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PubMed1994

[Loose bodies of the temporomandibular joint. A rare pathology].

Loose bodies of the temporomandibular joint (TMJ) are an uncommon condition which can be caused by various complaints that can now be diagnosed with high resolution CT. The authors report on 10 cases observed from 1983 to 1992 which were studied with both conventional radiography and CT. The most common conditions were synovial chondromatosis and osteochondrosis dissecans. In the two cases of synovial chondromatosis, the demonstration of ossified loose bodies made the diagnosis easier. The cases of osteochondrosis dissecans presented with more complex diagnostic problems: in two instances the characteristic subchondral bone fragment in the condylar head was clearly visible, but in the third case this small fragment was difficult to identify as it had migrated backwards, making the disorder troublesome to diagnose. An osteophyte fracture and the presence of a bone fragment following condylar head fracture were easily diagnosed by correctly assessing the associated articular changes resulting from an arthrosic and a traumatic condition, respectively. The only case of loose body due to previous TMJ remodeling was easily diagnosed as the totally ossified formation was not seen on the preoperative X-ray film. Finally, two very similar cases, characterized by the presence of an elongated radiopaque formation in the site of the posterior meniscal ligament, were difficult to interpret as no such case is reported in the literature. In both cases an anatomical variant was presumed, characterized by posterior meniscal ligament ossification.

Adult↗
PubMed1986

Tissue reactions associated with internal derangement of the temporomandibular joint. A radiographic, cryomorphologic, and histologic study.

Ten temporomandibular joint specimens, five with clinical signs of arthropathology and five without, were examined by means of tomography, double-contrast tomography, and serial cryosectioning combined with histologic staining of sections for tissue identification. Of the five joints with signs of arthropathology four demonstrated disc displacement. The fifth joint showed a post-traumatic condition. Four of the joints with clinical signs of arthropathology demonstrated hyperplastic connective tissue retaining contrast medium in the posterior part of the fossa. This hyperplastic connective tissue contained extravasated blood and enlarged cavernous structures lacking endothelial lining. Extravasated blood is one probable source of temporomandibular joint pain. All joints with permanently displaced discs demonstrated perforation of a hyalinized posterior disc attachment. Without tissue identification such an attachment is likely to be misinterpreted as being the disc itself.

Aged↗
PubMed2001

Mandibular and temporomandibular joint arthropathy in the differential diagnosis of the parotid mass.

OBJECTIVE: To increase awareness of temporomandibular joint and mandibular disease in the overall evaluation and diagnosis of the parotid mass. STUDY DESIGN: We describe clinical presentations of pigmented villonodular synovitis and synovial chondrocalcinosis of the temporomandibular joint, as well as osteoma of the mandible, as they may initially suggest primary neoplasms of the parotid gland. CONCLUSIONS: Preauricular swelling is a common presenting symptom for patients visiting an otolaryngologist. Often this symptom is suggestive of a parotid mass. However, lesions of the temporomandibular joint and mandible may also present in this fashion.

Adult↗
PubMed1998

Quantitative assessment of temporomandibular joint disk status.

The purpose of this study was to quantify temporomandibular joint disk-slice information produced by magnetic resonance imaging by means of a stepwise discriminant analysis. One hundred ninety-four adolescents consented to magnetic resonance imaging evaluation of their temporomandibular joints. Sagittal magnetic resonance imaging slices of each joint were assigned to one of six subjective categories of disk position by an experienced maxillofacial radiologist. Standardized reference planes transferred to each magnetic resonance image from corresponding lateral cephalometric radiographics facilitated the measurement of disk length and disk displacement and the computation of ratio values of these measurements. Discriminant analysis revealed that all three quantitative variables were descriptive and discriminant for grouping slice data into pre-established subjective categories. Cross-validation and misclassification error calculations showed a 69.3% agreement between subjective and discriminant classification. Therefore quantification of disk displacement can be used in place of subjective evaluation. In addition, discriminant analysis disclosed a reduction in disk length associated with increased severity of disk displacement.

Adolescent↗
PubMed1990

Magnetic resonance imaging of the temporomandibular joint.

