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At least 595 records · Page 33Linked to original sources
PubMed1999

Functional restoration by gap arthroplasty in temporomandibular joint ankylosis: a report of 50 cases.

OBJECTIVE: The purpose of this study was to determine the cause of temporomandibular ankylosis and the long-term results of gap arthroplasty with coronoidectomy followed by immediate postoperative jaw exercises as a treatment of the condition. STUDY DESIGN: This retrospective study evaluated the cause of temporomandibular joint ankylosis and the 36-month postoperative results of gap arthroplasty in 50 patients (62 joints). The patients were divided into 2 groups; group I (aged 0-12 years) consisted of 29 cases (24 unilateral and 5 bilateral; 34 joints); group II (aged 13-30 years) consisted of 21 cases (14 unilateral and 7 bilateral; 28 joints). A postoperative jaw opening exercise regimen was followed. Descriptive statistics, the Wilcoxon signed rank test, and rank sum 2-sample (Mann-Whitney) tests were applied. RESULT: Trauma to the temporomandibular joint was documented as a major etiologic factor in 86% of cases. The 36-month postoperative mean maximal incisal opening was 30.62 mm (+/- 6.25 mm) for group I and 30.14 mm (+/- 3.9 mm) for group II. The P value in each group was highly significant for the Wilcoxon signed rank test; the Mann-Whitney test showed no difference between the groups, indicating that both groups had done well. The recurrence rate was 2%. CONCLUSION: Trauma is the major cause of temporomandibular joint ankylosis in India. The long-term functional results of gap arthroplasty are satisfactory and comparable to those obtained through use of other treatments. Postoperative exercises play a crucial role in lasting success.

Adolescent↗
PubMed2002

Long-term outcome after treatment of temporomandibular joint osteoarthritis with exercise and manual therapy.

In a previous study, exercise and manual therapy demonstrated a 90% success rate in patients with osteoarthrosis of the temporomandibular joints in the short-term. The aim of this follow-up study was to assess the long-term effect of these treatment modalities. Seventeen patients were evaluated. All patients suffered from osteoarthrosis of the temporomandibular joints with pain in the temporomandibular joint at baseline and were treated successfully in a prior short-term study. The parameters were pain at rest and at chewing, impairment in daily life, and mouth opening. At follow-up, 11 patients (65%) experienced no pain and 13 patients (76%) had no pain at rest (Fisher's Exact Test: p<0.02). Thirteen patients (76%) had a normal incisal edge clearance, and ten patients (59%) felt no impairment due to the disease (Fisher's Exact Test: p=0.01). Thirteen patients (76%), who had been treated once successfully, have not needed treatment within the three years after cessation of their therapy. Exercise therapy is an effective tool to treat osteoarthrosis of the temporomandibular joints.

Activities of Daily Living↗
PubMed2005

The effect of experimental cartilage damage and impairment and restoration of synovial lubrication on friction in the temporomandibular joint.

AIMS: To evaluate how the frictional coefficient of the porcine temporomandibular joint (TMJ) is affected by an impairment of the synovial lubrication produced by an experimental abrasion of the articular cartilage and the application of hyaluronic acid (HA) with different molecular weights to the abraded cartilage surfaces. METHODS: Erosion of the articular cartilage was produced by scouring it with sandpaper. Impairment and restoration of synovial lubrication were modeled by washing the joint space with phosphate-buffered saline (PBS) and by the application of HA with different molecular weights. After measuring the frictional coefficients in the intact TMJs (n = 10), the effects of washing with PBS, sandpaper scouring, and the application of HA were subsequently examined. RESULTS: The mean frictional coefficient in the intact joint was 0.0154 (SD 0.0043). After PBS washing and sandpaper scouring, it increased significantly to 0.0235 (SD 0.0052) and 0.0520 (SD 0.0088), respectively. Subsequent application of HA resulted in a significant decrease (43% to 56%) of the frictional coefficient. Observations by scanning electron microscopy showed that after sandpaper scouring, the superficial cartilage layer was disrupted and inner layer was exposed, creating an irregular surface. CONCLUSION: Joint friction may increase by approximately 350% following an experimental scouring of the cartilage surface and impairment of synovial lubrication. Lubrication by means of HA decreased joint friction by approximately 50%.

