary to inhibit primary sensory afferents in the trigeminal pathway and reduce inflammatory orofacial nociception. PMID:22521829

Observing the development of the temporomandibular joint in embryonic and post-natal mice using various staining methods

PubMed Central

LIANG, WENNA; LI, XIHAI; GAO, BIZHEN; GAN, HUIJUAN; LIN, XUEJUAN; LIAO, LINGHONG; LI, CANDONG

2016-01-01

The temporomandibular joint (TMJ) is a specialized synovial joint that is essential for the movement and function of the mammalian jaw. The TMJ develops from two mesenchymal condensations, and is composed of the glenoid fossa that originates from the otic capsule by intramembranous ossification, the mandibular condyle of the temporal bone and a fibrocartilagenous articular disc derived from a secondary cartilaginous joint by endochondral ossification. However, the development of the TMJ remains unclear. In the present study, the formation and development of the mouse TMJ was investigated between embryonic day 13.5 and post-natal day 180 in order to elucidate the morphological and molecular alterations that occur during this period. TMJ formation appeared to proceed in three stages: Initiation or blastema stage; growth and cavitation stage; and the maturation or completion stage. In order to investigate the activity of certain transcription factors on TMJ formation and development, the expression of extracellular matrix (ECM), sex determining region Y-box 9, runt-related transcription factor 2, Indian hedgehog homolog, Osterix, collagen I, collagen II, aggrecan, total matrix metalloproteinase (MMP), MMP-9 and MMP-13 were detected in the TMJ using in situ and/or immunohistochemistry. The results indicate that the transcription factors, ECM and MMP serve critical functions in the formation and development of the mouse TMJ. In summary, the development of the mouse TMJ was investigated, and the molecular regulation of mouse TMJ formation was partially characterized. The results of the present study may aid the systematic understanding of the physiological processes underlying TMJ formation and development in mice. PMID:26893634

Three-dimensional temporomandibular joint modeling and animation.

PubMed

Cascone, Piero; Rinaldi, Fabrizio; Pagnoni, Mario; Marianetti, Tito Matteo; Tedaldi, Massimiliano

2008-11-01

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.

Can orthodontic relapse be blamed on the temporomandibular joint?

PubMed Central

Wolford, Larry M

2014-01-01

There are many temporomandibular joint (TMJ) conditions that can cause orthodontic treatment instability and relapse. These conditions are often associated with dentofacial deformities, malocclusion, TMJ pain, headaches, myofascial pain, TMJ and jaw functional impairment, ear symptoms, etc., Many of these TMJ conditions can cause progressive and continuous changes in the occlusion and jaw relationships. Patients with these conditions may benefit from corrective orthodontic and surgical intervention. The difficulty for many clinicians may lie in identifying the presence of a TMJ condition, diagnosing the specific TMJ pathology, and selecting the proper treatment for that condition. This paper will discuss the most common TMJ pathologies that can adversely affect orthodontic stability and outcomes as well as present the treatment considerations to correct the specific TMJ conditions and associated jaw deformities to provide stable and predictable treatment results. PMID:25426452

Nonsurgical Management of Pediatric Temporomandibular Joint Dysfunction.

PubMed

Scrivani, Steven John; Khawaja, Shehryar Nasir; Bavia, Paula Furlan

2018-02-01

Temporomandibular disorders (TMD) are a subgroup of craniofacial pain problems involving the temporomandibular joint (TMJ), masticatory muscles, and associated head and neck musculoskeletal structures. These disorders are subclassified into TMJ articular disorders and masticatory muscle disorders. Patients with TMD most commonly present with pain, restricted or asymmetric mandibular motion, and TMJ sounds during mandibular movements. The prevalence tends to increase with age. Management of TMJ articular disorders consists of a combination of patient education, home-care plan, biobehavioral therapy, physical therapy, orthotic jaw appliance therapy, pharmacotherapy, and/or surgery. The goal is to increase function, reduce pain, and improve quality of life. Copyright © 2017 Elsevier Inc. All rights reserved.

Temporomandibular Joint Disorders: A Review of Etiology, Clinical Management, and Tissue Engineering Strategies

PubMed Central

Murphy, Meghan K.; MacBarb, Regina F.; Wong, Mark E.; Athanasiou, Kyriacos A.

2015-01-01

Epidemiology reports state temporomandibular joint disorders (TMD) affect up to 25% of the population, yet their etiology and progression are poorly understood. As a result, treatment options are limited and fail to meet the long-term demands of the relatively young patient population. TMD are a class of degenerative musculoskeletal conditions associated with morphological and functional deformities. In up to 70% of cases, TMD are accompanied by malpositioning of the TMJ disc, termed “internal derangement.” Though onset is not well characterized, correlations between internal derangement and osteoarthritic change have been identified. Due to the complex and unique nature of each TMD case, diagnosis requires patient-specific analysis accompanied by various diagnostic modalities. Likewise, treatment requires customized plans to address the specific characteristics of each patient’s disease. In the mechanically demanding and biochemically active environment of the TMJ, therapeutic approaches capable of restoring joint functionality while responding to changes in the joint have become a necessity. Capable of integration and adaptation in the TMJ, one such approach, tissue engineering, carries significant potential in the development of repair and replacement tissues. The following review presents a synopsis of etiology, current treatment methods, and the future of tissue engineering for repairing and/or replacing diseased joint components, specifically the mandibular condyle and TMJ disc. Preceding the current trends in tissue engineering is an analysis of native tissue characterization, toward identifying tissue engineering objectives and validation metrics for restoring healthy and functional structures of the TMJ. PMID:24278954

Assessment of Growth Factor Treatment on Fibrochondrocyte and Chondrocyte Co-Cultures for TMJ Fibrocartilage Engineering

PubMed Central

Kalpakci, Kerem N.; Kim, Eric J.; Athanasiou, Kyriacos A.

2011-01-01

Treatments for patients suffering from severe temporomandibular joint (TMJ) dysfunction are limited, motivating the development of strategies for tissue regeneration. In this study, co-cultures of fibrochondrocytes (FC) and articular chondrocytes (AC) were seeded in agarose wells, and supplemented with growth factors, to engineer tissue with biomechanical properties and ECM composition similar to native TMJ fibrocartilage. In the first phase, growth factors were applied alone and in combination, in the presence or absence of serum, while in the second phase, the best overall treatment was applied at intermittent dosing. Continuous treatment of AC/FC co-cultures with TGF-β1 in serum-free medium resulted in constructs with GAG/WW (12.2%), instantaneous compressive moduli (790 kPa), relaxed compressive moduli (120 kPa), and Young’s moduli (1.87 MPa) that overlap with native TMJ disc values. Among co-culture groups, TGF-β1 treatment increased collagen deposition ~20%, compressive stiffness ~130%, and Young’s modulus ~170% relative to no growth factor controls. Serum supplementation, though generally detrimental to functional properties, was identified as a powerful mediator of FC construct morphology. Finally, both intermittent and continuous TGF-β1 treatment showed positive effects, though continuous treatment resulted in greater enhancement of construct functional properties. This work proposes a strategy for regeneration of TMJ fibrocartilage and its future application will be realized through translation of these findings to clinically viable cell sources. PMID:21185408

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

PubMed Central

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

2010-01-01

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. PMID:18514492

Temporomandibular joint dislocation

PubMed Central

Sharma, Naresh Kumar; Singh, Akhilesh Kumar; Pandey, Arun; Verma, Vishal; Singh, Shreya

2015-01-01

Temporomandibular joint (TMJ) dislocation is an uncommon but debilitating condition of the facial skeleton. The condition may be acute or chronic. Acute TMJ dislocation is common in clinical practice and can be managed easily with manual reduction. Chronic recurrent TMJ dislocation is a challenging situation to manage. In this article, we discuss the comprehensive review of the different treatment modalities in managing TMJ dislocation. PMID:26668447

Outcomes of office-based temporomandibular joint arthroscopy: a 5-year retrospective study.

PubMed

Hossameldin, R H; McCain, J P

2018-01-01

Temporomandibular joint (TMJ) arthroscopy is a minimally invasive surgical approach for intra-articular TMJ diseases. Office-based arthroscopy using the smallest TMJ scope allows for good visualization, as well as the ability to lavage the joint in an office setting. This study aimed to assess the efficacy of an office-based TMJ arthroscopic technique. A retrospective evaluation of 363 patients with a TMJ disorder was performed. These patients underwent office-based arthroscopy using the OnPoint 1.2mm Scope System (Biomet Microfixation, Jacksonville, FL, USA) in Florida, USA, from July 2007. The following outcomes of the procedure were assessed: improvement in painless range of mandibular motion, pain on loading, and functional jaw pain; these were evaluated using a visual analog scale (VAS) over an average follow-up period of 263.81±142.1 days. The statistical analysis was performed using IBM SPSS Statistics version 20. Statistically significant improvements in TMJ pain and function, and other variables (P=0.001) were shown following TMJ arthroscopic lysis and lavage. Office-based arthroscopy using the OnPoint System was demonstrated to be a safe and efficient procedure for the treatment of patients with TMJ disorders as the first level of the algorithm of care. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Osteophyte formation and matrix mineralization in a TMJ osteoarthritis mouse model are associated with ectopic hedgehog signaling

PubMed Central

Bechtold, Till E.; Saunders, Cheri; Decker, Rebekah S.; Um, Hyo-Bin; Cottingham, Naiga; Salhab, Imad; Kurio, Naito; Billings, Paul C.; Pacifici, Maurizio; Nah, Hyun-Duck; Koyama, Eiki

2016-01-01

The temporomandibular joint (TMJ) is a diarthrodial joint that relies on lubricants for frictionless movement and long-term function. It remains unclear what temporal and causal relationships may exist between compromised lubrication and onset and progression of TMJ disease. Here we report that Proteoglycan 4 (Prg4)-null TMJs exhibit irreversible osteoarthritis-like changes over time and are linked to formation of ectopic mineralized tissues and osteophytes in articular disc, mandibular condyle and glenoid fossa. In the presumptive layer of mutant glenoid fossa’s articulating surface, numerous chondrogenic cells and/or chondrocytes emerged ectopically within the type I collagen-expressing cell population, underwent endochondral bone formation accompanied by enhanced Ihh expression, became entrapped into temporal bone mineralized matrix, and thereby elicited excessive chondroid bone formation. As the osteophytes grew, the roof of the glenoid fossa/eminence became significantly thicker and flatter, resulting in loss of its characteristic concave shape for accommodation of condyle and disc. Concurrently, the condyles became flatter and larger and exhibited ectopic bone along their neck, likely supporting the enlarged condylar heads. Articular discs lost their concave configuration, and ectopic cartilage developed and articulated with osteophytes. In glenoid fossa cells in culture, hedgehog signaling stimulated chondrocyte maturation and mineralization including alkaline phosphatase, while treatment with hedgehog inhibitor HhAntag prevented such maturation process. In sum, our data indicate that Prg4 is needed for TMJ integrity and long-term postnatal function. In its absence, progenitor cells near presumptive articular layer and disc undergo ectopic chondrogenesis and generate ectopic cartilage, possibly driven by aberrant activation of Hh signaling. The data suggest also that the Prg4-null mice represent a useful model to study TMJ osteoarthritis-like degeneration

Comparison of the instructional efficacy of an internet-based temporomandibular joint (TMJ) tutorial with a traditional seminar.

PubMed

Al-Riyami, S; Moles, D R; Leeson, R; Cunningham, S J

2010-12-11

There has been growing interest in the use of virtual learning environments (VLEs) by universities over the past decade to supplement traditional teaching methods. In this study a tutorial providing information about the temporomandibular joint (TMJ), temporomandibular disorders and teaching of a thorough TMJ examination was developed on a VLE platform to enable students to enhance their examination and diagnostic skills. The success of this VLE tutorial was compared with conventional teaching by a cross-over trial. Thirty students were initially randomly allocated to one of two groups; Group 1 completed the VLE tutorial and Group 2 attended the face-to-face seminar in the first instance. The groups then crossed over and had the other method of teaching provided. The findings from the cross-over trial and the students' feedback indicated that no differences were found between either teaching modes, and both are equally effective at delivering information to students. In addition, the order in which the students received the teaching did not make a difference, but giving the teaching twice reinforced their knowledge. There is a strong case to be made for introducing clinical lectures on a VLE platform, and this form of e-learning is, in general, well perceived by new generations of students.

Preclinical Animal Models for Temporomandibular Joint Tissue Engineering.

PubMed

Almarza, Alejandro J; Brown, Bryan N; Arzi, Boaz; Ângelo, David Faustino; Chung, William; Badylak, Stephen F; Detamore, Michael

2018-06-01

There is a paucity of in vivo studies that investigate the safety and efficacy of temporomandibular joint (TMJ) tissue regeneration approaches, in part due to the lack of established animal models. Review of disease models for study of TMJ is presented herein with an attempt to identify relevant preclinical animal models for TMJ tissue engineering, with emphasis on the disc and condyle. Although degenerative joint disease models have been mainly performed on mice, rats, and rabbits, preclinical regeneration approaches must employ larger animal species. There remains controversy regarding the preferred choice of larger animal models between the farm pig, minipig, goat, sheep, and dog. The advantages of the pig and minipig include their well characterized anatomy, physiology, and tissue properties. The advantages of the sheep and goat are their easier surgical access, low cost per animal, and its high tissue availability. The advantage of the dog is that the joint space is confined, so migration of interpositional devices should be less likely. However, each species has limitations as well. For example, the farm pig has continuous growth until about 18 months of age, and difficult surgical access due to the zygomatic arch covering the lateral aspect of joint. The minipig is not widely available and somewhat costly. The sheep and the goat are herbivores, and their TMJs mainly function in translation. The dog is a carnivore, and the TMJ is a hinge joint that can only rotate. Although no species provides the gold standard for all preclinical TMJ tissue engineering approaches, the goat and sheep have emerged as the leading options, with the minipig as the choice when cost is less of a limitation; and with the dog and farm pig serving as acceptable alternatives. Finally, naturally occurring TMJ disorders in domestic species may be harnessed on a preclinical trial basis as a clinically relevant platform for translation.

A time-dependent degeneration manner of condyle in rat CFA-induced inflamed TMJ.

PubMed

Xu, Liqin; Guo, Huilin; Li, Cheng; Xu, Jie; Fang, Wei; Long, Xing

2016-01-01

Temporomandibular joint (TMJ) inflammation is a potential risk factor of osteoarthritis (OA) but the detailed degenerative changes in the inflamed TMJ remain unclear. In this study, we evaluated the changes of condylar cartilage and subchondral bone in rat inflamed TMJ induced by Freund's complete adjuvant (CFA). Articular cavity was injected with CFA and the TMJ samples were collected 1, 2, 3, and 4-week post-injection. Hematoxylin & Eosin (H&E) staining, toluidine blue (TB) staining, Safranin O (S.O) staining, Masson trichrome staining and micro-CT were used to assess TMJ degeneration during inflammation. Osteoclast and osteoblast activities were analyzed by tartrate-resistant acid phosphatase (TRAP) staining and osteocalcin (OCN) immunohistochemistry staining respectively. The expression of receptor activator of NF-kB ligand (RANKL) and osteoprotegerin (OPG) in condylar cartilage and subchondral bone was also evaluated through immunohistochemistry and RANKL/OPG ratio was evaluated. Reduced cartilage thickness, decreased number of chondrocytes, and down-regulated proteoglycan expression were observed in the condylar cartilage in the inflamed TMJ. Enhanced osteoclast activity, and expanded bone marrow cavity were reached the peak in the 2-week after CFA-injection. Meanwhile the RANKL/OPG ratio in the cartilage and subchondral bone also increased in the 2-week CFA-injection. Immature, unmineralized new bones with irregular trabecular bone structure, atypical condylar shape, up-regulated OCN expression, and decreased bone mineral density (BMD) were found in the inflamed TMJ. The time-dependent degeneration manner of TMJ cartilage and subchondral bone was found in CFA-induced arthritis rat model. The degeneration in the TMJ with inflammation might be a risk factor and should be concerned.

The Yucatan Minipig Temporomandibular Joint Disc Structure-Function Relationships Support Its Suitability for Human Comparative Studies.

PubMed

Vapniarsky, Natalia; Aryaei, Ashkan; Arzi, Boaz; Hatcher, David C; Hu, Jerry C; Athanasiou, Kyriacos A

2017-11-01

Frequent involvement of the disc in temporomandibular joint (TMJ) disorders warrants attempts to tissue engineer TMJ disc replacements. Physiologically, a great degree of similarity is seen between humans and farm pigs (FPs), but the pig's rapid growth confers a significant challenge for in vivo experiments. Minipigs have a slower growth rate and are smaller than FPs, but minipig TMJ discs have yet to be fully characterized. The objective of this study was to determine the suitability of the minipig for TMJ studies by extensive structural and functional characterization. The properties of minipig TMJ discs closely reproduced previously reported morphological, biochemical, and biomechanical values of human and FP discs. The width/length dimension ratio of the minipig TMJ disc was 1.95 (1.69 for human and 1.94 for FP). The biochemical evaluation revealed, on average per wet weight, 24.3% collagen (22.8% for human and 24.9% for FP); 0.8% glycosaminoglycan (GAG; 0.5% for human and 0.4% for FP); and 0.03% DNA (0.008% for human and 0.02% for FP). Biomechanical testing revealed, on average, compressive relaxation modulus of 50 kPa (37 kPa for human and 32 kPa for FP), compressive instantaneous modulus of 1121 kPa (1315 kPa for human and 1134 kPa for FP), and coefficient of viscosity of 13 MPa·s (9 MPa·s for human and 3 MPa·s for FP) at 20% strain. These properties also varied topographically in accordance to those of human and FP TMJ discs. Anisotropy, quantified by bidirectional tensile testing and histology, again was analogous among minipig, human, and FP TMJ discs. The minipig TMJ's ginglymoarthrodial nature was verified through cone beam computer tomography. Collectively, the similarities between minipig and human TMJ discs support the use of minipig as a relevant model for TMJ research; considering the practical advantages conferred by its growth rate and size, the minipig may be a preferred model over FP.

Tinnitus with temporomandibular joint disorders: a specific entity of tinnitus patients?

PubMed

Vielsmeier, Veronika; Kleinjung, Tobias; Strutz, Jürgen; Bürgers, Ralf; Kreuzer, Peter Michael; Langguth, Berthold

2011-11-01

Tinnitus is frequently associated with temporomandibular joint (TMJ) dysfunction. However, the nature of the relationship is not fully understood. Here the authors compared 30 patients with a confirmed diagnosis of temporomandibular joint dysfunction and tinnitus to a group of 61 patients with tinnitus but without any subjective complaints of TMJ dysfunction with respect to clinical and demographic characteristics. Case-control study. Tertiary referral center. Tinnitus patients with and without TMJ dysfunction presenting at the Department of Prosthetic Dentistry and th: Tinnitus Clinic at the University of Regensburg. Tinnitus patients with TMJ disorder had better hearing function (P < .0005), lower age (P = .001), and lower age at tinnitus onset (P = .002) and were more frequently female (P = .003). Their subjectively perceived tinnitus loudness was lower (P = .01), and more of them could modulate their tinnitus by jaw or neck movements (P = .001). Classical risk factors for tinnitus (age, male gender, hearing loss) are less relevant in tinnitus patients with TMJ disorder, suggesting a causal role of TMJ pathology in the generation and maintenance of tinnitus. Based on this finding, treatment of TMJ disorder may represent a causally oriented treatment strategy for tinnitus.

[Application of joint reconstruction with autogenous coronoid process graft to treat temporomandibular joint ankylosis].

PubMed

Xie, Qing-tiao; Huang, Xuan-ping; Jiang, Xian-fang; Yang, Yuan-yuan; Li, Hua; Lin, Xi

2013-08-01

To evaluate the clinical effect of joint reconstruction by using autogenous coronoid process graft to treat temporomandibular joint(TMJ) ankylosis. Nine cases of TMJ ankylosis from September 2008 to September 2010 were surgically treated by joint reconstruction with autogenous coronoid process graft, using autogenous articular disc or prosthodontic membrane as interpositional material. Mouth opening, occlusion and cone beam CT(CBCT) were used for evaluation before and after surgery. Satisfactory mouth opening was achieved in all patients and no one got occlusal changes or reankylosis during follow-up. CBCT showed that coronoid process graft reached bone union with the ramus and turned to be round. It is effective to cure TMJ ankylosis through joint reconstruction with autogenous coronoid process graft.

Assessment of growth factor treatment on fibrochondrocyte and chondrocyte co-cultures for TMJ fibrocartilage engineering.

PubMed

Kalpakci, Kerem N; Kim, Eric J; Athanasiou, Kyriacos A

2011-04-01

Treatments for patients suffering from severe temporomandibular joint (TMJ) dysfunction are limited, motivating the development of strategies for tissue regeneration. In this study, co-cultures of fibrochondrocytes (FCs) and articular chondrocytes (ACs) were seeded in agarose wells, and supplemented with growth factors, to engineer tissue with biomechanical properties and extracellular matrix composition similar to native TMJ fibrocartilage. In the first phase, growth factors were applied alone and in combination, in the presence or absence of serum, while in the second phase, the best overall treatment was applied at intermittent dosing. Continuous treatment of AC/FC co-cultures with TGF-β1 in serum-free medium resulted in constructs with glycosaminoglycan/wet weight ratios (12.2%), instantaneous compressive moduli (790 kPa), relaxed compressive moduli (120 kPa) and Young's moduli (1.87 MPa) that overlap with native TMJ disc values. Among co-culture groups, TGF-β1 treatment increased collagen deposition ∼20%, compressive stiffness ∼130% and Young's modulus ∼170% relative to controls without growth factor. Serum supplementation, though generally detrimental to functional properties, was identified as a powerful mediator of FC construct morphology. Finally, both intermittent and continuous TGF-β1 treatment showed positive effects, though continuous treatment resulted in greater enhancement of construct functional properties. This work proposes a strategy for regeneration of TMJ fibrocartilage and its future application will be realized through translation of these findings to clinically viable cell sources. Copyright © 2011 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

Mechanical properties of human articular disk and its influence on TMJ loading studied with the finite element method.

PubMed

Tanaka, E; Sasaki, A; Tahmina, K; Yamaguchi, K; Mori, Y; Tanne, K

2001-03-01

The present study was designed to investigate the elastic modulus of human temporomandibular joint (TMJ) disk under tension and its influences on TMJ loading. Seven human TMJ disks served as specimens. Continuous tensile stress was applied to each specimen, and the elastic moduli of human TMJ disks were calculated at 2% strain. Furthermore, using a three-dimensional finite element model of the mandible including the TMJ, changes in the TMJ stresses during clenching were evaluated in association of varying elastic moduli of the articular disk determined by the tensile tests. The elastic moduli at 2% strain varied from 27.1 to 65.2 MPa with a mean of 47.1 MPa. A significant correlation was found between the elastic moduli and age (P < 0.01). On the surface of condyle, compressive stress in the anterior area and tensile stress in the posterior area increased when the elastic moduli of the TMJ disk was varied from 25 to 65 MPa. In the TMJ disk, shear stresses in all the areas became larger with greater stiffness. In conclusion, it is shown that the elastic modulus of human TMJ disk is increased with age and that higher stiffness of the disk exerts substantial influences on mechanical loading for the TMJ structures.

An electrochemical investigation of TMJ implant metal alloys in an artificial joint fluid environment: the influence of pH variation.

PubMed

Royhman, Dmitry; Radhakrishnan, Rashmi; Yuan, Judy Chia-Chun; Mathew, Mathew T; Mercuri, Louis G; Sukotjo, Cortino

2014-10-01

To investigate the corrosion behaviour of commonly used TMJ implants alloys (CoCrMo and Ti6Al4V) under simulated physiological conditions. Corrosion behaviour was evaluated using standard electrochemical corrosion techniques and galvanic corrosion techniques as per ASTM standards. Standard electrochemical tests (E(corr), I(corr), R(p) and C(f)) were conducted in bovine calf serum (BCS), as a function of alloys type and different pHs. Galvanic corrosion tests were conducted in BCS at a pH of 7.6. Alloy surfaces were characterized using white-light interferometry (WLI) and scanning electron microscopy (SEM). The potentiodynamic test results exhibited the enhanced passive layer growth and a better corrosion resistance of Ti6Al4V compared to CoCrMo. Electrochemical impedance spectroscopy measurements demonstrated the influence of protein as a function of pH on corrosion mechanisms/kinetics. Galvanic coupling was not a major contributor to corrosion. SEM and WLI images demonstrated a significantly higher in surface roughness in CoCrMo after corrosion. The results of this study suggest that Ti6Al4V shows superior corrosion behaviour to CoCrMo due to its strong passive layer, simulated joint fluid components can affect the electrochemical nature of the metal/electrolyte interface as a function of pH, and the galvanic effect of coupling CoCrMo and Ti6Al4V in a single joint is weak. Published by Elsevier Ltd.

Efficacy of Temporomandibular Joint Arthrocentesis with Sodium Hyaluronate in the Management of Temporomandibular Joint Disorders: A Prospective Randomized Control Trial.

PubMed

Gorrela, Harsha; Prameela, J; Srinivas, G; Reddy, B Vijay Baskar; Sudhir, Mvs; Arakeri, Gururaj

2017-12-01

This study was designed to investigate the efficacy of the temporomandibular joint arthrocentesis with and without injection of sodium hyaluronate (SH) in the treatment of temporomandibular joint disorders. A total of sixty two TMJs in 34 males and 28 females aged 20-65 years comprised the study material. The patients' complaints were limited mouth opening, TMJ pain, and joint noises during function. Patients were randomly divided into 2 groups in which arthrocentesis plus intra-articular injection of sodium hyaluronate was performed in 1 group and only arthrocentesis was performed in the other group. Both groups contained patients with disc displacement with reduction and without reduction. Clinical evaluation of the patients was done before the procedure, immediately after the procedure, at 1 week and 1, 3 and 6 months postoperatively. Intensity of TMJ pain was assessed using visual analog scales. Maximal mouth opening and lateral jaw movements also were recorded at each follow-up visit. Both techniques increased maximal mouth opening, lateral movements, and function, while reducing TMJ pain and noise. Although patients benefitted from both techniques, arthrocentesis with injection of SH seemed to be superior to arthrocentesis alone.

Inflammation is more distinct in temporomandibular joint osteoarthritis compared to the knee joint.

PubMed

Vos, Lukas M; Kuijer, Roel; Huddleston Slater, James J R; Bulstra, Sjoerd K; Stegenga, Boudewijn

2014-01-01

Most of the current understanding of articular cartilage maintenance and degradation is derived from large load-bearing synovial joints, in particular the knee joint. The aim of this study was to identify valuable degradation markers for cartilage degradation in the temporomandibular joint (TMJ) by comparing the relative concentrations of carboxyterminal telopeptides of collagen types I and II (CTX-I and CTX-II), cartilage oligomeric matrix protein (COMP), and prostaglandin E2 (PGE2) in synovial fluid (SF) of TMJ and knee joints with cartilage degradation. In this cross-sectional comparative study, participants were recruited from the University Medical Center Groningen, The Netherlands. Patients with TMJ osteoarthritis were compared with patients with knee osteoarthritis. The outcome variables were the relative SF concentrations of CTX-I, CTX-II, COMP, and PGE2. An independent samples Mann-Whitney U test was used to compare the relative concentrations. Thirty consecutive patients (9 male, 21 female; mean age, 40.1 yr; standard deviation, 15.3 yr) with TMJ osteoarthritis and 31 consecutive patients (20 male, 11 female; mean age, 37.4 yr; standard deviation, 13.7 yr) who were scheduled for arthroscopy of the knee joint participated in this study. Significant differences were found between relative concentrations of COMP (P = .000) and PGE2 (P = .005), and no significant differences were found between relative concentrations of CTX-I (P = .720) and CTX-II (P = .242). Relative SF concentrations of COMP and PGE2 showed significant differences between the TMJ and the knee joint, suggesting that there are differences in pathophysiology and that the inflammatory component may be more distinct in the TMJ. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Utility of Vaccum Pressed Silicon Sheet as a Bite Raising Appliance in the Management of TMJ Dysfunction Syndrome.

PubMed

Datarkar, Abhay; Daware, Surendra; Dande, Ravi

2017-09-01

Temporomandibular disorders (TMDs) represent a group of painful conditions involving the muscles of mastication and the temporomandibular joint (TMJ) that frequently encountered in general clinical practice. This study is designed to assess the utility of vacuum pressed silicon sheet as a bite raising appliance in the management of TMJ dysfunction syndrome. The patients for this study were selected from those with the chief complaint of TMJ disorder. Out of 200 patients, 104 patients were diagnosed with subluxation and 96 patients were diagnosed with internal derangement of temporomandibular joint. All the reported cases were managed conservatively with physiotherapy and muscle relaxant therapy for one week period and followed with silicon bite raising appliance over both the arches in the subsequent period. All the patients had pain relief within six months duration as graded over verbal analog scale. ANOVA scale was used for comparision of VAS scores. The use of vacuum pressed bite raising appliance in the management of TMJ disorder was found to be satisfactorily effective in alleviation of pain symptom in our study group.

[Diagnosis of temporo-mandibular joint dysfunction caused by occlusion pathology and treatment of such patients].

PubMed

Semkin, V A; Rabukhina, N A; Kravchenko, D V

2007-01-01

Patients with temporo-mandibular joint (TMJ) dysfunction need complex treatment that includes prosthetic treatment in intrajoint relation stabilization. In cases of TMJ pathology it is necessary to examine patients and make axiography, function analysis, MPI-analysis, magnetic resonance tomography and zonography of TMJ, electromyography of the masticatory muscles. The authors examined 47 patients with TMJ dysfunction, 43 of them had occlusion pathology. We managed to eliminate the dysfunction symptoms and to receive stable result of the treatment in all the patients.

Short-term changes in temporomandibular joint function in subjects with cleft lip and palate treated with maxillary distraction osteogenesis.

PubMed

Hashimoto, K; Otsuka, R; Minato, A; Sato-Wakabayashi, M; Takada, J; Inoue-Arai, M S; Miyamoto, J J; Ono, T; Ohyama, K; Moriyama, K

2008-05-01

To investigate the short-term effects of maxillary distraction osteogenesis (DO) on temporomandibular joint (TMJ) function in 21 subjects with cleft lip and palate (CLP). Design - Morphological changes in the maxillofacial region were measured using lateral cephalometric radiographs taken immediately before (pre-DO) and after DO (post-DO) and 1 year after DO (1-year follow-up). A questionnaire was evaluated using a visual analog scale. A chi-square test was used to compare the prevalence of TMJ symptoms between pre-DO and 1-year follow-up. The Spearman correlation coefficient was used to determine the correlation between changes in cephalometric variables and TMJ symptoms in association with maxillary DO. Statistical significance was set at p < 0.05. Results - The ANB (anteroposterior relationship of the maxilla with the mandible) angle and the mandibular plane angle at pre-DO, post-DO, and 1-year follow-up were -4.3 degrees , +5.8 degrees , +4.3 degrees and 32.1 degrees , 33.5 degrees , 33.6 degrees , respectively. The average amounts of anterior and downward movement of the maxilla at post-DO and 1-year follow-up were 8.3, -1.3 and 0.9, 1.1 mm, respectively. The prevalence of TMJ symptoms showed no significant increase in association with maxillary DO. Moreover, there was no significant correlation between changes in cephalometric variables and TMJ symptoms. Conclusion - These results suggest that there was no short-term (i.e., up to 1 year after DO) effect of maxillary DO on TMJ function in subjects with CLP.

Three-dimensional morphological changes of the temporomandibular joint and functional effects after mandibulotomy.

PubMed

Al-Saleh, Mohammed A Q; Punithakumar, Kumaradevan; Lagravere, Manuel; Boulanger, Pierre; Jaremko, Jacob L; Wolfaardt, John; Major, Paul W; Seikaly, Hadi

2017-01-28

The midline and paramedian mandibulotomy are surgical procedures that divide the mandibular bone into two halves and disconnects the condylar heads of the TMJ from each other. This study aimed to prospectively evaluate the temporomandibular joint (TMJ) functional and morphological changes after mandibulotomy using a reconstructed 3D models of the TMJ. Sixteen adult patients diagnosed with oral and oropharyngeal tumors with planned surgical mandibulotomy (test group, 9 patients) or transoral (control group, seven patients) treatments were included in the study. MRI and CBCT images were obtained immediately preceeding surgery and 6-8 weeks after surgery. Using the MRI-CBCT registered images, TMJ tissues were segmented at the two occasions by the same operator and 3D models were reconstructed for morphological assessment. Changes across time were measured using the volume overlap and Hausdorff distance of the disc and condyle 3D models. Disc-condyle relationship was measured using point-based and color map analysis. To assess the early functional changes, the Jaw function limitation scale (JFLS) and the maximum mouth opening were measured. Two-sample Hotelling T 2 t-test was performed to determine the significance of the morphological and clinical outcomes' differences between the two groups. The two-sample Hotelling T 2 t-test showed significant differences (T 2 (df1,df2) = 0.97 (5,26), p <0.01) between the mean values of all outcomes among the 2 groups. The change in disc displacement was significantly different between the two groups (p <0.05). However, the condylar displacement was not significantly different between the two groups (p =0.3). The average of the JFLS score was five times larger after mandibulotomy, and was 2 times larger after transoral surgery (p < 0.01). Patients showed decrease in the average of the maximum interincisal mouth opening by 11 mm after mandibulotomy, and by 5.4 mm after transoral surgery. The quantitative assessment of the

Recent Tissue Engineering Advances for the Treatment of Temporomandibular Joint Disorders.

PubMed

Aryaei, Ashkan; Vapniarsky, Natalia; Hu, Jerry C; Athanasiou, Kyriacos A

2016-12-01

Temporomandibular disorders (TMDs) are among the most common maxillofacial complaints and a major cause of orofacial pain. Although current treatments provide short- and long-term relief, alternative tissue engineering solutions are in great demand. Particularly, the development of strategies, providing long-term resolution of TMD to help patients regain normal function, is a high priority. An absolute prerequisite of tissue engineering is to understand normal structure and function. The current knowledge of anatomical, mechanical, and biochemical characteristics of the temporomandibular joint (TMJ) and associated tissues will be discussed, followed by a brief description of current TMD treatments. The main focus is on recent tissue engineering developments for regenerating TMJ tissue components, with or without a scaffold. The expectation for effectively managing TMD is that tissue engineering will produce biomimetic TMJ tissues that recapitulate the normal structure and function of the TMJ.

Recent tissue engineering advances for the treatment of temporomandibular joint disorders

PubMed Central

Aryaei, Ashkan; Vapniarsky, Natalia; Hu, Jerry C; Athanasiou, Kyriacos A

2016-01-01

Temporomandibular disorders (TMD) are among the most common maxillofacial complaints and a major cause of orofacial pain. Although, current treatments provide short- and long-term relief, alternative tissue engineering solutions are in great demand. Particularly, the development of strategies, providing long-term resolution of TMD to help patients regain normal function is a high priority. An absolute prerequisite of tissue engineering is to understand normal structure and function. The current knowledge of anatomical, mechanical, and biochemical characteristics of the temporomandibular joint (TMJ) and associated tissues will be discussed, followed by a brief description of current TMD treatments. The main focus is on recent tissue engineering developments for regenerating TMJ tissue components, with or without a scaffold. The expectation for effectively managing TMD is that tissue engineering will produce biomimetic TMJ tissues that recapitulate the normal structure and function of the TMJ. PMID:27704395

Unilateral Ankylosis of Temporomandibular Joint (TMJ) with Contralateral Condylar Aplasia and Related Orthopedic Deformity – Syndromic or Nonsyndromic?

PubMed Central

Vijay, Pradkhshana; Sunil, VSB; Bajpai, Manas; Chhibber, Neha

2015-01-01

Condylar aplasia which means “failure of development” is a rare condition and can be unilateral or bilateral. Mandibular condylar Aplasia without any association with syndrome is extremely rare. Temporomandibular joint (TMJ) ankylosis results from trauma, infection and inadequate surgical treatment of the condylar area. Congenital cases are very rare. We report case of congenital unilateral aplasia of left mandibular condyle with ankylosis of right condyle, with an associated orthopedic deformity in a nine-year-old male patient, which may be a part of some unreported syndrome that has not been mentioned so far in literature. As per our best knowledge, no other case including such clinical features has been reported. PMID:25738097

Temporomandibular joint fibrocartilage degeneration from unilateral dental splints.

PubMed

Henderson, Sarah E; Lowe, Jesse R; Tudares, Mauro A; Gold, Michael S; Almarza, Alejandro J

2015-01-01

The objective of this study was to determine the extent to which altered loading in the temporomandibular joint (TMJ), as might be associated with a malocclusion, drives degeneration of articulating surfaces in the TMJ. We therefore sought to quantify the effects of altered joint loading on the mechanical properties and biochemical content and distribution of TMJ fibrocartilage in the rabbit. Altered TMJ loading was induced with a 1mm splint placed unilaterally over the maxillary and mandibular molars for 6 weeks. At that time, TMJ fibrocartilage was assessed by compression testing, biochemical content (collagen, glycosaminoglycan (GAG), DNA) and distribution (histology), for both the TMJ disc and the condylar fibrocartilage. There were no changes in the TMJ disc for any of the parameters tested. The condylar fibrocartilage from the splinted animals was significantly stiffer and the DNA content was significantly lower than that in control animals. There was significant remodeling in the condylar fibrocartilage layers as manifested by a change in GAG and collagen II distribution and a loss of defined cell layers. A connection between the compressive properties of TMJ condylar fibrocartilage after 6 weeks of splinting and the changes in histology was observed. These results suggest a change in joint loading leads to condylar damage, which may contribute to pain associated with at least some forms of TMJ disease. Copyright © 2014 Elsevier Ltd. All rights reserved.

Temporomandibular Joint Fibrocartilage Degeneration from Unilateral Dental Splints

PubMed Central

Henderson, Sarah E.; Lowe, Jesse R.; Tudares, Mauro A.; Gold, Michael S.; Almarza, Alejandro J.

2014-01-01

Objective The objective of this study was to determine the extent to which altered loading in the temporomandibular joint (TMJ), as might be associated with a maloclussion, drives degeneration of articulating surfaces in the TMJ. We therefore sought to quantify the effects of altered joint loading on the mechanical properties and biochemical content and distribution of TMJ fibrocartilage in the rabbit. Design Altered TMJ loading was induced with a 1 mm splint placed unilaterally over the maxillary and mandibular molars for six weeks. At that time, TMJ fibrocartilage was assessed by compression testing, biochemical content (collagen, glycosaminoglycan (GAG), DNA) and distribution (histology), for both the TMJ disc and the condylar fibrocartilage. Results There were no changes in the TMJ disc for any of the parameters tested. The condylar fibrocartilage from the splinted animals was significantly stiffer and the DNA content was significantly lower than that in control animals. There was significant remodeling in the condylar fibrocartilage layers as manifested by a change in GAG and collagen II distribution and a loss of defined cell layers. Conclusions A connection between the compressive properties of TMJ condylar fibrocartilage after 6 weeks of splinting and the changes in histology was observed. These results suggest a change in joint loading, leads to condylar damage, which may contribute to pain associated with at least some forms of TMJ disease. PMID:25247778

Two different techniques of manufacturing TMJ replacements - A technical report.

PubMed

Kozakiewicz, Marcin; Wach, Tomasz; Szymor, Piotr; Zieliński, Rafał

2017-09-01

Presently, during the surgical treatment of the patients in maxillofacial surgery, one can use various medical implants. Moreover custom made implants are being used. Replacements may be fitted to the structure and shape of the human skull owing to CAD/CAM (custom aided design/manufacture) called customized implants. This study was aimed to report for the first time clinical material from which custom implants, using two different techniques, were manufactured to reconstruct the temporomandibular joint (TMJ). In this study, eleven patients with an average age of 54 years were included. All of the patients underwent TMJ reconstruction using direct metal laser sintering (DMLS) or computer numerical control milling (CNC) techniques for implant manufacture. Four of the eleven patients had a malignancy diagnosis, and seven had a benign diagnosis. Patients complained of hypomobility of the TMJ, facial asymmetry, pain and swelling of the preauricular region. Treatment included 7 CNC milled implants and 4 implants in DMLS. More metallic implant parts with a rough surface were associated with the DMLS technique. Post operational, uneventful healing was observed in all clinical cases during an average of 26.8 months of follow-up. Three months post-operation, facial nerve palsy, swallowing disturbances and pain were not observed. Infections, allergic reactions to materials and re-ankylosis were also not observed. Replacements received correct forms and functions owing to the CAM techniques. Post-operational maximal interincisal opening improved (p < 0.01) and was not significantly related to preoperational opening, age, sex, diagnosis or adjuvant radiotherapy. Considering both methods, the feature that differentiates the manufacture technique is the more subtractive surface finishing required for the DMLS implant than the CNC implant. Both techniques resulted the same clinical outcomes and can be used successfully in patients with neoplastic lesions and other TMJ disorders

[Pigmented villonodular synovitis of the temporo mandibular joint. Differential diagnosis and therapy].

PubMed

Kunz, C; Leiggener, C S; Fridrich, K; Schmuziger, N; Hammer, B

2003-07-01

For the temporomandibular joint (TMJ), functional disorders are common but tumors and tumor like lesions are rare, although these are often mistaken for functional ailments. Early examination by computed tomography or, as a method of choice, magnetic resonance imaging is recommended in case of persisting TMJ problems. Pigmented villonodular synovitis (PVNS) is a rare benign but locally destructive fibrohistiocytic lesion originating in synovial tissue. Involvement of the temporomandibular joint is extremely rare, with the average age of patients being 44.6 years. This paper reports on a 13-year-old patient with diffuse PVNS involving the middle ear and middle cranial fossa. The treatment of choice involves wide local excision and reconstruction of the temporomandibular joint with long-term follow-up. Pathogenesis and differential diagnosis are discussed.

Lubricin is Required for the Structural Integrity and Post-natal Maintenance of TMJ

PubMed Central

Koyama, E.; Saunders, C.; Salhab, I.; Decker, R.S.; Chen, I.; Um, H.; Pacifici, M.; Nah, H.D.

2014-01-01

The Proteoglycan 4 (Prg4) product lubricin plays essential roles in boundary lubrication and movement in limb synovial joints, but its roles in temporomandibular joint (TMJ) are unclear. Thus, we characterized the TMJ phenotype in wild-type and Prg4 –/– mouse littermates over age. As early as 2 weeks of age, mutant mice exhibited hyperplasia in the glenoid fossa articular cartilage, articular disc, and synovial membrane. By 1 month of age, there were fewer condylar superficial tenascin-C/Col1-positive cells and more numerous apoptotic condylar apical cells, while chondroprogenitors displayed higher mitotic activity, and Sox9-, Col2-, and ColX-expressing chondrocyte zones were significantly expanded. Mutant subchondral bone contained numerous Catepsin K- expressing osteoclasts at the chondro-osseous junction, increased invasive marrow cavities, and suboptimal subchondral bone. Mutant glenoid fossa, disc, synovial cells, and condyles displayed higher Hyaluronan synthase 2 expression. Mutant discs also lost their characteristic concave shape, exhibited ectopic chondrocyte differentiation, and occasionally adhered to condylar surfaces. A fibrinoid substance of unclear origin often covered the condylar surface. By 6 months of age, mutant condyles displayed osteoarthritic degradation with apical/mid-zone separation. In sum, lubricin exerts multiple essential direct and indirect roles to preserve TMJ structural and cellular integrity over post-natal life. PMID:24834922

Isolated marginal facial nerve paresis after TMJ discopexy: a case report.

PubMed

Reychler, H; Mahy, P

2011-01-01

Isolated marginal facial nerve paresis after TMJ discopexy: a case report. This is the first report of a transient, isolated marginal facial nerve paresis after temporomandibular joint arthrotomy. The paresis seems to have resulted from a crush lesion by Backhaus forceps, placed transcutaneously during the operation to distract the intra-articular space.

Cancer risk among patients with finger and hand joint and temporo-mandibular joint prostheses in Denmark.

PubMed

Fryzek, J P; Mellemkjaer, L; McLaughlin, J K; Blot, W J; Olsen, J H

1999-05-31

The use of artificial joint implants has risen greatly over the past years. However, few investigations of the cancer risk associated with implants have been performed. We investigated cancer risk in patients with finger and hand joint and temporo-mandibular (TMJ) joint implants. A nationwide cohort in Denmark of patients with finger and hand joint prostheses (n = 858) or TMJ implants (n = 389) was followed from January 1, 1977, to December 31, 1995, to evaluate any potential cancer risks subsequent to receiving these implants. Standardized incidence ratios (SIRs) for all cancers were 1.0 (95% CI = 0.8-1.2) for the finger and hand joint cohort and 1.1 (95% CI = 0.8-1.7) for the TMJ cohort. A significant risk for non-Hodgkin's lymphoma was found in the finger and hand joint cohort (SIR = 3.8, 95% CI = 1.5-7.8). When the finger and hand joint cohort was stratified by diagnosis of rheumatoid arthritis, the excess risk was seen only in the group with rheumatoid arthritis. This is consistent with past studies, which have found an association between rheumatoid arthritis and non-Hodgkin's lymphoma. Our results provide evidence that the cancer risk for patients with finger and hand joint prostheses and TMJ implants is similar to that for the general population.

Spry1 and Spry2 Are Essential for Development of the Temporomandibular Joint

PubMed Central

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

2012-01-01

The temporomandibular joint (TMJ) is a specialized synovial joint essential for the function of the mammalian jaw. The main components of the TMJ are the mandibular condyle, the glenoid fossa of the temporal bone, and a fibrocartilagenous disc interposed between them. The genetic program for the development of the TMJ remains poorly understood. Here we show the crucial role of sprouty (Spry) genes in TMJ development. Sprouty genes encode intracellular inhibitors of receptor tyrosine kinase (RTK) signaling pathways, including those triggered by fibroblast growth factors (Fgfs). Using in situ hybridization, we show that Spry1 and Spry2 are highly expressed in muscles attached to the TMJ, including the lateral pterygoid and temporalis muscles. The combined inactivation of Spry1 and Spry2 results in overgrowth of these muscles, which disrupts normal development of the glenoid fossa. Remarkably, condyle and disc formation are not affected in these mutants, demonstrating that the glenoid fossa is not required for development of these structures. Our findings demonstrate the importance of regulated RTK signaling during TMJ development and suggest multiple skeletal origins for the fossa. Notably, our work provides the evidence that the TMJ condyle and disc develop independently of the mandibular fossa. PMID:22328578

Influence of Thickness and Contact Surface Geometry of Condylar Stem of TMJ Implant on Its Stability

NASA Astrophysics Data System (ADS)

Arabshahi, Zohreh; Kashani, Jamal; Kadir, Mohammed Rafiq Abdul; Azari, Abbas

The aim of this study is to examine the effect thickness and contact surface geometry of condylar stem of TMJ implant on its stability in total reconstruction system and evaluate the micro strain resulted in bone at fixation screw holes in jaw bone embedded with eight different designs of temporomandibular joint implants. A three dimensional model of a lower mandible of an adult were developed from a Computed Tomography scan images. Eight different TMJ implant designs and fixation screws were modeled. Three dimensional finite element models of eight implanted mandibles were analyzed. The forces assigned to the masticatory muscles for incisal clenching were applied consisting of nine important muscular loads. In chosen loading condition, The results indicated that the anatomical curvature contact surface design of TMJ implant can moderately improve the stability and the strain resulted in fixation screw holes in thinner TMJ implant was diminished in comparison with other thicknesses.

Mechanical stiffness of TMJ condylar cartilage increases after artificial aging by ribose.

PubMed

Mirahmadi, Fereshteh; Koolstra, Jan Harm; Lobbezoo, Frank; van Lenthe, G Harry; Ghazanfari, Samaneh; Snabel, Jessica; Stoop, Reinout; Everts, Vincent

2018-03-01

Aging is accompanied by a series of changes in mature tissues that influence their properties and functions. Collagen, as one of the main extracellular components of cartilage, becomes highly crosslinked during aging. In this study, the aim was to examine whether a correlation exists between collagen crosslinking induced by artificial aging and mechanical properties of the temporomandibular joint (TMJ) condyle. To evaluate this hypothesis, collagen crosslinks were induced using ribose incubation. Porcine TMJ condyles were incubated for 7 days with different concentrations of ribose. The compressive modulus and stiffness ratio (incubated versus control) was determined after loading. Glycosaminoglycan and collagen content, and the number of crosslinks were analyzed. Tissue structure was visualized by microscopy using different staining methods. Concomitant with an increasing concentration of ribose, an increase of collagen crosslinks was found. The number of crosslinks increased almost 50 fold after incubation with the highest concentration of ribose. Simultaneously, the stiffness ratio of the samples showed a significant increase after incubation with the ribose. Pearson correlation analyses showed a significant positive correlation between the overall stiffness ratio and the crosslink level; the higher the number of crosslinks the higher the stiffness. The present model, in which ribose was used to mimic certain aspects of age-related changes, can be employed as an in vitro model to study age-related mechanical changes in the TMJ condyle. Copyright © 2017 Elsevier Ltd. All rights reserved.

Dislocation of temporo-mandibular joint - an uncommon circumstance of occurrence: vaginal delivery.

PubMed

El Bouazzaoui, Abderrahim; Labib, Smael; Derkaoui, Ali; Adnane Berdai, Mohammed; Bendadi, Azzeddine; Harandou, Mustapha

2010-06-25

Dislocation of temporo-mandibular joint (TMJ) is an infrequent disease but still spectacular. This disease consists of a permanent, to some extent complete disruption of the temporo-mandibular joint. These dislocations often occur in a context of yawning, and less frequently after a burst of laughing or relatively mild facial trauma (slap, punch on the chin). We report a case of TMJ occurring in an uncommon circumstance: vaginal delivery. A woman aged 24-years with no special past medical history; primipara was admitted in the Department of Maternity of the University Hospital Hassan II of Fez for an imminent delivery of a twin pregnancy. Ten minutes after admission, the patient delivered vaginally with episiotomy. She gave birth to twins weighing 2800 g and 2400 g. During labour, and due to efforts of crying, the patient developed a sudden and immediate loss of function of the temporo-mandibular joint, with difficulty of speaking, the mouth permanently opened and with the chin lowered and thrown forward. The examination found an empty glenoid fossa of the temporo-mandibular joint in both sides. The diagnosis of dislocation of the TMJ was established. A CT scan of facial bones was done, objectifying a bilateral dislocation of TMJ. The reduction of this dislocation was performed in the operating room under sedation.

Orofacial symptoms related to temporomandibular joint arthritis in juvenile idiopathic arthritis: smallest detectable difference in self-reported pain intensity.

PubMed

Stoustrup, Peter; Kristensen, Kasper D; Verna, Carlalberta; Küseler, Annelise; Herlin, Troels; Pedersen, Thomas K

2012-12-01

Temporomandibular joint (TMJ) inflammation in patients with juvenile idiopathic arthritis (JIA) may lead to mandibular growth disturbances and interfere with optimal joint and muscle function. Orofacial symptoms are common clinical findings in relation to TMJ arthritis in adolescence. Knowledge about their clinical manifestation is important for TMJ arthritis diagnosis, treatment choice, and outcome evaluation. The aim of our prospective observational study was to evaluate and describe the frequency, the main complaints, and the localization of TMJ arthritis-related orofacial symptoms. The smallest detectable differences (SDD) for minimal, average, and maximal pain were estimated. Thirty-three patients with JIA and arthritis-related orofacial symptoms in relation to 55 affected TMJ were included in our questionnaire study (mean age 14.11 yrs). Calculation of the SDD was based on a duplicate assessment 45 min after the first questionnaire was completed. The majority of the patients had common orofacial symptoms during mastication and maximal mouth opening procedures. Persistent orofacial symptoms were rare. The TMJ area in combination with the masseter muscle region was the orofacial region where symptoms were most common. The SDD for minimal, average, and maximal pain were between 10 and 14 mm on a visual analog scale. Our study offers new knowledge about TMJ arthritis-related orofacial symptoms that may aid diagnosis and clinical decision-making. We suggest that TMJ arthritis-related orofacial symptoms could be understood as products of the primary TMJ inflammation in combination with secondary myogenic and functional issues.

[Application of temporomandibular joint dics reduction in the operation of condylar sagittal fracture].

PubMed

Wenli, Zeng; Wuchao, Zhou; Jingkun, Zhang; Yisen, Shao; Weihong, Xi

2017-10-01

To explore the selection of temporomandibular joint (TMJ) disc reduction and fixation methods in condylar sagittal fracture surgery. A total of 36 patients with condylar fractures were chosen. The follow-up period was more 6 months. All 36 cases of condylar sagittal fracture were fixed with long screw. In the operation, the displaced joint disc was repositioned and fixed. The fixed method included direct suture (22 cases) and anchorage (14 cases). Clinical followups were performed before surgery and 1 month, 3 months, 6 months and 1 year after surgery. Clinicians recorded data related to the Fricton craniomandibular index (CMI) and evaluated the postoperative joint function during followup before surgery and 6 months after surgery. In both groups, function of TMJ significantly improved after surgery. The CMI decreased from 0.213±0.162 and 0.273±0.154 to 0.059±0.072 and 0.064±0.068 (P<0.05), respectively. No statistical difference was observed between the two groups in palpation index (PI), dysfunction index (DI) and CMI (P>0.05) before or after surgery. Both methods could effectively improve the dysfunction of the TMJ caused by trauma. The selection of joint disc reduction and fixation methods is based on the displacement and damage degree of the joint disc.

Quantitative 3D Ultrashort Time-to-Echo (UTE) MRI and Micro-CT (μCT) Evaluation of the Temporomandibular Joint (TMJ) Condylar Morphology

PubMed Central

Geiger, Daniel; Bae, Won C.; Statum, Sheronda; Du, Jiang; Chung, Christine B.

2014-01-01

Objective Temporomandibular dysfunction involves osteoarthritis of the TMJ, including degeneration and morphologic changes of the mandibular condyle. Purpose of this study was to determine accuracy of novel 3D-UTE MRI versus micro-CT (μCT) for quantitative evaluation of mandibular condyle morphology. Material & Methods Nine TMJ condyle specimens were harvested from cadavers (2M, 3F; Age 85 ± 10 yrs., mean±SD). 3D-UTE MRI (TR=50ms, TE=0.05 ms, 104 μm isotropic-voxel) was performed using a 3-T MR scanner and μCT (18 μm isotropic-voxel) was performed. MR datasets were spatially-registered with μCT dataset. Two observers segmented bony contours of the condyles. Fibrocartilage was segmented on MR dataset. Using a custom program, bone and fibrocartilage surface coordinates, Gaussian curvature, volume of segmented regions and fibrocartilage thickness were determined for quantitative evaluation of joint morphology. Agreement between techniques (MRI vs. μCT) and observers (MRI vs. MRI) for Gaussian curvature, mean curvature and segmented volume of the bone were determined using intraclass correlation correlation (ICC) analyses. Results Between MRI and μCT, the average deviation of surface coordinates was 0.19±0.15 mm, slightly higher than spatial resolution of MRI. Average deviation of the Gaussian curvature and volume of segmented regions, from MRI to μCT, was 5.7±6.5% and 6.6±6.2%, respectively. ICC coefficients (MRI vs. μCT) for Gaussian curvature, mean curvature and segmented volumes were respectively 0.892, 0.893 and 0.972. Between observers (MRI vs. MRI), the ICC coefficients were 0.998, 0.999 and 0.997 respectively. Fibrocartilage thickness was 0.55±0.11 mm, as previously described in literature for grossly normal TMJ samples. Conclusion 3D-UTE MR quantitative evaluation of TMJ condyle morphology ex-vivo, including surface, curvature and segmented volume, shows high correlation against μCT and between observers. In addition, UTE MRI allows

TMJ disorders

MedlinePlus

... conditions can cause TMJ symptoms, from arthritis to whiplash injuries. Experts who are specially trained in facial ... Garza I, Schwedt TJ, Robertson CE, Smith JH. Headache and other craniofacial pain. In: Daroff RB, Jankovic ...

Electromyographic evaluation of the 'vertical' dimension: the Learreta TMJ decompression test.

PubMed

Freire Matos, Marcelo; Durst, Andreas C; Freire Matos, Jane Luzia; Learreta, Jorge Alfonso

2011-10-01

The clinical observation of the incisors overbite is the most common form used to evaluate the occlusal vertical dimension (OVD); however, this technique offers poor information about the compression state of the TMJ. In order to obtain such information, it is necessary to evaluate the electrical activity of the elevator muscles using surface electromyography (EMG). In case of a compressive irritation of the joint receptors, the trigeminal nucleus returns an inhibitory motor response of the elevator muscles that can be measured. The Learreta's EMG decompression test is done by measuring the EMG response of the masticatory muscles at maximal occlusion in four different OVD positions in such a way that the reduction of the TMJ pressure, and subsequently, relief of the inhibitory motor response can be studied. The aim of this study is to illustrate this technique, its clinical use and its limitations.

Hyaline cartilage cells outperform mandibular condylar cartilage cells in a TMJ fibrocartilage tissue engineering application.

PubMed

Wang, L; Lazebnik, M; Detamore, M S

2009-03-01

To compare temporomandibular joint (TMJ) condylar cartilage cells in vitro to hyaline cartilage cells cultured in a three-dimensional (3D) environment for tissue engineering of mandibular condylar cartilage. Mandibular condylar cartilage and hyaline cartilage cells were harvested from pigs and cultured for 6 weeks in polyglycolic acid (PGA) scaffolds. Both types of cells were treated with glucosamine sulfate (0.4 mM), insulin-like growth factor-I (IGF-I) (100 ng/ml) and their combination. At weeks 0 and 6, cell number, glycosaminoglycan (GAG) and collagen content were determined, types I and II collagen were visualized by immunohistochemistry and GAGs were visualized by histology. Hyaline cartilage cells produced from half an order to a full order of magnitude more GAGs and collagen than mandibular condylar cartilage cells in 3D culture. IGF-I was a highly effective signal for biosynthesis with hyaline cartilage cells, while glucosamine sulfate decreased cell proliferation and biosynthesis with both types of cells. In vitro culture of TMJ condylar cartilage cells produced a fibrous tissue with predominantly type I collagen, while hyaline cartilage cells formed a fibrocartilage-like tissue with types I and II collagen. The combination of IGF and glucosamine had a synergistic effect on maintaining the phenotype of TMJ condylar cells to generate both types I and II collagen. Given the superior biosynthetic activity by hyaline cartilage cells and the practical surgical limitations of harvesting cells from the TMJ of a patient requiring TMJ reconstruction, cartilage cells from elsewhere in the body may be a potentially better alternative to cells harvested from the TMJ for TMJ tissue engineering. This finding may also apply to other fibrocartilages such as the intervertebral disc and knee meniscus in applications where a mature cartilage cell source is desired.

Synovial chondromatosis of the temporomandibular joint: a case report and literature review.

PubMed

Reed, Lucas S; Foster, Michael D; Hudson, John W

2013-10-01

Synovial chondromatosis (SC) is a pathologic condition in which mesenchymal tissue rests in a given synovial membrane undergo a metaplastic process, ultimately producing and secreting cartilaginous bodies into the joint space. It is more commonly discussed in the orthopedic literature, since the axial skeleton is the most frequently affected. Although rare, it does occur within the temporomandibular joint (TMJ), with approximately 100 cases previously being described. Within the TMJ, its presentation can be variable, though most cases will show it to be unilateral with fixed and/or loose cartilaginous bodies confined to the superior joint space. Clinically, patients may present with symptoms similar to that of an internal derangement disorder, including pain, clicking, tenderness, functional limitations, and swelling. A thorough history and physical examination, along with proper radiographic examination, are paramount in properly diagnosing SC. Treatment options consist of arthroscopy, arthrotomy with synovectomy, excision of cartilaginous bodies, and possible discectomy. In the current paper, the authors describe the presentation, diagnosis, and surgical management of a SC case involving the right TMJ in a 31-year-old Caucasian female.

Muenke Syndrome Mutation, FgfR3P244R, Causes TMJ Defects

PubMed Central

Yasuda, T.; Nah, H.D.; Laurita, J.; Kinumatsu, T.; Shibukawa, Y.; Shibutani, T.; Minugh-Purvis, N.; Pacifici, M.; Koyama, E.

2012-01-01

Muenke syndrome is characterized by various craniofacial deformities and is caused by an autosomal-dominant activating mutation in fibroblast growth factor receptor 3 (FGFR3P250R). Here, using mice carrying a corresponding mutation (FgfR3P244R), we determined whether the mutation affects temporomandibular joint (TMJ) development and growth. In situ hybridization showed that FgfR3 was expressed in condylar chondroprogenitors and maturing chondrocytes that also expressed the Indian hedgehog (Ihh) receptor and transcriptional target Patched 1(Ptch1). In FgfR3P244R mutants, the condyles displayed reduced levels of Ihh expression, H4C-positive proliferating chondroprogenitors, and collagen type II- and type X-expressing chondrocytes. Primary bone spongiosa formation was also disturbed and was accompanied by increased osteoclastic activity and reduced trabecular bone formation. Treatment of wild-type condylar explants with recombinant FGF2/FGF9 decreased Ptch1 and PTHrP expression in superficial/polymorphic layers and proliferation in chondroprogenitors. We also observed early degenerative changes of condylar articular cartilage, abnormal development of the articular eminence/glenoid fossa in the TMJ, and fusion of the articular disc. Analysis of our data indicates that the activating FgfR3P244R mutation disturbs TMJ developmental processes, likely by reducing hedgehog signaling and endochondral ossification. We suggest that a balance between FGF and hedgehog signaling pathways is critical for the integrity of TMJ development and for the maintenance of cellular organization. PMID:22622662

Neocondyle distraction osteogenesis in the management of temporomandibular joint ankylosis: Report of five cases with review of literature.

PubMed

Sharma, Ravi; Manikandhan, R; Sneha, P; Parameswaran, Anantanarayanan; Kumar, J Naveen; Sailer, Hermann F

2017-01-01

Management of temporomandibular joint (TMJ) ankylosis is a challenging and rather daunting task owing to complex abnormal anatomy and its sequel to craniofacial structures. Various autogenous grafts and alloplastic materials have been tried with variable success for creation of a near-normal joint. In recent years, neocondyle distraction has added a new dimension to the management of TMJ ankylosis. The aim of this paper is to describe the role of neocondyle distraction in TMJ ankylosis. Neocondyle distraction was carried out in five patients with TMJ ankylosis following gap arthroplasty. Computed tomogram scans were taken before surgery and 1-year postdistraction for surgical planning and postoperative assessment, respectively. The intraoral distractors (KLS Martin, Jacksonville, FL, USA) were used in this study. All five patients reported with adequate mouth opening and functional jaw movements. The procedure was well tolerated by all the patients. None of the patients underwent reankylosis following neocondyle distraction. With proper surgical planning and distraction protocol, neocondyle distraction is an effective and safe technique for TMJ reconstruction and preventing reankylosis.

Correlation between MRI evidence of degenerative condylar surface changes, induction of articular disc displacement and pathological joint sounds in the temporomandibular joint.

