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PubMed1994

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

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

Adult↗

PubMed1989

The radiographic and surgical evaluation of meniscal dysfunction of the temporomandibular joint.

A retrospective study of 106 patients who underwent temporomandibular joint surgery for meniscal dysfunction was conducted. The patients were evaluated by tomography and arthrography of the temporomandibular joint and abnormalities of the hard and soft tissue structures were determined by these investigations and compared directly with the findings at surgical examination. Tomography had a high degree of correlation with bony pathology as did arthrography with meniscal displacement. The arthrogram also frequently revealed the presence of meniscal scarring associated with the head of condyle in long-standing cases, but gave an incidence of 3% false/positive findings of a perforation of the meniscus.

Adult↗

PubMed2006

Denervation of the painful temporomandibular joint.

The successful management of temporomandibular joint (TMJ) pain remains elusive. Often the initial relief of pain is complicated by recurrence of the symptoms. This time frame suggests that the pain may be related to neuromas of the nerves that innervate the TMJ. In 2003, an anatomic description of the innervation of the TMJ suggested that denervation of this joint might be the appropriate treatment for pain resistant to traditional forms of therapy. In January, 2005, this approach was used to treat recalcitrant left TMJ pain in a 21-year-old woman with congenital hearing loss who had recurrent dislocations of her TMJ articular disc. She previously had two arthroscopic surgeries and one open attempt to treat her TMJ pain. The last failed TMJ surgery created a painful neuroma that prevented her from wearing her hearing aid. A medial and lateral denervation of the TMJ joint was done. The successful results of this surgery are presented at one-year follow-up. The technical considerations of this approach and risk to the facial nerve are discussed.

Adult↗

PubMed1995

Molecular biology of temporomandibular joint disorders: proposed mechanisms of disease.

PURPOSE: The biologic processes of temporomandibular joint adaptation and disease are poorly understood. However, recent technologic advances have provided methods that allow sophisticated studies of the molecular mechanisms that are relevant to the pathophysiology of degenerative temporomandibular joint diseases. This review examines current models of the molecular events that may underlie both adaptive and pathologic responses of the articular tissues of the temporomandibular joint to mechanical stress. It is hoped that an increased understanding of these complex biologic processes will lead to improved diagnostic and therapeutic approaches directed to the management of temporomandibular disorders.

Adaptation, Physiological↗

PubMed1991

Functional anatomy of the temporomandibular joint. A morphologic study on human autopsy material.

A study of 72 temporomandibular joints of adults without any gross signs of degenerative changes was made, in order to analyse the stress on individual regions of the joint, and to determine the path of the split line pattern in the articular cartilage. The cancellous architecture and the material distribution in the juxta-articular bone were also investigated. Zones of high-density compact substance in the lateral region of the joint, and the presence of attractive singular points in the split line orientation in this localization, suggest great stress on the lateral part of the temporomandibular joint. This increased stress in the lateral region is confirmed by the fact that arthrotic changes in the temporomandibular joint first almost always appear laterally. Degenerative changes usually originate at the articular disc, affect the articular tubercle after a delay, and finally spread to the condyle. Besides the greater physiological, mechanical stress on the lateral region of the joint, the force acting on every individual temporomandibular joint is influenced by the dental condition. The molars and bicuspids serving as a support zone play a decisive role in this context.

Adult↗

PubMed1996

Generalized joint hypermobility as a factor in clicking of the temporomandibular joint.

Twenty-six patients with clicking or locking of the temporomandibular joint (TMJ) and 28 age- and sex-matched controls were assessed for generalized joint hypermobility by BEIGHTON's method. Function of the masticatory apparatus was measured with FRICTON's Craniomandibular Index. The TMJ patients had significantly higher joint mobility scores, but within the patient group there was no correlation between either the dysfunction or palpation scores and the hypermobility scores. The findings are interpreted as supporting multiple causes of TMJ internal derangement, one of which is a systemic joint factor.

Adolescent↗

PubMed1998

Morphological characteristics of primary sensory and post-synaptic sympathetic neurones supplying the temporomandibular joint in the cat.

The cells of origin of peripheral nerves that supply the temporomandibular joint were investigated by examining the centripetal transport of wheat germ agglutinin-horseradish peroxidase (WGA-HRP). Following WGA-HRP injection into the temporomandibular joint capsule of the cat, a large number of labelled neurones were observed in the trigeminal and superior cervical ganglia ipsilateral to the injection site, while no labelled neurones were detected in the cervical dorsal-root ganglia. Only one labelled neurone was seen in the stellate ganglion. Labelled neurones were primarily located in the posterolateral and dorsal regions of the trigeminal ganglion, but their distribution in the superior cervical ganglion was not localized to specific regions. The labelled neurones in the trigeminal ganglion were significantly larger than those in the superior cervical ganglion but the sizes of smaller neurones overlapped, suggesting that trigeminal ganglion neurones send both myelinated and unmyelinated fibres to the temporomandibular joint. The innervation of the temporomandibular joint by somatosensory and sympathetic fibres suggests that sympathetic nerves could be responsible for allodynia or neuropathic pain caused by temporomandibular disorders.

