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PubMed1997

[Imaging of the temporomandibular joint].

A large number of imaging techniques are available nowadays to visualise the temporomandibular joint and surrounding structures. It is important that osseous structures as well as soft tissue can be shown. Transcranial images, conventional tomography, panoramic radiography and computed tomography (CT) are more suitable for viewing the osseous structures. The best techniques to evaluate the soft tissues are arthrography and especially magnetic resonance imaging (MR). The panoramic radiography is the technique of choice in the general practice and provides adequate screening images of the temporomandibular joints, mandible, maxilla, teeth and surrounding tissues. When the joint is suspected of developmental anomalies, neoplastic conditions or a condylar trauma, CT-images are necessary to depict the bony abnormalities. CT has a poor reliability in imaging the disk. For this reason, disk displacements of the temporomandibular joint are best shown with MR, although the clinician should be very restrictive in using MR-images. They are very expensive and are only useful to confirm an uncertain diagnosis, or if disc surgery is the treatment of choice. The anamnesis and the clinical investigation are still the most important elements in diagnosing craniomandibular dysfunction.

Arthrography↗
PubMed2003

Association between condylar position, joint morphology and craniofacial morphology in orthodontic patients without temporomandibular joint disorders.

The present study investigated condylar position and joint morphology in adolescent patients and elucidated the possible association between the joint structure and condylar position, and craniofacial morphology. Sixty-five adolescent patients were selected as subjects and their tomograms and lateral cephalograms were analysed. No significant differences in joint spaces were found between the right and left temporomandibular joints. Both the condyles in this population were located slight anteriorly in the glenoid fossa. With respect to the association between condylar position, joint morphology and craniofacial morphology, the ramus plane angle also exhibited significant negative correlations with posterior, lateral and medial joint spaces. Furthermore, there was a significant negative correlation between the gonial angle and the anterior joint space. These findings imply that the condyle was likely to show more posterior position in the glenoid fossa when the mandible exhibited clockwise rotation. In conclusion, the condyle in the adolescent subjects showed a symmetrical anterior position relative to the glenoid fossa. In addition, the joint spaces and it ratios were significantly related to the craniofacial morphology associated with vertical dimension. It is suggested that the condylar position may be affected by craniofacial growth pattern.

Adolescent↗
PubMed1989

A short-term evaluation of the effectiveness of stabilization-type occlusal splint therapy for specific symptoms of temporomandibular joint dysfunction syndrome.

To clarify the short-term effectiveness of stabilization-type occlusal splint therapy, a specific symptom approach was used toward 30 temporomandibular joint dysfunction patients with more than two major symptoms (temporomandibular joint and/or masticatory muscle pain, temporomandibular joint sounds, and limitation of mandibular movement). Eighty-seven percent of the patients with pain responded with this therapy and more than 50% had complete relief of pain 4 weeks after insertion of the splint. Temporomandibular joint sounds and limitation of mandibular movement responded more slowly than pain. These results suggest that the stabilization-type occlusal splint should be selected as a first choice among several therapies and that temporomandibular joint pain is particularly susceptible to this therapy.

Acrylic Resins↗
PubMed1999

[Current problems in the diagnosis and treatment of injuries to the temporomandibular joint].

Complex examination of 2103 patients with temporomandibular joint (TMJ) injuries was carried out. This examination included contrast arthrotomography, computed tomography (CT) and MR tomography of the TMJ. It gas been established, that in mandibular condyle fractures not only bone structures of the TMJ, but also soft tissue ones (the articular disk and capsular-ligamentous apparatus) are being injured. Our investigation has shown that condylar fractures in the region of condylar base and neck are combined with the injuries of the articular disk and capsular-ligamentous apparatus in 54.1 +/- 5.4% cases, mandibular head fractures with its dislocation--in 100%. The term "TMJ injuries" reflecting the injuries of bone and soft tissue structures of the TMJ has been introduced. The classification of TMJ injuries including TMJ contusion, mandibular dislocations, condylar and glenoid fossa fractures, the injuries of the articular disk and capsular-ligamentous apparatus has been developed. Distant results of traditional methods of treatment used in TMJ trauma have been studied and the necessity of the restoring of correct relation: glenoid fossa --articular disk--mandibular head--has been shown. The method of TMJ reconstruction consisting in the restoration of TMJ bone structures and the articular disk and capsular-ligamentous apparatus has been developed.

