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PubMed1983

Clinical and radiological study of patients with anterior disc displacement of the temporomandibular joint.

Patients displaying temporomandibular joint clicking or with a history of clicking followed by limitation of opening were subjected to clinical and radiological examinations including arthrography. Arthrotomographically the patients were found to have anterior displacement of the disc. In patients with clicking the disc was repositioned in association with clicking during opening. In patients with limitation of opening the disc was constantly displaced anterior to the condyle, blocking anterior condylar translation. The patients with limitation of opening had more pain, more signs of mandibular dysfunction, more hard tissue changes and more frequent perforation and deformation of the disc, compared to patients with clicking only. These findings may justify two different diagnoses, displacement with and without repositioning of the disc on opening. Displacement without repositioning seems to be the more advanced condition and may in some cases be a precursor of osteoarthrosis.

Adolescent↗
PubMed2005

[Indications for validity of computed tomography and magnetic resonance imaging of the temporomandibular joint].

Recurrent pains of the temporomandibular joint represent a frequent symptom with numerous different causes. CT and MRI can reliably show the cause of these disorders and therefore have substituted conventional X-ray imaging. Modern multi-slice-CT (MSCT) allows for examination of the skull base including the mandible in a very short time with thinnest slice collimation (0.75mm). With 2D- and 3D-reformations reconstructed out of this volume data set in parasagittal, coronal or any other arbitrary slice orientation excellent imaging of fractures and bony changes of arthrosis as well as benign and malignant tumors of the temporomandibular joint can be performed. MRI offers very good soft tissue contrast in order to visualize the intra-articular disc, the ligaments and muscles, as well the possibility to acquire cross sectional images in any user-defined orientation. MRI is the method of choice to diagnose ,,internal derangement", particularly displacement of the intra-articular disc and inflammatory disease of the temporomandibular joint. The present paper will provide diagnostic strategies for the use of MSCT or MRI imaging concerning the different causes of disorders of the temporomandibular joint.

Arthralgia↗
PubMed1998

[The characteristics of formulating a diagnosis in diseases of the temporomandibular joint].

Classifications of temporomandibular diseases are discussed and formulations of diagnosis considered. The terms "articular dysfunction", "arthropathy", "arthritis", and "arthrosis" are defined and variants of their usage determined. A notion "arthralgia" is introduced as an individual nosological entity among temporomandibular diseases. The most frequent diagnostic errors are enumerated. The authors emphasize the undesirability of using some obscure terms and of diagnoses formulated as "arthrosis-arthritis" in diseases of the temporomandibular joint.

Adult↗
PubMed1992

The relationship between level of mandibular pain and dysfunction and stage of temporomandibular joint internal derangement.

Temporomandibular joint internal derangement (TMJ ID) is the most common intra-articular TM disorder and can progress from TMJ ID with reduction to TMJ ID without reduction. It is not known whether this anatomical progression is associated with increasing levels of mandibular dysfunction. The objective of this study was to determine whether the level of clinically detectable mandibular dysfunction was related to the stage of TMJ ID. Two clinicians examined 42 subjects prior to bilateral TMJ arthrographic evaluation. The level of mandibular dysfunction was calculated by Helkimo's Clinical Dysfunction Index (Di) and the Craniomandibular Index (CMI). Statistical analysis revealed that the level of mandibular dysfunction as determined by the Di and CMI was not related to the arthrographic presence or absence of TMJ ID. Therefore, the clinician cannot assume that the level of mandibular dysfunction is directly related to the absence or presence of TMJ ID. Epidemiologically, the CMI and Di can be used only for estimation of the degree of mandibular dysfunction, since they do not provide direct information on a specific TM disorder.

Adolescent↗
PubMed2005

Ultrasonography of the temporomandibular joint: comparison of findings in patients with rheumatic diseases and temporomandibular disorders. A preliminary report.

