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At least 109 records · Page 6Linked to original sources
PubMed1984

Joint play movements of the temporomandibular joint: clinical considerations.

During the voluntary mandibular movements produced by various combinations of medial and lateral pterygoid muscle activity, the mandibular condyle is confined to a line roughly parallel to the articular surface of the temporal bone. Techniques using involuntary joint-play movements of the temporomandibular joint (TMJ) can move the condyles downward or mediolaterally. Condylar distraction is accomplished by application of a downward force to the patient's posterior molar and a simultaneous upward force to the patient's chin. Variations, such as addition of a forward component to the distraction, or bilateral distraction (requiring an assistant to stabilize the patient's head), are often used. Lateral condylar movement requires application of a gentle lateral force to the lingual surface of the patient's posterior molar, as an opposite force is applied to the anterior part of the patient's mandible. These joint-play procedures are indicated initially, in TMJ evaluation, or during treatment of TMJ hypomobility. However, these techniques must be used cautiously if the joint is inflamed, as indicated by tenderness to palpation. TMJ evaluation requires gentle downward and lateral movements, while treatment of TMJ hypomobility may require alternation of forceful distraction and gentle lateral movements. Hypomobility due to an anteriorly displaced disc requires a strong distraction to reduce the disc and a removable dental prosthesis to maintain it in its correct position as the posterior ligament retracts. These joint play techniques are valuable in restoring function to the TMJ.

Humans↗
PubMed1995

Computerized three-dimensional magnetic resonance imaging reconstructions of temporomandibular joints for both a model and patients with temporomandibular pain dysfunction.

The aim of this study was to assess computerized three-dimensional reconstruction of magnetic resonance images generated of a temporomandibular joint model and the temporomandibular joints of five patients with varying degrees of temporomandibular joint pain and dysfunction. The three-dimensional image reconstruction of an artificial temporomandibular joint model, consisting of a human dried skull and synthetic disk, was used to test the accuracy and reproducibility of the three-dimensional technique. It was found that computerized three-dimensional reconstruction improved the display format of magnetic resonance imaging by enabling multiple two-dimensional images in shades of grey to be viewed as one three-dimensional image with anatomic structures colored as desired. Further, by rotating this image, the anatomic relationships of the temporomandibular joint could be seen from any viewpoint. Volume measurements showed accuracy and reproducibility by independent operators. Computerized three-dimensional reconstruction was applied to the magnetic resonance images obtained from patients. They were used to assess magnetic resonance imaging technique and its applications for interpreting the clinical findings. Disk position, as revealed by the three-dimensional images, was found to correspond with the clinical assessment, except in two instances when the original, right-sided, magnetic resonance imaging was unclear. Three-dimensional reconstruction was simple to apply, required no patient involvement, and made multiple magnetic resonance images easier to interpret.

Adolescent↗
PubMed1990

Ankylosing spondylitis associated with temporomandibular joint ankylosis: report of a case.

Ankylosing spondylitis is a disease process that causes inflammatory changes of the involved joints. Often the first clinical indication of the condition is lumbosacral pain and discomfort with limited range of motion. Progressive synovial changes eventually involve all of the axial joints including the temporomandibular joint. Although temporomandibular joint dysfunction is usually found in patients with ankylosing spondylitis, there are only nine documented cases of true bony ankylosis. A case report and review of the literature of ankylosis spondylitis associated with true temporomandibular joint bony ankylosis is presented. Surgical treatment included a gap arthroplasty and placement of an interpositional Silastic implant.

Arthroplasty↗
PubMed1988

The autogenous dermal graft in temporomandibular joint disc surgery.

Repair or replacement of the disc in 58 patients (64 joints) with temporomandibular joint internal derangement was done using an autogenous dermal graft. Long-term follow-up of 3 to 8 years revealed successful elimination of symptoms and restoration of mandibular function in 51 patients (87.9%). The autogenous dermal graft, rather than alloplastic materials, may be the procedure of choice when repair or replacement of the temporomandibular joint disc is indicated.

Adolescent↗
PubMed1988

Systemic joint laxity (the hypermobile joint syndrome) is associated with temporomandibular joint dysfunction.