PubMed

Honda, Kosuke; Natsumi, Yoshiko; Urade, Masahiro

2008-12-01

The relationship of bony changes in the condylar surfaces in articular disc displacement without reduction in temporomandibular joint (TMJ) was investigated using diagnostic imaging. The study also evaluated whether the bony changes in the condylar surfaces limit disc and condyle motion, and produce pathological joint sounds. Thirty-seven joints in 28 patients diagnosed with degenerative bony changes in the condylar surfaces radiographically and anterior disc displacement without reduction using magnetic resonance imaging (MRI) were studied. The bony changes were assessed by radiographic examination and classified into two types: pathological bone changes (PBCs) including erosion, osteophyte formation and deformity, and adaptive bone changes (ABCs) including flattening and concavity. MRI was performed on the TMJ to examine the configuration and position of the discs. Joint sounds in the TMJ were determined using electrovibratograghy with a joint vibration analysis. The articular disc motion to the condyle in the PBC group was smaller than in the ABC group irrespective of the configuration of the disc, even though there were no significant differences between the two types of bony changes in the disc position during jaw closing. The joint vibration analysis of the TMJ showed that joint sounds with a higher frequency were observed in the PBC group than in the ABC group. High energy levels needed to produce the higher frequencies (over 300 Hz) were observed only in the PBC group.

Th1/Th17/Th22 immune response and their association with joint pain, imagenological bone loss, RANKL expression and osteoclast activity in temporomandibular joint osteoarthritis: A preliminary report.

PubMed

Monasterio, G; Castillo, F; Rojas, L; Cafferata, E A; Alvarez, C; Carvajal, P; Núñez, C; Flores, G; Díaz, W; Vernal, R

2018-05-15

It is well accepted that the presence of cytokines belonging to the Th1/Th17/Th22 axis of immuno-inflammatory response in the joint environment, such as IL-1β, IL-17 and IL-22, respectively, are associated with pathogenesis of several synovial joint degenerative disorders. During temporomandibular joint osteoarthritis (TMJ-OA), IL-1β and IL-17 have been implicated in the inflammation and resorption of sub-chondral bone; however, the role of Th22 response in the TMJ-OA pathophysiology has not been established. This study aimed to compare the expression of Th1/Th17/Th22-type cytokines, chemokines and chemokine receptors in synovial fluid samples obtained from TMJ-OA or disk displacement with reduction (DDWR) patients. In addition, it aimed to associate these levels with joint pain, imagenological signs of bone degeneration, RANKL production, osteoclastogenesis and osteoclast-induced bone resorption. Higher levels of IL-1β, IL-17 and IL-22 were expressed in TMJ-OA compared with DDWR subjects, and these increased levels significantly correlated with RANKL expression, joint pain and articular bone degeneration. Higher levels of CCR5, CCR6 and CCR7, as well as their respective ligands CCL5 and CCL20, responsible for recruitment of IL-1β, IL-17 and IL-22-producing cells, were over-expressed in TMJ-OA compared with DDWR subjects. Osteoclastogenesis and osteoclast-induced bone resorption were significantly greater in presence of synovial fluid from TMJ-OA compared with DDWR subjects. These data demonstrate that cytokines, CCLs and CCRs associated with the Th1/Th17/Th22 axis of immuno-inflammatory response are involved in TMJ-OA pathogenesis. These findings suggest that IL-22 is involved in the RANKL expression in TMJ-OA, which in turn induces differentiation of osteoclasts and subsequent resorption of sub-chondral bone. © 2018 John Wiley & Sons Ltd.

Unlocking the jaw: advanced imaging of the temporomandibular joint.

PubMed

Petscavage-Thomas, Jonelle M; Walker, Eric A

2014-11-01

Temporomandibular joint (TMJ) dysfunction is a common condition, affecting up to 28% of the population. The TMJ can be affected by abnormal dynamics of the disk-condyle complex, degenerative arthritis, inflammatory arthritis, and crystal arthropathy. Less commonly, neoplasms and abnormal morphologic features of the condyle are causes of TMJ symptoms. Cross-sectional imaging is frequently used for diagnosis. Knowledge of the normal imaging appearance of the TMJ, its appearance on radiological examination, and interventional techniques are useful for providing a meaningful radiologic contribution. This article will review normal TMJ anatomy; describe the normal ultrasound, CT, and MRI appearances of TMJ; provide imaging examples of abnormal TMJs; and illustrate imaging-guided therapeutic TMJ injection.

Virtual arthroscopy of the visible human female temporomandibular joint.

PubMed

Ishimaru, T; Lew, D; Haller, J; Vannier, M W

1999-07-01

This study was designed to obtain views of the temporomandibular joint (TMJ) by means of computed arthroscopic simulation (virtual arthroscopy) using three-dimensional (3D) processing. Volume renderings of the TMJ from very thin cryosection slices of the Visible Human Female were taken off the Internet. Analyze(AVW) software (Biomedical Imaging Resource, Mayo Foundation, Rochester, MN) on a Silicon Graphics 02 workstation (Mountain View, CA) was then used to obtain 3D images and allow the navigation "fly-through" of the simulated joint. Good virtual arthroscopic views of the upper and lower joint spaces of both TMJs were obtained by fly-through simulation from the lateral and endaural sides. It was possible to observe the presence of a partial defect in the articular disc and an osteophyte on the condyle. Virtual arthroscopy provided visualization of regions not accessible to real arthroscopy. These results indicate that virtual arthroscopy will be a new technique to investigate the TMJ of the patient with TMJ disorders in the near future.

[Temporo-mandibular joints and orthognathic surgery].

PubMed

Bouletreau, P

2016-09-01

Temporo-Mandibular Joints (TMJ) and orthognathic surgery are closely linked. In the past, some authors have even described (with mixed results) the correction of some dysmorphosis through direct procedures on the TMJs. Nowadays, performing orthognathic surgery involves the TMJ in three different occasions: (1) TMJ disorders potentially responsible for dento-maxillary dysmorphosis, (2) effects of orthognathic surgery on TMJs, and (3) condylar positioning methods in orthognathic surgery. These three chapters are developed in order to focus on the close relationships between TMJ and orthognathic surgery. Some perspectives close this article. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

TMJ inflammation increases Fos expression in the nucleus raphe magnus induced by subsequent formalin injection of the masseter or hindpaw of rats.

PubMed

Oh, Sang-Hoon; Imbe, Hiroki; Iwai-Liao, Yasutomo

2006-08-01

The study was designed to examine the effect of persistent temporomandibular joint (TMJ) inflammation on neuronal activation in the descending pain modulatory system in response to noxious stimulus. Formalin was injected into the left masseter muscle or hindpaw of rats 10 days after injection of the left TMJ with saline or complete Freund's adjuvant (CFA). The results showed that 10-day persistent TMJ inflammation (induced by CFA) alone did not induce a significant increase in Fos-like immunoreactive (Fos-LI) neurons in the rostral ventromedial medulla (RVM) or locus coeruleus (LC), but that formalin injection of the masseter muscle or hindpaw induced a significant increase in Fos-LI neurons in the RVM and LC of rats with and without TMJ inflammation (P < 0.05). However, persistent TMJ inflammation significantly increased Fos-LI neurons in the nucleus raphe magnus (NRM) induced by subsequent formalin injection of the masseter muscle and hindpaw (70.2% increase and 53.8% increase, respectively, over the control TMJ-saline-injected rats; P < 0.05). The results suggest that persistent TMJ inflammation increases neuronal activity, in particularly in the NRM, by the plastic change of the descending pain modulatory system after ipsilateral application of a noxious stimulus to either orofacial area or a spatially remote body area.

Temporomandibular joint injury potential imposed by the low-velocity extension-flexion maneuver.

PubMed

Howard, R P; Hatsell, C P; Guzman, H M

1995-03-01

It has been proposed that significant temporomandibular joint injury can occur as a result of rapid extension-flexion motion of the neck (whip-lash). This motion, which is experienced by passengers in vehicles that undergo rear-end collisions, has been described as causing rapid protrusion and opening of the mandible. It has been speculated that this relative motion between the mandible and the cranium produces forces at the temporomandibular joint (TMJ) that injure the articular elements. The objective of this study was to measure these forces by an experimental method. Accelerometer sensor and high-speed cinematographic data were obtained from the kinematic responses of live human test subjects positioned as occupants in motor vehicles that underwent staged low-velocity rear-end collisions. Linear and moment forces generated at the TMJs were obtained from the resultant acceleration pulse at the craniomandibular complex, estimation of the mass properties of the mandible and its appended soft tissues, and the application of Newton's Second Law of motion. The maximum linear forces generated at the TMJ in a rear-end collision resulting in a velocity change of the test subject of 8 km/h (5 mph) were in the 7 to 10 N (1.6 to 2.2 lb) range. Moment forces at the joint peaked briefly at 0.55 N.m (4.81 lb-in). These force magnitudes generated at the TMJ constitute a minor fraction of the forces experienced at the joint during normal physiologic function. It is a conclusion of this study that injuries to the TMJ attributed to low-velocity "whiplash" cannot be accounted for by the joint forces produced by this maneuver.

Prevalence of TMJ Disorders among the Patients Attending the Dental Clinic of Ajman University of Science and Technology-Fujairah Campus, UAE.

PubMed

AlShaban, Kashef K; Gul Abdul Waheed, Zainab

2018-01-01

The objective of this study was to determine the prevalence of temporomandibular joint (TMJ) disorders (if any) among the patients attending the dental clinic (for routine dental treatment) of Ajman University of Science and Technology (AUST)-Fujairah campus, UAE, and its possible causes. A sample of 100 adult patients attending the dental clinic of AUST for different types of dental treatment were collected; the routine examination of the TMJ and possible disorders such as clicking, crepitation, limitation or deviation during mouth opening, or tenderness reveals that 41% of the sample experience varying degrees of disorders in the TMJ. Radiographs were taken if needed (panoramic radiograph). The information was collected and recorded for each patient through questionnaires.

Assessment of articular disc displacement of temporomandibular joint with ultrasound.

PubMed

Razek, Ahmed Abdel Khalek Abdel; Al Mahdy Al Belasy, Fouad; Ahmed, Wael Mohamed Said; Haggag, Mai Ahmed

2015-06-01

To assess pattern of articular disc displacement in patients with internal derangement (ID) of temporomandibular joint (TMJ) with ultrasound. Prospective study was conducted upon 40 TMJ of 20 patients (3 male, 17 female with mean age of 26.1 years) with ID of TMJ. They underwent high-resolution ultrasound and MR imaging of TMJ. The MR images were used as the gold standard for calculating sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) of ultrasound for diagnosis of anterior or sideway displacement of the disc. The anterior displaced disc was seen in 26 joints at MR and 22 joints at ultrasound. The diagnostic efficacy of ultrasound for anterior displacement has sensitivity of 79.3 %, specificity of 72.7 %, accuracy of 77.5 %, PPV of 88.5 %, NPV of 57.1 %, PLR of 2.9 and NLR of 0.34. The sideway displacement of disc was seen in four joints at MR and three joints at ultrasound. The diagnostic efficacy of ultrasound for sideway displacement has a sensitivity of 75 %, specificity of 63.6 %, accuracy of 66.7 %, PPV of 42.8, NPV of 87.5 %, PLR of 2.06, and NLR of 0.39. We concluded that ultrasound is a non-invasive imaging modality used for assessment of anterior and sideway displacement of the articular disc in patients with ID of TMJ.

Alloplastic total temporomandibular joint replacements: do they perform like natural joints? Prospective cohort study with a historical control.

PubMed

Wojczyńska, A; Leiggener, C S; Bredell, M; Ettlin, D A; Erni, S; Gallo, L M; Colombo, V

2016-10-01

The aim of this study was to qualitatively and quantitatively describe the biomechanics of existing total alloplastic reconstructions of temporomandibular joints (TMJ). Fifteen patients with unilateral or bilateral TMJ total joint replacements and 15 healthy controls were evaluated via dynamic stereometry technology. This non-invasive method combines three-dimensional imaging of the subject's anatomy with jaw tracking. It provides an insight into the patient's jaw joint movements in real time and provides a quantitative evaluation. The patients were also evaluated clinically for jaw opening, protrusive and laterotrusive movements, pain, interference with eating, and satisfaction with the joint replacements. The qualitative assessment revealed that condyles of bilateral total joint replacements displayed similar basic motion patterns to those of unilateral prostheses. Quantitatively, mandibular movements of artificial joints during opening, protrusion, and laterotrusion were all significantly shorter than those of controls. A significantly restricted mandibular range of motion in replaced joints was also observed clinically. Fifty-three percent of patients suffered from chronic pain at rest and 67% reported reduced chewing function. Nonetheless, patients declared a high level of satisfaction with the replacement. This study shows that in order to gain a comprehensive understanding of complex therapeutic measures, a multidisciplinary approach is needed. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Effectiveness of Physiotherapy and GaAlAs Laser in the Management of Temporomandibular Joint Disorders

PubMed Central

Hlinakova, Petra; Kasparova, Magdalena; Rehacek, Adam; Vavrickova, Lenka; Navrátil, Leoš

2012-01-01

Abstract Objective: Low-level laser therapy (LLLT) is a treatment method commonly used in physiotherapy for musculoskeletal disorders. The aim of this study was to monitor the function of temporomandibular joint (TMJ) and surrounding tissues and compare the objective measurements of the effect of LLLT. Background data: LLLT has been considered effective in reducing pain and muscular tension; thus improving the quality of patients' lives. Materials and Methods: TMJ function was evaluated by cephalometric tracing analysis, orthopantomogram, TMJ tomogram, and computer face-bow record. Interalveolar space between central incisors before and after therapy was measured. Patients evaluated pain on the Visual Analog Scale. LLLT was performed in five treatment sessions (energy density of 15.4 J/cm2) by semiconductive GaAlAs laser with an output of 280 mW, emitting radiation wavelength of 830 mm. The laser supplied a spot of∼0.2 cm2. Results: Baseline comparisons between the healthy patients and patients with low-level laser application show that TMJ pain during function is based on anatomical and function changes in TMJ areas. Significant differences were seen in the posterior and anterior face height. The results comparing healthy and impaired TMJ sagittal condyle paths showed that patients with TMJ pain during function had significantly flatter nonanatomical movement during function. After therapy, the unpleasant feeling was reduced from 27.5 to 4.16 on the pain Visual Analog Scale. The pain had reduced the ability to open the mouth from 34 to 42 mm. Conclusions: The laser therapy was effective in the improvement of the range of temporomandibular disorders (TMD) and promoted a significant reduction of pain symptoms. PMID:22551049

TMJ: Symptoms, Diagnosis and Treatment | NIH MedlinePlus the Magazine

MedlinePlus

... please turn Javascript on. Feature: TMJ TMJ: Symptoms, Diagnosis and Treatment Past Issues / Winter 2010 Table of ... way the upper and lower teeth fit together Diagnosis There is no standard test for diagnosing TMJ. ...

MRI-based stereolithographic models of the temporomandibular joint: technical innovation.

PubMed

Undt, G; Wild, K; Reuther, G; Ewers, R

2000-10-01

A new technique of manufacturing dual-colour stereolithographic models of hard and soft tissues of the temporomandibular joint (TMJ) is presented. Sagittal T1/PD weighted magnetic resonance (MR) images of joints with and without disc displacement were obtained in the closed and open mouth positions. Individual interactive contour identification of bony structures and the articular disc followed by binary interpolation provided the data for the generation of acrylic TMJ models. Three dimensional in vivo visualization of the articular disc in relation to bony structures in the closed and open mouth positions allows a new perception of normal and pathological TMJ anatomy.

Development of a Mandibular Motion Simulator for Total Joint Replacement

PubMed Central

Celebi, Nukhet; Rohner, E. Carlos; Gateno, Jaime; Noble, Philip C.; Ismaily, Sabir K.; Teichgraeber, John F.; Xia, James J.

2015-01-01

Purpose The purpose of this study was to develop a motion simulator capable of recreating and recording the full range of mandibular motions in a cadaveric preparation for an intact temporomandibular joint (TMJ) and after total joint replacement. Material and Methods A human cadaver head was used. Two sets of tracking balls were attached to the forehead and mandible, respectively. Computed tomographic (CT) scan was performed and 3-dimensional CT models of the skull were generated. The cadaver head was then dissected to attach the muscle activation cables and mounted onto the TMJ simulator. Realistic jaw motions were generated through the application of the following muscle forces: lateral pterygoid muscle, suprahyoid depressors (geniohyoid, mylohyoid, and digastric muscles), and elevator muscles. To simulate muscle contraction, cables were inserted into the mandible at the center area of each muscle's attachment. To provide a minimum mouth closing force at the initial position, the elevator muscles were combined at the anterior mandible. During mandibular movement, each motion was recorded using a high-resolution laser scanner. The right TMJ of the same head was reconstructed with a total TMJ prosthesis. The same forces were applied and the jaw motions were recorded again. CT scan was performed and 3-dimensional CT models of the skull with TMJ prosthesis were generated. Results Mandibular motions, before and after TMJ replacement, with and without lateral pterygoid muscle reattachment, were re-created in a cadaveric preparation. The laser-scanned data during the mandibular motion were used to drive 3-dimensional CT models. A movie for each mandibular motion was subsequently created for motion path analysis. Compared with mandibular motion before TMJ replacement, mandibular lateral and protrusive motions after TMJ replacement, with and without lateral pterygoid muscle reattachment, were greatly limited. The jaw motion recorded before total joint replacement was

[Whiplash lesions and temporomandibular joint disorders].

PubMed

Gola, R; Richard, O; Guyot, L; Cheynet, F

2004-11-01

Attributing dysfunction of the temporomandibular joint (TMJ) to whiplash injury is a difficult problem to solve. TMJ disorders do not seem to be secondary to direct articular trauma but rather caused by a postural disorder of the cervical spine. Occlusal disorders and stress further complicate the picture. Four clinical cases illustrate a new hypothetical approach.

[Temporomandibular joint, occlusion and bruxism].

PubMed

Orthlieb, J D; Ré, J P; Jeany, M; Giraudeau, A

2016-09-01

Temporomandibular joint and dental occlusion are joined for better and worse. TMJ has its own weaknesses, sometimes indicated by bad functional habits and occlusal disorders. Occlusal analysis needs to be addressed simply and clearly. The term "malocclusion" is not reliable to build epidemiological studies, etiologic mechanisms or therapeutic advice on this "diagnosis". Understanding the impact of pathogenic malocclusion is not just about occlusal relationships that are more or less defective, it requires to locate them within the skeletal framework, the articular and behavioural context of the patient, and above all to assess their impact on the functions of the masticatory system. The TMJ-occlusion couple is often symbiotic, developing together in relation to its environment, compensating for its own shortcomings. However, a third partner may alter this relationship, such as bruxism, or more generally oral parafunctions, trauma or an interventionist practitioner. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Temporomandibular joint arthrocentesis for internal derangement with disc displacement without reduction.

PubMed

Bhargava, Darpan; Jain, Megha; Deshpande, Ashwini; Singh, Ajita; Jaiswal, Jagdish

2015-06-01

Temporomandibular joint (TMJ) disc derangement is defined as a malpositioning of the articular disc relative to the condyle and eminence. Arthrocentesis of the TMJ is a minimally invasive chair side procedure for the patients with TMJ internal derangement. This case report presents convincing results to keep arthrocentesis as an imperative procedure to relieve such patients of their acute symptoms. TMJ dynamics has also been discussed for an in-depth understanding of the pathology in cases with internal derangement.

Radiation dose in temporomandibular joint zonography

DOE Office of Scientific and Technical Information (OSTI.GOV)

Coucke, M.E.; Bourgoignie, R.R.; Dermaut, L.R.

1991-06-01

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.

[Primary and secondary prevention procedures of temporo-mandibular joint disease in the evolutive age].

PubMed

Ciavarella, D; Mastrovincenzo, M; Sabatucci, A; Campisi, G; Di Cosola, M; Suriano, M; Lo Muzio, L

2009-02-01

In the last years prevention of temporomandiboular joint (TMJ) disease had acquired great importance. According to the neuro-occlusal rehabilitation (RNO) it is possible to say that TMJ disease starts since first years of life. So it is important both for dentist and for pediatric know what are the conditions and the atypical functions which predispose to this pathology. The aim of this work was to show how it is possible to intercept since primary teeth and the correct norms of primary and secondary prevention.

Dietary correlates of temporomandibular joint morphology in the great apes.

PubMed

Terhune, Claire E

2013-02-01

Behavioral observations of great apes have consistently identified differences in feeding behavior among species, and these differences have been linked to variation in masticatory form. As the point at which the mandible and cranium articulate, the temporomandibular joint (TMJ) is an important component of the masticatory apparatus. Forces are transmitted between the mandible and cranium via the TMJ, and this joint helps govern mandibular range of motion. This study examined the extent to which TMJ form covaries with feeding behavior in the great apes by testing a series of biomechanical hypotheses relating to specific components of joint shape using linear measurements extracted from three-dimensional coordinate data. Results of these analyses found that taxa differ significantly in TMJ shape, particularly in the mandibular fossa. Chimpanzees have relatively more anteroposteriorly elongated joint surfaces, whereas gorillas tend to have relatively anteroposteriorly compressed joints. Orangutans were most commonly intermediate in form between Pan and Gorilla, perhaps reflecting a trade-off between jaw gape and load resistance capabilities. Importantly, much of the observed variation among taxa reflects differences in morphologies that facilitate gape over force production. These data therefore continue to emphasize the unclear relationship between mandibular loading and bony morphology, but highlight the need for further data regarding food material properties, jaw gape, and ingestive/food processing behaviors. Copyright © 2012 Wiley Periodicals, Inc.

[TMJ and orthodontics, "past, present and future"].

PubMed

Manière-Ezvan, A; Oueiss, A; Busson, F

2016-12-01

In the past, the ATM was mainly associated with the growth of the mandibular condyle. Many studies (on rats) showed the role of condylar cartilage in the growth response following stimulation by orthopedic appliances. From where, Class II dysmorphosis "orthopedic" treatments to grow the mandible; but this concept is discussed in the literature in the absence of fully conclusive results and especially since the contribution of orthognathic surgery. Currently, the operating concept is the mechanical stimulation and therefore the function will shape the ATM during growth and that, from an early age. Prevention of dysmorphoses must go through behavioral counseling to be adopted by parents from the birth of their child: to stimulate mandibular propulsion breastfeeding, then by a hard diet inducing an alternating unilateral chewing. Ignorance of the specificity of temporomandibular dysfunction (TMD) notably among teenagers has, in the past, left a doubt about the positive or negative role that could have orthodontic treatment on the TMJ. Currently, the best knowledge of TMJ and TMD provides a better therapeutic conduct: behavioral counseling especially for the girl hyperdivergente with small condyles, control of the condylar position, occlusal adjustments at the end of orthodontic treatment. The future of TMJ in relation with orthodontics is based on prevention, screening and deepening of our knowledge. The orthodontist will thus not make a treatment in patients at risk or will identify it and finish the treatment perfectly. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Augmented Indian hedgehog signaling in cranial neural crest cells leads to craniofacial abnormalities and dysplastic temporomandibular joint in mice

PubMed Central

Yang, Ling; Gu, Shuping; Ye, Wenduo; Song, Yingnan; Chen, YiPing

2016-01-01

Extensive studies have pinpointed the crucial role of Indian hedgehog (Ihh) signaling in the development of the appendicular skeleton and the essential function of Ihh in the formation of the temporomandibular joint (TMJ). In this study, we have investigated the effect of augmented Ihh signaling in TMJ development. We took a transgenic gain-of-function approach by overexpressing Ihh in the cranial neural crest (CNC) cells using a conditional Ihh transgenic allele and the Wnt1-Cre allele. We found that Wnt1-Cre-mediated tissue-specific overexpression of Ihh in the CNC lineage caused severe craniofacial abnormalities, including cleft lip/palate, encephalocele, anophthalmos, micrognathia, and defective TMJ development. In the mutant TMJ, the glenoid fossa was completely absent, whereas the condyle and the articular disc appeared relatively normal with slightly delayed chondrocyte differentiation. Our findings thus demonstrate that augmented Ihh signaling is detrimental to craniofacial development, and that finely tuned Ihh signaling is critical for TMJ formation. Our results also provide additional evidence that the development of the condyle and articular disc is independent of the glenoid fossa. PMID:26553654

Experimental investigations of the use of an erbium:YAG laser on temporomandibular joint (TMJ) structures: first experimental results

NASA Astrophysics Data System (ADS)

Nuebler-Moritz, Michael; Niederdellmann, Herbert; Hering, Peter; Deuerling, Christian; Dammer, Ralf; Behr, M.

1995-04-01

The following paper introduces the results of an interdisciplinary research project. With the aid of photomacroscopic examination, light and scanning electron microscope investigations, changes to temporomandibular joint structures were detected in vitro after irradiation with an Erbium:YAG laser system. The solid-state Erbium:YAG laser, operating at a wavelength of 2.94 micrometers was used in the normal- spiking mode. The free-running laser beam was focussed onto freshly excised porcine tissue samples using a 108-mm sapphire lens. In this study the output was generally pulsed at a repetition rate of 4 Hz, with a pulse duration varying from 120 microsecond(s) to 500 microsecond(s) . Between 50 mJ and 500 mJ per pulse were applied to create pinpoint lesions. The optimum average energy density and pulse duration of the Erbium:YAG laser radiation for the purpose of TMJ-surgery (as far as it concerns meniscus and articulating facets) - which means efficient etch rate and minimal adjacent injury - seems to be about 24-42 J/cm2 and 120 microsecond(s) -240 microsecond(s) , respectively.

The Effects of Oxygen Level and Glucose Concentration on the Metabolism of Porcine TMJ Disc Cells

PubMed Central

Cisewski, Sarah E.; Zhang, Lixia; Kuo, Jonathan; Wright, Gregory J.; Wu, Yongren; Kern, Michael J.; Yao, Hai

2015-01-01

Objective To determine the combined effect of oxygen level and glucose concentration on cell viability, ATP production, and matrix synthesis of temporomandibular joint (TMJ) disc cells. Design TMJ disc cells were isolated from pigs aged 6-8 months and cultured in a monolayer. Cell cultures were preconditioned for 48 hours with 0, 1.5, 5, or 25mM glucose DMEM under 1%, 5%, 10%, or 21% O2 level, respectively. The cell viability was measured using the WST-1 assay. ATP production was determined using the Luciferin-Luciferase assay. Collagen and proteoglycan synthesis were determined by measuring the incorporation of [2, 3-3H]proline and [35S]sulfate into the cells, respectively. Results TMJ disc cell viability significantly decreased (P<0.0001) without glucose. With glucose present, decreased oxygen levels significantly increased viability (P<0.0001), while a decrease in glucose concentration significantly decreased viability (P<0.0001). With glucose present, decreasing oxygen levels significantly reduced ATP production (P<0.0001) and matrix synthesis (P<0.0001). A decreased glucose concentration significantly decreased collagen synthesis (P<0.0001). The interaction between glucose and oxygen was significant in regards to cell viability (P<0.0001), ATP production (P=0.00015), and collagen (P=0.0002) and proteoglycan synthesis (P<0.0001). Conclusions Although both glucose and oxygen are important, glucose is the limiting nutrient for TMJ disc cell survival. At low oxygen levels, the production of ATP, collagen, and proteoglycan are severely inhibited. These results suggest that steeper nutrient gradients may exist in the TMJ disc and it may be vulnerable to pathological events that impede nutrient supply. PMID:26033165

The effects of oxygen level and glucose concentration on the metabolism of porcine TMJ disc cells.

PubMed

Cisewski, S E; Zhang, L; Kuo, J; Wright, G J; Wu, Y; Kern, M J; Yao, H

2015-10-01

To determine the combined effect of oxygen level and glucose concentration on cell viability, ATP production, and matrix synthesis of temporomandibular joint (TMJ) disc cells. TMJ disc cells were isolated from pigs aged 6-8 months and cultured in a monolayer. Cell cultures were preconditioned for 48 h with 0, 1.5, 5, or 25 mM glucose DMEM under 1%, 5%, 10%, or 21% O2 level, respectively. The cell viability was measured using the WST-1 assay. ATP production was determined using the Luciferin-Luciferase assay. Collagen and proteoglycan synthesis were determined by measuring the incorporation of [2, 3-(3)H] proline and [(35)S] sulfate into the cells, respectively. TMJ disc cell viability significantly decreased (P < 0.0001) without glucose. With glucose present, decreased oxygen levels significantly increased viability (P < 0.0001), while a decrease in glucose concentration significantly decreased viability (P < 0.0001). With glucose present, decreasing oxygen levels significantly reduced ATP production (P < 0.0001) and matrix synthesis (P < 0.0001). A decreased glucose concentration significantly decreased collagen synthesis (P < 0.0001). The interaction between glucose and oxygen was significant in regards to cell viability (P < 0.0001), ATP production (P = 0.00015), and collagen (P = 0.0002) and proteoglycan synthesis (P < 0.0001). Although both glucose and oxygen are important, glucose is the limiting nutrient for TMJ disc cell survival. At low oxygen levels, the production of ATP, collagen, and proteoglycan are severely inhibited. These results suggest that steeper nutrient gradients may exist in the TMJ disc and it may be vulnerable to pathological events that impede nutrient supply. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

An interesting radiological picture of post traumatic TMJ ankylosis due to sagittal condylar fracture.

PubMed

Kumar L K, Surej; Manuel, Suvy; Kurien, Nikhil M; Khalam, Sherin A; P Menon, Varun

2015-01-01

In a condylar fracture whether to intervene or to go for conservative management still remains a dilemma. Studies and hypothesis suggests that it's medially dislocated condylar fracture segment that is more likely to ankylose, moreover no consensus have been put forth as to whether to remove the medially displaced fracture segment. The current article describes a case of unilateral temporomandibular joint (TMJ) ankylosis, which resulted as a sequlae from conservative management of a bilateral condylar fracture of which, the ankylosed side had a sagittal fracture of condyle. In our case the post trauma CT shows the lateral segment abutting with the arch and that the area has become ankylotic in a span of 2 years. Here we report a case of posttraumatic unilateral TMJ ankylosis resulting from closed reduction of a bilateral condylar fracture with interesting radiological findings. We have tried to discuss a rather interesting radiological picture of posttraumatic TMJ ankylosis which resulted as a sequlae from conservative management of a bilateral condylar fracture. The dilemma for a clinician as to whether to intervene in a condylar fracture or to go for conservative management still remains at large. As in this case the medial fracture segment was intact and the lateral segment was resulting in ankylosis. Copyright © 2015. Published by Elsevier Ltd.

Trachlight management of succinylcholine-induced subluxation of the Temporo-mandibular joint: a case report and review of the literature.

PubMed

Roze des Ordons, Amanda; Townsend, Derek R

2008-09-01

We present a case of spontaneous subluxation of the Temporo-mandibular joint (TMJ) induced by succinylcholine, to compare our experience with previous cases reported in the literature, and to review the pathophysiology, preoperative screening, and intraoperative management of TMJ instability. A 39-yr-old female with primary hyperparathyroidism and a normal airway examination presented for elective parathyroidectomy. Following induction of anesthesia and the administration of succinylcholine prior to jaw manipulation, her mouth could not be opened, and we suspected spontaneous subluxation of the TMJ. We secured the airway with the use of a Trachlight and, subsequently, reduced the joint. Postoperatively, a history of mild TMJ-related symptoms was elicited. Instability of the TMJ is not uncommon, and has several implications for airway management, highlighting the importance of preoperative screening. Limited mouth opening, due to spontaneous subluxation of the TMJ following succinylcholine-induced muscle relaxation in the absence of airway manipulation, has only twice been reported in the literature. This report highlights how tracheal intubation may be accomplished using the Trachlight, in order to secure the airway prior to reduction of the subluxed joint.

Is LLLT effective in the management of TMJ pain?

NASA Astrophysics Data System (ADS)

Pinheiro, Antonio L. B.; Manzi, Cecilia T.; Rolim, Aluizio B.; Vieira, Alessandro L. B.

1999-05-01

This paper reports the result of the use of LLLT on the treatment of TMJ pain and present LLLT as an effective method of treating such problem. One hundred and eighty one female and 23 male patients aged between 7 and 81 years old (average 36.9 years old) suffering TMJ pain were treated with 632.8, 670, and 830nm diodes lasers at the Laser Center of the UFPE. The treatment consisted of a series of 12 applications twice a week. Patients were treated with an average dose of 3 J/cm2. One hundred forty one out of 204 patients were asymptomatic at the end of the treatment, 37 improved considerably and 26 were symptomatic. These result show although LLLT does not cure TMJ disorders it is effective in reducing TMJ pain.

[Comparative evolution surgical accesses to temporo-mandibular joint].

PubMed

Sysoliatin, P G; Novikov, A I; Sysoliatin, S P; Bobylev, N G; Brega, I N

2007-01-01

In experiment on 30 corpses of adult people criteria of an operational wound (depth of a wound, a corner of operational action, an axis of operational action, a corner of an inclination of operational action) were studied at preauricularis, intrauricularis, intrauriculo-temporalis and posterior mandibullaris access to temporo-mandibular joint (TMJ). New surgical intrauriculo-temporalis access to the joint is substantrated. On the basis of the analysis of 289 operations at 268 patients the indications to a choice of surgical access were developed at various diseases and damages of TMJ.

Scleroderma and the temporomandibular joint: reconstruction in 2 variants.

PubMed

MacIntosh, Robert Bruce; Shivapuja, Prasanna-Kumar; Naqvi, Rabia

2015-06-01

This article reviews the pathophysiology of scleroderma (systemic sclerosis [SSc]) and its destructive effects on the mandible in general and the temporomandibular joint (TMJ) in particular. It discusses the considerations of operating on patients with devastating chronic disease and presents 2 cases of TMJ reconstruction in patients with the diagnosis. Two patients with different degrees of SSc involvement underwent TMJ reconstruction with costochondral grafts. The patients represent the surgical considerations pertinent to this disease and different outcomes as determined by the variance in severity of their afflictions. The 2 patients tolerated the surgeries well and exhibited improvement in function in the long-term. One patient thrives and continues to do well despite her SSc approximately 10 years postoperatively; the second patient died of her disease approximately 9 years after her initial surgical care. The experience with these 2 cases showed that patients with SSc can safely undergo TMJ reconstruction with anticipated good results, but that the overall severity of the disease remains paramount in determining the feasibility of corrective surgery under this diagnosis. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Choosing sheep (Ovis aries) as animal model for temporomandibular joint research: Morphological, histological and biomechanical characterization of the joint disc.

PubMed

Angelo, D F; Morouço, P; Alves, N; Viana, T; Santos, F; González, R; Monje, F; Macias, D; Carrapiço, B; Sousa, R; Cavaco-Gonçalves, S; Salvado, F; Peleteiro, C; Pinho, M

2016-12-01

Preclinical trials are essential to the development of scientific technologies. Remarkable molecular and cellular research has been done using small animal models. However, significant differences exist regarding the articular behavior between these models and humans. Thus, large animal models may be more appropriate to perform trials involving the temporomandibular joint (TMJ). The aim of this work was to make a morphological (anatomic dissection and white light 3D scanning system), histological (TMJ in bloc was removed for histologic analysis) and biomechanical characterization (tension and compression tests) of sheep TMJ comparing the obtained results with human data. Results showed that sheep processus condylaris and fossa mandibularis are anatomically similar to the same human structures. TMJ disc has an elliptical perimeter, thinner in the center than in periphery. Peripheral area acts as a ring structure supporting the central zone. The disc cells display both fibroblast and chondrocyte-like morphology. Marginal area is formed by loose connective tissue, with some chondrocyte-like cells and collagen fibers in diverse orientations. Discs obtained a tensile modulus of 3.97±0.73MPa and 9.39±1.67MPa, for anteroposterior and mediolateral assessment. The TMJ discs presented a compressive modulus (E) of 446.41±5.16MPa and their maximum stress value (σmax) was 18.87±1.33MPa. Obtained results suggest that these animals should be considered as a prime model for TMJ research and procedural training. Further investigations in the field of oromaxillofacial surgery involving TMJ should consider sheep as a good animal model due to its resemblance of the same joint in humans. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Roller-coaster Ride to, Relief From TMJ | NIH MedlinePlus the Magazine

MedlinePlus

... a medical facility that can offer physicians, dentists, pain management specialists, and physical therapists familiar with TMJ. Also, look for psychologists expert in pain management, surgeons specializing in TMJ, and other TMJ experts." ...

Temporo-mandibular joint disease in ankylosing spondylitis.

PubMed Central

Davidson, C; Wojtulewski, J A; Bacon, P A; Winstock, D

1975-01-01

The occurrence of temporo-mandibular joint (TMJ) disease in ankylosing spondylitis is not widely recognized and its incidence is disputed. Seventy-nine patients attending two routine rheumatology clinics were therefore examined by dental surgeon and nine (11-5 per cent) were considered to have specific TMJ involvement. These patients were older than the remainder, and had more extensive spinal and peripheral joint disease. Symptoms were mild and the predominant clinical feature was restricted mouth opening, which could present considerable difficulties during emergency anaesthesia. Bilateral condylectomy was undertaken in one patient with some benefit. Images PMID:1124959

A cohort study of patients with juvenile idiopathic arthritis and arthritis of the temporomandibular joint: outcome of arthrocentesis with and without the use of steroids.

PubMed

Olsen-Bergem, H; Bjørnland, T

2014-08-01

The purpose of this study was to evaluate the effects of intra-articular temporomandibular joint (TMJ) treatment in patients with juvenile idiopathic arthritis (JIA). The inclusion criteria were met by 21 patients (38 joints). Joints were randomly selected for either arthrocentesis alone (n=17) or arthrocentesis with the additional use of triamcinolone hexacetonide (n=21) using a closed single-needle system. Measurements of pain and function were performed at baseline and at follow-up after 3 and 8 months. Pain on opening and lateral excursion improved significantly after injections. Pain decreased significantly from baseline to first and second control on a visual analogue scale (VAS) for overall pain (49-18-8) and overall function (41-19-4). Significant improvement was recorded for pain on palpation of muscles and joints. There was no statistically significant difference between the treatment modalities, with or without glucocorticoid injection. Arthrocentesis in the TMJ treatment of patients with JIA may be beneficial and steroids had no additional effect. Further studies are needed to evaluate the long-term effects on the TMJ structures and on condylar growth from arthrocentesis and intra-articular steroid injections. Copyright © 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Real-time MRI of the temporomandibular joint at 15 frames per second-A feasibility study.

PubMed

Krohn, Sebastian; Gersdorff, Nikolaus; Wassmann, Torsten; Merboldt, Klaus-Dietmar; Joseph, Arun A; Buergers, Ralf; Frahm, Jens

2016-12-01

The purpose of this study was to develop and evaluate a novel method for real-time MRI of TMJ function at high temporal resolution and with two different contrasts. Real-time MRI was based on undersampled radial fast low angle shot (FLASH) acquisitions with iterative image reconstruction by regularized nonlinear inversion. Real-time MRI movies with T1 contrast were obtained with use of a radiofrequency-spoiled FLASH sequence, while movies with T2/T1 contrast employed a gradient-refocused FLASH version. TMJ function was characterized in 40 randomly selected volunteers by sequential 20s acquisitions of both the right and left joint during voluntary opening and closing of the mouth (in a medial, central and lateral oblique sagittal section perpendicular to the long axis of the condylar head). All studies were performed on a commercial MRI system at 3T using the standard head coil, while online reconstruction was achieved with a bypass computer fully integrated into the MRI system. As a first result, real-time MRI studies of the right and left TMJ were successfully performed in all 40 subjects (80 joints) within a total examination time per subject of only 15min. Secondly, at an in-plane resolution of 0.75mm and 5mm section thickness, the achieved temporal resolution was 66.7ms per image or 15 frames per second. Thirdly, both T1-weighted and T2/T1-weighted real-time MRI movies provided information about TMJ function such as disc position, condyle mobility and disc-condyle relationship. While T1 contrast offers a better delineation of structures during rapid jaw movements, T2/T1 contrast was rated superior for characterizing the articular disc. In conclusion, the proposed real-time MRI method may become a robust and efficient tool for the clinical assessment of TMJ function. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

[Displacement and tissue remodeling of temporomandibular joint disc].

PubMed

Wang, M Q

2017-03-09

Sounding takes the highest prevalence of the signs of temporomandibular disorders (TMD). The well accepted theory of the mechanism for temporomandibular joint (TMJ) sounding is the internal derangement typically characterized by disc displacement. However, according to literature, there are approximately one third of asymptomatic joints in population had disc displacement, and, on the other hand, there are one fourth of TMJ sounding patients had not signs or very limited signs of disc displacement. Replacing the displaced disc to the normal position via methods like surgical operation did not achieve satisfactory long-term outcomes. In this review, we discuss and analyze the possible remodeling of the joint disc displacement diagnosed with imaging based on the anatomy and pathophysiology.

Temporo-mandibular joint dislocation: an unusual complication of transoesophageal echocardiography.

PubMed

Anantharam, Brijesh; Chahal, Navtej; Stephens, Nigel; Senior, Roxy

2010-03-01

Temporo-mandibular joint (TMJ) dislocation is an unusual complication of transoesophageal echocardiography (TEE). We report a rare case of bilateral TMJ dislocation in an 84-year-old man prior to DC cardioversion (DCCV) for atrial flutter. Shortly after TEE and DCCV, the patient complained of bilateral facial pain. An orthopantomogram revealed bilateral TMJ dislocation. A closed reduction was performed by maxillo-facial surgeons under intravenous anaesthesia. Although very uncommon, the physician should be aware of the complication and its management.

Development of a patient-specific temporomandibular joint prosthesis according to the Groningen principle through a cadaver test series.

PubMed

Kraeima, J; Merema, B J; Witjes, M J H; Spijkervet, F K L

2018-05-01

Patients suffering from osteoarthritis, ankylosis (e.g. post-trauma or tumour) in the temporomandibular joint (TMJ) can present with symptoms such as severely restricted mouth opening, pain or other dynamic restrictions of the mandible. To alleviate the symptoms, a total joint prosthesis can be indicated, such as the Groningen TMJ prosthesis. This was developed as a stock device with a lowered centre of rotation for improved translational and opening capacity. This study aimed to improve the design of the prosthesis, and produce a workflow for a customized Groningen TMJ prosthesis, in order to make it more accurate and predictable. The fossa and mandibular components of the Groningen TMJ prosthesis were customized. A series of five human cadavers was operated and bilateral TMJ prostheses were placed using custom cutting and drilling guides. Placement accuracy was evaluated based on post-operative CT data. A total of N = 10 prostheses were placed and analysed. The average Euclidean distance deviation from planned to actual position was 0.81 mm (SD 0.21). All prostheses were placed according to the routine surgical approaches and had an excellent alignment with the bony structures. The newly developed custom Groningen TMJ prosthesis can be placed with great accuracy and is the first step for improving TMJ total joint replacement surgery. Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Diagnostic index of 3D osteoarthritic changes in TMJ condylar morphology

NASA Astrophysics Data System (ADS)

Gomes, Liliane R.; Gomes, Marcelo; Jung, Bryan; Paniagua, Beatriz; Ruellas, Antonio C.; Gonçalves, João. Roberto; Styner, Martin A.; Wolford, Larry; Cevidanes, Lucia

2015-03-01

The aim of this study was to investigate imaging statistical approaches for classifying 3D osteoarthritic morphological variations among 169 Temporomandibular Joint (TMJ) condyles. Cone beam Computed Tomography (CBCT) scans were acquired from 69 patients with long-term TMJ Osteoarthritis (OA) (39.1 ± 15.7 years), 15 patients at initial diagnosis of OA (44.9 ± 14.8 years) and 7 healthy controls (43 ± 12.4 years). 3D surface models of the condyles were constructed and Shape Correspondence was used to establish correspondent points on each model. The statistical framework included a multivariate analysis of covariance (MANCOVA) and Direction-Projection- Permutation (DiProPerm) for testing statistical significance of the differences between healthy control and the OA group determined by clinical and radiographic diagnoses. Unsupervised classification using hierarchical agglomerative clustering (HAC) was then conducted. Condylar morphology in OA and healthy subjects varied widely. Compared with healthy controls, OA average condyle was statistically significantly smaller in all dimensions except its anterior surface. Significant flattening of the lateral pole was noticed at initial diagnosis (p < 0.05). It was observed areas of 3.88 mm bone resorption at the superior surface and 3.10 mm bone apposition at the anterior aspect of the long-term OA average model. 1000 permutation statistics of DiProPerm supported a significant difference between the healthy control group and OA group (t = 6.7, empirical p-value = 0.001). Clinically meaningful unsupervised classification of TMJ condylar morphology determined a preliminary diagnostic index of 3D osteoarthritic changes, which may be the first step towards a more targeted diagnosis of this condition.

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

ERIC Educational Resources Information Center

Funch, Donna P.; Gale, Elliot N.

1984-01-01

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)

Benign joint hypermobility syndrome in soldiers; what is the effect of military training courses on associated joint instabilities?

PubMed

Azma, Kamran; Mottaghi, Peyman; Hosseini, Alireza; Abadi, Hossein Hassan; Nouraei, Mohammad Hadi

2014-07-01

Hypermobile joints are joints with beyond normal range of motion and may be associated with joint derangements. This study aimed to evaluate the prevalence of benign joint hypermobility syndrome (BJHS) among soldiers and effect of training courses on related joint instabilities. In a prospective cohort study on 721 soldiers of Iran Army in Isfahan in 2013 the prevalence of joint hypermobility was obtained by using Beighton criteria. Soldiers divided in two groups of healthy and suffered based on their scores. The prevalence of ankle sprain, shoulder and temporomandibular joint (TMJ) dislocations identified before beginning service by history-taking and reviewing paraclinical documents. After 3 months of military training, a recent occurrence of mentioned diseases was revaluated in two groups. The collected data were analyzed using SPSS-20 software using Independent-T and Chi-square tests. The frequency of BJHS before military training was 29.4%. After passing military training period, the incidence of ankle sprain was significantly higher in suffered group achieving the minimum Beighton score (BS) of 4 (4.3%, P = 0.03), 5 (5.5%, P = 0.005) and also 6 out of 9 (6.5%, P = 0.01). The incidence of TMJ dislocation was not significantly different based on a minimum score of 4, while it was higher in suffered group when considering the score of 5 (2.1%) and 6 (2.6%) for discrimination of two groups (P = 0.03). There was no significant difference between two groups in case of shoulder dislocation anyway. Military training can increase the incidence of ankle sprains and TMJ dislocations in hypermobility persons with higher BS in comparison with healthy people. Therefore, screening of joint hypermobility may be useful in identifying individuals at increased risk for joint instabilities.

Relationship between head posture and dentofacial morphology in patients with TMJ osteoarthritis/osteoarthrosis.

PubMed

Ioi, Hideki; Matsumoto, Ryusuke; Nishioka, Masato; Goto, Tazuko K; Nakata, Shunsuke; Nakasima, Akihiko; Counts, Amy L

2008-01-01

To test whether there is a relationship between head and cervical posture and dentofacial morphology in patients with temporomandibular joint osteoarthritis/osteoarthrosis (OA). The subjects consisted of 34 Japanese females with TMJ OA (aged 24.7 +/- 6.1 years). Six craniocervical angular measurements were constructed for head posture. Two angular and 6 linear measurements were constructed for the skeletal relationship, while 1 angular and 6 linear measurements were constructed for the dental relationship. Pearson correlation coefficients were calculated between head posture and dentofacial variables. In the skeletal relationship, increased craniocervical angulations were significantly associated with a more posterior position of the maxilla, a decreased Frankfort to mandibular plane angle, decreased mandibular length, and a decreased lower facial height. In the dental relationship, increased craniocervical angulations were significantly associated with more posterior positions of the anterior teeth to the basal bone and decreased alveolar height of the anterior-posterior teeth. The hypothesis was rejected. These results suggest that an association may exist between head and cervical posture and dentofacial morphology in patients with TMJ OA.

Effects of cranberry components on IL-1β-stimulated production of IL-6, IL-8 and VEGF by human TMJ synovial fibroblasts.

PubMed

Tipton, David A; Christian, James; Blumer, Adam

2016-08-01

Osteoarthritis (OA) in the TMJ is characterized by deterioration of articular cartilage and secondary inflammatory changes. Interleukin-1β (IL-1β) stimulates IL-6, IL-8, and vascular endothelial growth factor (VEGF) in synovial fluid of TMJ with internal derangement and bony changes. The cranberry (Vaccinium macrocarpon) contains polyphenolic compounds that inhibit production of pro-inflammatory molecules by gingival cells in response to several stimulators. This study examined effects of cranberry components on IL-1β-stimulated IL-6, IL-8, and VEGF production by human TMJ synovial fibroblast-like cells. Cranberry high molecular weight non-dialyzable material (NDM) was derived from cranberry juice. Human TMJ synovial fibroblast-like cells from joints with degenerative OA and an ankylosed TMJ without degeneration were incubated with IL-1β (0.001-1nM)±NDM (25-250μg/ml) (2h preincubation). Viability was assessed via activity of a mitochondrial enzyme. IL-6, IL-8, and VEGF in culture supernatants were measured by ELISA; NF-κB and AP-1 transcription factors were measured in nuclear extracts via binding to specific oligonucleotides. ANOVA and Scheffe's F procedure for post hoc comparisons. NDM did not affect cell viability but inhibited IL-1β stimulated IL-6, IL-8, and VEGF production in all cell lines (p<0.05). NDM partially reduced nuclear levels of NF-κB and AP-1 (p<0.04), depending upon cell line and time of exposure to IL-1β+NDM. Cranberry NDM inhibition of IL-1β-stimulated IL- 6, IL-8, and VEGF production by TMJ synovial fibroblast-like cells suggests that cranberry components may be useful as a host modulatory therapeutic agent to prevent or treat inflammatory arthropathies of the TMJ. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Intra-articular injections of hyaluronic acid for anterior disc displacement of temporomandibular joint].

PubMed

Long, X

2017-03-09

Anterior disc displacement (ADD) of temporomandibular joint (TMJ) is regarded as one of the major findings in temporomandibular disorders (TMD). It is related to joint noise, pain, mandibular dysfunction, degenerative change and osteoarthritis. In the mean time, the pathological changes were found in synovial membrane and synovial fluid. Hyaluronic acid is a principal component of the synovial fluid which plays an important role in nutrition, lubrication, anti-inflammation and cartilage repair. The synthesis, molecule weight, and concentration of hyaluronic acid are decreased during TMD and cause TMJ degenerative changes. The clinical conditions, pathological changes, the mechanism of action for hyaluronic acid and the treatment of anterior disc displacement of TMJ are discussed in this article.

Oral Glucosamine Hydrochloride Combined With Hyaluronate Sodium Intra-Articular Injection for Temporomandibular Joint Osteoarthritis: A Double-Blind Randomized Controlled Trial.

PubMed

Yang, Wenbin; Liu, Wei; Miao, Cheng; Sun, Haibin; Li, Longjiang; Li, Chunjie

2018-06-02

Temporomandibular joint (TMJ) disorders occur in many people and osteoarthritis (OA) is a severe form of this disease. Glucosamine has been used to treat OA of the large joints for many years and has been proved effective. A double-blinded randomized controlled trial was designed to investigate the effectiveness and safety of oral glucosamine hydrochloride pills combined with hyaluronate sodium intra-articular injection in TMJ OA. One hundred forty-four participants with TMJ OA were randomized to 4 hyaluronate sodium injections and oral glucosamine hydrochloride (1.44 g/day) for 3 months (group A) or 4 hyaluronate sodium injections and oral placebo for 3 months (group B). All participants were followed for 1 year. Eighteen participants were lost to follow-up. The intention-to-treat analysis showed that group A had similar maximal interincisal mouth opening and pain intensity during TMJ function at months 1 and 6 (P > .05). However, during long-term follow-up, group A had significantly greater maximal interincisal mouth opening compared with group B at month 12 (41.5 vs 37.9 mm; P < .001). For pain intensity, group A showed obviously lower visual analog scale scores than group B at month 6 (20.6 vs 29.2 mm; P = .007) and month 12 (17.4 vs 28.6 mm; P = .001). Twenty-four participants had gastrointestinal tract side effects, fatigue, and rash. Of these, 23 had slight side effects that were not correlated with glucosamine. There was no significant difference between the 2 groups (P > .05). The results of this study suggest that, compared with hyaluronate sodium injection alone, glucosamine hydrochloride pills added to hyaluronate sodium injection had no meaningful effect on TMJ OA in the short-term but did relieve the pain caused by TMJ OA and improved TMJ functions in the long-term. Copyright © 2018 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

COMPUTED TOMOGRAPHIC APPEARANCE OF THE TEMPOROMANDIBULAR JOINT IN 1018 ASYMPTOMATIC HORSES: A MULTI-INSTITUTION STUDY.

PubMed

Carmalt, James L; Kneissl, Sibylle; Rawlinson, Jennifer E; Zwick, Timo; Zekas, Lisa; Ohlerth, Stefanie; Bienert-Zeit, Astrid

2016-05-01

Published descriptions of nonseptic arthritis of the equine temporomandibular joint (TMJ) are rare and large studies investigating variations in the TMJ for asymptomatic horses are lacking. The objectives of this cross-sectional, retrospective, multi-institutional study were to describe anatomical variations in the TMJ detected using computed tomography (CT) in an equid population asymptomatic for TMJ disease and determine whether these variations were associated with patient signalment, reason for CT examination, or CT slice width. Medical records at eight hospitals were searched for horses that had head/neck CT scans and no clinical signs of TMJ disease. Age, breed, sex, clinical presentation, and CT slice width data were recorded. Alterations in CT contour and density of the mandibular condyles, mandibular fossae, and TMJ intra-articular discs were described for each horse. Generalized logistic regression was used to test associations between anatomical variations and horse age. A total of 1018 horses were sampled. Anatomical variations were found in TMJ CT images for 40% of horses and 29% of joints. These were dichotomous with regard to age. Horses <1 year old commonly had alterations in the shape and density of the mandibular condyle. Older horses commonly had spherical hypodensities within the mandibular condyles consistent with bone cysts; and hyperdense regions of the intra-articular disc consistent with dystrophic mineralization. Findings indicated that TMJ anatomic variations were common in CT images of younger and older horses asymptomatic for TMJ disease. Future studies are needed to more definitively characterize these CT variations using gross pathology and histopathology. © 2016 American College of Veterinary Radiology.

Interpositional Gap Arthroplasty by Versatile Pedicled Temporalis Myofascial Flap in the Management of Temporomandibular Joint Ankylosis- A Case Series Study.

PubMed

Aneja, Vikas; Raval, Rushik; Bansal, Anupam; Kumawat, Vinod; Kaur, Jasleen; Shaikh, Ahemer Arif

2016-10-01

Temporomandibular Joint (TMJ) ankylosis is a situation in which the mandibular condyle is fused to the glenoid fossa by bone or fibrous tissue. The management of TMJ ankylosis has a complicated chore and it is challenging for the maxillofacial surgeon because of technical hitches and high rate of re-ankylosis. Interpositional gap arthroplasty is one of the modalities for its management. A range of inter-positional materials have been used to avert recurrence after gap arthroplasty in TMJ ankylosis. The aim of this series was to evaluate the effectiveness of the temporomyofacial flap in the treatment of TMJ ankylosis as an interpositional gap arthroplasty. A total of 10 cases with unilateral TMJ ankylosis were treated by interpositional gap arthroplasty by pedicled temporalis myofacial flap and evaluated with a follow-up of 6 months to 5 years (Mean 3.3 years) for the functional stability of TMJ. All the patients were successfully treated. There were no signs of recurrence in any patients up to last follow up visit. The result showed that temporalis myofascial flap is a preferable choice for inter-positional gap arthroplasty which proves its versatility as an inter-positional material.

Interpositional Gap Arthroplasty by Versatile Pedicled Temporalis Myofascial Flap in the Management of Temporomandibular Joint Ankylosis- A Case Series Study

PubMed Central

Aneja, Vikas; Bansal, Anupam; Kumawat, Vinod; Kaur, Jasleen; Shaikh, Ahemer Arif

2016-01-01

Temporomandibular Joint (TMJ) ankylosis is a situation in which the mandibular condyle is fused to the glenoid fossa by bone or fibrous tissue. The management of TMJ ankylosis has a complicated chore and it is challenging for the maxillofacial surgeon because of technical hitches and high rate of re-ankylosis. Interpositional gap arthroplasty is one of the modalities for its management. A range of inter-positional materials have been used to avert recurrence after gap arthroplasty in TMJ ankylosis. The aim of this series was to evaluate the effectiveness of the temporomyofacial flap in the treatment of TMJ ankylosis as an interpositional gap arthroplasty. A total of 10 cases with unilateral TMJ ankylosis were treated by interpositional gap arthroplasty by pedicled temporalis myofacial flap and evaluated with a follow-up of 6 months to 5 years (Mean 3.3 years) for the functional stability of TMJ. All the patients were successfully treated. There were no signs of recurrence in any patients up to last follow up visit. The result showed that temporalis myofascial flap is a preferable choice for inter-positional gap arthroplasty which proves its versatility as an inter-positional material. PMID:27891496

Whiplash injuries of the temporomandibular joint in motor vehicle accidents: speculations and facts.

PubMed

McKay, D C; Christensen, L V

1998-10-01

Referring to the temporomandibular joint (TMJ) of the human mandibular locomotor system, it has been asserted that displacement of the TMJ disc and inflammation of TMJ tissues are the results of acute and indirect trauma to the TMJ; on occasion this is allegedly experienced in motor vehicle accidents and commonly known as a TMJ whiplash injury. It is postulated that the TMJ whiplash injury is released in the occupant or occupants of a target vehicle when its rear end is impacted by the front end of a bullet vehicle. On the basis of detailed analyses of TMJ trauma/pain histories and TMJ magnetic resonance images, presented as circumstantial evidence in favour of the postulated TMJ whiplash injury, and detailed analyses of the mathematical biophysics of the mandibular locomotor system as well as direct experimental evidence, it is concluded that the postulated TMJ whiplash injury does not exist as a single and independent disease entity caused by motor vehicle accidents. If TMJ disc displacement and inflammation are present, they are expressions of an insidious and progressive pre-existing (pre-accident) disease entity that is comprised of TMJ synovitis/osteoarthritis (phase of inflammation with presence of immune system cells), TMJ internal derangement (phase of disc displacement and deformation with presence of proteinases), and TMJ osteoarthrosis (phase of degeneration with absence of immune system cells). For the asserted TMJ whiplash manoeuvre and ensuing injury to occur as postulated, the laws of physics and biology would have to be suspended.

3-D sonography for diagnosis of disk dislocation of the temporomandibular joint compared with MRI.

PubMed

Landes, Constantin A; Goral, Wojciech A; Sader, Robert; Mack, Martin G

2006-05-01

This study determines the value of three-dimensional (3-D) sonography for the assessment of disk dislocation of the temporomandibular joint (TMJ). Sixty-eight patients (i.e.,136 TMJ) with clinical dysfunction were examined by 272 sonographic 3-D scans. An 8- to 12.5-MHz transducer, angulated by step-motor, was used after picking a volume box on 2-D scan; magnetic resonance imaging followed immediately. Every TMJ was scrutinized in closed- and open-mouth position for normal or dislocated disk position. Fifty-three patients had complete data sets, i.e., 106 TMJ, 212 examinations. Sonographic examination took 5 min, with 74% specificity (62% closed-mouth; 85% open-mouth); sensitivity 53% (62/43%); accuracy 70% (62/77%); positive predictive value 49% (57/41%); and negative predictive value 77% (67/86%). This study encourages more research on the diagnostic capacity of 3-D TMJ sonography, with the advantage of multidimensional joint visualization. Although fair in specificity and negative predictive value, sensitivity and accuracy may ameliorate with future higher-sound frequency, real-time 3-D viewing and automated image analysis.

Medium-term outcomes and complications after total replacement of the temporomandibular joint. Prospective outcome analysis after 3 and 5 years.

PubMed

Gruber, E A; McCullough, J; Sidebottom, A J

2015-05-01

In this prospective analysis, we assess the medium-term benefits, efficacy, and safety of the TMJ Concepts joint replacement system in the United Kingdom. Outcome measures of pain, maximum mouth opening, and diet were recorded preoperatively and at intervals up to 3 and 5 years. All patients who had replacement temporomandibular joints (TMJ) within a 6-year period were included. A total of 58 patients (84 joints) were followed up for 3 years (mean age 47, range 19-72) and 26 (42 joints) for 5 years (mean age 46, range 27-70). The female to male ratio was 52:6 at 3 years and 23:3 at 5 years. The most common diagnosis was degenerative disease, and the mean number of previous TMJ procedures was 2.4 (range 0-14). There were significant improvements in pain scores (7.4 reduced to 0.6 at 3 years and 0.8 at 5 years), maximum mouth opening (21.0-35.5mm at 3 years and 23.8-33.7mm at 5 years), and dietary scores (4.1-9.7 at 3 years and 3.7-9.6 at 5 years). Revision operations were required in 2 patients (not included in the outcome data) for biofilm infection of the prosthesis secondary to local infection in the head and neck. One patient had weakness of the temporal branch of the facial nerve that needed correction. TMJ replacement is an effective form of management for an irreparably damaged joint, particularly in cases of ankylosis. It lessens pain and improves function with minimal long-term morbidity. Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Effect of simvastatin injections on temporomandibular joint inflammation in growing rats.

PubMed

George, Mark D; Owen, Callista M; Reinhardt, Adam L; Giannini, Peter J; Marx, David B; Reinhardt, Richard A

2013-05-01

Juvenile idiopathic arthritis often affects the temporomandibular joint (TMJ), resulting in facial deformities, and intra-articular injections of anti-inflammatory steroids used in treatment may inhibit bone growth in the developing condyle. The purpose of this pilot study was to evaluate the anti-inflammatory properties of simvastatin (SIM), a bone anabolic drug, compared with the common steroid triamcinolone hexacetonide (TH) in experimental TMJ arthritis of growing rats. Joint inflammation was induced by injecting complete Freund's adjuvant (CFA) into the TMJs of 32 growing (4-week-old) Sprague-Dawley rats while simultaneously receiving 1) ethanol drug carrier, 2) 0.1 mg of SIM, 3) 0.5 mg of SIM, or 4) 0.15 mg of TH. Six rats had no treatment to the TMJ. Animals were euthanized 28 days later, and TMJs were decalcified and stained with hematoxylin-eosin. Histopathologic TMJ results showed that CFA injection along with drug carrier induced increased thickness of the articular layer on the head of the condyle and inflammation of the retrodiscal area (CFA and ethanol). Although both TH and SIM reduced the articular layer thickness, 0.5 mg of SIM was more effective at reducing subsynovial inflammation. Intra-articular simvastatin showed anti-inflammatory properties in this TMJ model, prompting its further study in the growing TMJ, where bone anabolic properties would be important. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Can skull form predict the shape of the temporomandibular joint? A study using geometric morphometrics on the skulls of wolves and domestic dogs.

PubMed

Curth, Stefan; Fischer, Martin S; Kupczik, Kornelius

2017-11-01

The temporomandibular joint (TMJ) conducts and restrains masticatory movements between the mammalian cranium and the mandible. Through this functional integration, TMJ morphology in wild mammals is strongly correlated with diet, resulting in a wide range of TMJ variations. However, in artificially selected and closely related domestic dogs, dietary specialisations between breeds can be ruled out as a diversifying factor although they display an enormous variation in TMJ morphology. This raises the question of the origin of this variation. Here we hypothesise that, even in the face of reduced functional demands, TMJ shape in dogs can be predicted by skull form; i.e. that the TMJ is still highly integrated in the dog skull. If true, TMJ variation in the dog would be a plain by-product of the enormous cranial variation in dogs and its genetic causes. We addressed this hypothesis using geometric morphometry on a data set of 214 dog and 60 wolf skulls. We digitized 53 three-dimensional landmarks of the skull and the TMJ on CT-based segmentations and compared (1) the variation between domestic dog and wolf TMJs (via principal component analysis) and (2) the pattern of covariation of skull size, flexion and rostrum length with TMJ shape (via regression of centroid size on shape and partial least squares analyses). We show that the TMJ in domestic dogs is significantly more diverse than in wolves: its shape covaries significantly with skull size, flexion and rostrum proportions in patterns which resemble those observed in primates. Similar patterns in canids, which are carnivorous, and primates, which are mostly frugivorous imply the existence of basic TMJ integration patterns which are independent of dietary adaptations. However, only limited amounts of TMJ variation in dogs can be explained by simple covariation with overall skull geometry. This implies that the final TMJ shape is gained partially independently of the rest of the skull. Copyright © 2017 Elsevier Gmb

Histological fate of abdominal dermis-fat grafts implanted in the temporomandibular joint of the rabbit following condylectomy.

