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Biomechanical tissue characterization of the superior joint space of the porcine temporomandibular joint.

The objective of this study was to characterize the biomechanical properties of articular cartilage in the superior joint space of the porcine temporomadibular joint (TMJ). These properties and thickness of the disk and fossa cartilage were obtained from eight joints using creep indentation. Five sites per surface were tested to obtain the aggregate modulus, Poisson's ratio, permeability, creep, recovery percentage, and cartilage thickness. Histology was also performed to characterize the orientation of the collagen fibers and the proteoglycan content. It was found that the temporal fossa cartilage was 57% thinner and 50% stiffer than the disk. The aggregate modulus of the porcine TMJ disk and fossa was much smaller, but the permeability of the TMJ disk and fossa was much higher than those of articular cartilage in other joints. It was also noted that the TMJ disk did not fully recover following indentation testing unlike the articular cartilage in other joints. The biomechanical properties of the TMJ disk and temporal fossa obtained in this study are significantly different from those of cartilage present in other diarthrodial joints. This suggests that the function of the fibrocartilage in the superior TMJ space is substantially different from that of hyaline cartilage in other joints.

Animals↗

Overview of computed tomography of the temporomandibular joint.

Computed tomography of the temporomandibular joint has been shown to be an accurate method of assessing the position of the disk. To date, we have examined over 500 patients with this modality and have found it also to be effective in the evaluation of other osseous and soft tissue abnormalities. An overview of temporomandibular joint pathology is presented, including the range of osteoarthritic changes from spur formation to complete fusion. Anterior dislocation, with and without reduction, and closed lock are demonstrated. A heretofore unreported phenomenon--posterior dislocation of the meniscus with open lock--is presented. Also shown is the computed tomography evaluation of splint therapy, which has not been dealt with in other publications.

Adult↗

Temporomandibular joint dysfunction: evaluation and treatment.

Temporomandibular joint dysfunction is a complicated problem requiring interdisciplinary cooperation for diagnosis and treatment. Functional problems including bruxism and psychological disorders frequently occur with joint dysfunction making evaluation more difficult. Many new diagnostic modalities are now available to supplement the history and physical examination to provide an accurate assessment of the joint. Although conservative treatment is successful in a majority of the patients, some form of surgical treatment remains the only option for those who do not respond to conservative management. We have discussed the etiology, diagnosis, and treatment of the pathological conditions of the TMJ and introduced a new modality of treatment, temporalis fascia interpositional arthroplasty. Further work is necessary to elucidate the etiology of TMJ dysfunction and develop treatment modalities that avoid the use of alloplastic materials.

Arthroscopy↗

Correction of micrognathia with ankylosis of the temporomandibular joint in childhood.

Insult of temporomandibular joints in infancy may result in severe micrognathia with ankylosis. These patients require tracheostomy and a pureed diet for survival. Between July of 1987 and December of 1990, we treated eight patients with severe micrognathia and ankylosis of one or both temporomandibular joints. Preoperative range of motion at the central incisors was 3.2 +/- 2.1 mm (mean +/- SD). Patients underwent functional reconstruction of one (n = 3) or both (n = 5) temporomandibular joints using costochondral grafts and mandibular advancement at 10.4 +/- 1.7 years of age (mean +/- SD). Rigid fixation of bone grafts with early remobilization was achieved in all cases. Average mandibular advancement was 23.8 +/- 3.7 mm (mean +/- SD), and average elongation was 21.4 +/- 3.3 mm (mean +/- SD). Range of motion at the central incisors was 27.4 +/- 4.2 mm (mean +/- SD) 1.7 +/- 0.8 years (mean +/- SD) postoperatively. Seven patients had tracheostomies prior to surgery, and all were successfully decannulated within 6 months postoperatively. One patient was treated with closed capsulotomy under general anesthesia. Two were treated with open capsulotomy and fascial flap transposition. Functional reconstruction of this deformity in mixed dentition offers these unfortunate individuals significant predictable improvement.

Ankylosis↗

Isokinetic exercise management of temporomandibular joint clicking in young adults.

Temporomandibular joint clicking is frequently a sign of craniomandibular disorders, and the etiologic predisposing, initiating, and perpetuating factors must be considered in its management. The present study assesses the usefulness of isokinetic exercises in the treatment of temporomandibular joint clicking. At the end of a 6-month test period, 18 of 22 subjects (approximately 82%) with clicks no longer had clicking, but four subjects (approximately 18%) with bilateral reciprocal clicking did not lose their clicks. A number of proposals have been suggested in the past as an explanation of the cause of temporomandibular joint clicking, but the present study has shown that clicking in young adults is predominantly neuromuscular in origin and may be a reversible condition that can be treated successfully with a conservative exercise regimen.

