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PubMed1995

Rheumatoid diseases and the temporomandibular joint: a review.

Rheumatic diseases cause patients to seek care for musculoskeletal pain or dysfunction, as well as other problems. Rheumatic diseases are musculoskeletal and connective tissue disorders demonstrating chronicity, variability, and periods of exacerbation and remission. Practitioners must be aware of the features of many of these diseases and be able to address patients' concerns, especially as they relate to the temporomandibular joint, temporomandibular dysfunction, and/or myofascial pain. Rheumatoid arthritis and systemic lupus erythematosus are sufficiently common to necessitate the dental practitioner having a working knowledge of both of these diseases. This paper presents the salient points of the general pathology of rheumatoid arthritis and systemic lupus erythematosus and specifics of temporomandibular involvement in rheumatoid arthritis.

Arthritis, Rheumatoid↗

PubMed1999

Surgical correction of temporomandibular joint ankylosis in two cats.

Two cats with temporomandibular joint ankylosis were examined. Difficulty in opening the mouth and malocclusion were associated with trauma and fracture around the zygomatic arch and the condyle of the mandible after an automobile accident. Unilateral condylectomy or aggressive caudal mandibulectomy was performed to improve quality of life. Excision arthroplasty of the temporomandibular joint improved mandibular function and appearance. Some malocclusion remained but had no clinical significance.

Accidents, Traffic↗

PubMed1990

Treatment of temporomandibular joint dysfunction by intraoral vertical ramus osteotomy.

The purpose of this study was to determine if the intraoral vertical ramus osteotomy is an effective treatment for anterior disk displacements with reduction and associated temporomandibular joint pain and dysfunction. Success with this procedure was predicated on producing a more functional articular disk-condyle relationship by anterior and inferior repositioning of the condyle. The prospective study was undertaken of nine (eight female and one male) patients (mean age of 25.8 years) with anterior disk displacement with reduction and associated temporomandibular joint pain and dysfunction (mean duration of pain of 6.8 years). History, clinical dysfunction, and pain indices were used to determine the frequency and severity of temporomandibular joint dysfunction. The incidence of ear pain, muscle fatigue, tinnitus, headaches, and clicking was also assessed. The severity of the pain experience in the masticatory muscles and temporomandibular joints was evaluated through the use of a pain index. The severity of the pain experience and temporomandibular joint dysfunction in all of the patients was significantly reduced or totally eliminated during the period of followup. Surgical treatment of anterior disk displacement with reduction by intraoral vertical ramus osteotomy resulted in improved temporomandibular joint function and resolution of symptoms.

Adolescent↗

PubMed1975

Rheumatoid arthritis of the temporomandibular joint.

An investigation into the involvement of the temporomandibular joint in rheumatoid arthritis is described. There is evidence to show that is is affected in two-thirds of all cases of the disease, and this figure agrees broadly with other recent studies. The clinical and radiographic presentation is discussed and its relationship to degenerative disease (osteoarthosis) of the temporomandibular joint is shown. The clinical course of this manifestation of rheumatoid arthritis is proposed and a line of treatment is suggested.

Adult↗

PubMed1995

Lateral cephalometric analysis of skeletal patterns in patients with and without internal derangement of the temporomandibular joint.

Twenty-three female volunteers with normal temporomandibular joints (TMJ) were compared with 24 female patients with documented TMJ internal derangements. Magnetic resonance imaging and lateral cephalometric radiographs were used to investigate the relationship between TMJ disk displacement and skeletal facial form. Results indicated that the patients with internal derangements have significantly smaller mandibles and maxillae. However, these sagittal measurements of jaw length were not associated with disproportionate changes in other cephalometric variables. In general, no district relationship was found between the morphologic features of the face and the internal derangements of the temporomandibular joint.

Adolescent↗

PubMed1994

Is there a role for temporomandibular joint surgery?

In North America, surgery of the temporomandibular joint (TMJ) has made considerable progress, although significant failures have plagued this field in recent years. In spite of the controversies, surgery of the TMJ continues to have a small, but nonetheless, important role in the management of specific temporomandibular disorders (TMD). A general overview of the current thinking in TMJ surgery is presented with the clear message that careful case selection is the most essential ingredient for a successful outcome.

