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PubMed2007

Temporomandibular joint reconstruction using a vascularized bone graft with Alloderm.

Vascularized free bone grafts have been used extensively for reconstruction of the mandible. When surgical resection includes the temporomandibular joint, definitive management remains controversial. We describe a novel technique that involves the use of a fibula free flap with Alloderm to reconstruct the lateral hemi-mandible and temporomandibular joint capsule. The study was performed by retrospective review of a case series at an academic center. Patients undergoing composite resection of the lateral hemi-mandible including the condyle with disruption of the temporomandibular joint were evaluated. These patients were all reconstructed with a vascularized fibula free flap with an Alloderm neocondyle reconstruction. There were nine patients with a mean age of 49.9 years. Mean follow-up was 13.1 months. There were no flap failures, infections, or complications. All patients reported improved facial symmetry, excellent jaw opening, and acceptable occlusion. All patients were able to tolerate a soft oral diet following surgery. No patients required gastrostomy tubes postoperatively. The lateral hemi-mandible and temporomandibular joint can be resected and successfully reconstructed using a fibula free flap with Alloderm to create the neocondyle. Improved postoperative cosmesis, decreased trismus, adequate jaw opening, minimal jaw drift, and the ability to chew were achieved in the majority of patients treated in this manner.

Adolescent↗
PubMed2001

The effect of disc thickness and trauma on disc surface friction in the porcine temporomandibular joint.

The pathomechanics of osteoarthritis in the human temporomandibular joint (TMJ) are unknown. Compromised lubrication is a potential factor, but, lubrication within even the normal TMJ is not understood completely. Weeping lubrication is a concept that may be applicable to the TMJ. A characteristic of weeping lubrication is a slow increase in friction during static loading. The rate of increase in friction is related to the rate of lateral movement of synovial fluid away from the loading area. The TMJ disc is expected to be the main source of TMJ lubrication. This study tested two variables, disc thickness and magnitude of trauma to the disc, as factors that can affect the rate of flow of synovial fluid and thus alter lubrication of the disc surfaces. To test these variables, TMJ disc surface friction was measured before and after an impulse load. Before the impulse load, all discs demonstrated a gradual increase in friction during light static loading. The rate of increase in friction was inversely related to the disc thickness (R(2)=0.75). After an impulse load of known magnitude and peak force, disc surface friction was higher. The magnitude of this surface friction was correlated with the magnitude of the impulsive blow (R(2)=0.89) and the area of surface damage (R(2)=0.85). Disc thickness was a significant factor in determining the minimal impulse needed to produce higher surface friction (R(2)=0.99). These results confirm that disc thickness and trauma to the disc affect surface friction in the TMJ, and therefore may be important factors in compromised lubrication and the development of osteoarthritis.

Animals↗
PubMed1987

Radiographic measurements of severe temporomandibular joint destruction at cervical radiography. Designed for evaluation in rheumatoid arthritis.

Radiological examinations of the temporomandibular joints are not so often performed in patients with rheumatoid arthritis (RA). However, greater abnormalities of the mandibular head and neck may be evaluated at cervical radiography. With a new method, where the perpendicular distance from the palato-occipital line to the mandibular angle was measured, normal values of the distance or of ramal height were found to be above 27.5 mm in women and 33 mm in men. A significantly diminished ramal height was found in a patient material with RA compared with a normal material. Minor changes of the temporomandibular joints cannot be detected with this method, but severe arthritic destruction of the mandibular head or neck will give subnormal values.

Age Factors↗
PubMed1984

Anteriorly displaced temporomandibular joint articular disk. Report of a case diagnosed by computed tomography.

The diagnosis of anterior displacement of a temporomandibular joint articular disk was made with computed tomography and documented with conventional arthrography. We are reporting the case to show the potential value of computed tomography for evaluating problems of the temporomandibular joint. The patient underwent thin-section axial computed tomography with advanced software imaging techniques. The articular disk was evident on the scan. It was anterior to the condyle and inferior to the articular eminence. Further studies are planned to determine whether computed tomography can supplement or possibly supplant conventional arthrography in the diagnosis of soft-tissue disorders of the temporomandibular joint.

Adult↗
PubMed1987

A three-year follow-up of patients with reciprocal temporomandibular joint clicking.

It has been suggested in the literature that reciprocal temporomandibular joint clicking progresses to locking, but little information is available on the longitudinal course of this stage of internal derangement. Seventy patients with reciprocal clicking were therefore followed for 3 years. Reciprocal clicking remained unchanged in fifty patients (71%) and disappeared in twenty patients (29%). Fourteen patients (20%), in whom clicking disappeared, attained normal mouth opening, whereas locking developed in six patients (9%). At the initial examination, these six patients had more pain, more frequent joint tenderness, greater frequency of missing molar support and more often dental abrasion on the affected side than the patients who did not develop locking. It was concluded that reciprocal clicking does not usually progress to locking. However, locking is more likely to occur in patients who initially have pronounced pain, joint tenderness, dental abrasion, and no molar support on the affected side.

