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PubMed2005

Derangement, osteoarthritis, and rheumatoid arthritis of the temporomandibular joint: implications, diagnosis, and management.

Temporomandibular joint (TMJ) dysfunction is often believed to bea young person's malady. However, geriatric patients also present with clinical findings of TMJ clicking, locking, crepitation, limited opening, and pain. With our aging population and the high prevalence of rheumatic and musculoskeletal diseases in the elderly, it is important to understand the etiopathogenesis, clinical presentation, and management of derangement, rheumatoid arthritis, and osteoarthritis of the TMJ. Although arthritis of the TMJ usually causes only mild-to-moderate dysfunction in older patients, they present challenges related to medication use and comorbidity. This article presents the most recent understanding and therapeutic protocols for patient diagnosis and management.

Adrenal Cortex Hormones↗

PubMed1992

Temporomandibular joint imaging.

Pain and discomfort caused by internal derangement of the temporomandibular joint are frequent in our society. Patients can present with very divergent complaints, not always clearly related to the temporomandibular joint. Good imaging studies of the temporomandibular joint that can show the presence or absence of a problem and give an idea as to type of disease and its seriousness are, therefore, necessary. The choice of which imaging study to use largely depends on whether MR imaging is easily available. Ongoing investigations show that MR imaging of the temporomandibular joint not only depicts the soft tissue derangements very well, but also shows the associated bony changes. However, the exact significance of disk displacement is not always clear because anterior displacement is also seen in asymptomatic volunteers and after clinically successful treatment.

Diagnostic Imaging↗

PubMed1999

The outcome of arthroscopic treatment of temporomandibular joint arthropathy.

Ninety patients underwent arthroscopic temporomandibular joint surgery to 124 joints for arthropathy which had failed to respond to at least six months of non-surgical treatment. They were surveyed at between 6 months and 5 years (mean 2.5 years) after surgery and 63 per cent responded to the survey. They reported an 82 per cent improvement for pain (50 to 100 per cent better), 80 per cent for clicking and 82 per cent for locking. There was no morbidity following the treatment. Arthroscopic surgery should be considered for advanced temporomandibular joint arthropathy which is refractory to non-surgical treatment.

Adolescent↗

PubMed2002

The incidence of reoperation after temporomandibular joint arthroscopic surgery: a retrospective study of 450 consecutive joints.

PURPOSE: The purpose of this study was to investigate the incidence of reoperation after temporomandibular joint arthroscopic surgery in 315 consecutive patients (488 joints). STUDY DESIGN: The clinical data and operative reports of all patients who underwent arthroscopic procedures from 1995 to 2000 were reviewed retrospectively. Patients had a preoperative clinical and panoramic radiographic evaluation. Most of the patients had disk displacement without reduction. In the remaining patients, the intra-articular pathologic conditions ranged from disk displacement with reduction to degenerative joint disease. The outcome assessment was based on reduction in pain, improvement in vertical dimension of mouth opening, and mandibular excursions. The same surgical team performed all arthroscopic procedures. Before surgery, all patients received at least 3 to 6 months of nonsurgical therapy consisting of anti-inflammatory medications, muscle relaxants, splint therapy, physiotherapy, exercise, moist heat, cold laser, ultrasound, and soft diet or a combination thereof. Patients were monitored postoperatively for as long as 5 years. RESULTS: Results showed that approximately 20% of those patients who had temporomandibular joint arthroscopic surgery underwent further temporomandibular joint procedures ranging from repeat arthroscopic surgery to open-joint arthrotomy. CONCLUSION: Temporomandibular joint surgical arthroscopy is an appropriate therapeutic modality for patients with temporomandibular joint internal derangements, with reoperation required for only 20% of patients.

Adolescent↗

PubMed1991

Arthrographic evaluation of the internal derangement of temporomandibular joint.