Animals↗
PubMed1996

Radiographic changes in the temporomandibular joint in patients with generalized osteoarthritis and rheumatoid arthritis.

This is the first study concerned with radiographic characteristics in patients with generalized osteoarthritis and signs and symptoms of temporomandibular joint involvement. For comparison, patients with rheumatoid arthritis and temporomandibular joint involvement were used. The patient material comprised 20 patients with generalized osteoarthritis (20 joints) and 21 patients with rheumatoid arthritis (21 joints). The radiographic methods were corrected sagittal tomography (hard tissue changes, joint space, and condylar position), frontal tomography (hard tissue changes), and individualized oblique lateral transcranial projections (condylar translation). Sixteen (80%) joints in the group of patients with generalized osteoarthritis and 15 (71%) joints in the group with rheumatoid arthritis revealed structural changes. The condyle was the predominant location. No radiographic criterion was pathognomonic for generalized osteoarthritis or rheumatoid arthritis. However, osteophytes, flattening of the condyle, or a reduced joint space was observed more often in joints with generalized osteoarthritis, whereas erosions in the condyle were more common in joints with rheumatoid arthritis. The radiographic findings in patients with generalized osteoarthritis are more similar to those seen in patients who have the common form of temporomandibular joint osteoarthritis than to those in patients with rheumatoid arthritis.

Adolescent↗
PubMed2002

An experimental model of osteoarthrosis of the temporomandibular joint in monkeys.

The purpose of this study was to develop a model of osteoarthrosis of the temporomandibular joint in monkeys, which is remarkably similar in structure and function to that of humans. Nine juvenile monkeys, two as controls and seven as an experimental group, were used in this study. In the experimental group, the articular eminence on both sides was surgically made steeper. Two animals were killed at 1 week, four at 6 months, and one at 1 year postoperatively and the temporomandibular joints were examined macroscopically and microscopically. Typical changes of osteoarthrosis were observed in the 6-month and 1-year specimens. These comprised clustering of chondrocytes which resulted in vertical and horizontal splitting in the articular cartilage, and fibrillation of the articular surface resulting in fibrous union in the joint cavity. These degenerative changes advanced progressively over time. Slight anterior displacement and degenerative changes in the articular disc were also seen.

Animals↗
PubMed1998

An immunohistochemical study of the localization of biglycan, decorin and large chondroitin-sulphate proteoglycan in adult rat temporomandibular joint disc.

To analyse regional variations in extracellular matrix components of adult rat temporomandibular joint discs, immunohistochemical techniques were used to examine the localization of two small dermatan-sulphate proteoglycans, biglycan and decorin, and a large chondroitin-sulphate proteoglycan. Staining for biglycan was intense in the posterior band, although it had a rather weak and even distribution throughout the disc. In contrast, staining for decorin was faint in the intermediate zone and the central part of the posterior band, moderate in the anterior and posterior attachments and most intense in the junction between the anterior band and attachment. The upper surface of the disc stained more intensely than the lower. Similarly, there was intense staining for large chondroitin-sulphate proteoglycan in the peripheral band, but both the anterior and the temporal parts of the posterior attachments were faintly stained. These results demonstrate marked regional differences in the expression of biglycan, decorin and large chondroitin-sulphate proteoglycan in the temporomandibular joint discs of adult rats. These variations probably reflect the different biomechanical environments caused by the complicated articulatory functions of the temporomandibular joint.

Animals↗
PubMedDate not supplied

Pigmented villonodular synovitis of the temporomandibular joint: a case report.

The eighth known case of pigmented villonodular synovitis of the temporomandibular joint is presented. Pigmented villonodular synovitis is a benign but locally destructive lesion of obscure cause. In the temporomandibular joint, this lesion is characterized by the insidious onset of a mildly symptomatic preauricular mass. The treatment of choice is complete excision.