PubMed

Dimitroulis, G; Slavin, J; Morrison, W

2011-02-01

The histological fate of abdominal dermis-fat grafts implanted into the temporomandibular joint (TMJ) following condylectomy was studied. 21 rabbits underwent left TMJ discectomies and condylectomies; 6 were controls (Group A; no graft used); 15 (Group B) had autogenous abdominal grafts transplanted into the left TMJ. Animals were killed after 4, 12 and 20 weeks. Specimens of the TMJ were histologically and histomorphometrically evaluated. At 4 weeks, fat necrosis was clear in all specimens. The dermis component survived and formed cysts with no necrosis. By 12 weeks, viable fat deposits appeared with no evidence of necrotic fat. At 20 weeks, large amounts of viable fat were present in Group B specimens. Group A had no fat, although the missing condyles regenerated. In the presence of viable fat, Group B showed little condyle regeneration 20 weeks after condylectomy. Non-vascularised fat grafts do not survive transplantation, but stimulate neoadipogenesis. The fate of the dermis component of the graft is independent of the fat component. Fat in the joint space disrupts the regeneration of a new condylar head. Neoadipogensis inhibits growth of new bone and cartilage. This has clinical implications for TMJ ankylosis management and preventing heterotopic bone formation around prosthetic joints. Crown Copyright © 2010. Published by Elsevier Ltd. All rights reserved.

Chewing movements altered in the presence of temporomandibular joint internal derangements.

PubMed

Radke, John C; Kull, Robert S; Sethi, Manminder S

2014-07-01

The objectives were to find specific factors that are mathematically distinct between the chewing timings, movement pattern shapes, variability, and movement velocities of: (1) normal asymptomatic subjects and (2) a group of subjects with verified temporomandibular joint (TMJ) internal derangements. Left- and right-sided chewing movement recordings of 28 subjects (34.5 ± 14.0 years) were randomly selected from a large database of patients exhibiting verified unilateral or bilateral TMJ internal derangements. The chewing movements of an age- and gender-matched control group of 20 asymptomatic subjects (32.5 ± 11.6 years, P>0.60) with verified normal TMJ function were also recorded. Means and standard deviations of the opening, closing, turning point, terminal chewing position, and velocity patterns were calculated. A two-tailed Student's t-test with unequal variances was used to compare the parameters between the two groups (alpha = 0.05). The dysfunctional group functioned significantly slower and with greater variability than the control group. The vertical dimension was consistently smaller in the dysfunctional group (P<0.00001). The terminal chewing position was significantly less precise in the dysfunctional group (vertical: P<0.002 and lateral: P<0.037). The maximum lateral width was significantly less (P<0.0071), and the peak and the average velocities were significantly lower (P<0.00001 for both) in the dysfunctional group. This group of dysfunctional subjects exhibited significantly slower, smaller, and more variable chewing patterns than the control group. The functional pattern of mastication appears to be significantly altered in the presence of an internal derangement of the TMJ.

[A primary application and evaluation of temporomandibular joint replacement with stock prosthesis].

PubMed

Zhang, Xiao-hu; Chen, Min-jie; Qiu, Ya-ting; Yang, Chi

2012-06-01

To evaluate the effect of total joint replacement in treatment of temporomandibular joint(TMJ) osteoarthropathy with stock prostheses. Six female patients involving 10 joints (2 unilateral and 4 bilateral), with an average age of 59 years old, were involved in this study. Three patients (5 joints) were diagnosed as internal derangement in V stage depending on MRI, 3D-CT findings and clinical characteristics. The other 3 patients (5 joints) had histories of failed temporomandibular joint operation using costochondral graft or temporalis fascial flap. The maximal mouth opening was 1.9 cm on average (range, 1.0 to 2.9cm). All the joints were replaced with Biomet standard prosthesis under general anesthesia. The follow-up period was from 7 to 49 months (average, 17.5 months). All the operations were successfully performed. Heterotopic ossification happened in a bilateral case 1 year postoperatively. One patient with bilateral joint disease complained of severe uncomfortable feeling in the region of the ears and the temples, although there was no significant positive signs according to an ENT examination. Pain relief of the joint and mouth opening improvement were significant in 4 patients. No failure was noted secondary to infection or loosening of the prostheses. The occlusal relationship kept stable postoperatively in all cases. Total TMJ joint replacement with standard prosthesis is a good choice for TMJ reconstruction. It can significantly reduce joint pain and the mouth opening limitation resulted from osteoarthritis. Long-term result remains to be evaluated based on a long-term follow-up.

Rebamipide Attenuates Mandibular Condylar Degeneration in a Murine Model of TMJ-OA by Mediating a Chondroprotective Effect and by Downregulating RANKL-Mediated Osteoclastogenesis

PubMed Central

Izawa, Takashi; Mori, Hiroki; Shinohara, Tekehiro; Mino-Oka, Akiko; Hutami, Islamy Rahma; Iwasa, Akihiko; Tanaka, Eiji

2016-01-01

Temporomandibular joint osteoarthritis (TMJ-OA) is characterized by progressive degradation of cartilage and changes in subchondral bone. It is also one of the most serious subgroups of temporomandibular disorders. Rebamipide is a gastroprotective agent that is currently used for the treatment of gastritis and gastric ulcers. It scavenges reactive oxygen radicals and has exhibited anti-inflammatory potential. The aim of this study was to investigate the impact of rebamipide both in vivo and in vitro on the development of cartilage degeneration and osteoclast activity in an experimental murine model of TMJ-OA, and to explore its mode of action. Oral administration of rebamipide (0.6 mg/kg and 6 mg/kg) was initiated 24 h after TMJ-OA was induced, and was maintained daily for four weeks. Rebamipide treatment was found to attenuate cartilage degeneration, to reduce the number of apoptotic cells, and to decrease the expression levels of matrix metalloproteinase-13 (MMP-13) and inducible nitric oxide synthase (iNOS) in TMJ-OA cartilage in a dose-dependent manner. Rebamipide also suppressed the activation of transcription factors (e.g., NF-κB, NFATc1) and mitogen-activated protein kinases (MAPK) by receptor activator of nuclear factor kappa-B ligand (RANKL) to inhibit the differentiation of osteoclastic precursors, and disrupted the formation of actin rings in mature osteoclasts. Together, these results demonstrate the inhibitory effects of rebamipide on cartilage degradation in experimentally induced TMJ-OA. Furthermore, suppression of oxidative damage, restoration of extracellular matrix homeostasis of articular chondrocytes, and reduced subchondral bone loss as a result of blocked osteoclast activation suggest that rebamipide is a potential therapeutic strategy for TMJ-OA. PMID:27123995

Rebamipide Attenuates Mandibular Condylar Degeneration in a Murine Model of TMJ-OA by Mediating a Chondroprotective Effect and by Downregulating RANKL-Mediated Osteoclastogenesis.

PubMed

Izawa, Takashi; Mori, Hiroki; Shinohara, Tekehiro; Mino-Oka, Akiko; Hutami, Islamy Rahma; Iwasa, Akihiko; Tanaka, Eiji

2016-01-01

Temporomandibular joint osteoarthritis (TMJ-OA) is characterized by progressive degradation of cartilage and changes in subchondral bone. It is also one of the most serious subgroups of temporomandibular disorders. Rebamipide is a gastroprotective agent that is currently used for the treatment of gastritis and gastric ulcers. It scavenges reactive oxygen radicals and has exhibited anti-inflammatory potential. The aim of this study was to investigate the impact of rebamipide both in vivo and in vitro on the development of cartilage degeneration and osteoclast activity in an experimental murine model of TMJ-OA, and to explore its mode of action. Oral administration of rebamipide (0.6 mg/kg and 6 mg/kg) was initiated 24 h after TMJ-OA was induced, and was maintained daily for four weeks. Rebamipide treatment was found to attenuate cartilage degeneration, to reduce the number of apoptotic cells, and to decrease the expression levels of matrix metalloproteinase-13 (MMP-13) and inducible nitric oxide synthase (iNOS) in TMJ-OA cartilage in a dose-dependent manner. Rebamipide also suppressed the activation of transcription factors (e.g., NF-κB, NFATc1) and mitogen-activated protein kinases (MAPK) by receptor activator of nuclear factor kappa-B ligand (RANKL) to inhibit the differentiation of osteoclastic precursors, and disrupted the formation of actin rings in mature osteoclasts. Together, these results demonstrate the inhibitory effects of rebamipide on cartilage degradation in experimentally induced TMJ-OA. Furthermore, suppression of oxidative damage, restoration of extracellular matrix homeostasis of articular chondrocytes, and reduced subchondral bone loss as a result of blocked osteoclast activation suggest that rebamipide is a potential therapeutic strategy for TMJ-OA.

Regional cell density distribution and oxygen consumption rates in porcine TMJ discs: an explant study.

PubMed

Kuo, J; Shi, C; Cisewski, S; Zhang, L; Kern, M J; Yao, H

2011-07-01

To determine the regional cell density distribution and basal oxygen consumption rates (based on tissue volume and cell number) of temporomandibular joint (TMJ) discs and further examine the impact of oxygen tension on these rates. TMJ discs from pigs aged 6-8 months were divided into five regions: anterior, intermediate, posterior, lateral and medial. The cell density was determined using confocal laser scanning microscopy. The change in oxygen tension was recorded while TMJ disc explants were cultured in sealed metabolism chambers. The volume based oxygen consumption rate of explants was determined by theoretical curve-fitting of the recorded oxygen tension data with the Michaelis-Menten equation. The rate on a per-cell basis was calculated based on the cell density measurements and volume based rate measured in another group of discs. The overall cell density [mean, 95% confidence interval (CI)] was 51.3 (21.3-81.3) × 10(6) cells/mL wet tissue. Along the anteroposterior axis, the anterior band had 25.5% higher cell density than the intermediate zone (P<0.02) and 29.1% higher than the posterior band (P<0.008). Along the mediolateral axes, the medial region had 26.2% higher cell density than the intermediate zone (P<0.04) and 25.4% higher than the lateral region (P<0.045). The overall volume and cell based maximum oxygen consumption rates were 1.44 (0.44-2.44) μmol/mL wet tissue/h and 28.7 (12.2-45.2)nmol/10(6)cells/h, respectively. The central regions (intermediate, lateral, and medial) had significantly higher volume based (P<0.02) and cell based (P<0.005) oxygen consumption rates than the anterior and posterior bands. At high oxygen tension, the oxygen consumption rate remained constant, but dropped as oxygen tension fell below 5%. The TMJ disc had higher cell density and oxygen consumption rates than articular cartilage reported in the literature. These results suggest that a steeper oxygen gradient may exist in the TMJ disc and may be vulnerable to

Regional Cell Density Distribution and Oxygen Consumption Rates in Porcine TMJ Discs: An Explant Study

PubMed Central

Kuo, Jonathan; Shi, Changcheng; Cisewski, Sarah; Zhang, Lixia; Kern, Michael J.; Yao, Hai

2011-01-01

Objective To determine the regional cell density distribution and basal oxygen consumption rates (based on tissue volume and cell number) of temporomandibular joint (TMJ) discs and further examine the impact of oxygen tension on these rates. Design TMJ discs from pigs aged 6–8 months were divided into five regions: anterior, intermediate, posterior, lateral and medial. The cell density was determined using confocal laser scanning microscopy. The change in oxygen tension was recorded while TMJ disc explants were cultured in sealed metabolism chambers. The volume based oxygen consumption rate of explants was determined by theoretical curve fitting of the recoded oxygen tension data with the Michaelis-Menten equation. The rate on a per-cell basis was calculated based on the cell density measurements and volume based rate measured in another group of discs. Results The overall cell density (mean, 95% CI) was 51.3(21.3–81.3)×106cells/mL wet tissue. Along the anteroposterior axis, the anterior band had 25.5% higher cell density than the intermediate zone (p<0.02) and 29.1% higher than the posterior band (p<0.008). Along the mediolateral axes, the medial region had 26.2% higher cell density than the intermediate zone (p<0.04) and 25.4% higher than the lateral region (p<0.045). The overall volume and cell based maximum oxygen consumption rates were 1.44(0.44–2.44) μmol/mL wet tissue/hr and 28.7(12.2–45.2) nmol/106 cells/hr, respectively. The central regions (intermediate, lateral, and medial) had significantly higher volume based (p<0.02) and cell based (p<0.005) oxygen consumption rates than the anterior and posterior bands. At high oxygen tension, the oxygen consumption rate remained constant, but dropped as oxygen tension fell below 5%. Conclusions The TMJ disc had higher cell density and oxygen consumption rates than articular cartilage reported in the literature. These results suggest that a steeper oxygen gradient may exist in the TMJ disc and may be

Adaptive plasticity in mammalian masticatory joints

NASA Astrophysics Data System (ADS)

Ravosa, Matthew J.; Kunwar, Ravinder; Nicholson, Elisabeth K.; Klopp, Emily B.; Pinchoff, Jessie; Stock, Stuart R.; Stack, M. Sharon; Hamrick, Mark W.

2006-08-01

Genetically similar white rabbits raised on diets of different mechanical properties, as well as wild-type and myostatin-deficient mice raised on similar diets, were compared to assess the postweaning effects of elevated masticatory loads due to increased jaw-adductor muscle and bite forces on the proportions and properties of the mandibular symphysis and temporomandibular joint (TMJ). Microcomputed tomography (microCT) was used to quantify bone structure at a series of equidistant external and internal sites in coronal sections for a series of joint locations. Discriminant function analyses and non-parametric ANOVAs were used to characterize variation in biomineralization within and between loading cohorts. In both species, long-term excessive loading results in larger joint proportions, thicker articular and cortical bone, and increased biomineralization of hard tissues. Such adaptive plasticity appears designed to maintain the postnatal integrity of masticatory joint systems for a primary loading environment(s). This behavioral signal may be increasingly mitigated in older organisms by the interplay between adaptive and degradative joint tissue responses.

Development of collagen fibers and vasculature of the fetal TMJ.

PubMed

Yang, L; Wang, H; Wang, M; Ohta, Y; Suwa, F

1992-10-01

Using 12 human fetuses, histological development and changes in connective fiber structure and fine vascular patterns have been investigated in various fetal gestational stages by light and scanning electron microscopy. The main arterial supply of the articular disc was from the bilaminar region and pterygoideus lateralis muscle. The vascular network on the disc surface was related with fluid secretion. When the bilaminar region was compressed, it caused ischemia and fibrosis as the main pathological changes in TMJ derangement. A decrease in fluid from blood vessels might occur in TMJ degeneration. Collagen fibers in the disc passed mainly anteroposteriorly. In the anterior and posterior bands, muscular tendon fibers came from the pterygoideus lateralis muscle and superior stratum of the bilaminar region. In the posterior band three-dimensional structures of collagen fibers suitable for load bearing were observed. The compass network and process on the disc showed the normal structure that is formed gradually and has functions including dispersion, pressure bearing, friction-proofing and storage of the synovial fluid. Attachments of the disc were suitable for disc function. Large elastic fibers in the posterolateral part of the superior stratum of the bilaminar region may be antagonistic to the upper head of the pterygoideus lateralis muscle fibers passing medioanteriorly, indicating that this antagonism is available for disc function.

Temporomandibular joint MR images: Incidental head and neck findings and pathologies.

PubMed

Orhan, Kaan; Avsever, Hakan; Aksoy, Seçil; Seki, Umut; Bozkurt, Poyzan

2017-10-17

To report the number and frequency of incidental findings (IFs) detected during magnetic resonance (MR) imaging screening of the temporomandibular joint (TMJ) and to define related diseases. Bilateral TMJ MR images in the sagittal and coronal sections, from 518 patients with TMJ symptoms were evaluated retrospectively. Patients who were diagnosed with IFs were sent for consultation and clarification of the findings. Patient age, gender, IFs, locations, and diseases were classified and noted.  Results: Seventy-eight (15%) patients were diagnosed with 117 IFs. Of them, 43 were diagnosed with a single IF, and 35 were diagnosed with more than one IF. The most frequent locations were paranasal sinuses and mastoid air cells. The most frequent diseases were inflammatory and cystic lesions.  Discussion: While examining TMJ MR images, it is important to check for evidence of IFs or pathologies that may have mimicked signs and symptoms of TMJ disorders.

Effect of platelet-rich plasma on fibrocartilage, cartilage, and bone repair in temporomandibular joint.

PubMed

Kütük, Nükhet; Baş, Burcu; Soylu, Emrah; Gönen, Zeynep Burçin; Yilmaz, Canay; Balcioğlu, Esra; Özdamar, Saim; Alkan, Alper

2014-02-01

The purpose of the present study was to explore the potential use of platelet-rich-plasma (PRP) in the treatment of temporomandibular joint osteoarthritis (TMJ-OA). Surgical defects were created bilaterally on the condylar fibrocartilage, hyaline cartilage, and bone to induce an osteoarthritic TMJ in rabbits. PRP was applied to the right joints of the rabbits (PRP group), and the left joints received physiologic saline (control group). After 4 weeks, the rabbits were sacrificed for histologic and scanning electron microscopy (SEM) examinations. The data were analyzed statistically. The new bone regeneration was significantly greater in the PRP group (P < .011). Although the regeneration of the fibrocartilage and hyaline cartilage was greater in the PRP group, no statistically significant difference was found between the 2 groups. SEM showed better ultrastructural architecture of the collagen fibrils in the PRP group. PRP might enhance the regeneration of bone in TMJ-OA. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

[Diagnosis and treatment of diffuse tenosynovial giant cell tumor arising from temporomandibular joints].

PubMed

Meng, J H; Guo, Y X; Luo, H Y; Guo, C B; Ma, X C

2016-12-18

To retrospectively analyze the clinical features, treatment and prognosis to the diffuse tenosynovial giant cell tumor (D-TSGCT) arising from the temporomandibular joint (TMJ), and to give a reference for the early diagnosis and treatment of this disease. In this study, 15 patients finally diagnosed as D-TSGCT of TMJ histopathologically at the Peking University Hospital of Stomatology from October 2003 to August 2015 were selected and reviewed. Their clinical manifestations, imaging and histological features, diagnoses and differential diagnoses, treatments and follow-ups were summarized and discussed. D-TSGCT of TMJ showed obvious female predominance (12/15), the main symptoms included painful preauricular swelling or mass, limited mouth-opening and mandibular deviation with movement. D-TSGCT on computed tomography (CT) scan often showed ill-defined soft tissue masses around TMJ, enhancement after contrast administration, usually with widening of the joint spaces and with bone destruction of the condyle, the fossa and even the skull base. On magnetic resonance images (MRI), the majority of lesions on T1 weighted images and T2 weighted images both showed the characteristics of low signals (6/11). The lesions could extend beyond the joints (9/11) and into the infratemporal fossa (4/11) and the middle cranial fossa (4/11). Surgical resection was performed in 14 cases and biopsy in 1 case. Postoperative radiotherapy was performed in 3 cases. In follow-ups, 3 cases showed recurrence postoperatively. D-TSGCT arising from TMJ should be differentiated with TMJ disorders, other tumors and tumor-like lesions of TMJ and parotid neoplasms, etc. CT and MRI examinations have important values in the diagnosis and treatment design of D-TSGCT. Because of the local aggressive and extensive behavior, complete resection should be performed as soon as possible. Postoperative radiotherapy was helpful for the extensive lesions including destruction of skull base and may be a good

Biomechanical calculation of human TM joint loading with jaw opening.

PubMed

Kuboki, T; Takenami, Y; Maekawa, K; Shinoda, M; Yamashita, A; Clark, G T

2000-11-01

A three-dimensional, static mathematical calculation of the stomatognathic system was done to predict total temporomandibular joint (TMJ) loading at different levels of jaw opening. The model assumed that muscle forces acting on the mandible could be simulated by a combination of contractile components (CCs) and elastic components (ECs) and that static equilibrium existed within the body of the mandible. The model also imposed the constraint that any generated joint reaction force would act on the centre of the condyle. The results of the model demonstrated that under all conditions of opening and for all values of the elastic modulus selected, the forces between the TMJ condyle and the articular eminence were compressive in nature. The compressive force magnitude increased from 2.7 to 27.6 N incrementally as the jaw opened from 10 to 40 mm. Overall data in this study indicated that the TMJ tissues undergo low levels of compression at open positions up to 40 mm. Finally, the condition of trismus (increased jaw closing activation with opening) was simulated, the joint reaction force at 20 mm opening increased from 7.7 to 64.9 N with only a 20% activation of the closers.

MRI and CBCT image registration of temporomandibular joint: a systematic review.

PubMed

Al-Saleh, Mohammed A Q; Alsufyani, Noura A; Saltaji, Humam; Jaremko, Jacob L; Major, Paul W

2016-05-10

The purpose of the present review is to systematically and critically analyze the available literature regarding the importance, applicability, and practicality of (MRI), computerized tomography (CT) or cone-beam CT (CBCT) image registration for TMJ anatomy and assessment. A systematic search of 4 databases; MEDLINE, EMBASE, EBM reviews and Scopus, was conducted by 2 reviewers. An additional manual search of the bibliography was performed. All articles discussing the magnetic resonance imaging MRI and CT or CBCT image registration for temporomandibular joint (TMJ) visualization or assessment were included. Only 3 articles satisfied the inclusion criteria. All included articles were published within the last 7 years. Two articles described MRI to CT multimodality image registration as a complementary tool to visualize TMJ. Both articles used images of one patient only to introduce the complementary concept of MRI-CT fused image. One article assessed the reliability of using MRI-CBCT registration to evaluate the TMJ disc position and osseous pathology for 10 temporomandibular disorder (TMD) patients. There are very limited studies of MRI-CT/CBCT registration to reach a conclusion regarding its accuracy or clinical use in the temporomandibular joints.

Protocol for concomitant temporomandibular joint custom-fitted total joint reconstruction and orthognathic surgery utilizing computer-assisted surgical simulation.

PubMed

Movahed, Reza; Teschke, Marcus; Wolford, Larry M

2013-12-01

Clinicians who address temporomandibular joint (TMJ) pathology and dentofacial deformities surgically can perform the surgery in 1 stage or 2 separate stages. The 2-stage approach requires the patient to undergo 2 separate operations and anesthesia, significantly prolonging the overall treatment. However, performing concomitant TMJ and orthognathic surgery (CTOS) in these cases requires careful treatment planning and surgical proficiency in the 2 surgical areas. This article presents a new treatment protocol for the application of computer-assisted surgical simulation in CTOS cases requiring reconstruction with patient-fitted total joint prostheses. The traditional and new CTOS protocols are described and compared. The new CTOS protocol helps decrease the preoperative workup time and increase the accuracy of model surgery. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Bilateral septic arthritis of the temporo mandibular joint: case report.

PubMed

Ayachi, Samia; Mziou, Zouha; Moatemri, Ramzi; Khochtali, Habib

2016-01-01

Septic arthritis of the temporo-mandibular joint (TMJ) is a rare disease that has been reported infrequently. To the best of the authors' knowledge, only one case of bilateral TMJ septic arthritis has been reported. The contamination may result from direct extension of adjacent infection (dental or ENT), from hematogenous spread of blood-borne organisms or from direct inoculation. The most common presenting are trismus and pain, although swelling, tenderness and erythema have also been described. In addition, patients may develop fever, regional lymphadenopathy and malocclusion. Through a successively bilateral case of TMJ arthritis, without obvious portal of entry of the bacteria, we will analyze characteristics and treatment of this disease.

PAR(2) and temporomandibular joint inflammation in the rat.

PubMed

Denadai-Souza, A; Cenac, N; Casatti, C A; Câmara, P R de Souza; Yshii, L M; Costa, S K P; Vergnolle, N; Muscará, M N

2010-10-01

The proteinase-activated receptor 2 (PAR(2)) is a putative therapeutic target for arthritis. We hypothesized that the early pro-inflammatory effects secondary to its activation in the temporomandibular joint (TMJ) are mediated by neurogenic mechanisms. Immunofluorescence analysis revealed a high degree of neurons expressing PAR(2) in retrogradely labeled trigeminal ganglion neurons. Furthermore, PAR(2) immunoreactivity was observed in the lining layer of the TMJ, co-localizing with the neuronal marker PGP9.5 and substance-P-containing peripheral sensory nerve fibers. The intra-articular injection of PAR(2) agonists into the TMJ triggered a dose-dependent increase in plasma extravasation, neutrophil influx, and induction of mechanical allodynia. The pharmacological blockade of natural killer 1 (NK(1)) receptors abolished PAR(2)-induced plasma extravasation and inhibited neutrophil influx and mechanical allodynia. We conclude that PAR(2) activation is pro-inflammatory in the TMJ, through a neurogenic mechanism involving NK(1) receptors. This suggests that PAR(2) is an important component of innate neuro-immune response in the rat TMJ.

Osteoarthritis of the temporo-mandibular joint in free-living Soay sheep on St Kilda.

PubMed

Arthur, Colin; Watt, Kathryn; Nussey, Daniel H; Pemberton, Josephine M; Pilkington, Jill G; Herman, Jeremy S; Timmons, Zena L; Clements, Dylan N; Scott, Philip R

2015-01-01

Osteoarthritis (OA) is a common degenerative disease of synovial joints with the potential to cause pathology and welfare issues in both domestic and wild ruminants. Previous work has identified OA of the elbow joint in domestic sheep, but the prevalence of OA of the jaw and in particular the temporomandibular joint (TMJ) has not been previously reported. Following up a previous report of a single case of TMJ OA in a free-living population of Soay sheep on St Kilda in the Outer Hebrides, an archive of 2736 jaw bones collected from this population between 1985 and 2010 was surveyed. Evidence of TMJ OA was found in 35 sheep. Of these, 15 cases were unilateral (11 right side, 4 left side) and the remaining 20 were bilateral. TMJ pathology was much more common in females than males: only 3/35 cases were in males, with overall prevalence at 2.3% for females and 0.2% in males. Radiographic examination of TMJ with OA revealed extensive bone re-modelling with osteophytosis, particularly of the condyle of the mandible. There was a highly significant age-dependence in TMJ OA incidence among age classes: 30/35 cases occurred in geriatric sheep (aged 7 years or more; 11.1% prevalence within this age class), four in adults (2-6 years old; 0.9% prevalence), one in yearlings (0.3% prevalence) and none in lambs. The low incidence in males was confounded by sex differences in longevity: while 18% of females sampled died in the geriatric age class, only 2% of males did so. Although the low prevalence of the pathology limited the ability to test its association with other traits, it was possible to examine relationships with reproductive performance measures amongst geriatric females with and without TMJ OA. Although there were trends towards lower fecundity and lower lamb birth weight in the breeding season prior to death, these were not statistically significant. Copyright © 2014 Elsevier Ltd. All rights reserved.

[Custom-made implant for complex facial reconstruction: A case of total replacement of temporo-mandibular joint, zygomatic arch and malar bone].

PubMed

Guillier, D; Moris, V; See, L-A; Girodon, M; Wajszczak, B-L; Zwetyenga, N

2017-02-01

Total prosthetic replacement of the temporo-mandibular joint (TMJ) has become a common procedure, but it is usually limited to the TMJ itself. We report about one case of complex prosthetic joint reconstruction extending to the neighbouring bony structures. A 57-year-old patient, operated several times for a cranio-facial fibrous dysplasia, presented with a recurring TMJ ankylosis and a complexe latero-facial bone loss on the right side. We performed a reconstruction procedure including the TMJ, the zygomatic arch and the malar bone by mean of custom made composite prosthesis (chrome-cobalt-molybdenum-titanium and polyethylene). Five years postoperatively, mouth opening, nutrition, pain and oral hygiene were significantly improved. Nowadays technical possibilities allow for complex facial alloplastic reconstructions with good medium term results. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Evaluation of body posture in individuals with internal temporomandibular joint derangement.

PubMed

Munhoz, Wagner Cesar; Marques, Amélia Pasqual; de Siqueira, José Tadeu Tesseroli

2005-10-01

Temporomandibular dysfunctions (TMD) comprise a great number of disruptions that may affect the temporomandibular joint (TMJ), the masticatory muscles, or both. TMJ internal derangement is a specific type of TMD, of which the etiology and physiopathology are broadly unknown, but have been suggested to be linked to head, neck, and body posture factors. This study aimed at verifying possible relationships between body posture and TMJ internal derangements (TMJ-id), by comparing 30 subjects presenting typical TMJ-id signs to 20 healthy subjects. Subjects' clinical evaluations included anamnesis, stomatognatic system evaluation, and plotting analysis on body posture photographs. No statistically significant differences were found between the groups. Results do not support the assertion that body posture plays a role in causing or enhancing TMD; however, these results should be cautiously considered because of the small number of subjects evaluated and the many posture variables submitted to statistical procedures that lead to high standard deviations.

Histochemical study of the elastic fibers in pathologic human temporomandibular joint discs.

PubMed

Leonardi, R; Villari, L; Bernasconi, G; Caltabiano, M

2001-10-01

This study investigated histochemically the elastic fibers in human temporomandibular joint (TMJ) discs with varying degrees of tissue degeneration/regeneration to determine whether there are differences that correlate with the histologic findings. Ten diseased human TMJ discs and 2 control specimens were studied histochemically by staining with Weigert's resorcin-fuchsin after oxidation with peracetic acid. This technique selectively stains elastic, elaunin, (pre-elastic), and oxytalan fibers. In TMJ discs with an abnormal collagen fiber arrangement, an increased number of oxytalan fibers could be observed, contrary to discs with scar-like tissue transformation in which oxytalan fibers were decreased in number. In discs showing tears and clefts, the oxytalan fibers run perpendicular to the defects, whereas elaunin and elastic fibers were mainly circumferentially arranged. In discs with chondroid metaplasia, elastic, elaunin, and oxytalan fibers were extensively detected. It is hypothesized that the elastic, elaunin, and oxytalan fibers found in severely damaged discs appear to ensure biomechanical compliance by reinforcing regions devoid of collagen bundles and thus function as shock absorbers of stretch and compression. Copyright 2001 American Association of Oral and Maxillofacial Surgeons

Replacing Shox2 with human SHOX leads to congenital disc degeneration of the temporomandibular joint in mice

PubMed Central

Li, Xihai; Liu, Hongbing; Gu, Shuping; Liu, Chao; Sun, Cheng; Zheng, Yuqian; Chen, YiPing

2013-01-01

The temporomandibular joint (TMJ) consists of the glenoid fossa arising from the otic capsule through intramembranous ossification, the fibrocartilaginous disc and the condyle, derived from the secondary cartilage by endochondral ossification. We have reported previously that cranial neural crest-specific inactivation of the homeobox gene Shox2, which is expressed in the mesenchymal cells of maxilla-mandibular junction and later in the progenitor cells and perichondrium of the developing chondyle, led to dysplasia and ankylosis of the TMJ, and replacement of the mouse Shox2 with the human SHOX gene rescued the dysplastic and ankylosis phenotypes but developed a prematurely worn out articular disc. In this study, we investigated the molecular and cellular bases for the premature wear out articular disc in the TMJ of mice carrying the human SHOX replacement allele in the Shox2 locus (referred as Shox2SHOX-KI/KI). We found that the developmental process and expression of several key genes in the TMJ of Shox2SHOX-KI/KI mice appeared similar to the controls. However, the disc of the Shox2SHOX-KI/KI TMJ exhibited a reduced level of Col I and Aggrecan, accompanied by increased activities of matrix metalloproteinases (MMPs) and a down-regulation of Ihh expression. Dramatically increased cell apoptosis in the disc was also observed. These combinatory cellular and molecular defects appear to contribute to the observed disc phenotype, suggesting that while the human SHOX can exert similar function as the mouse Shox2 in regulating early TMJ development, it apparently has a distinct function in the regulation of those molecules that are involved in tissue homeostasis. PMID:24248941

Association of Condylar Bone Quality with TMJ Osteoarthritis.

PubMed

Shi, J; Lee, S; Pan, H C; Mohammad, A; Lin, A; Guo, W; Chen, E; Ahn, A; Li, J; Ting, K; Kwak, J H

2017-07-01

The etiology and treatment of temporomandibular joint (TMJ) osteoarthritis (TMJOA) remain complex and unclear. Based on clinical observations, we hypothesized that low condylar bone quality is significantly correlated with TMJOA and explored this association in a cross-sectional study with human patients. A total of 254 postmenopausal female participants were included in this study. Radiographic findings from cone beam computed tomography (CBCT) and clinical symptoms were used to classify each TMJ data sample as healthy control ( n = 124) or TMJOA ( n = 130). Condylar bone mineral density (BMD) (computed tomography Hounsfield unit [CT HU]) and bone volume fraction (BV/TV) were measured and modeled as predictors of healthy control versus TMJOA status in multilevel logistic regression analyses. Both CT HU (adjusted odds ratio [AOR] = 0.9989, interquartile odds ratio [IOR] = 0.4206) and BV/TV (AOR= 0.8096, IOR = 0.1769) were negatively associated with TMJOA ( P = 0.049, 0.011, respectively). To assess the diagnostic performance of CT HU and BV/TV for identification of TMJOA, receiver operating characteristic (ROC) curves were plotted. The estimated areas under the curve (AUC) were 0.6622 for BV/TV alone, 0.6074 for CT HU alone, and 0.7136 for CT HU and BV/TV together. The model incorporating CT HU and BV/TV together had a significantly higher AUC than the models using BV/TV alone ( P = 0.038) or HU alone ( P = 0.021). In conclusion, we found that low condylar bone quality was significantly correlated with TMJOA development and that condylar CT HU and BV/TV can be used together as a potential diagnostic tool for TMJOA. Careful clinical evaluation of the condyle coupled with appropriate radiographic interpretation would thus be critical for the early detection of TMJOA.

Anatomy of the temporomandibular joint in the cat: a study by microdissection, cryosection and vascular injection.

PubMed

Arredondo, Jorge; Agut, Amalia; Rodríguez, María Jesús; Sarriá, Ricardo; Latorre, Rafael

2013-02-01

The minute anatomy of the temporomandibular joint (TMJ) is of great clinical relevance in cats owing to a high number of lesions involving this articulation. However, the precise anatomy is poorly documented in textbooks and scientific articles. The aim of this study was to describe, in detail, the TMJ anatomy and its relationship with other adjacent anatomical structures in the cat. Different anatomical preparations, including vascular and articular injection, microdissection, cryosection and plastination, were performed in 12 cadaveric cats. All TMJ anatomical structures were identified and described in detail. A thorough understanding of the TMJ anatomy is essential to understand the clinical signs associated with TMJ disorders, to locate lesions precisely and to accurately interpret the results in all diagnostic imaging techniques.

Internal Maxillary Artery Preoperative Embolization Using n-Butyl Cyanoacrylate and Pushable Coils for Temporomandibular Joint Ankylosis Surgery.

PubMed

Alderazi, Yazan J; Shastri, Darshan; Wessel, John; Mathew, Melvin; Kass-Hout, Tareq; Aziz, Shahid R; Prestigiacomo, Charles J; Gandhi, Chirag D

2017-05-01

Temporomandibular joint (TMJ) ankylosis causes disability through impaired digestion, mastication, speech, and appearance. Surgical treatment increases range of motion with resultant functional improvement. However, substantial perioperative blood loss can occur (up to 3 L) if the internal maxillary artery (IMAX) is injured as it traverses the ankylotic mass. Achieving hemostasis is difficult because of limited proximal IMAX access and poor visualization. Our aim is to investigate the technical feasibility and preliminary safety of preoperative IMAX embolization in patients undergoing TMJ ankylosis surgery. Case series using chart reviews of 2 patients who underwent preoperative embolization before TMJ ankylosis surgery. Both patients were women (28 and 51 years old) who had severely restricted mouth opening. Embolization was performed using general anesthesia with nasal intubation on the same day of TMJ surgery. Both patients underwent bilateral IMAX embolization using pushable coils (Vortex, Boston Scientific) of distal IMAX followed by n-butyl-cyanoacrylate (Trufill, Cordis) embolization from coil mass up to proximal IMAX. There were no complications from the embolization procedures. Both patients had normal neurologic examination results. TMJ surgery occurred with minimal operative blood loss (≤300 mL for each surgery). Maximum postoperative mouth opening was 35 mm and 34 mm, respectively. One patient had a postoperative TMJ wound infection that was managed with antibiotics. Preoperative IMAX embolization before TMJ ankylosis surgery is technically feasible with encouraging preliminary safety. There were no complications from the embolization procedures and surgeries occurred with low volumes of blood loss. Copyright © 2017 Elsevier Inc. All rights reserved.

Disk repositioning surgery of the temporomandibular joint with bioabsorbable anchor.

PubMed

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

2013-01-01

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.

A Study on Prevalence of Dental Attrition and its Relation to Factors of Age, Gender and to the Signs of TMJ Dysfunction.

PubMed

Yadav, Sangeeta

2011-06-01

A study was planned to determine the severity of dental attrition in adults of both sexes in different age groups and its possible relationship to temporomandibular disorders. 500 subjects comprising of 260 females and 240 males in the age group of 18-55 years were clinically examined for bruxism, attrition, and signs of temporomandibular disorders. Tooth sensitivity, tooth or restoration fracture, scalloping of tongue, ridging of buccal mucosa, TMJ sounds, muscle tenderness, TMJ tenderness, referred pain, pain on mouth opening and limitation of mouth opening were recorded along with attrition score in a proforma. The basic data was then analysed to arrive at certain conclusions. A high prevalence of attrition (88.0%) with increase in age (P < 0.00) and was seen more in males as compared to females (P < 0.01). On comparing attrition with some of the signs of bruxism it was shown that tooth or restoration fracture and scalloping of tongue had no relation to the severity of attrition score. Whereas a significant relation was seen between attrition and tooth sensitivity (P < 0.00), and ridging of buccal mucosa (P < 0.05). Muscle tenderness (P < 0.00), pain on mouth opening (P < 0.05) and deviation of mandible on mouth opening (P < 0.00) had significant relation to attrition. Other signs of temporomandibular disorders such as joint tenderness, referred pain, joint sounds and limitation of mouth opening had no relation to attrition score. This study showed a limited association between the severity of attrition and TMJ dysfunction.

High-resolution ultrasonography in assessing temporomandibular joint disc position.

PubMed

Talmaceanu, Daniel; Lenghel, Lavinia Manuela; Bolog, Nicolae; Popa Stanila, Roxana; Buduru, Smaranda; Leucuta, Daniel Corneliu; Rotar, Horatiu; Baciut, Mihaela; Baciut, Grigore

2018-02-04

The purpose of this study was to determine the diagnostic value of high-resolution ultrasonography (US) in temporomandibular joint (TMJ) disc displacements. A number of 74 patients (148 TMJs) with signs and symptoms of TMJ disorders, according to the Research Diagnostic Criteria for Temporomandibular Disorders, were included in this study. All patients received US and magnetic resonance imaging (MRI) of both TMJs 1 to 5 days after the clinical examination. MRI examinations were performed using 1.5 T MRI equipment (Siemens Avanto, Siemens, Erlangen). Ultrasonographic examination was performed on a Hitachi EUB 8500 (Hitachi Medical Corp., Tokyo, Japan) scanner with L 54 M6.5-13 MHz linear transducer. MRI depicted 68 (45.95%) normal joints, 47 (31.76%) with disc displacement with reduction, 33 (22.3%) with disc displacement without reduction and 34 (22.97%) with degenerative changes. US detected 78 (52.7%) normal joints, 37 (25%) with disc displacement with reduction, 33 (22.3%) with disc displacement without reduction and 21 (14.19%) with degenerative changes. Compared to MRI, US showed a sensitivity of 93.1%, specificity of 87.88%, accuracy of 90.32%, a positive predictive value of 87.1% and a negative predictive value of 93.55% for overall diagnosis of disc displacement. The Youden index was 0.81. Based on our results, high-resolution ultrasonography showed high sensitivity, specificity and accuracy in the diagnosis of TMJ disc displacement. It could be a valuable imaging technique in assessing TMJ disc position. The diagnostic value of high-resolution ultrasonography depends strictly on the examiner's skills and on the equipment used.

Frequency of temporomandibular joint osteoarthritis and related symptoms in a hand osteoarthritis cohort.

PubMed

Abrahamsson, A K; Kristensen, M; Arvidsson, L Z; Kvien, T K; Larheim, T A; Haugen, I K

2017-05-01

The prevalence of osteoarthritis (OA) in the temporomandibular joints (TMJs) in hand OA patients is largely unknown. Our aims were to explore (1) The frequency of TMJ-related symptoms and clinical findings; (2) The TMJ OA frequency defined by cone beam computed tomography (CBCT); and (3) The relationship between TMJ-related symptoms/clinical findings and CBCT-defined TMJ OA, in a hand OA cohort. We calculated the frequencies of TMJ-related symptoms, clinical findings and diagnosis of TMJ OA by CBCT and clinical examination in 54 patients from the Oslo hand OA cohort (88% women, mean (range) age 71 (61-83) years). Participants with and without CBCT-defined TMJ OA were compared for differences in proportions (95% confidence interval (CI)) of symptoms and clinical findings. Sensitivity and specificity of the clinical TMJ OA diagnosis were calculated using CBCT as reference. Self-reported symptoms and clinical findings were found in 24 (44%) and 50 (93%) individuals (93%), respectively, whereas 7 (13%) had sought healthcare. Individuals with CBCT-defined TMJ OA (n = 36, 67%) reported statistically significantly more pain at mouth opening (22%, 95% CI 4-40%), clicking (33%, 95% CI 14-52%) and crepitus (25%, 95% CI 4-46%). By clinical examination, only crepitus was more common in TMJ OA (33%, 95% CI 29-77%). Clinical diagnosis demonstrated low sensitivity (0.42) and high specificity (0.93). CBCT-defined TMJ OA was common in hand OA patients, suggesting that TMJ OA may be part of generalized OA. Few had sought healthcare, despite high burden of TMJ-related symptoms/findings. Clinical examination underestimated TMJ OA frequency. Copyright © 2017 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

The anti-inflammatory effect of tramadol in the temporomandibular joint of rats.

PubMed

Lamana, Simone Monaliza S; Napimoga, Marcelo H; Nascimento, Ana Paula Camatta; Freitas, Fabiana F; de Araujo, Daniele R; Quinteiro, Mariana S; Macedo, Cristina G; Fogaça, Carlos L; Clemente-Napimoga, Juliana T

2017-07-15

Tramadol is a centrally acting analgesic drug able to prevent nociceptor sensitization when administered into the temporomandibular joint (TMJ) of rats. The mechanism underlying the peripheral anti-inflammatory effect of tramadol remains unknown. This study demonstrated that intra-TMJ injection of tramadol (500µg/TMJ) was able to inhibit the nociceptive response induced by 1.5% formalin or 1.5% capsaicin, suggesting that tramadol has an antinociceptive effect, acting directly on the primary nociceptive neurons activating the nitric oxide/cyclic guanosine monophosphate signaling pathway. Tramadol also inhibited the nociceptive response induced by carrageenan (100µg/TMJ) or 5-hydroxytryptamine (225µg/TMJ) along with inhibition of inflammatory cytokines levels, leukocytes migration and plasma extravasation. In conclusion, the results demonstrate that peripheral administration of tramadol has a potential antinociceptive and anti-inflammatory effect. The antinociceptive effect is mediated by activation of the intracellular nitric oxide/cyclic guanosine monophosphate pathway, at least in part, independently from the opioid system. Copyright © 2017 Elsevier B.V. All rights reserved.

Rheumatoid arthritis-affected temporomandibular joint pain analgesia by linear polarized near infrared irradiation.

PubMed

Yokoyama, K; Oku, T

1999-07-01

To describe a new short-term treatment for pain in rheumatoid arthritis (RA)-affected temporomandibular joint (TMJ). We investigated four female patients (age 42.8+/-26.0 yr) with chronic rheumatoid arthritis affecting a single TMJ. Patients had received antirheumatic drugs such as sodium aurothiomalate, and as a result showed no symptoms in other body joints. Linear polarized near infrared radiation using Super Lizer was applied weekly with and/or without jaw movement to the unilateral skin areas overlying the mandibular fossa, anterior articular tubercle, masseter muscle and posterior margin of the ramus of the mandible. The duration of irradiation to each point was two seconds on and ten seconds off per cycle and the intensity at each point was approximately 138 J x cm(-2) at a wavelength of 830 nm. Interincisal distance was measured with maximal mouth opening in the absence and presence of pain before and after each treatment. Additionally, subjective TMJ pain scores assessed using a visual analog scale were performed for painful maximal mouth opening before and after each irradiation. TMJ pain disappeared after only four treatments. Moreover, painless maximal mouth opening without pain after irradiation in three patients was on average improved to 5.3+/-2.1 mm. However, one case was observed where the opening length prior to irradiation did not improve, despite the fact that the RA-affected TMJ pain had disappeared. Application of linear polarized near infrared irradiation to patients with RA-affected TMJ pain is an effective and non-invasive short-term treatment.

Prevalence of different temporomandibular joint sounds, with emphasis on disc-displacement, in patients with temporomandibular disorders and controls.

PubMed

Elfving, Lars; Helkimo, Martti; Magnusson, Tomas

2002-01-01

Temporomandibular joint (TMJ) sounds are very common among patients with temporomandibular disorders (TMD), but also in non-patient populations. A variety of different causes to TMJ-sounds have been suggested e.g. arthrotic changes in the TMJs, anatomical variations, muscular incoordination and disc displacement. In the present investigation, the prevalence and type of different joint sounds were registered in 125 consecutive patients with suspected TMD and in 125 matched controls. Some kind of joint sound was recorded in 56% of the TMD patients and in 36% of the controls. The awareness of joint sounds was higher among TMD patients as compared to controls (88% and 60% respectively). The most common sound recorded in both groups was reciprocal clickings indicative of a disc displacement, while not one single case fulfilling the criteria for clicking due to a muscular incoordination was found. In the TMD group women with disc displacement reported sleeping on the stomach significantly more often than women without disc displacement did. An increased general joint laxity was found in 39% of the TMD patients with disc displacement, while this was found in only 9% of the patients with disc displacement in the control group. To conclude, disc displacement is probably the most common cause to TMJ sounds, while the existence of TMJ sounds due to a muscular incoordination can be questioned. Furthermore, sleeping on the stomach might be associated with disc displacement, while general joint laxity is probably not a causative factor, but a seeking care factor in patients with disc displacement.

Bilateral septic arthritis of the temporo mandibular joint: case report

PubMed Central

Ayachi, Samia; Mziou, Zouha; Moatemri, Ramzi; Khochtali, Habib

2016-01-01

Septic arthritis of the temporo-mandibular joint (TMJ) is a rare disease that has been reported infrequently. To the best of the authors' knowledge, only one case of bilateral TMJ septic arthritis has been reported. The contamination may result from direct extension of adjacent infection (dental or ENT), from hematogenous spread of blood-borne organisms or from direct inoculation. The most common presenting are trismus and pain, although swelling, tenderness and erythema have also been described. In addition, patients may develop fever, regional lymphadenopathy and malocclusion. Through a successively bilateral case of TMJ arthritis, without obvious portal of entry of the bacteria, we will analyze characteristics and treatment of this disease. PMID:28292063

Effectiveness of Dexamethasone Iontophoresis for Temporomandibular Joint Involvement in Juvenile Idiopathic Arthritis

PubMed Central

Mina, Rina; Melson, Paula; Powell, Stephanie; Rao, Marepalli; Hinze, Claas; Passo, Murray; Graham, T. Brent; Brunner, Hermine I.

2011-01-01

Objective Temporomandibular joint (TMJ) involvement is common in Juvenile Idiopathic Arthritis (JIA). Dexamethasone iontophoresis (DIP) uses low-grade electric currents for transdermal dexamethasone delivery into deeper anatomic structures. The purpose of this study was to assess the safety and effectiveness of DIP for the treatment of TMJ involvement in JIA, and to delineate variables that are associated with improvement after DIP. Methods Medical records of all JIA patients who underwent DIP for TMJ involvement at a larger tertiary pediatric rheumatology center from 1997 to 2011 were reviewed. DIP was performed using a standard protocol. The effectiveness of DIP was assessed by comparing the maximal inter-incisor opening (MIOTMJ) and the maximal lateral excursion (MLETMJ) before and after treatment. Results Twenty-eight patients (ages 2– 21 years) who received an average of eight DIP treatment sessions per involved TMJ were included in the analysis. Statistically significant improvement in the median MIOTMJ (p< 0.0001) was observed in 68%. The median MLETMJ (p= 0.03) improved in 69%, and resolution of TMJ pain occurred in 73% of the patients who had TMJ pain at baseline. Side effects of DIP were transient site erythema (86%), skin blister (4%), and metallic taste (4%). Improvement in TMJ range of motion from DIP is associated with lower MIOTMJ, lower MLETMJ, and absence of TMJ crepitus at baseline. Conclusion In this pilot study DIP appeared to be an effective and safe initial treatment of TMJ involvement in JIA, especially among patients with decreased TMJ measurements. Prospective controlled studies are needed. PMID:22034112

Recurrent dislocation of the temporomandibular joint: a literature review and two case reports treated with eminectomy.

PubMed

Martins, Wilson Denis; Ribas, Marina de Oliveira; Bisinelli, Julio; França, Beatriz Helena S; Martins, Guilherme

2014-04-01

Dislocation of the temporomandibular joint (TMJ) is a troublesome condition that occurs in a chronic or acute form. It is a distressing and highly embarrassing situation that may occur as a result of daily activities such as yawning, laughing, or during events that require keeping the mouth open for a long time. This review aims to present and discuss different conservative and surgical techniques to treat patients with a dislocated mandible, and to present two cases of surgical treatment. A search of the literature was completed (Medline, PubMed) using the keywords TMJ dislocation, TMJ luxation, mandibular dislocation and surgical and non-surgical methods of treatment for this condition. Eminectomy (Myrhaug's surgery) has been used with satisfactory results. Most of reports present large series of patients with more than one year of follow-up and no recurrence of complications. Is less invasive and take a short operation time; need no bone transplantation or placing any kind of foreign body into the joint. Eminectomy results in long-term resolution of recurrent TMJ dislocations, when compared with others surgical techniques.

Computed tomographic findings in dogs and cats with temporomandibular joint disorders: 58 cases (2006-2011).

PubMed

Arzi, Boaz; Cissell, Derek D; Verstraete, Frank J M; Kass, Philip H; DuRaine, Grayson D; Athanasiou, Kyriacos A

2013-01-01

To describe CT findings in dogs and cats with temporomandibular joint (TMJ) disorders. Retrospective case series. 41 dogs and 17 cats. Medical records and CT images of the skull were reviewed for dogs and cats that were examined at a dentistry and oral surgery specialty practice between 2006 and 2011. Of 142 dogs and 42 cats evaluated, 41 dogs and 17 cats had CT findings consistent with a TMJ disorder. In dogs, the most common TMJ disorder was osteoarthritis; however, in most cases, there were other TMJ disorders present in addition to osteoarthritis. Osteoarthritis was more frequently identified at the medial aspect rather than the lateral aspect of the TMJ, whereas the frequency of osteoarthritic involvement of the dorsal and ventral compartments did not differ significantly. In cats, fractures were the most common TMJ disorder, followed by osteoarthritis. Clinical signs were observed in all dogs and cats with TMJ fractures, dysplasia, ankylosis, luxation, and tumors; however, only 4 of 15 dogs and 2 of 4 cats with osteoarthritis alone had clinical signs. Results indicated that TMJ disorders were frequently present in combination. Osteoarthritis was the most common TMJ disorder in dogs and the second most common TMJ disorder in cats. Computed tomography should be considered as a tool for the diagnosis of TMJ disorders in dogs and cats with suspected orofacial disorders and signs of pain. (J Am Vet Med Assoc 2013;242:69-75).

Experience of Orthodontic Treatment and Symptoms of Temporomandibular Joint in South Korean Adults.

PubMed

Hwang, Sang-Hee; Park, Shin-Goo

2018-01-01

No epidemiological studies have targeted the association between experience of orthodontic treatment and symptoms of temporomandibular joint (TMJ) in a large adult population. In this study, we investigated whether experience of orthodontic treatment is associated with symptoms of TMJ in adults. We used data from the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V), conducted in 2011. Trained dentists asked subjects to report their experience of orthodontic treatment and symptoms of TMJ. Overall, 5936 subjects aged over 19 yr were included in this study (2528 males). The data were analyzed using the chi-square test and multiple logistic regression tests. The group with experience of orthodontic treatment had more symptoms of TMJ than the group without orthodontic experience. After adjusting for all covariates (i.e., age, sex, marital status, income, education, stress, teeth injury, and occupation), the adjusted odds ratio was 2.53 (95%CI 1.74-3.67). Experience of orthodontic treatment could be related to increased symptoms of TMJ.

Three-dimensional reconstruction of TMJ MR images: a technical note and case report.

PubMed

Kitai, Noriyuki; Eriksson, Lars; Kreiborg, Sven; Wagner, Aase; Takada, Kenji

2004-01-01

MR images of the temporomandibular joint at occlusion and at various stages of mouth opening were registered and reconstructed three-dimensionally before and after a modified condylotomy in a patient with painful disk displacement. Following the condylotomy, the condyle/disk relationship had become normalized in all three planes of space at closed mouth and during mouth opening. The post-operative distances of the condylar and diskal paths had increased when compared with the preoperative distances. The three-dimensional visualizing method may, besides providing diagnostic advantages, be a valuable tool for qualitative and quantitative documentation of the efficiency of different treatment methods for normalization of the disk/condyle relationship in patients with TMJ disk displacement.

Influence of the upper joint surface and synovial lining in the outcome of chronic closed lock of the temporomandibular joint treated with arthroscopy.

PubMed

González-García, Raúl; Rodríguez-Campo, Francisco J; Monje, Florencio; Román-Romero, Leticia; Sastre-Pérez, Jesús; Usandizaga, José L Gil-Díez

2010-01-01

Temporomandibular joint (TMJ) arthroscopy has been reported to be an effective and reliable technique for the treatment of chronic closed lock (CCL) of the TMJ. The purpose of the present study was to evaluate whether the status of the joint surface and the synovial lining directly visualized with arthroscopy could determine postoperative results in patients with CCL of the TMJ. In all, 257 of 500 patients (344 joints) fulfilled the inclusion criteria for CCL of the TMJ. Of these patients, 172 with unilateral TMJ involvement were finally selected for the study. Synovitis and chondromalacia were chosen as the main features for evaluation of the joint surface and synovial lining. Two groups of patients were established: 1) patients with scarce affectation (synovitis grades I-II and chondromalacia grades I-II); and 2) patients with severe affectation (synovitis grades III-IV and/or chondromalacia grades III-IV). Pain and maximal interincisal opening were chosen as dependent variables. All patients were assessed at 1, 3, 6, 12, and 24 months postoperatively. The paired-samples Student's t test was used to compare mean values for pain (using a visual analog scale) and maximal interincisal opening (MIO) both pre- and postoperatively. The Student's t test for unpaired data was applied for the statistical analysis. A P value less than .05 was considered statistically significant. Synovitis grades I-II were arthroscopically observed in 87 (50.58%) patients, whereas synovitis grades III-IV were present in 72 (41.86%) patients. Chondromalacia grades I-II were arthroscopically observed in 66 (38.37%) patients, whereas chondromalacia grades III-IV were present in 54 (31.39%) patients. A statistically significant decrease in pain (P < .001) with a parallel increase in mouth opening (P < .001) after arthroscopy was observed for patients with synovitis I-II, synovitis III-IV, chondromalacia I-II, and chondromalacia III-IV during the whole follow-up period. A significant difference

[Bilateral chronic dislocation of the temporomandibular joints and Meige syndrome].

PubMed

Arzul, L; Henoux, M; Marion, F; Corre, P

2015-04-01

Chronic dislocation of the temporo-mandibular joint (TMJ) is rare. It occurs when an acute dislocation is left untreated, in certain situations, including severe illness, neurologic or psychiatric diseases or prolonged oral intubation. A 79 years old woman, with Meige syndrome, suffered from bilateral dislocation of the TMJ for over 1 year. Surgical repositioning of the mandibular condyles and temporal bone eminectomy were performed. At the 18 postoperative months control, no recurrence has been noted. Treatment of chronic TMJ dislocations often requires a surgical procedure. Manual reduction, even under general anaesthesia, often fails because of severe muscular spasm and periarticular fibrotic changes. The management of this disorder is still controversial. We review available surgical procedures. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

The incidence and influence of abnormal styloid conditions on the etiology of craniomandibular functional disorders.

PubMed

Krennmair, G; Piehslinger, E

1999-10-01

This study aimed to examine the incidence and influence of craniomandibular functional disorders caused by abnormal styloid-stylohyoid chains. Seven hundred sixty-five patients with temporomandibular joint (TMJ) disorders were divided into two groups (with and without radiographically visible abnormal styloid conditions). In the group with abnormal stylohyoid conditions, the etiology of TMJ disorders was further subdivided into poly-, oligo- and monoetiological factors, and, after this classification, evaluated regarding a clear, possible or unlikely involvement of abnormal stylohyoid conditions in TMJ disorders. One hundred thirty-six out of 765 patients presented abnormal styloid-stylohyoid chains. One hundred five of the patients (77.2%) demonstrated polyetiological causes of TMJ symptoms with an unlikely involvement of the abnormal styloid-stylohyoid chain. Twenty-nine of the patients (21.3%) showed oligoetiological causes with possible involvement of the abnormal styloid-stylohyoid chain. In two patients (1.5%), the abnormal styloid conditions showed up as the only definite cause of TMJ symptoms (monoetiological). Detailed knowledge of variations and possible effects of suprahyoid structures is important for an accurate diagnosis of TMJ disorders. All in all, the incidence of a stylohyoid involvement in TMJ disorders is very low. However, after an initial subdivision into abnormal and normal stylohyoid conditions, the incidence of pathological stylohyoid chains gains significant importance in the etiology of TMJ disorders.

A Rare, Unusual Presentation of Primary Tuberculosis in the Temporomandibular Joint.

PubMed

Towdur, Geetha N; Upasi, Amarnath P; Veerabhadrappa, Umashankara Kagathur; Rai, Kirthikumar

2018-04-01

Tuberculosis (TB) is a very common health problem in developing nations such as India. It can present as its primary form or as secondary forms (extrapulmonary TB). Maxillofacial manifestations of TB compose nearly 10% of all extrapulmonary manifestations of the disease. Extrapulmonary TB involving the maxillofacial region is very rare and can present in any tissues in this region. These infections generally involve the head and neck through hematogenous or lymphatic routes. Very few cases of primary TB of the temporomandibular joint (TMJ) have been reported in the literature. The presentation of TB infection of the TMJ can resemble arthritis, osteomyelitis, or any other kind of chronic joint disease. It is very important to diagnose this disease at an early stage. If left untreated, it can prove fatal within 5 years in more than half the cases. Therefore, early diagnosis and management of these cases is critical. This article describes a case of primary TB of the TMJ that presented as a preauricular swelling. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Animating functional anatomy for the web.

PubMed

Guttmann, G D

2000-04-15

The instructor sometimes has a complex task in explaining the concepts of functional anatomy and embryology to health professional students. However, animations can easily illustrate functional anatomy, clinical procedures, or the developing embryo. Web animation increases the accessibility of this information and makes it much more useful for independent student learning. A modified version of the animation can also be used for patient education. This article defines animation, provides a brief history of animation, discusses the principles of animation, illustrates and evaluates some of the video-editing or movie-making computer software programs, and shows examples of two of the author's animations. These two animations are the inferior alveolar nerve block from the mandibular nerve anesthetics unit and normal temporomandibular joint (TMJ) function from the muscles of the mastication and the TMJ function unit. The software discussed are the industry leaders and have made the job of producing computer-based animations much easier. The programs are Adobe Premiere, Adobe After Effects, Apple QuickTime and Macromedia Flash .

Computed tomographic findings in dogs and cats with temporomandibular joint disorders: 58 cases (2006–2011)

PubMed Central

Arzi, Boaz; Cissell, Derek D.; Verstraete, Frank J. M.; Kass, Philip H.; DuRaine, Grayson D.; Athanasiou, Kyriacos A.

2013-01-01

Objective To describe CT findings in dogs and cats with temporomandibular joint (TMJ) disorders. Design Retrospective case-series. Animals 41 dogs and 17 cats. Procedures Medical records and CT images of the skull were reviewed for dogs and cats that were examined at a dentistry and oral surgery specialty practice between 2006 and 2011. Results Of 142 dogs and 42 cats evaluated, 41 dogs and 17 cats had CT findings consistent with a TMJ disorder. In dogs, the most common TMJ disorder was osteoarthritis; however, in most cases, there were other TMJ disorders present in addition to osteoarthritis. Osteoarthritis was more frequently identified at the medial aspect rather than the lateral aspect of the TMJ, whereas the frequency of osteoarthritic involvement of the dorsal and ventral compartments did not differ significantly. In cats, fractures were the most common TMJ disorder, followed by osteoarthritis. Clinical signs were observed in all dogs and cats with TMJ fractures, dysplasia, ankylosis, luxation, and tumors; however, only 4 of 15 dogs and 2 of 4 cats with osteoarthritis alone had clinical signs. Conclusions and Clinical Relevance Results indicated that TMJ disorders are frequently present in combination. Osteoarthritis was the most common TMJ disorder in dogs and the second most common TMJ disorder in cats. Computed tomography should be considered as a tool for the diagnosis of TMJ disorders in dogs and cats with suspected orofacial disorders and pain. PMID:23234284

Subjects with temporomandibular joint disc displacement do not feature any peculiar changes in body posture.

PubMed

Rocha, T; Castro, M A; Guarda-Nardini, L; Manfredini, D

2017-02-01

The presence of body posture changes among patients with temporomandibular disorders (TMD) has been a controversial topic in dentistry. Based on that, the aim of this study was to assess postural features of pain-free subjects with internal derangement of the temporomandibular joint (TMJ), viz. disc displacement, when compared to subjects with normal disc position. A total of 21 subjects with unilateral, pain-free TMJ disc displacement (DD) and 21 subjects without any TMD signs of symptoms were assessed for body posture changes by means of posturographic evaluation of several body segments and postural balance reactions through the centre of mass during jaw movements using a balance platform. Posturographic measurements showed the absence of any significant differences between the two groups in any of the outcome parameters. Similarly, all balance platform responses to mandibular movements were not different between groups. There are no significant differences in body posture between subjects with and without unilateral disc displacement in the temporomandibular joint. Such observations, indicating a well-preserved postural balance in the presence of TMJ internal derangement, put into serious question the potential influence of TMJ disorders on whole body posture and viceversa. © 2016 John Wiley & Sons Ltd.

Modified Labial Button Technique for Maintaining Occlusion After Caudal Mandibular Fracture/Temporomandibular Joint Luxation in the Cat.