OBJECTIVE: The objective of the study was to compare findings from ultrasonography (US) of the temporomandibular joint (TMJ) in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and temporomandibular disorders (TMD). STUDY DESIGN: US assessment of the temporomandibular joints was bilaterally performed in 68 patients (22 with RA, 11 with PsA, and 35 with TMD). All the TMJs were assessed for the presence of disc displacement, effusion, and changes of the condylar profile, and the prevalence of such abnormalities was compared across the 3 groups of patients. To confirm generalizability of results, US findings were also compared with those of magnetic resonance (MR), taken as the standard of reference. RESULTS: Prevalence of disc displacement and changes in condylar profile were similar between patients with rheumatic diseases and temporomandibular disorders, while effusion was significantly more present in TMJs of TMD patients. Sensitivity of US to detect TMJ abnormalities was acceptable, while specificity was low for condylar alterations. CONCLUSIONS: Temporomandibular joint involvement in patients with rheumatic diseases seems to be similar to that described in subjects with temporomandibular disorders. Ultrasonography confirmed to be an accurate technique to detect disc displacement and effusion within the temporomandibular joint, but not to detect condylar abnormalities.

Adult↗
PubMed1997

The diagnostic value of ultrasonography to determine the temporomandibular joint disk position.

OBJECTIVE: Temporomandibular joint (TMJ) arthrography and magnetic resonance imaging are the imaging techniques of choice in patients presenting with signs and symptoms of TMJ disorders suggesting soft tissue pathosis. With the disadvantage of arthrography as an invasive procedure and magnetic resonance imaging posing a problem in clinical availability and cost, the purpose of this study was to determine whether ultrasonography could be used to assess the presence or absence of disk displacement in patients with TMJ disorders. STUDY DESIGN: In 17 patients, 100 TMJ positions were investigated by static and dynamic ultrasonography to analyze the disk-condyle relationship. To compare the respective findings with those of a diagnostic method offering high accuracy, coronal and sagittal magnetic resonance imaging was carried out immediately afterwards. RESULTS: With static ultrasonography showing a sensitivity of 0.41 and a specificity of 0.70 and dynamic ultrasonography a sensitivity of 0.31 and a specificity of 0.95, the data revealed that static and dynamic ultrasonography are marginal in detecting the presence of disk displacement, but dynamic ultrasonography is sensitive in detecting the absence of disk displacement. However, with a positive predictive value of 0.61 and a negative predictive value of 0.51 for static ultrasonography, and a positive predictive value of 0.88 and a negative predictive value of 0.55 for the dynamic technique, the results indicate that both modalities are insufficient in establishing a correct diagnosis for the presence or absence of disk displacement. CONCLUSION: In view of the fact that dynamic ultrasonography proved to be a reliable diagnostic aid for the detection of normal disk position, the results of this study should be of further interest and encourage research in its potential uses and diagnostic capabilities.

Adolescent↗
PubMed2003

Measurement of nitric oxide in temporomandibular joint saline aspirates.

Temporomandibular joint (TMJ) saline aspirates, obtained from the upper joint space of 17 patients undergoing TMJ arthroscopy under general anaesthesia were assayed for the presence of nitrite, a stable metabolite of nitric oxide by a spectrophotographic method using the Griess reaction. Measurable levels of nitrites were found in the saline aspirates of both symptomatic and asymptomatic joints. There was no statistically significant difference between the two sides. The presence of nitric oxide metabolites in the asymptomatic joints has not been previously reported in the literature. This finding may represent a latent disease process in the symptomless joint.

Adult↗
PubMed1997

[Involvement of the temporomandibular joints in Bechterew's disease].

Temporomandibular joints are involved in Bechterew's diseases in 59.6% of cases, more often in the peripheral form of the disease. Involvement at the debut of the disease was observed in 33.3%, including monoarthritis in 28.6%. The incidence of these lesions correlated with involvement of the hip, knee, and ankle joints. Unstable symmetrical arthritides with early rigidity predominate in the clinical picture. Extraarticular symptoms, such as defiguration, tenosynovitis, are typical. X-ray examination reveals pseudodilatation of the joint fissure, periarticular osteosclerosis, ossification of the ligaments, early ankylosis without predestruction. Erosive changes of the temporomandibular joint are not typical. Scintigraphy with pertechnephore is an informative method for ruling out other diseases of the temporomandibular joint.

Cephalometry↗
PubMed1989

[A preliminary study on the clinical application of temporomandibular joint arthroscopy].

The temporomandibular joint arthroscopy was performed on 24 joints of 18 patients. The procedure was carried out under local anaesthesia by inferiolateral approach. Main changes of upper compartments were showed on the bilaminar zone, including disc perforation and anterior displacement and capsular loosening. The abnormal discoveries of lower compartments were mainly erosion of the condylar cartilage. The indications and techniques of arthroscopy of TMJ were discussed and described.