Diagnosis, Differential↗
PubMed1999

Prevalence of temporomandibular joint disk displacement in infants and young children.

OBJECTIVE: The purpose of this study was to determine the prevalence of temporomandibular joint disk displacement in infants and young children. STUDY DESIGN: Magnetic resonance images were obtained of the temporomandibular joints in 30 infants and young children ranging in age from 2 months to 5 years (median age, 3 years; mean age, 2.5 years). RESULTS: All joints had normal superior disk position. The computed 95% confidence interval was 0.00-0.06, which implies a minimal probability that disk displacement would occur in this age group. CONCLUSIONS: The result contradicts previous suggestions that temporomandibular joint disk displacement could represent a congenital normal anatomic variant.

Argentina↗
PubMed1993

Thermographic characterization of osteoarthrosis of the temporomandibular joint.

This study assessed the use of electronic thermography in the thermal image characterization of 20 patients with osteoarthrosis of the temporomandibular joint as proven by radiographic detection of bone erosions. Thermal assessments included: pattern recognition, pattern symmetry, absolute temperature, delta T measurements, and mean temperature measurements and differences within five designated anatomic zones. In patients with osteoarthrosis of the temporomandibular joint, results demonstrated some characteristically abnormal thermal patterns; low levels of thermal symmetry; and substantially elevated absolute temperature measurements, mean temperature zone measurements, and delta T values. These observations suggest that electronic thermography may prove to be clinically useful as a diagnostic method of assessing temporomandibular joint disorders, particularly osteoarthrosis. However, more extensive studies are needed before thermographic evaluation of the temporomandibular joint will be accepted clinically.

Adult↗
PubMed1997

Correlation between arthroscopic diagnosis of osteoarthritis and synovitis of the human temporomandibular joint and keratan sulfate levels in the synovial fluid.

PURPOSE: The specific aims of this investigation were to determine if there is a relationship between an arthroscopic diagnosis of synovitis and osteoarthritis, and if the presence of synovitis influences the level of cartilage degradation, as evidenced by keratan sulfate levels in the synovial fluid. PATIENTS AND METHODS: Arthroscopic surgery was performed on 114 temporomandibular joints in 88 patients who had significant pain or dysfunction and whose condition had failed to improve with conservative treatment. Synovial fluid aspirates were obtained immediately before arthroscopy and used for the determination of keratan sulfate levels. Arthroscopic examination included assessment of the presence or absence of osteoarthritis and synovitis. RESULTS: Synovitis was present in 90% of joints, and osteoarthritis was present in 62% of joints examined arthroscopically. Both osteoarthritis and synovitis existed in 57% of the joints. Joints with an arthroscopic diagnosis of synovitis had significantly lower levels of keratan sulfate in the synovial fluid aspirates than joints with osteoarthritis. Synovial fluid aspirates from temporomandibular joints with osteoarthritis had significantly higher levels of keratan sulfate than synovial fluids from joints without osteoarthritis. CONCLUSIONS: Osteoarthritis and synovitis are common diagnoses and are often present concurrently in patients with symptomatic temporomandibular joints. Osteoarthritis is associated with elevated keratan sulfate levels; however, the elevation of keratan sulfate is less in patients with concomitant synovitis.

Analysis of Variance↗
PubMed2002

Intraoral mandibular distraction osteogenesis in facial asymmetry patients with unilateral temporomandibular joint bony ankylosis.

Gap arthroplasty and costochondral rib bone graft are commonly performed by oral and maxillofacial surgeons to reconstruct the temporomandibular joint with ankylosis. However, unpredictable and unsatisfactory results such as re-ankylosis, growth disturbance, and facial asymmetry often occur. Even if the costochondral graft is successful, donor-site morbidity is inevitable. More recently, surgeons have become interested in distraction osteogenesis as a means of temporomandibular joint reconstruction. This case series presents the results of intraoral mandibular distraction osteogenesis and gap arthroplasty in two patients with facial asymmetry and unilateral temporomandibular joint bony ankylosis. Both patients had experienced failed gap arthroplasty and costochondral graft for the reconstruction of the temporomandibular joint. Distraction osteogenesis with gap arthroplasty proved successful in these two patients with follow-up of longer than 2 years.

