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Avascular necrosis of the mandibular condyle causing fibrous ankylosis of the temporomandibular joint in sickle cell anemia.

Avascular necrosis, which most commonly affects the femoral head, is a well-recognized entity in orthopedic surgery. Maxillofacial surgeons have recently recognized that a similar process may also be at work in the temporomandibular joint because of the involvement of the mandibular condyle. Avascular necrosis of the mandibular condyle in association with sickle cell anemia is an infrequent finding. In this report, a patient with avascular necrosis of the mandibular condyle in the late stage causing fibrous ankylosis of the temporomandibular joint in sickle cell anemia is presented.

Adult↗

Dimensional growth and extracellular matrix accumulation by neonatal rat mandibular condyles in long-term culture.

Mandibular condyles in organ culture commonly have been used as a model system for examination of the factors that influence skeletal growth and development. The work reported here complements previously published histological studies by providing quantitative temporal information on growth and matrix accumulation. Condyles maintained for as long as 5 weeks in serum-free and 1% serum-supplemented culture media were found to remain viable and metabolically active as demonstrated by continued dimensional growth as well as cell and matrix accumulation. Growth occurred by a combination of cell proliferation, matrix synthesis and accumulation, and cell hypertrophy (with the latter two mechanisms dominating). Increases in tissue volume correlated directly with increased glycosaminoglycan content; both increased 7-fold over 5 weeks. In comparison with serum-free culture, after 35 days in medium containing 1% serum, glycosaminoglycan content was 24% lower and collagen content was 36% higher, whereas dry weight, condyle length, and DNA content were not significantly different; in addition, histological observation suggested that, for samples cultured with serum, chondrogenic phenotype had been lost from some regions. The temporal behavior for all growth parameters exhibited a transient phase 1-2 weeks in duration followed by a steady-state period in which dimensions and tissue constituents or content increased at a constant or near constant rate. Comparison of the rates of incorporation of [35S]sulfate with glycosaminoglycan content in serum-free cultures suggests that the loss of glycosaminoglycan occurs only initially or is negligible; therefore, under these baseline conditions, cartilage glycosaminoglycan content reflects the biosynthetic rate. The high degree of reproducibility seen during steady-state growth suggests that these data provide reliable baseline information and further supports the notion that this model system is useful for investigation of the effects of specific physical factors on in vitro growth and development.

Animals↗

Changes in cells's secretory organelles and extracellular matrix during endochondral ossification in the mandibular condyle of the growing rat.

The mandibular condyle from 20-day-old rats was examined in the electron microscope with particular attention to intracellular secretory granules and extracellular matrix. Moreover, type II collagen was localized by an immunoperoxidase method. The condyle has been divided into five layers: (1) the most superficial, articular layer, (2) polymorphic cell layer, (3) flattened cell layer, (4) upper hypertrophic, and (5) lower hypertrophic cell layers. In the articular layer, the cells seldom divide, but in the polymorphic layer and upper part of the flattened cell layer, mitosis gives rise to new cells. In these layers, cells produce two types of secretory granules, usually in distinct stacks of the Golgi apparatus; type a, cylindrical granules, in which 300-nm-long threads are packed in bundles which appear "lucent" after formaldehyde fixation; and type b, spherical granules loaded with short, dotted filaments. The matrix is composed of thick banded "lucent" fibrils in a loose feltwork of short, dotted filaments. The cells arising from mitosis undergo endochondral differentiation, which begins in the lower part of the flattened cell layer and is completed in the upper hypertrophic cell layer; it is followed by gradual cell degeneration in the lower hypertrophic cell layer. The cells produce two main types of secretory granules: type b as above; and type c, ovoid granules containing 300-nm-long threads associated with short, dotted filaments. A possibly different secretory granule, type d, dense and cigar-shaped, is also produced. The matrix is composed of thin banded fibrils in a dense feltwork. In the matrix of the superficial layers, the "lucency" of the fibrils indicated that they were composed of collagen I, whereas the "lucency" of the cylindrical secretory granules suggested that they transported collagen I precursors to the matrix. Moreover, the use of ruthenium red indicated that the feltwork was composed of proteoglycan; the dotted filaments packed in spherical granules were similar to, and presumably the source of, the matrix feltwork. The superficial layers did not contain collagen II and were collectively referred to as perichondrium. In the deep layers, the ovoid secretory granules displayed collagen II antigenicity and were likely to transport precursors of this collagen to the matrix, where it appeared in the thin banded fibrils. That these granules also carried proteoglycan to the matrix was suggested by their content of short dotted filaments. Thus the deep layers contained collagen II and proteoglycan as in cartilage; they were collectively referred to as the hyaline cartilage region.