Arthroscopy↗

PubMed1995

Electronic thermography for the assessment of mild and moderate temporomandibular joint dysfunction.

Today facial heat emission patterns may be rapidly obtained and quantified with the use of advanced electronic thermography units that have the promise of being a nonionizing, noninvasive, low-cost diagnostic alternative for the evaluation of temporomandibular joint disorders. This study design measured the use of electronic thermography as a tool to select between asymptomatic (control) subjects and a patient group with mild to moderate temporomandibular joint disorders. Study populations consisted of 24 asymptomatic (control) subjects and 20 patients with (1) either locked or unlocked temporomandibular joints, (2) varying degrees of limitation of mouth opening, (3) mild to moderate muscle pain, and (4) mild to moderate temporomandibular joint arthralgia. The results indicated that the control group demonstrated a high level of thermal symmetry over the temporomandibular joint region. The patient group demonstrated a low level of thermal symmetry with a delta T value of 0.4 degrees C. The control group was selected from the patient group with 85% sensitivity (17 of 20), and 92% specificity (22 of 24), and 89% overall accuracy (39 of 44), when selecting among the 44 subjects used in this study. The conclusion therefore is that electronic thermography shows promise as a method of diagnosing mild to moderate temporomandibular joint disorders.

Adult↗

PubMed1998

Steepness of articular eminence and movement of the condyle and disk in asymptomatic temporomandibular joints.

OBJECTIVE: The purpose of this study was to investigate the rotational motion characteristics of the disk-condyle complex in relation to the steepness of the articular eminence of the normal temporomandibular joint. STUDY DESIGN: We studied 14 asymptomatic volunteers with normal temporomandibular joints using magnetic resonance images with gradient recoil acquisition in the steady state. The degree of condyle and disk rotation within the glenoid fossa, the inclination of the condyle path, and the steepness of the articular eminence were measured and correlated. RESULTS: The condyle and disk both rotated during forward translation within the glenoid fossa during mouth opening. The movement of the disk was smaller than the movement of the condyle, resulting in a posterior rotation of the disk relative to the condyle. The inclination of the condyle path (mean, 61.1 degrees) was significantly smaller than the steepness of the articular eminence (mean, 68.7 degrees). The steepness of the articular eminence was statistically significantly correlated with the degree of disk rotation, which indicated that the disk tended to rotate farther backward in a temporomandibular joint with steeper articular eminence. CONCLUSION: We found that on mouth opening the disk rotated backward relative to the condyle. The posterior disk rotation was more prominent in joints with a steep articular eminence than in joints with a less steep eminence. The results may be helpful for understanding the biomechanics of the temporomandibular joint, especially relative to the development of disk displacement.

Adult↗

PubMed1997

Effect of lavage with injection of sodium hyaluronate for patients with nonreducing disk displacement of the temporomandibular joint.

OBJECTIVE: The purpose of this study was to determine whether lavaging of the superior joint space with injection of sodium hyaluronate can be used as an alternative treatment method for nonreducing disk displacement of the temporomandibular joint. STUDY DESIGN: In 26 patients with nonreducing disk displacement of the temporomandibular joint, the superior joint space was rinsed with 1% xylocaine, and then sodium hyaluronate was injected there (experimental group). As a control group, 50 patients with nonreducing disk displacement of the temporomandibular joint who received no treatment were used (control group). The frequency of the patients with successful clinical resolution was evaluated in each group during 6 months. RESULTS: The frequency of the patients with successful clinical resolution in the experimental group (73.1%) was significantly higher than that in the control group (36.0%) at the 6-month follow-up (chi-squared test, p < 0.05). CONCLUSIONS: This therapy appears to represent an alternative treatment method for nonreducing disk displacement of the temporomandibular joint.

Adolescent↗

PubMed1990

The radiologic morphology of painful temporomandibular joints.

A high frequency of remodeling changes was demonstrated radiographically in a series of patients having pain in the temporomandibular joint region. Radiologic morphologic differences between painful and asymptomatic temporomandibular joints were in frequency rather than type. Caution should be taken not to overestimate the significance of radiologic abnormality in patients with pain in the temporomandibular joint region.