Adolescent↗
PubMed1999

Virtual arthroscopy of the visible human female temporomandibular joint.

PURPOSE: This study was designed to obtain views of the temporomandibular joint (TMJ) by means of computed arthroscopic simulation (virtual arthroscopy) using three-dimensional (3D) processing. MATERIAL AND METHODS: Volume renderings of the TMJ from very thin cryosection slices of the Visible Human Female were taken off the Internet. Analyze(AVW) software (Biomedical Imaging Resource, Mayo Foundation, Rochester, MN) on a Silicon Graphics 02 workstation (Mountain View, CA) was then used to obtain 3D images and allow the navigation "fly-through" of the simulated joint. RESULTS: Good virtual arthroscopic views of the upper and lower joint spaces of both TMJs were obtained by fly-through simulation from the lateral and endaural sides. It was possible to observe the presence of a partial defect in the articular disc and an osteophyte on the condyle. Virtual arthroscopy provided visualization of regions not accessible to real arthroscopy. CONCLUSION: These results indicate that virtual arthroscopy will be a new technique to investigate the TMJ of the patient with TMJ disorders in the near future.

Arthroscopy↗
PubMed2003

The redox states of serum and synovial fluid of patients with temporomandibular joint disorders.

The redox states of albumin in serum and synovial fluid (SF) were analyzed in 35 female patients with temporomandibular joint disorders and 9 asymptomatic female healthy volunteers by high-performance liquid chromatographic (HPLC) analysis. Human serum albumin (HSA) is divided by HPLC analysis into three fractions: mercaptalbumin (HMA, reduced form) and nonmercaptalbumin (HNA-1 and HNA-2, oxidized forms). It was found that the characterized values of albumin in SF of patients with the disorders were the fraction of HMA (f (HMA), 65.8 +/- 9.1%), the fraction of HNA-1 (f (HNA-1), 31.3 +/- 8.8%), and the fraction of HNA-2 (f (HNA-2), 2.9 +/- 0.9%), respectively, and similarly the values of albumin in serum of same subjects were f (HMA), 79.4 +/- 4.0%; f (HNA-1), 18.7 +/- 3.8%; and f (HNA-2), 1.9 +/- 0.5%. The HNA fractions in SF were significantly higher than those in serum (p < 0.0001). The SF of patients and even control showed more oxidative condition compared with sera of the same subjects. Each fraction of SF showed significant difference in control (p < 0.05), and greater significance in patients (p < 0.0001). Furthermore, the HNA-2 fraction (f (HNA-2), 2.9 +/- 0.9%) in SF of the patients with temporomandibular joint disorders revealed a significantly higher value (p < 0.01) than that (f (HNA-2), 1.7 +/- 0.3%) of controls. These findings suggested that SF of the temporomandibular joint is more locally oxidized than serum; thus oxidative factors are concerned in the pathogenesis of the temporomandibular joint disorders. It was also suggested that synovial albumin may play a scavenging role against the intraarticular oxidative stress.

Adolescent↗
PubMedDate not supplied

Pigmented villonodular synovitis of the temporomandibular joint.

Pigmented villonodular synovitis (PVNS) rarely occurs in the temporomandibular joint. The bony changes are easily assessed by tomography. Pluridirectional tomography cannot, however, evaluate the soft tissue component of the lesion especially that medial to the mandibular condyle. This area is accessible to CT scan evaluation. A case is presented in which the medial extent of the lesion was determined by CT scan. The radiologic findings of PVNS of the temporomandibular joint are discussed.

Female↗
PubMed1989

Histologic features of the temporomandibular joint disk and posterior disk attachment: comparison of symptom-free persons with normally positioned disks and patients with internal derangement.

