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PubMed1987

[Effects of intubation anesthesia on the temporomandibular joint].

Hardly any attention has so far been paid to temporomandibular joint (TMJ) dysfunction after endotracheal intubation. We examined perioperative lesions of the TMJ in 100 patients who underwent operations in areas other than the head and neck. Fifty of these patients were anesthetized with orotracheal intubation; the other 50 were operated under spinal or peridural anesthesia. The orotracheal intubations were carried out with Macintosh laryngoscopes (blatesize 3). Size 32 Kuhn tubes or Magill tubes were used in 25 patients each. Preoperatively and daily for the first 4 postoperative days, we repeated the history and examined the minimal distance between the occlusal edges of upper and lower incisors (SKD), deviations of the mandible during opening and closing movements, and snapping or grinding of the TMJ. We further measured the duration of intubation, technical difficulties, and the number of years of training of the anesthetist. Age, body length, and preoperative findings were compatible in both patient groups. Operating time was 25% longer in the spinal or peridural anesthesia group. Of the 50 patients with orotracheal intubation, 33 demonstrated a reduced ability of maximal oral opening of up to 35% on the 1st postoperative day. Snapping of the TMJ was observed in 80% of the orotracheally intubated patients on the 1st postoperative day, which was 20% above the preoperative value. TMJ grinding showed no significant changes. Two of the 50 intubated patients complained of TMJ pain, another two had occlusal disturbances, and two had a reduced SKD. There were no detectable differences within the group of intubated patients regarding type of tube or experience of the anesthetist.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

A retrospective evaluation of the impact of temporomandibular joint arthroscopy on the symptoms of headache, neck pain, shoulder pain, dizziness, and tinnitus.

Forty-three patients who underwent arthroscopic surgery for arthrogenous TMD were polled concerning the effect of surgery on the symptoms of headache, neck pain, shoulder pain, dizziness and tinnitus. Statistically significant levels of symptom reduction were recorded for all symptoms polled. This indicates that a substantial number of significant symptoms are produced by the influence of temporomandibular joint pathology on central neural processes. A model for the affect of temporomandibular joint pathology on cervical and masticatory musculature is proposed. This data implies that we cannot use muscle tenderness, hypertonicity and/or pain to differentiate arthrogenous from myogenous temporomandibular disorders. The characteristics of a population of whiplash onset TMD patients were compared to other TMD populations. The results indicate that whiplash induced TMD may differ from insidious onset TMD and even other trauma onset TMDs by prevalence of neck pain, intensity of neck pain and probability of concurrence of neck pain, shoulder pain, headache and jaw pain. These symptoms resolved within 24 hours of arthroscopic temporomandibular joint surgery indicating that the temporomandibular joint pathology was the perpetuating force behind, if not the cause of, these symptoms.

Accidents, Traffic↗
PubMed1992

[Role of arthrography in imaging of the temporomandibular joint in 1992].

In this text we briefly want to discuss the role of the arthrographic examination of the temporomandibular joint for detection of disc pathology. We will mention the normal anatomy and function of the temporomandibular joint, the technique for performing arthrograms and the classification of the most frequent disc pathology. This will be illustrated by some arthrographic examples of anterior disc displacement without reduction, disc perforation, and medial disc displacement. Finally the advantages of arthrography in comparison with other investigation techniques will be discussed.

Arthrography↗
PubMed2002

Chondrocyte apoptosis in temporomandibular joints with disc displacement.

PURPOSE: We sought to study the presence of apoptosis in cartilage from rabbit temporomandibular joints with disc displacement (DD), and to examine the relationship between chondrocyte apoptosis and chondrocyte proliferation. MATERIALS AND METHODS: Thirty Japanese white rabbits were used in this study. The right joints of 20 rabbits were subjected to surgical DD. Specimens were collected for study at 4 days and 1, 2, 4, and 6 weeks after surgery. Temporomandibular joints were studied by microscopy and in situ detection of apoptosis. RESULTS: Experimental and sham surgery animals tolerated the surgical procedures well, and 16 of 20 of the surgically displaced discs were successful. A decrease in the number of chondrocytes in articular cartilage was observed after 2 weeks. Apoptotic chondrocytes were abundant in cartilage from DD joints. Apoptotic chondrocytes, most obvious at 1 or 2 weeks after surgery, were mostly found in the proliferative and hypertrophic zones. At 6 weeks after surgery, there were fewer apoptotic chondrocytes, but the cartilage layer was thinner than that of the control. CONCLUSION: This study shows that chondrocyte apoptosis is increased in rabbit DD articular cartilage at early stage and that the apoptotic cells were localized predominantly in the proliferative and hypertrophic zones. Chondrocyte death may be of pathogenetic significance during cartilage repair in response to DD.