A consecutive series of 37 individuals admitted to the hospital for elective temporomandibular joint (TMJ) reconstructive surgery and 3 seen as outpatients with TMJ disease were evaluated for rheumatic disease or for another etiologic factor that might account for this problem. These 40 patients were screened by history, physical examination, and laboratory study. We soon noticed that many patients had generalized joint laxity. Eighteen of the first 40 individuals satisfied established criteria for the hypermobile joint syndrome. An additional 3 were found to have Ehlers-Danlos syndrome or a forme fruste of this disorder. Many were markedly hypermobile and could perform a number of flexible maneuvers. Although excessive joint laxity is known to be associated with a variety of rheumatic conditions, TMJ disease has not been recognized as one of them. No patient in this series had a systemic inflammatory disorder or any other apparent etiologic factor for TMJ disease. We suggest that there is a cause-and-effect relationship between generalized joint laxity and TMJ disease.

Adolescent↗
PubMed1989

[Evaluation of inferior joint space arthrography for type III temporomandibular arthrosis (internal derangements of temporomandibular joint)].

Inferior joint space arthrographies for the 37 patients with internal derangements of temporomandibular joint or joints were examined clinically. All arthrograms showed various problems of postural and morphological findings of the disc. Clinical diagnosis for the existence of internal derangements of the temporomandibular joint was completely confirmed by lower joint space arthrography. It must be considered, however, that clinical diagnosis for the morphological changes of the disc associated with internal derangements of temporomandibular joint is difficult. Inferior joint space arthrography was very useful to evaluate optically the discal formation in the cases.

Arthrography↗
PubMed1991

Concentrations of neuropeptides substance P, neurokinin A, calcitonin gene-related peptide, neuropeptide Y and vasoactive intestinal polypeptide in synovial fluid of the human temporomandibular joint. A correlation with symptoms, signs and arthroscopic findings.

Arthroscopy was performed on 18 patients (19 joints) with temporomandibular joint arthropathy. Arthroscopic investigation revealed that 12 patients had disk derangement, including 3 patients with rheumatoid arthritis. Six patients had osteoarthrosis, including one patient with rheumatoid arthritis. Synovial fluid content of substance P-like immunoreactivity (SP-LI), neurokinin A (NKA-LI), calcitonin gene-related peptide (CGRP-LI), neuropeptide Y (NPY-LI) and vasoactive intestinal polypeptide (VIP-LI) were analysed using radioimmunoassay technique. All peptides analysed were found, although in various concentrations, in the different joints. There were no significant differences in concentrations of the peptides in the synovial fluid between patients in the various groups. No significant correlation was found between clinical symptoms and signs, arthroscopic findings, or use of analgesic/anti-inflammatory medication versus concentrations of peptides in the synovial fluid. In comparison with earlier findings in the knee joint significantly higher concentrations of SP-LI, CGRP-LI and NPY-LI were found in the TMJ.

Adult↗
PubMed1999

Trauma modifies strength and composition of retrodiscal tissues of the goat temporomandibular joint.

OBJECTIVES: Temporomandibular pain is often accompanied by pathologic changes to joint retrodiscal tissues. The substantial representation of females in this condition has encouraged hypotheses which link genetic or hormonally induced abnormalities in tissue composition (type III collagen, type I collagen, type III/type I ratio) to the development of temporomandibular disorders. As this condition is often associated with a history of orofacial trauma, we investigated the functional impact of retrodiscal trauma on the composition and biomechanics of retrodiscal tissues. DESIGN AND METHODS: Retrodiscal tissue of female goats received trauma or sham trauma. Following a healing period of 30 days, the tissues were pulled to failure on an extensometer. OUTCOME MEASURES: Assessments were made of tissue biomechanical properties (failure force, elastic stiffness, strain distribution). Tissue fragments were assayed for collagens I and III. RESULTS: Thirty days after surgical section of retrodiscal tissues, the tissue had reformed, but the composition and biomechanics were substantially changed. Healed tissue manifested less than half the strength of normal tissue (P = 0.02). In addition, the development of tissue strain shifted from a relatively even distribution to a confined region near the retrodiscal-discal attachment zone. It appeared that a large increase in the expression of type III collagen (179.6%; P = 0.038) and the ratio of type III/type I collagen (180.9%; P = 0.011) accounted for these functional changes. CONCLUSIONS: We suggest that shifts in collagen expression following injury create shifts in strain development which focus tissue stresses near the interface of the disc and retrodiscal tissue, and that this shift dramatically weakens the tissue and increases the probability of re-injury, inflammation and pain.

