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PubMed1989

[Arthrographic investigation for the disk configuration with closed lock of the temporomandibular joint].

The authors examined arthrotomographies of 89 patients (96 joints) with closed lock of the temporomandibular joint to clarify the frequency of disk deformity correlated with disk perforation, bone change and patients' age. The disk configurations were divided into 3 types, those were type-1-elongated and preserved shape of the disk, 39 joints, type 2-folded disk, 11 joints, and type 3-massed disk, 46 joints. The frequency of disk deformity was 66.7% (64 joints). The numbers of disk perforation, (and bone change) in each type were type 1-2 (5) joints, type 2-1 (1) joint, and type 3-11 (13) joints. The average ages of each type were type 1-28.1 years, type-2-27.2 years, and type 3-40.1 years. These results indicate that high percentage of disk deformations exist in the closed lock patients with degenerative changes of the soft and hard parts of the temporomandibular joint.

Adult↗
PubMed2004

Treatment of temporomandibular joint ankylosis by a modified fossa prosthesis.

BACKGROUND AND OBJECTIVE: Treatment of temporomandibular joint ankylosis is a challenge and suffers from a high incidence of recurrence. Although treatment of ankylosis has been tried as early as nearly 200 years ago, no single technique produced satisfactory results. An alternative technique and a modified spacer system are described in this paper. MATERIAL AND METHODS: Fifteen patients, nine of whom had unilateral and the remaining six had bilateral ankylosis were evaluated. Modified fossa implants were used in all cases. RESULTS: The highest incidence of ankylosis was observed in the 11-20 year age group (nine patients). Falls during childhood was the common aetiological factor. Eight patients had been previously operated upon. Postoperative interinsicial opening values were remarkably different from the preoperative ones and the long-term results were satisfactory. CONCLUSION: With continued research and development in the treatment of ankylosis, temporomandibular joint implants will become more predictable and reliable. This specially designed fossa implant seems to be promising in the treatment of TMJ ankylosis.

Acrylic Resins↗
PubMed1986

Distribution of substance P-like immunoreactive nerve fibers in temporomandibular joint soft tissues of monkey.

The distribution of substance P-immunoreactive and silver impregnated nerve fibers in the temporomandibular joint soft tissues of the Macaca fascicularis monkey was investigated in frozen sections. The pattern of substance P-immunoreactive structures in the soft tissues and periosteum of the temporomandibular joint was compared with the distribution of silver impregnated nerve fibers within these tissues. Presence of substance P-immunoreactive fibers was demonstrated in the temporomandibular joint capsule, disc attachments, fascia, adjacent periosteum and within the interfascicular connective tissue of the lateral pterygoid muscle. The overall distribution corresponded to that of silver impregnated nerve fibers. Substance P-immunoreactive nerve fibers were found in the adventitia of arteries in all vascularized temporomandibular joint soft tissues but could not be found in the adventitia of veins. No substance P-immunoreactive or silver impregnated nerve fibers were seen in the dense collagenous tissue forming the disc. Substance P is suggested to influence the major features of inflammation and to play a role in acute and chronic pain conditions.

Animals↗
PubMed2002

Fluid extravasation of the articular capsule as a complication of temporomandibular joint pumping and perfusion.

This report is a retrospective study of fluid extravasation as a complication of temporomandibular joint pumping and perfusion. Contrast-enhanced 3D-CT of the upper joint compartment was performed for presurgical diagnosis before temporomandibular joint arthroscopic surgery in our hospital from 1996 to 2000. From these cases, 43 joints and 38 patients were selected because they had not improved under conservative treatment during the previous six months. Fluid extravasation of the articular capsule was recognized in 9 joints (20.9%) in 9 patients, 3 males and 6 females. Two of the nine patients had undergone arthroscopic observation before surgery. This test had revealed only thin articular capsule, not a perforation, in any of these cases. The data indicate only extremely tiny perforations or infiltration leakage due to the fluid pressure in the upper joint compartment during pumping or perfusion. Oral and maxillofacial surgeons should be aware of this complication.

Adolescent↗
PubMed2004

[Cine MRI of the temporomandibular joint in comparison to static MRI and axiography].