From a functional point of view, the temporomandibular joint(TMJ) is one of the most important joints in the body. Optimal radiographic visualization is becoming increasingly important to medical and dental specialists as abnormal TMJ derangements are becoming better understood. Because the most common TMJ arthropathy is the internal derangement of TMJ, arthrography of the temporomandibular joint is widely performed in clinical practice. From January 1986 to December 1990, twenty temporomandibular joint arthrographies were performed in patients with symptoms of pain, clicking and dysfunction. We report our findings on these twenty patients who were examined by arthrography, which was conducted due to internal derangements related to meniscal dysfunction.

Adolescent↗

PubMed1989

Mechanisms of disc displacement in the temporomandibular joint.

The sign of 'clicking' in the temporomandibular joint is not a normal phenomenon. It is, in fact, often the first indication of potential myofascial pain or temporomandibular joint pain dysfunction syndrome and as such should be detected early and diagnosed correctly. Clicking is a cardinal sign of altered function within the joint, the aetiology for which can only be diagnosed from a sound knowledge of anatomy and physiology. With this background it is possible to ascertain whether the cause is essentially biochemical, neuromuscular, or occlusal in nature or multifactorial components of all three categories. An attempt has been made to provide background knowledge in order that a correct diagnosis can be made.

Cartilage, Articular↗

PubMed1992

Facial nerve function following temporomandibular joint surgery using the preauricular approach.

Sixty-eight patients (83 temporomandibular joints) consecutively operated on who had a variety of temporomandibular joint operations using a preauricular approach were assessed for facial nerve function following surgery. Nine patients (10.84%) showed signs of facial nerve injury in which the temporal and zygomatic branches were involved. The incidence of facial nerve injury was greater in patients who had undergone previous temporomandibular joint surgery (17.64%) than in patients with previously unoperated joints (9%). Normal facial nerve function returned in 9 to 14 weeks except in one patient who showed a mild deficit of the zygomatic branch at 20 weeks. The nature and duration of the surgical procedure did not correlate with facial nerve injury. Scarring of tissues as a result of previous temporomandibular joint surgery may significantly increase the risk of facial nerve injury during subsequent temporomandibular joint surgery.

Adult↗

PubMed1980

[Changes in the temporomandibular joint after orthodontic interventions].

Temporomandibular joint alterations were reported which were determined on the basis of reproducible preoperative and postoperative roentgenograms. The films were produced with the help of the Hanel. C arch in the transcranial, lateral oblique projection. Displacements were demonstrated particularly in the anterior and the caudal directions. This method however does not allow a definite statement to be made concerning the postoperative position of the condyles.

Humans↗

PubMedDate not supplied

The hypomobile temporomandibular joint.

The hypomobile (restricted) temporomandibular joint (TMJ) is usually caused by a restricted joint capsule or by an anteriorly displaced disk. Here, painful unilateral hypomobility (19 mm jaw opening), with normal disk position, caused by voluntary immobilization after a dental procedure, was the presenting symptom. Management included inflammation control, TMJ manipulation (mobilization), and lateral pterygoid muscle relaxation. Inflammation and pain were alleviated by nonsteroidal anti-inflammatory drugs (NSAIDs) and local TMJ ice massage. TMJ mobilization was performed at every visit, to tear joint capsule adhesions and to realign collagen fibers. Exercise consisted mainly of resistive opening (the patient resists an upward force applied to the chin), with the jaw maintained at full opening. This produced lateral pterygoid muscle relaxation at full length, aiding in the restoration of a pain-free 44 mm opening.

Aged↗

PubMed1992

[Simultaneous pseudodynamic MR evaluation of bilateral temporomandibular joints].

Coordination of bilateral temporomandibular joints (TMJs) was evaluated using bilateral simultaneous pseudodynamic magnetic resonance (MR) imaging. Seven patients (6 patients with internal derangement and one with osteoarthritis) were examined by multiplanar gradient echo technique in closed-loop cine fashion on both sagittal and coronal planes. Incoordination of bilateral TMJ motion was observed in 2 of 7 patients. This technique might be suitable for evaluation of TMJ disorders.

Humans↗

PubMed1986

Arthroscopy of the temporomandibular joint. A clinical study.