Arthroplasty↗
PubMed1993

Articular degeneration and remodeling in human temporomandibular joints with normal and abnormal disc position.

Temporomandibular joints with normal and abnormal disc positions, obtained from 15 females and 38 males (most between 15 and 50 years of age), were examined under a light microscope. Histologic changes attributed to degeneration and remodeling of the articular tissues were graded according to their prominence and extension along the articular surfaces. These changes seemed little affected by internal derangement in the condyle and the temporal component. In contrast, degeneration and regressive remodeling of the disc and, although to a much lesser degree, its attachments were more severe and increased more steeply with age in internally deranged as compared to normal joints. The present findings suggest that the disc indeed suffers from an abnormal position. However, this conclusion seems tenable only for adults, as rather prominent progressive remodeling changes have been observed in joints from adolescents, but no significant degenerative variations were noted.

Adolescent↗
PubMed1999

Specific expression of interleukin-1 beta in temporomandibular joints with internal derangement: correlation with clinical findings.

OBJECTIVE: Interleukin-1 beta appears to play an important role in the pathophysiology of joint diseases. The aim of this study was to analyze the expression of interleukin-1 beta in temporomandibular joint internal derangement. STUDY DESIGN: Using an immunohistochemical technique with specific antibodies, we examined 20 human temporomandibular joint samples from patients with internal derangement of the temporomandibular joint: 5 extirpated disks and 15 biopsy specimens from the synovitic area of the temporomandibular joint upper compartment. We also examined 2 control specimens. The evaluation of interleukin-1 beta expression compared with clinical findings. RESULTS: Interleukin-1 beta was predominantly localized in the synovial lining cells and endothelial cells of blood vessels. Statistically significant correlation was found between interleukin-1 beta expression and some clinical findings. CONCLUSIONS: The results suggest that interleukin-1 beta may be involved in the pathogenesis of temporomandibular joint internal derangement and that the intensity of interleukin-1 beta expression may correlate with clinical findings, especially pain.

Adult↗
PubMed1983

The clicking painful temporomandibular joint. Use of arthrography in diagnosis.

Why does the clicking temporomandibular joint not lock, and the locked joint not click. Why is either of these conditions painful? Improved temporomandibular joint arthrography is able to delineate the problem and to direct surgical intervention appropriately, rather than toward the empirical remedies of the recent past.

Humans↗
PubMed1991

Nondiscogenic causes of temporomandibular joint pain.

Magnetic resonance imaging of the temporomandibular joint is a topic of recent interest and has gained widespread use for the assessment of internal derangement and other temporomandibular joint-related symptoms. In this article the authors present six proven cases of pathologic abnormalities of the temporomandibular joint region that may clinically mimic internal derangement. These cases demonstrate the importance of the monitoring of studies by a radiologist and also the utility of computed tomography as an adjunctive modality. Magnetic resonance imaging and computed tomography are often complimentary in diagnosing etiologies that may mimic internal derangement. Because abnormalities other than internal derangement are often encountered during the use of magnetic resonance imaging, it is essential for the radiologist to assume an active role in monitoring such cases.

Adolescent↗
PubMed1989

Cryosectional observations of functional anatomy of the temporomandibular joint.

The anatomy and function of the temporomandibular joint are complex, and our understanding about how the retrocondylar tissues change when the condyle translates anteriorly has been incomplete. We therefore examined the sectional anatomy of 24 fresh human temporomandibular joints at different gradations of jaw opening, protrusion, and laterotrusion. We found that the tissues of the posterior disk attachment expanded in volume and occupied the space behind the condyle when the mouth was opened, protruded, or laterotruded to the contralateral side. Volumetric expansion of the tissue seemed to be due mainly to distension of the venous structures in the retrodiskal area. In the lateral region of the joint, tissue from the superior aspect of the parotid gland also seemed to contribute to the filling of the space posterior to the condyle. Thus, the retrodiskal tissue appears to have a substantial capacity to expand and fill the mandibular fossa when the condyle translates anteriorly. The possibility of a dynamic vascular physiology is suggested.