Correct diagnosis of internal derangements of the temporomandibular joint requires both a comprehensive clinical and radiographic evaluation. Plain film tomography, transcranial radiography, arthrography and computed tomography have all been used to assess the status of the joint structures. Magnetic resonance imaging is a relatively new modality used for imaging many different organ systems. Magnetic resonance imaging of the temporomandibular joint has certain distinct advantages over previously used techniques in evaluating patients for internal joint derangements. The applicability of magnetic resonance imaging in the diagnosis of internal derangements will be discussed.

Humans↗
PubMed2002

Multifactorial comparison of disk displacement with and without reduction to normals according to temporomandibular joint hard tissue anatomic relationships.

STATEMENT OF PROBLEM: There is disagreement about the predictive value of temporomandibular joint tomographic anatomy in the diagnosis of internal derangements. PURPOSE: This study aimed to identify multifactorial temporomandibular hard tissue relationships that differentiate disk displacement with reduction and disk displacement without reduction from normals. MATERIAL AND METHODS: Temporomandibular joint tomograms from females diagnosed with unilateral disk displacement with (n=84) or without (n=78) reduction were compared to 42 asymptomatic normal joints with the use of 14 linear and angular measurements and 8 ratios. A validated classification tree model was tested for accuracy with sensitivity, specificity, goodness of fit, and the amount of log likelihood accounted for. The tree model was compared with a multiple logistic regression model and univariate testing. RESULTS: The disk displacement with reduction tree model consisted of 3 disease and 2 normal pathways with interactions between fossa width to depth ratio, condyle position, and linear posterior joint space. This class was characterized by either a much wider- and shallower-than-average fossa shape and/or by a moderately posterior condyle position when the fossa shape was average to deeper and/or narrower. The logistic regression and univariate models also suggested wider and/or shallower fossae, as well as longer eminence length. The disk displacement without reduction tree model consisted of 2 disease pathways and 1 normal pathway. Interactions characterized this class by either a posterior to very posterior condyle position or by a much deeper than average fossa depth when the condyle position was concentric to anterior. The logistic regression model emphasized greater fossa depth and width versus normals. The tree models conservatively predicted the disease classes: Rescaled Cox and Snell R(2) 37.0%, sensitivity 70.2%, and specificity 90.5% for disk displacement with reduction; R(2) 28.8%, sensitivity 66.7%, and specificity 85.7% for disk displacement without reduction. CONCLUSION: Within the limitations of this study, hard tissue relationships revealed by central tomogram sections were able to model notable differences between disk displacement with reduction and disk displacement without reduction versus asymptomatic normals when temporomandibular joints were examined as a multifactorial system typified by interactions of fossa width to depth proportions and condyle position. While substantial, the hard tissue predicted only part of the biology. The model could be broadened by additional factors and interactions.

Adult↗
PubMed1984

Surgery of the temporomandibular joint. II. Microsurgery.

The operating microscope has revolutionized many surgical procedures. Pioneering microtechniques for exploring and reconstructing the temporomandibular joint have been modified. The preauricular, endaural, and postauricular incisions may be used for approaching the temporomandibular joint in microsurgery procedures. Determinations of pathologic conditions and observations of temporomandibular joint function-dysfunction are dramatic and rewarding. Precision surgery using microinstruments, microneedles, microdrills, bipolar cautery, and the laser allows accuracy of technique that previously was impossible. Representative case presentations illustrate patient treatment, surgical incision, microsurgical technique employed, and clinical results obtained.

Adult↗
PubMed1988

Hemophilic arthropathy of the temporomandibular joint: review of the literature, a case report, and discussion.

Hemarthrosis of extremity joints in patients with hemophilia has been well documented. However, hemarthrosis of the temporomandibular joint in patients with coagulopathies appears to be rare. Consequently, management of a temporomandibular joint hemarthrosis is difficult because of the lack of treatment guidelines. The purpose of this article is to review the pathophysiology of hemophilic arthropathy and its management. A case of temporomandibular joint hemophilic arthropathy in a patient with a factor XI deficiency will be presented. A brief review of factor XI deficiency and a hypothetical pathophysiological mechanism for internal derangement induced by myofascial pain dysfunction are included.