To gain further knowledge about the differences between normal and pathologic anatomy of the temporomandibular joint disk, we examined histologically disks obtained at autopsy from 10 symptom-free persons and compared our findings with observations involving 17 surgically removed disks. The surgical patients had internal derangement and severe long-standing temporomandibular joint pain and dysfunction. The normal disks were biconcave, whereas the surgically removed disks were deformed and thicker than the normal disks. Chondrocytes (4 joints), a surface layer of proliferative connective tissue (4 joints), vessels (2 joints), and splitting (4 joints) were seen in the surgical specimens but not in the normal specimens. The surgical specimens also showed higher maximal density of fibroblasts and vessels. It was concluded that surgically removed temporomandibular joint disks demonstrated several histologic alterations that were not seen in normal disks. These characteristics may serve as the basis for development of a histologic grading of pathologic conditions of the temporomandibular joint disk and the posterior disk attachment.

Adolescent↗
PubMed2002

Application of alginate three-dimensional culture system for in vitro culture of mandibular condylar chondrocytes from human osteoarthritic temporomandibular joint.

OBJECTIVE: To evaluate the use of alginate three-dimensional culture system for mandibular condylar chondrocytes culture in vitro from human osteoarthritic temporomandibular joint. METHODS: The cultured mandibular condylar chondrocytes from the operatively removed cartilage from a patient with osteoarthritic temporomandibular joint were harvested by mechanical dissection and enzyme digestion. Partial chondrocytes were suspended in the aqueous sodium alginate beads with high seeding density and cultured for 4 weeks, while the others were cultured in monolayer culture condition for 1 week. Thereafter, the alginate beads were embedded in paraffin and sectioned, then studied immunologically with type II collagen antibody and aggrecan antibody, same studies were adopted for the monolayer cultures. RESULTS: The monolayer cultures were confirmed as chondrocytes. The chondrocytes cultured in the alginate medium showed well. These cells exhibited the excellent differentiated phenotype after 4 weeks culture in alginate gel. CONCLUSIONS: The condylar chondrocytes from human osteoarthritic temporomandibular joint were successfully cultured in vitro. The alginate three-dimensional culture system was successfully adopted for in vitro culture of condylar chondrocytes from human osteoarthritic temporomandibular joint, in which the chondrocytes exhibited the excellent differentiated phenotype.

Cartilage, Articular↗
PubMed2004

Topical review: new insights into the pathology and diagnosis of disorders of the temporomandibular joint.

The collection of conditions affecting the temporomandibular joint (TMJ) and masticatory muscles, the so-called temporomandibular disorders, can be classified according to the Research Diagnostic Criteria for Temporomandibular Disorders. Of the 3 subgroups--muscle disorders (Group I); disc displacements (Group II); and arthralgia, arthritis, and arthrosis (Group III)--the muscle disorders are most frequently seen in community samples; Group II and Group III diagnoses are less prevalent. This may explain the relative scarcity of studies involving intracapsular TMJ disorders. In this review, new insights into the functional anatomy, imaging, and pathology of disorders of the TMJ are presented. Studies of TMJ dynamics may provide insight into the functional anatomy of the TMJ and thereby into the consequences of Group II and Group III disorders. The clinical use of imaging modalities such as computed tomography and magnetic resonance imaging for the TMJ and related structures remains controversial. Nevertheless, imaging is regularly used in the diagnosis of some Group II and Group III disorders. Magnetic resonance imaging may be of use not only for the visualization of disc displacements but also for the study of bone mineral density of the condyle. Cytokines such as interleukin-1 (IL-1) and tumor necrosis factor alpha (TNFalpha) play an important role in TMJ pathology. For example, IL-1beta, which has been associated with TMJ pain, hyperalgesia, and anterior bite opening, is mostly absent in the synovial fluid of healthy joints. Since both IL-1 and TNFalpha are involved in the development of chronic pain and joint destruction, they may be the targets for specific treatments. While the advances reviewed in this paper are significant, multidisciplinary efforts and formation of international research collaborations will be necessary to continue advancement in the understanding of TMJ pathology and diagnosis.

Arthralgia↗