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PubMed1998

Physical mechanisms involved in the genesis of temporomandibular joint sounds.

Several different mechanisms are potentially capable of generating sounds in the temporomandibular joint (TMJ). These include impact, sliding and stick-slip friction, fluid dynamic effects and the release of elastic strain energy. It is the aim of this paper to provide a framework with which to separate sounds resulting from the different underlying causes. Each mechanism is described and its relevance to TMJ sounds and clinical significance discussed. Since it is not possible to observe these mechanisms in vivo the arguments are based mainly on analogies which are used to make predictions of the characteristic acoustic signatures of the sounds produced by these different mechanisms. In particular the changes in the characteristics of the sounds as parameters such as mandibular speed and loading are stressed. It is suggested that single short duration sounds (clicks) are due to impact, multiple short duration sounds (creaks) to stick-slip friction and defects of form and long duration sounds (crepitus) to simple sliding friction. Several other mechanisms which have no obvious clinical significance but which are capable of producing similar sounds are also described and methods of distinguishing them from the sounds that do have clinical implications are discussed.

Acoustics↗
PubMed1976

[A standard projection for temporomandibular joint radiographs in oblique lateral projection].

A standard projection for temporomandibular joint radiographs in oblique lateral transcranial projection was determined by a clinical method. The individualized projections from 1644 TMJ radiographs, made with a fluoroscopic examination unit with image intensifier, were evaluated in a pilot study. A mean projection 20 degree cranial eccentric and 12 degree dorsal eccentric resulted. Reference planes were the Camper plane and the middle frontal plane. This projection, corrected in 22 degree/10 degree, was studied in a clinical study in order to test the readability of the radiographs of 100 temporomandibular joints. The readability of these radiographs was compared with that of radiographs obtained with an individualized projection. 81 radiographs out of 100 were well or very well readable, 7 were limitedly readable and 12 were unreadable. The number of radiographs in these last two categories could not be reduced by an individual angulation of the x-ray beam. Therefore anatomical reasons have to be considered to be responsible for the insufficient readability of these TMJ radiographs. This projection avoided superposition of the petrous portion of the temporal bone without giving an extreme view of the lateral slope of the condyle. From the evaluation of the 100 individualized projections resulted a mean projection 21 degree/10 degrees, which confirmed the projection 22 degrees/10 degrees used in this study. The projection 21-22 degrees/10 degrees turned out to be a most favourable projection for the dental office to make TMJ radiographs in connection with the diagnosis of the occlusion in patients with TMJ disorders.

Adolescent↗
PubMed1986

Magnetic resonance imaging of internal derangement of the temporomandibular joint.

MRI is currently capable of diagnosing anterior derangements of the temporomandibular joint. Although large prospective studies comparing MRI with conventional modalities have not yet been done, early evidence suggests that findings seen on high-resolution surface coil MR images correlate very well with CT, arthrographic, and surgical findings. Much additional work will need to be performed before MRI of the temporomandibular joint becomes a standard diagnostic tool. However, we believe strongly that it will begin to replace arthrography and CT for diagnosing internal derangements within the next few years.

Arthrography↗
PubMed2006

Open versus arthroscopic surgery for internal derangement of the temporomandibular joint: a retrospective study comparing two centres' results using the Jaw Pain and Function Questionnaire.