Temporomandibular joint (TMJ) arthroscopy on 30 joints of 26 patients with different signs and symptoms of TMJ arthropathy was evaluated. Local anaesthesia was used and proved efficient. In 27 cases, the superior, and in 3 cases both, compartments were punctured. Successful examination was performed in 26 superior and 3 attempted inferior compartments. Functional impairment following arthroscopy was minor and rarely lasted more than one week. No postoperative bleeding, nerve damage, or infection was observed. Of the 2 systems tested, the rod-lens arthroscope showed superior optical quality.

Anesthesia, Local↗

PubMed1981

The condyle as a stress-distributing component of the temporomandibular joint.

Even though the temporomandibular joint is loaded in function, it often arthroses under heavy use. The effects of stress to the joint are not well understood. This study utilized three-dimensional photo-elastic stress analysis to visualize the intensity and direction of stress within the mandibular condyle generated by various occlusal forces. Functional stress were shown to concentrate in the condylar neck, but were reduced within the condylar head due to its elliptical shape. Stress directions within the condyle were found to be non-preferential, varying with different mandibular positions. This supports the idea that the condyle is designed to receive light varied forces rather than heavy, cyclical unidirectional forces.

Humans↗

PubMed2006

[Occupational differentiation in dentistry 3. Hypermobility of the temporomandibular joint and condylar position at maximal mouth opening].

Hypermobility of the temporomandibular joint is only noted when it interferes with smooth mandibular movements. These interferences may result from a condylar dislocation beyond the temporal eminence at maximum mouth opening. Aim of this study was to test whether the condyle of a symptomatically hypermobile temporomandibular joint is positioned more anterosuperiorly to the temporal eminence at maximum mouth opening than a condyle without hypermobility. Nine persons with a hypermobile temporomandibular joint and 9 control persons participated. Diagnostics were based upon opto-electronic mandibular movement recordings. Condylar positions at maximum mouth opening were assessed by magnetic resonance imaging. A small significant difference in condylar position was found between groups. Condyles of persons with a hypermobile temporomandibular joint moved beyond the temporal eminence. However, this was also true for nearly half of the control persons. This suggests that condylar position alone is not a sufficient condition for symptomatic hypermobility of the temporomandibular joint. Maybe, symptoms of hypermobility only become apparent in combination with a particular line of action of the masticatory muscles.

Adult↗

PubMed1996

Teledentistry: protocols for the transmission of digitized radiographs of the temporomandibular joint.

Tomograms of the temporomandibular joint were digitized in three different formats using a PC-based system. The image resolution for various projections was determined at different camera-film distances. Three series of images were transmitted by telephone, and transmission times were measured. The original radiographs, the digitized images, the transmitted images and the transmitted-and-printed images were presented to 10 observers, who were asked to rate image quality. No difference in image quality was found between the initial digitized and the transmitted images. However, transmitted and transmitted-and-printed images were of significantly lower quality than the original radiographs or the digitized images viewed on a computer monitor. Transmission time was reduced significantly (50%) by cropping the images before transmission. The image quality of individual radiographs was better than radiographs formatted as a series.

Analog-Digital Conversion↗

PubMed1995

A new retinacular ligament and vein of the human temporomandibular joint.

In the human temporomandibular joints of 14 Japanese cadavers, we observed a new retinacular ligament that connected to the retrodiskal pad posterolaterally and was accompanied by a vein draining the retrodiskal pad. This retinacular ligament originated from lateral to posterolateral part of the joint. The origin included the articular tubercle of the zygomatic process of the temporal bone. The ligament descended along the mandibular ramus to insert into the fascia of the masseter muscle at the mandibular angle. The vein originated from the venous plexus in the retrodiskal pad and ran parallel to the retinacular ligament, giving off branches to the retromandibular, transverse facial, and superfacial temporal veins. There were no remarkable differences in the size of the retinacular ligaments among individuals as well as between the left and right sides. The retinacular ligament had firm fibrous connections with the posterolateral part of the retrodiskal pad, where the external fibrous membrane of the articular capsule was lacking. These findings suggest that the retinacular ligament and its accompanying vein function together to maintain blood circulation during jaw movement and may also be related to the development of occlusal disorders.