Adolescent↗
PubMed2002

Long-term follow-up of the CAD/CAM patient fitted total temporomandibular joint reconstruction system.

PURPOSE: The purpose of this study was the assessment of the long-term safety and effectiveness of the Techmedica (Camarillo, CA) CAD/CAM Total Temporomandibular Joint Reconstruction System (now called the TMJ Concepts Patient Fitted Total Temporomandibular Joint Reconstruction System, Ventura, CA). PATIENTS AND METHODS: A survey was mailed to the available addresses of 170 (79%) of the 215 patients who had been implanted with the Techmedica System devices between 1990 and 1994. Seventy-nine (46%) surveys were returned by the US Postal Service as undeliverable. Three patients (1.4%) were reported as deceased in returns from relatives. Therefore, of the remaining 91 possible responses, 60 (65.9%) were returned. Fifty-eight (58) surveys, considered complete and valid (96.7%), representing 97 (39 bilateral, 19 unilateral) devices with a mean follow-up of 107.4 +/- 15.5 months (range, 60 to 120 months) were analyzed. Subjective data related to pain, mandibular function, diet consistency, and present quality of life were collected using visual analog scales. Objective measures of mandibular interincisal opening and lateral excursions were obtained from direct measurements using the Therabite (Therabite, Philadelphia, PA) measuring scale provided in the survey with instructions as to its use. RESULTS: Analysis of the subjective data at 10 years revealed a 76% reduction in mean pain scores and a 68% increase in mean mandibular function and diet consistency scores (P <.0001). Analysis of objective data revealed a 30% improvement in mandibular range of motion after 10 years (P =.0009). Long-term quality of life improvement scores were statistically related to the number of prior temporomandibular joint operations the patients had undergone. CONCLUSION: These data indicate that the CAD/CAM Patient Fitted Total Temporomandibular Joint Reconstruction System has proved to be a safe and effective long-term management modality in the patient population surveyed for this study.

Adolescent↗
PubMed1999

Association between arthroscopic diagnosis of temporomandibular joint osteoarthritis and synovial fluid nitric oxide levels.

OBJECTIVE: The purpose of this study was to determine whether there is a relationship between synovial fluid levels of nitric oxide and clinical and arthroscopic findings of synovitis or cartilaginous degeneration. STUDY DESIGN: Arthroscopic surgery was performed on 20 joints in 15 female patients with internal derangement and osteoarthritis of the temporomandibular joint. Synovial fluid aspirates were obtained immediately before arthroscopy. Synovial fluid was also obtained from 14 joints of 11 female asymptomatic volunteers. The concentration of nitrite in the fluid recovered from each temporomandibular joint was measured through use of a highly sensitive and specific chemiluminescence detection method, calibrated per 1 mg of synovial fluid protein and expressed as nitric oxide; the result was then compared with clinical and arthroscopic findings of synovitis and cartilaginous degeneration. RESULTS: Significantly higher levels of nitric oxide (median, 0.331 micromol/mg) were seen in the patients with internal derangement and osteoarthritis than in the control group (median, 0.001 micromol/mg; P<.0001). Synovial fluid from joints with pain in the joint area had significantly higher levels of nitric oxide than did fluid from joints without such pain. Synovial fluid from joints with degenerative changes (median, 0.467 micromol/mg) had significantly higher levels of nitric oxide than did fluid from joints without osteoarthritis (median, 0.057 micromol/mg; P<.05). Although the levels of nitric oxide in synovial fluid aspirates were markedly elevated in some joints with synovitis, there was no correlation between the levels of nitric oxide and the presence of synovitis. CONCLUSIONS: The findings indicate that increased levels of nitric oxide are involved in the pathogenesis of cartilaginous degeneration of the temporomandibular joint.

Adult↗
PubMedDate not supplied

[A clinico-genetic analysis of functional temporomandibular joint lesions in children].