Adult↗
PubMed2002

Immunohistochemical study of interleukin-1beta and interleukin-1 receptor antagonist in an antigen-induced arthritis of the rabbit temporomandibular joint.

BACKGROUND: In temporomandibular joint (TMJ) arthritis, there is limited knowledge of the relationship between interleukin-1beta (IL-1beta) and interleukin-1 receptor antagonist (IL-1ra), as well as the source of these cytokines. We investigated the development of an antigen-induced arthritis in the rabbit TMJ immunohistochemically. METHODS: Unilateral TMJ arthritis was induced in 32 adult New Zealand White rabbits. From 6 h to 12 weeks after induction of arthritis, topology of IL-1beta and IL-1ra were observed. RESULT: The acute stage of induced arthritis lasted for one week after induction, thereafter it became chronic. In the early phase of the acute stage, infiltrating inflammatory cells, as well as synovial cells, produced IL-1beta and IL-1ra. In the late phase of the acute stage, the main source of these cytokines was subsynovial fibroblasts. In this phase of arthritis, IL-1beta and IL-1ra did not appear to be produced by synovial cells. From the early to intermediate phase of the chronic stage, proliferating synovial cells produced IL-1beta and IL-1ra. In this phase of the arthritis, these cytokines were also observed in a cluster formation in chondrocytes. CONCLUSION: This arthritis model shows a staging of the joint inflammation process with time. IL-1beta and IL-1ra are produced by a certain kind of cells depending on the stage of inflammation.

Acute Disease↗
PubMed2002

Asymptomatic cervical spine dysfunction (CSD) in patients with internal derangement of the temporomandibular joint.

Patients with temporomandibular disorders (TMDs) frequently show symptoms related to the cervical spine. It is however unknown whether patients with TMD who have no symptoms in the neck region often have signs of cervical spine dysfunction (CSD) and whether there is a predominant localization of these asymptomatic CSDs. In a prospective and controlled examiner-blinded clinical trial, the prevalence and localization of asymptomatic CSD in patients with TMD was examined. Thirty patients with internal derangement of the temporomandibular joint but without any neck problems were compared with 30 age and gender matched healthy controls. Significantly more asymptomatic dysfunctions of the vertebral joints and increased muscle tenderness were found in the patient group. The difference between patents and nonpatients for vertebral joint dysfunction and muscle tenderness was greatest in the upper cervical spine. These findings support the thesis that a complementary examination of this area should be performed, even when TMD patents do not report any neck problems.

Adult↗
PubMed1975

Innervation of the temporomandibular joint.

The human temporomandibular joint in transverse and longitudinal section was found to have two types of mechanoreceptors. One of capsular form approximately 40 times 200 mum innervated by myelinated nerve fibres 8 mum in diameter and the other corresponding to the Golgi tendon organ was innervated by myelinated nerve fibers 15 mum in diameter which on entering the tendon organ lost their myelin sheaths.

Adipose Tissue↗
PubMed1998

Soft and hard tissue correction of facial deformity associated with bilateral temporomandibular joint ankylosis.

Bilateral temporomandibular joint ankylosis in childhood can result in severe facial deformity characterized by both hard and soft tissue changes. The soft tissue deformity manifests as a submental hump of redundant soft tissue which has been displaced inferiorly due to deficiency of skeletal attachments. Improved results can be produced in these cases if the orthognathic correction is complemented by correction of the soft tissues. The presence of microgenia makes it possible to reach the subplatysmal plane through an intraoral incision allowing for the plication of platysma and relocation of the displaced soft tissues from the cervical to the mental region.

Adipose Tissue↗
PubMed2004

Involvement of tumor necrosis factor-alpha and interleukin-8 in antigen-induced arthritis of the rabbit temporomandibular joint.

BACKGROUND: In temporomandibular joint (TMJ) arthritis, knowledge is limited about the source of the inflammatory mediators. The aim of this study was to investigate the immunohistochemical role of tumor necrosis factor-alpha (TNF-alpha) and interleukin-8 (IL-8) in the development of the antigen-induced arthritis of the rabbit TMJ. METHODS: Unilateral TMJ arthritis was induced in 28 adult rabbits. From 6 h to 6 weeks after induction of arthritis, the topology of TNF-alpha and IL-8 was observed. RESULTS: Positive reaction for TNF-alpha of synovial cells was observed within 3 days after induction and at 3 weeks after induction. TNF-alpha positive vascular endothelial cells and chondrocytes were identified throughout the observation period. IL-8 was detected only during the acute stage. CONCLUSIONS: The cytokines TNF-alpha and IL-8 were observed in specific cells depending on the stage. TNF-alpha was particularly related with angiogenesis and cartilage destruction and IL-8 was involved in the acute stage of inflammation.