Adolescent↗
PubMed1996

Prospective comparison of arthroscopy and arthrocentesis for temporomandibular joint disorders.

PURPOSE: A prospective, randomized study was undertaken to compare arthroscopy and arthrocentesis for treatment of temporomandibular joint disorders. PATIENTS AND METHODS: Nineteen patients with clinical and radiographic documentation of internal derangement of the temporomandibular joint(s) unresponsive to nonsurgical therapy were randomized to one of two surgical groups: arthroscopic lysis and lavage under general anesthesia or arthrocentesis, hydraulic distention, and lavage under intravenous sedation. Objective data were collected; including interincisal opening, lateral excursions, occlusal evaluation, deviation on opening, and tenderness to palpation. A questionnaire in the form of visual analog scales relating to pain, joint noise, jaw mobility, and dietary alterations was completed by each patient at 1 week, and 1, 3, 4, 12, and 26 months postoperatively. RESULTS: There was no statistically significant difference in outcome between the two groups for any parameter evaluated. Categorization of a particular subject into a successful outcome was based on statistically significant improvement in maximum incisal opening and pain scores; the overall success rate was 82% for arthroscopy and 75% for arthrocentesis. CONCLUSIONS: Therapeutic success was not significantly different for arthroscopy and arthrocentesis; both surgical modalities are useful for decreasing patient reports of pain while increasing functional mobility of the mandible.

Adolescent↗
PubMed1994

Radiographic morphology of the temporomandibular joint related to occlusal characteristics.

The radiographic image of the temporomandibular joints of 52 individuals obtained by oblique lateral transcranial exposure was studied in terms of the appearance of the articular components (depth of the mandibular fossa, inclination of the posterior slope of the articular eminence, and condyle shape) and correlated with occlusal characteristics (overbite, tooth wear or attrition, and Spee curve). This investigation did not permit us to demonstrate a definite correlation between dental occlusion and articular morphology based on the radiographic image of the temporomandibular joint.

Adult↗
PubMed2001

Arthrocentesis of the temporomandibular joint in adult horses.

OBJECTIVE: To develop a method for arthrocentesis of the temporomandibular joint in adult horses. ANIMALS: 7 equine cadaver heads and 6 clinically normal adult horses. PROCEDURE: Fluoroscopy, contrast radiography, and computed tomography were used on cadaver specimens to locate the temporomandibular joint, identify externally palpable landmarks for joint access, guide needle placement into the joint, and illustrate regional anatomy. The arthrocentesis technique was performed on 6 live healthy adult horses to determine efficacy and safety of this procedure. RESULTS: Externally palpable structures were identified as landmarks for temporomandibular arthrocentesis, including the lateral border of the condylar process of the mandible, the zygomatic process of the temporal bone, and the lateral pericapsular fat pad. Arthrocentesis was successful in all 6 joints in the live horses, and no complications developed. CONCLUSIONS AND CLINICAL RELEVANCE: The technique identified will improve the ability to examine and treat the temporomandibular joint in horses.

Animals↗
PubMed1996

A classification system for occlusions that relates maximal intercuspation to the position and condition of the temporomandibular joints.

Interarch occlusal relationships are defined by temporomandibular joint (TMJ) position. Determination of the most physiologic joint position is a logical prerequisite for occlusal analysis. Existing classification systems for occlusion do not consider TMJ position or condition when relating the mandibular arch to the maxillary arch or the range of adaptive changes that can affect the position of the condyles or influence long-term occlusal stability. If the relationship between occlusion and TMJ position is as important as many clinicians believe, condylar position must be defined precisely as an essential control in any clinical study that purports to evaluate the relationship between occlusion and any masticatory system disorder to include temporomandibular disorders. This article presents a new classification system that defines the relationship between maximal intercuspation and the position and condition of the TMJs. The classification uses guidelines that are specific enough to be consistent and verifiably reproducible. A recently introduced term, "adapted centric posture," is used in this classification to distinguish deformed TMJs that have remodeled or adapted to a conformation that can comfortably accept maximal loading. This classification is necessary because deformed but adapted joints may within certain conditions function with the same degree of comfort as intact, properly aligned condyle disk assemblies in centric relation.

Adaptation, Physiological↗
PubMed1999

Discectomy of the temporomandibular joint: an experimental study in monkeys.