The authors review the results of a clinical genealogic investigation of 130 families with children suffering from abnormalities of the temporomandibular joints presenting as recurrent subluxations and/or arthrosis. A genetic statistic study, carried out by proband Weinberg's method in sibs families, has lead the authors to a conclusion on the monogenic autosomal dominant type of inheriting the temporomandibular joint abnormalities. A high incidence of diseases due to connective tissue failure in the body (lower limb varicose veins, spinal deformations, platypodia, hernias, hemorrhoids, etc.) in the families with children suffering from temporomandibular joint abnormalities has permitted the authors regard recurrent subluxations and/or arthrosis of the temporomandibular joints as a component of the total involvement of the connective tissue.

Adolescent↗
PubMedDate not supplied

The prospective use of COX-2 inhibitors for the treatment of temporomandibular joint inflammatory disorders.

Development of a new class of drugs designed to selectively inhibit the inducible cyclooxygenase isoenzyme, COX-2, was initially prescribed for individuals diagnosed with osteoarthritis or rheumatoid arthritis. Although these inflammatory disorders are more typically related to the joints of the knee, ankle, or hand, the temporomandibular joint (TMJ) plays a special role due to its involvement in our normal day-to-day activities of eating and communicating. The TMJ, unlike most of the other joints, contains some unique morphological characteristics that support various inflammatory disorders. An overview of these characteristics and the prospective use of the COX-2 inhibitors for temporomandibular joint inflammation are presented.

Animals↗
PubMed1990

[An experimental study on change in temporomandibular joint following occlusal changes].

In order to clarify the cause of temporomandibular arthrosis, an experimental study on change in temporomandibular joint resulting from faulty occlusion which is thought to be one of the causes was performed. In this study, macroscopic, radiologic and histopathologic effects of a forced distal positioning of the mandible by occlusal metal splints and loss of posterior teeth in adult Macaca fuscatas were observed. Cephalometric radiograph including posteroanterior and axial projection were taken to determine the individual projection angle for standardized TMJ radiography including lateral oblique transcranial and transpharyngeal projection prior to the experimental procedures. The upper and lower molars of the monkey were extracted and the remaining teeth were prepared and the cast metal splints were adhered in place. They were maintained on their regular diet. Radiographic observation of the joints and macroscopic clinical observation of the occlusion were made individually, immediately after operation, at the 10th, 20th, 40th and 83rd day postoperatively. The monkeys were killed individually at the 10th, 20th, 40th and 83rd day postoperatively, each temporomandibular joints were removed and prepared for contact microradiographic, fluorescent micrographic and histopathologic observations. The results obtained were as follows: 1) Macroscopically, the opening between the upper and lower lateral teeth in full closure was about 2mm, overbite about 2mm in anterior teeth immediately after the splints were adhered in place and molar extraction. The opening between the lateral teeth decreased slowly after the 10th day postoperatively and they were approximating occlusal contact from the distal area of the splints. The whole area of the occlusal surface of the splints came into contact and the mandible positioned posteriorly by the 40th day. 2) Though the cephalometric radiographs in posteroanterior and axial projection did not show the changes of mandible through the whole experimental period, lateral head plates and standardized TMJ radiographs showed posterosuperior positioning of the mandible after 20th day postoperatively, and osseous absorption in the posterior aspect of the condyle at the 83rd day. 3) Contact microradiographic and fluorescent micrographic observations showed osseous remodeling in the neck of condyle at the site of the insertion of the lateral pterygoid muscle, anterior aspect of the retroarticular process and posterior aspect of the condyle.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed2001

Remodeling of the temporomandibular joint following mandibular distraction osteogenesis in the transverse dimension.