PubMed

Goodman, Alice E; Carmichael, Daniel T

2016-03-01

Maxillofacial trauma in cats often results in mandibular symphyseal separation in addition to injuries of the caudal mandible and/or temporomandibular joint (TMJ). Caudal mandibular and TMJ injuries are difficult to access and stabilize using direct fixation techniques, thus indirect fixation is commonly employed. The immediate goals of fixation include stabilization for return to normal occlusion and function with the long-term objective of bony union. Indirect fixation techniques commonly used for stabilization of caudal mandibular and temporomandibular joint fracture/luxation include maxillomandibular fixation (MMF) with acrylic composite, interarcade wiring, tape muzzles, and the bignathic encircling and retaining device (BEARD) technique. This article introduces a modification of the previously described "labial reverse suture through buttons" technique used by Koestlin et al and the "labial locking with buttons" technique by Rocha et al. In cases with minimally displaced subcondylar and pericondylar fractures without joint involvement, the labial button technique can provide sufficient stabilization for healing. Advantages of the modified labial button technique include ease of application, noninvasive nature, and use of readily available materials. The construct can remain in place for a variable of amount of time, depending on its intended purpose. It serves as an alternative to the tape muzzle, which is rarely tolerated by cats. This technique can be easily used in conjunction with other maxillomandibular repairs, such as cerclage wire fixation of mandibular symphyseal separation. The purpose of this article is to demonstrate a modified labial button technique for maintaining occlusion of feline caudal mandibular fractures/TMJ luxations in a step-by-step fashion.

Chondrosarcoma of the temporomandibular joint: a case report and review of the literature.

PubMed

Oh, Kyu-Young; Yoon, Hye-Jung; Lee, Jae-Il; Hong, Sam-Pyo; Hong, Seong-Doo

2016-07-01

Chondrosarcoma is the second most common sarcoma arising in the bone, but it rarely involves the temporomandibular joint (TMJ). To date, 30 cases of TMJ chondrosarcoma have been reported in the English literature, and the authors report an additional case arising from a cystic lesion in a 60-year-old female patient. The clinical and radiological diagnosis of the lesion was initially synovial cyst, and periodic check-ups were done after aspiration of the lesion. After three years, the patient perceived swelling of the lesion, and surgical excision was performed. The final diagnosis was grade I chondrosarcoma. When clinicians detect a cystic lesion in the radiographic imaging of the TMJ, chondrosarcoma should be included in the differential diagnosis. In addition, computed tomography (CT) as well as magnetic resonance imaging (MRI) is recommended for the accurate diagnosis and proper preoperative planning in TMJ chondrosarcoma.

TMJ function after partial condylectomy in active mandibular condylar hyperplasia

PubMed Central

Olate, Sergio; Martinez, Felipe; Uribe, Francisca; Pozzer, Leandro; Cavalieri-Pereira, Lucas; de Moraes, Marcio

2014-01-01

Condylar hyperplasia is a frequent pathology that causes severe facial asymmetries. The partial condylectomy generally halts the disease. The aim of this research was to examine post-condylectomy TMJ function; 14 patients were included in this study, 6 male and 8 female. The average age was 21 years old. In all, the partial condylectomy was performed with preauricular or endaural access and the osteotomy were performed with drills, saw or an ultrasonic system. The patients were assessed with 3 or more time after surgery and were considering maximum mouth opening, right and left lateralities, presence of pain, noises, alterations in the facial nerve (VII) and esthetic alteration from the scar. The analysis was performed with the visual analog scale (VAS) and with a 7 cm metallic rule. Data analysis was descriptive plus chi-square test considering p value < 0.05 for statistical differences. With an average of 11 month after surgery, the results showed that the open mouth (over 35 mm) and lateralities (average 9 mm for the both right and left side) were normal and without statistical differences between the right or left side. Noise was observed in 3 patients and pain was observed in two patients with level 2 and 1 (VAS score). Scar was not related to problem with patient and the temporal branch of facial nerve was observed with limitations but without problem for patients. It can be concluded that the condylectomy is a safe and effective procedure with low morbidity for patients. PMID:24753777

Expressing human SHOX in Shox2SHOX KI/KI mice leads to congenital osteoarthritis-like disease of the temporomandibular joint in postnatal mice

PubMed Central

Liang, Wenna; Li, Xihai; Chen, Houhuang; Shao, Xiang; Lin, Xuejuan; Shen, Jianying; Ding, Shanshan; Kang, Jie; Li, Candong

2016-01-01

The temporomandibular joint (TMJ), a unique synovial joint whose development differs from that of other synovial joints, develops from two distinct mesenchymal condensations that grow toward each other and ossify through different mechanisms. The short stature homeobox 2 (Shox2) gene serves an important role in TMJ development and previous studies have demonstrated that Shox2SHOX KI/KI mice display a TMJ defective phenotype, congenital dysplasia and premature eroding of the articular disc, which is clinically defined as a TMJ disorder. In the present study, Shox2SHOX KI/KI mouse models were used to investigate the mechanisms of congenital osteoarthritis (OA)-like disease during postnatal TMJ growth. Shox2SHOX KI/KI mice were observed to develop a severe muscle wasting syndrome from day 7 postnatal. Histological examination indicated that the condyle and glenoid fossa of Shox2SHOX KI/KI mice was reduced in size in the second week after birth. The condyles of Shox2SHOX KI/KI mice exhibited reduced expression levels of collagen type II and Indian hedgehog, and increased expression of collagen type I. A marked increase in matrix metalloproteinase 9 (MMP9) and MMP13 in the condyles was also observed. These cellular and molecular defects may contribute to the observed (OA)-like phenotype of Shox2SHOX KI/KI mouse TMJs. PMID:27601064

Expressing human SHOX in Shox2SHOX KI/KI mice leads to congenital osteoarthritis‑like disease of the temporomandibular joint in postnatal mice.

PubMed

Liang, Wenna; Li, Xihai; Chen, Houhuang; Shao, Xiang; Lin, Xuejuan; Shen, Jianying; Ding, Shanshan; Kang, Jie; Li, Candong

2016-10-01

The temporomandibular joint (TMJ), a unique synovial joint whose development differs from that of other synovial joints, develops from two distinct mesenchymal condensations that grow toward each other and ossify through different mechanisms. The short stature homeobox 2 (Shox2) gene serves an important role in TMJ development and previous studies have demonstrated that Shox2SHOX KI/KI mice display a TMJ defective phenotype, congenital dysplasia and premature eroding of the articular disc, which is clinically defined as a TMJ disorder. In the present study, Shox2SHOX KI/KI mouse models were used to investigate the mechanisms of congenital osteoarthritis (OA)‑like disease during postnatal TMJ growth. Shox2SHOX KI/KI mice were observed to develop a severe muscle wasting syndrome from day 7 postnatal. Histological examination indicated that the condyle and glenoid fossa of Shox2SHOX KI/KI mice was reduced in size in the second week after birth. The condyles of Shox2SHOX KI/KI mice exhibited reduced expression levels of collagen type II and Indian hedgehog, and increased expression of collagen type I. A marked increase in matrix metalloproteinase 9 (MMP9) and MMP13 in the condyles was also observed. These cellular and molecular defects may contribute to the observed (OA)‑like phenotype of Shox2SHOX KI/KI mouse TMJs.

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

PubMed Central

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

2013-01-01

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

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

PubMed

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

2013-01-01

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. 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). 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. 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.

Laterality of proprioception in the orofacial muscles and temporomandibular joint.

PubMed

Frayne, Ellie; Coulson, Susan; Adams, Roger; Croxson, Glen; Waddington, Gordon

2016-12-02

Laterality of function in the orofacial musculature suggests there may be side-to-side asymmetry of proprioceptive acuity in lip movement compared to the temporomandibular joint (TMJ). In the present work, 14 young adults were tested for acuity of lip and TMJ closure movements onto plugs varying from 5 to 8mm without visual feedback. Testing was conducted on both left and right sides, using the same psychophysical task and stimuli. Results showed superior proprioceptive acuity at the lips, with no significant side effect. However, there was side-to-side asymmetry in the correlations between proprioceptive performance for the two anatomical structures, with performance on the right side strongly correlated but not on the left. This is consistent with the need for coordination between structures during chewing. When acuity at different points in the stimulus range was examined, the right side lips were better with small stimuli. Overall, results support enhanced use-specific proprioception. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Comparison of temporomandibular joint and ramus morphology between class II and class III cases before and after bi-maxillary osteotomy.

PubMed

Iguchi, Ran; Yoshizawa, Kunio; Moroi, Akinori; Tsutsui, Takamitsu; Hotta, Asami; Hiraide, Ryota; Takayama, Akihiro; Tsunoda, Tatsuya; Saito, Yuki; Sato, Momoko; Baba, Nana; Ueki, Koichiro

2017-12-01

The purpose of this study was to compare changes in temporomandibular joint (TMJ) and ramus morphology between class II and III cases before and after sagittal split ramus osteotomy (SSRO) and Le Fort I osteotomy. The subjects were 39 patients (78 sides) who underwent bi-maxillary surgery. They consisted of 2 groups (18 class II cases and 21 class III cases), and were selected randomly from among patients who underwent surgery between 2012 and 2016. The TMJ disc tissue and joint effusion were assessed by magnetic resonance imaging (MRI) and the TMJ space, condylar height, ramus height, ramus inclination and condylar square were assessed by computed tomography (CT), pre- and post-operatively. The number of joints with anterior disc displacement in class II was significantly higher than that in class III (p < 0.0001). However, there were no significant differences between the two classes regarding ratio of joint symptoms and ratio of joint effusion pre- and post-operatively. Class II was significantly better than class III regarding reduction ratio of condylar height (p < 0.0001) and square (p = 0.0005). The study findings suggest that condylar morphology could change in both class II and III after bi-maxillary surgery. The findings of the numerical analysis also demonstrated that reduction of condylar volume occurred frequently in class II, although TMJ disc position classification did not change significantly, as previously reported. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

[Analysis of factors related to the number of mesenchymal stem cells derived from synovial fluid of the temporomandibular joint].

PubMed

Sun, Y P; Zheng, Y H; Zhang, Z G

2017-06-09

Objective: To analyze related factors on the number of mesenchymal stem cells in the synovial fluid of the temporomandibular joint (TMJ) and provide an research basis for understanding of the source and biological role of mesenchymal stem cells derived from synovial fluid in TMJ. Methods: One hundred and twenty-two synovial fluid samples from 91 temporomandibular disorders (TMD) patients who visited in Department of TMJ Center, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University from March 2013 to December 2013 were collected in this study, and 6 TMJ synovial fluid samples from 6 normal volunteers who were studying in the North Campus of Sun Yat-sen University were also collected, so did their clinical information. Then the relation between the number of mesenchymal stem cells derived from synovial fluid and the health status of the joints, age of donor, disc perforation, condylar bony destruction, blood containing and visual analogue scale score of pain were investigated using Mann-Whitney U test and Spearman rank correlation test. Results: The number of mesenchymal stem cells derived from synovial fluid had no significant relation with visual analogue scale score of pain ( r= 0.041, P= 0.672), blood containing ( P= 0.063), condylar bony destruction ( P= 0.371). Linear correlation between the number of mesenchymal stem cells derived from synovial fluid and age of donor was very week ( r= 0.186, P= 0.043). The number of mesenchymal stem cells up-regulated when the joint was in a disease state ( P= 0.001). The disc perforation group had more mesenchymal stem cells in synovial fluid than without disc perforation group ( P= 0.042). Conclusions: The number of mesenchymal stem cells derived from synovial fluid in TMJ has no correlation with peripheral blood circulation and condylar bony destruction, while has close relation with soft tissue structure damage of the joint.

Optimizing Functional Outcomes in Mandibular Condyle Reconstruction With the Free Fibula Flap Using Computer-Aided Design and Manufacturing Technology.

PubMed

Lee, Z-Hye; Avraham, Tomer; Monaco, Casian; Patel, Ashish A; Hirsch, David L; Levine, Jamie P

2018-05-01

Mandibular defects involving the condyle represent a complex reconstructive challenge for restoring proper function of the temporomandibular joint (TMJ) because it requires precise bone graft alignment for full restoration of joint function. The use of computer-aided design and manufacturing (CAD/CAM) technology can aid in accurate reconstruction of mandibular condyle defects with a vascularized free fibula flap without the need for additional adjuncts. The purpose of this study was to analyze clinical and functional outcomes after reconstruction of mandibular condyle defects using only a free fibula graft with the help of virtual surgery techniques. A retrospective review was performed to identify all patients who underwent mandibular reconstruction with only a free fibula flap without any TMJ adjuncts after a total condylectomy. Three-dimensional modeling software was used to plan and execute reconstruction for all patients. From 2009 through 2014, 14 patients underwent reconstruction of mandibular defects involving the condyle with the aid of virtual surgery technology. The average age was 38.7 years (range, 11 to 77 yr). The average follow-up period was 2.6 years (range, 0.8 to 4.2 yr). Flap survival was 100% (N = 14). All patients reported improved facial symmetry, adequate jaw opening, and normal dental occlusion. In addition, they achieved good functional outcomes, including normal intelligible speech and the tolerance of a regular diet with solid foods. Maximal interincisal opening range for all patients was 25 to 38 mm with no lateral deviation or subjective joint pain. No patient had progressive joint hypomobility or condylar migration. One patient had ankylosis, which required release. TMJ reconstruction poses considerable challenges in bone graft alignment for full restoration of joint function. The use of CAD/CAM technology can aid in accurate reconstruction of mandibular condyle defects with a vascularized free fibula flap through precise

Influence of serotonin on the analgesic effect of granisetron on temporomandibular joint arthritis.

PubMed Central

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

2004-01-01

The influence of circulating serotonin (5-HT) on the effects of intra-articular administration of granisetron on temporomandibular joint (TMJ) pain was investigated in 11 patients with chronic polyarthritides. An analgesic effect superior to placebo has been shown previously. The change in TMJ movement pain intensity was negatively correlated to circulating 5-HT; that is, the higher the 5-HT before injection, the greater the reduction of pain intensity. The resting pain intensity reduction was not related to 5-HT. In conclusion, this study indicates a stronger short-term analgesic effect on TMJ movement pain by intra-articular administration of the 5-HT3 receptor antagonist granisetron in patients with high levels of circulating 5-HT. PMID:15770056

Clinical effects of an avocado-soybean unsaponifiable extract on arthralgia and osteoarthritis of the temporomandibular joint: preliminary study.

PubMed

Catunda, I S; Vasconcelos, B C do E; Andrade, E S de S; Costa, D F N

2016-08-01

The aim of the present preliminary study was to investigate the effectiveness of an avocado-soybean unsaponifiable extract (ASU) in patients with arthralgia and osteoarthritis of the temporomandibular joint (TMJ). A randomized, double-blind, placebo-controlled trial was carried out. Fourteen women diagnosed with arthralgia and osteoarthritis of the TMJ using the Research Diagnostic Criteria for Temporomandibular Disorders were included in the statistical analysis. The women were allocated randomly to two groups: ASU group and placebo group. Pain was measured using a visual analogue scale and pressure algometer. Mandibular function was evaluated through measurement of mandibular movements. Quality of life was measured using the Oral Health Impact Profile (OHIP-14). The medication (ASU capsules or placebo capsules) was used for 4 months and the total follow-up was 6 months. Those taking the ASU extract had a decrease in pain symptoms and an improvement in quality of life. Moreover, a significant reduction in the use of rescue medication was found in the ASU group compared to the placebo group. This preliminary study provides strong evidence of the effectiveness of an avocado-soybean unsaponifiable extract in patients with degenerative joint diseases and arthralgia in the TMJ. Further studies with larger samples should be performed. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

[Absorbed dose and the effective dose of panoramic temporo mandibular joint radiography].

PubMed

Matsuo, Ayae; Okano, Tsuneichi; Gotoh, Kenichi; Yokoi, Midori; Hirukawa, Akiko; Okumura, Shinji; Koyama, Syuji

2011-01-01

This study measured the radiation doses absorbed by the patient during Panoramic temporo mandibular joint radiography (Panoramic TMJ), Schüllers method and Orbitoramus projection. The dose of the frontal view in Panoramic TMJ was compared to that with Orbitoramus projection and the lateral view in Panoramic TMJ was compared to that with Schüllers method. We measured the doses received by various organs and calculated the effective doses using the guidelines of the International Commission on Radiological Protection in Publication 103. Organ absorbed doses were measured using an anthropomorphic phantom, loaded with thermoluminescent dosimeters (TLD), located at 160 sensitive sites. The dose shows the sum value of irradiation on both the right and left sides. In addition, we set a few different exposure field sizes. The effective dose for a frontal view in Panoramic TMJ was 11 µSv, and that for the lateral view was 14 µSv. The lens of the Orbitoramus projection was 40 times higher than the frontal view in Panoramic TMJ. Although the effective dose of the lateral view in Panoramic TMJ was 3 times higher than that of the small exposure field (10×10 cm on film) in Schüller's method, it was the same as that of a mid-sized exposure field. When the exposure field in the inferior 1/3 was reduced during panoramic TMJ, the effective doses could be decreased. Therefore we recommend that the size of the exposure field in Panoramic TMJ be decreased.

Quantifying the Effect of Temporomandibular Joint Intra-Articular Steroid Injection on Synovial Enhancement in Juvenile Idiopathic Arthritis.

PubMed

Resnick, Cory M; Vakilian, Pouya M; Kaban, Leonard B; Peacock, Zachary S

2016-12-01

To quantify the effect of intra-articular steroid injections (IASIs) on temporomandibular joint (TMJ) synovitis in children with juvenile idiopathic arthritis (JIA) using gadolinium-enhanced magnetic resonance imaging (MRI). The present study was a retrospective study of children with JIA who had undergone TMJ IASIs at Boston Children's Hospital. The patients were included if they had undergone contrast-enhanced MRI both before and after IASI and if the pre-IASI MRI had demonstrated synovitis (enhancement ratio [ER] >1.55). Patients with TMJ pathology or pain unrelated to JIA or a history of facial trauma were excluded. The predictor variables were age, gender, JIA subtype, exposure to medications for arthritis, and a family history of autoimmune disease. The primary outcome variable was the ER. Additional outcome variables included patient-reported pain and the maximal incisal opening (MIO). Twenty-nine subjects (83% female) with a total of 50 injected TMJs were included. The average age at JIA diagnosis and at IASI was 6.8 ± 1.7 years and 12.1 ± 1.9 years, respectively. The mean follow-up period was 22.9 ± 4.3 months (range 5 to 48). The ER decreased in all injected joints, with a mean reduction of 1.05 ± 1.01 (P < .001). The post-IASI ER was less than the normal threshold (1.55) in 18% of the injected TMJs. IASI was associated with an elimination of pain in 89% of the subjects (P < .001) and in augmentation of the MIO by 5.8 ± 2.6 mm (P < .001). In children with JIA and TMJ synovitis, TMJ IASI was associated with a reduction in synovial enhancement, decreased pain, and an increased MIO. Only 18% of injected joints, however, experienced complete resolution of synovitis. These results support the use of IASI in the management of the pain and dysfunction associated with TMJ synovitis. Further study is required to determine the efficacy of IASI in limiting inflammation and future joint destruction. Copyright © 2016 American Association of Oral and

The contribution of collagen fibers to the mechanical compressive properties of the temporomandibular joint disc.

PubMed

Fazaeli, S; Ghazanfari, S; Everts, V; Smit, T H; Koolstra, J H

2016-07-01

The Temporomandibular Joint (TMJ) disc is a fibrocartilaginous structure located between the mandibular condyle and the temporal bone, facilitating smooth movements of the jaw. The load-bearing properties of its anisotropic collagenous network have been well characterized under tensile loading conditions. However, recently it has also been speculated that the collagen fibers may contribute dominantly in reinforcing the disc under compression. Therefore, in this study, the structural-functional role of collagen fibers in mechanical compressive properties of TMJ disc was investigated. Intact porcine TMJ discs were enzymatically digested with collagenase to disrupt the collagenous network of the cartilage. The digested and non-digested articular discs were analyzed mechanically, biochemically and histologically in five various regions. These tests included: (1) cyclic compression tests, (2) biochemical quantification of collagen and glycosaminoglycan (GAG) content and (3) visualization of collagen fibers' alignment by polarized light microscopy (PLM). The instantaneous compressive moduli of the articular discs were reduced by as much as 50-90% depending on the region after the collagenase treatment. The energy dissipation properties of the digested discs showed a similar tendency. Biochemical analysis of the digested samples demonstrated an average of 14% and 35% loss in collagen and GAG, respectively. Despite the low reduction of collagen content the PLM images showed considerable perturbation of the collagenous network of the TMJ disc. The results indicated that even mild disruption of collagen fibers can lead to substantial mechanical softening of TMJ disc undermining its reinforcement and mechanical stability under compression. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

TMJ symptoms reduce chewing amplitude and velocity, and increase variability.

PubMed

Radke, John C; Kamyszek, Greg J; Kull, Robert S; Velasco, Gerardo R

2017-09-04

The null hypothesis was that mandibular amplitude, velocity, and variability during gum chewing are not altered in subjects with temporomandibular joint (TMJ) internal derangements (ID). Thirty symptomatic subjects with confirmed ID consented to chew gum on their left and right sides while being tracked by an incisor-point jaw tracker. A gender and age matched control group (p > 0.67) volunteered to be likewise recorded. Student's t-test compared the ID group's mean values to the control group. The control group opened wider (p < 0.05) and chewed faster (p < 0.05) than the ID group. The mean cycle time of the ID group (0.929 s) was longer than the control group (0.751 s; p < 0.05) and more variable (p < 0.05). The ID group exhibited reduced amplitude and velocity but increased variability during chewing. The null hypothesis was rejected. Further study of adaptation to ID by patients should be pursued.

RNA sequencing reveals target genes of temporomandibular joint osteoarthritis in rats after the treatment of low-intensity pulsed ultrasound.

PubMed

He, Dong; An, Yanxin; Li, Yanhua; Wang, Jing; Wu, Gaoyi; Chen, Lei; Zhu, Guoxiong

2018-06-06

To explore the potential molecular mechanism of low-intensity pulsed ultrasound (LIPUS) in the treatment of temporomandibular joint osteoarthritis (TMJ-OA), and identify the target genes for therapy of TMJ-OA. Rat TMJ-OA was induced by unilateral occlusal trauma (UOT). At 8 weeks, the experimental group rats were treated by LIPUS for 4 weeks (5 days every week). The cartilage was examined by histological techniques. Gene expression profile in control, placebo and LIPUS-treated group were measured by RNA sequencing (RNA-Seq). Gene oncology (GO) and kyoto encyclopedia of genes and genomes (KEGG) annotated were performed and ten differentially expressed genes (DEGs) were further validated in another individual by quantitative real-time polymerase chain reaction (qRT-PCR). Per-2, a circadian rhythm gene, was further confirmed by western blot. TMJ-OA model was successfully established in rats through UOT. LIPUS played a positive role in attenuating the retrogression of cartilage. The cartilage lesion was determined by HE and Safranin-O staining. A significant and bran-new gene profile of 58 mRNAs was obtained from the RNA-Seq (LIPUS-treated/placebo) and generated approximately 30GB data. Annotation, functional classification and pathway of the data were analyzed based on GO and KEGG database and ten candidate DEGs were identified. Some of these genes were proved to be related to OA, such as matrix-degrading enzyme (ADAMTS-8), complement (C1qa, C3, C5aR1). Some were reported for the first time in TMJ-OA, such as circadian gene (Per-2, Dbp, Npas2 and Arntl). According to the results of qRT-PCR validation, the sequencing data was with a high degree of credibility. The circadian gene Per-2 was up-regulated by LIPUS in TMJ-OA on the mRNA and protein level. This study reveals the potential therapeutic genes related to TMJ-OA. Especially the circadian Per-2 gene was detected up-regulated by the treatment of LIPUS. It provides us a precious, new target OA-related gene and

The Efficacy of Platelets Rich Plasma Injection in the Superior Joint Space of the Tempromandibular Joint Guided by Ultra Sound in Patients with Non-reducing Disk Displacement.

PubMed

Al-Delayme, Ra'ed M Ayoub; Alnuamy, Shefaa H; Hamid, Firas Taha; Azzamily, Tariq Jassim; Ismaeel, Salah AbdulMahdy; Sammir, R; Hadeel, M; Nabeel, Jafaar; Shwan, R; Alfalahi, Shahad Jamal; Yasin, Alaa

2017-03-01

The objective of this study was to determine average improvement during the rest and active mouth opening after ultrasound guided platelets rich plasma injection in the tempromandibular superior joint space for the patients complaining from non-reducing disk displacement. Thirty-four patients with non-reducing disk displacement underwent guided ultrasound injection of platelet rich plasma to the upper joint space. The extent of maximal mouth opening, chewing efficiency, sound intensity of the TMJ, and tenderness of the TMJ and the masticatory muscles at rest, motion and mastication were thoroughly assessed at the beginning of the study and scheduled for next follow-up at 1st, 3rd, and 6th months. Injection with platelets rich plasma was significantly more effective in improvements of the extent of maximal mouth opening, statistics result demonstrated a significant reduction in the VAS values of pain at rest, motion and mastication compared to the baseline VAS values. PRP injection to the upper temporomandibular joint space provided improvement in signs and symptoms of patient with non-reducing disk displacement of the temporomandibular joint.

A study of the temporomandibular joint during bruxism.

PubMed

Commisso, María S; Martínez-Reina, Javier; Mayo, Juana

2014-06-01

A finite element model of the temporomandibular joint (TMJ) and the human mandible was fabricated to study the effect of abnormal loading, such as awake and asleep bruxism, on the articular disc. A quasilinear viscoelastic model was used to simulate the behaviour of the disc. The viscoelastic nature of this tissue is shown to be an important factor when sustained (awake bruxism) or cyclic loading (sleep bruxism) is simulated. From the comparison of the two types of bruxism, it was seen that sustained clenching is the most detrimental activity for the TMJ disc, producing an overload that could lead to severe damage of this tissue.

A study of the temporomandibular joint during bruxism

PubMed Central

Commisso, María S; Martínez-Reina, Javier; Mayo, Juana

2014-01-01

A finite element model of the temporomandibular joint (TMJ) and the human mandible was fabricated to study the effect of abnormal loading, such as awake and asleep bruxism, on the articular disc. A quasilinear viscoelastic model was used to simulate the behaviour of the disc. The viscoelastic nature of this tissue is shown to be an important factor when sustained (awake bruxism) or cyclic loading (sleep bruxism) is simulated. From the comparison of the two types of bruxism, it was seen that sustained clenching is the most detrimental activity for the TMJ disc, producing an overload that could lead to severe damage of this tissue. PMID:24651655

Pigmented villonodular synovitis of the temporomandibular joint with intracranial extension: A case series and systematic review.

PubMed

Safaee, Michael; Oh, Taemin; Sun, Matthew Z; Parsa, Andrew T; McDermott, Michael W; El-Sayed, Ivan H; Bloch, Orin

2015-08-01

Pigmented villonodular synovitis (PVNS) is a rare proliferative disorder of the synovial membrane. PVNS generally affects large joints but occasionally involves the temporomandibular joint (TMJ), with occasional extension into the middle cranial fossa. The purpose of this study was to report our experience with PVNS along with a focused literature review. Patients with PVNS of the TMJ treated at the University of California - San Francisco from 2007 to 2013 were reviewed. A PubMed search was performed to identify additional cases. Five patients underwent surgical resection, with 1 recurrence at 61 months. A literature review identified 58 patients, 19 of which had intracranial involvement. Interestingly, intracranial extension was more common in men. Intracranial extension was not associated with an increased rate of recurrence. PVNS of the TMJ is a rare entity associated with excellent outcomes, even with intracranial extension. Management should consist of maximal resection, with radiotherapy reserved for extensive or recurrent lesions. © 2014 Wiley Periodicals, Inc.

A comparative analysis of temporomandibular joint morphology in the African apes.

PubMed

Taylor, Andrea B

2005-06-01

A number of researchers have suggested a functional relationship between dietary variation and temporomandibular joint (TMJ) morphology, yet few studies have evaluated TMJ form in the African apes. In this study, I compare TMJ morphology in adults and during ontogeny in Gorilla (G.g. beringei, G.g. graueri, and G.g. gorilla) and Pan (P. paniscus, P. troglodytes troglodytes, P.t. schweinfurthii, and P.t. verus). I test two hypotheses: first, compared to all other African apes, G.g. beringei exhibits TMJ morphologies that would be predicted for a primate that consumes a diet comprised primarily of moderately to very tough, leafy vegetation; and second, all gorillas exhibit the same predicted morphologies compared to Pan. Compared to all adult African apes, G.g. beringei has higher rami and condyles positioned further above the occlusal plane of the mandible, relative to jaw length. Thus, mountain gorillas have the potential to generate relatively more muscle force, more evenly distribute occlusal forces along the postcanine teeth, and generate relatively greater jaw adductor moment. G.g. beringei also exhibits relatively wider mandibular condyles, suggesting these folivorous apes are able to resist relatively greater compressive loads along the lateral and/or medial aspect of the condyle. All gorillas likewise exhibit these same shape differences compared to Pan. These morphological responses are the predicted consequences of intensification of folivory and, as such, provide support for functional hypotheses linking these TMJ morphologies to degree of folivory. The African apes to not, however, demonstrate a systematic pattern of divergence in relative condylar area as a function of intensification of folivory. The ontogenetic trajectories for gorillas are significantly elevated above those of Pan, and to a lesser but still significant degree, mountain gorillas similarly deviate from lowland gorillas (G.g. gorilla and G.g. graueri). Thus, adult shape differences in

Motivation, characterization, and strategy for tissue engineering the temporomandibular joint disc.

PubMed

Detamore, Michael S; Athanasiou, Kyriacos A

2003-12-01

The purpose of this review is to serve as the standard point of reference in guiding researchers investigating the tissue engineering of the temporomandibular joint (TMJ) disc. Tissue engineering of the TMJ disc is in its infancy, and currently there exists a gap between the tissue engineering community and the TMJ characterization community. The primary goal is to help bridge that gap by consolidating the characterization studies here as a reference to researchers attempting to tissue engineer the TMJ disc. A brief review of TMJ anatomy is provided, along with a description of relevant pathology, current treatment, and a rationale for engineering the TMJ disc. The biochemical composition and organization of the disc are reviewed, including glycosaminoglycan (GAG) and collagen content. The collagen of the disc is almost exclusively type I and primarily runs anteroposteriorly through the center and in a ringlike fashion around the periphery. The GAG content is approximately an order of magnitude less than that of hyaline cartilage, and although the distribution is not entirely clear, it seems as though chondroitin and dermatan sulfate are by far the primary GAGs. Cellular characterization and mechanical properties under compression, tension, and shear are reviewed as well. The cells of the disc are not chondrocytes, but rather resemble fibrocytes and fibrochondrocytes and may be of the same lineage. Mechanically, the disc is certainly anisotropic and nonhomogeneous. Finally, a review of efforts in tissue engineering and cell culture studies of the disc is provided and we close with a description of the direction we envision/propose for successful tissue engineering of the TMJ disc.

Effect of arthrocentesis plus platelet-rich plasma and platelet-rich plasma alone in the treatment of temporomandibular joint osteoarthritis: A retrospective matched cohort study (A STROBE-compliant article).

PubMed

Lin, Shang-Lun; Tsai, Chiang-Chin; Wu, Shang-Liang; Ko, Shun-Yao; Chiang, Wei-Fan; Yang, Jung Wu

2018-04-01

Although the research on using platelet-rich plasma (PRP) for temporomandibular joint osteoarthritis (TMJ-OA) has advanced, no unified standards exist for determining the joint use of arthrocentesis and the injection dose and frequency of PRP. This study aimed to compare the efficacy of 2 TMJ-OA treatment approaches, arthrocentesis plus platelet-rich plasma (A+PRP) and PRP alone, and attempted to provide another potential treatment option with a single injection of 2 mL of high-concentration and high-purity PRP.This retrospective matched cohort study enrolled 208 patients who were treated for temporomandibular disorders (TMDs) in the Department of Oral and Maxillofacial Surgery of Tainan Sin-Lau Hospital between August of 2013 and January of 2016, from which 90 patients were selected for the final analysis. The predictor variables were treatment outcome indicators, including joint crepitus sounds, TMD-associated headache, jaw range of motion <6 mm, myofascial pain with referral, temporomandibular joint (TMJ) arthralgia, pain when chewing most foods, and maximum assisted opening (MAO). The data were analyzed using χ tests, t tests, and multiple regression analyses.Among the 90 patients, 30 were assigned into the A+PRP group, and 60 were included in the PRP group. A matching method was used to ensure no statistically significant differences in the categorical and continuous variables between the 2 groups. After treatment, both the A+PRP and PRP groups showed improvements in TMJ-OA. The 2 treatment groups did not show statistically significant differences in the symptom improvement rates of joint crepitus sounds, reparative remodeling, and TMJ arthralgia. However, compared with PRP alone, the A+PRP treatment demonstrated superior performance in improving TMD-associated headache, jaw range of motion <6 mm, myofascial pain with referral, and pain when chewing most foods.Both A+PRP and PRP treatments can effectively improve multiple symptoms of TMJ-OA. Based on the

Fibrochondrocyte Growth and Functionality on TiO₂ Nanothin Films.

PubMed

Ronald, Sharon; Mills, David K

2016-06-14

Disorders affecting the temporomandibular joint (TMJ) are a long-standing health concern. TMJ disorders (TMJD) are often associated with an internal disc derangement accompanied by a suite of symptoms including joint noises, jaw dysfunction, and severe pain. The severity of patient symptoms and their reoccurrence can be alleviated to some extent with conservative therapy; however, refractory cases often require surgery that has shown only limited success. Bioengineered scaffolds with cell supportive surfaces an d nanoarchitectures that mimic TMJ tissue structure may offer an alternative treatment modality. In this study, titanium dioxide (TiO₂) nanothin films, fabricated by layer-by-layer assembly, were examined as means for creating such a scaffold. The viability and growth of TMJ discal fibrochondrocytes (FCs) were assessed through MTT and DNA assays and total protein content over a 14-day experimental period. ELISA was also used to measure expression of types I and II collagen, decorin and aggrecan. Quantitative analyses demonstrated that FCs synthesized characteristic discal matrix proteins, with an increased production of type I collagen and decorin as opposed to collagen type II and aggrecan. A stimulatory effect on discal FC proliferation and extracellular matrix (ECM) expression with thicker nanofilms was also observed. The cumulative results suggest that TiO₂ nanofilms may have potential as a TMJ scaffolding material.

Overexpression of Shox2 Leads to Congenital Dysplasia of the Temporomandibular Joint in Mice

PubMed Central

Li, Xihai; Liang, Wenna; Ye, Hongzhi; Weng, Xiaping; Liu, Fayuan; Liu, Xianxiang

2014-01-01

Our previous study reported that inactivation of Shox2 led to dysplasia and ankylosis of the temporomandibular joint (TMJ), and that replacing Shox2 with human Shox partially rescued the phenotype with a prematurely worn out articular disc. However, the mechanisms of Shox2 activity in TMJ development remain to be elucidated. In this study, we investigated the molecular and cellular basis for the congenital dysplasia of TMJ in Wnt1-Cre; pMes-stop Shox2 mice. We found that condyle and glenoid fossa dysplasia occurs primarily in the second week after the birth. The dysplastic TMJ of Wnt1-Cre; pMes-stop Shox2 mice exhibits a loss of Collagen type I, Collagen type II, Ihh and Gli2. In situ zymography and immunohistochemistry further demonstrate an up-regulation of matrix metalloproteinases (MMPs), MMP9 and MMP13, accompanied by a significantly increased cell apoptosis. In addition, the cell proliferation and expressions of Sox9, Runx2 and Ihh are no different in the embryonic TMJ between the wild type and mutant mice. Our results show that overexpression of Shox2 leads to the loss of extracellular matrix and the increase of cell apoptosis in TMJ dysplasia by up-regulating MMPs and down-regulating the Ihh signaling pathway. PMID:25062348

Application of the rapid prototyping technique to design a customized temporomandibular joint used to treat temporomandibular ankylosis

PubMed Central

Chaware, Suresh M.; Bagaria, Vaibhav; Kuthe, Abhay

2009-01-01

Anthropometric variations in humans make it difficult to replace a temporomandibular joint (TMJ), successfully using a standard “one-size-fits-all” prosthesis. The case report presents a unique concept of total TMJ replacement with customized and modified TMJ prosthesis, which is cost-effective and provides the best fit for the patient. The process involved in designing and modifications over the existing prosthesis are also described. A 12-year- old female who presented for treatment of left unilateral TMJ ankylosis underwent the surgery for total TMJ replacement. A three-dimensional computed tomography (CT) scan suggested features of bony ankylosis of left TMJ. CT images were converted to a sterolithographic model using CAD software and a rapid prototyping machine. A process of rapid manufacturing was then used to manufacture the customized prosthesis. Postoperative recovery was uneventful, with an improvement in mouth opening of 3.5 cm and painless jaw movements. Three years postsurgery, the patient is pain-free, has a mouth opening of about 4.0 cm and enjoys a normal diet. The postoperative radiographs concur with the excellent clinical results. The use of CAD/CAM technique to design the custom-made prosthesis, using orthopaedically proven structural materials, significantly improves the predictability and success rates of TMJ replacement surgery. PMID:19881026

Iatrogenic arteriovenous fistula of the superficial temporal artery after manual reduction of temporomandibular joint dislocation.

PubMed

Takeuchi, Satoru; Takasato, Yoshio

2011-09-01

A 33-year-old man fell from a height and was referred to our hospital. Physical examination showed a swelling in the left preauricular region without laceration. No thrill or bruit was detected at this time. A face x-ray and a computed tomographic scan showed a left temporomandibular joint (TMJ) dislocation, Le Fort I fractures, and a mandibular body fracture. Left TMJ dislocation was treated by manual reduction. Two days after admission, a swelling in the left preauricular region progressed, with thrill and bruit. Left external carotid artery angiograms showed an arteriovenous fistula with a dilated pouch near the left TMJ. The fistula was fed by the left superficial temporal artery and drained into the left superficial temporal vein. The fistula was successfully embolized using Tornado coils. This is the first case of an arteriovenous fistula of the superficial temporal artery after manual reduction of TMJ dislocation.

[Inferior hemiarthroplasty of the temporo-mandibular joint with articulated condylar prosthesis type Stryker].

PubMed

Bucur, A; Dincă, O; Totan, C; Ghită, V

2007-01-01

The optimal reconstruction of the mandible and of the temporo-mandibular joint after mandibular hemi-resection with disarticulation is still controversial in literature. This paperwork presents our experience on four cases in the reconstruction of the mandible together with the inferior arthroplasty of the temporo-mandibular joint, after the resection of extended benign tumors of the mandible, based on fibular free vascularized grafts having attached a Stryker titanium condylar prosthesis reconstructing the inferior segment of the temporo-mandibular joint. Our results for the this technique were excellent, with a functional rehabilitation very close to normal. After reviewing the various techniques and their arguments in literature, with accent on the TMJ reconstruction, we consider this method to be optimal for the reconstruction of mandibular defects in patients with neoplastic conditions.

Non-steroidal Anti-inflammatory Drugs Attenuate Hyperalgesia and Block Upregulation of Trigeminal Ganglionic Sodium Channel 1.7 after Induction of Temporomandibular Joint Inflammation in Rats.

PubMed

Bi, Rui Yun; Ding, Yun; Gan, Ye Hua

2016-03-01

To investigate the association between the analgesic effect of non-steroidal antiinflammatory drugs (NSAIDs) and sodium channel 1.7 (Nav1.7) expression in the trigeminal ganglion (TG). Temporomandibular joint (TMJ) inflammation was induced by complete Freund's adjuvant (CFA) in female rats. Ibuprofen, diclofenac sodium and meloxicam were given intragastrically before induction of TMJ inflammation. Histopathological evaluation and scoring of TMJ inflammation was used to evaluate the level of inflammation. The head withdrawal threshold and food intake were measured to evaluate TMJ nociceptive responses. The mRNA and protein expression of trigeminal ganglionic Nav1.7 was examined using real-time polymerase chain reaction and western blot. Twenty-four hours after the injection of CFA into the TMJs, NSAIDs attenuated hyperalgesia of inflamed TMJ and simultaneously blocked inflammation-induced upregulation of Nav1.7 mRNA and protein expression in the TG. However, ibuprofen and diclofenac sodium slightly attenuated TMJ inflammation and meloxicam did not affect TMJ inflammation. Attenuation of hyperalgesia of inflamed TMJ by NSAIDs might be associated with their role in blocking upregulation of trigeminal ganglionic Nav1.7.

Single stage treatment of ankylosis of the temporomandibular joint using patient-specific total joint replacement and virtual surgical planning.

PubMed

Haq, Jahrad; Patel, Nishma; Weimer, Katherine; Matthews, N Shaun

2014-04-01

Ankylosis of the temporomandibular joint (TMJ) is a debilitating condition that can result in pain, trismus, and a poor quality of life. It can be caused by injury, infection, and rheumatoid disease. Current management includes gap arthroplasty, interpositional arthroplasty, and reconstruction. Traditionally, joints are reconstructed using stock implants, or the procedure is done in two stages with an additional computed tomography (CT) scan between the resective and reconstructive procedures and use of stereolithographic models to aid the design of the definitive prostheses. We describe a technique for the resection of ankylosis and reconstruction of the joint in a single operation using virtually designed custom-made implants. Five patients with ankylosis of the TMJ had a single stage operation with reconstruction between 2010 and 2012. All had preoperative high-resolution CT with contrast angiography. During an international web-based teleconference between the surgeon and the engineer a virtual resection of the ankylosis was done using the reconstructed CT images. The bespoke cutting guides and implants were designed virtually at the same time and were then manufactured precisely using computer-aided design and manufacture (CAD-CAM) over 6 weeks. After release of the ankylosis and reconstruction, the patients underwent an exercise regimen to improve mouth opening. Follow-up was for a minimum of 6 months. Four patients had one operation, and one patient had two. Median/Mean maximum incisal opening increased from 0.6mm before operation to 25 mm afterwards (range 23-27), and there was minimal surgical morbidity. This new method effectively treats ankylosis of the TMJ in a single stage procedure. Fewer operations and hospital stays, and the maintenance of overall clinical outcome are obvious advantages. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

[The temporomandibular joint and inflammatory rheumatic diseases].

PubMed

Marotte, H

2016-09-01

Some inflammatory rheumatic diseases can involve the temporomandibular joint, such as rheumatoid arthritis and spondylarthritis. The aim of our work was to evaluate the current prevalence of these inflammatory TMJ diseases, to indicate the new therapeutics and to describe the collaboration between rheumatologist and maxillofacial surgeon in these pathologies. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Juvenile porcine temporomandibular joint: Three different cartilaginous structures?

PubMed

Tabeian, Hessam; Bakker, Astrid D; de Vries, Teun J; Zandieh-Doulabi, Behrouz; Lobbezoo, Frank; Everts, Vincent

2016-12-01

The temporomandibular joint (TMJ) consists of three cartilaginous structures: the fossa, disc, and condyle. In juvenile idiopathic arthritis (JIA), inflammation of the TMJ leads to destruction of the condyle, but not of the fossa or the disc. Such a different effect of inflammation might be related to differences in matrix composition of the cartilaginous structures. The matrix composition of the three TMJ structures was analyzed in juvenile porcine samples and in an in vitro system of cells isolated from each anatomical structure embedded in 3% agarose gels. The matrix of all three anatomical structures of the TMJ contained collagen type I and its gene expression was maintained after isolation. The condyle and the fossa stained positive for collagen type II and proteoglycans, but the condyle contained considerably more collagen type II and proteoglycans than the fossa. The disc contained neither collagen type II protein nor expression of its gene, and the disc did not stain positive for proteoglycans. Aggrecan gene expression was lower in the disc compared to condyle and fossa cell-isolates. In general, the cell-isolates in vitro closely mimicked the characteristic features found in the tissue. The collagen type II content of the condyle clearly distinguished this cartilaginous structure from the disc and fossa. Since autoimmunity against collagen type II is associated with JIA, the relatively abundant presence of this type of collagen in the condyle might provide an explanation why primarily this cartilaginous structure of the TMJ is affected in JIA patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

Temporomandibular joint disorder in a patient with multiple sclerosis--review of literature with a clinical report.

PubMed

Badel, Tomislav; Carek, Andreja; Podoreski, Dijana; Pavicin, Ivana Savić; Lovko, Sandra Kocijan

2010-09-01

Temporomandibular disorders are a form of musculoskeletal disorders, which reduce the function of stomatognathic system and they are related to some other diseases causing painful conditions and disorders of oral function. The aim of this paper is to describe a one year follow up clinical case of a female patient with comorbid multiple sclerosis and a relatively rare form of articular disc disorder. Primary clinical diagnostics encompassed manual methods of TMJ examination. Definite diagnosis included radiologic examination. Clinical hyperextensive condyle position was palpated bilaterally and subsequently confirmed by a functional panoramic radiograph of TMJ. The anterior displacement of disc with reduction was diagnosed by magnetic resonance and in the right joint there was a disc displacement upon excursive movement. From relevant literature, the relationship of a number of diseases that can be related to functional disorder of the orofacial system, such as multiple sclerosis, has been described from many aspects. Also, apart from the standard classification of one form of anterior displacement of the disc, made primarily by magnetic resonance, cases of disc displacement upon excursive mandibular movement can rarely be found in literature.

Dental and skeletal maturation in female adolescents with temporomandibular joint osteoarthritis.

PubMed

Kang, J-H; Yang, I-H; Hyun, H-K; Lee, J-Y

2017-11-01

Occurrence of temporomandibular disorders (TMDs) and temporomandibular joint (TMJ) osteoarthritis (OA) during adolescence may have interactions with mandibular and dental development. The aim of the present study was to investigate relationships between occurrence of TMD and TMJ OA and extents of dental and skeletal development in juvenile female patients. In total, 95 female adolescents (age range, 11-15 years) were selected. Among them, 15 subjects (control) had no signs of TMD, 39 TMD patients did not have OA (TMDnoOA), 17 TMD patients were at initial stage of TMJ OA (TMJOA), and 27 patients showed progressive stage of TMJ OA (TMJOA). Dental age was estimated by Demirjian's stages used in a previous study with Korean adolescents. Craniofacial parameters and cervical vertebrae maturation (CVM) stages, representing skeletal maturity levels, were measured using lateral cephalograms. The estimated dental age was significantly lower than chronological age in all groups, but CVM differences were not statistically significant. Dental age was the lowest, and differences between the chronological age and estimated dental age were the highest among initial stage of TMJOAs followed by progressive stage of TMJOAs, TMDnoOAs and control and were not associated with CVM stages. Cephalometric parameters revealed significant clockwise rotation of the mandible among the TMJOAs compared with controls and TMDnoOAs and were not associated with CVM stages as well. The juvenile female patients with TMD, particularly TMJ OA, showed retarded dental development, mandibular backward positioning and hyperdivergent facial profiles. The TMJ OA may be associated with retarded dental development but not with skeletal maturations. © 2017 John Wiley & Sons Ltd.

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

PubMed

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

2010-04-19

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

Comparison of the effectiveness of three different treatment methods for temporomandibular joint disc displacement without reduction.

PubMed

Tatli, U; Benlidayi, M E; Ekren, O; Salimov, F

2017-05-01

The aim of this study was to compare the effectiveness of three treatment methods for unilateral temporomandibular joint (TMJ) disc displacement without reduction (DDwoR). One hundred and twenty patients with unilateral TMJ DDwoR were assigned randomly to one of three treatment groups (40 patients in each): group 1 received arthrocentesis, group 2 received stabilization splint therapy following arthrocentesis, and group 3 received splint therapy only. The groups were compared in terms of pain (visual analogue scale), joint function (maximum mouth opening and laterotrusive movements), disability and psychological status (validated questionnaire), and success rates. These were recorded before treatment and during follow-up after treatment (1, 3, and 6 months). The between-group and within-group differences in the data were analyzed statistically. The baseline characteristics were similar in all groups (P>0.05). Significant improvements were noted in all parameters compared to baseline values in all groups (all P<0.01). Groups 1 and 2 showed comparable outcomes that were superior to those of group 3. Arthrocentesis reduces pain and functional impairment more rapidly and effectively than splint therapy. Simultaneous splint application has no additional effect on the effectiveness of arthrocentesis for the treatment of unilateral DDwoR. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Impalement of an unusual foreign body on the temporomandibular joint causing severe trismus.

PubMed

Ito, Ryohei; Kubota, Kosei; Furudate, Ken; Nakagawa, Hiroshi; Kon, Takao; Tamura, Yoshihiro; Kobayashi, Wataru

2016-12-01

A penetrating injury by a foreign body is comparatively common in the oral and maxillofacial region. On the other hand, injury to the temporomandibular joint (TMJ) by a foreign object is very rare. The TMJ is an anatomically narrow space surrounded by hard bony processes. An unusual case of trauma with severe trismus caused by a foreign body that impaled the TMJ is reported. A 55-year-old man presented with a 5 × 1-cm laceration to the right cheek caused by a flying object propelled during the use of a lawn mower. The edge of the foreign body had a metallic wire, which became imbedded in the wound. His jaw opening was severely limited. Computed tomography revealed that the foreign body was 3 mm in diameter and was impaled on the articular capsule. The object was successfully removed, and the wound and interior of the TMJ were irrigated. Rehabilitation of mouth opening was started on postoperative day 3. On day 9, mouth opening had improved to 35 mm, and he was discharged. After 1 year, mouth opening was 45 mm with no sign of any TMJ disorders. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Engineering functional anisotropy in fibrocartilage neotissues.

PubMed

MacBarb, Regina F; Chen, Alison L; Hu, Jerry C; Athanasiou, Kyriacos A

2013-12-01

The knee meniscus, intervertebral disc, and temporomandibular joint (TMJ) disc all possess complex geometric shapes and anisotropic matrix organization. While these characteristics are imperative for proper tissue function, they are seldom recapitulated following injury or disease. Thus, this study's objective was to engineer fibrocartilages that capture both gross and molecular structural features of native tissues. Self-assembled TMJ discs were selected as the model system, as the disc exhibits a unique biconcave shape and functional anisotropy. To drive anisotropy, 50:50 co-cultures of meniscus cells and articular chondrocytes were grown in biconcave, TMJ-shaped molds and treated with two exogenous stimuli: biomechanical (BM) stimulation via passive axial compression and bioactive agent (BA) stimulation via chondroitinase-ABC and transforming growth factor-β1. BM + BA synergistically increased Col/WW, Young's modulus, and ultimate tensile strength 5.8-fold, 14.7-fold, and 13.8-fold that of controls, respectively; it also promoted collagen fibril alignment akin to native tissue. Finite element analysis found BM stimulation to create direction-dependent strains within the neotissue, suggesting shape plays an essential role toward driving in vitro anisotropic neotissue development. Methods used in this study offer insight on the ability to achieve physiologic anisotropy in biomaterials through the strategic application of spatial, biomechanical, and biochemical cues. Copyright © 2013 Elsevier Ltd. All rights reserved.

Engineering Functional Anisotropy in Fibrocartilage Neotissues

PubMed Central

MacBarb, R.F.; Chen, A.L.; Hu, J.C.; Athanasiou, K.A.

2013-01-01

The knee meniscus, intervertebral disc, and temporomandibular joint (TMJ) disc all possess complex geometric shapes and anisotropic matrix organization. While these characteristics are imperative for proper tissue function, they are seldom recapitulated following injury or disease. Thus, this study’s objective was to engineer fibrocartilages that capture both gross and molecular structural features of native tissues. Self-assembled TMJ discs were selected as the model system, as the disc exhibits a unique biconcave shape and functional anisotropy. To drive anisotropy, 50:50 co-cultures of meniscus cells and articular chondrocytes were grown in biconcave, TMJ-shaped molds and treated with two exogenous stimuli: biomechanical (BM) stimulation via passive axial compression and bioactive agent (BA) stimulation via chondroitinase-ABC and transforming growth factor-β1. BM+BA synergistically increased Col/WW, Young’s modulus, and ultimate tensile strength 5.8-fold, 14.7-fold, and 13.8-fold that of controls, respectively; it also promoted collagen fibril alignment akin to native tissue. Finite element analysis found BM stimulation to create direction-dependent strains within the neotissue, suggesting shape plays an essential role toward driving in vitro anisotropic neotissue development. Methods used in this study offer insight on the ability to achieve physiologic anisotropy in biomaterials through the strategic application of spatial, biomechanical, and biochemical cues. PMID:24075479

Radiation-induced temporo-mandibular joint disorder in post-radiotherapy nasopharyngeal carcinoma patients: assessment and treatment.

PubMed

Wu, Vincent W C; Lam, Ying-Na

2016-06-01

Nasopharyngeal carcinoma (NPC) is endemic in southern China, and its incidence in Hong Kong is relatively high. Radiotherapy is the mainstay treatment for NPC due to its relatively high radiosensitivity and deep-seated anatomical position, which is not readily accessible by surgery. Although the technique of radiotherapy in NPC has been advancing and offers promising treatment outcome, complications around the irradiation areas are inevitable and the quality of life of the post-radiotherapy patients is often compromised. Trismus, which is defined as the restricted mouth opening or jaw movement due to the disorder of temporo-mandibular joint (TMJ), is one of the possible late complications for radiotherapy of NPC and is found in 5-17% of the post-radiotherapy (post-RT) patients. Trismus at early stage may only affect the speech, but in severe cases nutritional intake and oral hygiene condition may deteriorate seriously. This article reviewed the possible causes of radiation-induced TMJ damage, the various assessments including imaging modalities and possible treatments. The conclusion is that the availability of simple, yet effective examinations for trismus is essential for delaying the progression and restoring TMJ functions. Although there is no absolutely effective treatment for trismus, many supportive, restorative and palliative management are possible under different clinical situations.

Fibrochondrocyte Growth and Functionality on TiO2 Nanothin Films

PubMed Central

Ronald, Sharon; Mills, David K.

2016-01-01

Disorders affecting the temporomandibular joint (TMJ) are a long-standing health concern. TMJ disorders (TMJD) are often associated with an internal disc derangement accompanied by a suite of symptoms including joint noises, jaw dysfunction, and severe pain. The severity of patient symptoms and their reoccurrence can be alleviated to some extent with conservative therapy; however, refractory cases often require surgery that has shown only limited success. Bioengineered scaffolds with cell supportive surfaces an d nanoarchitectures that mimic TMJ tissue structure may offer an alternative treatment modality. In this study, titanium dioxide (TiO2) nanothin films, fabricated by layer-by-layer assembly, were examined as means for creating such a scaffold. The viability and growth of TMJ discal fibrochondrocytes (FCs) were assessed through MTT and DNA assays and total protein content over a 14-day experimental period. ELISA was also used to measure expression of types I and II collagen, decorin and aggrecan. Quantitative analyses demonstrated that FCs synthesized characteristic discal matrix proteins, with an increased production of type I collagen and decorin as opposed to collagen type II and aggrecan. A stimulatory effect on discal FC proliferation and extracellular matrix (ECM) expression with thicker nanofilms was also observed. The cumulative results suggest that TiO2 nanofilms may have potential as a TMJ scaffolding material. PMID:27314395

Study on the effectiveness of the kinetic method in patients with rheumatic diseases and temporomandibular joint dysfunction.

PubMed

Havriş, Maria Daniela; Ancuţa, Codrina; Iordache, Cristina; Chirieac, Rodica Marieta

2012-01-01

Selecting the appropriate treatment decision is essential for achieving optimal results in the management of algo-dysfunctional syndrome of the temporo-mandibular joint (TMJD). The study aims to decide on the most effective (symptomatic control, preserved motility) kinetic program in patients with TMJ involvement. prospective observational study on 83 consecutive patients with rheumatic diseases and TMJ dysfunction. Clinical assessment (pain, noises, muscle spasm, range of motion, ROM) was performed at baseline and after 3 months of specific kinetic rehabilitation program. Change in clinical parameters and TM3 index was reported, p<0.05. over 45% TMJ involvement at baseline as defined by TMJ index (mean value of 13.56) and only 36.66% at 3 months (p<0.05). Significant improvement in pain (presence, severity) was demonstrated at 3 moths (p<0.05): 18.05% spontaneous pain, 75.9% provoked pain, with 12.11% respectively 2.41% decreased in nocturnal respectively diurnal pain. Significant decrease (p<0.05) in joint noises at movements: 27.71% when opening and 12.04% when closing the mouth, 8.43 at protrusion and 3.61% at retraction, while 18% at the side movements. Complex accurate kinetic reeducation is mandatory for achieving correct posture (head, neck and trunk), normal mastication, swallowing and respiration, as well as correction of neuromuscular imbalances in patients with TMJD secondary to rheumatic disorders.

Cryoanalgesia in the management of intractable pain in the temporomandibular joint: a five-year retrospective review.

PubMed

Sidebottom, A J; Carey, E C; Madahar, A K

2011-12-01

Cryoanalgesia is a controversial adjunct to the management of chronic pain, but we know of no studies that have investigated its effect in the management of temporomandibular joint (TMJ) pain. In this five-year retrospective study we treated 17 patients who had severe pain that had failed to respond to all forms of conventional conservative treatment and were not appropriate for simple open operation. None had a clear indication for open operation on the joint or had too severe disease to warrant a simple procedure. Preliminary diagnostic injections of bupivacaine to the TMJ relieved the pain. We applied the cryoprobe in the region of the auriculotemporal nerve and TMJ capsule. There was a small but insignificant improvement in mean mouth opening together with a significant (p=0.000) improvement in visual analogue pain scores (VAS) from 6.8 (range 4-10) to 2.0 (range 0-7). Two patients had no change in their pain scores, and 2 had complete resolution of their pain. The mean number of pain-free months after treatment was 7 (IQR 3-15). Three patients had long-term pain relief, and 12 temporary relief; 6 of these subsequently had successful relief after total replacement of the TMJ. One patient had further cryoanalgesia, one was referred for specialist pain management, and one controlled the pain with nortriptyline. Of the 17 cases studied, 2 had temporary complications after cryoanalgesia. Cryoanalgesia is a useful adjunct to the management of intractable pain in the TMJ. Short-term pain relief can be achieved, and long-term relief is possible in some, deferring more complex and costly treatments. Crown Copyright © 2010. Published by Elsevier Ltd. All rights reserved.

Dentists' knowledge of occlusal splint therapy for bruxism and temporomandibular joint disorders.

PubMed

Candirli, C; Korkmaz, Y T; Celikoglu, M; Altintas, S H; Coskun, U; Memis, S

2016-01-01

The aim of this study was to investigate dentist's approaches to the use of splint therapy for myofascial pain, bruxism, and temporomandibular joint (TMJ) disorders and to assessment of treatment modalities. A 12-item questionnaire was developed to determine dentists' knowledge of TMJ disorders and approaches for occlusal splint treatments. The researchers spoke with each dentist included in the study at his/her clinic or by telephone to assess their immediate knowledge and approach to the TMJ disorders. Chi-squared test was performed to analyze the values. The confidence interval was set as 95%. A total of 370 dentists working in Turkey were participated in this study. The most common splint application reason for occlusal splint treatment was bruxism (77.8%) while TMJ pain was very rare (%1.4). The use of hard splint ratios for 0-5 years of professional experience was 57.0%, 42.4.0%, and 26.8% for the experience of 5-15 years and over 15 years groups, respectively (P < 0.001). While the dentists' with sufficient knowledge soft splint application rates were 11.6%, hard splint application rates were 43.4% for the dentists with sufficient knowledge. Occlusion adjustment rate of dentists who practice in all three groups was under 16.0%. The knowledge of the dentists about TMJ disorders and occlusal splint therapy were found to be insufficient. Their knowledge decreased with increasing experience.

Intra-articular corticosteroid injections to the temporomandibular joints are safe and appear to be effective therapy in children with juvenile idiopathic arthritis.

PubMed

Stoll, Matthew L; Good, Jennifer; Sharpe, Tyler; Beukelman, Timothy; Young, Daniel; Waite, Peter D; Cron, Randy Q

2012-08-01

The purpose of this study was to evaluate the safety and efficacy of intra-articular corticosteroid injections (IACIs) of the temporomandibular joint (TMJ) in children with juvenile idiopathic arthritis (JIA) when administered by an oral and maxillofacial surgeon without imaging guidance. This was a retrospective study of children with JIA, seen at a single center, who were selected based on having received IACIs of the TMJ. All subjects received the intervention, which consisted of referral to a single oral and maxillofacial surgeon for TMJ IACI with 5 to 10 mg triamcinolone hexacetonide, under general anesthesia. Primary outcomes assessed in all subjects were the safety of the procedure and efficacy as determined by the change in maximal incisal opening (MIO). In addition, a subset of 31 subjects underwent repeat magnetic resonance imaging of the TMJ, permitting analysis of the change in the acute and chronic findings of arthritis in those patients. Sixty-three patients (68% female) received 137 IACIs. The mean age for diagnosis of JIA was 8.5 years, and the mean age at presentation for TMJ injections was 10 years. The injections were well tolerated: only 1 patient developed the steroid complication of hypopigmentation, and none developed degeneration or ankylosis. In terms of efficacy, the mean MIO increased from 40.8 ± 0.93 to 43.5 ± 0.90 mm (P = .001); in addition, changing the unit of analysis to individual joints, in patients who underwent repeat magnetic resonance imaging examination, 51% of TMJs showed magnetic resonance imaging evidence of improvement of arthritic changes, of whom 18% had complete resolution of TMJ arthritis. The results indicate that IACI of the TMJ can be safely performed by experienced oral and maxillofacial surgeons without a requirement for computed tomographic guidance. In addition, these results show that IACI may be effective in the management of TMJ arthritis, although further studies are required. Copyright © 2012 American

Dietary variation and mechanical properties of articular cartilage in the temporomandibular joint: implications for the role of plasticity in mechanobiology and pathobiology.

PubMed

Ravosa, Matthew J; Kane, Robert J

2017-10-01

Due to their nature as tissue composites, skeletal joints pose an additional challenge in terms of evaluating the functional significance of morphological variation in their bony and cartilaginous components in response to altered loading conditions. Arguably, this complexity requires more direct means of investigating joint plasticity and performance than typically employed to analyze macro- and micro-anatomical phenomena. To address a significant gap in our understanding of the plasticity of the mammalian temporomandibular joint (TMJ), we investigated the histology and mechanical properties of condylar articular cartilage in rabbits subjected to long-term variation in diet-induced masticatory stresses, specifically cyclical loading. Three cohorts of male weanlings were raised for six months on different diets until adulthood. Following euthanasia, the TMJ condyles on one side were dissected away, fixed, decalcified, dehydrated, embedded and sectioned. Safranin O staining was employed to identify variation in proteoglycan content, which in turn was used to predict patterns of articular cartilage stiffness in contralateral condylar specimens for each treatment group. Hematoxylin and eosin staining was used to quantify diet-induced changes in chondrocyte hypertrophy and cellularity. Mechanical tests document significant decreases in articular cartilage stiffness corresponding to patterns of extracellular matrix relative protein abundance in rabbits subjected to greater cyclical loading. This indicates that TMJs routinely subjected to higher masticatory stresses due to a challenging diet eventually develop postnatal decreases in the ability to counter compressive loads during postcanine biting and chewing. These findings provide novel information regarding TMJ performance, with broader implications about the costs and benefits of phenotypic plasticity as well as implications for how such biological processes affect connective tissue mechanobiology and pathobiology

IL-1β mediating high mobility group box protein-1 expression in condylar chondrocyte during temporomandibular joint inflammation.