OBJECTIVES: Surgical procedures currently used for treating of internal derangement of the temporomandibular joint vary widely. Although different studies present favourable results following open or arthroscopic TMJ surgery, the criteria for a successful treatment outcome are not always defined identically. In a retrospective study, two groups of patients who underwent either open or arthroscopic surgery for internal derangement (stages III-V according to Wilkes' classification) were investigated using the so-called JPF-Questionnaire. PATIENTS AND METHODS: The Kyoto collective (group 1) consisted of 28 patients, 2 men and 26 women, who underwent arthroscopic surgery. At the time of surgery, age ranged from 13 to 77 years (mean 32.8 y). The postoperative follow-up period ranged from 4 years and 4 months to 5 years and 9 months. Twelve of the 28 patients were classified as stage III, 10 as stage IV and 6 were classified as stage V (according to Wilkes) at the time of surgery. The Vienna collective (group 2) also consisted of 28 patients, 2 men and 26 women, who underwent open meniscoplasty or discectomy. At the time of surgery age ranged from 17 to 55 years (mean 31.6 years). The postoperative follow-up ranged from 5 to 6 years and 9 months. Fourteen of the 28 patients were classified as stage III, 11 as stage IV and 3 were classified as stage V (according to Wilkes) at the time of surgery. The results of the JPF-Questionnaire of the two groups were compared by Wilcoxon 2-sample tests. The Japanese version was applied, while in Austria the German version of this questionnaire was applied. RESULTS: At a level of significance alpha=0.05 no significant difference was found when comparing the subgroups (Wilkes stages III, IV and V) or both groups of patients 5 years after temporomandibular joint surgery. CONCLUSION: There cannot be any clear indication for only one of the treatment modalities as similar results were noted following open or arthroscopic temporomandibular joint surgery. Nevertheless, arthroscopic surgery is a minimally invasive procedure resulting in a shorter or no time of hospitalization when compared with open surgery and therefore is preferred by many surgeons nowadays.

Adolescent↗
PubMed2001

Validity of clinical diagnostic criteria for temporomandibular disorders: clinical versus magnetic resonance imaging diagnosis of temporomandibular joint internal derangement and osteoarthrosis.

OBJECTIVES: Research is needed to assess the validity of clinical decision criteria for the diagnoses of temporomandibular disorders. The objective of this study was to assess the reliability of clinical diagnoses in predicting magnetic resonance imaging diagnoses of temporomandibular joint internal derangement and osteoarthrosis in a patient pain group with temporomandibular disorders. METHODS: One clinician used the Clinical Diagnostic Criteria for Temporomandibular Disorders to classify 163 consecutive patients with temporomandibular disorders on physical diagnosis. The radiologist subsequently performed magnetic resonance imaging on 326 temporomandibular joints. Diagnostic agreement was determined for the diagnostic categories of absence of internal derangement, disk displacement with reduction, disk displacement without reduction, and osteoarthrosis. RESULTS: Use of the Kappa statistic test indicated a poor diagnostic agreement between the clinician and the radiologist. CONCLUSIONS: The classification system of the Clinical Diagnostic Criteria for Temporomandibular Disorders provides insufficient reliability for determination of the presence of temporomandibular joint internal derangement and osteoarthrosis. It should be supplemented by evidence from cross-sectional and longitudinal investigations to assess decisive differences in the areas of pathogenesis, treatment, and prognosis.

Adolescent↗
PubMedDate not supplied

The temporomandibular joint in juvenile rheumatoid arthritis: I. Computed tomographic findings.

The temporomandibular joints (TMJ) of children afflicted with juvenile rheumatoid arthritis (JRA) were evaluated with clinical examinations and computed tomography (CT). Thirty-seven consecutive patients (6-17 years old) from the Texas Scottish Rite Hospital arthritis clinic were studied to investigate morphological abnormalities in the TMJ by CT. Both qualitative and quantitative measures of TMJ morphology were made from axial CT scans. Ten children without JRA served as a control group. Various ANOVA and nonparametric statistical models were used for analysis. Evidence of TMJ abnormalities from the CTs was found in 62% of these JRA children. The TMJ pathosis indices for left and right joints were significantly higher in the JRA subjects than those in the control children (P < 0.03) and joint spaces were narrower (P < 0.02). These features are indicative of TMJ destruction. Thus, there is considerable risk for TMJ involvement and its debilitating and deforming sequelae in children afflicted with JRA.

Adolescent↗
PubMed1991

[Use of a posterior temporal muscle flap in surgery of the temporomandibular joint].