Adult↗

Temporomandibular joint morphology in Cavalier King Charles Spaniels.

Temporomandibular joint dysplasia has been reported in several breeds of dog. Three Cavalier King Charles Spaniel (CKCS) skulls were examined and radiographed during the course of a separate study and all demonstrated changes consistent with bilateral temporomandibular joint dysplasia. Subsequently, skull radiographs from all CKCS dogs examined at the University of Glasgow Veterinary School between 1991 and 2001 were reviewed (n = 26). Only two of these dogs were radiographed specifically for investigation of the temporomandibular joint, although varying degrees of dysplasia were identified in all dogs where the joints were adequately visualized (n = 20). The head of four CKCS cadavers was also radiographed, and similar changes were found. This finding suggests that temporomandibular joint dysplasia is a widespread asymptomatic condition in the CKCS and should be regarded as a normal morphologic variation rather than a pathologic anomaly. Subtle changes are best seen on lateral oblique radiographs, although marked changes are also visible on dorsoventral views. The rotational angle or angle of articulation of each of the dysplastic mandibular condyles was measured and was related to the severity of the dysplastic changes. However, there was overlap between the values calculated for these abnormal joints and normal ones in other breeds, suggesting this measurement was of limited significance and the shape of the components of the temporomandibular joint are more relevant when assessing this joint for the presence of dysplastic changes.

Animals↗

Computed tomography of the temporomandibular joint meniscus.

Fifteen patients with temporomandibular joint dysfunction were examined by computed tomography using standard CT techniques. The data obtained were evaluated and correlated with arthrographic findings or surgical observations. CT scans may become a valid alternative to the often painful procedure of arthrography for assessment of temporomandibular joint pathology if the potential pitfalls are avoided.

Adult↗

Preliminary studies on the use of a viscoelastic solution in arthroscopic surgery of the temporomandibular joint.

Arthroscopic surgery of the temporomandibular joint includes the potential for iatrogenic damage of intracapsular structures during introduction of instruments and manipulation of the tissues. A modification of an elastoviscous solution of crosslinked sodium hyaluronate, called hylan fluid, was used for irrigation during surgery in 55 temporomandibular joints. Forty-nine of the joints were monitored postoperatively in a study to measure safety and efficacy of the material during the arthroscopic procedure. The hylan fluid was found to be as safe as the standard irrigating fluid. The hylan fluid also significantly protected the joint surfaces and facilitated the surgical procedure.

Adult↗

A cadaveric study of the potential damage in arthroscopic examination of the temporomandibular joints.

An arthroscopic study on 22 temporomandibular joints in 13 cadavers was undertaken. Dissections were carried out to correlate the arthroscopic with macroscopic findings in the joints. Iatrogenic damage to the temporomandibular joints and their surrounding tissues was also examined. Correlation between arthroscopy and macro findings was 91.0%. There was no damage to the facial nerve and superficial temporal vessels. Iatrogenic damage to the temporomandibular joint included scuffing of the articular surfaces of the glenoid fossa and articular eminence (31.8%), scuffing of the condylar articular surface (9%), one disc perforation (4.5%) and one perforation of the medial capsule (4.5%). Prevention of iatrogenic injuries is discussed.

Adult↗

Method of help for the diagnosis of the temporomandibular joint internal derangements. Discriminant analysis applied to the temporomandibular derangements.

OBJECTIVE: The purpose of the study is to find an objective method of help for the clinician in the diagnosis of the pathology of the temporomandibular joint, different of the image methods habitually utilized until this moment. MATERIAL AND METHOD: This study is based initially on the data obtained of a sample of 1164 patients with symptoms and/or signs of pathology of the temporomandibular joint. Nine different and excluding diagnostic groups settled down, according to the classification of the American Academy of Orofacial Pain (AAOP), in collaboration with the International Headache Society (IHS). We realized magnetic resonances to the patients and were selected those that adjust to the clinical criterion and of diagnosis for the image, and could only in a diagnostic group. Finally 449 patients were selected, 390 women and 59 men. RESULTS: The results obtained (expressed in percentage of well classified cases) by means of the proposed method were: Arthrosis 98.9%, Anterior Disk Displacement with Reduction (ADDR) 87.5%, Anterior Disk Displacement without Reduction (ADD) 100%, Capsulitis 100%, Disk Immobile (DIN) 97.9%, Hypermobility Condylar (HC)95.8%, Lateral Displacement Without Reduction (LD) 100%, Pathology Muscular (PM)100%, Disk Hipomobile (DHM) 86.4%. CONCLUSION: The proposed method reaches a fine percentage of successes in the diagnosis of these processes good enough, through its effectiveness as for its cost and should be considered an alternative in the diagnosis of temporomandibular derangements.