Animals↗

PubMedDate not supplied

[The comparative characteristics of the temporomandibular joints in the rabbit and man].

Examination of rabbit temporomandibular joints has yielded new data contradictory to current notions accepted in dentistry. There are articular tubercles in the temporomandibular joints of rabbits, belonging to rodents, and these joints are incongruent, like in a man. Incongruence of rabbit joints permits combined mandibular movements. The presence of articular tubercles and occlusion curves in the rabbit is in line with an assumption of the compensation theory on their relationship and interdependence. These data permit a conclusion that rabbit temporomandibular joints are in many respects similar to those of man.

Animals↗

PubMed1990

[The temporomandibular joint: anatomy, physiology, clinical review].

The temporomandibular joint (TM joint) is a synovial joint with two condylar surfaces and an intra-articular cartilaginous disc. Its development has two origins. Its physiology is complex and intimately related to dental occlusion, which is why we talk about the temporomandibular and dental joint. Recent neurophysiological data allow a better approach to TM joint dysfunction. The lateral pterygoid muscle plays decisive role in the pathogenesis of TM joint dysfunction.

Humans↗

PubMed1989

[Clinical application of arthroscopy on temporomandibular joint].

We present the anatomy, methodology, procedure for arthroscopy on temporomandibular joint. Arthroscopic view of normal and pathologic view on superior articular cavity of temporomandibular joint are presented. There were no serious complications except slight swelling on temporomandibular joint.

Arthroscopy↗

PubMed1995

Effect of mandibular distraction on the temporomandibular joint: Part 1, Canine study.

The effect of osteodistraction on the temporomandibular joint was evaluated in a canine model. Eleven mongrel dogs were used in the study. An intraoral expansion device was placed after an osteotomy was made at the angle of the mandible via an intraoral approach. The mandibles were expanded either fully to 20 mm or partially to 10 mm. After expansion, nine animals were immediately killed; the remaining two were maintained in fixation for an additional 10 weeks. Cephalometric radiographs and computed tomographic scans obtained preoperatively and before killing were evaluated. No gross temporomandibular joint deformation or bodily movement was noted in the expanded or contralateral, unexpanded side. The temporomandibular joints were harvested en bloc for gross and microscopic evaluation. Flattening of the posterior aspect of the expanded condylar head was noted, with thinning of the condylar cartilage. New bone deposition was noted, which was evident as anterior lipping. Condyles maintained in 10 weeks fixation showed reparative changes. No evidence of avascular necrosis, microfracture, or cystic degeneration was noted. This study indicates that the force of distraction can induce bony changes in the temporomandibular joint and that these effects are minimal and reversible.

Adaptation, Physiological↗

PubMed2001

Does joint effusion on T2 magnetic resonance images reflect synovitis? Comparison of arthroscopic findings in internal derangements of the temporomandibular joint.

OBJECTIVE: The purpose of this study was to clarify the characteristics of joint effusion (JE) in the temporomandibular joint by comparing T2-weighted magnetic resonance (MR) images with arthroscopic findings. STUDY DESIGN: MR images of 47 symptomatic temporomandibular joints (47 patients) with internal derangement associated with painful hypomobility were taken to evaluate the degree of JE on a scale of 0 to 3. Within 2 months after MR images, arthroscopic findings with respect to the severity of synovitis, adhesion, and degenerative change in the superior compartment were each quantitatively assessed on a scale of 0 to 10. The arthroscopic scores were compared among the 4 JE grades, as well as between 2 groups, effusion-present (grades 2 and 3) and effusion-absent (grades 0 and 1), by using the Spearman correlation coefficient and the Mann-Whitney U test. RESULTS: The distribution of JE was as follows: 10 joints had grade 0, 5 joints had grade 1, 19 joints had grade 2, and 13 joints had grade 3. The synovitis score had a significant relationship to the degree of effusion (P =.0012) and was higher in the effusion-present group (6.4 +/- 2.0) than in the effusion-absent group (4.2 +/- 1.6) (P =.0005) On the other hand, there was no statistically significant correlation between either adhesion or degenerative change and effusion. CONCLUSIONS: JE may reflect synovitis; however, the nature of JE itself needs to be further elucidated by additional studies.

