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PubMed1994

Tomographic changes in the temporomandibular joint following arthroscopic surgery with lysis and lavage and eminentia release.

Seventy-one patients (128 joints) who underwent temporomandibular arthroscopies with lysis and lavage, capsular stretch, and release of adhesions and lateral capsular fibrosis were followed for an average of 24 months. Prearthroscopic and postarthroscopic temporomandibular joint tomograms were compared; 77.3% of the temporomandibular joints showed no postoperative changes, and 22.7% of the temporomandibular joints studied showed changes. The majority of these tomographic changes involved increase in condylar flattening and beaking. However, postoperative painful symptoms significantly decreased regardless of the radiographic findings.

Arthroscopy↗
PubMed1986

Inferior joint space arthrography of normal temporomandibular joints: reassessment of diagnostic criteria.

Inferior joint space arthrograms of the temporomandibular joints of 31 healthy volunteers (62 joints) were obtained to determine normal arthrographic findings. The superior margin of the anterior recess was smooth and flat in 68% of the joints and concave in 32% with the subjects' mouths closed. The concavity was the result of the anterior ridge of the meniscus impinging on the contrast material. The concave impression could be distinguished easily from an anteriorly displaced meniscus on videotaped studies, which demonstrated a smooth transition of contrast material from the anterior to the posterior recess during opening of a subject's mouth. With the mouth open, the anterior recess decreased in size, appearing as a small, crescent-shaped collection of contrast material anterior to the head of the condyle in 52 joints (84%); it remained large in ten joints (16%) at maximal mouth opening. The configuration of the posterior recess was identical to that described previously; however, with the subjects' mouths closed, it was larger than the anterior recess, contrary to most previously reported results.

Adult↗
PubMed1991

Imaging of the temporomandibular joint.

Imaging of the temporomandibular joint recently has been characterized by a shift in emphasis from plain films, arthrography, and computed tomography toward magnetic resonance imaging. The past year represents the continuation of the era of refinement in magnetic resonance technology not immediately obvious as an advantage for temporomandibular joint imaging but nonetheless, of potential significant impact. A few examples of relatively "quiet" developments include: 1) new alloys for lighter weight permanent magnets with reduced operating costs; 2) gradient coil technology for more rapid image acquisition leading to the possibility of true cine magnetic resonance; and 3) smaller, more powerful computers for more rapid data processing. The implications are for comprehensive anatomic and physiologic assessments of the joint along with increased patient throughput and reduced costs. This review surveys the recent literature on the techniques and selection of imaging modalities, new observations regarding the pathophysiology of temporomandibular joint diseases afforded by advances in imaging technology, and my opinions regarding future directions in imaging technology based on my own experience and a review of the current literature.

Arthrography↗
PubMed2005

A surface-regional and freeze-thaw characterization of the porcine temporomandibular joint disc.

The temporomandibular joint (TMJ) disc is a central element in several TMJ disorders. Tissue-engineered TMJ disc replacements may alleviate discomfort associated with TMJ disorders; however, prior to developing a replacement, a thorough understanding of the native disc must be attained. Toward this end, we developed an unconfined compression, incremental stress relaxation viscoelastic model which simultaneously incorporates the strain increment magnitude and total deformation in the stress relaxation solution. This multiple strain step model was fit to stress relaxation data from (i) 80 test sites from eight porcine TMJ discs for the purposes of a surface-regional characterization and (ii) 30 test sites from five porcine TMJ discs for the purposes of a freeze-thaw characterization. The model estimated viscoelastic parameters accurately and surface-regional variations were detected throughout the TMJ disc. Regionally, the medial and anterior regions have the largest relaxation moduli, and the posterior and anterior regions have the largest instantaneous moduli. The inferior surface was found to have higher instantaneous modulus values than the superior surface. Furthermore, material properties were retained over five freeze-thaw cycles. The results of this study allow for the creation of design and validation criteria for future engineering efforts and shed light on the disc's role in TMJ function and dysfunction.

Animals↗
PubMed1992

[SPECT in the study of pathology of the temporomandibular joint. The authors' personal experience].

Symptomatic temporomandibular joint dysfunctions may affect about 25% of the adult population, with a smaller though significant percentage of patients experiencing severe impairment. From 1986 through 1991, 107 patients with severe temporomandibular joint symptoms and with various temporomandibular joint disorders were evaluated with conventional radiology and with closed/open-mouth temporomandibular joint tomograms. Single-photon emission-computed tomography (SPECT) and planar imaging were performed on 32 patients using a rotating gamma camera equipped with a general purpose collimator. Transaxial, coronal and sagittal tomoscintigrams were reconstructed. Increased radiotracer uptake in the temporomandibular joint was regarded as a positive finding, and the intensity of temporomandibular joint activity was compared with that of adjacent calvarium using regions of interest. In the 32 patients submitted to scintigraphy, conventional radiology showed no pathologic patterns, while SPECT showed pathologic findings in 31 patients (97% of cases). The patient with normal temporomandibular joint findings on SPECT exhibited abnormal maxillary isotope uptake, ipsilateral to the symptoms. Our results indicate that SPECT is a simple, noninvasive, inexpensive and very sensitive screening test relative to the internal derangement of the temporomandibular joint. Moreover, it provides information which is not available by means of routine bone scans or X-ray studies. Thus, SPECT appears to be the modality of choice for patients whose clinical findings are equivocal or whose symptoms are unclear, and it can guide treatment strategies and be useful in the follow-up.