Transverse mandibular distraction osteogenesis involves moving the osteotomized segments of the mandible in either a varus or valgus direction. This maneuver allows for widening of the bigonial distance or for a lateral shift of an asymmetric mandibular midline. During this process, a significant amount of torque is placed on the mandibular condyles, because they act as the pivot point for the mandibular translation. Although standard linear distraction osteogenesis induces transient, reversible changes in the temporomandibular joint, it is not known what effect the varus and valgus stresses of transverse distraction have on the temporomandibular joint. We therefore designed a study to document the temporomandibular joint changes following various degrees of transverse distraction. Bilateral transverse mandibular distraction was performed on 10 adult, female mongrel dogs using an external, multiplanar mandibular distraction device. The distraction protocol was as follows: (1) complete osteotomy at the angle of the mandible, (2) 5-day latency period, (3) distraction rate of 1 mm/day, (4) rhythm of one turn per day, (5) linear activation 16 to 30 mm bilaterally, and (6) 8-week consolidation period. A variety of varus and valgus distraction vectors were applied to the mandible only after 10 mm of initial linear distraction had been achieved. Posteroanterior and lateral cephalograms were performed throughout the entire process. Pre-distraction and post-consolidation computed tomographic scans were also performed. Changes in mandibular conformation, axis of rotation, temporomandibular joint structure, and glenoid fossa changes were directly assessed by evaluating the postmortem craniofacial skeleton. The findings were compared with those of normal, age-matched mongrel dog skulls. Significant remodeling changes were observed in the temporomandibular joints of all animals involved in the study. The mandibular condyles demonstrated varying degrees of flattening and erosion at all contact points with the craniofacial skeleton. In some cases, the condyle became part of the distraction regenerate process and was hypertrophied in all dimensions. The condyles were frequently displaced out of the glenoid fossa, particularly on the side in the direction of varus distraction. When the latter occurred, a new fossa was created on the undersurface of the zygomatic arch. Varying degrees of mandibular rotation in the sagittal plane were also observed, which led to abnormal torquing of the condyles in the coronal plane, depending on whether the axis of rotation occurred primarily around the condyle or around the distraction regenerate zone.In conclusion, transverse mandibular distraction is an effective means of producing a varus or valgus shift in the gonion relative to the midsagittal plane. However, unlike linear or angular mandibular distraction, transverse distraction has a multitude of nontransient effects on the temporomandibular joint. Therefore it must be emphasized that in clinical practice, transverse distraction should be used cautiously. One must also be aware that such a maneuver in distraction can have negative effects on the temporomandibular joint.

Animals↗
PubMed1996

The short-term effect of discectomy on the osteoarthrotic temporomandibular joint in sheep.

The short-term effect of discectomy on osteoarthrotic joints was tested experimentally in sheep. Bilateral temporomandibular joint (TMJ) osteoarthrosis was induced, and at 3 months discectomy was performed on one joint, with the other being left as a control. Neither masticatory nor mouth-opening disturbances had been found after discectomy. The animals were killed at 6 months, and the TMJs were removed, fixed, and assessed radiologically, macroscopically, and histologically. The control joints showed ongoing degenerative changes consistent with previous reports. The discectomy joints showed marked fibrous repair with joint surface remodelling rather than ongoing degeneration. This result is consistent with the clinical findings after discectomy for osteoarthrotic joints.

Animals↗
PubMed1994

A case of open bite accompanied by temporomandibular joint disorder. A comparison of occlusal conditions before and after treatment in lateral-oblique radiogram.

According to the authors' clinical experience, malocclusion accompanied by temporomandibular joint disorder involves mainly cross bite, open bite, deep overbite or axillary protrusion. However, it is possible that the symptoms of this disorder are associated with other types of malocclusion or even with nearly normal occlusion. In fact, it can be said that temporomandibular joint disorder may develop with any type of occlusion. This paper reports a case of open bite accompanied by temporomandibular joint disorder occurring in a patient who visited our hospital because of pain in the left temporomandibular joint region, vertigo and partial deafness. In this patient, the temporomandibular symptoms disappeared after orthodontic treatment. The patient received no particular treatment thereafter because follow-up observation confirmed that the therapeutic results were favorable without any relapse of the symptoms of temporomandibular disorder. The positions of the temporomandibular joint and mandibular condyle were determined in lateral-oblique radiograms obtained using our radiographic system, by which the mandibular condyle is radiographed using a projection consistent with its long axis.

Adult↗