Animals↗
PubMed1993

The use of the holmium laser for temporomandibular joint arthroscopic surgery.

Temporomandibular joint arthroscopic surgery was performed on 86 human joints with a holmium yttrium aluminum garnet (YAG) laser (Coherent, Palo Alto, CA) passed through a quartz fiber. The wattage and number of pulses needed for tissue response, the temperature produced, and the average time needed for this surgery are presented. Holmium laser technology applied to the temporomandibular joint appears to be an effective, safe, and efficient modality.

Arthroscopy↗
PubMed1988

Temporomandibular joint arthrography: dynamic study by videorecording.

Temporomandibular joint symptoms are common. Patients not successfully treated by conservative methods require accurate assessment of the internal derangements of the joint. Temporomandibular joint arthrography using only videorecorded intensifier fluorography displays the anatomy and function accurately with a low radiation dose.

Arthrography↗
PubMed1999

Total temporomandibular joint replacement. Who? What? When? Where?

The temporomandibular joint, like other joints such as the hip and knee, can be affected by a number of conditions that may lead to joint failure, necessitating total joint replacement. The TMJ Implants, Inc., or Christensen alloplastic reconstruction prostheses, play an important role in the treatment of these conditions. Patients with severely degenerated and/or nonfunctioning joints who undergo reconstruction with the Christensen total joint replacement prosthesis experience an increase in quality of life similar to that experienced by orthopedic patients with total joint replacement of the knee or hip.

Adult↗
PubMed1992

Evaluation of a technique for recording temporomandibular joint sounds.

Analysis of temporomandibular joints sounds may contribute to the differential diagnosis of temporomandibular joint disorders. In this article an advanced system for the recording of joint sounds is presented. The method proved to be reliable. The problem of filtering out artifacts has been solved to a great extent but not completely. Temporomandibular joint sounds measured with this technique vary considerably in energy, frequency spectrum, and peak-to-peak amplitude over 3 months, as well as within 1 day. These differences seem to reflect natural variations in joint sounds caused by the physical impossibility of performing identical jaw movements. The results indicate that joint sound characteristics do not yet offer a solid basis for inferences concerning the development of temporomandibular joint abnormalities in the clinical setting.

Adolescent↗
PubMed1995

[Evaluation of radiographic diagnosis on osteoarthrosis of the temporomandibular joint].

84 cadavers' temporomandibular joints were used to compare the results shown in standard lateral tomographs and Schuller's position films with gross views on the bone and cartilage changes. The results and conclusions were as follows: (1) The positive rates of the radiographic evidences were associated with the degrees of the macroscopic lesions. The more severe the macroscopic lesion, the higher the positive rate of radiographic evidence. (2) The sensitivity of radiographic examination was positively correlated with the extent of the macroscopic lesion. So, the negative predictive value was. However, the specificity and the positive predictive value of the radiographic examination were negatively correlated with macroscopic change index. It has been found that the more the extent of osteoarthrosis changes, the higher the sensitivity of radiographic examination; the higher the negative predictive values, the higher the positive rate of radiographic evidence, and the lower the underdiagnosis rate was. Meanwhile, the more the extent of bone pathological changes in the joint, the lower specificity of the radiographic examination, and the lower the positive predictive values and the misdiagnosis is increased. (3) The radiographic diagnostic value based on the standard latreal tomographs of TMJ, Schuller's position films or based on the both methods was not satisfied. Its underdiagnosis rate was higher. Therefore, we suggest that multiple-layers lateral tomography should be widely used in clinical practice.

Aged↗
PubMed2005

Mice deficient in biglycan and fibromodulin as a model for temporomandibular joint osteoarthritis.

The temporomandibular joint (TMJ) within the craniofacial complex is unique. In humans, the TMJ can become diseased resulting in severe and disabling pain. There are no cures for TMJ disease at this time. Animal models of TMJ disease are scarce, but some exist, and they are described in this paper. We present in greater detail one animal model that is deficient in two extracellular matrix (ECM) proteoglycans, biglycan (BGN) and fibromodulin (FMOD). Doubly deficient BGN/FMOD mice develop premature TMJ osteoarthritis (OA). In order to explore the mechanistic basis of TMJ-OA, tissues from the condyle of mutant mice were examined for their relative capacity to differentiate and undergo apoptosis. Our data show that there is a redistribution of the critical ECM protein, type II collagen, in mutant mice compared with controls. Mutant mice also have increased apoptosis of the chondrocytes embedded in the articular cartilage. We speculate that the overall imbalance in apoptosis may be the cellular basis for the abnormal production of structural ECM proteins. The abnormal production of the ECM could, in turn, lead to premature erosion and degradation of the articular surface resulting in TMJ-OA. These data underscore the importance of the ECM in controlling the structural integrity of the TMJ.