Adolescent↗

PubMed1992

[Temporomandibular joint and rheumatoid polyarthritis. Correlations between clinical and tomodensitometric abnormalities].

Clinical and CT scan abnormalities of the temporomandibular joint in rheumatoid arthritis have been little studied in the literature. The temporomandibular joint was examined clinically and by CT scan in 26 patients with rheumatoid arthritis and 26 controls. In the rheumatoid arthritis group, 61.2% of patients had physical signs of temporomandibular disease as compared with 42.3% of the controls. 88.4% of rheumatoid arthritis had erosive or geodic lesions of the temporomandibular joint by CT scan as compared with 57.6% of the controls (p less than 0.05). The temporomandibular clinical score was not correlated with CT scan score in rheumatoid arthritis. CT scan score was correlated with the number of basic drugs used, rheumatoid factor levels and radiological scores of the hands and cervical spine. The authors feel that the only CT scan abnormalities specific to rheumatoid arthritis consist of erosive and geodic lesions of the mandibular condyle, that there is no correlation between clinical and CT scan abnormalities of the temporomandibular joint in rheumatoid arthritis and that the extent of destructive lesions of the temporomandibular joint by CT scan in rheumatoid arthritis is closely correlated with the severity of the disease.

Arthritis, Rheumatoid↗

PubMed1979

Arthrotomographic evaluation of the temporomandibular joint.

Thirty-five arthrotomograms of the temporomandibular joint (TMJ) were done on 33 patients who had chronic pain and dysfunction of the TMJ. All patients were refractory to conservative treatment. Five arthrotomograms were normal; abnormalities were observed in 30. Abnormalities of the meniscus were anterior dislocation, anterior subluxation, perforation, tenting, and degenerative changes and adhesions. The significance of these abnormalities is discussed. Arthrotomography was found to be an integral part of the diagnosis and treatment of TMJ disorders.

Adolescent↗

PubMed2002

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

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.

Adolescent↗

PubMed1998

Extra-articular pigmented villonodular synovitis of the temporomandibular joint.

Pigmented villonodular synovitis, a benign but locally destructive fibrohistiocytic proliferative lesion involving tendon sheaths, bursae and diarthrodial joints, is distinctly rare in the temporomandibular joint. We report one such case occurring in a 42-year-old housewife who presented with a progressively enlarging right zygomatic mass for six months. On exploration, an orange-brown firm mass, 5 x 3 x 2 cm, was seen adherent to the lateral aspect of the capsule of the right temporomandibular joint, and eroding into the inferior aspect of the right temporal bone and part of the mandibular condyle. The mass was completely excised. Pathological examination showed features typical of those of pigmented villonodular synovitis and the lesion was entirely extra-articular in location. The patient remained well with no evidence of local recurrence two years after operation. Review of the literature and careful analysis of the clinicopathological features showed that the vast majority of the reported cases of pigmented villonodular synovitis of the temporomandibular joint belonged to the extra-articular variant, which is associated with a more aggressive local infiltrative behaviour and higher rate of local recurrence than the localized type. The recommended treatment for this condition is therefore wide local excision, aiming to remove the lesion as completely as possible without producing severe disability for the patient.

Adult↗

PubMed2006

Temporomandibular joint cytokine profiles in the horse.

It has been suggested that dental abnormalities lead to temporomandibular joint inflammation and pain that may be mitigated by regular dental care. There is considerable literature on the pathophysiology of equine joint disease including studies on cytokine profiles in diseased appendicular joints. This study examined the effects of age and dental malocclusions summarized as a dental pathology score on equine temporomandibular joint cytokine (IL-1, IL-6, IL-8, TNF alpha and TGF-beta1, -beta2, -beta3) concentrations. TGF-beta3 was not detected in any joint sample. IL-1, IL-6 and TNF alpha were not influenced by age. Foals had significantly lower concentrations of lL-8 and TGF-beta1, and higher levels of TGF-beta2 compared with older horses. Age did not effect cytokine concentration in older horses although there was a trend towards increasing 1L-8 with age. The dental pathology score increased with age in mature horses, however there was no effect of dental pathology score on cytokine concentration. There was no effect of incisor eruption, and presence or number of periodontal lesions on temporomandibular joint cytokine concentration. Our findings indicate that age but not dental pathology affected temporomandibular joint proinflammatory cytokine concentration in this population of horses.

Aging↗

PubMed2005

Ganglion cyst of the temporomandibular joint.

Ganglion cysts of the temporomandibular joint are rare and arise from myxoid degeneration of die collagenous tissue of the capsule of the joint as a result of trauma.

Diagnosis, Differential↗