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PubMed1992

Glycosaminoglycans in normal and osteoarthrotic human temporomandibular joint disks.

Glycosaminoglycans in normal and osteoarthrotic temporomandibular joint disks were studied by means of high-performance liquid chromatography methods. Normal disk tissue contains galactosaminoglycans (chondroitin sulfate and dermatan sulfate) as the main polysaccharides and with smaller amounts of hyaluronate and heparan sulfate. The galactosaminoglycans are mainly sulfated in 6-position, and some of the disaccharides contain iduronic acid. There was a slight general variation in glycosaminoglycan concentration with increasing age. In the severely arthrotic disks the content of glycosaminoglycans was considerably lower than in normal disk tissue. This decrease was far more extensive than that observed in relation to age in normal tissue. The 4/6-sulfate ratio of the galactosaminoglycans was increased, whereas the proportion of iduronic acid was markedly decreased.

Adolescent↗
PubMed1992

Facial skeleton remodeling due to temporomandibular joint degeneration: an imaging study of 100 patients.

One hundred patients with recently acquired, externally visible mandibular deformity and no history of previous extraarticular mandible fracture were selected for retrospective analysis. All had been investigated clinically and with radiography, tomography, and high-field surface-coil MR imaging to determine the presence or absence and extent of temporomandibular joint degeneration. Temporomandibular joint degeneration was found in either one or both joints of each patient studied. Chin deviation was always toward the smaller mandibular condyle or more diseased joint, and many patients either complained of or exhibited malocclusion, often manifested by unstable or fluctuating occlusion disturbances. Three radiologically distinct forms of degenerative vs adaptive osteocartilaginous processes--(1) osteoarthritis, (2) avascular necrosis, and (3) regressive remodeling--involving the mandibular condyle and temporal bone were identified in joints most often exhibiting meniscus derangement. Osteoarthritis and avascular necrosis of the mandibular condyle and temporal bone were generally associated with pain, mechanical joint symptoms, and occlusion disturbances. Regressive remodeling was less frequently associated with occlusion disturbances, despite remodeling of the facial skeleton, and appears to result from regional osteoporosis. Forty patients (52 joints) underwent open arthroplasty procedures, including either meniscectomy or microsurgical meniscus repair, at which time major radiologic diagnoses were confirmed. Surgical and pathologic findings included meniscus displacement, disk degeneration, synovitis, joint effusion, articular cartilage erosion, cartilage healing/fibrosis, cartilage hypertrophy, osseous sclerosis, osteophyte formation, osteochondritis dissecans, localized or extensive avascular necrosis, and decreased mandibular condyle mass and vertical dimension. We conclude that temporomandibular joint degeneration is the principal cause of both acquired facial skeleton remodeling and unstable occlusion in patients with intact dentition and without previous mandible fracture.

Adolescent↗
PubMed1999

[The Value of CT Scanning in the Diagnosis of Temporomandibular Joint Dysfunction]

OBJECTIVE:To evaluate the role of CT in the diagnosis of temporomandibular joint dysfunction MATERIAL: 48 temporomandibular joints of 26 patients suspecting osseous changes were examined by CT, with 1mm of layer thickness. All patients had Sch llers position projection as comparison. RESULTS:CT is more sensitive to detect the osseous changes of TMJ than Sch llers position projection, but not well demonstrating sclerosis of TMJ. The Sch llers position projection can only shows the lesion of lateral 1/3 of condyle, but CT including total condyle. CONCLUSION: CT is an important and sensitive tool in detecting osseous changes of temporomandibular joint.

Journal Article↗
PubMed1986

A numerical model of temporomandibular joint loading.

A numerical model of the mandible, its articulating surfaces, and the forces exerted by the primary masticatory muscles has been developed for the purpose of investigating loading of the temporomandibular joint. Evidence is presented which shows that the temporomandibular joint. Evidence is presented which shows that the temporomandibular joint is a load-bearing joint over the normal functional range of bite-force positions and angles. In this investigation, temporomandibular joint loads were found to vary from a maximum appositional force of 60% of the bite force (when bite forces were applied to the incisors) to a distracting force of about 5% of the bite force (when applied to the distal surfaces of the third molars). TMJ loads tended to reach a minimum as a result of vertically directed bite forces positioned at the second molars. A range of conditions in which bite forces were directed parallel to or within approximately 20 degrees of the mid-sagittal plane was found to be conducive to stability of the temporomandibular joint. This stability included symmetry in the direction and in the magnitude of condylar loads as well as the presence of small forces tending to oppose the condyle and articular eminence. TMJ loads tended to reach a maximum in response to mediolaterally directed bite forces. This result is consistent with the fact that no muscle of mastication exhibits a spatial orientation in which the muscle fibers are predominantly mediolateral in direction.