Animals↗
PubMed1992

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

Degenerative changes in the temporomandibular joint were induced in 24 rabbits by surgical perforation of the disk. The incongruence obtained between the joint surfaces caused a gradual increase in macroscopic and microscopic changes, including gross remodeling, loss of tissue volume, and altered cell morphology within a 16-week observation period. These changes occurred concurrently with major alterations in the composition of the matrix, as demonstrated by increase in the glycosaminoglycan content of both condylar cartilage and disk and by loss of hydroxyproline in the disk. The lesions in the disk tissue were clearly discernible, whereas those in the condylar cartilage were less extensive. The described method is concluded to give alterations in the temporomandibular tissues, as seen in degenerative joint disease of an early stage.

Animals↗
PubMedDate not supplied

The added gradient echo pulse sequence technique: application to imaging of fluid in the temporomandibular joint.

PURPOSE: To assess the value of an added gradient echo in the same pulse sequence with a T1-weighted spin echo for determining the presence of an abnormal fluid collection in the temporomandibular joint with no additional imaging time. MATERIALS AND METHODS: Using a standard T1-weighted sequence used in cine temporomandibular joint imaging, a readout gradient reversal was added and the resulting gradient echo collected. This image was compared with standard T1- and T2-weighted sequences, a short inversion recovery imaging sequence, and a small flip angle fast low-angle shot gradient-echo sequence. RESULTS: The T1-weighted spin echo preceding the added gradient echo is not affected by the gradient reversal, but the additional gradient echo adds T2* contrast information that displays fluid as bright as and compares favorably with other fluid detection sequences. CONCLUSION: The added gradient-echo technique adds sensitivity for the detection of an abnormal increase in fluid in the temporomandibular joint without adding to the overall imaging time of a routine T1-weighted sequence.

Humans↗
PubMed2001

[MRI manifestation of temporomandibular joints after indirect trauma].

OBJECTIVE: The objective of this study is to investigate the structure changes in temporomandibular joints (TMJs) of goats after indirect trauma. METHODS: The trauma of TMJs of goats achieved under an impact to the right and left mandibular angles with a self-made device. These goats were killed after 2 hours, 7 days, 1 month and 3 months. The TMJs of goats were examined using MRI before killed and checked by histological method, the normal temporomandibular joints were treated as the control. RESULTS: The results of MRI: in the early post-trauma stage, the condylar articular surface was partially lost, and the discs were displaced and ruptured. Further, the hemathrosis of the TMJ and the decreased joint spaces were also observed in the eroded, eburnous surface of the condyle and the deformed disc. In the later stage, the surfaces of condyles were eroded and eburnated, and the discs were deformed. CONCLUSION: The indirect trauma on the TMJs of goats can cause TMJ internal derangement and TMJ osteroarthrosis. MRI cab be used to investigate both hard and soft tissue injuries of the temporomandibular joint, and is appreciated in understanding the pathogenesis of indirect trauma on the TMJ.

Animals↗
PubMed2001

Localization of keratan sulphate and chondroitin-6-sulphate on the anteriorly displaced human temporomandibular joint disc--histological and immunohistochemical analysis.

The aetiology of temporomandibular joint (TMJ) disc displacement has been investigated using human post-mortem material. Twenty TMJ specimens were used for a histological procedure with haematoxylin and eosin staining and orcein staining. Immunohistological analysis with chondroitin-6-sulphate and keratan sulphate was also carried out on the same specimens. Immunohistochemically, the specific localization of chondroitin-6-sulphate and keratan sulphate in the antero-medial parts of the anteriorly displaced deformed TMJ disc, which may be load-bearing areas, was observed. Orcein staining revealed that specific elastic fibres pulling the anterior band and stretching the disc continuously, may be an important factor in disc displacement. On the basis of these results, we were able to propose a significant new hypothesis for the aetiology of disc displacement.