Adult↗
PubMed1995

Co-variation of neuropeptide Y, calcitonin gene-related peptide, substance P and neurokinin A in joint fluid from patients with temporomandibular joint arthritis.

Forty-one patients (37 female and four male) with signs and symptoms of temporomandibular joint arthritis, were separated into two diagnostic groups (group I: inflammatory; group II: degenerative/non-specific joint disease). They were examined clinically, fluid was aspirated from the joint with saline and venous blood samples were collected at the same time. The joint fluid and plasma samples were analysed for neuropeptide-like immunoreactivity, i.e. neuropeptide Y (NPY-LI), calcitonin gene-related peptide (CGRP-LI), substance P (SP-LI) and neurokinin A (NKA-LI), using competitive radioimmunoassays. The aim was to investigate any co-variation of the peptides in the joint fluid and plasma. In group I, the median values of peptide concentrations in joint fluid were SP-LI = 129, CGRP-LI = 75, NKA-LI = 36 and NPY-LI = 676 pmol/l and in group II, SP-LI = 52, CGRP-LI = 64, NKA-LI = 45 and NPY-LI = 318 pmol/l. There were no significant differences between the groups for peptide concentrations. In group I, all the neuropeptides were strongly correlated. In group II, SP-LI and NKA-LI were strongly correlated while CGRP-LI was weakly correlated with NPY-LI and NKA-LI. Multiple step-wise regression analysis showed that most of the variation in NPY-LI, CGRP-LI and SP-LI in group I was explained by NKA-LI, but the regression did not reach statistical significance in group II.

Adult↗
PubMed1997

Guide to evaluation of permanent impairment of the temporomandibular joint. American Academy of Head, Neck and Facial Pain; American Academy of Orofacial Pain; American Academy of Pain Management; American College of Prosthodontists; American Equilibration Society and Society of Occlusal Studies; American Society of Maxillofacial Surgeons; American Society of Temporomandibular Joint Surgeons; International College of Cranio-mandibular Orthopedics; Society for Occlusal Studies.

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Ankylosis↗
PubMedDate not supplied

The effect of obliquity on the radiographic appearance of the temporomandibular joint in dogs.

The temporomandibular joint is formed between the condyloid process of the mandible and the mandibular fossa of the temporal bone. The basic anatomy of this joint was assessed and described in a series of skulls including dolichocephalic, mesaticephalic and brachycephalic breeds. The facial index and rotational angles were measured with the facial index providing a useful method of classifying skull types but the rotational angle being of limited use in assessment of the temporomandibular joint until normal breed values are established. Equipment was designed to allow repeatable positioning of the temporomandibular joint for radiography at a variety of lateral and long axis rotational angles relative to the central x-ray beam. The regions of the joint and anatomic features visualized in each view are demonstrated. 10 degrees rotation was required in either axis to project the joints independently of each other. Lateral rotational angles of 10 to 30 degrees in mesaticephalic and dolichocephalic breeds and 20 to 30 degrees in brachycephalics and long axis rotational views of 10 to 30 degrees depending on the region of interest were considered to be the most useful.

Animals↗
PubMed2000

Effect of methotrexate on the temporomandibular joint and facial morphology in juvenile rheumatoid arthritis patients.