Bite Force↗
PubMed1995

Microscopy and tomography of erosive changes in the temporomandibular joint. An autopsy study.

Thirty-nine temporomandibular joint autopsy specimens were examined by microscopy and tomography for erosive changes. We found two types of erosive changes, an extensive type with complete loss of cartilage and a local type with retained articular cartilage. On microscopic examination nearly twice as many temporal components as condyles were eroded. The erosions were generally more extensive in the condyle. Erosions in the condyle were evenly distributed. In the temporal component there was a slight predominance of erosions located to the lateral part of the tubercle. The radiologic investigation underestimated both the presence and the extent of the erosions. Positive predictive values and negative predictive values were 0.70 and 0.83, respectively, for erosions in the condyle and 0.91 and 0.68 for erosions in the temporal component. It is suggested that the initial event in osteoarthrosis of the TMJ can occur as a subarticular hard-tissue change. The need for more accurate diagnostic tools than radiography should be stressed.

Aged↗
PubMed2001

Three-dimensional finite element analysis of the cartilaginous structures in the human temporomandibular joint.

While the movability of the human temporomandibular joint is great, the strains and stresses in the cartilaginous structures might largely depend on the position of the mandible with respect to the skull. This hypothesis was investigated by means of static three-dimensional finite element simulations involving different habitual condylar positions. Furthermore, the influence of several model parameters was examined by sensitivity analyses. The results indicated that the disc moved together with the condyle in the anterior direction without the presence of ligaments and the lateral pterygoid muscle. By adapting its shape to the changing geometry of the articular surfaces, the disc prevented small contact areas and thus local peak loading. In a jaw-closed configuration, the influence of 30 degrees variations of the loading direction was negligible. The load distribution capability of the disc appeared to be proportional to its elasticity and was enhanced by the fibrocartilage layers on the articular surfaces.

Aged↗
PubMed2002

Influence of sex on reflex jaw muscle activity evoked from the rat temporomandibular joint.

Injection of glutamate into the rat temporomandibular joint (TMJ) evoked a concentration-dependent increase in jaw muscle activity. We investigated whether there are sex-related differences in glutamate-evoked jaw muscle activity that are mediated by sex hormones and whether prior injection of glutamate into the TMJ alters the magnitude of jaw muscle activity evoked by a subsequent injection of the algesic and inflammatory compound mustard oil (MO) into the TMJ. The magnitude of glutamate-evoked digastric and masseter muscle activity was significantly greater in female than male rats when 1000 mM glutamate was injected into the TMJ. Gonadectomy significantly reduced the magnitude of glutamate-evoked digastric muscle activity in female rats. Treatment of gonadectomized female rats with estrogen (20 microg/day) increased the magnitude of glutamate-evoked digastric muscle activity. Glutamate-evoked jaw muscle activity in gonadectomized and estrogen-treated gonadectomized males was not significantly different from intact males. Prior injection of glutamate over a concentration range of 10-1000 mM significantly increased digastric muscle activity evoked by MO injection into the TMJ 30 min later. In contrast, MO-evoked masseter muscle activity was significantly increased by prior injection of 250 mM glutamate only. There were, however, no sex-related differences in the enhancement of MO-evoked jaw muscle activity by prior injection of glutamate. These findings indicate that there are sex-related differences in glutamate-evoked jaw muscle activity that are dependent on female sex hormones, and increased glutamate concentrations sensitize the TMJ to noxious chemical stimuli.

Animals↗
PubMed1985

Diskectomy of the temporomandibular joint: a double-contrast arthrotomographic follow-up study.

The manner in which temporomandibular joint soft-tissue structures remodel following diskectomy has been assessed by double-contrast arthrotomography. Pre- and postoperative arthrograms were compared in ten joints. The intra-articular soft-tissue cover of the bony components was frequently thicker 1 to 3 years after the operation. The most pronounced thickening was observed in the mandibular fossa, whereas a thinner cover was found on the condyle and the tubercle. Development of a thick soft-tissue cover on the articulating surfaces indicates that the temporomandibular joint has a capacity articulating surfaces indicates that the temporomandibular joint has a capacity for functional adaptation following diskectomy. This may be an essential factor for a favorable postoperative result.

Adult↗
PubMed1983

Surgical orthodontics and the temporomandibular joint. I. Superior repositioning of the maxilla.