Adult↗

PubMed2007

Direct AAV-mediated gene delivery to the temporomandibular joint.

Successful intra-temporomandibular joint gene transfer is a prerequisite for gene therapy to induce mandibular condylar growth. This study was carried out to investigate the expression of recombinant adeno-associated virus (rAAV) based vector-mediated enhanced green fluorescence protein (eGFP) in the mandibular condyle. The transduction efficiencies for primary chondrocytes using different hybrids of rAAV vectors were identified by fluorescence microscopy and FACS. Sprague-Dawley rats were injected with either rAAV(2/2)-eGFP construct or saline into both mandibular condyles. The spatial and temporal transgene expression was detected by in situ hybridization, RT-PCR and real-time PCR. Our result showed that rAAVs were capable of infecting rat chondrocytes. rAAV(2/2) was the best serotype to infect chondrocytes in vitro. By in situ hybridization, eGFP expression was clearly detected in the deeper layer of mandibular condyle as early as 7 days after injection. By real-time PCR, the transgene expression reached a peak at 21 days. This study was the first report to explore that rAAV-mediated genes could be transferred to mandibular condyle in vivo. Our results strongly suggest that rAAV(2/2) mediated gene delivery is a promising approach to deliver candidate genes for future regulating mandibular condylar growth.

Animals↗

PubMed1996

Characterization of sounds emanating from the human temporomandibular joints.

Sounds from the temporomandibular joint were recorded on audiotape from 238 individuals by placing microphones in both ears. The recordings were later digitized at a sample rate of 1.7 kHz with 10-bit resolution and stored on computer disk. At least two open-close cycles were assessed from each individual; 2707 different individual sounds were analysed in the time and frequency domains. The sounds were classified as: (a) single, short duration (clicks), (b) multiple, short-duration (creaks) and (c) long duration (crepitus). The sounds were further subclassified into either high or low amplitude by (i) the attack, which produced hard and soft categories and (ii) comparing the amplitude between sides-bilateral sounds were those with amplitudes differing by < 40 mV; the rest were unilateral. To establish the robustness of the classification 42 acoustic events were selected to be classified visually by three observers on two separate occasions. Intraobserver agreement was 82% (kappa = 0.75) while interobserver agreement was 60% (kappa = 0.71). Statistically significant differences were noted between all classifications of sound. These were most marked in the time domain. A simple, automated classification scheme was devised that was capable of categorizing the sounds with 82% agreement (kappa = 0.71) compared to a human observer.

Adolescent↗

PubMed2000

Functional magnetic resonance imaging of temporomandibular joint disorders.

Fifty-eight temporomandibular joints (TMJs) from 40 patients with TMJ-related symptoms were examined by means of magnetic resonance scans with modified gradient echo sequences and a special double coil. This technique yielded a good spatial resolution of the intra-articular soft tissues, especially the articular disc and the bone structure of the TMJ. In combination with an incremental jaw opener, the disc-condyle complex was analysed in various closed and open mouth positions, depending on the clinical examination. Open mouth movement with differentiation of disc-condyle rotational and translation movement was demonstrated. Disturbances of TMJ motion showed interrupted condylar translation combined with mandibular deviation during open mouth movement (n = 8/58). Early phases of internal derangement of the TMJ with partial anterior disc displacement with (n = 12/58) or without (n = 2/58) reduction, total anterior disc displacement without reduction (n = 10/58), disc deformation (n = 10/58), disc adhesion (n = 2/58), condylar hypermobility (n = 6/58), condylar displacement (n = 8/58), and late phases of internal derangement of the TMJ with osteoarthrosis (n = 14/58) were clearly identified. Bilateral TMJ disorder was found in 72.5 per cent of the patients. By using motion-adapted, semi-dynamic magnetic resonance imaging (MRI), it is possible to improve the understanding of the complexity of TMJ movements.

Adult↗