Adult↗
PubMed1992

Mandibular retrusion, temporomandibular joint derangement, and orthognathic surgery planning.

One-hundred consecutive orthognathic surgery candidates with mandibular retrusion were selected for retrospective analysis. Patients had undergone imaging studies that included magnetic resonance imaging (MRI) of both temporomandibular joints to assess the presence or absence, stage, and activity of suspected internal derangement(s). Patients were divided into stable and unstable deformity groups based on the presence or absence of change in their facial contour and/or occlusal disturbances in the 24 months prior to evaluation. Each of the 58 unstable and 30 of 42 stable patients were found to have internal derangements of at least one temporomandibular joint. The degree of joint degeneration directly paralleled the severity of retrognathia in most cases. We concluded that temporomandibular joint internal derangement is common in cases of mandibular retrusion and leads to the facial morphology in a high percentage of patients. Preoperative temporomandibular joint imaging with MRI is recommended prior to orthognathic surgical correction of retrognathic deformities.

Adolescent↗
PubMed1999

The vascular relationship between the temporomandibular joint and the middle ear in the human fetus.

PURPOSE: The aim of this work was to clarify the vascular relationships between the middle ear and the temporomandibular joint region during human fetal development. MATERIALS AND METHODS: Light microscopic studies were done on 40 human fetuses from 72 mm crown-rump length (C-R) to 150 mm C-R, which were stained by various methods. Five human fetuses were dissected. Natural latex with industrial coloring was injected through the external carotid artery. All specimens were dissected bilaterally. RESULTS: The limits of the retroarticular region and the fetal tympanosquamosal fissure are shown. The anterior tympanic artery has a variable origin. In most cases, it originates from the maxillary artery; in other cases it originates from the superficial temporal artery or the bifurcation of the external carotid artery. On its way through the retroarticular region, it gives branches to the posterior part of the temporomandibular joint. It progresses along the most lateral part of the tympanosquamosal fissure, dividing into three branches that extend throughout the middle ear. A number of venous spaces in the retroarticular region that constitute the retrodiscal venous plexus. Small venous vessels along the fetal tympanosquamosal fissure accompany the anterior tympanic artery and drain into the retrodiscal venous plexus. CONCLUSIONS: During human fetal development, there is a wide connection across the tympanosquamosal fissure between the middle ear and the temporomandibular joint region. The anterior tympanic artery and its branches, as well as small venous vessels that are connected with the retrodiscal venous plexus, extend along the most lateral part of the fissure.

Arteries↗
PubMed1995

Controversies on anatomy and function of the ligaments associated with the temporomandibular joint: a literature survey.

Varying opinions are found in the literature regarding the role of the ligaments associated with the temporomandibular joint, eg, with respect to recording of mandibular positions and diagnosis and to treatment of patients with temporomandibular disorders. A literature survey was done to explore controversies of anatomy and function of the temporomandibular joint ligaments. Only 20 research-based anatomic/functional articles were registered in the Index Medicus system under the selected headings from 1897 to 1995. By examining the reference lists of the articles found, 22 more articles not included in Index Medicus were identified. Thus, the total number of original publications concerning the temporomandibular ligaments was limited. Although the conventional textbook descriptions of the anatomy of the ligaments are fairly consistent, there are several controversies and unanswered questions. Information about the functional role of the ligaments is especially insufficient. The results of this survey indicate that there is a need for additional anatomic and functional investigations of ligaments associated with the temporomandibular joint.

Humans↗
PubMed1991

Accuracy of measures of temporomandibular joint space and condylar position with three tomographic imaging techniques.

Fourteen temporomandibular joints in seven dry skulls, representing the distribution of horizontal and vertical condylar axis inclinations of a larger population, were imaged with three tomographic projection techniques. Closest anterior and posterior joint spaces were measured on radiographs, and sectioned plaster casts were made from impressions of actual joint space, Individualized horizontal and vertical correction of the condylar axis produced significantly more accurate (p less than 0.005) measures of condylar space than either standard 20-degree horizontal correction (SHC) or individualized horizontal correction (IHC) of the axis. Representations of joint space by SHC and IHC were not significantly different from each other. Numbers of uninterpretable images displayed a similar pattern of 9.5% for individualized horizontal and vertical correction, 14% for IHC, and 17% for SHC. This study supports the use of fully individualized condylar axis correction with temporomandibular joint tomography for increased accuracy of visualization of the osseous anatomy of the joint.