Ten randomly selected adults who had undergone orthodontic treatment and isolated superior repositioning of the maxilla for vertical maxillary excess (VME) were evaluated clinically and radiographically (mean, 48.7 months postsurgery) for signs and symptoms of masticatory and temporomandibular joint dysfunction. The patients ranged from 18 years to 37 years of age (mean, 26.2 years) when evaluated. A three-part evaluation of the subjects was performed. This consisted of an anamnestic evaluation (previous medical history), a clinical examination, and a radiographic evaluation. The anamnestic evaluation revealed that, prior to surgery, facial pain was reported by one patient and was not present in any of the patients upon follow-up examination. We believed that the pain was not related to the masticatory musculature and/or the temporomandibular joint. No patients reported pain or sounds in their joints preoperatively, while 30 percent (3/10) of the patients related a history of temporomandibular joint sounds immediately after release of intermaxillary fixation, which subsequently was reported to have resolved in all instances without treatment. Clinical examination of the temporomandibular joints at the time of recall evaluated mandibular movements and the presence of pain or sounds during joint function. These examinations revealed that clinical measures of mandibular movements were somewhat reduced relative to normal. All patients were free of temporomandibular joint and masticatory muscle pain during function, upon contralateral masticatory loading, and upon palpation. Fifteen percent (3/20) of the joints examined demonstrated sounds (popping or crepitation) via auscultation. Masticatory loading in the contralateral premolar region did not induce noise in any of the joints examined. Cephalometric laminagraphic radiographs were obtained of each of the twenty temporomandibular joints with the mandible in three positions; maximum intercuspation, mandibular rest position, and maximal opening. Numerous anatomic relations were quantified from these radiographs. However, only three parameters (condylar position, movement, and evidence of arthrosis) were compared to normative data available in the literature. These comparative data suggested that persons who had undergone orthodontic treatment in conjunction with superior maxillary repositioning demonstrated (1) a relatively retropositional condyle within the fossa and (2) reduced condylar movement during maximal mandibular opening. Two of twenty temporomandibular joints demonstrated radiographic evidence of arthrosis; one condyle demonstrated articular surface erosions, and another exhibited articular surface sclerosis. The overall incidence of arthrosis was not much greater than normal, with 20 percent (4/20) of the joints demonstrating a reduced interarticular joint space. Overall, the clinical findings revealed a low incidence of pathologic masticatory muscle and temporomandibular joint symptoms and signs compared to normative data in the literature...

Adolescent↗
PubMed1977

Thickness of the soft tissue layers and the articular disk in the temporomandibular joint.

Out of 115 right temporomandibular joints from Swedish subjects aged 1 day to 93 years, 48 joints without any gross sign of arthrosis or deviation in form were examined histologically. The joint components were cut sagittaly, each into four parts. Histological sections were made of the condyle, the temporal component and of the articular disk. The total thickness of the soft tissue layers was measured in decalcified sections, cut from the medio-central and lateral parts of the condyle and the temporal component and from the medial, medio-central, latero-central and lateral regions of the disk. In the medio-central sections from the condyle and temporal component the thickness of the fibrous connective tissue layer i.e. the surface layer was also registered. The soft tissue layers were thickest in the condyle superiorly, about 0.4-0.5 mm, in the temporal component on the postero-inferior slope of the articular tubercle, about 0.5 mm, and in the disk posteriorly about 2.9 mm. In the roof of the fossa it was only 0.1 mm. The soft tissue layers on the condyle as well as the disk were thinner laterally while the corresponding tissue in the temporal component was thicker laterally. The thickness of the soft tissue layers seem to reflect the growth and functional load to which the joint is exposed.

Adolescent↗
PubMed1995

Spatial and morphologic aspects of temporomandibular joints with sounds.

Various spatial and morphological aspects of the temporomandibular joint may be involved in the development of TMJ sounds. The present study examines their contribution to the prediction of sounds. A non-patient sample was studied using sensitive sound measurement and panoramic radiography. It was found that temporomandibular joint sounds are common in asymptomatic subjects showing substantial variation in several spatial and morphological parameters. An autonomous contribution of spatial relationships, asymmetries or morphology of bony structures to the prediction of joint sounds could not be detected. When unilateral sounds were present, they were more likely to be found on the side with the less steep condylar movement path. Joint imaging is not indicated in the detection of relationships between bony structures and their eventual asymmetries and joint sounds.

Auscultation↗
PubMed1983

The disco-malleolar ligament: a possible cause of subjective hearing loss in patients with temporomandibular joint dysfunction.