PURPOSE: To evaluate Cine MRI (cMRI) of the temporomandibular joint in comparison to static MRI (sMRI) and axiography. MATERIALS AND METHODS: In a prospective study with 57 healthy volunteers as well as 33 patients after temporomandibular joint (TMJ) surgery or with severe joint dysfunction, we measured the mobility of both condyle and disc as well as the sagittal angle of condylar inclination with sMRI and cMRI. Measurements and image analysis were performed by a radiologist and a maxillofacial surgeon in consensus. The results of axiography served as standard of reference. RESULT: Concerning the assessment of the discoligamentous complex, sMRI was superior to cMRI in the patient-group (sensitivity sMRI 85 %, cMRI 76 %), while no significant difference was found in the volunteer-group (sensitivity sMRI 97.4 %, cMRI 98.3 %). The results of cMRI and sMRI showed a highly significant correlation with each other, as well as with the axiographic reference tracings (r = 0.90). The average mobility of the disc and condyle was 6 % and 10 % higher in sMRI compared to cMRI (p = 0.001) and showed a slightly higher variance (0.043 vs. 0.038). Concerning the condylar inclination angle, both MRI-procedures had the best correlation (r = 0.94) with each other and axiography. CONCLUSION: Real-time MRI of the TMJ is comparable to axiography in its accuracy and is a useful adjunct to conventional static MRI.

Adult↗
PubMed1992

Temporomandibular joint: surgically created disk displacement causes arthrosis in the rabbit.

To document a causal relationship between temporomandibular joint disk displacement and arthrosis, the disk was surgically displaced in one temporomandibular joint in each of three rabbits. The rabbits were sacrificed after 4 weeks and the mandibular condyles were studied radiographically and histologically. All three joints that underwent disk displacement had radiographic and histologic evidence of arthrosis, which included erosion of the bone, irregularity and fissure formation of the articular soft tissue cover, disruption of the subchondral layer of cartilage cells, and chondrocyte proliferation. No radiographic or histologic changes occurred in the joints that were untouched. The results suggest that surgically created disk displacement can cause arthrosis in the temporomandibular joint of the rabbit.

Animals↗
PubMed1990

Temporomandibular joint osteoarthrosis and internal derangement. Part II: Additional treatment options.

In some cases of temporomandibular joint osteoarthrosis and internal derangement, the initial treatment needs to be supported by additional treatment modalities. In this paper, the basic principles of the most common additional modalities used are discussed. Orthopaedic appliances are used to either stabilize, or reposition the mandible. Consequently, there are two splint types: the stabilization splint and the repositioning splint. The major indication for applying the former is to decrease the load imposed on the joint. Secondary effects are stabilization of the occlusion and masticatory muscle relaxation. The repositioning splint may be used in some cases to reduce a displaced articular disc. Physical therapy is often used to mobilize the joint and to re-educate mandibular movement patterns. Based on the stages of temporomandibular joint osteoarthrosis and internal derangement, guidelines are given for the treatment strategy to be followed in the management of this common disorder.

Cartilage, Articular↗
PubMed1979

Temporomandibular joint meniscectomy--effects on joint structure and masticatory function in macaca fascicularis.

The postoperative effects of unilateral temporomandibular joint meniscectomy on joint structure and masticatory function were evaluated in four mature Macaca fascicularis and compared with one control. Mandibular movement during mastication was monitored objectively with an optoelectronic tracking system within four months and again within twelve months postmeniscectomy in each animal. Temporomandibular joint structure was documented radiographically and histologically. Results showed that degenerative joint disease was produced in the postsurgical joint, and that the morphological changes were location-dependent. Fibrous ankylosis was observed histologically in three animals. The contralateral joints were not affected morphologically, except for bony resorption of the articular eminence noted microscopically in one animal. Radiographically, however, the joint appeared normal. Variable alterations in masticatory patterns were observed following unilateral meniscectomy. While there appeared to be an association between temporomandibular joint structure and masticatory function, radiographic and microscopic observation of morphological alterations in the joint did not result in predictable functional limitations in chewing pattern.