PubMed

Li, Cheng; Cai, Hengxing; Meng, Qinggong; Feng, Yaping; Guo, Huilin; Fang, Wei; Long, Xing

2016-08-01

Temporomandibular joint (TMJ) osteoarthritis(OA)characterized with cartilage degen-eration is associated with inflammation. High mobility group box chromosomal protein-1(HMGB-1)is a potent mediator of inflammation and the trigger of OA. The expression of HMGB-1 in TMJ OA was uncovered, but the role of HMGB-1 in TMJ cartilage degeneration is not fully understood. In this study, the regulation of HMGB-1 in TMJ condylar cartilage was revealed. A complete Freund's adjuvant (CFA)-induced TMJ inflammation animal model was employed and the expression of HMGB-1 was detected at 1st, 2nd, and 6th weeks by immunohistochemistry. TMJ condylar chondrocytes were incubated with IL-1β (10 and 40 ng/ml) at 24, 48, and 72 h, and the translocation and protein level of HMGB-1 were evaluated by immunofluorescence and Western blot. Nuclear HMGB-1 staining was predominantly located in chondrocytes of both the fibrosis and proliferative zones in healthy TMJ. 1st week and 2nd week after CFA injection, immunoreaction could be detected in the cytoplasms of HMGB-1-positive cells and cartilage matrix especially in hypertrophic zone. At 6th week after CFA injection, cartilage matrix expression was disappeared and the cytoplasm expression of HMGB-1 was very weak in hypertrophic zone. HMGB-1 was translocated from the nucleus to the cytoplasm at 48 h after incubated with IL-1β (10 ng/ml and 40 ng/ml). The protein level of HMGB-1 was increased after stimulation and had a peak at 48 h. HMGB-1 might be associated with TMJ inflammation and OA. Insight into the role of HMGB-1 in TMJ inflammation is helpful to add the new knowledge into the pathogenesis of TMJ OA. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Estrogen in cycling rats alters gene expression in the temporomandibular joint, trigeminal ganglia and trigeminal subnucleus caudalis/upper cervical cord junction

PubMed Central

Puri, Jyoti; Bellinger, Larry L.; Kramer, Phillip R.

2011-01-01

Females report temporomandibular joint (TMJ) pain more than men and studies suggest estrogen modulates this pain response. Our goal in this study was to determine genes that are modulated by physiological levels of 17β-estradiol that could have a role in TMJ pain. To complete this goal, saline or complete Freund’s adjuvant was injected in the TMJ when plasma 17β-estradiol was low or when it was at a high proestrus level. TMJ, trigeminal ganglion and trigeminal subnucleus caudalis/upper cervical cord junction (Vc/C1–2) tissues were isolated from the treated rats and expression of 184 genes was quantitated in each tissue using real time PCR. Significant changes in the amount of specific transcripts were observed in the TMJ tissues, trigeminal ganglia and Vc/C1–2 region when comparing rats with high and low estrogen. GABA A receptor subunit α6 (Gabra6) and the glycine receptor α2 (Glra2) were two genes of interest because of their direct function in neuronal activity and a greater than 29 fold increase in the trigeminal ganglia was observed in proestrus rats with TMJ inflammation. Immunohistochemical studies showed that Gabrα6 and Glrα2 neuronal and not glial expression increased when comparing rats with high and low estrogen. Estrogen receptors α and β are present in neurons of the trigeminal ganglia, whereby 17β-estradiol can alter expression of Gabrα6 and Glrα2. Also, estrogen receptor α (ERα) but not ERβ was observed in satellite glial cells of the trigeminal ganglia. These results demonstrate that genes associated with neurogenic inflammation or neuronal excitability were altered by changes in the concentration of 17β-estradiol. PMID:21321935

Management of pain secondary to temporomandibular joint syndrome with peripheral nerve stimulation.

PubMed

Rodriguez-Lopez, Manuel J; Fernandez-Baena, Mariano; Aldaya-Valverde, Carlos

2015-01-01

Temporomandibular joint syndrome, or Costen syndrome, is a clinically diagnosed disorder whose most common symptoms include joint pain and clicking, difficulty opening the mouth, and temporomandibular joint discomfort. The temporomandibular joint (TMJ) is supplied by the auriculotemporal nerve, a collateral branch of the mandibular nerve (the V3 branch of the trigeminal nerve). The aim of this study is to assess the effectiveness and safety of permanent peripheral nerve stimulation to relieve TMJ pain. This case series is a prospective study. Pain Unit of a regional universitary hospital. The study included 6 female patients with temporomandibular pain lasting from 2 to 8 years that did not respond to intraarticular local anesthetic and corticoid injections. After a positive diagnostic block test, the patients were implanted with quadripolar or octapolar leads in the affected preauricular region for a 2-week stimulation test phase, after which the leads were connected to a permanent implanted pulse generator. Results of the visual analog scale, SF-12 Health Survey, Brief Pain Inventory, and drug intake were recorded at baseline and at 4, 12, and 24 weeks after the permanent implant. Five out of 6 patients experienced pain relief exceeding 80% (average 72%) and received a permanent implant. The SF-12 Health Survey results were very positive for all specific questions, especially items concerning the physical component. Patients reported returning to normal physical activity and rest at night. Four patients discontinued their analgesic medication and 1 patient reduced their gabapentin dose by 50%. Sample size; impossibility of placebo control. Patients affected with TMJ syndrome who do not respond to conservative treatments may find a solution in peripheral nerve stimulation, a simple technique with a relatively low level of complications.

Signal intensity on fluid-attenuated inversion recovery images of condylar marrow changes correspond with slight pain in patients with temporomandibular joint disorders.

PubMed

Kodama, Sayaka; Otonari-Yamamoto, Mika; Sano, Tsukasa; Sakamoto, Junichirou; Imoto, Kenichi; Wakoh, Mamoru

2014-01-01

Edema and necrosis of the temporomandibular joint (TMJ) have been described in terms of bone marrow signal abnormalities in magnetic resonance imaging (MRI). However, painful joints often show no such signaling abnormalities, making the diagnosis of TMJ disorders difficult in the clinical setting. An association has been suggested between TMJ bone marrow change and TMJ pain, but even when such change results in slight pain, it may be too slight to be visually apparent on MR images. We hypothesized that fluid-attenuated inversion recovery (FLAIR) can be used to detect such minimal changes. The purpose of this study was to determine whether there is an association between signal intensity on FLAIR images and pain in the TMJ. The study included 85 TMJs in 45 patients referred to our department for MRI. The signal intensity on FLAIR images was measured. Pain was evaluated based on the visual analog scale. An unpaired t test and Pearson's product-moment correlation coefficient were used for the statistical analysis. A p value of <0.05 was considered statistically significant. Signal intensity on the FLAIR images was significantly higher in painful than in nonpainful TMJs, although a significant correlation was not observed between the signal intensity and the pain score. The results of this study suggest an association between abnormalities in the marrow of the mandibular condyle and pain. They also indicate that FLAIR imaging is a useful tool in the clinical diagnosis of painful TMJs.

Management of temporo-mandibular joint ankylosis in growing children.

PubMed

Shashikiran, N D; Reddy, S V V; Patil, R; Yavagal, C

2005-03-01

Although temporo-mandibular joint (TMJ) ankylosis is one of the most common pathologies afflicting the facial skeleton, it is also the most overlooked and under-managed problem in children. The TMJ forms the very cornerstone of cranio-facial integrity and hence its ankylosis in growing children adversely affects the growth and development of the jaws and occlusion. Impairment of speech, difficulty in mastication, poor oral hygiene, rampant caries and acute compromise of the airway pose a severe psychologic burden on the tender minds of children. The aim of this article is to present an overview of efficient management strategies, based on a case report, so as to increase its awareness among all dental surgeons involved in the treatment of children.

Temporomandibular disorders: a review of etiology, clinical management, and tissue engineering strategies.

PubMed

Murphy, Meghan K; MacBarb, Regina F; Wong, Mark E; Athanasiou, Kyriacos A

2013-01-01

Temporomandibular disorders (TMD) are a class of degenerative musculoskeletal conditions associated with morphologic and functional deformities that affect up to 25% of the population, but their etiology and progression are poorly understood and, as a result, treatment options are limited. In up to 70% of cases, TMD are accompanied by malpositioning of the temporomandibular joint (TMJ) disc, termed "internal derangement." Although the onset is not well characterized, correlations between internal derangement and osteoarthritic change have been identified. Because of the complex and unique nature of each TMD case, diagnosis requires patient-specific analysis accompanied by various diagnostic modalities. Likewise, treatment requires customized plans to address the specific characteristics of each patient's disease. In the mechanically demanding and biochemically active environment of the TMJ, therapeutic approaches that can restore joint functionality while responding to changes in the joint have become a necessity. One such approach, tissue engineering, which may be capable of integration and adaptation in the TMJ, carries significant potential for the development of repair and replacement tissues. The following review presents a synopsis of etiology, current treatment methods, and the future of tissue engineering for repairing and/or replacing diseased joint components, specifically the mandibular condyle and TMJ disc. An analysis of native tissue characterization to assist clinicians in identifying tissue engineering objectives and validation metrics for restoring healthy and functional structures of the TMJ is followed by a discussion of current trends in tissue engineering.

The use of phototherapy in the management of TMJ pain: clinical evidence of benefits and limitations

NASA Astrophysics Data System (ADS)

Pinheiro, A. L. B.; Soares, A. P.; Marques, A. M. C.; de Carvalho, F. B.; Soares, L. G. P.; de Oliveira, S. C. P. S.; Cangussú, M. C. T.

2017-02-01

Temporomandibular disorders - TMDs are common painful multifactorial conditions affecting the temporomandibular joint whose treatment depends on the type and symptoms. Initially it requires pain control and for this, drugs, biting plates, occlusal adjustment, physiotherapy or their association are used. Laser-phototherapy (LPT) has been used on the treatment of pain of several origins including TMDs. It is known that wavelength, energy density, frequency of application influences the outcome of many clinical protocols. This work reports a series of patients of the Center of Biophotonics of the Federal University of Bahia over 15 years. Following standard anamneses, clinical and imaginologic examination and with the diagnosis of any type of TMD, the patients were set for light treatment. Treatment consisted of three sessions a week during six week. Prior irradiation, the patients were asked to score their pain using a VAS. IR and/or Red diode lasers were used on each session. The medical records of 432 patients (73 male and 359 female) suffering from TMJ disorders were revised. Most patients were female ( 47.9 years old). At the end of the 12 sessions the patients were again examined and score their pain using VAS. No other intervention was carried out during the treatment. The results were statistically analyzed and showed that 51.16 % of the patients were asymptomatic or improved after treatment. It is concluded that LPT was effective on pain reduction on TMJ disorders of several origins.

Quantification of disc displacement in internal derangement of the temporomandibular joint using magnetic resonance imaging.

PubMed

Arayasantiparb, Raweewan; Tsuchimochi, Makoto

2010-02-01

Many measures have been developed to determine the extent of disc displacement in internal derangements of the temporomandibular joint (TMJ) using magnetic resonance imaging. The purpose of this study was to develop a quantitative method of analyzing disc position and to evaluate the positions of the disc in internal derangements of the TMJ (group 1, with reduction; group 2, without reduction). Magnetic resonance images of 150 TMJs in 20 healthy volunteers and 55 patients with internal derangements were evaluated. The anatomical points of interest of the TMJ, including the anterior (DA) and posterior (DP) points of the disc, were marked on parasagittal magnetic resonance images of the TMJ disc taken in both the closed- and the open-mouth positions. All points were recorded using an x-y coordinate system, with reference to a referral line. In the closed-mouth position, the DP in patients in group 1 was situated in a more-anterior direction than the DP in volunteers. The DP in group 2 was located further anterior and inferior than the DP in group 1. However, the position of the DA did not differ between group 1 and group 2. In the open-mouth position, the DP was displaced anteroinferiorly to a greater extent in group 2 than in group 1 (one-way ANOVA, followed by Scheffe's test; P < 0.0001). The distance between the disc points in the closed- and open-mouth positions was also evaluated. Comparison of the disc point position in the closed- and open-mouth positions in symptomatic and asymptomatic displaced TMJ discs revealed no significant difference. In conclusion, most of our results quantitatively support previously reported findings in imaging, surgical, and histopathological studies of TMJ internal derangement. We suggest that our measure of disc position of the TMJ would be useful to assess the status and response to treatment of internal derangements of the TMJ.

Implant-supported mandibular splinting affects temporomandibular joint biomechanics.

PubMed

Zaugg, Balthasar; Hämmerle, Christoph H F; Palla, Sandro; Gallo, Luigi M

2012-08-01

Mandibular functional movements lead to complex deformations of bony structures. The aim of this study was to test whether mandibular splinting influences condylar kinematics and temporomandibular joint (TMJ) loading patterns. Six subjects were analyzed by means of dynamic stereometry during jaw opening-closing with mandibles unconstrained as well as splinted transversally by a cast metal bar fixed bilaterally to two implant pairs in the (pre)molar region. Statistical analysis was performed by means of ANOVAs for repeated measurements (significance level α=0.05). Transversal splinting reduced mandibular deformation during jaw opening-closing as measured between two implants in the (pre)molar region on each side of the mandible significantly by 54%. Furthermore, splinting significantly reduced the distance between lateral condylar poles (average displacement vector magnitude of each pole: 0.84±0.36 mm; average mediolateral displacement component: 45±28% of the magnitude) and led to a medial displacement of their trajectories as well as a mediolateral displacement of stress-field paths. During jaw opening-closing, splinting of the mandible leads to a significant reduction of mandibular deformation and intercondylar distance and to altered stress-field paths, resulting in changed loading patterns of the TMJ structures. © 2011 John Wiley & Sons A/S.

Magnetic resonance imaging of the equine temporomandibular joint anatomy.

PubMed

Rodríguez, M J; Agut, A; Soler, M; López-Albors, O; Arredondo, J; Querol, M; Latorre, R

2010-04-01

In human medicine, magnetic resonance imaging (MRI) is considered the 'gold standard' imaging procedure to assess the temporomandibular joint (TMJ). However, there is no information regarding MRI evaluation of equine TMJ. To describe the normal sectional MRI anatomy of equine TMJ by using frozen and plastinated anatomical sections as reference; and determine the best imaging planes and sequences to visualise TMJ components. TMJs from 6 Spanish Purebred horse cadavers (4 immature and 2 mature) underwent MRI examination. Spin-echo T1-weighting (SE T1W), T2*W, fat-suppressed (FS) proton density-weighting (PDW) and fast spin-echo T2-weighting (FSE T2W) sequences were obtained in oblique sagittal, transverse and dorsal planes. Anatomical sections were procured on the same planes for a thorough interpretation. The oblique sagittal and transverse planes were the most informative anatomical planes. SE T1W images showed excellent spatial resolution and resulted in superior anatomic detail when comparing to other sequences. FSE T2W sequence provided an acceptable anatomical depiction but T2*W and fat-suppressed PDW demonstrated higher contrast in visualisation of the disc, synovial fluid, synovial pouches and articular cartilage. The SE T1W sequence in oblique sagittal and transverse plane should be the baseline to identify anatomy. The T2*W and fat-suppressed PDW sequences enhance the study of the articular cartilage and synovial pouches better than FSE T2W. The information provided in this paper should aid clinicians in the interpretation of MRI images of equine TMJ and assist in the early diagnosis of those problems that could not be diagnosed by other means.

A review of temporomandibular joint-related papers published between 2014-2015.

PubMed

Singh, Vaibhav; Sudhakar, K N V; Mallela, Kiran Kumar; Mohanty, Rajat

2017-12-01

We conducted a retrospective study and reviewed the temporomandibular joint (TMJ)-related papers published in a leading international journal, Journal of Oral and Maxillofacial Surgery , between January 2014 and December 2015. The study was conducted to ascertain and compare the trends of articles being published in the years 2014 and 2015. A total of 28 articles were reviewed, of which most of the full-length articles were on clinical management and outcomes and the role of radiology. The bulk of the studies were prospective, and less interest was shown in experimental research. A thorough review and analysis thus gives the impression that there is a great need for well-designed clinical studies on TMJ.

A comparative study of the skeletal morphology of the temporo-mandibular joint of children and adults.

PubMed

Meng, F; Liu, Y; Hu, K; Zhao, Y; Kong, L; Zhou, S

2008-01-01

The skeletal morphology of the temporo-mandibular joint (TMJ) is constantly remodeled. A comparative study was undertaken to determine and characterize the differences in the skeletal morphology of TMJ of children and adults. The study was conducted on 30 children cadavers and 30 adult volunteers. Parameters that could reflect TMJ skeletal morphology were measured with a new technology combining helical computed tomography (CT) scan with multi-planar reformation (MPR) imaging. Significant differences between children cadavers and adults were found in the following parameters (P<0.05): Condylar axis inclination, smallest area of condylar neck/largest area of condylar process, inclination of anterior slope in inner, middle, and outer one-third of condyle, anteroposterior/mediolateral dimension of condyle, length of anterior slope/posterior slope in inner and middle one-third of condyle, anteroposterior dimension of condyle/glenoid fossa, mediolateral dimension of condyle/glenoid fossa, inclination of anterior slope of glenoid fossa, depth of glenoid fossa, and anteroposterior/mediolateral dimension of glenoid fossa. There are significant differences of TMJ skeletal morphology between children and adults.

Teaching Dental Students to Understand the Temporomandibular Joint Using MRI: Comparison of Conventional and Digital Learning Methods.

PubMed

Arús, Nádia A; da Silva, Átila M; Duarte, Rogério; da Silveira, Priscila F; Vizzotto, Mariana B; da Silveira, Heraldo L D; da Silveira, Heloisa E D

2017-06-01

The aims of this study were to evaluate and compare the performance of dental students in interpreting the temporomandibular joint (TMJ) with magnetic resonance imaging (MRI) scans using two learning methods (conventional and digital interactive learning) and to examine the usability of the digital learning object (DLO). The DLO consisted of tutorials about MRI and anatomic and functional aspects of the TMJ. In 2014, dental students in their final year of study who were enrolled in the elective "MRI Interpretation of the TMJ" course comprised the study sample. After exclusions for nonattendance and other reasons, 29 of the initial 37 students participated in the study, for a participation rate of 78%. The participants were divided into two groups: a digital interactive learning group (n=14) and a conventional learning group (n=15). Both methods were assessed by an objective test applied before and after training and classes. Aspects such as support and training requirements, complexity, and consistency of the DLO were also evaluated using the System Usability Scale (SUS). A significant between-group difference in the posttest results was found, with the conventional learning group scoring better than the DLO group, indicated by mean scores of 9.20 and 8.11, respectively, out of 10. However, when the pretest and posttest results were compared, both groups showed significantly improved performance. The SUS score was 89, which represented a high acceptance of the DLO by the users. The students who used the conventional method of learning showed superior performance in interpreting the TMJ using MRI compared to the group that used digital interactive learning.

In vivo measurement of the 3D kinematics of the temporomandibular joint using miniaturized electromagnetic trackers: technical report.

PubMed

Baeyens, J-P; Gilomen, H; Erdmann, B; Clijsen, R; Cabri, J; Vissers, D

2013-04-01

The aim of this study was to evaluate the use of miniaturized electromagnetic trackers (1 × 0.5 × 0.5 cm) fixed on teeth of the maxilla and mandible to analyse in vivo the 3D kinematics of the temporomandibular joint (TMJ). A third sensor was fixed to the forehead, and a fourth sensor was used as a stylus pointer to detect several anatomical landmarks in order to embed a local frame on the cranium. Temporomandibular opening/closing, chewing, laterotrusion and protrusion were examined. The prime objective within this study was to rigidly attach electromagnetic minisensors on teeth. The key for a successful affixation was the kevlar interface. The distances between the two mandibular affixed sensors and between the two maxillar affixed sensors were overall smaller than 0.033 cm for position and 0.2° for attitude throughout the temporomandibular motions. The relative motions between a forehead sensor and the maxilla affixed sensor are too big to suggest a forehead sensor as an alternative for a maxilla affixed sensor. The technique using miniaturized electromagnetic trackers furthers on the methods using electromagnetic trackers on external appliances. The method allows full range of motion of the TMJ and does not disturb normal TMJ function.

Stress distribution in the temporo-mandibular joint discs during jaw closing: a high-resolution three-dimensional finite-element model analysis.

PubMed

Savoldelli, Charles; Bouchard, Pierre-Olivier; Loudad, Raounak; Baque, Patrick; Tillier, Yannick

2012-07-01

This study aims at analysing the stresses distribution in the temporomandibular joint (TMJ) using a complete high-resolution finite element model (FE Model). This model is used here to analyse the stresses distribution in the discs during a closing jaw cycle. In the end, this model enables the prediction of the stress evolution in the TMJ disc submitted to various loadings induced by mandibular trauma, surgery or parafunction. The geometric data for the model were obtained from MRI and CT scans images of a healthy male patient. Surface and volume meshes were successively obtained using a 3D image segmentation software (AMIRA(®)). Bone components of skull and mandible, both of joint discs, temporomandibular capsules and ligaments and dental arches were meshed as separate bodies. The volume meshes were transferred to the FE analysis software (FORGE(®)). Material properties were assigned for each region. Boundary conditions for closing jaw simulations were represented by different load directions of jaws muscles. The von Mises stresses distribution in both joint discs during closing conditions was analyzed. The pattern of von Mises stresses in the TMJ discs is non-symmetric and changed continuously during jaw movement. Maximal stress is reached on the surface disc in areas in contact with others bodies. The three-dimension finite element model of masticatory system will make it possible to simulate different conditions that appear to be important in the cascade of events leading to joint damage.

Investigation of human frontal cortex under noxious thermal stimulation of temporo-mandibular joint using functional near infrared spectroscopy

NASA Astrophysics Data System (ADS)

Yennu, Amarnath; Rawat, Rohit; Manry, Michael T.; Gatchel, Robert; Liu, Hanli

2013-03-01

According to American Academy of Orofacial Pain, 75% of the U.S. population experiences painful symptoms of temporo-mandibular joint and muscle disorder (TMJMD) during their lifetime. Thus, objective assessment of pain is crucial for efficient pain management. We used near infrared spectroscopy (NIRS) as a tool to explore hemodynamic responses in the frontal cortex to noxious thermal stimulation of temporomadibular joint (TMJ). NIRS experiments were performed on 9 healthy volunteers under both low pain stimulation (LPS) and high pain stimulation (HPS), using a temperature-controlled thermal stimulator. To induce thermal pain, a 16X16 mm2 thermode was strapped onto the right TMJ of each subject. Initially, subjects were asked to rate perceived pain on a scale of 0 to 10 for the temperatures from 41°C to 47°C. For the NIRS measurement, two magnitudes of temperatures, one rated as 3 and another rated as 7, were chosen as LPS and HPS, respectively. By analyzing the temporal profiles of changes in oxy-hemoglobin concentration (HbO) using cluster-based statistical tests, we were able to identify several regions of interest (ROI), (e.g., secondary somatosensory cortex and prefrontal cortex), where significant differences (p<0.05) between HbO responses to LPS and HPS are shown. In order to classify these two levels of pain, a neural-network-based classification algorithm was used. With leave-one-out cross validation from 9 subjects, the two levels of pain were identified with 100% mean sensitivity, 98% mean specificity and 99% mean accuracy to high pain. From the receiver operating characteristics curve, 0.99 mean area under curve was observed.

Undiagnosed mandibular condylar fractures causing temporomandibular joint ankylosis: A problem in northern India.

PubMed

Nagori, Shakil Ahmed; Jose, Anson; Bhutia, Ongkila; Roychoudhury, Ajoy

2014-01-01

Temporomandibular joint (TMJ) ankylosis due to undiagnosed condylar fractures has a high incidence in India compared to western countries. We evaluated the demographics, injury pattern, hospital reporting and referral pattern of undiagnosed condylar fractures complicating TMJ ankylosis in northern India. We did a retrospective analysis by retrieving medical records of patients with post-traumatic TMJ ankylosis reporting to the Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences between 1 July 2012 and 30 June 2013. Of 90 patients with post-traumatic TMJ ankylosis, 74 (82.2%) resided in rural areas. Sixty-three (70%) patients were from the states of Uttar Pradesh, Bihar and Jharkhand. Only 8.8% had higher education and 10% had an annual income of more than `2 lakh. In 69 (84.4%) patients, fall was the aetiological factor. Primary health centres (42%) and private clinics (20.5%) received the major share of patients immediately following injury. Few patients (19.3%) had some radiographic examination done and only 17% were referred by the primary healthcare provider. Of those referred only 3 were examined by a dental practitioner. Only 10% of all were diagnosed with condylar fractures. Patients with TMJ ankylosis presenting to us have poor literacy and income levels. A missed diagnosis of condylar fractures by rural healthcare providers contributes to its high incidence in India. Improving awareness of clinicians and improved rural healthcare infrastructure can help prevent this complication. Copyright 2014, NMJI.

[Topography and mechanical property of goat temporomandibular joint disc cells].

PubMed

Bao, Guangjie; Kong, Nannan; Guo, Manli; Su, Xuelian; Kang, Hong

2015-08-01

This study is performed to investigate the cell topographies and biomechanical properties of two different types of temporomandibular joint (TMJ) discs from goats by using JPK Nano Wizard 3 biological atomic force microscopy (AFM). This process provides a guideline for selecting seed cells for TMJ disc tissue engineering. TMJ disc cells from primary goats were cultured by monolayer culture method. AFM was used to contact scan the topographies of the two types of TMJ disc cells under physiological environment. Approximately 20 chondrocyte-like and fibroblast-like cells were selected randomly to plot the force-versus-distance curves of the cytoplasm and nucleus. Young's modulus and adhesion were analyzed by JPK Data Processing. The triangle-shapednucleus of the chondrocyte-like cell occupied a large portion of the cell. Cytoskeleton was arranged dendritically on the surface. Pseudopodia were extended from cell edges. The spindle-shaped nucleus of the fibroblast-like cell occupied a significantly larger region compared with the cytoplasmic region. Cytoskeleton was arranged regularly. Cell edges were smooth with less pseudopodia extended. No difference was found in the surface roughness between the two types of cells. According to the force-versus-distance curves, the Young's moduli of the two types of cells were not statistically different (P>0.05), but differences were found in the cytoplasmic regions (P=0.047). No statistical difference was found in the adhesions between the two types of cells (P>0.05). The AFM topography and curves were compared and analyzed. The two types of TMJ disc cells exhibited significantly different topographies, but only slight difference in their mechanical abilities.

[Treatment of temporo-mandibular joint closed-lock using intra-articular injection of mepivacaine with immediate resolution durable in time (six months follow-up)].

PubMed

Guarda Nardini, L; Tito, R; Beltrame, A

2002-01-01

The purpose of this study was to assess the value of intra-articular fluid injection under pressure, as a technique suggested for temporo-mandibular joint (TMJ) closed-lock treatment, and to determine if there is a persisting lock resolution in time. Twelve patients were studied at our centre, with a diagnosis of TMJ closed-lock, not amenable with conventional therapies. All patients underwent a MRI scan, confirming the presence of anteriorly displaced disk. This technique is based on intra-articular injection of anaesthetic (mepivacaine cloridrate) under pressure, using the so called pumping technique, that allows an inferior distraction of the condyle. The study has a six months follow-up. After closed-lock resolution all patients underwent physiotherapy with guided mouth opening, for one month. Mandibular function (maximal mouth opening) increased on average of 20.2 mm after treatment, and of 21.1 mm six months later (p=0.00000; with p<0.005). Pain decreased on average from VAS=6.75 to VAS=0.3 (p=0.00001; with p<0.005). The masticatory efficiency improved from VAS=5.25 to VAS=8.75 (p=0.002; p<0.005). Functional TMJ limitation level is significantly increased (p=0.002; p<0.005). Also, patient's efficacy judgement (mean value 3.58= good) and tolerability judgement (mean value 2.92=good) indicate that this therapy is well accepted. This technique is easy to perform, well tolerated and does not need specific instruments: it permits the resolution of TMJ closed-lock, decreases the pain and improves masticatory efficiency. All these effects persist in time. Subjects with recent closed-lock have an immediate and complete functional recovery while patients with chronic closed-lock do not.

Resolution of temporomandibular joint dysfunction (TMJD) by correcting a lateral head translation posture following previous failed traditional chiropractic therapy: a CBP® case report

PubMed Central

Jaeger, Jason O.; Oakley, Paul A.; Moore, Robert R.; Ruggeroli, Edward P.; Harrison, Deed E.

2018-01-01

[Purpose] To present the case of the resolution of right temporomandibular joint dysfunction (TMJD) following the correction of a right lateral head translation posture. [Subject and Methods] A 24 year old female reported facial pain and jaw clicking in the right TMJ. Radiography revealed a 19 mm right head (shift) translation posture. TMJ vibration analysis showed characteristic abnormalities for the right TMJ. The patient was treated with CBP® technique mirror image® left sided exercises, and traction methods as well as spinal manipulative therapy (SMT). [Results] After 36 treatments over a 12-week time period, a complete correction of the lateral head posture was achieved corresponding with a complete resolution of jaw pain and clicking. TMJ vibration analysis demonstrated normal right side TMJ characteristics following treatment. [Conclusion] Abnormal head/neck postures, such as lateral head translation, may be an unrealized source of TMJD and may be explained through the ‘regional interdependence’ model or by how seemingly unrelated anatomy may be associated with a primary complaint. PMID:29410576

Resolution of temporomandibular joint dysfunction (TMJD) by correcting a lateral head translation posture following previous failed traditional chiropractic therapy: a CBP® case report.

PubMed

Jaeger, Jason O; Oakley, Paul A; Moore, Robert R; Ruggeroli, Edward P; Harrison, Deed E

2018-01-01

[Purpose] To present the case of the resolution of right temporomandibular joint dysfunction (TMJD) following the correction of a right lateral head translation posture. [Subject and Methods] A 24 year old female reported facial pain and jaw clicking in the right TMJ. Radiography revealed a 19 mm right head (shift) translation posture. TMJ vibration analysis showed characteristic abnormalities for the right TMJ. The patient was treated with CBP ® technique mirror image ® left sided exercises, and traction methods as well as spinal manipulative therapy (SMT). [Results] After 36 treatments over a 12-week time period, a complete correction of the lateral head posture was achieved corresponding with a complete resolution of jaw pain and clicking. TMJ vibration analysis demonstrated normal right side TMJ characteristics following treatment. [Conclusion] Abnormal head/neck postures, such as lateral head translation, may be an unrealized source of TMJD and may be explained through the 'regional interdependence' model or by how seemingly unrelated anatomy may be associated with a primary complaint.

Tumor Necrosis Factor Alpha Signaling in Trigeminal Ganglion Contributes to Mechanical Hypersensitivity in Masseter Muscle During Temporomandibular Joint Inflammation.

PubMed

Ito, Reio; Shinoda, Masamichi; Honda, Kuniya; Urata, Kentaro; Lee, Jun; Maruno, Mitsuru; Soma, Kumi; Okada, Shinji; Gionhaku, Nobuhito; Iwata, Koichi

To determine the involvement of tumor necrosis factor alpha (TNFα) signaling in the trigeminal ganglion (TG) in the mechanical hypersensitivity of the masseter muscle during temporomandibular joint (TMJ) inflammation. A total of 55 male Sprague-Dawley rats were used. Following injection of Complete Freund's Adjuvant into the TMJ, the mechanical sensitivities of the masseter muscle and the overlying facial skin were measured. Satellite glial cell (SGC) activation and TNFα expression in the TG were investigated immunohistochemically, and the effects of their inhibition on the mechanical hypersensitivity of the masseter muscle were also examined. Student t test or two-way repeated-measures analysis of variance followed by Bonferroni multiple comparisons test were used for statistical analyses. P < .05 was considered to reflect statistical significance. Mechanical allodynia in the masseter muscle was induced without any inflammatory cell infiltration in the muscle after TMJ inflammation. SGC activation and an increased number of TNFα-immunoreactive cells were induced in the TG following TMJ inflammation. Intra-TG administration of an inhibitor of SGC activity or of TNFα-neutralizing antibody depressed both the increased number of TG cells encircled by activated SGCs and the mechanical hypersensitivity of the masseter following TMJ inflammation. These findings suggest that persistent masseter hypersensitivity associated with TMJ inflammation was mediated by SGC-TG neuron interactions via TNFα signaling in the TG.

Delayed gadolinium-enhanced MRI of the fibrocartilage disc of the temporomandibular joint--a feasibility study.

PubMed

Pittschieler, Elisabeth; Szomolanyi, Pavol; Schmid-Schwap, Martina; Weber, Michael; Egerbacher, Monika; Traxler, Hannes; Trattnig, Siegfried

2014-12-01

To 1) test the feasibility of delayed Gadolinium-Enhanced Magnetic Resonance Imaging of Cartilage (dGEMRIC) at 3 T in the temporomandibular joint (TMJ) and 2) to determine the optimal delay for measurements of the TMJ disc after i.v. contrast agent (CA) administration. MRI of the right and left TMJ of six asymptomatic volunteers was performed at 3 T using a dedicated coil. 2D inversion recovery (2D-IR) sequences were performed at 4 time points covering 120 minutes and 3D gradient-echo (3D GRE) dual flip-angle sequences were performed at 14 time points covering 130 minutes after the administration of 0.2 mmol/kg of Gd-diethylenetriamine pentaacetic acid ion (Gd-DTPA)(2-), i.e., 0.4 mL of Magnevist™ per kg body weight. Pair-wise tests were used to assess differences between pre-and post-contrast T1 values. 2D-IR sequences showed a statistically significant drop (p<0.001) in T1 values after i.v. CA administration. The T1 drop of 50% was reached 60 minutes after bolus injection in the TMJ disc. The 3D GRE dual flip-angle sequences confirmed these results and show plateau of T1 after 60 minutes. T1(Gd) maps calculated from dGEMRIC data allow in vivo assessment of the fibrocartilage disc of the TMJ. The recommended measurement time for dGEMRIC in the TMJ after i.v. CA administration is from 60 to 120 minutes. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Manipulative management of the temporomandibular joint pain-dysfunction syndrome: a report of two cases

PubMed Central

Nykoliation, J. W.; Cassidy, J. D.

1984-01-01

The temporomandibular pain-dysfunction syndrome (TMJ-PDS) is a frequent but often unappreciated cause of head, neck, and facial pain. Information regarding its etiology, pathophysiology, diagnosis, and treatment is fragmentary, and often reflects an approach influenced by the background specialty of the involved practitioner. Current treatment is often multidisciplinary, involving the use of various dental splints in conjunction with physiotherapy, psychotherapy, and analgesic medication. This paper suggests that chiropractic manipulation to the temporomandibular joints (TMJ) may be an effective approach to treatment of TJM-PDS. Illustrative cases are presented. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6Figure 6Figure 7Figure 8Figure 9

Evaluation of total alloplastic temporo-mandibular joint replacement with two different types of prostheses: A three-year prospective study

PubMed Central

Gonzalez-Perez-Somarriba, Borja; Centeno, Gabriel; Vallellano, Carpóforo; Montes-Carmona, Jose-Francisco

2016-01-01

Background Temporo-Mandibular Joint (TMJ) replacement has been used clinically for years. The objective of this study was to evaluate outcomes achieved in patients with two different categories of TMJ prostheses. Material and Methods All patients who had a TMJ replacement (TMJR) implanted during the study period from 2006 through 2012 were included in this 3-year prospective study. All procedures were performed using the Biomet Microfixation TMJ Replacement System, and all involved replacing both the skull base component (glenoid fossa) and the mandibular condyle. Results Fifty-seven patients (38 females and 19 males), involving 75 TMJs with severe disease requiring reconstruction (39 unilateral, 18 bilateral) were operated on consecutively, and 68 stock prostheses and 7 custom-made prostheses were implanted. The mean age at surgery was 52.6±11.5 years in the stock group and 51.8±11.7 years in the custom-made group. In the stock group, after three years of TMJR, results showed a reduction in pain intensity from 6.4±1.4 to 1.6±1.2 (p<0.001), and an improvement in jaw opening from 2.7±0.9 cm to 4.2±0.7 cm (p<0.001). In the custom-made group, after three years of TMJR, results showed a reduction in pain intensity from 6.0±1.6 to 2.2±0.4 (p<0.001), and an improvement in jaw opening from 1.5±0.5 cm to 4.3±0.6 cm (p<0.001). No statistically significant differences between two groups were detected. Conclusions The results of this three-year prospective study support the surgical placement of TMJ prostheses (stock prosthetic, and custom-made systems), and show that the approach is efficacious and safe, reduces pain, and improves maximum mouth opening movement, with few complications. As such, TMJR represents a viable technique and a stable long-term solution for cranio-mandibular reconstruction in patients with irreversible end-stage TMJ disease. Comparing stock and custom-made groups, no statistically significant differences were detected with respect to pain

Total antioxidant capacity and total oxidant status of synovial fluids in patients with temporomandibular joint pain and dysfunction.

PubMed

Etöz, Osman A; Akçay, Hüseyin; Neşelioğlu, Salim; Erel, Özcan; Alkan, Alper

2012-12-01

The objective of this study was to investigate whether a relationship exists between total antioxidant capacity (TAC) and total oxidant status (TOS) of synovial fluids (SFs) of temporomandibular joint (TMJ) pain patients with pain and dysfunction. Forty-two patients with TMJ pain were included in this study. TAC and TOS values of SFs were measured with a novel colorimetric method. Independent t test and correlations were used to analyze the data. TAC of SFs in patients with TMJ pain and limited mouth opening (LMO; n = 21) were significantly lower (P = 0.03) than patients without LMO (n = 21). TOS of SF was negatively correlated with duration of the disease. There was no correlation between TAC, TOS, and VAS scores of the patients as well as age and maximum mouth opening values. Antioxidant response to oxidative changes (TAC and TOS) in SF decreased as the stage of dysfunction increased. Local administration of antioxidant agents might be considered in management of TMJ pain and dysfunction to prevent possible increased oxidative stress.

Peripheral hyperpolarization-activated cyclic nucleotide-gated channels contribute to inflammation-induced hypersensitivity of the rat temporomandibular joint.

PubMed

Hatch, R J; Jennings, E A; Ivanusic, J J

2013-08-01

Hyperpolarization-activated cyclic nucleotide-gated (HCN) channels conduct an inward cation current (Ih ) that contributes to the maintenance of neuronal membrane potential and have been implicated in a number of animal models of neuropathic and inflammatory pain. In the current study, we investigated HCN channel involvement in inflammatory pain of the temporomandibular joint (TMJ). The contribution of HCN channels to inflammation (complete Freund's adjuvant; CFA)-induced mechanical hypersensitivity of the rat TMJ was tested with injections of the HCN channel blocker ZD7288. Retrograde labelling and immunohistochemistry was used to explore HCN channel expression in sensory neurons that innervate the TMJ. Injection of CFA into the TMJ (n = 7) resulted in a significantly increased mechanical sensitivity relative to vehicle injection (n = 7) (p < 0.05). The mechanical hypersensitivity generated by CFA injection was blocked by co-injection of ZD7288 with the CFA (n = 7). Retrograde labelling and immunohistochemistry experiments revealed expression predominantly of HCN1 and HCN2 channel subunits in trigeminal ganglion neurons that innervate the TMJ (n = 3). No change in the proportion or intensity of HCN channel expression was found in inflamed (n = 6) versus control (n = 5) animals at the time point tested. Our findings suggest a role for peripheral HCN channels in inflammation-induced pain of the TMJ. Peripheral application of a HCN channel blocker could provide therapeutic benefit for inflammatory TMJ pain and avoid side effects associated with activation of HCN channels in the central nervous system. © 2012 European Federation of International Association for the Study of Pain Chapters.

Overexpression of Indian hedgehog partially rescues short stature homeobox 2-overexpression-associated congenital dysplasia of the temporomandibular joint in mice

PubMed Central

LI, XIHAI; LIANG, WENNA; YE, HONGZHI; WENG, XIAPING; LIU, FAYUAN; LIN, PINGDONG; LIU, XIANXIANG

2015-01-01

The role of short stature homeobox 2 (shox2) in the development and homeostasis of the temporomandibular joint (TMJ) has been well documented. Shox2 is known to be expressed in the progenitor cells and perichondrium of the developing condyle. A previous study by our group reported that overexpression of shox2 leads to congenital dysplasia of the TMJ via downregulation of the Indian hedgehog (Ihh) signaling pathway, which is essential for embryonic disc primordium formation and mandibular condylar growth. To determine whether overexpression of Ihh may rescue the overexpression of shox2 leading to congenital dysplasia of the TMJ, a mouse model in which Ihh and shox2 were overexpressed (Wnt1-Cre; pMes-stop shox2; pMes-stop Ihh mice) was utilized to assess the consequences of this overexpression on TMJ development during post-natal life. The results showed that the developmental process and expression levels of runt-related transcription factor 2 and sex determining region Y-box 9 in the TMJ of the Wnt1-Cre; pMes-stop shox2; pMes-stop Ihh mice were similar to those in wild-type mice. Overexpression of Ihh rescued shox2 overexpression-associated reduction of extracellular matrix components. However, overexpression of Ihh did not inhibit the shox2 overexpression-associated increase of matrix metalloproteinases (MMPs) MMP9, MMP13 and apoptosis in the TMJ. These combinatory cellular and molecular defects appeared to account for the observed congenital dysplasia of TMJ, suggesting that overexpression of Ihh partially rescued shox2 overexpression-associated congenital dysplasia of the TMJ in mice. PMID:26096903

Delayed gadolinium-enhanced MRI of the fibrocartilage disc of the temporomandibular joint – a feasibility study

PubMed Central

Pittschieler, Elisabeth; Szomolanyi, Pavol; Schmid-Schwap, Martina; Weber, Michael; Egerbacher, Monika; Traxler, Hannes; Trattnig, Siegfried

2014-01-01

Objective To 1) test the feasibility of delayed Gadolinium-Enhanced Magnetic Resonance Imaging of Cartilage (dGEMRIC) at 3 T in the temporomandibular joint (TMJ) and 2) to determine the optimal delay for measurements of the TMJ disc after i.v. contrast agent (CA) administration. Design MRI of the right and left TMJ of six asymptomatic volunteers was performed at 3 T using a dedicated coil. 2D inversion recovery (2D-IR) sequences were performed at 4 time points covering 120 minutes and 3D gradient-echo (3D GRE) dual flip-angle sequences were performed at 14 time points covering 130 minutes after the administration of 0.2 mmol/kg of Gd-diethylenetriamine pentaacetic acid ion (Gd-DTPA)2-, i.e., 0.4 mL of Magnevist™ per kg body weight. Pair-wise tests were used to assess differences between pre-and post-contrast T1 values. Results 2D-IR sequences showed a statistically significant drop (p < 0.001) in T1 values after i.v. CA administration. The T1 drop of 50% was reached 60 minutes after bolus injection in the TMJ disc. The 3D GRE dual flip-angle sequences confirmed these results and show plateau of T1 after 60 minutes. Conclusions T1(Gd) maps calculated from dGEMRIC data allow in vivo assessment of the fibrocartilage disc of the TMJ. The recommended measurement time for dGEMRIC in the TMJ after i.v. CA administration is from 60 to 120 minutes. PMID:25131629

Prospective analysis of temporomandibular joint reconstruction in ankylosis with sternoclavicular graft and buccal fat pad lining.

PubMed

Singh, Virendra; Dhingra, Rahul; Bhagol, Amrish

2012-04-01

To evaluate the feasibility of sternoclavicular graft (SCG) as an adaptive center along with buccal fat pad (BFP) lining for temporomandibular joint (TMJ) reconstruction in TMJ ankylosis. A prospective, preliminary, short-term study with only 6 months' follow-up was performed in 10 patients with TMJ ankylosis. All patients had complete osseous ankylosis, and the mean duration of ankylosis was 6.4 years (range, 3 to 13 years). Interpositional arthroplasty with SCG along with BFP lining was done in all cases. Postoperative clinical and radiographic follow-up was performed for 6 to 9 months. Maximum interincisal opening at 6 months' follow-up was 35.6 ± 4.97 mm (range, 31 to 45 mm). Similarly, protrusive movement at follow-up of 6 months was 2.7 ± 1.25 mm (range, 1.5 to 5.5 mm), whereas laterotrusive movement was 4.1 ± 1.98 mm (range, 1.5 to 7.0 mm) toward the affected side and 2.4 ± 0.99 mm (range, 1 to 4.0 mm) toward the normal side. After 3 months, 9 of 10 patients had no pain on function, and all the patients were relieved of pain at the end of 6 months. On radiographic follow-up at 9 months, there was noticeably significant adaptation and remodeling of SCG as observed on panoramic radiography and computed tomography scan. In all the patients there was some degree of mandibular deviation toward the operated side, although the occlusion was satisfactory and they were pleased with the outcome. On the basis of the findings of this study, we conclude that after release of TMJ ankylosis, reconstruction with SCG combined with interposition of BFP lining followed by vigorous physiotherapy is a successful strategy for the management of TMJ ankylosis with short-term follow-up of 6 months. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Temporomandibular Joint Disorder Complaints in Tinnitus: Further Hints for a Putative Tinnitus Subtype

PubMed Central

Vielsmeier, Veronika; Strutz, Jürgen; Kleinjung, Tobias; Schecklmann, Martin; Kreuzer, Peter Michael; Landgrebe, Michael; Langguth, Berthold

2012-01-01

Objective Tinnitus is considered to be highly heterogeneous with respect to its etiology, its comorbidities and the response to specific interventions. Subtyping is recommended, but it remains to be determined which criteria are useful, since it has not yet been clearly demonstrated whether and to which extent etiologic factors, comorbid states and interventional response are related to each other and are thus applicable for subtyping tinnitus. Analyzing the Tinnitus Research Initiative Database we differentiated patients according to presence or absence of comorbid temporomandibular joint (TMJ) disorder complaints and compared the two groups with respect to etiologic factors. Methods 1204 Tinnitus patients from the Tinnitus Research Initiative (TRI) Database with and without subjective TMJ complaints were compared with respect to demographic, tinnitus and audiological characteristics, questionnaires, and numeric ratings. Data were analysed according to a predefined statistical analysis plan. Results Tinnitus patients with TMJ complaints (22% of the whole group) were significantly younger, had a lower age at tinnitus onset, and were more frequently female. They could modulate or mask their tinnitus more frequently by somatic maneuvers and by music or sound stimulation. Groups did not significantly differ for tinnitus duration, type of onset (gradual/abrupt), onset related events (whiplash etc.), character (pulsatile or not), hyperacusis, hearing impairment, tinnitus distress, depression, quality of life and subjective ratings (loudness etc.). Conclusion Replicating previous work in tinnitus patients with TMJ complaints, classical risk factors for tinnitus like older age and male gender are less relevant in tinnitus patients with TMJ complaints. By demonstrating group differences for modulation of tinnitus by movements and sounds our data further support the notion that tinnitus with TMJ complaints represents a subgroup of tinnitus with clinical features that are

Functionally Graded Adhesives for Composite Joints

NASA Technical Reports Server (NTRS)

Stapleton, Scott E.; Waas, Anthony M.; Arnold, Steven M.

2012-01-01

Adhesives with functionally graded material properties are being considered for use in adhesively bonded joints to reduce the peel stress concentrations located near adherend discontinuities. Several practical concerns impede the actual use of such adhesives. These include increased manufacturing complications, alterations to the grading due to adhesive flow during manufacturing, and whether changing the loading conditions significantly impact the effectiveness of the grading. An analytical study is conducted to address these three concerns. An enhanced joint finite element, which uses an analytical formulation to obtain exact shape functions, is used to model the joint. Furthermore, proof of concept testing is conducted to show the potential advantages of functionally graded adhesives. In this study, grading is achieved by strategically placing glass beads within the adhesive layer at different densities along the joint.

Radiographic evaluation of cervical spine of subjects with temporomandibular joint internal disorder.

PubMed

Munhoz, Wagner Cesar; Marques, Amélia Pasqual; Siqueira, José Tadeu Tesseroli de

2004-01-01

Although the etiopathophysiology of internal temporomandibular joint internal disorders (TMJ ID) is still unknown, it has been suggested that head and body posture could be related to its initial onset, development and perpetuation. The purpose of the present study was to observe the relationship between cervical spine X-ray abnormalities and TMJ ID. This investigation evaluated 30 subjects with internal TMJ disorder symptoms (test group) and 20 healthy subjects (control group). Subjects were submitted to clinical and radiographic evaluation. Clinical evaluation comprised anamnesis and stomatognathic system physical examination. Radiographic evaluation comprised analysis of lateral cervical spine X-rays by three physical therapists and tracing on the same images. The test group presented twice as much cervical spine hyperlordosis as the control group (20.7% versus 10.5%), but almost half of rectification prevalence (41.4 versus 79.0%, p = 0.03). After that, the test group was divided into three subgroups according to TMJ dysfunction severity, evaluated by Helkimo's index. These subgroups were not significantly different, but the subgroup with more severe TMD showed a tendency to cervical spine hyperlordosis prevalence. Results showed a tendency for subjects with more severe TMD to exhibit cervical spine hyperlordosis. Nevertheless, studies with a larger number of subjects suffering from severe TMD are encouraged in order to corroborate the present findings.

Masticatory muscle and temporomandibular joint pain in Croatian war veterans with posttraumatic stress disorder.

PubMed

Uhac, Ivone; Tariba, Petra; Kovac, Zoran; Simonić-Kocijan, Suncana; Lajnert, Vlatka; Mesić, Vesna Fugosić; Kuis, Davor; Braut, Vedrana

2011-12-01

The aim of this study was to investigate the prevalence and intensity of masticatory muscle and temporomandibular joint (TMJ) pain in Croatian war veterans with posttraumatic stress disorder (PTSD). The examined group consisted of 100 Croatian war veterans, in whom PTSD had previously been diagnosed. Patients were compared with 92 subjects who had not taken part in the war and in whom PTSD was excluded by psychiatric examination. The clinical examination consisted of palpation of the masticatory muscles, the prominent neck musculature, and TMJ. The examination technique used and the definition of items were previously tested for reliability and validity. 93% of the subjects with PTSD had masticatory muscle tenderness compared to 45.65% of the subjects in the control group (chi2 = 51.46, p < 0.0001). The most frequent painful location in the subjects with PTSD was the left lateral pterygoid site in 88%, and in subjects of the control group the right lateral pterygoid site in 28.26% of cases. The most painful location in the PTSD group was the left lateral pterygoid site in 72%, and in the control group the left posterior digastric in 4.35% of cases. 58% of the subjects with PTSD had TMJ tenderness compared to 3.26% of subjects in the control group (chi2 = 66.23, p < 0.0001). The most frequent painful location of TMJ in both groups was the left posterior capsule; in the PTSD group 38% and in subjects in the control group 2.17% of cases. The most painful location was the left posterior capsule in 28% of subjects with PTSD, while not one subject in the control group reported severe painful sensitivity. The very high frequency and intensity of pain in subjects with PTSD confirms the effect of stress on muscle and joint sensitivity, i.e. perception of pain.

Accurate 3D kinematic measurement of temporomandibular joint using X-ray fluoroscopic images

NASA Astrophysics Data System (ADS)

Yamazaki, Takaharu; Matsumoto, Akiko; Sugamoto, Kazuomi; Matsumoto, Ken; Kakimoto, Naoya; Yura, Yoshiaki

2014-04-01

Accurate measurement and analysis of 3D kinematics of temporomandibular joint (TMJ) is very important for assisting clinical diagnosis and treatment of prosthodontics and orthodontics, and oral surgery. This study presents a new 3D kinematic measurement technique of the TMJ using X-ray fluoroscopic images, which can easily obtain the TMJ kinematic data in natural motion. In vivo kinematics of the TMJ (maxilla and mandibular bone) is determined using a feature-based 2D/3D registration, which uses beads silhouette on fluoroscopic images and 3D surface bone models with beads. The 3D surface models of maxilla and mandibular bone with beads were created from CT scans data of the subject using the mouthpiece with the seven strategically placed beads. In order to validate the accuracy of pose estimation for the maxilla and mandibular bone, computer simulation test was performed using five patterns of synthetic tantalum beads silhouette images. In the clinical applications, dynamic movement during jaw opening and closing was conducted, and the relative pose of the mandibular bone with respect to the maxilla bone was determined. The results of computer simulation test showed that the root mean square errors were sufficiently smaller than 1.0 mm and 1.0 degree. In the results of clinical application, during jaw opening from 0.0 to 36.8 degree of rotation, mandibular condyle exhibited 19.8 mm of anterior sliding relative to maxillary articular fossa, and these measurement values were clinically similar to the previous reports. Consequently, present technique was thought to be suitable for the 3D TMJ kinematic analysis.

Role of central opioid on the antinociceptive effect of sulfated polysaccharide from the red seaweed Solieria filiformis in induced temporomandibular joint pain.

PubMed

Araújo, Ianna Wivianne Fernandes; Chaves, Hellíada Vasconcelos; Pachêco, José Mário; Val, Danielle Rocha; Vieira, Lorena Vasconcelos; Santos, Rodrigo; Freitas, Raul Sousa; Rivanor, Renata Line; Monteiro, Valdécio Silvano; Clemente-Napimoga, Juliana Trindade; Bezerra, Mirna Marques; Benevides, Norma Maria Barros

2017-03-01

This study aimed to investigate the effect of sulfated polysaccharide from red seaweed Solieria filiformis (Fraction F II) in the inflammatory hypernociception in the temporomandibular joint (TMJ) of rats. Male Wistar rats were pretreated (30min) with a subcutaneous injection (s.c.) of vehicle or FII (0.03, 0.3 or 3.0mg/kg) followed by intra-TMJ injection of 1.5% Formalin or 5-hydroxytryptamine (5-HT, 225μg/TMJ). In other set of experiments rats were pretreated (15min) with an intrathecal injection of the non-selective opioid receptors Naloxone, or μ-opioid receptor antagonist CTOP, or δ-opioid receptor Naltridole hydrochloride, or κ-opioid receptor antagonist Nor-Binaltorphimine (Nor-BNI) followed by injection of FII (s.c.). After 30min, the animals were treated with an intra-TMJ injection of 1.5% formalin. After TMJ treatment, behavioral nociception response was evaluated for a 45-min observation period, animals were terminally anesthetized and periarticular tissue, trigeminal ganglion and subnucleus caudalis (SC) were collected plasma extravasation and ELISA analysis. Pretreatment with F II significantly reduced formalin- and serotonin-induced TMJ nociception, inhibit the plasma extravasation and inflammatory cytokines release induced by 1.5% formalin in the TMJ. Pretreatment with intrathecal injection of Naloxone, CTOP, Naltridole or Nor-BNI blocked the antinociceptive effect of F II in the 1.5% formalin-induced TMJ nociception. In addition, F II was able to significantly increase the β-endorphin release in the subnucleus caudalis. The results suggest that F II has a potential antinociceptive and anti-inflammatory effect in the TMJ mediated by activation of opioid receptors in the subnucleus caudalis and inhibition of the release of inflammatory mediators in the periarticular tissue. Copyright © 2017. Published by Elsevier B.V.

Quantitative and qualitative comparison of MR imaging of the temporomandibular joint at 1.5 and 3.0 T using an optimized high-resolution protocol.

PubMed

Manoliu, Andrei; Spinner, Georg; Wyss, Michael; Erni, Stefan; Ettlin, Dominik A; Nanz, Daniel; Ulbrich, Erika J; Gallo, Luigi M; Andreisek, Gustav

2016-01-01

To quantitatively and qualitatively compare MRI of the temporomandibular joint (TMJ) using an optimized high-resolution protocol at 3.0 T and a clinical standard protocol at 1.5 T. A phantom and 12 asymptomatic volunteers were MR imaged using a 2-channel surface coil (standard TMJ coil) at 1.5 and 3.0 T (Philips Achieva and Philips Ingenia, respectively; Philips Healthcare, Best, Netherlands). Imaging protocol consisted of coronal and oblique sagittal proton density-weighted turbo spin echo sequences. For quantitative evaluation, a spherical phantom was imaged. Signal-to-noise ratio (SNR) maps were calculated on a voxelwise basis. For qualitative evaluation, all volunteers underwent MRI of the TMJ with the jaw in closed position. Two readers independently assessed visibility and delineation of anatomical structures of the TMJ and overall image quality on a 5-point Likert scale. Quantitative and qualitative measurements were compared between field strengths. The quantitative analysis showed similar SNR for the high-resolution protocol at 3.0 T compared with the clinical protocol at 1.5 T. The qualitative analysis showed significantly better visibility and delineation of clinically relevant anatomical structures of the TMJ, including the TMJ disc and pterygoid muscle as well as better overall image quality at 3.0 T than at 1.5 T. The presented results indicate that expected gains in SNR at 3.0 T can be used to increase the spatial resolution when imaging the TMJ, which translates into increased visibility and delineation of anatomical structures of the TMJ. Therefore, imaging at 3.0 T should be preferred over 1.5 T for imaging the TMJ.

Upregulation of cystathionine-β-synthetase expression contributes to inflammatory pain in rat temporomandibular joint

PubMed Central

2014-01-01

Background Hydrogen sulfide (H2S), an endogenous gaseotransmitter/modulator, is becoming appreciated that it may be involved in a wide variety of processes including inflammation and nociception. However, the role for H2S in nociceptive processing in trigeminal ganglion (TG) neuron remains unknown. The aim of this study was designed to investigate whether endogenous H2S synthesizing enzyme cystathionine-β-synthetase (CBS) plays a role in inflammatory pain in temporomandibular joint (TMJ). Methods TMJ inflammatory pain was induced by injection of complete Freund’s adjuvant (CFA) into TMJ of adult male rats. Von Frey filaments were used to examine pain behavioral responses in rats following injection of CFA or normal saline (NS). Whole cell patch clamp recordings were employed on acutely isolated TG neurons from rats 2 days after CFA injection. Western blot analysis was carried out to measure protein expression in TGs. Results Injection of CFA into TMJ produced a time dependent hyperalgesia as evidenced by reduced escape threshold in rats responding to VFF stimulation. The reduced escape threshold was partially reversed by injection of O-(Carboxymethyl) hydroxylamine hemihydrochloride (AOAA), an inhibitor for CBS, in a dose-dependent manner. CFA injection led to a marked upregulation of CBS expression when compared with age-matched controls. CFA injection enhanced neuronal excitability as evidenced by depolarization of resting membrane potentials, reduction in rheobase, and an increase in number of action potentials evoked by 2 and 3 times rheobase current stimulation and by a ramp current stimulation of TG neurons innervating the TMJ area. CFA injection also led to a reduction of IK but not IA current density of TG neurons. Application of AOAA in TMJ area reduced the production of H2S in TGs and reversed the enhanced neural hyperexcitability and increased the IK currents of TG neurons. Conclusion These data together with our previous report indicate that

Comparative analysis of the structure of temporomandibular joint in human and rabbit.

PubMed

Tomasello, Giovanni; Sorce, Alessandra; Mazzola, Margherita; Barone, Rosario; Lo Piccolo, Chiara; Farina, Felicia; Zummo, Giovanni; Carini, Francesco

2017-01-16

In order to increase knowledge on the morphology and structure of the articular disc of the TMJ for a better understanding of the functional role of the same, it proceeded with an investigation on histological samples in the block of 'TMJ and periarticular tissues of adult rabbits and human fetuses at different stage of development.

Temporomandibular Prosthetic Joint Infections Associated With Propionibacterium acnes: A Case Series, and a Review of the Literature.

PubMed

Khader, Ruba; Tingey, Joseph; Sewall, Steven

2017-12-01

The orthopedic literature has shown an increasing incidence of prosthetic joint infections (PJIs) associated with Propionibacterium acnes (P acnes). These infections present serious diagnostic and management challenges to the treating surgeons. In this review, the authors report on cases of P acnes-related temporomandibular joint (TMJ) PJIs that have been diagnosed and treated at their institution. After approval by the institutional review board, information was obtained through a retrospective chart review. Records were retrieved from clinic visits from January 1, 2010 through January 1, 2015 using appropriate International Classification of Diseases, Ninth Revision codes. Data extracted included patient demographics, prostheses details, prosthetic infection history, interventions, diagnostic procedures, and culture processing methods. Of the 7 patients who met the search criteria, 4 (1 with bilateral prostheses) had cultures positive for P acnes. For the 5 TMJ PJIs with cultures positive for P acnes, tissue cultures were obtained in the operating room and processed using mass spectrometry. Symptoms identified in these 4 patients were vague and included pain and intermittent swelling; clinical and radiographic findings were nonspecific. Treatment regimens included oral and parenteral antibiotics and operative interventions. In this case series, the authors report on the management of 4 cases of P acnes-related TMJ PJI. When patients with TMJ prostheses report vague symptoms of swelling and pain that do not fit the typical infection scenario, the surgeon should consider P acnes as a source of infection. Additional case series and retrospective reviews will be necessary before developing prospective trials that could aid in the prevention and management of this infection. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

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

PubMed

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

2010-09-01

Juvenile idiopathic arthritis (JIA) has an incidence that ranges from 1 to 22 per 100,000 children worldwide, with involvement of the temporomandibular joint (TMJ) in 17-87% of patients. Intraarticular corticosteroid injections are beneficial in the local treatment of JIA and of other types of arthritis. To describe and assess the accuracy of an US-guided technique for visualization of needle placement within the TMJ in children. Between January 2000 and November 2007, 180 TMJ injections were performed during 116 encounters in 83 children with arthritis (71 girls, 12 boys; mean age 12.0 years). Access was obtained under sterile conditions using US guidance (linear 15-MHz or curvilinear 8-MHz transducers) in a coronal plane, and confirmed with CT. To minimize radiation, a limited focused CT protocol was developed. A bilateral injection was performed in 65 encounters (57%). Twenty-three children had repeat TMJ injections. All injections were performed using US guidance. CT confirmation was used in 127/180 TMJs (70%). In those confirmed with CT, the needle tip was intra-articular in 91% of cases. Triamcinolone hexacetonide was used in 92% of injections and triamcinolone acetonide in 8%. One major complication was encountered (skin atrophy at the injection site). In our experience, TMJ injections using sonographic guidance is a safe, effective and accurate procedure.

Regulation of the trigeminal NR1 subunit expression induced by inflammation of the temporomandibular joint region in rats.

PubMed

Wang, Shuxing; Lim, Grewo; Mao, Ji; Sung, Backil; Mao, Jianren

2009-01-01

Expression of the N-methyl-d-aspartate (NMDA) receptor in trigeminal nuclei has been shown to play a role in the mechanisms of trigeminal pain. Here, we examined the hypothesis that the upregulation of the NR1 subunit of the NMDA receptor (NR1) in the trigeminal subnucleus caudalis (Sp5c) following inflammation of the temporomandibular joint (TMJ) region would be regulated by interleukin-6 (IL-6) and the nuclear factor-kappa B (NF-kappaB). Inflammation of a unilateral TMJ region was produced in rats by injecting 50mul of complete Freund's adjuvant (CFA) into a TMJ and adjacent tissues, which resulted in persistent pain behavior as assessed using algometer before (baseline) and on days 1, 3, and 7 after the CFA injection. The CFA injection also induced a significant upregulation of NR1 and NF-kappaB on days 3 and 7, and of IL-6 on days 1, 3, and 7, within the ipsilateral Sp5c, as compared with the sham TMJ injection group. Once daily intracisternal injection of an IL-6 antiserum or NF-kappaB inhibitor (PDTC) for 6 days, beginning on day 1 immediately after the CFA injection, prevented both the upregulation of NR1 in the ipsilateral Sp5C and pain behavior. Moreover, once daily intracisternal IL-6 administration for 6 days in naïve rats induced the NR1 upregulation and pain behavior similar to that after TMJ inflammation. These results indicate that the upregulation of IL-6 and NF-kappaB after inflammation of the unilateral TMJ region is a critical regulatory mechanism for the expression of NR1 in the ipsilateral Sp5c, which contributed to the development of TMJ pain behavior in rats.