Adult↗

PubMed2004

[Study on the characteristics of apoptosis in the condyles of osteoarthritic temporomandibular joints].

OBJECTIVE: To study the characteristics of apoptosis in the condyles of osteoarthritic temporomandibular joints, and investigate its role in the pathogenesis of the disease. METHODS: Temporomandibular joint osteoarthrosis model of rabbits was created by partial resection of joint disc. The animal models were sacrificed in the 15th day, the 1st month, the 2nd month, the 3rd month, the 4th month, the 5th month, and the 6th month chronologically. Then the pathological condyles were sectioned and detected with TUNEL method to investigate the apoptosis within the tissue. RESULTS: In the reactive repairing state of osteoarthrosis, the apoptosis cells mainly located in the superficial fibrous layer of articular cartilage. With the remodeling of articular cartilage and bone, the apoptosis cells gradually appeared in the proliferating layer, especially in the "clusters of chondrocytes". Accompanied with the severe damage and loss of articular cartilage, the phenomena of apoptosis decreased in the lower zone of cartilage and increased in the hypertrophic and calcified zone. CONCLUSION: There were abundant phenomena of apoptosis within the condylar cartilage of osteoarthritic temporomandibular joint. Abnormal proliferation and abundant apoptosis would disturb the regulation mechanism in the cartilage matrix and lead to the osteoarthrosis.

Animals↗

PubMed2005

The role of systemic hypermobility and condylar hypermobility in temporomandibular joint dysfunction syndrome.

OBJECTIVE: To evaluate the risk of temporomandibular joint dysfunction (TMD), when both systemic joint hypermobility (SJH) and localized condylar hypermobility (LCH) exist. MATERIALS AND METHODS: Sixty-four consecutive outpatients with temporomandibular joint clicking or pain, and 77 sex- and age-matched control subjects, were recruited in the study. LCH was diagnosed when condylar subluxation was present, and SJL was diagnosed by using Beighton's method. The frequency of symptoms, mean mouth opening, and the frequency of subjects with SJL and LCH were the main outcome measures. RESULTS: Out of the 64 patients, 16 patients were suffering from pain, 20 patients from joint-clicking and 28 patients from both. Both SJH and LCH were more frequently observed in those patients with TMD than in control subjects. The risk of TMD was higher if LCH and SJH existed jointly. CONCLUSION: Both systemic and localized hypermobility may have a role in the etiology of TMD.

Adult↗

PubMed1989

[Synovial chondromatosis of the temporomandibular joint--a differential diagnosis to parotid gland tumor].

Synovial chondromatosis of the temporomandibular joint is an uncommon disease of cartilaginous transformation of synovial membrane with formation of loose bodies within the joint space. The stimulus for synovial chondromatosis at this site is unknown. Symptoms frequently include pain and preauricular swelling with occasional snapping during jaw movements. Radiographs of the TMJ may be normal or show multiple, partially calcified loose bodies within the joint. Treatment consists of removal of the loose bodies together with all affected synovium. In this paper a case of synovial chondromatosis affecting the temporomandibular joint is reported and the literature of 38 cases is reviewed.

Chondroma↗

PubMed1998

Mandibular height asymmetry following experimentally induced temporomandibular joint disk displacement in rabbits.

OBJECTIVE: The purpose of this study was to test the hypothesis that nonreducing disk displacement of the temporomandibular joint causes mandibular asymmetry. STUDY DESIGN: Unilateral anterior temporomandibular joint disk displacement with intact posterior disk attachment was surgically created in the right joints of seven growing rabbits. In each of seven sham animals, the right temporomandibular joint was surgically opened without any disk manipulation. Seven animals served as references. For identification of ramal growth and inferior growth at the mandibular base, tantalum implants were inserted into the mandibular body. Lateral cephalograms were exposed repeatedly throughout the 3-month investigation period. Kruskal-Wallis one-way analysis of variance was used to compare the groups. RESULTS: Compared with the sham and reference groups, the experimental group exhibited a deviant growth pattern, with inferiorly directed growth along the mandibular base and in the gonial area. The ramal height was significantly shorter on the side with disk displacement. No significant side difference was present in the sham and reference groups. CONCLUSIONS: Disk displacement can cause mandibular asymmetry in growing rabbits, including shortening of the mandibular ramus and excessive inferiorly directed bone growth along the lower border of the mandible.