Animals↗
PubMed2003

Biomechanical behavior of the temporomandibular joint disc.

The temporomandibular joint (TMJ) disc consists mainly of collagen fibers and proteoglycans constrained in the interstices of the collagen fiber mesh. This construction results in a viscoelastic response of the disc to loading and enables the disc to play an important role as a stress absorber during function. The viscoelastic properties depend on the direction (tension, compression, and shear) and the type of the applied loading (static and dynamic). The compressive elastic modulus of the disc is smaller than its tensile one because the elasticity of the disc is more dependent on the collagen fibers than on the proteoglycans. When dynamic loading occurs, the disc is likely to behave less stiffly than under static loading because of the difference of fluid flow through and out of the disc during loading. In addition, the mechanical properties change as a result of various intrinsic and extrinsic factors in life such as aging, trauma, and pathology. Information about the viscoelastic behavior of the disc is required for its function to be understood and, for instance, for a suitable TMJ replacement device to be constructed. In this review, the biomechanical behavior of the disc in response to different loading conditions is discussed.

Adaptation, Physiological↗
PubMed2006

Effects of ascorbic acid concentration on the tissue engineering of the temporomandibular joint disc.

The temporomandibular joint (TMJ) disc is a specialized fibrocartilaginous tissue. When the disc becomes an obstacle and becomes damaged, surgeons have no choice but to perform a discectomy. Tissue engineering may provide a novel treatment modality for TMJ disorder patients who undergo discectomy. No studies have been conducted on the most favourable media for TMJ disc cells. The objective of the current study was to examine the effects on biochemical and biomechanical properties of varying ascorbic acid concentrations (0, 25, or 50 microg/ml) on TMJ disc cells seeded on non-woven PGA scaffolds. The ascorbic acid concentration of the 25 microg/ml group resulted in more effective cell seeding of the scaffolds, with 1.53 million cells per construct, by comparison with the 0 and 50 microg/ml groups which had 1.20 million and 1.32 million cells per scaffold respectively. At week 4, the 25 microg/ml group had a higher collagen content than the 0 microg/ml group, with 30.4 +/- 2.7 and 24.9 +/- 3.3 microg of collagen per construct respectively. The 25 microg/ml group had a higher aggregate modulus than the 50 microg/ml group, with values of 6.1 +/- 1.3 and 4.0 +/- 0.9 kPa respectively at week 4. The results of this study indicate that the use of 25 microg/ml of ascorbic acid in culture media is effective for the tissue engineering of the TMJ disc, significantly outperforming media without or with 50 microg/ml of ascorbic acid.

Animals↗
PubMed2000

A clinical study on temporomandibular joint ankylosis.

OBJECTIVE: Temporomandibular joint (TMJ) ankylosis results from trauma, infection and inadequate surgical treatment of the condylary area. Many techniques for treatment have been described so far. However, none of them gave uniformly successful results. A limited range of intrinsical opening due to relapse, loss of vertical height of the affected ramus, foreign body reactions and reankylosis are expected complications. However, wide bone resection, the use of interpositional spacer, insensitive and aggressive physiotherapy immediately after the operation are the basic principles as agreed by many authors. In this article, a review of the historical background of the treatment has been discussed. METHODS: A clinical and retrospective evaluation of 42 patients treated for this disorder showed that 89% of all patients had unilaterally and 11% had bilateral ankylosis. From the viewpoint of the techniques we used, patients fell into three groups. In two groups, two different type of spacers were used, and in the third group gap arthroplasty were performed for the treatment of TMJ ankylosis. RESULTS: Our results revealed a predominance of traumatic aetiology. The highest incidence was between the ages of 11 and 20. A total of 45.24% of the patients were treated by interpositional arthroplasty by using acrylic spacer, 11.90% of the patients by sylastic sheet used as an interpositional material and the rest of the cases (42.86%) were treated only by gap arthroplasty. CONCLUSION: The advantages of the spherical acrylic spacer and gap arthroplasty were discussed. The advantages of the techniques are, shorter operating time, and more importantly its very low cost.

Adolescent↗