Animals↗
PubMed2006

Somatosensory function following painful repetitive electrical stimulation of the human temporomandibular joint and skin.

Temporomandibular disorders (TMD) are common pain problems in the population with uncertain pathophysiology and mechanisms. The aim of this experimental study was to: (1) Establish an experimental pain model using electrical stimuli to describe characteristics of nociception from the human temporomandibular joint (TMJ) and overlying skin. (2) Test the hypothesis that there would be sex-related differences in TMJ sensitivity. Forty-three healthy subjects (24 men and 19 women) participated. Using two unipolar needle electrodes into the skin (above the TMJ) in one session or into the TMJ in the other session, sensory detection threshold (SDT), pain detection threshold (PDT), and summation threshold (SumT) were measured, before and after repetitive electrical stimulation. Painful repetitive electrical stimulation was applied for 20 min with individually adjustment of the intensity of the stimuli to keep the pain rating around five on a 0-10 cm visual analogue scale (VAS). Sensitivity to tactile and pin-prick stimuli were assessed at 11 sites around the TMJ using two von Frey nylon filaments (5.16 and 84.96 g), as well as pressure pain threshold (PPT) and pressure pain tolerance (PPTOL) before the stimulation, after 20 min of stimulation and finally 15 min after the end of stimulation. Numerical rating scale (NRS) from 0 to 100 was used to rate the intensity of applied von Frey filaments. SDT, PDT, and SumT were higher in the TMJ than in the skin. These three measures increased after painful repetitive stimulation for 20 min (de-sensitization). In contrast to this effect, a hypersensitivity to pin-prick stimuli was detected around the TMJ area on the stimulated side after 20 min of electrical stimulation in the TMJ, but not in the skin. A bilateral hyposensitivity to tactile stimuli was detected after skin and TMJ stimulation. PPT and PPTOL did not show a significant change over time. Except for lower TMJ PPTOLs in women than men there were no significant sex-related differences in mechanical or electrical measures. The present findings indicate differences in the elicitation of hypersensitivity following repetitive electrical stimulation of skin and deep tissues. The mechanisms underlying these findings are not clear but differences in the induction of long-term potentiation and depression is a possibility. From a clinical point of view, the lack of sex differences in most of the used measures indicates that the higher prevalence of women than men amongst patients with persistent TMJ pain problems not entirely can be ascribed to a higher sensitivity of the TMJ. Further studies will examine the somatosensory sensitivity of patients with TMJ pain problems.

Adult↗
PubMed2005

The relationship of bone marrow edema pattern in the mandibular condyle with joint pain in patients with temporomandibular joint disorders: longitudinal study with MR imaging.

The purpose of this study was to investigate the course of bone marrow edema pattern (decreased signal intensity on T1- or proton-density-weighted images and increased signal intensity on T2-weighted fat-suppressed images) in the mandibular condyle after improvement in clinical symptoms, and to clarify its relationship with temporomandibular joint (TMJ) pain. This study was based on 14 joints of 11 patients (all female, mean age 37.5 years) with TMJ disorders showing condylar bone marrow edema pattern on initial magnetic resonance (MR) images. All joints were re-evaluated clinically and using MR images after relief of joint pain following arthrocentesis combined with non-surgical treatment. The time interval between the initial and follow-up MR images ranged from 14 to 27 months (mean 17 months). Of the 14 joints, 4 joints (28.6%) showed a normal bone marrow signal, whereas 10 joints (71.4%) showed persistent bone marrow edema pattern on follow-up MR images (P = 0.125). Therefore, the reduction in TMJ pain did not correlate with resolution of bone marrow edema pattern in most joints. The results of this study suggest that the bone marrow edema pattern in the mandibular condyle does not always contribute to the occurrence of joint pain in patients with TMJ disorders.

Adolescent↗