Analysis of Variance↗

PubMed1984

Loose bodies of the temporomandibular joint: arthrographic diagnosis.

We report a series of four patients presenting with symptoms of temporomandibular joint pain and dysfunction, and manifesting calcified loose bodies within the temporomandibular joint. Tomographic and arthrotomographic findings are described. Surgical confirmation was obtained in two patients and the histopathology in one demonstrated that the loose body was calcified cartilage surrounded by synovial tissue. The synovial tissue of the joint space was normal in all four cases by arthrotomography and at surgery in two patients. The findings suggest that these cases may be examples of osteochondrosis dissecans.

Adult↗

PubMed2005

Co-morbid psychiatric disorders in Nigerian patients suffering temporomandibular joint pain and dysfunction.

OBJECTIVES: To determine the prevalence of psychiatric morbidity among Nigerian patients with temporomandibular joint pain and dysfunction (facial arthromyalgia). to delineate the specific types of comorbid psychiatric disorders and identify the socio-demographic characteristics of the patients with psychiatric disorders. DESIGN: A two-stage design was adopted to study the prevalence and types of co-morbid psychiatric disorders of identified 24 patients with temporomandibular joint pain and dysfunction over a period of 5 years. SETTING: Pain and Psychiatric clinics of the University of Benin Teaching Hospital, Benini City, Nigeria. METHODS: The patients were controlled for age gender, and marital status. The State-Trait Anxiety Inventory. 28-item General Health Questionnaires and the Hospital Anxiety and Depression Scales were used for first stage screening while the second stage interview utilised the Psychiatric Assessment Schedule. RESULTS: The prevalence of psychiatric morbidity was 37.5% and 12.5% in the study and control groups respectively. Generalised anxiety disorder and dysthmia were the main forms of psychiatric disorders identified. Temporomandibular joint pain and dysfunction patients with co-morbid psychiatric disorders were significantly older (P<0.0001), had the illness for shorter periods before presentation (p<0.001) and were non-professionals. CONCLUSION: The findings highlight the need for multi-disciplinary approach to the assessment and management of patients with temporomandibular joint pain and dysfunction.

Adult↗

PubMedDate not supplied

Osteochondrosis of the temporomandibular joint presenting as an apparent parotid mass.

A mass in the preauricular area usually indicates the presence of a neoplastic or inflammatory process within the parotid gland. Osteochondrosis is an unusual disease process affecting large joints, particularly the knee. Rarely, the temporomandibular joint (TMJ) may be affected. The disease process involves the synovial lining of the TMJ and is commonly ascribed to a benign neoplastic process or metaplasia, although trauma and inflammation have also been implicated. This process can result in single or multiple loose cartilage bodies (joint mice) within the joint cavity. Symptoms are usually those of a mass in the preauricular area, or those of TMJ dysfunction (pain, dislocation, click, decreased range of motion). Physical findings are limited to presence of a mass in the pre-auricular parotid area with a paucity of other parotid findings. Treatment involves removal of the loose cartilage bodies from the TMJ and possibly the synovial lining, if it appears to be severely damaged.

Biopsy, Needle↗

PubMed1981

Radiographic appearance of the normal temporomandibular joint in newborns and small children.

The radiographic anatomy of the normal temporomandibular joint in newborns and children up to 4 years of age was investigated, partly on specimens, obtained at autopsy, with methods corresponding to clinical procedures, and partly on patients. A rather flat mandibular fossa and immature mandibular head were found at birth, whereas a well-developed articular tubercle and an adult-like radiographic appearance of the joint were found at about one year of age. No evident changes of the radiographic anatomy seemed to occur from one to 4 years of age. A striking similarity was observed between the dystrophic temporomandibular joint in patients with juvenile rheumatoid arthritis and micrognathia and the normal radiographic appearance in the first months of life, indicating an early involvement of this joint in patients developing micrognathia.

Age Factors↗