Actin Cytoskeleton↗

[Diagnosis of luxation-fracture of mandibular condyle].

Based on an unusual case of bilateral mandibular condyle fracture the diagnostic problems are described. If conventional X-ray, panorama-tomograms and bilateral tomograms of both temporomandibular joints do not exactly show the fracture dislocation and the relation of the fragments CT scans should be taken.

Adolescent↗

Limitations of B-scan ultrasound for diagnosing fractures of the mandibular condyle and ramus.

The aim of this study was to analyse the applications and limitations of B-scan ultrasonography for diagnosing fractures of the mandibular condyle and ramus. Thirty-two patients with 39 radiologically proven fractures of the mandibular condyle and ramus were included in the study. The patients were examined with a 7.5 MHz small-part applicator. Five patients without fractures of the facial skeleton acted as controls. Normal sonoanatomical findings had been obtained for patients without mandibular fractures. B-scan ultrasonography enabled the experienced examiner to identify dislocated fractures of the mandibular ramus and the articular process in 67% of the fractures. The main disadvantage of ultrasonography was the inability of this technique to identify non-dislocated fractures. Because of its low sensitivity and specificity, B-scan ultrasonography does not provide an alternative to X-ray diagnosis of mandibular condyle and ramus fractures.

Adolescent↗

Eosinophilic granuloma of the mandibular condyle. A case report and management discussion.

The occurrence of eosinophilic granuloma in the mandibular condyle has been reported in only three cases. An additional case of eosinophilic granuloma of the mandibular condyle is reported. The lesion presented was treated with condylectomy and surgical curettage. There was no recurrence or soft tissue involvement on annual postoperative examination. Secondary reconstruction was planned but was not required.

Adult↗

Effects of lateral pterygoid muscle hyperactivity on differentiation of mandibular condyles in rats.

BACKGROUND: The effects of biomechanical stress on the growth and development of the mandibular condyle have been studied by many investigators. However, the role of the lateral pterygoid muscle in this development is not clear. METHODS: Hyperfunction of the lateral pterygoid muscles of male 3-week-old Sprague-Dawley rats was induced by electrical stimulation, and the responses of the mandibular condyles were compared to control tissues by a double-fluorescent staining technique using polyclonal antibodies against type I and type II collagen. Electrical stimulation consisted of repeated application (5 seconds on/5 seconds off) of a 5 Hz current for up to 7 days. RESULTS: In the first 2 days, cartilaginous tissues rich in type II collagen disappeared in the anterior and posterior areas, which were loaded by tensional force due to direct and indirect attachment of the lateral pterygoid muscles. Tissues in these areas were replaced by intramembranous bone that was reactive for type I collagen at 7 days. By the end of the experiment, the trabecula of the condyle was remodeled more perpendicularly, thus resisting the compressive force due to hyperfunction of the lateral pterygoid muscles. CONCLUSIONS: These results suggest that the activity of the lateral pterygoid muscle might play a significant role in the differentiation of progenitor cells and in the maturation and calcification of chondrocytes in mandibular condyles.

Animals↗

Degree and distribution of mineralization in the human mandibular condyle.

The degree of mineralization of bone (DMB) in the mandibular condyle reflects the age and remodeling rate of the bone tissue. Quantification of DMB facilitates a better understanding of possible effects of adaptive remodeling on mineralization of the condyle and its possible consequences for its mechanical quality. We hypothesized differences in the degree and distribution of mineralization between trabecular and cortical bone and between various cortical regions. Microcomputed tomography was used to measure mineralization in 10 human mandibular condyles. Mean DMB was higher in cortical (1,045 mg hydroxyapatite/cm(3)) than in trabecular bone (857 mg/cm(3)) and differed significantly between cortical regions (anterior 987 mg/cm(3), posterior 1,028 mg/cm(3), subchondral 1,120 mg/cm(3)). The variation of DMB distribution was significantly larger in the anterior cortex than in the posterior and subchondral cortex, indicating a larger amount of heterogeneity of mineralization anteriorly. Within the cortical bone, DMB increased with the distance from the cortical canals to the periphery. Similarly, the DMB of trabecular bone increased with the distance from the surface of the trabeculae to their cores. It was concluded that the rate of remodeling differs between condylar trabecular and cortical bone and between cortical regions and that DMB is not randomly distributed across the bone. The difference in DMB between condylar cortical and trabecular bone suggests a large difference in Young's modulus.