Regulation of the Trigeminal NR1 Subunit Expression Induced by Inflammation of the Temporomandibular Joint Region in Rats

PubMed Central

Wang, Shuxing; Lim, Grewo; Mao, Ji; Sung, Backil; Mao, Jianren

2012-01-01

Expression of the N-methyl-D-aspartate receptor (NMDA) receptor in trigeminal nuclei has been shown to play a role in the mechanisms of trigeminal pain. Here, we examined the hypothesis that the upregulation of the NR1 subunit of the NMDA receptor (NR1) in the trigeminal subnucleus caudalis (Sp5c) following inflammation of the temporomandibular joint (TMJ) region would be regulated by interleukin-6 (IL-6) and the nuclear factor kappa B (NF-κB). Inflammation of a unilateral TMJ region was produced in rats by injecting 50 μl of complete Freund’s adjuvant (CFA) into a TMJ and adjacent tissues, which resulted in persistent pain behavior as assessed using algometer before (baseline) and on day 1, 3 and 7 after the CFA injection. The CFA injection also induced a significant upregulation of NR1 and NF-κB on day 3 and 7, and of IL-6 on day 1, 3, and 7, within the ipsilateral Sp5c, as compared with the sham TMJ injection group. Once daily intracisternal injection of an IL-6 antiserum or NF-κB inhibitor (PDTC) for six days, beginning on day 1 immediately after the CFA injection, prevented both the upregulation of NR1 in the ipsilateral Sp5C and pain behavior. Moreover, once daily intracisternal IL-6 administration for six days in naïve rats induced the NR1 upregulation and pain behavior similar to that after TMJ inflammation. These results indicate that the upregulation of IL-6 and NF-κB after inflammation of the unilateral TMJ region is a critical regulatory mechanism for the expression of NR1 in the ipsilateral Sp5c, which contributed to the development of TMJ pain behavior in rats. PMID:19058915

Involvement of the MAPK pathway in the pressure-induced synovial metaplasia procedure for the temporomandibular joint.

PubMed

Wu, M J; Lu, H P; Gu, Z Y; Zhou, Y Q

2016-06-20

Abnormal pressure is an important factor that contributes to bone adaptation in the temporomandibular joint (TMJ). We determined the effect of the mitogen-activated protein kinases (MAPK) pathway on the pressure-induced synovial metaplasia procedure for the TMJ, both in vitro and in vivo. Synovial fibroblasts (SFs) were exacted from rat TMJs and exposed to different hydrostatic pressures. The protein extracts were analyzed to determine the activation of ERK1/2, JNK, and p38. Surgical anterior disc displacement (ADD) was also performed on Japanese rabbits, and the proteins of TMJ were isolated to analyze pressure-induced MAPK activation after 1, 2, 4, and 8 weeks. The results showed that the activation of ERK1/2 and JNK in SFs significantly changed with increasing hydrostatic pressure, whereas p38 activation did not change. Moreover, p38 was activated in animals 1 week after surgical ADD. The levels of p38 gradually increased after 2 and 4 weeks, and then slightly decreased but remained higher than in the control 8 weeks after surgical ADD. Nevertheless, JNK was rarely activated after the ADD treatment. Our findings suggest the involvement of MAPK activation in the pressure-induced synovial metaplasia procedure with pressure loading in TMJ.

[Condylar hyperplasia: qualitative and quantitative study of temporomandibular joints remodeling before and after condylectomy].

PubMed

Rojare, Camille; Wojcik, Thomas; Coussens, Camille; Ferri, Joël; Pertuzon, Bruno; Raoul, Gwénaël

2014-06-01

This retrospective study aimed to evaluate bone remodeling of temporo-mandibular joints (TMJ) using computed tomography (CT) before and after condylectomy for condylar hyperplasia. TMJ bone remodeling was studied by comparing the pre and postoperative CT scan of ten patients. Qualitative evaluation was performed by two-dimensional analysis. Three-dimensional analysis superimpositions were done after digital condylar units isolation. Condylar volume modifications were measured and compared on both sides. Lastly, before and after surgery, we studied the radio-clinic correlations. After surgery, all the operated condyles developed a new cortical bone. We noticed also a thickening of the glenoid fossa. Surgical condylectomy leaded to a 43.5% volume reduction on the operated side and 2.14% on the controlateral side. On the controlateral side, most of abnormalities seen preoperatively disappeared after surgery. For two patients, the condylar resection took away over 80% of the initial volume. For these patients, we observed major radiologic modifications on the controlateral TMJ associated with symptoms of dysfunction. These problems did not worsen their quality of life. Both TMJ presented with bone remodelling after condylectomy. In condylar hyperplasia, condylectomy provides orthopaedic results on dysmorphia and removal of the pathological prechondroblastic zone. In the future, an earlier detection of this pathology may help the surgeon to treat in childhood. This would limit surgical excision and would avoid important dysmorphia. © EDP Sciences, SFODF, 2014.

Quantitative and qualitative comparison of MR imaging of the temporomandibular joint at 1.5 and 3.0 T using an optimized high-resolution protocol

PubMed Central

Spinner, Georg; Wyss, Michael; Erni, Stefan; Ettlin, Dominik A; Nanz, Daniel; Ulbrich, Erika J; Gallo, Luigi M; Andreisek, Gustav

2016-01-01

Objectives: To quantitatively and qualitatively compare MRI of the temporomandibular joint (TMJ) using an optimized high-resolution protocol at 3.0 T and a clinical standard protocol at 1.5 T. Methods: A phantom and 12 asymptomatic volunteers were MR imaged using a 2-channel surface coil (standard TMJ coil) at 1.5 and 3.0 T (Philips Achieva and Philips Ingenia, respectively; Philips Healthcare, Best, Netherlands). Imaging protocol consisted of coronal and oblique sagittal proton density-weighted turbo spin echo sequences. For quantitative evaluation, a spherical phantom was imaged. Signal-to-noise ratio (SNR) maps were calculated on a voxelwise basis. For qualitative evaluation, all volunteers underwent MRI of the TMJ with the jaw in closed position. Two readers independently assessed visibility and delineation of anatomical structures of the TMJ and overall image quality on a 5-point Likert scale. Quantitative and qualitative measurements were compared between field strengths. Results: The quantitative analysis showed similar SNR for the high-resolution protocol at 3.0 T compared with the clinical protocol at 1.5 T. The qualitative analysis showed significantly better visibility and delineation of clinically relevant anatomical structures of the TMJ, including the TMJ disc and pterygoid muscle as well as better overall image quality at 3.0 T than at 1.5 T. Conclusions: The presented results indicate that expected gains in SNR at 3.0 T can be used to increase the spatial resolution when imaging the TMJ, which translates into increased visibility and delineation of anatomical structures of the TMJ. Therefore, imaging at 3.0 T should be preferred over 1.5 T for imaging the TMJ. PMID:26371077

[Temporo-mandibular joint. Morpho-functional considerations].

PubMed

Scutariu, M D; Indrei, Anca

2004-01-01

The temporo-mandibular joint is distinguished from most other synovial joints of the body by two features: 1. the two jointed components carry teeth whose position and occlusion introduce a very strong influence on the movements of the temporo-mandibular joint and 2. its articular surfaces are not covered by hyaline cartilage, but by a dense, fibrous tissue. This paper describes the parts of the temporo-mandibular joint: the articular surfaces (the condylar process of the mandible and the glenoid part of the temporal bone), the fibrocartilaginous disc which is interposed between the mandibular and the temporal surface, the fibrous capsule of the temporo-mandibular joint and the ligaments of this joint. All these parts present a very strong adaptation at the important functions of the temporo-mandibular joint.

Establishment of temporomandibular joint puncture technique in rats using in vivo micro-computed tomography (R_mCT®)

PubMed Central

Kameoka, S; Matsumoto, K; Kai, Y; Yonehara, Y; Arai, Y; Honda, K

2010-01-01

The aim of the report was to establish puncture techniques for the temporomandibular joint (TMJ) cavity in rats. The experimental sample comprised 30 male Sprague–Dawley rats. Under general anaesthesia the superior joint cavity of the rat was punctured either laterally (lateral puncture technique (LPT), n = 11), anteriorly (anterosuperior puncture technique (ASPT), n = 13) or anteroinferior puncture technique (AIPT), n = 6) using a 27-gauge needle. After the tip of the needle was confirmed by micro-CT (R-mCT®, Rigaku, Tokyo, Japan) located on the mandibular fossa, 0.05 ml of contrast media was injected under micro-CT fluoroscopic guidance. After confirmation that the joint cavity was filled with contrast media, micro-CT imaging was carried out. The puncture for LPT was accurate in 5 of the 11 animals. The ASPT was accurate in all 13 animals. The AIPT punctured 3 of the 6 animals. Furthermore, the ASPT and AIPT demonstrated improved preservation of the needle; it was harder to detach the needle, which led to greater stability. These results suggest that ASPT assisted by R-mCT® is useful for basic research, including drug discovery and pathogenesis of TMJ diseases. PMID:20841463

The role of molecular pain biomarkers in temporomandibular joint internal derangement.

PubMed

Ernberg, M

2017-06-01

There is evidence that low-grade inflammation may be responsible for pain and development of degenerative changes in temporomandibular joint internal derangement. This article reviews the current knowledge of the molecular mechanisms behind TMJ internal derangements. A non-systematic search was carried out in PubMed, Embase and the Cochrane library for studies regarding pathophysiological mechanisms behind internal derangements focusing on pain-mediating inflammatory and cartilage-degrading molecules. Recent data suggest that release of cytokines may be the key event for pain and cartilage destruction in TMJ internal derangements. Cytokines promote the release of matrix metalloproteinases (MMPs), and due to hypoxia, vascular endothelial growth factor (VEGF) is released. This activates chondrocytes to produce MMPs and reduce their tissue inhibitors (TIMPs) as well as the recruitment of osteoclasts, ultimately leading to cartilage and bone resorption. Also, proteoglycans have an important role in this process. Several cytokines, MMPs, TIMPs and VEGF have been identified in higher concentrations in the TMJ synovial fluid of patients with painful internal derangements and shown to be associated with the degree of degeneration. Other molecules that show elevated levels include hyaluronic acid synthase, disintegrin and metalloproteinase with thrombospondin motifs (ADAMTs), aggrecan, fibromodulin, biglycan and lumican. Taken together, more or less pronounced inflammation of TMJ structures with release of cytokines, MMPs and other molecular markers that interact in a complex manner may be responsible for tissue degeneration in internal derangements. As internal derangements may be symptom-free, the degree of inflammation, but also other mechanisms, may be important for pain development. © 2017 John Wiley & Sons Ltd.

Using three-dimensional-computerized tomography as a diagnostic tool for temporo-mandibular joint ankylosis: a case report.

PubMed

Kao, S Y; Chou, J; Lo, J; Yang, J; Chou, A P; Joe, C J; Chang, R C

1999-04-01

Roentgenographic examination has long been a useful diagnostic tool for temporo-mandibular joint (TMJ) disease. The methods include TMJ tomography, panoramic radiography and computerized tomography (CT) scan with or without injection of contrast media. Recently, three-dimensional CT (3D-CT), reconstructed from the two-dimensional image of a CT scan to simulate the soft tissue or bony structure of the real target, was proposed. In this report, a case of TMJ ankylosis due to traumatic injury is presented. 3D-CT was employed as one of the presurgical roentgenographic diagnostic tools. The conventional radiographic examination including panoramic radiography and tomography showed lesions in both sides of the mandible. CT scanning further suggested that the right-sided lesion was more severe than that on the left. With 3D-CT image reconstruction the size and extent of the lesions were clearly observable. The decision was made to proceed with an initial surgical approach on the right side. With condylectomy and condylar replacement using an autogenous costochondral graft on the right side, the range of mouth opening improved significantly. In this case report, 3D-CT demonstrates its advantages as a tool for the correct and precise diagnosis of TMJ ankylosis.

The Interface of Mechanics and Nociception in Joint Pathophysiology: Insights From the Facet and Temporomandibular Joints

PubMed Central

Sperry, Megan M.; Ita, Meagan E.; Kartha, Sonia; Zhang, Sijia; Yu, Ya-Hsin; Winkelstein, Beth

2017-01-01

Chronic joint pain is a widespread problem that frequently occurs with aging and trauma. Pain occurs most often in synovial joints, the body's load bearing joints. The mechanical and molecular mechanisms contributing to synovial joint pain are reviewed using two examples, the cervical spinal facet joints and the temporomandibular joint (TMJ). Although much work has focused on the macroscale mechanics of joints in health and disease, the combined influence of tissue mechanics, molecular processes, and nociception in joint pain has only recently become a focus. Trauma and repeated loading can induce structural and biochemical changes in joints, altering their microenvironment and modifying the biomechanics of their constitutive tissues, which themselves are innervated. Peripheral pain sensors can become activated in response to changes in the joint microenvironment and relay pain signals to the spinal cord and brain where pain is processed and perceived. In some cases, pain circuitry is permanently changed, which may be a potential mechanism for sustained joint pain. However, it is most likely that alterations in both the joint microenvironment and the central nervous system (CNS) contribute to chronic pain. As such, the challenge of treating joint pain and degeneration is temporally and spatially complicated. This review summarizes anatomy, physiology, and pathophysiology of these joints and the sensory pain relays. Pain pathways are postulated to be sensitized by many factors, including degeneration and biochemical priming, with effects on thresholds for mechanical injury and/or dysfunction. Initiators of joint pain are discussed in the context of clinical challenges including the diagnosis and treatment of pain. PMID:28056123

Effect of thumb joint mobilization on pressure pain threshold in elderly patients with thumb carpometacarpal osteoarthritis.

PubMed

Villafañe, Jorge H; Silva, Guillermo B; Fernandez-Carnero, Josue

2012-02-01

This study evaluated the effects of Maitland's passive accessory mobilization on local hypoalgesia and strength in thumb carpometacarpal osteoarthritis (TCOA). Twenty-eight patients between 70 and 90 years old with secondary TCOA were randomized into glide mobilization and sham groups. This study was designed as a double-blind, randomized controlled trial. Therapy consisted of Maitland's passive accessory mobilization of the dominant hand during 4 sessions over 2 weeks. We measured pressure pain threshold (PPT) at the trapeziometacarpal joint (TMJ), the tubercle of the scaphoid bone, and the unciform apophysis of the hamate bone by algometry. The tip and tripod pinch strength was also measured. Grip strength was measured by a grip dynamometer. Measurements were taken before treatment and after 1 week (first follow-up [FU]) and 2 weeks (second FU). All values in sham group remained unchanged along the treatment period. In the treated group, the PPT in the TMJ was 3.85 ± 0.35 kg/cm(2), which increased after treatment to 3.99 ± 0.37 and was maintained at the same level during the first FU 3.94 ± 0.39 and second FU 4.74 ± 0.40. In contrast, we found no differences in PPT in the other studied structures after treatment. Similarly, tip, tripod pinch, and grip strength remained without change after treatment. Passive accessory mobilization increased PPT in the TMJ; however, it did not increase motor function in patients with TCOA. Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

Bioengineered Temporomandibular Joint Disk Implants: Study Protocol for a Two-Phase Exploratory Randomized Preclinical Pilot Trial in 18 Black Merino Sheep (TEMPOJIMS)

PubMed Central

Monje, Florencio Gil; González-García, Raúl; Little, Christopher B; Mónico, Lisete; Pinho, Mário; Santos, Fábio Abade; Carrapiço, Belmira; Gonçalves, Sandra Cavaco; Morouço, Pedro; Alves, Nuno; Moura, Carla; Wang, Yadong; Jeffries, Eric; Gao, Jin; Sousa, Rita; Neto, Lia Lucas; Caldeira, Daniel; Salvado, Francisco

2017-01-01

Background Preclinical trials are essential to test efficacious options to substitute the temporomandibular joint (TMJ) disk. The contemporary absence of an ideal treatment for patients with severe TMJ disorders can be related to difficulties concerning the appropriate study design to conduct preclinical trials in the TMJ field. These difficulties can be associated with the use of heterogeneous animal models, the use of the contralateral TMJ as control, the absence of rigorous randomized controlled preclinical trials with blinded outcomes assessors, and difficulties involving multidisciplinary teams. Objective This study aims to develop a new, reproducible, and effective study design for preclinical research in the TMJ domain, obtaining rigorous data related to (1) identify the impact of bilateral discectomy in black Merino sheep, (2) identify the impact of bilateral discopexy in black Merino sheep, and (3) identify the impact of three different bioengineering TMJ discs in black Merino sheep. Methods A two-phase exploratory randomized controlled preclinical trial with blinded outcomes is proposed. In the first phase, nine sheep are randomized into three different surgical bilateral procedures: bilateral discectomy, bilateral discopexy, and sham surgery. In the second phase, nine sheep are randomized to bilaterally test three different TMJ bioengineering disk implants. The primary outcome is the histological gradation of TMJ. Secondary outcomes are imaging changes, absolute masticatory time, ruminant time per cycle, ruminant kinetics, ruminant area, and sheep weight. Results Previous preclinical studies in this field have used the contralateral unoperated side as a control, different animal models ranging from mice to a canine model, with nonrandomized, nonblinded and uncontrolled study designs and limited outcomes measures. The main goal of this exploratory preclinical protocol is to set a new standard for future preclinical trials in oromaxillofacial surgery

Facial morphology in children and adolescents with juvenile idiopathic arthritis and moderate to severe temporomandibular joint involvement.

PubMed

Hsieh, Yuh-Jia; Darvann, Tron A; Hermann, Nuno V; Larsen, Per; Liao, Yu-Fang; Bjoern-Joergensen, Jens; Kreiborg, Sven

2016-02-01

The aims of this study were to (1) assess lateral facial morphology in children and adolescents with juvenile idiopathic arthritis and moderate to severe temporomandibular joint (TMJ) involvement, (2) compare the lateral facial morphology of these subjects with and without TMJ involvement using cephalograms and 3-dimensional (3D) facial photographs, and (3) compare and correlate the results of the 3D photographic and cephalometric analyses. Sixty patients with juvenile idiopathic arthritis were included and grouped as follows: group 1, juvenile idiopathic arthritis patients without TMJ involvement; group 2, juvenile idiopathic arthritis patients with moderate to severe unilateral TMJ involvement; and group 3, juvenile idiopathic arthritis patients with moderate to severe bilateral TMJ involvement. Lateral cephalograms were used to assess and compare lateral facial morphologies between the groups. Lateral projections of oriented 3D photographs were superimposed on the lateral cephalograms. The results of the lateral 3D photographic analysis were correlated with those of lateral cephalometric analysis. Group 3 showed the most severe growth disturbances, including more retrognathic mandible and retruded chin, steep occlusal and mandibular planes, and more hyperdivergent type (P <0.01). Group 2 showed similar growth disturbances, but to a lesser extent than did group 3. Photographic variables were significantly correlated with the soft tissue and skeletal variables of cephalograms (0.5 < r < 0.9; P <0.001). Subjects with juvenile idiopathic arthritis and unilateral or bilateral moderate to severe TMJ involvement had significant growth disturbances. Early intervention is recommended for these patients to prevent unfavorable facial development. Furthermore, with proper orientation, 3D photographs can be used as an alternative to conventional lateral cephalograms and 2-dimensional photographs. Copyright © 2016 American Association of Orthodontists. Published by Elsevier

Investigation on physiological and clinical effects of different light sources in TMJ photobiomodulation therapy

NASA Astrophysics Data System (ADS)

Kamenoff, J.

2017-02-01

Introduction Laser light Electromagnetic energy has some typical properties for discussions on laser irradiation abilities to control the acute and chronic disorders in TMJ. Material and Methods During the last six years we have been completed well controlled clinical trials based on the criteria of the American Academy of orofacial pain. The study over the 600 patients (300 women and 300 men), mean age of 47 years have been developed. Patients have been selected on the main clinical sign of TMJ pain and have been divided into four main groups according to the type of PDT method. Based on the action spectra, various wavelengths have been used for TMJ Photodynamic Therapy. Constant dose and time of exposition, as well as various range of frequencies have been applied. In this way the Laser biostimulation response has been directly proportional to the total energy dose, depending of light intensity. Physiological and clinical effects of the followed "active regions"- 660 - 680, 760 - 780, 810 - 830 and 904 - 987 nm have been valued by method of comparative analysis. Methods applied: LLLT - TENS - red surface laser acupuncture (LA), PIPBM - LA, Laser bioenergetics approach, Complex therapeutic program (CTP). Results evaluation will be demonstrated by comparative digital ortopantomograph analysis, EEG brain maps, VAS, a metric analysis of the level of the maximum active Mandible opening and EPST through electrophysiological signal evaluation of the patient's body.

Fas/S1P1 crosstalk via NF-κB activation in osteoclasts controls subchondral bone remodeling in murine TMJ arthritis.

PubMed

Hutami, Islamy Rahma; Izawa, Takashi; Mino-Oka, Akiko; Shinohara, Takehiro; Mori, Hiroki; Iwasa, Akihiko; Tanaka, Eiji

2017-09-02

Enhanced turnover of subchondral trabecular bone is a hallmark of rheumatoid arthritis (RA) and it results from an imbalance between bone resorption and bone formation activities. To investigate the formation and activation of osteoclasts which mediate bone resorption, a Fas-deficient MRL/lpr mouse model which spontaneously develops autoimmune arthritis and exhibits decreased bone mass was studied. Various assays were performed on subchondral trabecular bone of the temporomandibular joint (TMJ) from MRL/lpr mice and MRL+/+ mice. Initially, greater osteoclast production was observed in vitro from bone marrow macrophages obtained from MRL/lpr mice due to enhanced phosphorylation of NF-κB, as well as Akt and MAPK, to receptor activator of nuclear factor-κB ligand (RANKL). Expression of sphingosine 1-phosphate receptor 1 (S1P 1 ) was also significantly upregulated in the condylar cartilage. S1P 1 was found to be required for S1P-induced migration of osteoclast precursor cells and downstream signaling via Rac1. When SN50, a synthetic NF-κB-inhibitory peptide, was applied to the MRL/lpr mice, subchondral trabecular bone loss was reduced and both production of osteoclastogenesis markers and sphingosine kinase (Sphk) 1/S1P 1 signaling were reduced. Thus, the present results suggest that Fas/S1P 1 signaling via activation of NF-κB in osteoclast precursor cells is a key factor in the pathogenesis of RA in the TMJ. Copyright © 2017 Elsevier Inc. All rights reserved.

A web-based system for neural network based classification in temporomandibular joint osteoarthritis.

PubMed

de Dumast, Priscille; Mirabel, Clément; Cevidanes, Lucia; Ruellas, Antonio; Yatabe, Marilia; Ioshida, Marcos; Ribera, Nina Tubau; Michoud, Loic; Gomes, Liliane; Huang, Chao; Zhu, Hongtu; Muniz, Luciana; Shoukri, Brandon; Paniagua, Beatriz; Styner, Martin; Pieper, Steve; Budin, Francois; Vimort, Jean-Baptiste; Pascal, Laura; Prieto, Juan Carlos

2018-07-01

The purpose of this study is to describe the methodological innovations of a web-based system for storage, integration and computation of biomedical data, using a training imaging dataset to remotely compute a deep neural network classifier of temporomandibular joint osteoarthritis (TMJOA). This study imaging dataset consisted of three-dimensional (3D) surface meshes of mandibular condyles constructed from cone beam computed tomography (CBCT) scans. The training dataset consisted of 259 condyles, 105 from control subjects and 154 from patients with diagnosis of TMJ OA. For the image analysis classification, 34 right and left condyles from 17 patients (39.9 ± 11.7 years), who experienced signs and symptoms of the disease for less than 5 years, were included as the testing dataset. For the integrative statistical model of clinical, biological and imaging markers, the sample consisted of the same 17 test OA subjects and 17 age and sex matched control subjects (39.4 ± 15.4 years), who did not show any sign or symptom of OA. For these 34 subjects, a standardized clinical questionnaire, blood and saliva samples were also collected. The technological methodologies in this study include a deep neural network classifier of 3D condylar morphology (ShapeVariationAnalyzer, SVA), and a flexible web-based system for data storage, computation and integration (DSCI) of high dimensional imaging, clinical, and biological data. The DSCI system trained and tested the neural network, indicating 5 stages of structural degenerative changes in condylar morphology in the TMJ with 91% close agreement between the clinician consensus and the SVA classifier. The DSCI remotely ran with a novel application of a statistical analysis, the Multivariate Functional Shape Data Analysis, that computed high dimensional correlations between shape 3D coordinates, clinical pain levels and levels of biological markers, and then graphically displayed the computation results. The findings of this

An epidemiological study of temporomandibular joint ankylosis

PubMed Central

Gupta, Vinay Kumar; Mehrotra, Divya; Malhotra, Seema; Kumar, Sandeep; Agarwal, Girdhar Gopal; Pal, Uma Shanker

2012-01-01

Introduction: The temporomandibular joint (TMJ) forms the very cornerstone of craniofacial integrity and its ankylosis in a growing child may cause problems in daily food intake, speech, appearance, and oral hygiene is affected to a major extent. It is one of the common acquired pathologies afflicting the skeleton. It is also the most overlooked and under-managed problem in children. Materials and Methods: A house to house survey was conducted between 2010 and 2011 in rural and urban areas of Lucknow. A total of 21,720 children aged between 3-15 years from 9090 houses comprising a representative sample were included. Results: Ten TMJ ankylosis cases were identified in 21,720 children. Of these, six were bilateral and four were unilateral. Male to female ratio was 1:9, with most patients (70.0%) being in the 10-15 years’ age group (mean age was 11.1 years ± 3.34). The most common cause of ankylosis was trauma for 90.0% of cases. The majority of patients (70%) were reporting the condition for the first time, with 30% patients having had previous treatment. Conclusion: TMJ ankylosis is an acquired condition in most of the cases. Birth/childhood trauma would be the major causative factor. Knowledge amongst parents, providers of health about this entity was poor. Initial management of the causative factor was poor. Mere knowledge among the general population and healthcare providers can result in primary prevention and also secondary prevention along with its successful definitive treatment. PMID:23251054

TMJ

MedlinePlus

... of the joint, is called the condyle. The socket is called the articular fossa. Between the condyle ... that is located between the jawbone and the socket. A displaced disk may produce clicking or popping ...

CT and MR findings in synovial chondromatosis of the temporo-mandibular joint: our experience and review of literature.

PubMed

Testaverde, Lorenzo; Perrone, Anna; Caporali, Laura; Ermini, Antonella; Izzo, Luciano; D'Angeli, Ilaria; Impara, Luca; Mazza, Dario; Izzo, Paolo; Marini, Mario

2011-06-01

To compare Computed Tomography (CT) and Magnetic Resonance (MR) features and their diagnostic potential in the assessment of Synovial Chondromatosis (SC) of the Temporo-Mandibular Joint (TMJ). Eight patients with symptoms and signs compatible with dysfunctional disorders of the TMJ underwent CT and MR scan. We considered the following parameters: soft tissue involvement (disk included), osteostructural alterations of the joints, loose bodies and intra-articular fluid. These parameters were evaluated separately by two radiologists with a "double blinded method" and then, after agreement, definitive assessment of the parameters was given. CT and MR findings were compared. Histopathological results showed metaplastic synovia in all patients and therefore confirmed diagnosis of SC. MR resulted better than CT in the evaluation of all parameters except the osteostructural alterations of the joints, estimated with more accuracy by CT scan. CT scan is excellent to define bony surfaces of the articular joints and flogistic tissue but it fails in the detection of loose bodies when these are not yet calcified. MR scan therefore is the gold standard when SC is suspected since it can visualize loose bodies at early stage and also evaluate disk condition and eventual extra-articular tissues involvement. The use of T2-weighted images and contrast medium allows identifying intra-articular fluid, estimating its entity and discriminating from sinovial tissue. Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.

Distribution of stress on TMJ disc induced by use of chincup therapy: assessment by the finite element method.

PubMed

Calçada, Flávio Siqueira; Guimarães, Antônio Sérgio; Teixeira, Marcelo Lucchesi; Takamatsu, Flávio Atsushi

2017-01-01

To assess the distribution of stress produced on TMJ disc by chincup therapy, by means of the finite element method. a simplified three-dimensional TMJ disc model was developed by using Rhinoceros 3D software, and exported to ANSYS software. A 4.9N load was applied on the inferior surface of the model at inclinations of 30, 40, and 50 degrees to the mandibular plane (GoMe). ANSYS was used to analyze stress distribution on the TMJ disc for the different angulations, by means of finite element method. The results showed that the tensile and compressive stresses concentrations were higher on the inferior surface of the model. More presence of tensile stress was found in the middle-anterior region of the model and its location was not altered in the three directions of load application. There was more presence of compressive stress in the middle and mid-posterior regions, but when a 50o inclined load was applied, concentration in the middle region was prevalent. Tensile and compressive stresses intensities progressively diminished as the load was more vertically applied. stress induced by the chincup therapy is mainly located on the inferior surface of the model. Loads at greater angles to the mandibular plane produced distribution of stresses with lower intensity and a concentration of compressive stresses in the middle region. The simplified three-dimensional model proved useful for assessing the distribution of stresses on the TMJ disc induced by the chincup therapy.

The efficacy of intra-articular sodium hyaluronate in patients with reducing displaced disc of the temporomandibular joint.

PubMed

Hepguler, S; Akkoc, Y S; Pehlivan, M; Ozturk, C; Celebi, G; Saracoglu, A; Ozpinar, B

2002-01-01

In this clinical trial, we examined the efficacy of intra-articular hyaluronic acid (HA) treatment in 38 patients with reducing displaced disc of the temporomandibular joint (TMJ). Subjects received two unilateral upper space injections of HA or physiological saline solution with 1 week apart. Efficacy was based on the following measurements: pain and sound intensity of the joint measured by visual analogue scale (VAS), modified Helkimo's clinical dysfunction index and the intensity of joint vibration during opening and closing the mouth measured by accelerometers. These measurements were performed before the first injection and 1 and 6 months after the last injection. In the treatment group (n=19), all measurements improved significantly at month 1 and at month 6 compared with the baseline (P < 0.01). The same measurements, in the placebo group (n=19), did not show any change, except for the pain intensity which improved at month 1 and month 6 (P < 0.05). The change in baseline measurements of all of the efficacy criteria at month 1 and at month 6 in the treatment group was significantly better compared with the change obtained with placebo at the same time intervals. This study demonstrates that intra-articular sodium hyaluronate (Orthovisc) injection into the TMJ is an effective treatment for a reducing displaced disc.

Tissue interaction is required for glenoid fossa development during temporomandibular joint formation

PubMed Central

Wang, Ying; Liu, Chao; Rohr, Joseph; Liu, Hongbing; He, Fenglei; Yu, Jian; Sun, Cheng; Li, Lu; Gu, Shuping; Chen, YiPing

2011-01-01

The mammalian temporomandibular joint (TMJ) develops from two distinct mesenchymal condensations that grow towards each other and ossify through different mechanisms, with the glenoid fossa undergoing intramembranous ossification while the condyle being endochondral in origin. In this study, we used various genetically modified mouse models to investigate tissue interaction between the condyle and glenoid fossa during TMJ formation in mice. We report that either absence or dislocation of the condyle results in an arrested glenoid fossa development. In both cases, glenoid fossa development was initiated, but failed to sustain, and became regressed subsequently. However, condyle development appears to be independent upon the presence of the forming glenoid fossa. In addition, we show that substitution of condyle by Meckel’s cartilage is able to sustain glenoid fossa development. These observations suggest that proper signals from the developing condyle or Meckel’s cartilage are required to sustain the glenoid fossa development. PMID:21953591

Comorbidity of internal derangement of the temporomandibular joint and silent dysfunction of the cervical spine.

PubMed

Stiesch-Scholz, M; Fink, M; Tschernitschek, H

2003-04-01

The aim of this evaluation was to examine correlations between internal derangement of the temporomandibular joint (TMJ) and cervical spine disorder (CSD). A prospective controlled clinical study was carried out. Thirty patients with signs and symptoms of internal derangement but without any subjective neck problems and 30 age- and gender-matched control subjects without signs and symptoms of internal derangement were examined. The investigation of the temporomandibular system was carried out using a 'Craniomandibular Index'. Afterwards an examiner-blinded manual medical investigation of the craniocervical system was performed. This included muscle palpation of the cervical spine and shoulder girdle as well as passive movement tests of the cervical spine, to detect restrictions in the range of movement as well as segmental intervertebral dysfunction. The internal derangement of the TMJ was significantly associated with 'silent' CSD (t-test, P < 0.05). Patients with raised muscle tenderness of the temporomandibular system exhibited significantly more often pain on pressure of the neck muscles than patients without muscle tenderness of the temporomandibular system (t-test, P < 0.05). As a result of the present study, for patients with internal derangement of the TMJ an additional examination of the craniocervical system should be recommended.

[Effect of different oxygen tension on the cytoskeleton remodeling of goat temporomandibular joint disc cells].

PubMed

Xiaolan, He; Guangjie, Bao; Linglu, Sun; Xue, Zhang; Shanying, Bao; Hong, Kang

2017-08-01

Objective The effect of different oxygen tensions on the cytoskeleton remodeling of goat temporomandibular joint (TMJ) disc cells were investigated. Methods Goat TMJ disc cells were cultured under normoxia (21% O₂) and hypoxia (2%, 4%, and 8% O₂). Toluidine blue, picrosirius red, and type Ⅰ collagen immunocytochemical staining were performed to observe the changes in cell phenotype under different oxygen levels. Immunofluorescent staining and real-time reverse transcription-polymerase chain reaction analysis were then performed to identify actin, tubulin, and vimentin in the cultured disc cells. Results TMJ disc cells still displayed fibroblast characteristics under different oxygen levels and their cytoskeletons had regular arrangement. The fluorescence intensities of actin and vimentin were lowest at 4% O₂(P<0.05), whereas that of tubulin was highest at 2% O₂ (P<0.05). No significant difference among the other groups was observed (P>0.05). Actin mRNA levels were considerably decreased at 2% O₂ and 4% O₂ in hypoxic conditions, while actin mRNA expression was highest in 21% O₂. Tubulin mRNA levels considerably increased at 2% O₂, while tubulin mRNA expression was lowest in 8% O₂ (P<0.05). Vimentin mRNA expression was lowest at 4% O₂ and highest at 21% O₂, and significant differences were observed between vimentin mRNA expression levels among these oxygen levels (P<0.05). Conclusion Cytoskeletons were reconstructed in different oxygen tensions, and 2% O₂ may be the optimal oxygen level required to proliferate TMJ disc cells.

Chondromalacia as pathological finding in arthroscopy of the temporomandibular joint: A retrospective study.

PubMed

Martin-Granizo, Rafael; Correa-Muñoz, Diana Carolina

2018-01-01

The objective of this study was to describe the arthroscopic findings of chondromalacia and its relation with the internal derangement of the temporomandibular joint (TMJ). A total of 161 patients (299 TMJs) who underwent arthroscopy were included in the study. The TMJs were evaluated objectively under arthroscopic vision, and 4 groups of patients were established according to the degree of involvement, degree I, II, III and IV. Statistical analyses were conducted using logistic regression models (P < 0.05). It was observed that 95 patients (59%) had no sign of chondromalacia and 66 (41%) in 88 joints exhibited some degree of chondromalacia (44 patients unilaterally and 22 bilaterally). Of the 88 joints with chondromalacia, 14 (15.9%) had chondromalacia degree I, 12 (13.6%) chondromalacia degree II, 20 (22.7%) chondromalacia degree III and 42 (47.7%) chondromalacia degree IV. The chondromalacia was more significantly found in patients with ADDwR and discal perforation (P < 0.05), even as a common finding in patients without any internal deragement. Chondromalacia degree IV was a significant finding in cases of ADDwoR (P = 0.000619). Chondromalacia of the TMJ is a common finding in patients with internal derangement even at the early stages. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Improving joint pain and function in osteoarthritis.

PubMed

Owens, Claire; Conaghan, Philip G

2016-12-01

Osteoarthritis has become a major chronic pain condition. It affects more than 10% of adults and accounts for almost 10% of health service resources. The impact of osteoarthritis is amplified by underuse of effective muscle strengthening exercises and a focus on often less effective and poorly tolerated analgesic therapies. Although traditionally considered to be primarily a disease of cartilage, there is now ample evidence that typical clinical osteoarthritis involves multiple tissue pathologies. Increased BMI is associated with a higher incidence of knee osteoarthritis. Anatomical abnormalities such as valgus alignment or previous joint trauma including meniscectomy, anterior cruciate ligament rupture and fracture through the joint are also associated with increased incidence of osteoarthritis. Pain is the main presenting symptom. However, we still have a poor understanding of the causes of pain in osteoarthritis. In patients aged 45 or over the diagnosis should be made clinically without investigations if the patient has activity-related joint pain in addition to early morning joint stiffness lasting less than 30 minutes. Muscle strengthening and aerobic exercise have been shown to improve joint pain and function. Weight loss not only improves joint pain and function but has a myriad of other health benefits, reducing the incidence of lifestyle associated diseases such as cardiovascular disease and type 2 diabetes, and mechanical stress on the joints.

The value of arthrography in the decision-making process regarding surgery for internal derangement of the temporomandibular joint.

PubMed

Nitzan, D W; Dolwick, F M; Marmary, Y

1991-04-01

In this study, the clinical and arthrographic findings from 43 internally deranged temporomandibular joints (TMJs) were compared with the intra-surgical observations. In 40 of 43 joints, arthrography did not provide any additional information useful for diagnosis or treatment. In six joints, the problem was misdiagnosed. Only in three joints did arthrography demonstrate the existence of perforation in the posterior attachment that had not been suspected during the clinical examination. Because of the doubtful importance of arthrographic information for the decision-making process, it is suggested that the method be applied only in cases in which clinical examination and plain radiographs have failed to uncover the signs and symptoms indicative of a TMJ disorder.

Exploiting endogenous fibrocartilage stem cells to regenerate cartilage and repair joint injury

PubMed Central

Embree, Mildred C.; Chen, Mo; Pylawka, Serhiy; Kong, Danielle; Iwaoka, George M.; Kalajzic, Ivo; Yao, Hai; Shi, Chancheng; Sun, Dongming; Sheu, Tzong-Jen; Koslovsky, David A.; Koch, Alia; Mao, Jeremy J.

2016-01-01

Tissue regeneration using stem cell-based transplantation faces many hurdles. Alternatively, therapeutically exploiting endogenous stem cells to regenerate injured or diseased tissue may circumvent these challenges. Here we show resident fibrocartilage stem cells (FCSCs) can be used to regenerate and repair cartilage. We identify FCSCs residing within the superficial zone niche in the temporomandibular joint (TMJ) condyle. A single FCSC spontaneously generates a cartilage anlage, remodels into bone and organizes a haematopoietic microenvironment. Wnt signals deplete the reservoir of FCSCs and cause cartilage degeneration. We also show that intra-articular treatment with the Wnt inhibitor sclerostin sustains the FCSC pool and regenerates cartilage in a TMJ injury model. We demonstrate the promise of exploiting resident FCSCs as a regenerative therapeutic strategy to substitute cell transplantation that could be beneficial for patients suffering from fibrocartilage injury and disease. These data prompt the examination of utilizing this strategy for other musculoskeletal tissues. PMID:27721375

Tenosynovial giant cell tumors of the temporomandibular joint and lateral skull base: Review of 11 cases.

PubMed

Carlson, Matthew L; Osetinsky, L Mariel; Alon, Eran E; Inwards, Carrie Y; Lane, John I; Moore, Eric J

2017-10-01

To elucidate the clinical behavior, treatment, and outcomes of tenosynovial giant cell tumors (TGCT) involving the temporomandibular joint (TMJ) and adjacent temporal bone. Retrospective case series with histopathologic review. A retrospective chart review was performed identifying and collecting data from all cases of TGCT involving the TMJ and adjacent temporal bone that were treated at the authors' center between January 1960 and December 2015. Eleven histopathologically confirmed cases met inclusion criteria. The median age at diagnosis was 49 years, eight patients were men, and the median follow-up was 116 months. Computed tomographic (CT) imaging revealed a lytic expansile mass centered on the TMJ. Magnetic resonance imaging (MRI) most commonly exhibited hypointense signal on precontrast T1- and T2-weighted sequences and variable postcontrast enhancement. The median delay in diagnosis was 24 months, and the most common presenting symptoms were hearing loss and pain. All patients underwent surgical resection, eight receiving gross total removal, one receiving near total removal, and two patients from early in the series receiving subtotal resection with neoadjuvant or adjuvant radiation. Histopathological review of surgical specimens revealed chondroid metaplasia in seven tumors. Eight of nine cases receiving gross total or near total resection have no evidence of recurrence to date. TGCT of the TMJ and temporal bone are rare and locally aggressive tumors that commonly present with nonspecific symptoms. A careful review of CT and MRI followed by early biopsy is critical in establishing an accurate diagnosis and facilitating appropriate treatment. TGCT of the TMJ more commonly contain chondroid metaplasia when compared to TGCT at other anatomic locations. Gross total resection is achievable in most cases and offers long-term cure. Radiation may be considered for recurrent disease or adjuvant therapy following subtotal resection. 4. Laryngoscope, 127

Preliminary longitudinal report on symptom outcomes in symptomatic and asymptomatic women with imaging evidence of temporomandibular joint arthritic changes.

PubMed

Schmitter, Marc; Wacker, Katrin; Pritsch, Maria; Giannakopoulos, Nikolas Nikitas; Klose, Christina; Faggion, Clovis; Kress, Bodo; Leckel, Michael; Rammelsberg, Peter

2010-01-01

The objectives of this preliminary, longitudinal, and explorative cohort study were to assess changes in and the onset of osteoarthrosis (OA)-related pain in the temporomandibular joint (TMJ) and to address factors that might impact the development or reduction of associated pain symptoms. In this sex-matched study, 60 women were recruited (30 asymptomatic with a magnetic resonance imaging [MRI] diagnosis of OA-related TMJ changes, 30 symptomatic with accompanying MRI evidence of OA of the TMJ). All subjects underwent a baseline clinical examination and MRI assessment and were subsequently referred to a dental practitioner, who was informed of the diagnosis and further treatment where required. Not all subjects underwent dental treatment interventions. Following a mean 4-year period, subjects were reexamined clinically. Spearman rank correlation and Mann-Whitney U tests were used to evaluate possible correlations in reported pain level changes with the number of posterior occlusal contacts and new dental restorations placed between baseline and recall appointments. The dropout rate was 28% (6.7% for symptomatic, 50% for asymptomatic). OA-related TMJ pain in symptomatic subjects decreased with time (pain reduction: ?3.6 ± 3.4 on a 0 to 10 numeric rating scale); asymptomatic patients rarely developed pain. These preliminary results suggest that factors other than dental occlusion might play a role in the reduction of pain.

Association Between Missing Posterior Teeth and Occurrence of Temporomandibular Joint Condylar Erosion: A Cone Beam Computed Tomography Study.

PubMed

Bertram, Felix; Hupp, Linus; Schnabl, Dagmar; Rudisch, Ansgar; Emshoff, Rüdiger

To determine a possible association between asymptomatic temporomandibular joint (TMJ) condylar erosion and the number of missing posterior teeth and their location, as well as the number of dental quadrants with missing posterior teeth. This case-control study involved 210 patients (male to female ratio = 98:112) aged 16-74 years, with 105 asymptomatic patients with TMJ condylar erosion and a control group of 105 patients without TMJ condylar erosion. Cone beam computed tomography images were evaluated to classify the severity of TMJ condylar erosion as grade 0 (absence of erosion), grade I (slight erosion), grade II (moderate erosion), or grade III (extensive erosion). The number of missing posterior teeth (mean ± standard deviation [SD]; 2.7 ± 2.4 vs 0.7 ± 1.2) (P < .001), number of dental quadrants with missing posterior teeth (1.5 ± 1.3 vs 0.6 ± 0.9) (P < .001), and bilateral location of missing posterior teeth (41 ± 39.0 vs 10 ± 9.5) (P < .001) were all significantly higher in patients with erosion than in those without erosion. The condylar erosion grade was significantly associated with the number of missing posterior teeth (odds ratio [OR] = 1.24; P = .006), the number of dental quadrants with missing posterior teeth (OR = 1.36; P = .006), and the bilateral occurrence of missing posterior teeth (OR = 3.03; P = .002). The findings from this study suggest a possible association between TMJ condylar erosion grades and the number of missing posterior teeth, the number of quadrants with missing posterior teeth, and the bilateral occurrence of missing posterior teeth.

Diagnostic index of three-dimensional osteoarthritic changes in temporomandibular joint condylar morphology

PubMed Central

Gomes, Liliane R.; Gomes, Marcelo; Jung, Bryan; Paniagua, Beatriz; Ruellas, Antonio C.; Gonçalves, João Roberto; Styner, Martin A.; Wolford, Larry; Cevidanes, Lucia

2015-01-01

Abstract. This study aimed to investigate imaging statistical approaches for classifying three-dimensional (3-D) osteoarthritic morphological variations among 169 temporomandibular joint (TMJ) condyles. Cone-beam computed tomography scans were acquired from 69 subjects with long-term TMJ osteoarthritis (OA), 15 subjects at initial diagnosis of OA, and 7 healthy controls. Three-dimensional surface models of the condyles were constructed and SPHARM-PDM established correspondent points on each model. Multivariate analysis of covariance and direction-projection-permutation (DiProPerm) were used for testing statistical significance of the differences between the groups determined by clinical and radiographic diagnoses. Unsupervised classification using hierarchical agglomerative clustering was then conducted. Compared with healthy controls, OA average condyle was significantly smaller in all dimensions except its anterior surface. Significant flattening of the lateral pole was noticed at initial diagnosis. We observed areas of 3.88-mm bone resorption at the superior surface and 3.10-mm bone apposition at the anterior aspect of the long-term OA average model. DiProPerm supported a significant difference between the healthy control and OA group (p-value=0.001). Clinically meaningful unsupervised classification of TMJ condylar morphology determined a preliminary diagnostic index of 3-D osteoarthritic changes, which may be the first step towards a more targeted diagnosis of this condition. PMID:26158119

OK-432 (Picibanil) sclerotherapy for recurrent dislocation of the temporomandibular joint in elderly edentulous patients: Case reports.

PubMed

Matsushita, Kazuhiro; Abe, Takae; Fujiwara, Toshikatsu

2007-09-01

Dislocation of the temporomandibular joint (TMJ) is a thorny problem not only for a patient but also a doctor. Especially for the elderly edentulous patients, it is very hard to treat the condition although there are many surgical and non-surgical procedures. We successfully treated it in two elderly edentulous patients by injection of OK-432 as a sclerosing agent.

Functional anatomy of the temporomandibular joint (I).

PubMed

Sava, Anca; Scutariu, Mihaela Monica

2012-01-01

Jaw movement is analyzed as the action between two rigid components jointed together in a particular way, the movable mandible against the stabilized cranium. Jaw articulation distinguishes form most other synovial joints of the body by the coincidence of certain characteristic features. Its articular surfaces are not covered by hyaline cartilage as elsewhere. The two jointed components carry teeth the shape, position and occlusion of which having a unique influence on specific positions and movements within the joint. A fibrocartilaginous disc is interposed between upper and lower articular surfaces; this disc compensates for the incongruities in opposing parts and allows sliding, pivoting, and rotating movements between the bony components. These are the reasons for our review of the functional anatomy of the temporomandibular joint.

Temporomandibular joint dysfunction after mandibular fracture in children: a 10-year review.

PubMed

Leuin, Shelby C; Frydendall, Emily; Gao, Dexiang; Chan, Kenny H

2011-01-01

To collect demographic and clinical data on pediatric mandibular fractures and to assess temporomandibular joint (TMJ) dysfunction in patients with condylar and subcondylar (C/SC) fractures. Retrospective case series of pediatric mandibular fractures (1999-2009) with follow-up telephone questionnaire of patients with C/SC fractures. Collected data included age, gender, unilateral vs bilateral C/SC fracture, presence of concomitant fracture, velocity of injury, and treatment modality. Tertiary care children's hospital. Of 164 patients with mandibular fractures, 83 (50.6%) had C/SC fractures, of which 45 (54.2%) completed the questionnaire. Helkimo Anamnestic Dysfunction Index (A(i)) quantification of TMJ dysfunction after C/SC fracture and treatment modality of C/SC fractures. Of the 164 patients, 122 (74.4%) were male (median age, 10.4 years; age range, 0.6-19.0 years). Of the 83 patients with C/SC fractures, 61 (73.5%) were male (median age, 9.1 years; age range, 1.1-18.7 years); 66 (79.5%) had unilateral fractures and 17 (20.5%) had bilateral fractures. The A(i) distribution of the 45 patients who completed the questionnaire was as follows: 15 (33.3%) none, 6 (13.3%) mild, and 24 (53.3%) severe. Females have more severe dysfunction than do males (95% confidence interval, 1.6-140.0; P = .02). No other significant predictors of treatment modality or TMJ dysfunction were identified. Patients with bilateral fracture are 8.1 times (95% confidence interval, 1.0-66.1 times; P = .05) more likely to have closed reduction than are those with unilateral fracture. This is one of the largest series of pediatric C/SC fractures reported in the recent literature. Findings are significant for increased severity of TMJ dysfunction in females and higher incidence of closed reduction in patients with bilateral C/SC fracture.

Interprofessional approach for teaching functional knee joint anatomy.

PubMed

Meyer, Jakob J; Obmann, Markus M; Gießler, Marianne; Schuldis, Dominik; Brückner, Ann-Kathrin; Strohm, Peter C; Sandeck, Florian; Spittau, Björn

2017-03-01

Profound knowledge in functional and clinical anatomy is a prerequisite for efficient diagnosis in medical practice. However, anatomy teaching does not always consider functional and clinical aspects. Here we introduce a new interprofessional approach to effectively teach the anatomy of the knee joint. The presented teaching approach involves anatomists, orthopaedists and physical therapists to teach anatomy of the knee joint in small groups under functional and clinical aspects. The knee joint courses were implemented during early stages of the medical curriculum and medical students were grouped with students of physical therapy to sensitize students to the importance of interprofessional work. Evaluation results clearly demonstrate that medical students and physical therapy students appreciated this teaching approach. First evaluations of following curricular anatomy exams suggest a benefit of course participants in knee-related multiple choice questions. Together, the interprofessional approach presented here proves to be a suitable approach to teach functional and clinical anatomy of the knee joint and further trains interprofessional work between prospective physicians and physical therapists as a basis for successful healthcare management. Copyright © 2016 The Authors. Published by Elsevier GmbH.. All rights reserved.

[Arthrography of the temporomandibular joint. Indications, technic and interpretation].

PubMed

Jend, H H; Triebel, H J; Jend-Rossmann, I

1986-09-01

Articular dysfunction of the TMJ with anterior displacement of the disc ("internal derangement") is an entity which has been separated from other types of the "myofascial pain syndromes" and which can be treated conservatively or by surgery. Arthrography of the TMJ has contributed greatly to an understanding of normal and abnormal function and, in many cases, it can provide a diagnosis. On the basis of our experience with 80 investigations we discuss technical problems and the clinical indications. The indications for arthrography are in the pre-operative diagnosis, when clinical findings are uncertain, in order to demonstrate perforation, in order to confirm a suspected diagnosis and to assist in prosthetic treatment.

Management of extra-capsular temporo-mandibular joint ankylosis: does conservative approach to treatment have a role?

PubMed

Anyanechi, C E; Osunde, O D; Bassey, G O

2015-06-01

The conventional management of fibrous extracapsular temporo-mandibular joint (TMJ) ankylosis, a debilitating disease, is associated with surgical complications and financial burden on the patients. To assess the outcome of conservative approach to the management of fibrous extracapsular TMJ ankylosis. This is a prospective study of patients who presented at the Dental and Maxillofacial Surgery Clinic of the University of Calabar Teaching Hospital, Nigeria, during the period from January 1999 to December 2012 with a history of inability to open the mouth diagnosed as fibrous extracapsular TMJ ankylosis. Twenty-one subjects were treated and their ages ranged from 11 to 22 years with mean at 15.0 years. There were 13 (61.9 %) males and 8 (38.1 %) females with male: female ratio of 1.6:1. The aetiological factor that predisposed to formation of extracapsular TMJ ankylosis was facial trauma. There was no facial asymmetry and the side distribution of the affliction showed that 1 (4.8 %) was bilateral while 20 (95.2 %) were unilateral. Eight cases (38.1 %) were incomplete ankylosis while the rest (n = 13, 61.9 %) were complete. The shorter the duration of fibrous ankylosis and the greater the initial inter-incisal distance before treatment, the better the treatment outcome. The outcome of treatment suggests that the conservative approach to management of this condition was beneficial to these patients because they presented early. However, randomized controlled clinical trials are needed to validate this treatment option.

Temporomandibular joint arthroplasty for osteoarthrosis: A series of 24 patients that received a uni- or bilateral inter-positional silicone sheet.

PubMed

Boutault, F; Cavallier, Z; Lauwers, F; Prevost, A

2018-06-01

To evaluate mid-term results from using a silicone sheet for inter-positional arthroplasty in moderate or severe cases of osteoarthrosis of the temporo-mandibular joint (TMJ). To also determine any remaining indications from this method. This retrospective study included patients that underwent surgery between 2008 and 2016. Pre- and post-operative mouth opening (MO), according to inter-incisal distance (mm) and pain score (PS: 0=no pain to 4=very severe pain) were recorded for 24 patients. Patients were divided according to thickness of the silicone sheet (group A: 1.0 mm, group B: 1.5 mm). The cohort included 22 females (92%). Mean age at surgery was 55 years±13 (26-80). Mean length of follow-up was 26 months±24 (6-80). Mean improvement in MO was 8.2 mm (+33%) and of PS was 1.7 (-68%). MO was not improved for two patients and worsened for one. PS score improved for all patients. No statistical difference was found between groups A and B. There was also a tendency for degradation of outcomes over time. The poor reputation of prosthetic discoplasty was not as evident in our series, even though anatomical and functional status seemed to deteriorate over time. This is because total-joint prosthetic replacement is often proposed instead. However, for elderly or fragile patients that have severe pain, and regarding cost-benefit aspects, conventional arthroplasty can still be discussed, especially since French national health-care insurance does not yet support TMJ prosthetic replacement for osteoarthrosis. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Functional joint regeneration is achieved using reintegration mechanism in Xenopus laevis

PubMed Central

Yamada, Shigehito

2016-01-01

Abstract A functional joint requires integration of multiple tissues: the apposing skeletal elements should form an interlocking structure, and muscles should insert into skeletal tissues via tendons across the joint. Whereas newts can regenerate functional joints after amputation, Xenopus laevis regenerates a cartilaginous rod without joints, a “spike.” Previously we reported that the reintegration mechanism between the remaining and regenerated tissues has a significant effect on regenerating joint morphogenesis during elbow joint regeneration in newt. Based on this insight into the importance of reintegration, we amputated frogs’ limbs at the elbow joint and found that frogs could regenerate a functional elbow joint between the remaining tissues and regenerated spike. During regeneration, the regenerating cartilage was partially connected to the remaining articular cartilage to reform the interlocking structure of the elbow joint at the proximal end of the spike. Furthermore, the muscles of the remaining part inserted into the regenerated spike cartilage via tendons. This study might open up an avenue for analyzing molecular and cellular mechanisms of joint regeneration using Xenopus. PMID:27499877

Oral splint for temporomandibular joint disorders with revolutionary fluid system

PubMed Central

Srivastava, Rahul; Jyoti, Bhuvan; Devi, Parvathi

2013-01-01

Temporomandibular joint (TMJ) diseases and disorders refer to a complex and poorly understood set of conditions, manifested by pain in the area of the jaw and associated muscles and limitations in the ability to make the normal movements of speech, facial expression, eating, chewing, and swallowing. The conventional soft occlusal splint therapy is a much safer and effective mode of a conservative line of therapy in comparison to the surgical therapy for temporomandibular joint disorders (TMD). The purpose of this article is to review the Aqualizer™, an hydrostatic oral splint, as accurate, effective treatment and differential diagnostic tool in TMD that allow treating the patient's pain quickly and accurately saving valuable treatment time. The review article has been prepared doing a literature review from the world-wide web and pubmed/medline. PMID:24019797

[Establishment of animal model of temporomandibular joint synovitis and its histological investigation].

PubMed

Chen, Cai-Yun; Ding, Yin; Liu, Ya-Jing; Zhang, Ya-Bo

2010-02-01

To establish a stable animal model of temporomandibular joint (TMJ) synovitis. Sixteen 6-week-old male SD rats were classified into four groups, control group, occlusal dimension increase group, masseter resection group, occlusal dimension increase group and masseter resection group. The rats in the occlusal dimension increase group were adhered composite resin to their maxillary molars in order to increase the occlusal vertical dimension when they were 9-week-old. The rats in the masseter resection group were cut off their bilateral masseter muscles when they were 6-week-old. In the occlusal dimension increase group and masseter resection group, rats' bilateral masseter muscles were resected and occlusal vertical dimension was increased. All rats were sacrificed at their 10 weeks old. TMJ samples were prepared for histology to evaluate the animal model. The control group showed non-inflammatory changes. The occlusal dimension increase group and the masseter resection group showed vascular dilation and synovial lining proliferation, but there were no statistically significant differences between the two groups (P > 0.05). Compared to the two disposed groups, the occlusal dimension increase group and masseter resection group showed significant inflammatory changes (P < 0.05), including synovial lining proliferation, vascular dilation and fibrin deposit. The animal model of TMJ synovitis created in the present investigation could simulate the real pathological features of synovitis in vivo, and this animal model showed the obvious merits of high stability and reproduction.

The Role of Transcutaneous Electrical Nerve Stimulation in the Management of Temporomandibular Joint Disorder.

PubMed

Awan, Kamran Habib; Patil, Shankargouda

2015-12-01

Temporomandibular joint disorders (TMD) constitutes of a group of diseases that functionally affect the masticatory system, including the muscles of mastication and temporomandibular joint (TMJ). A number of etiologies with specific treatment have been identified, including the transcutaneous electrical nerve stimulation (TENS). The current paper presents a literature review on the use of TENS in the management of TMD patients. Temporomandibular joint disorder is very common disorder with approximately 75% of people showing some signs, while more than quarter (33%) having at least one symptom. An attempt to treat the pain should be made whenever possible. However, in cases with no defined etiology, starting with less intrusive and reversible techniques is prescribed. Transcutaneous electrical nerve stimulation is one such treatment modality, i.e. useful in the management of TMD. It comprises of controlled exposure of electrical current to the surface of skin, causing hyperactive muscles relaxation and decrease pain. Although the value of TENS to manage chronic pain in TMD patients is still controversial, its role in utilization for masticatory muscle pain is significant. However, an accurate diagnosis is essential to minimize its insufficient use. Well-controlled randomized trials are needed to determine the utilization of TENS in the management of TMD patients.

Long-term results of the use of silicone sheets after diskectomy in the temporomandibular joint: clinical, radiographic and histopathologic findings.

PubMed

Schliephake, H; Schmelzeisen, R; Maschek, H; Haese, M

1999-10-01

The aim of the present study was to evaluate the long-term results of a group of patients who had the disk of the temporomandibular joint (TMJ) removed and permanently replaced by a silicone sheet. The study group comprised 48 patients, treated in the period from 1983 to 1993. In eight patients, the implants had to be removed after an average interval of 5.6 years and they were submitted for histopathological examination. Twenty-five of the 40 patients with silastic implants in place, and five of the 8 patients who had their implants removed, were available for long-term follow-up (mean interval of 7.0 years, SD 2.8 years). Clinical function was rated according to the Helkimo Dysfunction Index and compared to the preoperative findings. Results showed decreased tenderness of muscles and joints to palpation and increased mouth opening, but no statistically significant improvement in joint function. In 4 patients, a decrease in condylar width was found, while another 4 patients presented with thickening of the condyle by appositional bone formation. Histopathology of the failed implants showed scattered fragments of silastic material and dacron fibers with accumulation of histiocytes in immediate contact with the silicone particles and phagocytozed intracellular material. T-lymphocytes were also present in the vicinity of the silicone particles.

Soft versus hard occlusal splint therapy in the management of temporomandibular disorders (TMDs)

PubMed Central

Seifeldin, Sameh A; Elhayes, Khaled A.

2015-01-01

Aim To compare between soft and hard occlusal splint therapy for the management of myofacial pain dysfunction (MPD) or internal derangement (ID) of the temporomandibular joint (TMJ) with reciprocal clicking. Patients and methods This study included 50 patients (age range: 24–47 years) who had been diagnosed with MPD or ID of the TMJ in the form of reciprocal clicking. Patients were divided into two groups. They were treated for 4 months with either a vacuum-formed soft occlusal splint constructed from 2-mm-thick elastic rubber sheets (soft splint group) or a hard flat occlusal splint fabricated from transparent acrylic resin (hard splint group). Monthly follow-up visits were performed during the treatment period. Before treatment and 1, 2, 3 and 4 months after treatment, the dentist measured all parameters of TMJ function (pain visual analog scores, tenderness of masticatory muscles, clicking and tenderness of the TMJ, and range of mouth opening). Results All parameters of TMJ function showed significant improvement in both groups during the follow-up period, with a statistically significant difference between the two groups at the 4-month follow-up visit. Conclusions Both forms of occlusal splints (soft and hard) improved TMJ symptoms in patients with MPD or ID of the TMJ. However, the soft occlusal splints exhibited superior results after 4 months of use. PMID:26644756

[The temporo-mandibular articulation].

PubMed

Dargaud, J; Vinkka-Puhakka, H

2004-04-01

The standing posture of humans has created both morphological and functional adaptations in the temporo-mandibular joint and the masticatory function. This biped state is the one of the most important characteristic of human evolution. It is furthermore the agent determining most of the functional changes in the whole body. This survey will be carried out in several levels including, a descriptive anatomy, biomechanics, radiological imaging, functioning in the articulation of TMJ. The descriptive anatomic picture will be obtained by the traditional dissection techniques. 20 TMJ joints are dissected from 10 cadavers: 7 cadavers, 65-75 year old, 3 cadavers, 60-65 year old. The x-rays are lateral view and the subjects of the radiological imaging are young's, adults and olds: 1, 3 y-old Male; 1, 7 y-old Female; 1, 14 y-old Female; 10, 19-23 y-old Male; 1, 26 y-old Female; 1, 34 y-old Male; 1, 75 y-old Female. The anatomic elements in the TMJ well resembled the ones described in the literature of the capsule, the ligament, the masticator muscles (masseter, temporal, medial and lateral pterygoids). The temporo-mandibular ligament proved to be difficult to separate from the capsule in some of the specimens. Sometimes it was not always found after a dissection.

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

Akinbami, Babatunde O

2011-06-15

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. 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. 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. 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.

Reactive arthritis in relation to internal derangements of the temporomandibular joint: a case control study.

PubMed

Lund, Bodil; Holmlund, Anders; Wretlind, Bengt; Jalal, Shah; Rosén, Annika

2015-09-01

The aim of this study was to find out if reactive arthritis was involved in the aetiology of chronic closed lock of the temporomandibular joint (TMJ) by looking for bacterial antigens in the synovial membrane of the TMJ, and by studying the antibody serology and carriage of human leucocyte antigen (HLA) B27 in patients with chronic closed lock. Patients with reciprocal clicking and healthy subjects acted as controls. We studied a total of 43 consecutive patients, 15 with chronic closed lock, 13 with reciprocal clicking, and 15 healthy controls with no internal derangements of the TMJ. Venous blood samples were collected from all subjects for measurement of concentrations of HLA tissue antigen and serology against Chlamydia trachomatis, Yersinia enterocolitica, Salmonella spp., Campylobacter jejuni, and Mycoplasma pneumoniae. Samples of synovial tissue from patients with closed lock and reciprocal clicking were obtained during discectomy and divided into two pieces, the first of which was tested by strand displacement amplification for the presence of C trachomatis, and the second of which was analysed for the presence of species-specific bacterial DNA using 16s rRNA pan-polymerase chain reaction (PCR). There were no significant differences between the groups in the incidence of antibodies against M pneumoniae, Salmonella spp. or Y enterocolitica. No patient had antibodies towards C trachomatis or C jejuni. We found no bacterial DNA in the synovial fluid from any patient. The HLA B27 antigen was present in 2/15 subjects in both the closed lock and control groups, and none in the reciprocal clicking group. In conclusion, reactive arthritis does not seem to be the mechanism of internal derangement of the TMJ. Copyright © 2015. Published by Elsevier Ltd.