Humans↗
PubMed1992

[The temporomandibular joint].

With its discordant articular surfaces and complete division in two cavities separated by a disk, the temporomandibular joint appears as a complex anatomical and functional entity. Combined movements involving anteroposterior gliding between the disk and temporal bone in the upper cavity, anteroposterior condyle translation, hinge and rotation movements between the disk and mandibular condyle contribute to the different movements of the jaw. With dental occlusion, the masticatory apparatus therefore includes five functionally coordinated articular compartments. Various impairments of the normal static and dynamic features of the temporomandibular joint may lead to relatively frequent pathological conditions which can be easily diagnosed by modern imaging and arthroscopic methods.

Diagnostic Imaging↗
PubMed2000

Collagen crimping in the intra-articular disc and articular surfaces of the human temporomandibular joint.

The presence of crimping within soft fibrous connective tissues has a considerable role in determining the biomechanical properties of the tissue. However, there is little or no information on crimping of collagen in the human temporomandibular joint. To remedy this situation, the presence and nature of any crimping was studied in sections of human temporomandibular joints from individuals varying in age from between 4.5-63 years, using polarized light microscopy and differential interference contrast microscopy. The presence of crimping was looked for in collagen within the intra-articular disc and the articular surfaces of the mandibular fossa and mandibular condyle. By polarized light, crimping was seen throughout all three tissues at all ages studied. Quantification from micrographs enlarged to x250 showed that the periodicity of the banding (representing half a complete crimp wave) had a mean varying between about 15-20 microm. Crimping was also directly visualized by differential interference contrast microscopy. The presence of such a fundamental feature needs to be considered when explaining the normal function of the temporomandibular joint.

Adolescent↗
PubMed1979

Arthrotomography of the temporomandibular joint: new technique and preliminary observations.

A technique for arthrography of the temporomandibular joint using multidirectional tomography is described that greatly simplifies interpretation. In 21 attempts, 20 successful arthrograms were obtained in patients complaining of pain, tenderness, and clicking and locking of the joint who had not responded to conservative therapy. Abnormalities demonstrated were perforation of the meniscus, anterior dislocation and subluxation of the meniscus; and redundancy of the bilaminar zone. In all 11 patients who underwent surgical meniscoplasty, disc abnormalities included thinning, perforation, flaccidity, and bilaminar redundancy. No permanent complications of the arthrographic procedure occurred, but temporary postprocedure discomfort was frequent. This preliminary experience with temporomandibular joint arthrotomography suggests this easily performed procedure offers reliable information about disc function and integrity that may assist in a selection of patients for meniscoplasty and other surgical treatment.

Adolescent↗
PubMed1986

Hyperplastic soft-tissue formation in the temporomandibular joint associated with internal derangement. A radiographic and histologic study.

Hyperplastic connective tissue formation in the posterior part of the temporomandibular joint glenoid fossa has previously been described in autopsy specimens. The frequency of such hyperplastic tissue formation in patients with long-standing temporomandibular joint pain was studied in 103 joints from 80 patients by means of double-contrast arthrotomography. Five joints in four patients (5%) demonstrated hyperplastic tissue formation; in four cases this was associated with permanently displaced and deformed disks. All five joints were refractory to nonsurgical treatment. Surgically extirpated hyperplastic tissue and disk attachments contained nerve fibers and thickened adventitia of vessels, resulting in narrowed or obliterated lumina, extravasated erythrocytes, and fibrinlike deposits. The synovial membrane showed fibrinoid necrosis or was lost. The pain reaction in temporomandibular joints with hyperplastic soft-tissue formation may be released by compression or tension of nerves, breaking down products from blood or tissue ischemia. Contrast filling of both joint spaces, combined with tomography, was required for detection of the hyperplastic tissue formation.

Adult↗