Adult↗

Lag-screw osteosynthesis of mandibular condyle fractures: a clinical and radiological study.

PURPOSE: This study evaluates the clinical and radiologic results after open reduction and lag-screw osteosynthesis of fractured mandibular condyles. MATERIALS AND METHODS: Eleven adult patients underwent surgery for displaced or dislocated mandibular condyle fractures via a submandibular approach. The repositioned fragments were fixed using lag screws designed by Krenkel or Eckelt. Maxillomandibular fixation was used postoperatively for 2.6 weeks on average (range, 1 to 4 weeks) in nine patients. RESULTS: Slight transient weakness of the mandibular branch of the facial nerve occurred in three cases. Occlusal adjustment was needed in another three cases. Radiologically, the fracture line disappeared at 22.5 weeks on average (range, 8 to 38 weeks). Three screws had to be removed because of loosening. There were signs that the screws had migrated caudally from their original position in seven cases. Twenty-one months on average after operation (range, 8 to 31 months), patients were satisfied with treatment. Clinically, all patients had a stable occlusion and symmetry of the face. All had greater than 5-mm symmetrical lateral jaw excursions. Ten patients had wide (> 40 mm) painless mouth opening. Healing in malposition occurred in four cases and there was considerable shortening of the mandibular ramus in four cases. CONCLUSIONS: Despite good clinical results, lag screws do not meet the needs for rigid internal fixation in the treatment of mandibular condyle fractures.

Adult↗

Osteoarthritis and abnormal bone marrow of the mandibular condyle.

OBJECTIVE: The purpose of this study was to analyze the relationship between abnormal bone marrow of the mandibular condyle and osteoarthritis. STUDY DESIGN: The relationship between abnormal bone marrow and osteoarthritis of the mandibular condyle was analyzed in magnetic resonance images of the temporomandibular joints of 74 patients. Thirty-seven patients had magnetic resonance evidence of abnormal bone marrow, and 37 control patients had magnetic resonance images with normal bone marrow. RESULTS: Fifteen of 37 patients with magnetic resonance evidence of abnormal bone marrow had no magnetic resonance evidence of osteoarthritis; the other 22 patients had both abnormal bone marrow and osteoarthritis. CONCLUSIONS: Abnormal bone marrow of the mandibular condyle can occur separately from osteoarthritis; nearly one half of the joints with magnetic resonance evidence of abnormal bone marrow did not have any evident osteoarthritis. Abnormal bone marrow may therefore initially represent a separate disease entity. Over time, secondary osteoarthritis probably develops in joints with initial bone marrow abnormalities.

Adolescent↗

A comparative ultrastructural study of the mitotic chondrogenic cells in the mandibular condyle and tibial growth plate of the rat.

Mitotic cells in the rat mandibular condyle (proliferative mandibular cells) were compared with mitotic cells in the rat tibial growth plate (proliferative tibial cells). In the tibial proliferative cells, the rough endoplasmic reticulum mostly became vacuolated during the latter stage of mitosis, whereas the rough endoplasmic reticulum of the proliferative mandibular cells rarely underwent disorganization. Further, a wide area remained outside of the mitotic spindle in the proliferative tibial cells at the metaphase, while only a narrow area remained in the proliferative mandibular cells. This finding might account for the difference of disorganization of the rough endoplasmic reticulum.

Animals↗

Growth potential of the rat mandibular condyle as an isogeneic transplant traversing the interparietal suture.

The mandibular condyle of 5-, 10- or 20-day inbred male rats was transplanted across the interparietal suture of male litter-mates and the transverse dimension of the neurocranium was measured from dry skulls at 25 or 35 days. The width of the neurocranium had increased significantly from days 5 or 10 to 25 in the rats with the transplants, whereas the difference from controls was small or non-existent by 35 days. Histological examination showed that the cartilaginous zone was reduced in the transplants at 25 days but that there were still layers of chondrocytes at 35 days. It is suggested that the rat mandibular condyle is endowed with a tissue-separating, interstitial growth potential that, to some extent, is unrelated to mobility, and essentially effected by chondrocyte hypertrophy.

Animals↗

Interpretation of mandibular condyle fractures using 2D- and 3D-computed tomography.