Influence of wavelength on the outcome of the treatment of TMJ disorders: TMDS

NASA Astrophysics Data System (ADS)

Pinheiro, Antônio L. B.; Marques, Aparecida Maria C.; Carvalho, Carolina M.; Cangussú, Maria Cristina T.; Soares, Luiz Guilherme P.

2013-03-01

It is known that wavelength influences the outcome of many clinical protocols. Laser-phototherapy (LPT) and LEDs have been used on the treatment of pain of several origins including temporomandibular disorders - TMDs. TMDs are common painful multifactorial conditions affecting the temporomandibular joint whose treatment depends on the type and symptoms. Initially it requires pain control and for this, drugs, biting plates, oclusal adjustment, physiotherapy or their association are used. This work reports a series of patients of the Center of Biophotonics of the Federal University of Bahia over 10 years. Following standard anamneses, clinical and imaginologic examination and with the diagnosis of any type of TMD, the patients were set for light treatment. Treatment consisted of three sessions a week during six week. Prior irradiation, the patients were asked to score their pain using a VAS. λ780, λ 790, λ 830nm and/or λ660 and λ680nm lasers or LED were used on each session. Most patients were female (~43.6 years old). At the end of the 12 sessions the patients were again examined and score their pain using VAS. No other intervention was carried out during the treatment. The results were statistically analyzed and showed that most patients were asymptomatic or improved after treatment and that the association of wavelengths was very efficient on the symptomatic group. It is concluded that the association of both wavelengths was effective on pain reduction on TMJ disorders of several origins.

Adaptive alterations of elastic fibers in the bilaminar zone of rabbit temporomandibular joint following disc displacement.

PubMed

Gu, Zhiyuan; Wu, Huiling; Feng, Jianying; Shibata, Takanori; Hu, Ji'an; Zhang, Yinkai; Xie, Zhijian

2002-12-01

To study the adaptive alterations of elastic fibers in the bilaminar zone (BZ) of rabbit temporomandibular joint (TMJ) following disc displacement. Twenty-eight Japanese white rabbits were used in this study. The right temporomandibular joints of 20 of 28 rabbits were subjected to the surgical procedure of anterior disc displacement (ADD). Four rabbits in the surgical group were sacrificed at 2, 4, 6, 8 and 12 weeks after operation. Their temporomandibular joints were studied histochemically. Elastic fibers were reduced in number and ran irregularly in the superior lamina of BZ from ADD rabbits. The jungly elastic fibers (EFs) could still be seen at 2 weeks after operation. At 4 weeks, the number of EFs decreased significantly; EFs lost their jungly arrangement and were shaped like rough dots, of which the arrangement and the lengths were different. Six weeks after operation, many EFs were replaced by distorted, uneven, non-oriented fine EFs, distributed unevenly and some thick or fine EFs that ran irregularly. The number of EFs decreased further and their arrangement was more deranged at 8 weeks. At 10 and 12 weeks, EFs in the superior lamina of BZ were similar to those at 8 weeks. Our results show that EFs lost their function as well as their distribution and arrangement after disc displacement.

Strain rate dependent orthotropic properties of pristine and impulsively loaded porcine temporomandibular joint disk.

PubMed

Beatty, M W; Bruno, M J; Iwasaki, L R; Nickel, J C

2001-10-01

The purpose of this study was to characterize the tensile stress-strain behavior of the porcine temporomandibular joint (TMJ) disk with respect to collagen orientation and strain rate dependency. The apparent elastic modulus, ultimate tensile strength, and strain at maximum stress were measured at three elongation rates (0.5, 50, and 500 mm/min) for dumbbell-shaped samples oriented along either anteroposterior or mediolateral axes of the disks. In order to study the effects of impact-induced fissuring on the mechanical behavior, the same properties were measured along each orientation at an elongation rate of 500 mm/min for disks subjected to impulsive loads of 0.5 N. s. The results suggested a strongly orthotropic nature to the healthy pristine disk. The values for the apparent modulus and ultimate strength were 10-fold higher along the anteroposterior axis (p < or = 0.01), which represented the primary orientation of the collagen fibers. Strain rate dependency was evident for loading along the anteroposterior axis but not along the mediolateral axis. No significant differences in any property were noted between pristine and impulsively loaded disks for either orientation (p > 0.05). The results demonstrated the importance of choosing an orthotropic model for the TMJ disk to conduct finite element modeling, to develop failure criteria, and to construct tissue-engineered replacements. Impact-induced fissuring requires further study to determine if the TMJ disk is orthotropic with respect to fatigue.

Laser therapy reduces gelatinolytic activity in the rat trigeminal ganglion during temporomandibular joint inflammation.

PubMed

Desiderá, A C; Nascimento, G C; Gerlach, R F; Leite-Panissi, C R A

2015-07-01

To investigate whether low-level laser therapy (LLLT) alters the expression and activity of MMP-2 and MMP-9 in the trigeminal ganglion (TG) during different stages of temporomandibular joint (TMJ) inflammation in rats. It also evaluated whether LLLT modifies mechanical allodynia and orofacial hyperalgesia. Wistar rats (±250 g) were divided into groups that received saline (SAL) or complete Freund's adjuvant (CFA, 50 μl) in the TMJ, and that later underwent LLLT (20 J cm(-2) ) at their TMJ or not (groups SAL, SAL + LLLT, CFA, and CFA + LLLT). LLLT was applied on days 3, 5, 7, and 9 after SAL or CFA. Mechanical allodynia was evaluated on days 1, 3, 5, 7, and 10; orofacial hyperalgesia was assessed on day 10. Gelatin zymography and in situ zymography aided quantification of MMPs in the TG. Low-level laser therapy abolished the reduction in the mechanical orofacial threshold and the increase in orofacial rubbing during the orofacial formalin test induced by CFA. LLLT also decreased the CFA-induced rise in the levels of MMP-9 and MMP-2 as well as the gelatinolytic activity in the TG. Low-level laser therapy could constitute an adjuvant therapy to treat temporomandibular disorders and prevent inflammation-induced alterations in the levels of MMP-2 and MMP-9 and in the gelatinolytic activity in TGs. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Evaluation of total alloplastic temporo-mandibular joint replacement with two different types of prostheses: A three-year prospective study.

PubMed

Gonzalez-Perez, L-M; Gonzalez-Perez-Somarriba, B; Centeno, G; Vallellano, C; Montes-Carmona, J-F

2016-11-01

Temporo-Mandibular Joint (TMJ) replacement has been used clinically for years. The objective of this study was to evaluate outcomes achieved in patients with two different categories of TMJ prostheses. All patients who had a TMJ replacement (TMJR) implanted during the study period from 2006 through 2012 were included in this 3-year prospective study. All procedures were performed using the Biomet Microfixation TMJ Replacement System, and all involved replacing both the skull base component (glenoid fossa) and the mandibular condyle. Fifty-seven patients (38 females and 19 males), involving 75 TMJs with severe disease requiring reconstruction (39 unilateral, 18 bilateral) were operated on consecutively, and 68 stock prostheses and 7 custom-made prostheses were implanted. The mean age at surgery was 52.6±11.5 years in the stock group and 51.8±11.7 years in the custom-made group. In the stock group, after three years of TMJR, results showed a reduction in pain intensity from 6.4±1.4 to 1.6±1.2 (p<0.001), and an improvement in jaw opening from 2.7±0.9 cm to 4.2±0.7 cm (p<0.001). In the custom-made group, after three years of TMJR, results showed a reduction in pain intensity from 6.0±1.6 to 2.2±0.4 (p<0.001), and an improvement in jaw opening from 1.5±0.5 cm to 4.3±0.6 cm (p<0.001). No statistically significant differences between two groups were detected. The results of this three-year prospective study support the surgical placement of TMJ prostheses (stock prosthetic, and custom-made systems), and show that the approach is efficacious and safe, reduces pain, and improves maximum mouth opening movement, with few complications. As such, TMJR represents a viable technique and a stable long-term solution for cranio-mandibular reconstruction in patients with irreversible end-stage TMJ disease. Comparing stock and custom-made groups, no statistically significant differences were detected with respect to pain intensity reduction and maximum mouth opening

Low-level laser therapy stimulates tissue repair and reduces the extracellular matrix degradation in rats with induced arthritis in the temporomandibular joint.

PubMed

Lemos, George Azevedo; Rissi, Renato; de Souza Pires, Ivan Luiz; de Oliveira, Letícia Prado; de Aro, Andrea Aparecida; Pimentel, Edson Rosa; Palomari, Evanisi Teresa

2016-08-01

The objective of this study was to characterize morphological and biochemistry action of low-level laser therapy (LLLT) on induced arthritis in the temporomandibular joint (TMJ) of rats. Twenty-four male Wistar rats were randomly divided into groups with 12 animals each: (AG) group with arthritis induced in the left TMJ and (LG) group with arthritis induced in the left TMJ and treated with LLLT (830 nm, 30 mW, 3 J/cm(2)). Right TMJs in the AG group were used as noninjected control group (CG). Arthritis was induced by intra-articular injection of 50 μl Complete Freund's Adjuvant (CFA) and LLLT began 1 week after arthritis induction. Histopathological analysis was performed using sections stained with hematoxylin-eosin, Toluidine Blue, and picrosirius. Biochemical analysis was determined by the total concentration of sulfated glycosaminoglycans (GAGs) and evaluation of matrix metalloproteinases (MMP-2 and MMP-9). Statistical analysis was performed using paired and unpaired t tests, with p < 0.05. Compared to AG, LG had minor histopathological changes in the TMJ, smaller thickness of the articular disc in the anterior (p < 0.0001), middle (p < 0.0001) and posterior regions (p < 0.0001), high birefringence of collagen fibers in the anterior (p < 0.0001), middle (p < 0.0001) and posterior regions (p < 0.0001) on the articular disc, and statistically lower activity of MMP-2 latent (p < 0.0001), MMP-2 active (P = 0.02), MMP-9 latent (p < 0.0001), and MMP-9 active (p < 0.0001). These results suggest that LLLT can increase the remodeling and enhancing tissue repair in TMJ with induced arthritis.

Aural symptoms in patients with temporomandibular joint disorders: multiple frequency tympanometry provides objective evidence of changes in middle ear impedance.

PubMed

Riga, Maria; Xenellis, John; Peraki, Eleni; Ferekidou, Elisa; Korres, Stavros

2010-12-01

The association of temporomandibular joint (TMJ) disorders with aural symptoms, such as tinnitus, otic fullness, and subjective decrease of hearing acuity, is a well-established clinical observation. Although several hypotheses have been made about the otic-conductive origin of these complaints, conventional 226-Hz tympanometry has failed to demonstrate any middle ear abnormalities. The aim of this study was to evaluate patients with TMJ disorders with multiple frequency tympanometry (MFT). Prospective clinical study. Outpatient clinic. The population of this study consisted of 40 patients with unilateral TMJ disorders diagnosed for longer than 1 month. After verifying that there were no abnormal otoscopic findings, 226-Hz tympanometry, conventional pure-tone audiometry, brainstem auditory evoked potentials, and MFT were performed. Resonant frequency (RF) values. With the exception of MFT, no abnormal audiologic findings were revealed. The ear ipsilateral to the lesion demonstrated significantly higher (p = 0.002) RF values in comparison to the contralateral ear. The difference in RF values was more obvious in patients aged 45 years or younger. The results of this study imply an increase in the stiffness of the middle ear, which has not been detected by conventional tympanometry. This represents the first concrete documentation of minor alterations in the conductive properties of the middle ear and seems to support the various hypotheses on the middle-ear origin of aural complaints in patients with TMJ disorders. Further studies are needed before a clear insight on the presumably multifactorial pathophysiology of these complaints can finally be reached.

Effects on G Tolerance While Biting Down on a Mandibular Orthopedic Repositioning Appliance (MORA) Levels.

DTIC Science & Technology

1990-10-01

Repositioning Appliance (MORA) that properly aligns the temporo mandibular joint (TMJ) requires voluntary contraction of the masseter and temporal’s...growth, malocclusion, or bad oral posture may cause the Temporo Mandibular Joint (TMJ) to grad- ually become misaligned. The masseter and other muscles...books have been published on the use of a Mandibular Orthopedic Repositioning Appliance (MORA) to realign the joint (Figure 1). Realignment is claimed

A multidisciplinary approach in the treatment of tempromandibular joint pain associated with qat chewing.

PubMed

Shariff, Mansoor; Al-Moaleem, Mohammed M; Al-Ahmari, Nasser M

2013-01-01

Pain of the tempro-mandibular joint (TMJ) has a direct bearing to missing teeth and excessive physical activity. Consumption of qat requires chewing on the leaves to extract their juice for long hours. A 65-year-old male Yemeni patient, a Qat chewer, reported to the university dental hospital at King Khalid University complaining of pain in left temporomandibular joint with missing mandibular anterior teeth. A multidisciplinary approach for the overall treatment of the patient was decided. Initial treatment was the relief of patient's pain with the help of a night guard. This was followed by a fabrication of anterior FPD. The case was under maintenance and follow-up protocol for a period of 8 months with no complaint of pain discomfort.

A Multidisciplinary Approach in the Treatment of Tempromandibular Joint Pain Associated with Qat Chewing

PubMed Central

Shariff, Mansoor; Al-Moaleem, Mohammed M.; Al-Ahmari, Nasser M.

2013-01-01

Pain of the tempro-mandibular joint (TMJ) has a direct bearing to missing teeth and excessive physical activity. Consumption of qat requires chewing on the leaves to extract their juice for long hours. A 65-year-old male Yemeni patient, a Qat chewer, reported to the university dental hospital at King Khalid University complaining of pain in left temporomandibular joint with missing mandibular anterior teeth. A multidisciplinary approach for the overall treatment of the patient was decided. Initial treatment was the relief of patient's pain with the help of a night guard. This was followed by a fabrication of anterior FPD. The case was under maintenance and follow-up protocol for a period of 8 months with no complaint of pain discomfort. PMID:23573427

Validity of temporomandibular disorder examination procedures for assessment of temporomandibular joint status.

PubMed

Schmitter, Marc; Kress, Bodo; Leckel, Michael; Henschel, Volkmar; Ohlmann, Brigitte; Rammelsberg, Peter

2008-06-01

This hypothesis-generating study was performed to determine which items in the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and additional diagnostic tests have the best predictive accuracy for joint-related diagnoses. One hundred forty-nine TMD patients and 43 symptom-free subjects were examined in clinical examinations and with magnetic resonance imaging (MRI). The importance of each variable of the clinical examination for correct joint-related diagnosis was assessed by using MRI diagnoses. For this purpose, "random forest" statistical software (based on classification trees) was used. Maximum unassisted jaw opening, maximum assisted jaw opening, history of locked jaw, joint sound with and without compression, joint pain, facial pain, pain on palpation of the lateral pterygoid area, and overjet proved suitable for distinguishing between subtypes of joint-related TMD. Measurement of excursion, protrusion, and midline deviation were less important. The validity of clinical TMD examination procedures can be enhanced by using the 16 variables of greatest importance identified in this study. In addition to other variables, maximum unassisted and assisted opening and a history of locked jaw were important when assessing the status of the TMJ.

Effect of protraction facemask on the temporomandibular joint: a systematic review.

PubMed

Huang, Xinqi; Cen, Xiao; Liu, Jun

2018-03-12

The aim of this study was to assess the influence of protraction facemask (PFM) on temporomandibular joint (TMJ) of skeletal Class III malocclusion patients. Literature searches were carried out electronically in five English and three Chinese databases (Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, Embase, MEDLINE (via Ovid), Chinese Biomedical Literature Database, China National Knowledge Infrastructure, and VIP Database). The date of the most recent search was 22 March 2017. Randomized controlled trials, controlled clinical trials, cohort studies, and before-after studies comparing the effect of PFM and other treatments on TMJ were included. The data were collected and extracted by three authors. The risk of bias in the RCTs was assessed in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. For the nonrandomized studies, the risk of bias was judged with Newcastle-Ottawa Scale. For the 261 articles identified, 13 studies with 522 participants were included for the final qualitative analysis. Three studies were graded as high value of evidence, while seven studies and the other three studies were graded as moderate value and low value respectively. According to the available evidence, PFM contributed to the significant increase of CondAx-SBL and the significant decrease of CondAx-ML. Thin-plate spline (TPS) analysis showed a horizontal compression in condyles. Condyles tended to move superiorly and posteriorly. Concerning the occurrence of temporomandibular disorders (TMD), PFM was not involved in aggravating TMJ symptoms and signs. Clinical evidence suggests that PFM might contribute to the morphologic adaptation of TMJs and displacement of condyles, and PFM may well be not a risk factor for the development of TMD.

Gender Difference in Prevalence of Signs and Symptoms of Temporomandibular Joint Disorders: A Retrospective Study on 243 Consecutive Patients

PubMed Central

Bagis, Bora; Ayaz, Elif Aydogan; Turgut, Sedanur; Durkan, Rukiye; Özcan, Mutlu

2012-01-01

Background: This study evaluated the prevalence of the signs and symptoms of temporomandibular joint disorder (TMD) among patients with TMD symptoms. Methods: Between September 2011 and December 2011, 243 consecutive patients (171 females, 72 males, mean age 41 years) who were referred to the Department of Prosthodontics, Faculty of Dentistry, Karadeniz Technical University, Trabzon were examined physically and completed a questionnaire regarding age, gender, social status, general health, antidepressant drug usage, dental status, limited mouth opening, temporomandibular joint (TMJ) sounds, and parafunctions (bruxism, clenching). The data were analyzed using the chi-square test and binary logistic regression model (alpha = 0.05). Results: With a frequency of 92%, pain in the temporal muscle was the most common symptom, followed by pain during mouth opening (89%) in both genders. TMJ pain at rest, pain in the masseter muscle, clicking, grinding, and anti-depressant use were significantly more frequent in females than males. Age (p=0.006; odds ratio 0.954; 95% CI 0.922-0.987) and missing teeth (p=0.003; odds ratio 3.753; 95% CI 1.589-8.863) had significant effects on the prevalence of TMD. Conclusion: Females had TMD signs and symptoms more frequently than males in the study population. The most common problem in both genders was pain. PMID:22991492

Joint torques in a freely walking insect reveal distinct functions of leg joints in propulsion and posture control

PubMed Central

2016-01-01

Determining the mechanical output of limb joints is critical for understanding the control of complex motor behaviours such as walking. In the case of insect walking, the neural infrastructure for single-joint control is well described. However, a detailed description of the motor output in form of time-varying joint torques is lacking. Here, we determine joint torques in the stick insect to identify leg joint function in the control of body height and propulsion. Torques were determined by measuring whole-body kinematics and ground reaction forces in freely walking animals. We demonstrate that despite strong differences in morphology and posture, stick insects show a functional division of joints similar to other insect model systems. Propulsion was generated by strong depression torques about the coxa–trochanter joint, not by retraction or flexion/extension torques. Torques about the respective thorax–coxa and femur–tibia joints were often directed opposite to fore–aft forces and joint movements. This suggests a posture-dependent mechanism that counteracts collapse of the leg under body load and directs the resultant force vector such that strong depression torques can control both body height and propulsion. Our findings parallel propulsive mechanisms described in other walking, jumping and flying insects, and challenge current control models of insect walking. PMID:26791608

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

2011-01-01

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. PMID:21676208

Bony eminence on the middle cranial fossa corresponding to the temporomandibular joint.

PubMed

Tsunoda, Atsunobu; Sumi, Takuro; Shirakura, Satoshi; Kishimoto, Seiji; Akita, Keiichi

2007-07-01

We report a nameless bony eminence over the temporomandibular joint (TMJ) and its possible clinical significance. Forty-two half heads of 21 UK Caucasian cadavers (61-95 years old, mean 84.3 +/- 8.2 years, male:female = 11:10) were used to investigate the surface of the middle cranial fossa (MCF) over the TMJ. The thickness of the bony roof of the glenoid fossa was also measured. A bony eminence over the glenoid fossa was observed in half of the specimens. Some showed a complete oval bulge, which completely reflected the contour of the glenoid fossa. The others showed a bony bulge, which partially reflected that contour. The mean (+/-SD) thickness of the bone in the roof of glenoid fossa was 1.5 +/- 1.2 mm. The mean bony thickness of specimens showing the eminence was 0.8 +/- 0.5 mm, whereas it was 2.3 +/- 1.2 mm in specimens without an eminence. These differences were statistically significant (P < 0.01). The osteological features we describe may be relevant to certain clinical problems. Traumatic dislocation of mandibular condyle, for example, might relate to a weakness of the glenoid fossa. Copyright 2006 Wiley-Liss, Inc.

Multi-subject Manifold Alignment of Functional Network Structures via Joint Diagonalization.

PubMed

Nenning, Karl-Heinz; Kollndorfer, Kathrin; Schöpf, Veronika; Prayer, Daniela; Langs, Georg

2015-01-01

Functional magnetic resonance imaging group studies rely on the ability to establish correspondence across individuals. This enables location specific comparison of functional brain characteristics. Registration is often based on morphology and does not take variability of functional localization into account. This can lead to a loss of specificity, or confounds when studying diseases. In this paper we propose multi-subject functional registration by manifold alignment via coupled joint diagonalization. The functional network structure of each subject is encoded in a diffusion map, where functional relationships are decoupled from spatial position. Two-step manifold alignment estimates initial correspondences between functionally equivalent regions. Then, coupled joint diagonalization establishes common eigenbases across all individuals, and refines the functional correspondences. We evaluate our approach on fMRI data acquired during a language paradigm. Experiments demonstrate the benefits in matching accuracy achieved by coupled joint diagonalization compared to previously proposed functional alignment approaches, or alignment based on structural correspondences.

Outcomes of management of early temporomandibular joint disorders: How effective is nonsurgical therapy in the long-term?

PubMed Central

Mortazavi, Seyed Hossein; Motamedi, Mohammad Hosein Kalantar; Navi, Fina; Pourshahab, Majid; Bayanzadeh, Seyed Masoud; Hajmiragha, Habib; Isapour, Mona

2010-01-01

Aim The first step in the management of Temporomandibular Disorders (TMD) is usually noninvasive, especially if the disorder is in the early stages. Clinically, pain and clicking are early signs and symptoms of TMD. The management of TMD usually includes “splint therapy” and analgesics. In this study, we report our long-term outcomes in the treatment of patients suffering from early TMD. Materials and Methods: We assessed the records of 138 patients who were referred for management of TMD. Selection was based on pain and/or clicking of the Temporomandibular Joint (TMJ), no pathologic lesions of the TMJ, no anterior disc displacement without reduction (closed lock), no Degenerative Joint Disease, no history of migraine, trauma, osteoarthritis, metabolic disease, or malocclusion (deep bite, cross bite, jaw deformity, etc). The patients were treated with an acrylic maxillary Interocclusal Splint (IOS) cuspid-rise type and were told to refrain from biting, yawning and chewing hard food. The outcome of the treatment, potential etiologic factors (Bruxism), signs and symptoms and patient demographics (such as age, sex, treatment duration, etc.) were assessed. The data were analyzed using the Chi-square test to correlate significance. Results: One hundred thirty-eight patients (26 males and 112 females) with early signs and symptoms of TMD (pain and/or click of the TMJ) were treated from 2001 to 2010; 81% were females and 19% were males. All the 138 patients used the IOS at night only. The patients were followed-up for 1–9 years. Data analysis showed that 64% of the patients were completely relieved of signs and symptoms; 22% were moderately relieved (decreased severity of signs and symptoms) and 14% had no noticeable post-treatment changes in clicking or pain (P = 0.001). Patients with bruxism and those presenting with both pain and clicking showed a better response to IOS treatment (P = 0.046 and P = 0.001, respectively). The results also showed that age, sex

Anatomical and Functional Recovery of Intracapsular Fractures of the Mandibular Condyle: Analysis of 124 Cases after Closed Treatment

PubMed Central

Lee, Jong-Sung; Jeon, Eun-Gyu; Seol, Guk-Jin; Choi, So-Young; Kim, Jin-Wook; Kwon, Tae-Geon; Paeng, Jun-Young

2014-01-01

Purpose: The purpose of this study is to evaluate the influence of intracapsular fracture lines of the mandibular condyle on the anatomical and functional recovery after non-surgical closed treatment. Methods: Clinical and radiological follow-up of 124 patients with intracapsular fractures of the mandibular condyle was performed after closed treatment between 2005 and 2012. The intracapsular fractures were classified into three categories: type A (medial condylar pole fracture), type B (lateral condylar pole fracture with loss of vertical height) and type M (multiple fragments or comminuted fracture). Results: By radiological finding, fracture types B and M lost up to 24% vertical height of the mandibular condyle compared to the height on the opposite side. In Type M, moderate to severe dysfunction was observed in 33% of the cases. Bilateral fractures were significantly associated with the risk of temporomandibular joint (TMJ) dysfunction in fracture types A and B. Bilateral fracture and TMJ dysfunction were not statistically significantly associated in type M fractures. Conclusion: Most of the mandibular intracapsular condylar fractures recovered acceptably after conservative non-surgical treatment with functional rehabilitation, even with some anatomical shortening of the condylar height. The poor functional recovery encountered in type M fractures, especially in cases with additional fracture sites and bilateral fractures, points up the limitation of closed treatment in such cases. PMID:27489844

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

PubMed Central

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

2012-01-01

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. PMID:23027347

Clinical implications of magnetic resonance imaging in temporomandibular disorders patients presenting ear fullness.

PubMed

Lee, Sang Yeon; Park, Ji Woon; Park, Seo Eun; Nam, Dong Woo; Lim, Hyun Jung; Kim, Young Ho

2017-12-14

The aim of this study was to investigate whether findings detected by temporomandibular joint magnetic resonance imaging (TMJ-MRI) can provide pathognomonic evidence of temporomandibular disorders (TMD) in patients with nonspecific ear fullness (EF). The association of nonspecific EF with clinical characteristics of TMD based on TMJ-MRI findings was examined. Retrospective analysis. Thirty-four subjects (42 ears) who had no detectable otologic problems as a cause of EF were enrolled in this study. Each subject underwent TMJ-MRI to identify pathology of the TMJ as a possible cause of nonspecific EF. All subjects participated in the re-evaluation process following TMD treatment. Anatomical abnormalities in TMJ-MRI, irrespective of TMD signs, were observed in 34 of the 42 ears (80.9%), such as degenerative change of the TMJ (16 ears), articular disc displacement (11 ears), and joint effusion (seven ears). Specific abnormalities of the TMJ were associated with nonspecific EF, and this symptom showed improvement following individualized TMD treatment in those with internal derangement and/or effusion of the TMJ. However, abnormal TMJ-MRI findings were also observed in seven of nine ears with no TMD signs, and there was no significant association between the presence of TMD signs and abnormal TMJ-MRI findings (χ 2 = 0.075, P = .784). Patients presenting with nonspecific EF may have TMD, which can be effectively diagnosed using TMJ-MRI. The present study revealed the causal relationship between nonspecific EF and abnormal TMJ findings based on MRI. Individualized TMD treatments based on TMJ-MRI led to improved treatment outcomes with special regard to nonspecific EF LEVEL OF EVIDENCE: 4 Laryngoscope, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Using "Mighty Mouse" to understand masticatory plasticity: myostatin-deficient mice and musculoskeletal function.

PubMed

Ravosa, Matthew J; López, Elisabeth K; Menegaz, Rachel A; Stock, Stuart R; Stack, M Sharon; Hamrick, Mark W

2008-09-01

Knockout mice lacking myostatin (Mstn), a negative regulator of the growth of skeletal muscle, develop significant increases in the relative mass of masticatory muscles as well as the ability to generate higher maximal muscle forces. Wild-type and Mstn-deficient mice were compared to investigate the postnatal influence of elevated masticatory loads due to increased jaw-adductor and bite forces on the biomineralization of mandibular articular and cortical bone, the internal structure of the jaw joints, and the composition of temporomandibular joint (TMJ) articular cartilage. To provide an interspecific perspective on the long-term responses of mammalian jaw joints to altered loading conditions, the findings on mice were compared to similar data for growing rabbits subjected to long-term dietary manipulation. Statistically significant differences in joint proportions and bone mineral density between normal and Mstn-deficient mice, which are similar to those observed between rabbit loading cohorts, underscore the need for a comprehensive analysis of masticatory tissue plasticity vis-à-vis altered mechanical loads, one in which variation in external and internal structure are considered. Differences in the expression of proteoglycans and type-II collagen in TMJ articular cartilage between the mouse and rabbit comparisons suggest that the duration and magnitude of the loading stimulus will significantly affect patterns of adaptive and degradative responses. These data on mammals subjected to long-term loading conditions offer novel insights regarding variation in ontogeny, life history, and the ecomorphology of the feeding apparatus.

A Longitudinal Evaluation of the Effects of Orthodontic Treatment on Clinical Signs and Symptoms of Temporomandibular Disorders.

DTIC Science & Technology

1992-05-01

attention of the dental and medical professions that displaced condyles could cause orofacial pain , dentists have been treating and searching for the...50 Pain ............................................ 55 Temporomandibular Joint ................... 55 Palpation...123 Impaired Range of Movement/Mobility Index .... 123 Impaired TMJ Function .......................... 124 Muscle Pain

Sensory innervation of the temporomandibular joint in the mouse.

PubMed

Dreessen, D; Halata, Z; Strasmann, T

1990-01-01

The sensory innervation of the temporomandibular joints (TMJs) of 8 STR/IN mice was investigated by means of light and electron microscopy. Through the cutting of complete semithin sections in series it was possible to investigate the joints thoroughly. Additionally, one joint with its nerve supply was reconstructed three-dimensionally with a computerized three-dimensional programme. The reconstruction was based on one complete semithin section series. The joint's nerve supply originates from the nervus auriculotemporalis and additionally from motor branches of the n. mandibularis: n. massetericus, n. pterygoideus lateralis and the nn. temporales posteriores. The greatest number of nerve fibres and endings is located in the dorsolateral part of the joint capsule. They lie only in the stratum fibrosum and subsynovially. Neither the stratum synoviale nor the discus articularis contain any nerve fibres or endings, whereas the peri-articular loose connective tissue is richly innervated. The only type of nerve ending observed within the joint was the free nerve ending, which is assumed to serve not only as a nociceptor but also as a polymodal mechanoreceptor. Merely within the insertion of the musculus pterygoideus lateralis at the collum mandibulae single stretch receptors of the Ruffini type were observed. Ultrastructurally, they correspond to those described in the cat's knee joint. Neither lamellated nor nerve endings of the Golgi or Pacini type were observed in the joint or in the peri-articular connective tissue. The unexpected paucity of nerve fibres and endings in the TMJ itself of the mouse suggests that the afferent information from the joint is less important for position sense and movement than the afferent information from muscles, tendons and periodontal ligaments.

Magnetic Resonance Imaging (MRI) Evaluation for Anterior Disc Displacement of the Temporomandibular Joint.

PubMed

Yang, Zhongjun; Wang, Mingguo; Ma, Yingwei; Lai, Qingguo; Tong, Dongdong; Zhang, Fenghe; Dong, Lili

2017-02-08

BACKGROUND Magnetic resonance imaging (MRI) is the criterion standard imaging technique for visualization of the temporomandibular joint (TMJ) region, and is currently considered the optimum modality for comprehensive evaluation in patients with temporomandibular joint disorder (TMD). This study was aimed at finding the value of MRI in pre-clinical diagnosis of TMJ disc displacement. MATERIAL AND METHODS Patients primarily diagnosed as having anterior disc displacement by clinical symptoms and X-ray were selected in the present study. MRI was used to evaluate surrounding anatomical structures and position, as well as morphological and signal intensity change between patients and normal controls. RESULTS Posterior band position was significantly different between the patient group and control group. At the maximum opened-mouth position, the location of disc intermediate zone returned to normal. At closed-mouth position, the thickness of anterior and middle, but not posterior, band increased. The motion range of the condyle in the anterior disc displacement without reduction (ADDWR) patient group was significantly less than the value in the anterior disc displacement with reduction (ADDR) patient group and the control group. Whether at closed-mouth position or maximum opened-mouth position, the exudate volume in the patient group was greater than in the normal group. CONCLUSIONS MRI can be successfully used to evaluate multiple morphological changes at different mouth positions of normal volunteers and patients. The disc-condyle relationship can serve as an important indicator in assessing anterior disc displacement, and can be used to distinguish disc displacement with or without reduction.

Magnetic Resonance Imaging (MRI) Evaluation for Anterior Disc Displacement of the Temporomandibular Joint

PubMed Central

Yang, Zhongjun; Wang, Mingguo; Ma, Yingwei; Lai, Qingguo; Tong, Dongdong; Zhang, Fenghe; Dong, Lili

2017-01-01

Background Magnetic resonance imaging (MRI) is the criterion standard imaging technique for visualization of the temporomandibular joint (TMJ) region, and is currently considered the optimum modality for comprehensive evaluation in patients with temporomandibular joint disorder (TMD). This study was aimed at finding the value of MRI in pre-clinical diagnosis of TMJ disc displacement. Material/Methods Patients primarily diagnosed as having anterior disc displacement by clinical symptoms and X-ray were selected in the present study. MRI was used to evaluate surrounding anatomical structures and position, as well as morphological and signal intensity change between patients and normal controls. Results Posterior band position was significantly different between the patient group and control group. At the maximum opened-mouth position, the location of disc intermediate zone returned to normal. At closed-mouth position, the thickness of anterior and middle, but not posterior, band increased. The motion range of the condyle in the anterior disc displacement without reduction (ADDWR) patient group was significantly less than the value in the anterior disc displacement with reduction (ADDR) patient group and the control group. Whether at closed-mouth position or maximum opened-mouth position, the exudate volume in the patient group was greater than in the normal group. Conclusions MRI can be successfully used to evaluate multiple morphological changes at different mouth positions of normal volunteers and patients. The disc-condyle relationship can serve as an important indicator in assessing anterior disc displacement, and can be used to distinguish disc displacement with or without reduction. PMID:28176754

Functional added value of microprocessor-controlled knee joints in daily life performance of Medicare Functional Classification Level-2 amputees.

PubMed

Theeven, Patrick; Hemmen, Bea; Rings, Frans; Meys, Guido; Brink, Peter; Smeets, Rob; Seelen, Henk

2011-10-01

To assess the effects of using a microprocessor-controlled prosthetic knee joint on the functional performance of activities of daily living in persons with an above-knee leg amputation. To assess the effects of using a microprocessor-controlled prosthetic knee joint on the functional performance of activities of daily living in persons with an above-knee leg amputation. Randomised cross-over trial. Forty-one persons with unilateral above-knee or knee disarticulation limb loss, classified as Medicare Functional Classification Level-2 (MFCL-2). Participants were measured in 3 conditions, i.e. using a mechanically controlled knee joint and two types of microprocessor-controlled prosthetic knee joints. Functional performance level was assessed using a test in which participants performed 17 simulated activities of daily living (Assessment of Daily Activity Performance in Transfemoral amputees test). Performance time was measured and self-perceived level of difficulty was scored on a visual analogue scale for each activity. High levels of within-group variability in functional performance obscured detection of any effects of using a microprocessor-controlled prosthetic knee joint. Data analysis after stratification of the participants into 3 subgroups, i.e. participants with a "low", "intermediate" and "high" functional mobility level, showed that the two higher functional subgroups performed significantly faster using microprocessor-controlled prosthetic knee joints. MFCL-2 amputees constitute a heterogeneous patient group with large variation in functional performance levels. A substantial part of this group seems to benefit from using a microprocessor-controlled prosthetic knee joint when performing activities of daily living.

Relationship between mechanical ankle joint laxity and subjective function.

PubMed

Hubbard-Turner, Tricia

2012-10-01

An increase in ankle joint laxity has been reported in patients with chronic ankle instability (CAI). However, it is not known if this increase in joint laxity is responsible for the subjective level of functional deficits also reported in these patients. One hundred twenty subjects with unilateral CAI (55 males, 65 females; age, 20.6 ± 1.5 years; mass, 74.5 ± 13.6 kg; height, 174.2 ± 9.7 cm) participated in the study. Mechanical joint stability was measured with an instrumented ankle arthrometer. The arthrometer measured ankle joint motion for anterior/posterior translation and inversion/eversion angular displacement. Subjective level of function was assessed with the foot and ankle disability index (FADI) and foot and ankle disability index sport (FADIS). Bivariate correlations using Pearson Product Moments were made between all dependent variables taken on the unstable ankles. The strongest relationship was between anterior laxity and the FADIS (r = -0.88, p < 0.0001). As scores on the FADIS decreased, anterior laxity increased. Similar significant results were reported for anterior laxity and the FADI (r = -0.65, p = 0.013), as well as inversion laxity and the FADI (r = -0.53, p = 0.017) and FADIS (r = -0.45, p = 0.013). These data demonstrate that there appears to be a relationship between anterior and inversion ankle laxity and subjective function in those with CAI. Although numerous insufficiencies develop after an ankle sprain, increased laxity may cause some of the subjective functional deficits reported in those with CAI. Strategies to prevent increased laxity following ankle sprain may improve the patient's subjective level of function.

Functional roles of lower-limb joint moments while walking in water.

PubMed

Miyoshi, Tasuku; Shirota, Takashi; Yamamoto, Shin-Ichiro; Nakazawa, Kimitaka; Akai, Masami

2005-02-01

To clarify the functional roles of lower-limb joint moments and their contribution to support and propulsion tasks while walking in water compared with that on land. Sixteen healthy, young subjects walked on land and in water at several different speeds with and without additional loads. Walking in water is a major rehabilitation therapy for patients with orthopedic disorders. However, the functional role of lower-limb joint moments while walking in water is still unclear. Kinematics, electromyographic activities in biceps femoris and gluteus maximums, and ground reaction forces were measured under the following conditions: walking on land and in water at a self-determined pace, slow walking on land, and fast walking in water with or without additional loads (8 kg). The hip, knee, and ankle joint moments were calculated by inverse dynamics. The contribution of the walking speed increased the hip extension moment, and the additional weight increased the ankle plantar flexion and knee extension moment. The major functional role was different in each lower-limb joint muscle. That of the muscle group in the ankle is to support the body against gravity, and that of the muscle group involved in hip extension is to contribute to propulsion. In addition, walking in water not only reduced the joint moments but also completely changed the inter-joint coordination. It is of value for clinicians to be aware that the greater the viscosity of water produces a greater load on the hip joint when fast walking in water.

[Clinical application of transport distraction osteogenesis arthroplasty in the treatment of temporomandibular joint bony ankylosis].

PubMed

Liang, Cheng; Wang, Xing; Yi, Biao; Li, Zi-li; Wang, Xiao-xia

2013-03-12

To explore the clinical application of transport distraction osteogenesis arthroplasty (TDOAP) in the treatment of temporomandibular joint (TMJ) bony ankylosis. From December 1999 to December 2011, a total of 73 patients (89 sides of TMJ) underwent TDOAP were included. There were 39 males and 34 females with a mean age of 19.6 years (range: 3 - 60). Among them, 27 patients were recurrence cases and 30 cases were accompanied with micrognathia and obstructive sleep apnea-hypopnea syndrome (OSAHS). The mean preoperative degree of mouth opening was 6.6 mm (range: 1 - 20). After a release of ankylosis, a transport disc was performed and fixed to ramus with a distractor. Distraction began at Days 4 - 8 postoperation. The distraction rhythm and rate were 0.25 mm four times daily. Distraction stopped when planning distance was achieved. And a distractor was maintained in place for 3-6 months after completion of distraction and then removed. Active postoperative training of mouth opening was implemented. The mean distance of distraction was 15.3 mm (range: 12 - 23). The range of mouth opening of 65 patients increased to normal and bone formation in gaps were perfect. The mean follow-up period was 44.8 months (range: 18 - 102). Eight cases were recurrent. And 1/37 over 15 years old and 7/36 under 15 years old had recurrence. TDOAP is an effective treatment for TMJ ankylosis. A pediatric patient, especially recurrent, should be operated after adolescence to decrease recurrence. Micrognathia and OSAHS should be also considered during the treatment of ankylosis.

Distribution of pericellular matrix molecules in the temporomandibular joint and their chondroprotective effects against inflammation

PubMed Central

Chu, Wern Cui; Zhang, Shipin; Sng, Timothy J; Ong, Yu Jie; Tan, Wen-Li; Ang, Vivien Y; Foldager, Casper B; Toh, Wei Seong

2017-01-01

The objectives of this study were to (1) determine the distribution and synthesis of pericellular matrix (PCM) molecules (collagen VI, collagen IV and laminin) in rat temporomandibular joint (TMJ) and (2) investigate the effects of PCM molecules on chondrocytes against inflammation in osteoarthritis. Four zones (fibrous, proliferating, mature and hypertrophic) of condylar cartilage and three bands (anterior, intermediate and posterior) of disc were analysed by immunohistochemistry for the presence of PCM molecules in rat TMJs. Isolated chondrocytes were pre-treated with PCM molecules before being subjected to interleukin (IL)-1β treatment to stimulate inflammation. The responses of the chondrocytes were analysed using gene expression, nitric oxide release and matrix metalloproteinase (MMP)-13 production measures. Histomorphometric analyses revealed that the highest areal deposition of collagen VI (67.4%), collagen IV (45.7%) and laminin (52.4%) was in the proliferating zone of TMJ condylar cartilage. No significant difference in the distribution of PCM molecules was noted among the three bands of the TMJ disc. All three PCM molecules were expressed intracellularly by chondrocytes cultured in the monolayer. Among the PCM molecules, pre-treatment with collagen VI enhanced cellular proliferation, ameliorated IL-1β-induced MMP-3, MMP-9, MMP-13 and inducible nitric oxide synthase gene expression, and attenuated the downregulation of cartilage matrix genes, including collagen I, aggrecan and cartilage oligomeric matrix protein (COMP). Concurrently, collagen VI pretreatment inhibited nitric oxide and MMP-13 production. Our study demonstrates for the first time the distribution and role of PCM molecules, particularly collagen VI, in the protection of chondrocytes against inflammation. PMID:28282029

Mandibular kinematics and maximum voluntary bite force following segmental resection of the mandible without or with reconstruction.

PubMed

Linsen, Sabine S; Oikonomou, Annina; Martini, Markus; Teschke, Marcus

2018-05-01

The purpose was to analyze mandibular kinematics and maximum voluntary bite force in patients following segmental resection of the mandible without and with reconstruction (autologous bone, alloplastic total temporomandibular joint replacement (TMJ TJR)). Subjects operated from April 2002 to August 2014 were enrolled in the study. Condylar (CRoM) and incisal (InRoM) range of motion and deflection during opening, condylar retrusion, incisal lateral excursion, mandibular rotation angle during opening, and maximum voluntary bite force were determined on the non-affected site and compared between groups. Influence of co-factors (defect size, soft tissue deficit, neck dissection, radiotherapy, occlusal contact zones (OCZ), and time) was determined. Twelve non-reconstructed and 26 reconstructed patients (13 autologous, 13 TMJ TJR) were included in the study. InRoM opening and bite force were significantly higher (P ≤ .024), and both condylar and incisal deflection during opening significantly lower (P ≤ .027) in reconstructed patients compared with non-reconstructed. Differences between the autologous and the TMJ TJR group were statistically not significant. Co-factors defect size, soft tissue deficit, and neck dissection had the greatest impact on kinematics and number of OCZs on bite force. Reconstructed patients (both autologous and TMJ TJR) have better overall function than non-reconstructed patients. Reconstruction of segmental mandibular resection has positive effects on mandibular function. TMJ TJR seems to be a suitable technique for the reconstruction of mandibular defects including the TMJ complex.

Condyle fossa relationship associated with functional posterior crossbite, before and after rapid maxillary expansion.

PubMed

Leonardi, Rosalia; Caltabiano, Mario; Cavallini, Costanza; Sicurezza, Edoardo; Barbato, Ersilia; Spampinato, Concetto; Giordano, Daniela

2012-11-01

To investigate condylar symmetry and condyle fossa relationships in subjects with functional posterior crossbite comparing findings before and after rapid maxillary expansion (RME) treatment through low-dose computed tomography (CT). Twenty-six patients (14 girls and 12 boys, mean age 9.6 ± 1.4 years) with functional posterior crossbite (FPXB) diagnosis underwent rapid palatal expansion with a Hyrax appliance. Patients' temporomandibular joints (TMJ) underwent multislice CT scans before rapid palatal expansion (T0) and after (T1). Joint spaces were compared with those of a control sample of 13 subjects (7 girls and 5 boys, mean age 11 ± 0.6 years). Anterior space (AS), superior space (SS), and posterior space (PS) joint space measurements at T0 between the FPXB side and contralateral side demonstrated no statistically significant differences. After RME treatment (T1), all three joint spaces increased on both the FPXB side and the non-crossbite side. However, differences were statistically significant only for the SS when comparing the two sides at T1. SS increased more than AS and PS in the non-crossbite condyle (0.28 mm) and FPXB condyle (0.37 mm), and PS increased only on the FPXB side (0.34 mm). There were no statistically significant differences in condyle position within the glenoid fossa between the FPXB and non-crossbite side before treatment. Increases in joint spaces were observed after treatment with RME on both sides. These changes were, however, of small amounts.

Mobile Phone-Based Joint Angle Measurement for Functional Assessment and Rehabilitation of Proprioception

PubMed Central

Mourcou, Quentin; Fleury, Anthony; Diot, Bruno; Franco, Céline; Vuillerme, Nicolas

2015-01-01

Assessment of joint functional and proprioceptive abilities is essential for balance, posture, and motor control rehabilitation. Joint functional ability refers to the capacity of movement of the joint. It may be evaluated thereby measuring the joint range of motion (ROM). Proprioception can be defined as the perception of the position and of the movement of various body parts in space. Its role is essential in sensorimotor control for movement acuity, joint stability, coordination, and balance. Its clinical evaluation is commonly based on the assessment of the joint position sense (JPS). Both ROM and JPS measurements require estimating angles through goniometer, scoliometer, laser-pointer, and bubble or digital inclinometer. With the arrival of Smartphones, these costly clinical tools tend to be replaced. Beyond evaluation, maintaining and/or improving joint functional and proprioceptive abilities by training with physical therapy is important for long-term management. This review aims to report Smartphone applications used for measuring and improving functional and proprioceptive abilities. It identifies that Smartphone applications are reliable for clinical measurements and are mainly used to assess ROM and JPS. However, there is lack of studies on Smartphone applications which can be used in an autonomous way to provide physical therapy exercises at home. PMID:26583101

Interaction of 308-nm excimer laser light with temporomandibular joint related structures

NASA Astrophysics Data System (ADS)

Liesenhoff, Tim; Funk, Armin

1994-02-01

Arthroscopy of TMJ has become a clinically important and more and more accepted method for diagnosis and treatment of TMJ alteration. This minimal invasive method is clearly limited by the anatomical dimensions of the TMJ. A 308 nm excimer laserlight has already found clinical applications in angioplasty, ophthalmology, and dentistry. The aim of the presented study was to find out if it is possible to ablate TMJ related structures under arthroscopic conditions. It also aims to evaluate the energy-threshold for ablation and the maximal possible rate of ablation. Contrary to other laser systems it offers a unique combination of minimal tissue alteration, precise tissue ablation guidability through optical fibers, and a good transmission through water.

Antinociceptive, anti-inflammatory and toxicological evaluation of semi-synthetic molecules obtained from a benzyl-isothiocyanate isolated from Moringa oleifera Lam. in a temporomandibular joint inflammatory hypernociception model in rats.

PubMed

Dos Santos, Alain Oliveira; do Val, Danielle Rocha; da Silveira, Felipe Dantas; Gomes, Francisco Isaac Fernandes; Freitas, Hermany Capistrano; de Assis, Ellen Lima; de Almeida, Diana Kelly Castro; da Silva, Igor Iuco Castro; Barbosa, Francisco Geraldo; Mafezoli, Jair; da Silva, Marcos Reinaldo; de Castro Brito, Gerly Anne; Clemente-Napimoga, Juliana Trindade; de Paulo Teixera Pinto, Vicente de Paulo Teixeira; Filho, Gerardo Cristino; Bezerra, Mirna Marques; Chaves, Hellíada Vasconcelos

2018-02-01

Inflammation is a key component of many clinical conditions that affect the temporomandibular joint (TMJ) and Moringa oleifera Lam. has been used to treat inflammatory diseases. Here, we evaluated the toxicological effects on mice of a naturally-occurring isothiocyanate from M. oleifera and its seven analogue molecules. Further, the anti-nociceptive and anti-inflammatory effects on a rat model of TMJ inflammatory hypernociception were assessed. The systemic toxicological profile was determined in mice over a 14-day period: MC-1 1 μg/kg; MC-D1 1 μg/kg, MC-D3 100 μg/kg, MC-D6 1 μg/kg, MC-D7 1 μg/kg, MC-D8 1 μg/kg, MC-D9 10 μg/kg, and MC-H 1 μg/kg. The safest molecules were assayed for anti-nociceptive efficacy in the formalin (1.5%, 50 μL) and serotonin (255 mg) induced TMJ inflammatory hypernociception tests. The anti-inflammatory effect was evaluated through the vascular permeability assay using Evans blue. Further, the rota-rod test evaluated any motor impairment. Among the tested molecules, MC-D7, MC-D9, and MC-H were not toxic at the survival rate test, biochemical, and hystological analysis. They reduced the formalin-induced TMJ inflammatory hypernociception, but only MC-H decreased the serotonin-induced TMJ inflammation, suggesting an adrenergic receptor-dependent effect. They diminished the plasmatic extravasation, showing anti-inflammatory activity. At the rota-rod test, no difference was observed in comparison with control groups, reinforcing the hypothesis of anti-nociceptive effetc without motor impairment in animals. The analogues MC-D7, MC-D9, and MC-H were safe at the tested doses and efficient in reducing the formalin-induced TMJ hypernociception in rats. Our next steps include determining their mechanisms of anti-nociceptive action. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Altered neuromuscular control and ankle joint kinematics during walking in subjects with functional instability of the ankle joint.

PubMed

Delahunt, Eamonn; Monaghan, Kenneth; Caulfield, Brian

2006-12-01

The ankle joint requires very precise neuromuscular control during the transition from terminal swing to the early stance phase of the gait cycle. Altered ankle joint arthrokinematics and muscular activity have been cited as potential factors that may lead to an inversion sprain during the aforementioned time periods. However, to date, no study has investigated patterns of muscle activity and 3D joint kinematics simultaneously in a group of subjects with functional instability compared with a noninjured control group during these phases of the gait cycle. To compare the patterns of lower limb 3D joint kinematics and electromyographic activity during treadmill walking in a group of subjects with functional instability with those observed in a control group. Controlled laboratory study. Three-dimensional angular velocities and displacements of the hip, knee, and ankle joints, as well as surface electromyography of the rectus femoris, peroneus longus, tibialis anterior, and soleus muscles, were recorded simultaneously while subjects walked on a treadmill at a velocity of 4 km/h. Before heel strike, subjects with functional instability exhibited a decrease in vertical foot-floor clearance (12.62 vs 22.84 mm; P < .05), as well as exhibiting a more inverted position of the ankle joint before, at, and immediately after heel strike (1.69 degrees , 2.10 degrees , and -0.09 degrees vs -1.43 degrees , -1.43 degrees , and -2.78 degrees , respectively [minus value = eversion]; P < .05) compared with controls. Subjects with functional instability were also observed to have an increase in peroneus longus integral electromyography during the post-heel strike time period (107.91%.millisecond vs 64.53%.millisecond; P < .01). The altered kinematics observed in this study could explain the reason subjects with functional instability experience repeated episodes of ankle inversion injury in situations with only slight or no external provocation. It is hypothesized that the observed

MR imaging of the temporomandibular joint: comparison between acquisitions at 7.0 T using dielectric pads and 3.0 T

PubMed Central

Kuhn, Felix P; Spinner, Georg; Del Grande, Filippo; Wyss, Michael; Piccirelli, Marco; Erni, Stefan; Pfister, Pascal; Ho, Michael; Sah, Bert-Ram; Filli, Lukas; Ettlin, Dominik A; Gallo, Luigi M; Andreisek, Gustav

2017-01-01

Objectives: To qualitatively and quantitatively compare MRI of the temporomandibular joint (TMJ) at 7.0 T using high-permittivity dielectric pads and 3.0 T using a clinical high-resolution protocol. Methods: Institutional review board-approved study with written informed consent. 12 asymptomatic volunteers were imaged at 7.0 and 3.0 T using 32-channel head coils. High-permittivity dielectric pads consisting of barium titanate in deuterated suspension were used for imaging at 7.0 T. Imaging protocol consisted of oblique sagittal proton density weighted turbo spin echo sequences. For quantitative analysis, pixelwise signal-to-noise ratio maps of the TMJ were calculated. For qualitative analysis, images were evaluated by two independent readers using 5-point Likert scales. Quantitative and qualitative results were compared using t-tests and Wilcoxon signed-rank tests, respectively. Results: TMJ imaging at 7.0 T using high-permittivity dielectric pads was feasible in all volunteers. Quantitative analysis showed similar signal-to-noise ratio for both field strengths (mean ± SD; 7.0 T, 13.02 ± 3.92; 3.0 T, 14.02 ± 3.41; two-sample t-tests, p = 0.188). At 7.0 T, qualitative analysis yielded better visibility of all anatomical subregions of the temporomandibular disc (anterior band, intermediate zone and posterior band) than 3.0 T (Wilcoxon signed-rank tests, p < 0.05, corrected for multiple comparisons). Conclusions: MRI of the TMJ at 7.0 T using high-permittivity dielectric pads yields superior visibility of the temporomandibular disc compared with 3.0 T. PMID:27704872

MR imaging of the temporomandibular joint: comparison between acquisitions at 7.0 T using dielectric pads and 3.0 T.

PubMed

Kuhn, Felix P; Spinner, Georg; Del Grande, Filippo; Wyss, Michael; Piccirelli, Marco; Erni, Stefan; Pfister, Pascal; Ho, Michael; Sah, Bert-Ram; Filli, Lukas; Ettlin, Dominik A; Gallo, Luigi M; Andreisek, Gustav; Manoliu, Andrei

2017-01-01

To qualitatively and quantitatively compare MRI of the temporomandibular joint (TMJ) at 7.0 T using high-permittivity dielectric pads and 3.0 T using a clinical high-resolution protocol. Institutional review board-approved study with written informed consent. 12 asymptomatic volunteers were imaged at 7.0 and 3.0 T using 32-channel head coils. High-permittivity dielectric pads consisting of barium titanate in deuterated suspension were used for imaging at 7.0 T. Imaging protocol consisted of oblique sagittal proton density weighted turbo spin echo sequences. For quantitative analysis, pixelwise signal-to-noise ratio maps of the TMJ were calculated. For qualitative analysis, images were evaluated by two independent readers using 5-point Likert scales. Quantitative and qualitative results were compared using t-tests and Wilcoxon signed-rank tests, respectively. TMJ imaging at 7.0 T using high-permittivity dielectric pads was feasible in all volunteers. Quantitative analysis showed similar signal-to-noise ratio for both field strengths (mean ± SD; 7.0 T, 13.02 ± 3.92; 3.0 T, 14.02 ± 3.41; two-sample t-tests, p = 0.188). At 7.0 T, qualitative analysis yielded better visibility of all anatomical subregions of the temporomandibular disc (anterior band, intermediate zone and posterior band) than 3.0 T (Wilcoxon signed-rank tests, p < 0.05, corrected for multiple comparisons). MRI of the TMJ at 7.0 T using high-permittivity dielectric pads yields superior visibility of the temporomandibular disc compared with 3.0 T.

Periodontal Ligament Entheses and their Adaptive Role in the Context of Dentoalveolar Joint Function

PubMed Central

Lin, Jeremy D.; Jang, Andrew T.; Kurylo, Michael P.; Hurng, Jonathan; Yang, Feifei; Yang, Lynn; Pal, Arvin; Chen, Ling; Ho, Sunita P.

2017-01-01

Objectives The dynamic bone-periodontal ligament (PDL)-tooth fibrous joint consists of two adaptive functionally graded interfaces (FGI), the PDL-bone and PDL-cementum that respond to mechanical strain transmitted during mastication. In general, from a materials and mechanics perspective, FGI prevent catastrophic failure during prolonged cyclic loading. This review is a discourse of results gathered from literature to illustrate the dynamic adaptive nature of the fibrous joint in response to physiologic and pathologic simulated functions, and experimental tooth movement. Methods Historically, studies have investigated soft to hard tissue transitions through analytical techniques that provided insights into structural, biochemical, and mechanical characterization methods. Experimental approaches included two dimensional to three dimensional advanced in situ imaging and analytical techniques. These techniques allowed mapping and correlation of deformations to physicochemical and mechanobiological changes within volumes of the complex subjected to concentric and eccentric loading regimes respectively. Results Tooth movement is facilitated by mechanobiological activity at the interfaces of the fibrous joint and generates elastic discontinuities at these interfaces in response to eccentric loading. Both concentric and eccentric loads mediated cellular responses to strains, and prompted self-regulating mineral forming and resorbing zones that in turn altered the functional space of the joint. Significance A multiscale biomechanics and mechanobiology approach is important for correlating joint function to tissue-level strain-adaptive properties with overall effects on joint form as related to physiologic and pathologic functions. Elucidating the shift in localization of biomolecules specifically at interfaces during development, function, and therapeutic loading of the joint is critical for developing “functional regeneration and adaptation” strategies with an

Development and application of reflexodent in the quantitative functional evaluation of chewing control in patients with temporomandibular joint dysfunction and a control group.

PubMed

Angeles-Medina, F; Nuño-Licona, A; Alfaro-Moctezuma, P; Osorno-Escareño, C

2000-01-01

There has been controversy with respect to the diagnostic value of the inhibitory masseteric reflex in temporomandibular joint dysfunction (TMJD) because the whole reflex response was not considered. The purpose of this study was to characterize the reflex changes that occur in patients with different levels of TMJD and in a control group. Eighty-nine patients (ages 31.14 +/- 12.74 years) divided into three groups were studied and compared. The control group was without TMJD (n = 30), with moderate symptoms (n = 30), and with severe symptoms (n = 29). Using an instrument and a software program developed by our group (Reflexodent), the masseteric inhibitory reflex was studied. The electromyography record (EMG) was captured with surface electrodes and the inhibitory reflex was produced by tapping the chin. The EMG signal was processed, filtered, and averaged with the Reflexodent. Twenty series of records were applied to each patient. The faulty inhibitory area, the area's relation (potentiation/inhibition) regarding the values of healthy subjects previously characterized, and the bilateral symmetry were measured. Discriminate analysis showed a statistically significant correlation between clinical groups and electromyographic findings. Statistical function explained 91.8% of the discrimination among groups (canonical correlation = 0.918, chi(2) = 164.435, p <0.001). The study of whole inhibitory masseteric reflex and the Reflexodent technique are useful as a diagnostic tool to evaluate TMJ illness in the dental clinic.

Functional outcome from sacroiliac joint prolotherapy in patients with sacroiliac joint instability.

PubMed

Hoffman, Martin D; Agnish, Vikram

2018-04-01

Examine the effectiveness of sacroiliac (SI) joint prolotherapy for SI joint instability, and characterize the patients most likely to benefit from this treatment. Retrospective cohort study. Department of Veterans Affairs outpatient physical medicine clinic. Patients referred for low back pain and diagnosed with SI joint instability received a series of three SI joint prolotherapy injections (15% dextrose in lidocaine) at approximately a one-month interval. The outcome of those completing treatment was retrospectively examined, and characteristics were compared between those with at least a minimum clinically important improvement and those without improvement. Patients completed the Oswestry Disability Index (ODI) before treatment was initiated, immediately preceding each prolotherapy injection, and at 3-4 month follow-up. Of 103 treated patients returning for post-treatment follow-up at a median of 117 days, 24 (23%) showed a minimum clinically important improvement despite a median of 2 years with low back pain and a mean (±SD) pre-intervention ODI of 54 ± 15 points. Much of the improvement was evident after the initial prolotherapy injection, and a 15-point improvement in ODI prior to the second prolotherapy injection had a sensitivity of 92% and specificity of 80% for determining which patients would improve. A satisfactory proportion of patients with symptomatic SI joint instability as an etiology of low back pain can have clinically meaningful functional gains with prolotherapy treatment. The patients who are not likely to improve with prolotherapy are generally evident by lack of improvement following the initial prolotherapy injection. Published by Elsevier Ltd.

[Range of Hip Joint Motion and Weight of Lower Limb Function under 3D Dynamic Marker].

PubMed

Xia, Q; Zhang, M; Gao, D; Xia, W T

2017-12-01

To explore the range of reasonable weight coefficient of hip joint in lower limb function. When the hip joints of healthy volunteers under normal conditions or fixed at three different positions including functional, flexed and extension positions, the movements of lower limbs were recorded by LUKOtronic motion capture and analysis system. The degree of lower limb function loss was calculated using Fugl-Meyer lower limb function assessment form when the hip joints were fixed at the aforementioned positions. One-way analysis of variance and Tamhane's T2 method were used to proceed statistics analysis and calculate the range of reasonable weight coefficient of hip joint. There were significant differences between the degree of lower limb function loss when the hip joints fixed at flexed and extension positions and at functional position. While the differences between the degree of lower limb function loss when the hip joints fixed at flexed position and extension position had no statistical significance. In 95% confidence interval, the reasonable weight coefficient of hip joint in lower limb function was between 61.05% and 73.34%. Expect confirming the reasonable weight coefficient, the effects of functional and non-functional positions on the degree of lower limb function loss should also be considered for the assessment of hip joint function loss. Copyright© by the Editorial Department of Journal of Forensic Medicine

Can hybrid hyaluronic acid represent a valid approach to treat rizoarthrosis? A retrospective comparative study.

PubMed

Tenti, Sara; Pascarelli, Nicola Antonio; Giannotti, Stefano; Galeazzi, Mauro; Giordano, Nicola; Fioravanti, Antonella

2017-11-13

Osteoarthritis (OA) of the trapeziometacarpal joint (TMJ) is a disabling condition with a significant impact on quality of life. The optimal management of hand OA requires a combination of non-pharmacological and pharmacological treatments that include intra-articular (i.a.) therapy. EULAR experts recommend corticosteroid injections in TMJ OA and underline the usefulness of hyaluronic acid (HA). The aim of this study was the assessment of the efficacy and tolerability of i.a. injections of a hybrid formulation of HA (Sinovial H-L®) in comparison to triamcinolone in patients with TMJ OA. This 6-months observational comparative study, retrospective analyzed the medical records of 100 patients with monolateral or bilateral TMJ OA, treated with two injections of Sinovial H-L® (Sinovial H-L Group) or of triamcinolone acetonide (Triamcinolone Group). Clinical assessments were recorded at the time of the first and second injection and after one, 3 and 6 months. The primary outcomes were the change in global pain on a Visual Analogue Scale (VAS) and in hand function evaluated by the Functional Index for Hand OA (FIHOA) from baseline to month 6. Secondary outcomes were the improvement of the duration of morning stiffness, Health Assessment Questionnaire (HAQ) and the Medical Outcomes Study 36-Item Short Form (SF-36). The comparison between the two groups of treatment were performed with the Wilcoxon rank-sum test for continuous variables and with chi-square or Fisher exact test for categorical variables. Statistical significance was set at p < 0.05. Both therapies provided effective pain relief and joint function improvement, but the benefits achieved were statistically significantly superior in the Sinovial H-L Group than the Triamcinolone Group after one month (p < 0.01) from the beginning of the therapy and during the 6-months follow-up (p < 0.001). Furthermore, Sinovial H-L® was associated with a significant decrease in the duration of morning stiffness

Atypical prefrontal cortical responses to joint/non-joint attention in children with autism spectrum disorder (ASD): A functional near-infrared spectroscopy study

PubMed Central

Zhu, Huilin; Li, Jun; Fan, Yuebo; Li, Xinge; Huang, Dan; He, Sailing

2015-01-01

Autism spectrum disorder (ASD) is a neuro-developmental disorder, characterized by impairments in one’s capacity for joint attention. In this study, functional near-infrared spectroscopy (fNIRS) was applied to study the differences in activation and functional connectivity in the prefrontal cortex between children with autism spectrum disorder (ASD) and typically developing (TD) children. 21 ASD and 20 TD children were recruited to perform joint and non-joint attention tasks. Compared with TD children, children with ASD showed reduced activation and atypical functional connectivity pattern in the prefrontal cortex during joint attention. The atypical development of left prefrontal cortex might play an important role in social cognition defects of children with ASD. PMID:25798296

A clinical study on temporomandibular joint ankylosis.