Animals↗
PubMed2002

Adaptive alterations of elastic fibers in the bilaminar zone of rabbit temporomandibular joint following disc displacement.

OBJECTIVE: To study the adaptive alterations of elastic fibers in the bilaminar zone (BZ) of rabbit temporomandibular joint (TMJ) following disc displacement. METHODS: Twenty-eight Japanese white rabbits were used in this study. The right temporomandibular joints of 20 of 28 rabbits were subjected to the surgical procedure of anterior disc displacement (ADD). Four rabbits in the surgical group were sacrificed at 2, 4, 6, 8 and 12 weeks after operation. Their temporomandibular joints were studied histochemically. RESULTS: Elastic fibers were reduced in number and ran irregularly in the superior lamina of BZ from ADD rabbits. The jungly elastic fibers (EFs) could still be seen at 2 weeks after operation. At 4 weeks, the number of EFs decreased significantly; EFs lost their jungly arrangement and were shaped like rough dots, of which the arrangement and the lengths were different. Six weeks after operation, many EFs were replaced by distorted, uneven, non-oriented fine EFs, distributed unevenly and some thick or fine EFs that ran irregularly. The number of EFs decreased further and their arrangement was more deranged at 8 weeks. At 10 and 12 weeks, EFs in the superior lamina of BZ were similar to those at 8 weeks. CONCLUSION: Our results show that EFs lost their function as well as their distribution and arrangement after disc displacement.

Adaptation, Physiological↗
PubMed1986

Diagnostic accuracy of upper compartment arthroscopy of the temporomandibular joint: correlation with postmortem morphology.

The diagnostic accuracy of upper compartment arthroscopy of the temporomandibular joint was evaluated in fifty fresh human cadavers. Arthroscopic observations of remodeling, arthrosis, adhesion, and perforation were compared with dissection findings. About half of the joints were arthroscopically diagnosed in agreement with subsequent dissection findings. In the other joints there were discrepancies between arthroscopic and morphologic findings. The discrepancies were, with only two exceptions, underdiagnosis of pathologic changes. This was most pronounced for perforation of the disk, since only three of fourteen perforations were seen through the arthroscope. The position of the disk was difficult to study arthroscopically, since the injected air and the thick arthroscope in the joint compartment altered the positional relationship between the joint components and made it difficult to reproduce joint function during the examination. In conclusion, arthroscopy of the upper compartment of the temporomandibular joint provides information about the articular surfaces that is not available by other methods, and this examination may therefore be a valuable supplement to other diagnostic methods, and this examination may therefore be a valuable supplement to other diagnostic methods. An arthroscopic diagnosis of pathologic changes seems to be reliable (high specificity), but an arthroscopic diagnosis of normality includes a substantial risk of underdiagnosing pathologic changes (low sensitivity).

Aged↗
PubMed1989

[Arthroscopic surgery for habitual dislocation of the temporomandibular joint].

This study is to evaluate the effect of the arthroscopic surgery for habitual dislocation of the temporomandibular joint. Conclusively, it is believed that arthroscopic surgery for habitual dislocation of the temporomandibular joint is easier method, has fewer complications, and lower recurrence rate, when compared with the conventional temporomandibular joint surgery.

Arthroscopy↗
PubMed2002

Temporomandibular joint ankylosis: a case report.

This report is based on a case of temporomandibular joint ankylosis discovered in a cadaver during routine student dissection in the Department of Anatomy at Tokyo Dental College. Extensive osseous ankylosis in the left temporomandibular joint was evident in this case which exhibited a distinctive bird-like facial deformity caused by a mandibular growth disorder. This resulted in the underdevelopment of the mental area in particular. Furthermore, abnormally enlarged antegonal notching was present along the inferior border of the mandible anterior to the angle. Both these manifestations indicated the likelihood that the ankylosis had contributed to the abnormalities and had commenced at an early stage of skeletal development.

Ankylosis↗
PubMed1981

Internal derangements of the temporomandibular joint: correlation of arthrography with surgical findings.