Aged↗
PubMed1985

Long-term evaluation of meniscectomy of the temporomandibular joint.

Meniscectomy for treatment of pain and dysfunction of the temporomandibular joint is a controversial operation because of the possible late complications of limitation of movement and pain. Therefore, the long-term results of this operation were clinically and radiologically investigated in a sample of 15 patients that had had meniscectomies performed during the period from 1947-1960 (mean follow up, 29 years). On clinical examination, all patients were free of pain, none had subjectively experienced dysfunction, and all but one could open their mouths more than 39 mm. Two thirds of the operated joints were crepitant. Radiologically all joints showed structural hard-tissue changes, mainly the presence of osteophytes and flattening of the condyle and tubercle. Absence of joint space was seen in half of the joints. The results indicate that meniscectomy relieves joint pain and eliminates subjectively perceived dysfunction in the long term despite the presence of clinical and radiologic signs of degenerative joint disease; however, as the condition of many patients who have temporomandibular joint disorders improves over time without surgery, there is a need for a controlled study on the value of meniscectomy.

Adult↗
PubMed1996

The effect on joint fluid concentration of neuropeptide Y by intra-articular injection of glucocorticoid in temporomandibular joint arthritis.

Twenty-two patients (29 joints) with temporomandibular joint (TMJ) arthritis of specific or unspecific nature were given one intra-articular glucocorticoid (GC) injection. The effect on subjective symptoms and clinical signs in the craniomandibular system and on joint aspirate concentration of neuropeptide Y-like immunoreactivity (NPY-LI) was evaluated at follow-up visits 2-3 or 4-6 weeks after treatment. In the patients with specific inflammatory joint disease the treatment resulted in an improvement of symptoms and clinical signs and in a reduction in the TMJ level of NPY-LI 2-3 weeks after treatment. In the patients with unspecific inflammatory joint disease there was also an improvement in the clinical variables and a reduction in the NPY-LI level after 2-3 weeks, but not on a statistically significant level. The results of this study show that intra-articular GC treatment causes a short-term decrease of the TMJ fluid level of NPY-LI in patients with specific inflammatory joint disease, while symptoms and signs improve.

Adult↗
PubMed2004

Interleukin-1beta increases RANTES gene expression and production in synovial fibroblasts from human temporomandibular joint.

BACKGROUND: Synovial fibroblasts of temporomandibular joint (TMJ) are poorly characterized, although they have important roles in progression of temporomandibular disorders (TMD). In this study, we investigated responses of synovial fibroblasts to interleukin (IL)-1beta. METHODS: We examined gene expression profiles of synovial fibroblasts in response to IL-1beta, using Affymetrix GeneChip. Regulated upon activation normal T-cell expressed and secreted (RANTES) gene expression was confirmed by polymerase chain reaction (PCR) and real-time PCR. RANTES protein levels were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: The RANTES was preferentially up-regulated in synovial fibroblasts by IL-1beta. The increase in RANTES gene expression in response to IL-1beta was confirmed by PCR and real-time PCR. Protein level of RANTES in synovial fibroblasts was also increased by IL-1beta. CONCLUSIONS: The RANTES, a cc-type chemokine, has chemotactic effects on lymphocytes and monocytes. Increased gene expression and protein production of RANTES in synovial fibroblasts, in response to IL-1beta, may play an important role in recruitment of inflammatory cells into synovium and progression of synovitis in TMD.

Adolescent↗
PubMed2002

Bone SPECT imaging of patients with internal derangement of temporomandibular joint before and after splint therapy.

