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PubMedDate not supplied

[The temporomandibular joint from the rheumatologic viewpoint].

Temporomandibular joint affections in rheumatic disease are described. They were seen in inflamed joint diseases, mostly in rheumatoid arthritis, and less so in juvenile rheumatoid arthritis, psoriatic arthritis, Reiter's syndrome, ankylosing spondylitis, and collagen vascular disease. In osteoarthrosis, the temporomandibular joint affection occurs frequently but pain seems to occur most infrequently. We must bear in mind that a painful temporomandibular joint could be a symptom of myalgia, especially fibrositis syndrome with its painful tendon.

Arthritis, Rheumatoid↗
PubMed2001

Preserved costal cartilage homograft application for the treatment of temporomandibular joint ankylosis.

Ankylosis of the temporomandibular joint has been a daunting problem in oral and maxillofacial surgery. Condylectomy with gap arthroplasty is the basic technique for treatment of the fully grown patient. In the past, reconstruction has primarily been accomplished with alloplastic materials or with autogenous tissue harvested from the patient. Joints reconstructed with alloplastic materials have been subject to complications such as acute infection and chronic inflammatory problems as a result of foreign-body reaction with the immune system. Biologic reconstruction with autogenous materials does expose the patient to the risk of complications at the donor site. In the last 4 years, we have treated seven patients between the ages of 20 and 42 years who had complete temporomandibular joint ankylosis. In each patient, the affected joint was exposed through an extended preauricular incision. The ankylosed mandibular condyle with the surrounding abnormal bone, together with the coronoid process, was resected and removed. The ankylosed area was resected until an improvement of at least 15 mm in the interincisal opening distance was obtained. A solvent-preserved homologous cartilage graft was sculpted according to the size and shape of the gap and was then placed in it as interpositional material. Physical therapy, including active and passive mouth-opening exercises, began on the second postoperative day and continued for 6 months. Patients were observed for 6 months to 4 years. During this period, no major complications were noted, and satisfactory results were obtained. The initial mean interincisal opening distance was 15.2 mm after surgery, and the final mean interincisal opening distance was 32 mm after completion of physiotherapy. No recurrence was seen during the 4 years of follow-up. This technique seems to be an effective, time-saving, and simple alternative to other methods of joint reconstruction in adults who have fairly extensive ankylosis of the temporomandibular joint. In this article, a description of the surgical technique, a review of all cases, and recommendations for the use of this type of graft material are discussed. Our clinical experience over the past 4 years with the use of preserved homologous costal cartilage grafts as interpositional material has been encouraging.

Adult↗
PubMed2002

Magnetic resonance imaging findings of internal derangement in temporomandibular joints without a clinical diagnosis of temporomandibular disorder.

The purpose of this study was to assess the prevalences of magnetic resonance (MR) imaging findings of internal derangement (ID) in temporomandibular joints (TMJs) without a specific clinical diagnosis of temporomandibular disorder (TMD), and to investigate whether in this TMJ group the variable of pain may be linked to MR imaging findings of ID. The study comprised 109 patients, who were assigned a clinical uni- or bilateral TMJ-related diagnosis of 'absence of TMD'. Bilateral sagittal and coronal MR images were obtained subsequently to establish the prevalence of TMJ ID. An MR imaging diagnosis of ID was found in 99 (55.9%) of the 177 TMJs investigated. About 30.3% of the closed mouth-related TMJ positions characterized by disc displacement presented with anterior disc displacement, while 27.3% had anterolateral and 25.3% anteromedial disc displacement. Analysis of the data revealed the presence of TMJ pain to be associated with significantly more MR imaging diagnoses of disc displacement without reduction than disc displacement with reduction (P < 0.05), while there was no significant difference in the prevalences of ID and those of absence of ID (P > 0.05). Using chi-square analysis, no significant relationship was found between the presence of TMJ pain and the MR imaging diagnosis of TMJ ID (P=0.93). Use of the kappa statistical test indicated poor diagnostic agreement between the presence of TMJ pain and the MR imaging diagnosis of ID (kappa=0.01). The results suggest TMJs with a clinical diagnosis of 'absence of TMD' to be associated with a high rate of IDs, while in these instances the clinical variable of TMJ pain may have no effect on prevalences of MR imaging diagnoses TMJ ID. The data confirm the aspect of clinical diagnostic criteria as an unreliable instrument in predicting MR imaging diagnoses of TMJ ID.

Adolescent↗
PubMed1992

Temporomandibular joint: relationship between MR evidence of effusion and the presence of pain and disk displacement.