The presence of aural symptoms in patients with temporomandibular joint dysfunction has been known for a long time. Although many suggestions have been made as to their cause, none has yet proved adequate. In this article reports are given on four patients with temporomandibular joint dysfunction presenting with aural symptoms, the pertinent literature is reviewed, and a new theory of their causation is discussed.

Adult↗
PubMed1986

The risk of damage to facial nerve, superficial temporal vessels, disk, and articular surfaces during arthroscopic examination of the temporomandibular joint.

The risk of complications occurring during arthroscopic examination of the temporomandibular joint is not well documented. We therefore performed arthroscopic examinations of the upper compartment of the temporomandibular joint of fresh cadavers and during subsequent dissection studied possible damage to the facial nerve, superficial temporal vessels, disk, and articular surfaces. Damage to the facial nerve was not seen in any joint. The distance between the puncture site and any branch of this nerve was 3 mm or more in all but one of the specimens. The puncture site was repeatedly located immediately adjacent to the superficial temporal vessels, but damage to these vessels was not seen in any case. Scratch marks on the articular surfaces resulting from intra-articular manipulations with the instrument were seen in more than half of the joints. It was concluded that the risk of damage to the facial nerve or the superficial temporal vessels during arthroscopy of the temporomandibular joint is small. There is, however, a risk of damage to the articular surfaces. The frequency of this type of injury can probably be reduced in patients by sufficiently distending the joint before the instrument is inserted.

Aged↗
PubMed2000

[Autogenous costochondral graft applied in the reconstruction of the temporomandibular joint].

OBJECTIVE: To study the surgical treatment of ankylosis of the temporomandibular joint. METHODS: Autogenous costochondral grafts were applied in the reconstruction of the temporomandibular joint in 27 cases with condyle ankylosis from 1988-1998. The follow up period was 1-10 years. The pre- and post-operative degree of mouth opening and the TMJ function was examined. RESULTS: Postoperative mouth opening was improved up to 2 cm in the 27 cases. All the results were successful without recrudescence of condyle ankylosis. CONCLUSION: The use of autogenous costochondral grafts in TMJ reconstruction is the best method in the treatment of TMJ ankylosis.

Adolescent↗
PubMed1999

Relationship between joint effusion, joint pain, and protein levels in joint lavage fluid of patients with internal derangement and osteoarthritis of the temporomandibular joint.

PURPOSE: The purpose of this study was to investigate the relationship between the presence of joint effusion, joint pain, and protein levels in joint lavage fluid (JL) of patients with internal derangement (ID) and osteoarthritis (OA) of the temporomandibular joint (TMJ). PATIENTS AND METHODS: Thirty-eight joints in 26 patients with ID and OA of the TMJ were studied. Magnetic resonance imaging (MRI) evidence of joint effusion was evaluated in T2-weighted images. Samples of JL were collected from the superior joint space during pumping manipulation, and the protein concentration was measured. The presence of pain was based on joint tenderness or a complaint of pain in the preauricular region during mouth opening or closing. RESULTS: Joint effusion was demonstrated in 20 of 25 (80%) painful joints; a significantly higher incidence than in pain-free joints (5 of 13, 38.5%). The mean protein concentration (2.15 mg/mL) in JL from painful joints was significantly higher than in pain-free joints (1.22 mg/mL) (P < .05). Furthermore, the mean protein concentration (2.12 mg/mL) in JL from joints with effusion was significantly higher than in joints without joint effusion (1.27 mg/mL) (P < .05). CONCLUSIONS: These data demonstrate that painful joints are more likely to show joint effusion on MRI, and the protein levels in JL recovered from these joints is higher than in pain-free joints. These data also suggested that joint effusion may be related to the inflammatory changes seen in patients with ID and OA.

Adolescent↗
PubMed1981

[Clinical examination of the temporomandibular joint (author's transl)].

The temporomandibular joints and the dental articulation are physiologically closely related structures which form the "temporomandibulo-syndesmodental joint" complex described by Robin. Clinical examination is usually necessary because of pain, which may follow irradiation of the joints. The psychosomatic component may play a major role. Studying joint movements, combined with inspection and palpation enables the function of each joint to be assessed, together with its synchronization with the contralateral joint. Deduction movements are reliable indicators of joint movement capacity, their alterations often being the easiest to demonstrate. Dental articulation must be studied at the same time. Standard radiographs with the mouth open and closed are usually quite sufficient, tomography being necessary in only a precise, limited number of cases.

Humans↗