PubMed

Güven, O

2000-01-01

Temporomandibular joint (TMJ) ankylosis results from trauma, infection and inadequate surgical treatment of the condylary area. Many techniques for treatment have been described so far. However, none of them gave uniformly successful results. A limited range of intrinsical opening due to relapse, loss of vertical height of the affected ramus, foreign body reactions and reankylosis are expected complications. However, wide bone resection, the use of interpositional spacer, insensitive and aggressive physiotherapy immediately after the operation are the basic principles as agreed by many authors. In this article, a review of the historical background of the treatment has been discussed. A clinical and retrospective evaluation of 42 patients treated for this disorder showed that 89% of all patients had unilaterally and 11% had bilateral ankylosis. From the viewpoint of the techniques we used, patients fell into three groups. In two groups, two different type of spacers were used, and in the third group gap arthroplasty were performed for the treatment of TMJ ankylosis. Our results revealed a predominance of traumatic aetiology. The highest incidence was between the ages of 11 and 20. A total of 45.24% of the patients were treated by interpositional arthroplasty by using acrylic spacer, 11.90% of the patients by sylastic sheet used as an interpositional material and the rest of the cases (42.86%) were treated only by gap arthroplasty. The advantages of the spherical acrylic spacer and gap arthroplasty were discussed. The advantages of the techniques are, shorter operating time, and more importantly its very low cost.

A custom-made temporomandibular joint prosthesis for fabrication by selective laser melting: Finite element analysis.

PubMed

Xu, Xiangliang; Luo, Danmei; Guo, Chuanbin; Rong, Qiguo

2017-08-01

A novel and custom-made selective laser melting (SLM) 3D-printed alloplastic temporomandibular joint (TMJ) prosthesis is proposed. The titanium-6aluminium-4vanadium (Ti-6Al-4V) condyle component and ultra-high molecular weight polyethylene (UHMWPE) fossa component comprised the total alloplastic TMJ replacement prosthesis. For the condyle component, an optimized tetrahedral open-porous scaffold with combined connection structures, i.e. an inlay rod and an onlay plate, between the prosthesis and remaining mandible was designed. The trajectory of movement of the intact condyle was assessed via kinematic analysis to facilitate the design of the fossa component. The behaviours of the intact mandible and mandible with the prosthesis were compared. The biomechanical behaviour was analysed by assessing the stress distribution on the prosthesis and strain distribution on the mandible. After muscle force was applied, the magnitude of the compressive strain on the condyle neck of the mandible with the prosthesis was lower than that on the condyle neck of the intact mandible, with the exception of the area about the screws; additionally, the magnitude of the strain at the scaffold-bone interface was relatively high. Copyright © 2017. Published by Elsevier Ltd.

The effect of partial rostral hemimandibulectomy on mandibular mobility and temporomandibular joint morphology in the dog.

PubMed

Umphlet, R C; Johnson, A L; Eurell, J C; Losonsky, J

1988-01-01

Partial rostral hemimandibulectomy was performed in 10 adult dogs. The temporomandibular joints (TMJs) were examined radiographically and tomographically before surgery, and mandibular stability was evaluated before and immediately after surgery. Radiographic, tomographic, and hemimandibular mobility assessments were made again at months 3 and 6. The TMJs were examined grossly and histologically in five dogs euthanatized at month 3 and in five dogs euthanatized at month 6. Statistically significant hemimandibular instability (p less than 0.05) persisted in all subjects throughout the study. The radiographic appearance of the joints remained unaltered; however, space asymmetry was identified in postoperative tomograms of three dogs at month 3 and four dogs at month 6. The TMJs were grossly normal at necropsy. Histologically, there were degenerative changes in articular cartilage and subchondral bone in all of the joints. The authors conclude that partial rostral hemimandibulectomy causes TMJ degeneration, as a consequence of hemimandibular instability or abnormal loading, or both.

Is arthrocentesis of temporomandibular joint with corticosteroids beneficial? A systematic review.

PubMed

Davoudi, A; Khaki, H; Mohammadi, I; Daneshmand, M; Tamizifar, A; Bigdelou, M; Ansaripoor, F

2018-05-01

Temporomandibular disorders (TMDs) are musculoskeletal conditions that can inhibit the normal function of temporomandibular joints (TMJs) and affect the patient's quality of life, negatively. Arthrocentesis (AC) is a minimally invasive surgical procedure used for treating TMDs. The aim of present paper is to evaluate the advantages of administrating corticosteroid (CS) during AC by reviewing high quality released articles. Searching on Cochrane Library, Web of Science, Google Scholar, PubMed, ProQuest, and Scopus databases were performed with focusing on proper key words. Related titles and abstracts, up to December 2017, were screened and selected based on inclusion criteria. The full text of all randomized controlled trials (RCTs) was extensively read and subjected to quality assessments. After initial search, a total of 2067 articles were included into the study. Finally, 7 studies were reliable enough in methodology and randomization to be included into the study. All of the observed studies showed improvements in jaw functions and pain relief with no statistical differences in both AC and control groups. One study reported painless maximum incisal opening in CS group than the control group. Based on available RCTs, the AC of TMJ with CS seems to result in similar findings to other therapeutic drugs, with no significant differences.

Effects of the application of ankle functional rehabilitation exercise on the ankle joint functional movement screen and isokinetic muscular function in patients with chronic ankle sprain.

PubMed

Ju, Sung-Bum; Park, Gi Duck

2017-02-01

[Purpose] This study was conducted to investigate the effects of ankle functional rehabilitation exercise on ankle joint functional movement screen results and isokinetic muscular function in patients with chronic ankle sprain patients. [Subjects and Methods] In this study, 16 patients with chronic ankle sprain were randomized to an ankle functional rehabilitation exercise group (n=8) and a control group (n=8). The ankle functional rehabilitation exercise centered on a proprioceptive sense exercise program, which was applied 12 times for 2 weeks. To verify changes after the application, ankle joint functional movement screen scores and isokinetic muscular function were measured and analyzed. [Results] The ankle functional rehabilitation exercise group showed significant improvements in all items of the ankle joint functional movement screen and in isokinetic muscular function after the exercise, whereas the control group showed no difference after the application. [Conclusion] The ankle functional rehabilitation exercise program can be effectively applied in patients with chronic ankle sprain for the improvement of ankle joint functional movement screen score and isokinetic muscular function.

Effects of the application of ankle functional rehabilitation exercise on the ankle joint functional movement screen and isokinetic muscular function in patients with chronic ankle sprain

PubMed Central

Ju, Sung-Bum; Park, Gi Duck

2017-01-01

[Purpose] This study was conducted to investigate the effects of ankle functional rehabilitation exercise on ankle joint functional movement screen results and isokinetic muscular function in patients with chronic ankle sprain patients. [Subjects and Methods] In this study, 16 patients with chronic ankle sprain were randomized to an ankle functional rehabilitation exercise group (n=8) and a control group (n=8). The ankle functional rehabilitation exercise centered on a proprioceptive sense exercise program, which was applied 12 times for 2 weeks. To verify changes after the application, ankle joint functional movement screen scores and isokinetic muscular function were measured and analyzed. [Results] The ankle functional rehabilitation exercise group showed significant improvements in all items of the ankle joint functional movement screen and in isokinetic muscular function after the exercise, whereas the control group showed no difference after the application. [Conclusion] The ankle functional rehabilitation exercise program can be effectively applied in patients with chronic ankle sprain for the improvement of ankle joint functional movement screen score and isokinetic muscular function. PMID:28265157

Glial interleukin-1β upregulates neuronal sodium channel 1.7 in trigeminal ganglion contributing to temporomandibular joint inflammatory hypernociception in rats.

PubMed

Zhang, Peng; Bi, Rui-Yun; Gan, Ye-Hua

2018-04-20

The proinflammatory cytokine interleukin-1β (IL-1β) drives pain by inducing the expression of inflammatory mediators; however, its ability to regulate sodium channel 1.7 (Nav1.7), a key driver of temporomandibular joint (TMJ) hypernociception, remains unknown. IL-1β induces cyclooxygenase-2 (COX-2) and prostaglandin E2 (PGE2). We previously showed that PGE2 upregulated trigeminal ganglionic Nav1.7 expression. Satellite glial cells (SGCs) involve in inflammatory pain through glial cytokines. Therefore, we explored here in the trigeminal ganglion (TG) whether IL-1β upregulated Nav1.7 expression and whether the IL-1β located in the SGCs upregulated Nav1.7 expression in the neurons contributing to TMJ inflammatory hypernociception. We treated rat TG explants with IL-1β with or without inhibitors, including NS398 for COX-2, PF-04418948 for EP2, and H89 and PKI-(6-22)-amide for protein kinase A (PKA), or with adenylate cyclase agonist forskolin, and used real-time PCR, Western blot, and immunohistofluorescence to determine the expressions or locations of Nav1.7, COX-2, cAMP response element-binding protein (CREB) phosphorylation, and IL-1β. We used chromatin immunoprecipitation to examine CREB binding to the Nav1.7 promoter. Finally, we microinjected IL-1β into the TGs or injected complete Freund's adjuvant into TMJs with or without previous microinjection of fluorocitrate, an inhibitor of SGCs activation, into the TGs, and evaluated nociception and gene expressions. Differences between groups were examined by one-way analysis of variance (ANOVA) or independent samples t test. IL-1β upregulated Nav1.7 mRNA and protein expressions in the TG explants, whereas NS398, PF-04418948, H89, or PKI-(6-22)-amide could all block this upregulation, and forskolin could also upregulate Nav1.7 mRNA and protein expressions. IL-1β enhanced CREB binding to the Nav1.7 promoter. Microinjection of IL-1β into the TGs or TMJ inflammation both induced hypernociception of TMJ region

Facioskeletal changes in children with juvenile idiopathic arthritis

PubMed Central

Twilt, M; Schulten, A J M; Nicolaas, P; Dülger, A; van Suijlekom‐Smit, L W A

2006-01-01

Objective To investigate the facioskeletal morphology in patients with juvenile idiopathic arthritis (JIA) with and without temporomandibular joint (TMJ) involvement. Methods Eighty five patients were included. TMJ involvement was defined by orthopantomogram alterations. Lateral cephalograms were used to determine linear and angular measurements and occlusion. Results Patients regardless of their TMJ status had a 67% chance for retrognathia and a 52% chance for posterior rotation of the mandible and, respectively, 82% and 58% if TMJ involvement were present. Changes were not uniformly distributed among the different subtypes. Conclusion Patients with JIA have an altered facial morphology, especially in the presence of TMJ involvement. PMID:16699052

Effects of hook plate on shoulder function after treatment of acromioclavicular joint dislocation.

PubMed

Chen, Chang-Hong; Dong, Qi-Rong; Zhou, Rong-Kui; Zhen, Hua-Qing; Jiao, Ya-Jun

2014-01-01

Internal fixation with hook plate has been used to treat acromioclavicular joint dislocation. This study aims to evaluate the effect of its use on shoulder function, to further analyze the contributing factors, and provide a basis for selection and design of improved internal fixation treatment of the acromioclavicular joint dislocation in the future. A retrospective analysis was performed on patients treated with a hook plate for acromioclavicular joint dislocation in our hospital from January 2010 to February 2013. There were 33 cases in total, including 25 males and 8 females, with mean age of 48.27 ± 8.7 years. There were 29 cases of Rockwood type III acromioclavicular dislocation, 4 cases of type V. The Constant-Murley shoulder function scoring system was used to evaluate the shoulder function recovery status after surgery. Anteroposterior shoulder X-ray was used to assess the position of the hook plate, status of acromioclavicular joint reduction and the occurrence of postoperative complications. According to the Constant-Murley shoulder function scoring system, the average scores were 78 ± 6 points 8 to 12 months after the surgery and before the removal of the hook plate, the average scores were 89 ± 5 minutes two months after the removal of hook plate. Postoperative X-ray imaging showed osteolysis in 10 cases (30.3%), osteoarthritis in six cases (18.1%), osteolysis associated with osteoarthritis in four cases(12.1%), and steel hook broken in one case (3%). The use of hook plate on open reduction and internal fixation of the acromioclavicular joint dislocation had little adverse effect on shoulder function and is an effective method for the treatment of acromioclavicular joint dislocation. Osteoarthritis and osteolysis are the two common complications after hook plate use, which are associated with the impairment of shoulder function. Shoulder function will be improved after removal of the hook plate.

Skeletal pattern in subjects with temporomandibular joint disorders

PubMed Central

Almăşan, Oana Cristina; Almăşan, Horea Artimoniu; Bran, Simion; Lascu, Liana; Iancu, Mihaela; Băciuţ, Grigore

2013-01-01

Introduction To establish the skeletal pattern in subjects with malocclusions and temporomandibular disorders (TMD); to assess the relationship between craniofacial skeletal structures and TMD in subjects with malocclusions. Material and methods Sixty-four subjects with malocclusions, over 18 years of age, were included in the study. Temporomandibular disorders were clinically assessed according to the Helkimo Anamnestic Index. Subjects underwent a lateral cephalogram. Subjects were grouped according to the sagittal skeletal pattern (ANB angle) into class I, II and III. Parametric Student tests with equal or unequal variations were used (variations were previously tested with Levene test). Results Twenty-four patients with TMD (experimental sample); 40 patients without TMD (control group); interincisal angle was higher in class I and II (p < 0.05) experimental subjects; overjet was larger in experimental subjects; midline shift and Wits appraisal were broader in the experimental group in all three classes. In class III subjects, the SNB angle was higher in the experimental group (p = 0.01). Joint noises followed by reduced mandible mobility, muscular pain and temporomandibular joint (TMJ) pain were the most frequent symptoms in subjects with TMD and malocclusions. Conclusions Temporomandibular joint status is an important factor to consider when planning orthodontic treatment in patients with severe malocclusions; midline shift, large overjet and deep overbite have been associated with signs and symptoms of TMD. PMID:23515361

Management of Chronic Recurrent Dislocation of Temporomandibular Joint Using 'U' Shaped Graft: A New Restrictive Technique.

PubMed

Gadre, Kiran; Singh, Divya; Gadre, Pushkar; Halli, Rajshekhar

2017-06-01

Numerous procedures have been described for the treatment of chronic recurrent dislocation of the temporo-mandibular joint (TMJ), either in the form of enhancement or restriction of the condylar movement, with their obvious merits and demerits. We present a new technique of using U shaped iliac bone graft to restrict the condylar movement and its advantages over the conventional techniques.We have used this technique successfully in 8 cases where Dautrey's procedure had failed with follow up period of 2 years. No patient complained of recurrent dislocation postoperatively. This a very simple and effective technique where other procedures have failed.

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

PubMed Central

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

2012-01-01

The paper explains the alterations of the temporomandibular joint (TMJ) visualized by magnetic resonance imaging (MRI) according to the growth and development of schoolchildren. Appearance and disappearance of a “double contour-like structure” (DCLS) of the mandibular condyle on MRI according to the growth and development of schoolchildren were demonstrated. In addition, possible constituents of DCLS and the significance of detection of DCLS on MRI were also speculated. The relationship between red marrow and yellow marrow in the articular eminence of temporal bone, the disappearance of DCLS, and alterations of the mandibular condyle have been elucidated. PMID:23316233

Joint health and functional ability in children with haemophilia who receive intensive replacement therapy.

PubMed

Groen, W; van der Net, J; Bos, K; Abad, A; Bergstrom, B-M; Blanchette, V S; Feldman, B M; Funk, S; Helders, P; Hilliard, P; Manco-Johnson, M; Petrini, P; Zourikian, N; Fischer, K

2011-09-01

Joint physical examination is an important outcome in haemophilia; however its relationship with functional ability is not well established in children with intensive replacement therapy. Boys aged 4-16 years were recruited from two European and three North American treatment centres. Joint physical structure and function was measured with the Haemophilia Joint Health Score (HJHS) while functional ability was measured with the revised Childhood Health Assessment Questionnaire (CHAQ₃₈. Two haemophilia-specific domains were created by selecting items of the CHAQ₃₈ that cover haemophilia-specific problems. Associations between CHAQ, HJHS, cumulative number of haemarthroses and age were assessed. A total of 226 subjects - mean 10.8 years old (SD 3.8) - participated; the majority (68%) had severe haemophilia. Most severe patients (91%) were on prophylactic treatment. Lifetime number of haemarthroses [median=5; interquartile range (IQR)=1-12] and total HJHS (median = 5; IQR=1-12) correlated strongly (ρ = 0.51). Total HJHS did not correlate with age and only weakly (ρ=-0.19) with functional ability scores (median=0; IQR=-0.06-0). Overall, haemarthroses were reported most frequently in the ankles. Detailed analysis of ankle joint health scores revealed moderate associations (ρ=0.3-0.5) of strength, gait and atrophy with lower extremity tasks (e.g. stair climbing). In this population, HJHS summating six joints did not perform as well as individual joint scores, however, certain elements of ankle impairment, specifically muscle strength, atrophy and gait associated significantly with functional loss in lower extremity activities. Mild abnormalities in ankle assessment by HJHS may lead to functional loss. Therefore, ankle joints may warrant special attention in the follow up of these children. © 2011 Blackwell Publishing Ltd.

Characteristic Magnetic Resonance Imaging Findings in Rheumatoid Arthritis of the Temporomandibular Joint: Focus on Abnormal Bone Marrow Signal of the Mandibular Condyle, Pannus, and Lymph Node Swelling in the Parotid Glands.

PubMed

Hirahara, Naohisa; Kaneda, Takashi; Muraoka, Hirotaka; Fukuda, Taiga; Ito, Kotaro; Kawashima, Yusuke

2017-04-01

The purpose of this study was to determine the characteristic magnetic resonance imaging (MRI) findings indicating bone and soft tissue involvement in patients with rheumatoid arthritis (RA) of the temporomandibular joints (TMJs). Twenty-one patients with RA and TMJ pain who underwent MRI examination of the TMJs at the authors' hospital from August 2006 to December 2014 were included in this study. Twenty-two patients with normal TMJs who underwent MRI examination at the authors' hospital from November to December 2014 were included as controls. MRI findings were compared between the 2 groups. MRI findings of RA in the TMJ included 1) abnormal disc position (95.2%), 2) abnormal disc morphology (83.3%), 3) joint effusion (30.9%), 4) osseous changes in the mandibular condyle (83.3%), 5) synovial proliferation (pannus; 85.7%), 6) erosion of the articular eminence and glenoid fossa (9.52%), 7) deformity of the articular eminence and glenoid fossa (16.6%), 8) abnormal bone marrow signal in the mandibular condyle (83.3%), and 9) swelling of lymph nodes in the parotid glands (78.5%). The abnormal bone marrow signal and pannus in the mandibular condyle and lymph node swelling in the parotid glands were markedly more common in patients with RA than in controls. MRI findings of RA of the TMJs were characterized by bone and soft tissue involvement, including abnormal bone marrow signal of the mandibular condyle, pannus, and swelling of lymph nodes in the parotid glands. These characteristic MRI findings could be useful in detecting RA in the TMJ in a clinical situation. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Noninvasively measuring oxygen saturation of human finger-joint vessels by multi-transducer functional photoacoustic tomography

NASA Astrophysics Data System (ADS)

Deng, Zijian; Li, Changhui

2016-06-01

Imaging small blood vessels and measuring their functional information in finger joint are still challenges for clinical imaging modalities. In this study, we developed a multi-transducer functional photoacoustic tomography (PAT) system and successfully imaged human finger-joint vessels from ˜1 mm to <0.2 mm in diameter. In addition, the oxygen saturation (SO2) values of these vessels were also measured. Our results demonstrate that PAT can provide both anatomical and functional information of individual finger-joint vessels with different sizes, which might help the study of finger-joint diseases, such as rheumatoid arthritis.

Developing a musculoskeletal model of the primate skull: predicting muscle activations, bite force, and joint reaction forces using multibody dynamics analysis and advanced optimisation methods.

PubMed

Shi, Junfen; Curtis, Neil; Fitton, Laura C; O'Higgins, Paul; Fagan, Michael J

2012-10-07

An accurate, dynamic, functional model of the skull that can be used to predict muscle forces, bite forces, and joint reaction forces would have many uses across a broad range of disciplines. One major issue however with musculoskeletal analyses is that of muscle activation pattern indeterminacy. A very large number of possible muscle force combinations will satisfy a particular functional task. This makes predicting physiological muscle recruitment patterns difficult. Here we describe in detail the process of development of a complex multibody computer model of a primate skull (Macaca fascicularis), that aims to predict muscle recruitment patterns during biting. Using optimisation criteria based on minimisation of muscle stress we predict working to balancing side muscle force ratios, peak bite forces, and joint reaction forces during unilateral biting. Validation of such models is problematic; however we have shown comparable working to balancing muscle activity and TMJ reaction ratios during biting to those observed in vivo and that peak predicted bite forces compare well to published experimental data. To our knowledge the complexity of the musculoskeletal model is greater than any previously reported for a primate. This complexity, when compared to more simple representations provides more nuanced insights into the functioning of masticatory muscles. Thus, we have shown muscle activity to vary throughout individual muscle groups, which enables them to function optimally during specific masticatory tasks. This model will be utilised in future studies into the functioning of the masticatory apparatus. Copyright © 2012 Elsevier Ltd. All rights reserved.

Stone Man: A Case Report

PubMed Central

Mortazavi, Hamed; Eshghpour, Majid; Niknami, Mahdi; Saeedi, Morteza

2012-01-01

Fibrodysplasia ossificans progressiva (FOP) is a rare hereditary connective tissue disease characterized by the progressive ectopic ossification of ligaments, tendons, and facial and skeletal muscles throughout life. Symptoms begin in childhood as localized soft tissue swellings. Immobility and articular dysfunction appear with involvement of the spine and proximal extremities. The temporomandibular joint (TMJ) is a critical component involved in the maxillofacial region, resulting in severe limitation of masticatory function, although TMJ involvement is rare. The aim of this article is to present a 28-year-old man with dental problems and slowly progressive limitation of motion in the jaw, knees, shoulders and hips as well as neck distortion. PMID:23599712

Association between disk position and degenerative bone changes of the temporomandibular joints: an imaging study in subjects with TMD.

PubMed

Cortés, Daniel; Sylvester, Daniel Cortés; Exss, Eduardo; Marholz, Carlos; Millas, Rodrigo; Moncada, Gustavo

2011-04-01

The aim of this study was to determine the frequency and relationship between disk position and degenerative bone changes in the temporomandibular joints (TMJ), in subjects with internal derangement (ID). MRI and CT scans of 180 subjects with temporomandibular disorders (TMD) were studied. Different image parameters or characteristics were observed, such as disk position, joint effusion, condyle movement, degenerative bone changes (flattened, cortical erosions and irregularities), osteophytes, subchondral cysts and idiopathic condyle resorption. The present study concluded that there is a significant association between disk displacement without reduction and degenerative bone changes in patients with TMD. The study also found a high probability of degenerative bone changes when disk displacement without reduction is present. No association was found between TMD and condyle range of motion, joint effusion and/or degenerative bone changes. The following were the most frequent morphological changes observed: flattening of the anterior surface of the condyle; followed by erosions and irregularities of the joint surfaces; flattening of the articular surface of the temporal eminence, subchondral cysts, osteophytes; and idiopathic condyle resorption, in decreasing order.

Effects of hook plate on shoulder function after treatment of acromioclavicular joint dislocation

PubMed Central

Chen, Chang-Hong; Dong, Qi-Rong; Zhou, Rong-Kui; Zhen, Hua-Qing; Jiao, Ya-Jun

2014-01-01

Introduction: Internal fixation with hook plate has been used to treat acromioclavicular joint dislocation. This study aims to evaluate the effect of its use on shoulder function, to further analyze the contributing factors, and provide a basis for selection and design of improved internal fixation treatment of the acromioclavicular joint dislocation in the future. Methods: A retrospective analysis was performed on patients treated with a hook plate for acromioclavicular joint dislocation in our hospital from January 2010 to February 2013. There were 33 cases in total, including 25 males and 8 females, with mean age of 48.27 ± 8.7 years. There were 29 cases of Rockwood type III acromioclavicular dislocation, 4 cases of type V. The Constant-Murley shoulder function scoring system was used to evaluate the shoulder function recovery status after surgery. Anteroposterior shoulder X-ray was used to assess the position of the hook plate, status of acromioclavicular joint reduction and the occurrence of postoperative complications. Results: According to the Constant-Murley shoulder function scoring system, the average scores were 78 ± 6 points 8 to 12 months after the surgery and before the removal of the hook plate, the average scores were 89 ± 5 minutes two months after the removal of hook plate. Postoperative X-ray imaging showed osteolysis in 10 cases (30.3%), osteoarthritis in six cases (18.1%), osteolysis associated with osteoarthritis in four cases(12.1%), and steel hook broken in one case (3%). Conclusion: The use of hook plate on open reduction and internal fixation of the acromioclavicular joint dislocation had little adverse effect on shoulder function and is an effective method for the treatment of acromioclavicular joint dislocation. Osteoarthritis and osteolysis are the two common complications after hook plate use, which are associated with the impairment of shoulder function. Shoulder function will be improved after removal of the hook plate. PMID

Whole-body vibration does not influence knee joint neuromuscular function or proprioception.

PubMed

Hannah, R; Minshull, C; Folland, J P

2013-02-01

This study examined the acute effects of whole-body vibration (WBV) on knee joint position sense and indices of neuromuscular function, specifically strength, electromechanical delay and the rate of force development. Electromyography and electrically evoked contractions were used to investigate neural and contractile responses to WBV. Fourteen healthy males completed two treatment conditions on separate occasions: (1) 5 × 1 min of unilateral isometric squat exercise on a synchronous vibrating platform [30 Hz, 4 mm peak-to-peak amplitude] (WBV) and (2) a control condition (CON) of the same exercise without WBV. Knee joint position sense (joint angle replication task) and quadriceps neuromuscular function were assessed pre-, immediately-post and 1 h post-exercise. During maximum voluntary knee extensions, the peak force (PF(V)), electromechanical delay (EMD(V)), rate of force development (RFD(V)) and EMG of the quadriceps were measured. Twitch contractions of the knee extensors were electrically evoked to assess EMD(E) and RFD(E). The results showed no influence of WBV on knee joint position, EMD(V), PF(V) and RFD(V) during the initial 50, 100 or 150 ms of contraction. Similarly, electrically evoked neuromuscular function and neural activation remained unchanged following the vibration exercise. A single session of unilateral WBV did not influence any indices of thigh muscle neuromuscular performance or knee joint proprioception. © 2011 John Wiley & Sons A/S.

Rationale for early versus late intervention with arthroscopy for treatment of inflammatory/degenerative temporomandibular joint disorders.

PubMed

Israel, Howard A; Behrman, David A; Friedman, Joel M; Silberstein, Jennifer

2010-11-01

The goal of this study was to determine if there were differences in outcomes of arthroscopic surgery in patients with inflammatory/degenerative temporomandibular joint (TMJ) disease who underwent early surgical intervention versus late surgical intervention. The study population included 44 consecutive patients who met the criteria for TMJ operative arthroscopy who were divided into early and late intervention groups. The time between the onset of symptoms and the performance of arthroscopy was used to determine entry into the early versus late intervention group. All groups were evaluated for changes in preoperative versus postoperative pain levels based on visual analog scale (VAS) scores and maximum interincisal opening distance. Statistical analyses included the Student t test to determine if there were significant differences between preoperative and postoperative assessments in the early and late intervention groups. The mean time between onset of symptoms in the early intervention group (21 patients) was 5.4 months compared with 33 months in the late intervention group (23 patients). All patient groups had statistically significant decreases in pain and improvement in maximum interincisal opening distance after arthroscopy. The early intervention group had a mean decrease in VAS pain scores of 5.14 compared with the late intervention group with a mean decrease in VAS pain scores of 2.84, and this difference was significant (P = .012). The early intervention group had a mean increase in maximum interincisal opening of 12.38 mm compared with the late intervention group with a mean increase of 7.70. Although statistical significance was not achieved for increases in maximum interincisal opening between the early and late intervention groups (P = .089), the difference between the 2 groups was suggestive of a trend. There were no surgical complications for either group; however, 2 patients in the late intervention group developed persistent chronic neuropathic

What Variables Are Associated With the Outcome of Arthroscopic Lysis and Lavage Surgery for Internal Derangement of the Temporomandibular Joint?

PubMed

Haeffs, Tyler H; D'Amato, Lindsay N; Khawaja, Shehryar N; Keith, David A; Scrivani, Steven J

2018-04-26

Arthroscopic lysis and lavage surgery (AS) is an effective modality that can decrease pain and increase maximum interincisal opening (MIO) in patients with internal derangement (ID) of the temporomandibular joint (TMJ). However, some patients remain in pain or have limited mandibular range of motion despite AS. The purpose of this study was to determine the effectiveness, prevalence of adverse effects, and predictors of response to TMJ AS in patients with TMJ arthralgia and ID. A retrospective cohort study was conducted using data of patients who had undergone AS by a single surgeon (D.A.K.) from September 2010 to April 2015 in the Department of Oral and Maxillofacial Surgery at Massachusetts General Hospital (Boston, MA). Variables, including demographic data, medical history, and clinical presentation, were extracted and analyzed. Criteria for surgical success were defined as a postoperative MIO of at least 35 mm and a postoperative pain level no higher than 3 on an 11-point Likert-type numeric verbal pain rating scale. Appropriate descriptive and analytic statistics were computed and significance was set at a P value less than .05. Of the 247 participants, 226 (91.5%) were women. The mean age of the sample was 38 ± 15.4 years. Successful surgical outcome was achieved in 62.3% of patients. Based on logistic regression analysis, higher initial mean pain score and concurrent use of benzodiazepines were the only variables that predicted an unsuccessful surgical outcome (P < .001; P = .005). Adverse effects were reported by 13.4% of patients, the most common being postoperative increase in pain (13.4%), temporary malocclusion (1.2%), and temporary paresthesia in the preauricular region (0.4%). The results from this study indicate that in patients with ID of the TMJ unresponsive to noninvasive treatments, high initial pain scores and concurrent use of benzodiazepines are correlated with an unsuccessful outcome after AS. Copyright © 2018. Published by

Condylar repositioning using centric relation bite in bimaxillary surgery

PubMed Central

Lee, Chang-Youn; Jang, Chang-Su; Kim, Ju-Won; Kim, Jwa-Young

2013-01-01

Objective The purpose of this study was to evaluate displacement of the mandibular condyle after orthognathic surgery using a condylar-repositioning device. Methods The patient group comprised 20 adults who underwent bimaxillary surgery between August 2008 and July 2011. The degree of condylar displacement was measured by pre- and postoperative tomographic analysis using centric relation bite and a wire during surgery. A survey assessing temporomandibular joint (TMJ) sound, pain, and locking was performed. The 20 tomographs and surveys were analyzed using the Wilcoxon signed-rank test and McNemar's test, respectively. Results No significant changes were observed in the anterior, superior, or posterior joint space of the TMJ (p > 0.05). In addition, no significant change was observed in TMJ sound (p > 0.05). However, TMJ pain and locking both decreased significantly after surgery (p < 0.05). Conclusions Due to its simplicity, this method may be feasible and useful for repositioning condyles. PMID:23671832

Synovial sarcoma of the temporomandibular joint and infratemporal fossa.

PubMed

Nomura, Fuminori; Kishimoto, Seiji

2014-12-01

Synovial sarcoma in the head and neck region is rare, and is difficult to resect with adequate safety margins because of its anatomical complexity. We herein report our experiences with synovial sarcoma in this region, and review the literature regarding the management of such cases. We retrospectively examined four cases of synovial sarcoma arising from the temporomandibular joint (TMJ) area and infratemporal fossa. Only one patient remains alive without disease, while the other three patients have died. The local control of these tumors has improved because of the progress in the surgical operation methods, while it is expected that there is still a high rate of deaths due to distant metastasis increase. The development of strong chemotherapy is needed for the use after the initial treatment and surgery. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

[Correlation of medial compartmental joint line elevation with femorotibial angle correction and clinical function after unicompartmental arthroplasty].

PubMed

Zhang, Zhan-Feng; Wang, Dan; Min, Ji-Kang

2017-04-25

To study the correlation of postoperative femorotibial angle with medial compartmental joint line elevation after unicompartmental arthroplasty(UKA), as well as the correlation of joint line elevation with the clinical function by measuring radiological joint line. A retrospective study of 56 patients from July 2012 to August 2015 was performed. The mean body mass index (BMI) was 23.5 (ranged, 18.3 to 30.1). The standing anteroposterior radiographs of these patients were assessed both pre-and post-operatively, and the knee function was evaluated according to HSS grading. The correlation between postoperative femorotibial angle(FTA) and joint line elevation was analyzed as well as the correlation between joint line elevation and the clinical function. The mean medial joint line elevation was (2.2±2.0) mm(ranged, -3.3 to 7.0 mm), and the mean FTA correction was (2.3±3.0)°(ranged, -4.5° to 9.6°). The mean follow-up period was 12.2 months. There was a significant correlation between in joint line elevation and FTA correction( P <0.05), while there was no significant correlation between joint line elevation and the clinical function( P >0.05). There was a significant correlation between medial compartmental joint line elevation and FTA correction after UKA, and the proximal tibial osteotomy was critical during the procedure. There was no significant correlation between joint line elevation and the clinical function, which may be related to the design of UKA prosthesis.

Pathogenesis of post-traumatic ankylosis of the temporomandibular joint: a critical review.

PubMed

Arakeri, Gururaj; Kusanale, Atul; Zaki, Graeme A; Brennan, Peter A

2012-01-01

Many factors have been implicated in the development of bony ankylosis following trauma to the temporomandibular joint (TMJ) or ankylosis that recurs after surgical treatment for the condition. Although many reports have been published, to our knowledge very little has been written about the pathogenesis of the process and there are few scientific studies. Over the last 70 years various treatments have been described. Different methods have been used with perceived favourable outcomes although recurrence remains a problem in many cases, and ankylosis presents a major therapeutic challenge. We present a critical review of published papers and discuss the various hypotheses regarding the pathogenesis of the condition. Copyright © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Articular soft tissue anatomy of the archosaur hip joint: Structural homology and functional implications.

PubMed

Tsai, Henry P; Holliday, Casey M

2015-06-01

Archosaurs evolved a wide diversity of locomotor postures, body sizes, and hip joint morphologies. The two extant archosaurs clades (birds and crocodylians) possess highly divergent hip joint morphologies, and the homologies and functions of their articular soft tissues, such as ligaments, cartilage, and tendons, are poorly understood. Reconstructing joint anatomy and function of extinct vertebrates is critical to understanding their posture, locomotor behavior, ecology, and evolution. However, the lack of soft tissues in fossil taxa makes accurate inferences of joint function difficult. Here, we describe the soft tissue anatomies and their osteological correlates in the hip joint of archosaurs and their sauropsid outgroups, and infer structural homology across the extant taxa. A comparative sample of 35 species of birds, crocodylians, lepidosaurs, and turtles ranging from hatchling to skeletally mature adult were studied using dissection, imaging, and histology. Birds and crocodylians possess topologically and histologically consistent articular soft tissues in their hip joints. Epiphyseal cartilages, fibrocartilages, and ligaments leave consistent osteological correlates. The archosaur acetabulum possesses distinct labrum and antitrochanter structures on the supraacetabulum. The ligamentum capitis femoris consists of distinct pubic- and ischial attachments, and is homologous with the ventral capsular ligament of lepidosaurs. The proximal femur has a hyaline cartilage core attached to the metaphysis via a fibrocartilaginous sleeve. This study provides new insight into soft tissue structures and their osteological correlates (e.g., the antitrochanter, the fovea capitis, and the metaphyseal collar) in the archosaur hip joint. The topological arrangement of fibro- and hyaline cartilage may provide mechanical support for the chondroepiphysis. The osteological correlates identified here will inform systematic and functional analyses of archosaur hindlimb evolution and

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

PubMed

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

2013-09-01

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). Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Functional impacts of exoskeleton-based rehabilitation in chronic stroke: multi-joint versus single-joint robotic training

PubMed Central

2013-01-01

Stroke is a major cause of disability in the world. The activities of upper limb segments are often compromised following a stroke, impairing most daily tasks. Robotic training is now considered amongst the rehabilitation methods applied to promote functional recovery. However, the implementation of robotic devices remains a major challenge for the bioengineering and clinical community. Latest exoskeletons with multiple degrees of freedom (DOF) may become particularly attractive, because of their low apparent inertia, the multiple actuators generating large torques, and the fact that patients can move the arm in the normal wide workspace. A recent study published in JNER by Milot and colleagues underlines that training with a 6-DOF exoskeleton impacts positively on motor function in patients being in stable phase of recovery after a stroke. Also, multi-joint robotic training was not found to be superior to single-joint robotic training. Although it is often considered that rehabilitation should start from simple movements to complex functional movements as the recovery evolves, this study challenges this widespread notion whose scientific basis has remained uncertain. PMID:24354518

Comprehensive joint feedback control for standing by functional neuromuscular stimulation-a simulation study.

PubMed

Nataraj, Raviraj; Audu, Musa L; Kirsch, Robert F; Triolo, Ronald J

2010-12-01

Previous investigations of feedback control of standing after spinal cord injury (SCI) using functional neuromuscular stimulation (FNS) have primarily targeted individual joints. This study assesses the potential efficacy of comprehensive (trunk, hips, knees, and ankles) joint feedback control against postural disturbances using a bipedal, 3-D computer model of SCI stance. Proportional-derivative feedback drove an artificial neural network trained to produce muscle excitation patterns consistent with maximal joint stiffness values achievable about neutral stance given typical SCI muscle properties. Feedback gains were optimized to minimize upper extremity (UE) loading required to stabilize against disturbances. Compared to the baseline case of maximum constant muscle excitations used clinically, the controller reduced UE loading by 55% in resisting external force perturbations and by 84% during simulated one-arm functional tasks. Performance was most sensitive to inaccurate measurements of ankle plantar/dorsiflexion position and hip ab/adduction velocity feedback. In conclusion, comprehensive joint feedback demonstrates potential to markedly improve FNS standing function. However, alternative control structures capable of effective performance with fewer sensor-based feedback parameters may better facilitate clinical usage.

DIFFERENTIAL PATIENT RESPONSE TO INSTRUCTION, COUNSELING, AND DENTAL TREATMENT. PAPER PRESENTED AT A NATIONAL SEMINAR ON ADULT EDUCATION RESEARCH (CHICAGO, FEBRUARY 11-13, 1968).

ERIC Educational Resources Information Center

LUPTON, DANIEL E.

RESEARCH (1) ANALYZED SPECIFIC OUTCOMES OF COUNSELING, INSTRUCTION, AND DENTAL THERAPY, AND (2) DETERMINED THE RELATIVE EFFECTIVENESS OF PATIENT EDUCATION FOR RELIEF OF TEMPOROMANDIBULAR JOINT (TMJ) DYSFUNCTION. SIXTY ADULT PATIENTS ATTENDING THE UNIVERSITY OF ILLINOIS TMJ RESEARCH CENTER WERE RANDOMLY ASSIGNED TO ONE OF THREE PROGRAMS--DENTISTRY,…

In Vivo Talocrural Joint Contact Mechanics With Functional Ankle Instability.

PubMed

Kobayashi, Takumi; Suzuki, Eiichi; Yamazaki, Naohito; Suzukawa, Makoto; Akaike, Atsushi; Shimizu, Kuniaki; Gamada, Kazuyoshi

2015-12-01

Functional ankle instability (FAI) may involve abnormal kinematics and contact mechanics during ankle internal rotation. Understanding of these abnormalities is important to prevent secondary problems in patients with FAI. However, there are no in vivo studies that have investigated talocrural joint contact mechanics during weightbearing ankle internal rotation. The objective of this study to determine talocrural contact mechanics during weightbearing ankle internal rotation in patients with FAI. Twelve male subjects with unilateral FAI (age range, 18-26 years) were enrolled. Computed tomography and fluoroscopic imaging of both lower extremities were obtained during weightbearing passive ankle joint complex rotation. Three-dimensional bone models created from the computed tomographic images were matched to the fluoroscopic images to compute 6 degrees of freedom for talocrural joint kinematics. The closest contact area in the talocrural joint in ankle neutral rotation and maximum internal rotation during either dorsiflexion or plantar flexion was determined using geometric bone models and talocrural joint kinematics data. The closest contact area in the talus shifted anteromedially during ankle dorsiflexion-internal rotation, whereas it shifted posteromedially during ankle plantar flexion-internal rotation. The closest contact area in FAI joints was significantly more medial than that in healthy joints during maximum ankle internal rotation and was associated with excessive talocrural internal rotation or inversion. This study demonstrated abnormal talocrural kinematics and contact mechanics in FAI subjects. Such abnormal kinematics may contribute to abnormal contact mechanics and may increase cartilage stress in FAI joints. Therapeutic, Level IV: cross-sectional case-control study. © 2015 The Author(s).

Functional anatomy of the distal radioulnar joint in health and disease.

PubMed

Lees, V C

2013-04-01

The distal radioulnar joint (DRUJ) is critical to the function of the forearm as a mechanical unit. This paper is concerned with the concepts and observations that have changed understanding of the function of the DRUJ, notably with respect to the biomechanics of this joint. The DRUJ has been shown to be important in acting to distribute load and removal of the ulna head leads to the biomechanical equivalent of a one-bone forearm. The soft tissues with topographical relations to the distal forearm and DRUJ have also been investigated in our experimental series with findings including the description of a clinical disorder termed subluxation-related ulna neuropathy syndrome.

Temporomandibular joint dysfunction syndrome. A clinical report.

PubMed

Passero, P L; Wyman, B S; Bell, J W; Hirschey, S A; Schlosser, W S

1985-08-01

We have presented two clinical case reports of patients with TMJ dysfunction syndrome as an example of coordinated treatments between dentists and physical therapists. The clinical profiles of these patients with craniocervical pain were compiled from comprehensive physical therapy and dental-orthopedic evaluations. The significance of the relationship between the rest position of the mandible and forward head posture has been shown by the changes observed after correction of the postural deviations and vertical resting dimensions by dental treatments and physical therapy. Additional research is necessary to determine long-term effects of this combined approach in TMJ dysfunction syndrome.

Amalgamating Esthetics, Function and Comfort in Full Mouth Rehabilitation – A Case Report

PubMed Central

Thakral, Rashmi; Arora, Saurabh; Sharma, Neeraj; Chawla, Chetan

2014-01-01

Restoration of aesthetics, function and comfort in badly compromised dentition and its supporting tissues often poses a great challenge. The long term success of such cases depends largely on simultaneous achieving of satisfying aesthetics and a harmonious occlusion. Proper examination, evaluation and diagnosis of the prevailing oral conditions serve as a prelude to a rationalized treatment plan and its ultimate success. Invariably, it also becomes significant to understand and recognize the consequences of long term negligence by the patient. An unattended such condition, apart from causing compromised oral functions may also lead to neuromuscular problems in and around temporo-mandibular joint (TMJ) causing frequent pain in the region and unyielding headaches. Restoring physiologically advised health conditions from habitual positions and functions may require time, patience and effort by both – the patient and the dentist. A complete rehabilitation may also require involvement of more than one disciplines of dentistry. The case report highlights the contributions from prosthodontists, periodontists, endodontists and the radiologist as a team in complete rehabilitation of the patient. PMID:24959521

Impact of local steroid or statin treatment of experimental temporomandibular joint arthritis on bone growth in young rats.

PubMed

Holwegner, Callista; Reinhardt, Adam L; Schmid, Marian J; Marx, David B; Reinhardt, Richard A

2015-01-01

Juvenile idiopathic arthritis in temporomandibular joints (TMJs) is often treated with intra-articular steroid injections, which can inhibit condylar growth. The purpose of this study was to compare simvastatin (a cholesterol-lowering drug that reduces TMJ inflammation) with the steroid triamcinolone hexacetonide in experimental TMJ arthritis. Joint inflammation was induced by injecting complete Freund's adjuvant (CFA) into the TMJs of 40 growing Sprague Dawley rats; 4 other rats were left untreated. In the same intra-articular injection, one of the following was applied: (1) 0.5 mg of simvastatin in ethanol carrier, (2) ethanol carrier alone, (3) 0.15 mg of triamcinolone hexacetonide, (4) 0.5 mg of simvastatin and 0.15 mg of triamcinolone hexacetonide, or (5) nothing additional to the CFA. The animals were killed 28 days later, and their mandibles were evaluated morphometrically and with microcomputed tomography. The analysis showed that the TMJs subjected to CFA alone had decreased ramus height compared with those with no treatment (P <0.05). Groups that had injections containing the steroid overall had decreases in weight, ramus height, and bone surface density when compared with the CFA-alone group (P <0.0001). Groups that had injections containing simvastatin, however, had overall increases in weight (P <0.0001), ramus height (P <0.0001), condylar width (P <0.05), condylar bone surface density (P <0.05), and bone volume (P <0.0001) compared with the groups receiving the steroid injections, and they were not different from the healthy (no treatment) group. Treatment of experimentally induced arthritis in TMJs with intra-articular simvastatin preserved normal condylar bone growth. Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Joint Attention and Brain Functional Connectivity in Infants and Toddlers

PubMed Central

Eggebrecht, Adam T.; Elison, Jed T.; Feczko, Eric; Todorov, Alexandre; Wolff, Jason J.; Kandala, Sridhar; Adams, Chloe M.; Snyder, Abraham Z.; Lewis, John D.; Estes, Annette M.; Zwaigenbaum, Lonnie; Botteron, Kelly N.; McKinstry, Robert C.; Constantino, John N.; Evans, Alan; Hazlett, Heather C.; Dager, Stephen; Paterson, Sarah J.; Schultz, Robert T.; Styner, Martin A.; Gerig, Guido; Das, Samir; Kostopoulos, Penelope; Schlaggar, Bradley L.; Petersen, Steven E.; Piven, Joseph; Pruett, John R.

2017-01-01

Abstract Initiating joint attention (IJA), the behavioral instigation of coordinated focus of 2 people on an object, emerges over the first 2 years of life and supports social-communicative functioning related to the healthy development of aspects of language, empathy, and theory of mind. Deficits in IJA provide strong early indicators for autism spectrum disorder, and therapies targeting joint attention have shown tremendous promise. However, the brain systems underlying IJA in early childhood are poorly understood, due in part to significant methodological challenges in imaging localized brain function that supports social behaviors during the first 2 years of life. Herein, we show that the functional organization of the brain is intimately related to the emergence of IJA using functional connectivity magnetic resonance imaging and dimensional behavioral assessments in a large semilongitudinal cohort of infants and toddlers. In particular, though functional connections spanning the brain are involved in IJA, the strongest brain-behavior associations cluster within connections between a small subset of functional brain networks; namely between the visual network and dorsal attention network and between the visual network and posterior cingulate aspects of the default mode network. These observations mark the earliest known description of how functional brain systems underlie a burgeoning fundamental social behavior, may help improve the design of targeted therapies for neurodevelopmental disorders, and, more generally, elucidate physiological mechanisms essential to healthy social behavior development. PMID:28062515

Joint Attention, Self-Recognition, and Neurocognitive Function in Toddlers

ERIC Educational Resources Information Center

Nichols, Kate E.; Fox, Nathan; Mundy, Peter

2005-01-01

Recent studies have attempted to understand the processes involved in joint attention because of its relevance to both atypical and normal development. Data from a recent study of young children with autism suggests that performance on a delay nonmatch to sample (DNMS) task associated with ventromedial prefrontal functions, but not an…

Maximum voluntary joint torque as a function of joint angle and angular velocity: model development and application to the lower limb.

PubMed

Anderson, Dennis E; Madigan, Michael L; Nussbaum, Maury A

2007-01-01

Measurements of human strength can be important during analyses of physical activities. Such measurements have often taken the form of the maximum voluntary torque at a single joint angle and angular velocity. However, the available strength varies substantially with joint position and velocity. When examining dynamic activities, strength measurements should account for these variations. A model is presented of maximum voluntary joint torque as a function of joint angle and angular velocity. The model is based on well-known physiological relationships between muscle force and length and between muscle force and velocity and was tested by fitting it to maximum voluntary joint torque data from six different exertions in the lower limb. Isometric, concentric and eccentric maximum voluntary contractions were collected during hip extension, hip flexion, knee extension, knee flexion, ankle plantar flexion and dorsiflexion. Model parameters are reported for each of these exertion directions by gender and age group. This model provides an efficient method by which strength variations with joint angle and angular velocity may be incorporated into comparisons between joint torques calculated by inverse dynamics and the maximum available joint torques.

A cross-sectional study of the relationship between serum sexual hormone levels and internal derangement of temporomandibular joint.

PubMed

Madani, A S; Shamsian, A A; Hedayati-Moghaddam, M R; Fathi-Moghadam, F; Sabooni, M R; Mirmortazavi, A; Golmohamadi, M

2013-08-01

Temporomandibular disorders (TMD) are defined as clinical conditions that involve the masticatory muscles, temporomandibular joint (TMJ) or both. The aim of this study was to evaluate serum 17β-oestradiol and progesterone levels in menstruating women affected by internal derangement of the TMJ. A total of 142 women (mean age 30·2 ± 6·7) who referred to medical diagnostic laboratory of Iranian Academic Centre for Education, Culture and Research (ACECR), Mashhad Branch, were enrolled during 2007 and 2008. Forty-seven individuals had disc displacement with reduction (Group IIa) according to Research Diagnostic Criteria (RDC)/TMD Axis I diagnosis. Radioimmunoassay was used for the detection of serum 17β-oestradiol and progesterone levels in all 142 subjects. The mean progesterone level was significantly higher in control group (11·6 ± 10·4 ng mL(-1) ) compared to women with TMD (8·4 ± 6·8 ng mL(-1) , P = 0·03). No significant difference was found in two groups regarding 17β-oestradiol level. Lower progesterone level in women with TMD can suggest the more important role of this hormone in the development of the disorder. © 2013 John Wiley & Sons Ltd.

Comprehensive Joint Feedback Control for Standing by Functional Neuromuscular Stimulation – a Simulation Study

PubMed Central

Nataraj, Raviraj; Audu, Musa L.; Kirsch, Robert F.; Triolo, Ronald J.

2013-01-01

Previous investigations of feedback control of standing after spinal cord injury (SCI) using functional neuromuscular stimulation (FNS) have primarily targeted individual joints. This study assesses the potential efficacy of comprehensive (trunk, hips, knees, and ankles) joint-feedback control against postural disturbances using a bipedal, three-dimensional computer model of SCI stance. Proportional-derivative feedback drove an artificial neural network trained to produce muscle excitation patterns consistent with maximal joint stiffness values achievable about neutral stance given typical SCI muscle properties. Feedback gains were optimized to minimize upper extremity (UE) loading required to stabilize against disturbances. Compared to the baseline case of maximum constant muscle excitations used clinically, the controller reduced UE loading by 55% in resisting external force perturbations and by 84% during simulated one-arm functional tasks. Performance was most sensitive to inaccurate measurements of ankle plantar/dorsiflexion position and hip ab/adduction velocity feedback. In conclusion, comprehensive joint-feedback demonstrates potential to markedly improve FNS standing function. However, alternative control structures capable of effective performance with fewer sensor-based feedback parameters may better facilitate clinical usage. PMID:20923741

The Effectiveness of a Functional Knee Brace on Joint-Position Sense in Anterior Cruciate Ligament-Reconstructed Individuals.

PubMed

Sugimoto, Dai; LeBlanc, Jessica C; Wooley, Sarah E; Micheli, Lyle J; Kramer, Dennis E

2016-05-01

It is estimated that approximately 350,000 individuals undergo anterior cruciate ligament (ACL) reconstruction surgery in each year in the US. Although ACL-reconstruction surgery and postoperative rehabilitation are successfully completed, deficits in postural control remain prevalent in ACL-reconstructed individuals. In order to assist the lack of balance ability and reduce the risk of retear of the reconstructed ACL, physicians often provide a functional knee brace on the patients' return to physical activity. However, it is not known whether use of the functional knee brace enhances knee-joint position sense in individuals with ACL reconstruction. Thus, the effect of a functional knee brace on knee-joint position sense in an ACL-reconstructed population needs be critically appraised. After systematically review of previously published literature, 3 studies that investigated the effect of a functional knee brace in ACL-reconstructed individuals using joint-position-sense measures were found. They were rated as level 2b evidence in the Centre of Evidence Based Medicine Level of Evidence chart. Synthesis of the reviewed studies indicated inconsistent evidence of a functional knee brace on joint-position improvement after ACL reconstruction. More research is needed to provide sufficient evidence on the effect of a functional knee brace on joint-position sense after ACL reconstruction. Future studies need to measure joint-position sense in closed-kinetic-chain fashion since ACL injury usually occurs under weight-bearing conditions.

Joint laxity and the relationship between muscle strength and functional ability in patients with osteoarthritis of the knee.

PubMed

van der Esch, M; Steultjens, M; Knol, D L; Dinant, H; Dekker, J

2006-12-15

To establish the impact of knee joint laxity on the relationship between muscle strength and functional ability in osteoarthritis (OA) of the knee. A cross-sectional study of 86 patients with OA of the knee was conducted. Tests were performed to determine varus-valgus laxity, muscle strength, and functional ability. Laxity was assessed using a device that measures the angular deviation of the knee in the frontal plane. Muscle strength was measured using a computer-driven isokinetic dynamometer. Functional ability was assessed by observation (100-meter walking test) and self report (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]). Regression analyses were performed to assess the impact of joint laxity on the relationship between muscle strength and functional ability. In regression analyses, the interaction between muscle strength and joint laxity contributed to the variance in both walking time (P = 0.002) and WOMAC score (P = 0.080). The slope of the regression lines indicated that the relationship between muscle strength and functional ability (walking time, WOMAC) was stronger in patients with high knee joint laxity. Patients with knee OA and high knee joint laxity show a stronger relationship between muscle strength and functional ability than patients with OA and low knee joint laxity. Patients with OA, high knee joint laxity, and low muscle strength are most at risk of being disabled.

Effects of proprioceptive circuit exercise on knee joint pain and muscle function in patients with knee osteoarthritis.

PubMed

Ju, Sung-Bum; Park, Gi Duck; Kim, Sang-Soo

2015-08-01

[Purpose] This study applied proprioceptive circuit exercise to patients with degenerative knee osteoarthritis and examined its effects on knee joint muscle function and the level of pain. [Subjects] In this study, 14 patients with knee osteoarthritis in two groups, a proprioceptive circuit exercise group (n = 7) and control group (n = 7), were examined. [Methods] IsoMed 2000 (D&R Ferstl GmbH, Hemau, Germany) was used to assess knee joint muscle function, and a Visual Analog Scale was used to measure pain level. [Results] In the proprioceptive circuit exercise group, knee joint muscle function and pain levels improved significantly, whereas in the control group, no significant improvement was observed. [Conclusion] A proprioceptive circuit exercise may be an effective way to strengthen knee joint muscle function and reduce pain in patients with knee osteoarthritis.

Function-specific and Enhanced Brain Structural Connectivity Mapping via Joint Modeling of Diffusion and Functional MRI.

PubMed

Chu, Shu-Hsien; Parhi, Keshab K; Lenglet, Christophe

2018-03-16

A joint structural-functional brain network model is presented, which enables the discovery of function-specific brain circuits, and recovers structural connections that are under-estimated by diffusion MRI (dMRI). Incorporating information from functional MRI (fMRI) into diffusion MRI to estimate brain circuits is a challenging task. Usually, seed regions for tractography are selected from fMRI activation maps to extract the white matter pathways of interest. The proposed method jointly analyzes whole brain dMRI and fMRI data, allowing the estimation of complete function-specific structural networks instead of interactively investigating the connectivity of individual cortical/sub-cortical areas. Additionally, tractography techniques are prone to limitations, which can result in erroneous pathways. The proposed framework explicitly models the interactions between structural and functional connectivity measures thereby improving anatomical circuit estimation. Results on Human Connectome Project (HCP) data demonstrate the benefits of the approach by successfully identifying function-specific anatomical circuits, such as the language and resting-state networks. In contrast to correlation-based or independent component analysis (ICA) functional connectivity mapping, detailed anatomical connectivity patterns are revealed for each functional module. Results on a phantom (Fibercup) also indicate improvements in structural connectivity mapping by rejecting false-positive connections with insufficient support from fMRI, and enhancing under-estimated connectivity with strong functional correlation.

Arthroscopic management of temporomandibular joint disc perforations and associated advanced chondromalacia by discoplasty and abrasion arthroplasty: a supplemental report.

PubMed

Quinn, J H; Stover, J D

1998-11-01

This article describes the results of treating temporomandibular joint (TMJ) articular disc perforation and advanced chondromalacia arthroscopically by the use of discoplasty and abrasion arthroplasty. Forty-four joints were treated in 25 patients (23 females and 2 males). Twenty-nine disc perforations were present, 24 joints had grade III chondromalacia (fibrillated cartilage), and 14 joints had grade IV chondromalacia (exposed bone). Surgical procedures included 14 abrasion arthroplasties and 24 motorized shavings or holmium laser vaporizations. Holmium laser discoplasty with mobilization was used in 29 joints. Patients were followed-up for an average of 40.8 months (11 to 74 months). Preoperative pain on the visual analog scale (VAS) (1 to 10 cm) ranged from 5 to 10 cm, with an average of 7.4 cm. Postoperatively, nine patients had no pain and 16 patients had an average VAS of 2.7 cm (range, 1 to 5 cm). Preoperatively, 30 joints had clicking, and 14 joints had crepitation. Postoperatively, 25 joints had no noise, 12 joints had slight intermittent clicking, and seven joints had crepitation. The preoperative range of motion averaged 29.7 mm. Postoperatively, the range of motion averaged 37.7 mm (range, 33 to 42 mm). All patients could masticate a regular diet except hard food after an average of 40.8 months (11 to 74 months). These findings seem to justify the arthroscopic surgical procedures of discoplasty for disc perforations, motorized shaving, or holmium laser vaporization of grade III chondromalacia, and abrasion arthroplasty for bone exposure. The results also question the need for discectomy in the treatment of disc perforation.

Joint Attention and Brain Functional Connectivity in Infants and Toddlers.

PubMed

Eggebrecht, Adam T; Elison, Jed T; Feczko, Eric; Todorov, Alexandre; Wolff, Jason J; Kandala, Sridhar; Adams, Chloe M; Snyder, Abraham Z; Lewis, John D; Estes, Annette M; Zwaigenbaum, Lonnie; Botteron, Kelly N; McKinstry, Robert C; Constantino, John N; Evans, Alan; Hazlett, Heather C; Dager, Stephen; Paterson, Sarah J; Schultz, Robert T; Styner, Martin A; Gerig, Guido; Das, Samir; Kostopoulos, Penelope; Schlaggar, Bradley L; Petersen, Steven E; Piven, Joseph; Pruett, John R

2017-03-01

Initiating joint attention (IJA), the behavioral instigation of coordinated focus of 2 people on an object, emerges over the first 2 years of life and supports social-communicative functioning related to the healthy development of aspects of language, empathy, and theory of mind. Deficits in IJA provide strong early indicators for autism spectrum disorder, and therapies targeting joint attention have shown tremendous promise. However, the brain systems underlying IJA in early childhood are poorly understood, due in part to significant methodological challenges in imaging localized brain function that supports social behaviors during the first 2 years of life. Herein, we show that the functional organization of the brain is intimately related to the emergence of IJA using functional connectivity magnetic resonance imaging and dimensional behavioral assessments in a large semilongitudinal cohort of infants and toddlers. In particular, though functional connections spanning the brain are involved in IJA, the strongest brain-behavior associations cluster within connections between a small subset of functional brain networks; namely between the visual network and dorsal attention network and between the visual network and posterior cingulate aspects of the default mode network. These observations mark the earliest known description of how functional brain systems underlie a burgeoning fundamental social behavior, may help improve the design of targeted therapies for neurodevelopmental disorders, and, more generally, elucidate physiological mechanisms essential to healthy social behavior development. © The Author 2017. Published by Oxford University Press.

How invasive is TMJ double-contrast arthrography in combination with cinematography? Patient discomfort versus known diagnostic gain.

PubMed

Engelke, W; Mommaerts, M

1990-04-01

There is no doubt that double-contrast TMJ fluoroscopic tomography enables a differential diagnosis and treatment in internal derangement pathosis. Its indication is, apart from the expected diagnostic gain, also determined by the degree of its invasiveness, and other alternative diagnostics being available (nuclear magnetic resonance). Data on patient discomfort and complications were gathered in 63 arthrotomographies; pain sensations and mandibular mobility, during and after the procedure in particular, were studied. We consider, along with Westesson, the procedure to be less invasive than commonly considered, once the surgeon-radiologist has gained enough experience.

Temporomandibular joint status, occlusal attrition, cervical erosion and facial pain among substance abusers.

PubMed

Almas, Khalid; Al Wazzan, K; Al Hussain, I; Al-Ahdal, K Y; Khan, N B

2007-03-01

Drug addiction or substance abuse is an endemic habit globally. At present there is no data available regarding the temporomandibular joint status, occlusal and cervical tooth wear and facial pain among substance abusers from the Saudi Arabia. The aim of the study was to investigate the temporomandibular joint status, occlusal and cervical tooth wear and facial pain among the drug abusers from narcotics control prison, Riyadh, Saudi Arabia. One hundred subjects were included in the study as a convenience sample. Male comprised of 56 and female 44. An interview and clinical examination were performed. The age ranged from 20-65 years with mean (31.4 +/- 8.9). Smoking, drinking and chewing habits were most common modes of drug used. 98.0% were smokers, 61.0% alcohol drinkers and 41.0% were cannabis user. The duration of drug abuse was more than 5 years among most of the candidates. TMJ status revealed that clicking was reported by 40.0%, tenderness by 9% and reduced jaw mobility 0.0%. Occlusal enamel wear (attrition) was reported by 16.1% of male and 18.1% of female. However, the occlusal dentine exposure was among female only (18.1%). Cervical erosion abrasion was common among 16.1% male and 54.5% female. Facial pain was experienced by 6.0% and facial numbness by only 1.0% of the subjects. Smoking, alcohol and cannabis were common among the studied population. Only 9.0% of the subjects had tenderness in TMJ, occlusal enamel wear was among 17.0% of subjects. Only female subjects had dentinal exposure. Facial pain was common among up to only 6.0% of the studied population. From public health point of view, smoking cessation programs and oral health education should be introduced to adolescents to prevent unhealthy illicit substance abusing habits in future. Further studies are needed to assess the oral mucosal changes, dietary pattern, oral hygiene behavior, quality of life and level of satisfaction among the substance abusers from Saudi Arabia.