Juvenile rheumatoid arthritis is a disease characterized by chronic inflammation in one or more joints; it affects children and adolescents up to 18 years of age. This disease may cause significant skeletal joint destruction, and the temporomandibular joint, like other joints, may become severely affected resulting in aberrant mandibular growth, abnormal dentofacial development, and/or altered orofacial muscle function. Methotrexate is the most common remittive agent used in juvenile rheumatoid arthritis to modify the course of inflammatory destruction of peripheral joints. The purpose of this study was: (1) to evaluate the effect of methotrexate therapy on the prevalence of temporomandibular joint lesions and aberration in craniofacial development in children afflicted with juvenile rheumatoid arthritis; (2) to further examine the relationship between the temporomandibular joint/cephalometric findings and rheumatologic data (ie, age at onset, duration of disease); and (3) to evaluate further pauciarticular- and polyarticular-onset disease in juvenile rheumatoid arthritis and the prevalence of temporomandibular joint lesions and facial dysmorphology. The following information was obtained from 45 patients with juvenile rheumatoid arthritis: (1) routine rheumatologic clinical examination data; (2) anamnestic temporomandibular joint evaluation data; (3) clinical temporomandibular joint examination data; (4) lateral cephalometric measurement data; (5) posteroanterior cephalometric measurement data; and (6) individually corrected axial tomographic data. The results demonstrated the following: (1) radiographic evidence of condylar degeneration was apparent in 63% of all patients with juvenile rheumatoid arthritis with pauciarticular patients showing less temporomandibular involvement than polyarticular patients; (2) polyarticular juvenile rheumatoid arthritis patients receiving methotrexate showed less severe temporomandibular joint involvement than the polyarticular patients not receiving methotrexate; (3) the craniofacial structure was affected to a greater extent in the polyarticular form of the disease; (4) the craniomandibular index scores were significantly greater in the polyarticular group; (5) vertical height asymmetry and chin deviation were noted in more than 50% of the patients; and (6) there was a correlation between the severity of condylar lesions and cephalometric findings (ie, mandibular retroposition, posterior rotation, smaller ramus and mandibular dimensions) and the onset and duration of the disease. In conclusion, under the conditions of this study, methotrexate therapy was effective in minimizing temporomandibular joint destruction and craniofacial dysmorphology in juvenile rheumatoid arthritis patients with the polyarticular form of the disease.

Adolescent↗
PubMed1994

[Operative and pathological observations on secondary synovitis of temporomandibular joint dysfunction syndrome].

14 cases (16 joints) with temporomandibular joint dysfunction syndrome (TMJDS) were included in the present study. All the patients had severe pain of the joint for a long time and the conventional therapy was not effective. The operative and pathological findings of the 14 cases showed that synovitis secondary to microtrauma of the joint really existed and might be one of the reasons causing the severe pain of the joint in some patients with TMJDS.

Adult↗
PubMed2005

Botulinum toxin for the treatment of temporomandibular joint disk disfigurement: clinical experience.

Type A botulinum toxin was used for the treatment of symptoms of 26 patients (40 joints) with temporomandibular joint disk disfigurement. In all patients, 0.5 ml (12.5 U) was injected into the lateral pterygoid muscle. The temporalis, medial pterygoid, and masseter muscles were injected if severe tenderness was noted. The data were compared using the Wilcoxon signed rank test and the McNemar test. With the exception of clicking of the right joint, all mean outcome measures showed a significant difference between the preinjection and postinjection assessments. There was a significant difference between the preinjection and postinjection pain scores of the right joint (P=0.0019) and the left joint (P=0.000). Postinjection values of the mouth opening (P=0.002), subjective functional dysfunction (P=0.065), and clicking of the left joint (P=0.001) also showed a statistically significant difference from the preinjection values. In addition, the severity and frequency of headache were reduced after botulinum toxin-A injection into the lateral pterygoid muscle.

Adult↗
PubMed2001

The utility of panoramic imaging of the temporomandibular joint in patients with temporomandibular disorders.

OBJECTIVE: The objective of this study was to evaluate the utility of panoramic imaging in assessment of patients with temporomandibular disorders (TMDs). STUDY DESIGN: Fifty-five consecutive patients referred for diagnosis and management of facial pain and jaw dysfunction were included. A single examiner completed the history and clinical examination on all patients. All patients received panoramic imaging. On the basis of clinical and radiographic findings, a subset of patients received advanced imaging modalities. The panoramic radiographs were interpreted by 2 examiners; if any disagreement was noted, a third examiner interpreted the radiographs. RESULTS: Seventy-five percent of the patients had complaints of facial pain, and 75% exhibited tenderness in masticatory muscles. Tenderness was present in TM joint regions in 62%. Altered bony anatomy was seen in 43.6% of panoramic radiographs. Panoramic imaging did not lead to changes in clinical diagnosis in any of the patients seen, although the findings on the radiographs did lead to requests for additional imaging studies in 3 cases, one of which was later referred for surgical intervention because of radiographic findings. CONCLUSION: Clinical findings may be of greater relevance leading to the diagnoses associated with TMD and to determination of the need for additional imaging rather than the use of panoramic imaging in all patients with facial pain and TMD.

Adolescent↗
PubMed1984

Meniscoplasty of the displaced temporomandibular joint meniscus without violating the inferior joint space.

Twenty temporomandibular joints with anterior meniscus displacement, both with and without reduction, were treated by meniscoplasty of the superior lamina of the bilaminar zone through the superior joint space. Reduction of the eminence was also performed on each joint. All joints were judged markedly improved both by the surgeon and patients. With an average postoperative follow-up of 18.1 months, 13 (65%) of the joints were pain free and seven (35%) had mild, transient pain with prolonged hard chewing or prolonged wide mouth opening.

Adolescent↗