Postoperative changes have been observed in the temporomandibular joint (TMJ) after discectomies. Animal models have often shown that interventions in the TMJ may heal uneventfully. Discectomies were performed on 14 Macaca fascicularis and macroscopic and microscopic examination performed after sacrifice of the animals. Two of the animals did not show any apparent macroscopic or microscopic changes. The remaining 12 joints showed minor to major changes. The most serious changes were seen in three joints with fibrous ankylosis and five joints showed marked destruction of the articular cartilage.

Animals↗
PubMed1996

Outcome of arthrocentesis for temporomandibular joint with closed lock at 3 years follow-up.

OBJECTIVE: The aim of this study was to evaluate the intermediate term results of arthrocentesis for the management of temporomandibular joint closed lock. STUDY DESIGN: Twenty consecutive patients with closed locking of their temporomandibular joint were treated by arthrocentesis. All patients rated their pain level on a visual analogue scale, and completed pain, jaw dysfunction, and daily activity questionnaires before, 6 months, and 3 years after the procedure. The patients' jaw opening was also scaled. Preoperative and postoperative differences of the data were analyzed statistically. The success rate was also calculated according to our success criteria. RESULTS: The success rate was 70% at 6 months follow-up; it increased to 78.9% over the 3 years of follow-up. All posttreatment scores showed significant improvements in efficacy. CONCLUSION: Arthrocentesis was considered as an effective minimally invasive surgical treatment for temporomandibular joint closed lock based when evaluated 3 years after the procedure.

Adult↗
PubMed1991

[Immunohistochemical study of temporomandibular joint disturbance syndrome].

In this paper, condylar cartilages of 10 temporomandibular joint disturbance syndrome (TMJDS) patients were studied by means of immunofluorescence and immunogold staining to clarify if there are immune complexes. We also detected the antibodies to type II collagen in synovial fluids and sera of the TMJDS patients with passive hemagglutination. Through these studies, we found: there are autoimmune responses in articular tissues in TMJDS; these responses are caused by the exposure of sequestered antigens and taken place mainly in the involved joints, and may participate in the destruction of TMJ.

Adult↗
PubMed1999

Subjective and objective assessment of the temporalis myofascial flap in previously operated temporomandibular joints.

PURPOSE: This study evaluated the subjective and objective findings in patients who had undergone temporomandibular joint (TMJ) reconstruction with a temporalis myofascial flap. All joints had previously been reconstructed with alloplastic, allogeneic, or autogenous material. PATIENTS AND METHODS: Twenty-three consecutive patients who underwent 28 temporalis myofascial flap procedures were assessed subjectively and objectively preoperatively and at an average of 36 months postoperatively. Panoramic radiographs, magnetic resonance imaging (MRI), or coronal computed axial tomography scans (CT scans) were performed on all patients preoperatively to evaluate for joint disease. A visual analog scale (VAS) was used to assess pain preoperatively and postoperatively. Patients also reported their use of pain medication, ability to function, diet, complications, and overall satisfaction. Preoperative and postoperative objective assessment consisted of an evaluation of range of motion, deviation on opening, joint noise on function, and cosmesis. RESULTS: On preoperative radiographic examination, 24 of 28 joints showed signs of bony degeneration, including cortical erosion, condylar flattening, and joint space alterations. Four joints showed evidence of ankylosis. The average preoperative maximal interincisal opening (MIO) was 23.7 mm, and the postoperative average was 32.3 mm (P<.05). Preoperatively, all patients displayed one or more objective clinical signs of joint disease such as joint noise on function, deviation on opening, limited mouth opening (less than 20 mm), or limited excursions (less than 2 mm). Postoperatively, 65% displayed one or more of these signs, a significant reduction (P<.05). Preoperatively, the average pain score was 8.2 on the VAS, and postoperatively the average pain score was 3.4 (P<.0005). Fifteen patients used less pain medication postoperatively, 7 used the same amount, and 1 patient used more. Thirteen patients were very satisfied with the overall results of the surgery, 4 were satisfied, and 4 were not satisfied. Two patients were satisfied with their increased function but were not satisfied with their pain reduction. All were satisfied with their cosmetic appearance. Minor complications after the procedure included 3 patients who had preauricular paresthesia and 1 who had an intraoperative dura mater exposure without sequelae. Two patients had postoperative superficial suture infections, and 2 noted hearing changes that were found to be clinically insignificant by audiologic examination. CONCLUSION: The temporalis myofascial flap is an autogenous graft that has the advantages of close proximity to the temporomandibular joint, minimal surgical morbidity, and successful clinical results. It was found to be a valuable option for TMJ reconstruction in joints in which alloplastic, allogeneic, or autogenous materials have previously been placed unsuccessfully.

Adult↗