Computed tomography (CT) has been increasingly used in the examination of patients with craniofacial trauma. This technique is useful in the examination of the temporomandibular joint and allows the diagnosis of fractures of the mandibular condyle. Aiming to verify whether the three-dimensional reconstructed images from CT (3D-CT) produce more effective visual information than the two-dimensional (2D-CT) ones, we evaluated 2D-CT and 3D-CT examinations of 18 patients with mandibular condyle fractures. We observed that 2D-CT and 3D-CT reconstructed images produced similar information for the diagnosis of fractures of the mandibular condyle, although the 3D-CT allowed a better visualization of the position and displacement of bone fragments, as well as the comminution of fractures. These results, together with the possibility of refining and manipulating perspectives in 3D images, reinforce the importance of its use in the surgical planning and evaluation of treatment. We concluded that 3D-CT presented supplementary information for a more effective diagnosis of mandibular condyle fractures.

Computer Graphics↗

[Fractures of the mandibular condyle. Therapeutic controversies].

The condylar mandibular fractures are important because its incidence, possible complications and controversial treatment. The treatment of condylar fractures has generated more controversy and discussion than any other in the field of maxillofacial trauma. The main goal of treatment is restoration of function and not anatomic restoration of parts. Despite several clinical and anatomical studies still lack consensus regarding the best method of treatment. This review article focus on the controversy that surrounds treatment of the condylar fractures, trying to supply consensus about questions like: Should condylar mandibular fractures be managed via a closed or open technique? What is the best surgical approach? Surgical timing? What is the degree and duration of mandibular immobilization? Is or not necessary to treat the ATM disc?

Adolescent↗

Effect of occlusal (mechanical) stimulus on bone remodelling in rat mandibular condyle.

Mechanical load influences the remodelling of skeletal tissues. In the mandibular condyle, occlusal alterations and the consequent mechanical stimulus induce changes in chondrocytes and cartilage mineralization. In the present study we quantified in the mandibular condyle the effect of occlusal interference on remodelling of the subchondral bone. Computerized histomorphometry after 5-21-day exposure to the influence of a unilateral occlusal splint revealed an increased rate of trabecular remodelling, consisting of enhancement in osteoblast and osteoclast numbers and activities. The bone formation parameters reached their high values on Days 5 or 9 and remained stable thereafter. Bone resorption showed a gradual increase throughout the experimental period. These results further characterize the temporomandibular joint reaction to occlusal alterations. It is suggested that the present increase in bone turnover together with the known enhancement in chondrogenesis are part of a process of functional adaptation in response to mechanical stimulus.

Animals↗

Osseous abnormalities of the mandibular condyle: diagnostic reliability of cone beam computed tomography compared with helical computed tomography based on an autopsy material.

OBJECTIVES: We compared the diagnostic reliability of cone beam computed tomography (3DX) and helical computed tomography (helical CT) for the detection of osseous abnormalities of the mandibular condyle, using macroscopic observations as the gold standard. METHODS: Twenty-one temporomandibular joint autopsy specimens underwent imaging with 3DX and helical CT. The specimens were macroscopically evaluated for cortical erosion or osteophytosis and sclerosis. The images were independently assessed for the same osseous abnormalities. Observations with the two imaging modalities were compared with the macroscopic observations using the McNemar test. RESULTS: According to the macroscopic observations, 10 of the 21 mandibular condyles and one fossa showed osseous abnormalities. 3DX detected abnormalities in eight of these condyles and helical CT identified abnormalities in seven, giving a sensitivity of 0.80 for 3DX and 0.70 for helical CT. The specificity of the condyle assessment was 1.0 for both 3DX and helical CT and hence, the accuracy was 0.90 and 0.86, respectively. No significant differences were detected between the 3DX and helical CT for assessment of osseous abnormalities of the mandibular condyle (P=0.286). CONCLUSIONS: The cone beam CT equipment 3DX is a dose-effective and a cost-effective alternative to helical CT for the diagnostic evaluation of osseous abnormalities of the mandibular condyle.

Adult↗

Free grafting of traumatically displaced or resected mandibular condyles.

A technique of free grafting of the mandibular condyle with a vertical ramus osteotomy is advocated in cases presenting with markedly displaced fracture dislocation of the condyle, in reconstruction of the TMJ after mandibular resection, and in providing access for vascular surgery approaches to the treatment of carotid aneurysms. The technique of free transplantation of the condyle did not result in any aseptic necrosis or any arthritic changes in 35 patients observed over a period of 3 to 15 years. All patients had excellent TMJ function.

Aneurysm↗