The anatomical and physiological relation between temporal muscle and temporomandibular joint are well-knowed. The versatility of the temporo muscle-fascia flap must be stressed. The posterior temporal flap is a simply, reliable procedure, with low morbidity. This technique is probably the procedure of choice in discal replacement and in interposition arthroplasty for ankylosis.

Humans↗
PubMed1991

Ultrasonography as a diagnostic aid in temporomandibular joint dysfunction. A preliminary investigation.

Twenty-five patients presenting with temporomandibular joint dysfunction were examined by both ultrasonography and arthrotomography. Ultrasonography produced an image of the TMJ which was at right angles to the image produced by arthrotomography, since the ultrasound picture was in the coronal plane; with ultrasonography the meniscus became more visible during mouth opening. Anterior displacement of the meniscus was associated with deeper location of the condylar head within the glenoid fossa whilst a perforated meniscus produced a bilobed image. This study has provided a preliminary look at ultrasonography of the TMJ and has shown promise for further work. The present images are not ideal for clinical use but they show the possible potential for non-invasive diagnosis which might be provided by higher resolution ultrasound equipment than that used in this study.

Adolescent↗
PubMed1997

[Temporomandibular joint problems in assessment].

Manifestations of function disorders of the temporomandibular joint may have the same expression whether their origin is a natural cause or trauma. It is not always possible to make a scientifically valid distinction between a consequence of external trauma and internal cause(s). Often, the only reasonable attitude is to state that a transitive aggravation of the former status has occurred after trauma.

Expert Testimony↗
PubMedDate not supplied

[The treatment of arthrosis of the temporomandibular joint].

The most typical symptoms of degenerative changes in the temporomandibular joints are described, which are characterized by destructive changes in the periarticular connective tissue, synovial membrane, and the ligamentous system. The authors emphasize the efficacy of a comprehensive treatment of such conditions. The methodology of using plastic cups is described, not involving the occlusion restructuring within the occlusion height characteristic of the patient.

Adult↗
PubMed1991

Simplified approach in temporomandibular joint (TMJ) and odontostomatognathic (OSG) examination.

Malpractice lawsuits due to temporomandibular joint (TMJ) and odontostomatognathic (OSG) injuries following dental therapy are increasing. Therefore, dentists and their staff must know how to screen patients to determine pre-existing conditions. Anatomical and physiological considerations are presented. Three major steps such as taking a good history, examining the patient carefully, and establishing adequate records are discussed in detail.

Dental Records↗
PubMed1993

A technique for magnetic resonance imaging of the temporomandibular joint.

T1-weighted Magnetic Resonance Imaging (MRI) of 72 temporomandibular joints (TMJs) of symptomatic patients and normal subjects was performed after they had been clinically classified. The images were then interpreted by two radiologists, blinded to the clinical classification. The technique of imaging used a head coil for bilateral imaging, allowing a 3-position study in under 1 h. Correlation between MRI and clinical classification at the level of normal vs abnormal was achieved in 61/72 joints, giving a sensitivity of 79% and a specificity of 91% for MRI relative to the clinical assessment. True coronal images were of no added value. The addition of supplemental gradient-echo images was helpful in 12/15 joints. Osseous condylar abnormalities were present in 15 joints, all of which had otherwise identifiable disc abnormalities. Diminished condylar translation was a useful indirect sign of non-reducing disc displacement. We conclude that MRI is a very useful and reliable technique in TMJ imaging. The technique described is applicable to any MR unit, without the need for dedicated coils.

Adolescent↗
PubMed1990

Psychosocial correlates of temporomandibular joint pain and dysfunction.