OBJECTIVE: Temporomandibular joint (TMJ) patients with disc displacement without reduction have a misaligned disc-condyle structural relation. As the condition becomes chronic, painful osteoarthritic changes may occur. For these patients, splint therapy may help to position the condyle to a more structurally compatible and functional position and to decrease the loading force of articular surfaces. The aim of this study was (1). to evaluate osseous reactions and pain relief in patients with disc displacement without reduction after splint therapy and (2). to use single photon emission tomography (SPECT) bone imaging to compare the results with the opposite joint of the patient. STUDY DESIGN: Twelve patients, who presented with pain involving the TMJ and limited mouth opening and were confirmed by soft tissue imaging as having disc displacement without reduction, were included in the study. Each patient underwent bone SPECT imaging, after which semiquantitative evaluation of transaxial images was conducted. The ratios of affected TMJ to nonaffected TMJ, affected TMJ to occipital bone, and nonaffected TMJ to occipital bone were calculated. After 6 months of splint therapy, bone SPECT examinations were repeated. RESULTS: Before splint therapy, the ratios of affected TMJ to nonaffected TMJ and of affected TMJ to occipital bone were found to be significantly higher than the ratios after splint therapy (P < 0.005). CONCLUSION: Six-month splint therapy has a positive effect on the osseous reaction and pain related to internal derangements of TMJs.

Adolescent↗
PubMed1994

[The effects of tumor necrosis factor on rabbits' temporomandibular joint].

The histological changes of 16 rabbits' temporomandibular joints (TMJ) were studied after they had been injected with tumor necrosis factor (TNF). The results show that TNF can destroy the articular tissues. The changes are similar to those found in TMJ disturbance syndrome. With the finding that the TNF appears in the synovial fluids of TMJ DS, the authors consider that the changes of articular tissues in TMJ DS are related to the presence of TNF in the joints.

Animals↗
PubMed2003

[Postoperative evaluation of surgically treated cases with temporary silicone implant in temporomandibular joint].

We have carried out temporary silicone implants after diskectomies or arthroplasties in temporomandibular joint surgeries to avoid postoperative adhesion and to maintain articular space. We evaluated 19 joints in 15 patients who had received dacron-reinforced silicone implant after silicone sheet removal through follow-up for at least 6 months. The cases included temporomandibular joint disorder (10 joints in 9 patients), psoriatic arthritis (2 joints in 1 patient), ankylosis (4 joints in 3 patients) and synovial chondromatosis (2 joints in 2 patients). On the basis of the criteria of temporomandibular dysfunction for the results, they were classified as bad (4 patients). It is thought that factors other than the implant are related to the bad results in the postoperative evaluation. In this study, lymphadenopathy induced by exfoliated silicone debris could not be confirmed. The temporary silicone implant in the temporomandibular joint was thought to be useful.

Adolescent↗
PubMed1993

Reliability and validity of imaging diagnosis of temporomandibular joint disorder.

The purpose of this article is to review reliability and validity of imaging diagnosis of temporomandibular joint disorders. Plain-film and tomography are basic imaging techniques for assessment of the temporomandibular joint. These can be used for evaluation of osseous disease and as a baseline for follow-up. In patients with symptoms from the joint, plain-film and tomography are rarely definitive, and evaluation of the soft tissues is frequently necessary. Arthrography, computed tomography, and magnetic resonance imaging have all been used for evaluation of the soft-tissue components of the joints. Accuracy studies of these techniques have demonstrated the highest diagnostic accuracy for magnetic resonance imaging. Arthrography is relatively insensitive for detection of medial and lateral displacements. Magnetic resonance imaging accurately depicts both hard and soft tissues, and this technique is emerging as the prime diagnostic imaging technique in patients presenting with clinical signs and symptoms of a disorder of the temporomandibular joint. The most frequent findings when patients with clinical symptoms of temporomandibular joint disorders are "imaged" are different forms of disc displacement and degenerative joint disease. Studies have demonstrated a high prevalence of different forms of disc displacement in patients, although these abnormalities are also seen in some asymptomatic volunteers. Future research should further refine imaging techniques to come closer to an understanding of the association between morphologic alterations and patient symptoms.

Arthrography↗