The diagnosis of dysfunctional temporomandibular joint (TMJ) disorders unresponsive to nonsurgical treatments heretofore has often been empirical. With the development of TMJ arthrography, diagnosis has been greatly improved; an accurate picture of the condition of the joint now provides a substantial base on which to build a rational and reasonable treatment plan. Clinical symptoms can be accurately correlated with the radiographic picture, a valid surgical procedure can be performed because the joint condition is known, and a meaningful prognosis can be determined. Successful management, however, very often requires multifaceted treatment consisting not only of surgery but also of bite-plate, occlusal, restorative, and physical therapy, both preoperatively and postoperatively.

Cartilage, Articular↗
PubMed1999

Magnetic resonance imaging of the temporomandibular joint: diagnostic difficulty caused by extensive pneumatization of the mastoid air cells.

OBJECTIVE: During routine MR imaging of temporomandibular joints we have observed that an area of low signal is sometimes identified within the temporal bone overlying the glenoid fossa on proton-density sequences. This finding at times simulates a mass. CT in this situation has demonstrated marked pneumatization of the mastoid air cell extending to that portion of the temporal bone overlying the glenoid fossa. We undertook a clinical study to determine the frequency and appearance of such a finding. DESIGN AND PATIENTS: We reviewed the images of 12 patients who underwent both MR and CT examinations of their temporomandibular joints. The authors, by consensus, graded all 24 joints using a four-point scale for the presence and appearance of a low-signal area overlying the glenoid fossa on the MR images prior to seeing the corresponding CT images. We then compared our grading with the findings on CT to assess for the presence and extent of pneumatization of the temporal bone overlying the glenoid fossa. RESULTS: Of the 24 joints reviewed there was identical extent of low signal on MR imaging and extent of pneumatization on CT in 22 of 24 joints. In two of the 24 joints assessed there was overestimation of pneumatization due to extensive sclerosis secondary to surgery. CONCLUSION: The findings of an area of low signal overlying the glenoid fossa on a T2-weighted scan of a nonoperative temporomandibular joint is often due to extensive temporal bone pneumatization of the mastoid air cells. Recognition of the nature of this finding will avoid mistaking it for a fibrous or osseous lesion. Patients with previous operative history may, however, require further investigation with CT.

Adult↗
PubMed2000

Sonography of the temporomandibular joint from 60 examinations and comparison with MRI and axiography.

BACKGROUND AND OBJECTIVE: Establishing a diagnosis of temporomandibular joint disorder is mainly based on clinical assessment, functional examination, nuclear magnetic resonance imaging (MRI) and axiography. Sonographic examination was compared with MRI and axiography in assessing temporomandibular joint (TMJ) function in 55 patients. PATIENTS AND METHODS: Fifty-five patients with different TMJ problems were examined clinically, by means of axiography, sonography and some also by MRI. The range of motion was measured by sonography and axiography and the results compared using Student's t-test. Anatomical details diagnostic for disc-displacement were tested by sonography and MRI. RESULTS: The average time required for sonography was 2 min and for axiography 20 min. The mean measurement differences for condylar movement in maximal mouth opening was 1.7 mm, for protrusion 1.6 mm and for mediotrusion 2.5 mm. The range of condylar movement as measured by sonography and axiography coincided for opening and for protrusion (statistically significant). No significance was found for lateral excursions. The concordance in diagnosis of disc dislocation, hypermobility and impaired range of motion when comparing ultrasound with MRI was 83%. All sonographic examinations were performed by one person only. Sixty repeat examinations in patients produced no complaints and showed an absolute range of difference of 0.6 mm, with a relative range of 7%. Student's t-test was significant (p<0.05) (two repetitive measurements). CONCLUSION: Sonography proved to be a fast and reliable method for evaluating the range of movement of the TMJ. The lateral joint capsule, lateral disc, and upper condyle could be demonstrated. Pathological processes such as anterior or lateral disc displacement, disc perforation, seroma following contusion, capsular fibrosis, crystalline structures in the synovia and fracture dislocation of the condyle could be diagnosed with considerable reliability when compared with MRI. However, the medial aspect of the joint, medial disc dislocation and the angulation of the condylar slope could not be seen.

Adult↗