Diagnosis, Computer-Assisted↗

Clinical correlation of MRI findings of internal derangements of the temporomandibular joints.

We studied 131 temporomandibular joints (TMJs) in 73 patients (56 women, 17 men) with internal derangement using magnetic resonance imaging (MRI) in addition to clinical examinations. The type of TMJ sounds correlated significantly with the degree of disc displacement. Rounded and folded disc deformities caused crepitus, which was a sign of the advanced stage of anterior disc displacement without reduction. Tenderness on palpation of the lateral pterygoid muscle was found in anterior disc displacements with or without reduction. The more deformed the TMJ disc that was shown on MRI the more substantial the clinical signs and symptoms. As the MRI results correlated well with the clinical findings we concluded that expensive diagnostic methods such as MRI should be used for surgical planning and in difficult cases to diagnose pathological conditions of the TMJ.

Auscultation↗

Current trends in temporomandibular joint imaging.

Diagnostic imaging of the temporomandibular joint has undergone a revolutionary development during the last two decades. With advanced modalities we have been able to differentiate between different articular entities in patients with temporomandibular joint disorders. The purpose of this article is to review and discuss these modalities and their contribution to our present knowledge, with emphasis made on current trends in diagnostic temporomandibular joint imaging. The main section deals with diagnostic imaging of the subgroup of disorders with internal derangement caused by disk displacement including posttreatment imaging. Imaging of pathologic entities characterized by chronic inflammation such as rheumatoid arthritis are discussed in the second section. Finally, the potential of diagnostic imaging of infrequent conditions such as tumors is briefly reviewed. Magnetic resonance imaging has surpassed arthrography and computed tomography for the evaluation of most patients in these three subgroups. In patients who have various forms of disk displacements with or without accompanying bone abnormalities, a diagnostic accuracy of at least 90% may be achieved by oblique sagittal and coronal magnetic resonance imaging. In addition, alterations in the condylar marrow may be detected. T2-weighted magnetic resonance imaging can make a significant diagnostic contribution by demonstrating inflammatory reactions such as joint effusion and marrow edema. In the subgroup of patients with chronic inflammatory diseases, magnetic resonance imaging may also demonstrate abnormalities not shown with other imaging modalities. Disk deformation, fragmentation, and destruction may indirectly suggest the presence of synovial proliferation/pannus formation, which in selected cases may be directly depicted with intravenous gadopentetate dimeglumine. For more detailed evaluation of the bone condition and of soft tissue calcifications in joints with inflammatory diseases, tumors, or other disorders, computed tomography is the preferable imaging modality.

Arthritis, Rheumatoid↗

[Diagnostic steps in disk dislocations and other frequent illnesses of the temporomandibular joint].

Modern diagnosis of the temporomandibular joint (TMJ) consists of multiple steps, based on each other and amplifying one another. The first step is the clinical functional analysis, respecting general medical as well as specific dental aspects. If need arises electronic axiography, recording the movement of TMJ hingeaxis, is being added as well as occlusal analysis on mounted plaster casts. In case of open questions at this point of analysis, magnetresonance- and computer-tomographic imaging is brought in. The present paper is an overview describing the current step by step diagnosis of TMJ disorders, with special attention to luxation-reduction mechanism in the joints.

Diagnosis, Differential↗

The relationship between cervical whiplash and temporomandibular joint injuries: an MRI study.

Temporomandibular joint (TMJ) symptoms are a common finding in motor vehicle accident (MVA) patients with hyperextension/hyperflexion injuries of the cervical spine (cervical whiplash). The relationship between cervical whiplash and TMJ injuries was documented with magnetic resonance imaging (MRI) in 87 consecutive MVA cervical whiplash patients who presented with TMJ symptoms and had sustained no direct trauma to the face, head or mandible and had no TMJ complaints prior to the MVA. One hundred sixty-four TMJ patients were evaluated for internal derangement, effusion and inflammation, utilizing T1 and T2 weighted images. A high percentage of the TMJ patients demonstrated abnormal findings: disk displacement with reduction (DDR), 118/164 (72%); disk displacement without reduction (DDNR), 25/164 (15%); effusion, 113/164 (69%); inflammation or edema, 84/164 (51%); total TMJ abnormalities, 156/164 (95%). The high percentage of TMJ abnormalities in this study significantly illustrates the proximate relationship between cervical whiplash and TMJ injuries.

Accidents, Traffic↗

[Drill decompression-spongiosaplasty of the temporomandibular joint. A preliminary study of various temporomandibular dysfunctions].