This study examines psychological differences between temporomandibular joint pain and dysfunction (TMJPD) patients, pain controls, and healthy controls. Two hundred and two patients were classified, according to the diagnostic criteria of Eversole and Machado, as either myogenic facial pain (n = 42), internal derangement type I (n = 69), internal derangement type II (n = 85), or internal derangement type III (n = 6). Patients completed the Basic Personality Inventory, the Illness Behavior Questionnaire, the Multidimensional Health Locus of Control, the Perceived Stress Scale, and the Ways of Coping Checklist. Subjects also answered question pertaining to TMJPD symptomatology, including chronicity and severity. After conservative treatment with simple jaw exercise and ultrasound, patients were contacted again at 5 months to complete follow-up questionnaires similar to those previously completed. Comparison groups were comprised of 79 patients attending outpatient physiotherapy clinics for pain-related injuries not involving the temporomandibular joint and 71 pain-free, healthy students. Data were analyzed using multivariate statistics. The results indicate a significant relationship between pain intensity (and to some extent chronicity) and diverse measures of personality among the pain controls but not among the TMJPD patients. This calls into question the validity of assuming individual pain disorders are subsets of a larger, homogenous pain disorder population. TMJPD patients and pain controls score higher on hypochondriasis and anxiety than the pain-free controls but these elevations are not clinically significant. The elevations decrease to normal levels in response to a positive treatment outcome. There were no differences between the TMJPD patients and the pain controls on any of the measures. These results suggests that TMJPD patients do not appear to be significantly different from other pain patients or healthy controls in personality type, response to illness, attitudes towards health care, or ways of coping with stress.

Adult↗
PubMed1986

Temporomandibular joint arthroscopy by inferolateral approach.

A clinically successful technique for temporomandibular joint (TMJ) arthroscopy by the inferolateral approach is reported. The outline of the superior and inferior articular cavities of the TMJ except for the lower anterior pouch could be visualised; arthroscopy could be performed on most patients under local anesthesia in the out-patient operating room. Clinical usefulness and security of the TMJ arthroscopy based upon anatomical understanding is described.

Adolescent↗
PubMed1987

Comparison of arthrographic findings of the temporomandibular joint with palpation of the muscles of mastication.

Two hundred five patients were examined for temporomandibular joint pain and dysfunction and specifically for tenderness to muscle palpation. Arthrograms were performed on 222 joints (188 unilateral and 17 bilateral). Significant findings were ascertained for the middle portion of the temporal muscle in "normal" patients versus "with and without meniscus reduction" patients. The superficial masseter muscle was more tender in "normal" patients and in "reducing meniscus" patients than in "without meniscus reduction" patients. The medial pterygoid muscle was more tender in "normal" patients and in "without meniscus reduction" patients than in "reducing meniscus" patients. Though there are some significant findings with respect to muscle palpation, by itself muscle palpation is not a specific indicator of temporomandibular joint internal derangement.

Arthrography↗
PubMed1994

A finite element analysis of the human temporomandibular joint.

A 2-D finite element model of the human temporomandibular joint (TMJ) has been developed to investigate the stresses and reaction forces within the joint during normal sagittal jaw closure. The mechanical parameters analyzed were maximum principal and von Mises stresses in the disk, the contact stresses on the condylar and temporal surfaces, and the condylar reactions. The model bypassed the complexity of estimating muscle forces by using measured joint motion as input. The model was evaluated by several tests. The results demonstrated that the resultant condylar reaction force was directed toward the posterior side of the eminence. The contact stresses along the condylar and temporal surfaces were not evenly distributed. Separations were found at both upper and lower boundaries. High tensile stresses were found at the upper boundaries. High tensile stresses were found at the upper boundary of the middle portion of the disk.

Bias↗
PubMed1979

The bite in the temporomandibular joint pain dysfunction syndrome.

After reviewing the anatomy of the temporomandibular joint, the soft tissue classification of this syndrome is divided into three groups: macrotrauma, microtrauma, and stress situation. In each group, the etiology, physical findings, pathophysiology, and treatment are discussed. Bite assessment is reviewed so that the otolaryngologists will have a fuller understanding of the role that occlusal status plays in this syndrome. Before contemplating surgery, this status should be assessed by a competent dental colleague.

Arthritis↗