Long follow-up in TMJ patients shows often a lack of success with a recurrence of pain. To lower the rate of failures or at least partial failures, the relative positions between mandibular condyle and glenoïd fossa were studied, in case of recurrence after TMJ occlusal and surgical treatment: asymmetry was found between both sides. Sometimes the mandibular head is in a low and anterior position (in absence of major occlusal disorder): we call this "stretching syndrome" (for posterior apparatus). Patients complain of jaw instability. Sometimes the mandibular head is in a very high and posterior situation: we call this "compressive syndrome". In this case, patients complain of a recurrence of pain (generally the clicking disappeared after the first TMJ surgery). We propose in "stretching syndrome" to treat the instability by a cartilaginous graft, and in "compressive syndrome" to decompress the bone by drill tunnel with external effect (secondary bone settles down) and internal effect (venous drainage and oedema decrease). First results are good with a high healing rate, but the follow-up is not long enough to a complete assessment of this technic.

Cartilage, Articular↗

[Ontogeny of the human temporomandibular joint].

An analysis of the human temporomandibular joint is done regarding to the appearance of secondary cartilage formations during the prenatal development of condylus and temporal joint elements. Sagittal sections of nine human fetuses (49 mm CRL to 315 mm CRL) show a closed relationship between the development of the bony and soft tissues of the joint. The temporary appearance of secondary cartilage in the temporal joint area is induced by the functional loading of the capitulum. This process requires the genesis of the two free articular cavities on the one side and the functional attachment of the lateral pterygoid muscle to the discus and the collum mandibulae on the other. Pointing out the clear relationship of the articulating joint surfaces and the in between discuss, a left temporomandibular joint of a fetus (125 mm CRL) is reconstructed in a medioventral view with the help of a three dimensional drawing. The location of the temporal secondary cartilage formation within the centre of the temporal loading area of the condyle assures its functional genesis during the embryological development of the human temporomandibular joint.

Cartilage, Articular↗

An objective, noninvasive method for the diagnosis of temporomandibular joint disorders.

An objective, noninvasive method for the diagnosis and monitoring of pathology referable to the temporomandibular joint is presented. A computerized temporomandibular joint analyzer was developed to obtain data from the patient's temporomandibular joint area to provide an objective record of clinical symptoms and signs. This data, used in conjunction with a complete history and physical examination, aids in the diagnosis and decision-making process for therapy. Fifty patients with temporomandibular complaints were evaluated. Diagnoses made using the temporomandibular joint analyzer in conjunction with complete histories and physical examinations were confirmed in 81% of the patients by further examinations with x-ray studies, computed tomography scans, magnetic resonance imaging, and arthroscopy. Patients' progress during treatment was monitored using the temporomandibular joint analyzer. Results of the temporomandibular joint analyzer were compatible with patient's progress as reported subjectively and with clinical evaluation in 97% of the cases. The temporomandibular joint analyzer can be used to reduce time and expense as well as to minimize the discomfort involved in the evaluation of temporomandibular joint disorders.

Adolescent↗

Ultrastructural study on adhesions in internal derangement of the temporomandibular joint.

PURPOSE: This study examined the ultrastructural characteristics of adhesions in the upper joint compartment of temporomandibular joint (TMJ). MATERIALS AND METHODS: Tissue biopsy specimens of adhesions were obtained during arthroscopic operation on 36 joints in 22 patients with internal derangement (ID). The biopsy specimens were examined by light and transmission electron microscopy. RESULTS: Adhesions were grossly divided into two types based on arthroscopic observation: 1) a band-like type, which connected the articular fossa and TMJ disc, and 2) a pseudowall-like type, which faced the synovial fluid and was lined by articular tissue. Two types of collagen arrangement were observed at the electron microscopic level: orderly arranged collagen bundles and randomly arranged collagen bundles. Orderly arranged collagen bundles were prominent in the band-like adhesions. In pseudowall-like adhesions, mainly the randomly arranged collagen bundles were seen. However, in some dense fiber parts, orderly arranged collagen bundles also were observed. In other pseudowall-like adhesions, only orderly arranged collagen bundles were seen. Elastic fibers were abundant in some pseudowall-like adhesions with randomly arranged collagen bundles. There were no elastic fibers in the band-like adhesions, some dense fiber parts of the pseudowall-like adhesion, pseudowall-like adhesions consisting of only orderly arranged collagen bundles, and in the synovial membrane. CONCLUSION: The different arrangement of collagen fibers and presence or absence of elastic fibers were observed in the two types of adhesions. These findings served to show that extracellular components correspond to a dysfunction involving an ID of TMJ.

Adult↗