OBJECTIVE: The purpose of this study was to correlate MR evidence of joint effusion in the temporomandibular joint with symptoms of joint pain and the presence of disk displacement and arthrosis. SUBJECTS AND METHODS: The temporomandibular joints of 379 patients with clinical symptoms of temporomandibular joint disorders and 11 asymptomatic volunteers were imaged bilaterally. Sagittal and coronal proton density-weighted and T2-weighted images were obtained. Imaging findings of joint effusion were correlated with the presence of disk displacement and arthrosis and the symptom of pain. RESULTS: MR showed effusion in 7% of the joints with normal superior disk position, 40% of the joints with disk displacement with reduction, 50% of the joints with disk displacement without reduction, and 27% of the joints with arthrosis. Two of the control subjects had disk displacement with reduction; MR did not show joint effusion in any of the control subjects. A strong association was seen between joint effusion and joint pain. Joint effusion was seen in 46% of the joints on the more painful side and in 13% of the joints on the less painful side. CONCLUSION: The results show that temporomandibular joint effusions primarily occur in joints with disk displacement and are strongly associated with joint pain.

Humans↗
PubMed1978

Implant of articular eminence for recurrent dislocation of the temporomandibular joint.

Hypermobility of the temporomandibular joint is often caused by trauma, by opening the mouth too wide, by having a mouth forced open during general anesthesia procedures, or by dental procedures. The capsule may be stretched to an extent that dislocation occurs more easily thereafter. An implant of Vitallium mesh attached to the zygoma to restrict anterior movement of the condyle is used to prevent recurrent dislocation of the temporomandibular joint.

Dental Implantation↗
PubMed1992

A comparison of clinical examination, history, and magnetic resonance imaging for identifying orthodontic patients with temporomandibular joint disorders.

The temporomandibular joint (TMJ) status of 51 juvenile orthodontic patients was assessed with magnetic resonance imaging (MRI), clinical examination, and questionnaire data. The results of this study demonstrated that the prevalence of anterior displacement of the meniscus was 11.8% (6 of 51) as assessed by MRI. Clicking or pain in the TMJ area was found in 9.8% (5 of 51) of the subjects by clinical exam, and 19.8% (10 of 51) of the subjects had a history of pain or clicking of the TMJ. Three subjects had a positive MRI and a negative history and clinical examination. However, all subjects with positive MRI findings had a history of other risk factors known to be associated with TMJ internal derangement (TMJ-ID). Therefore practitioners should use a history form and a clinical examination technique that includes a broad range of signs and symptoms of temporomandibular disorders (TMD) to identify patients who may have abnormal condyle disk relationships and be at risk for TMD. Clicking and pain in the TMJ helped identify only one half of the patients with abnormal condyle-disk relationships in this study population. Future cephalometric studies will monitor the effects of abnormal condyle disk relationships on facial growth during orthodontic treatment.

Adolescent↗
PubMed1995

Magnetization transfer contrast on gradient echo MR imaging of the temporomandibular joint.

Thirty-nine temporomandibular joints (TMJ) from 20 patients with suspected internal derangements were imaged by a 1.5 T MR imager. The on-resonance binomial magnetization transfer contrast (MTC) pulse was applied to gradient echo images with a dual receiver coil (9 s/section). With the use of an opening device, a series of sequential images were obtained at increments of mouth opening and closing. The tissue signal intensities with (Ms) and without (Mo) MTC were measured and subjective image analysis was performed. Compared with the standard images, MTC technique provided selective signal suppression of disks. The average of Ms/Mo ratio of the disks (0.56) was lower than that of the retrodiskal pad (0.79) and of the effusion (0.89). With MTC technique, fluid conspicuity was superior to standard image. However, no significant superiority was found in disk definition subjectivity.

Adolescent↗
PubMed1994

Orofacial athletic injuries and involvement of the temporomandibular joint.

Injuries to the temporomandibular joint can range from contusion to complex displaced fractures. Major factors in the treatment of any injury are the patient's age and the stage in development of the temporomandibular joint and surrounding structures. A failure to diagnosis or the lack of proper treatment may lead to deformities. Following initial evaluation and management, vigorous mobilization of the joint remains a cornerstone of treatment.

Adolescent↗
PubMed1991

Ultrathin arthroscope for use in the lower compartment of the temporomandibular joint.

Arthroscopy of the temporomandibular joint has been performed mainly in the upper joint space because the instruments available have been too thick to be safely inserted into the lower joint space. This article describes a newly developed ultrathin arthroscope with an outer diameter of 0.69 mm that has been specifically developed to be used in the lower space of the temporomandibular joint. This arthroscope can be inserted into the lower joint space with a standard 18-gauge needle. The article describes the arthroscope in its initial application to patient and cadaver material.

Arthroscopes↗
PubMedDate not supplied

Osteomyelitis of the temporomandibular joint.

Osteomyelitis of the temporomandibular joint is very uncommon, and osteomyelitis as a result of Aspergillus niger infection has not previously been reported. A case report of skull base and condylar osteomyelitis is presented. Previously reported cases of temporomandibular joint osteomyelitis are reviewed, and management is discussed. Because of the significant morbidity possible with infections in this region, otolaryngologists should be familiar with the anatomy, diagnostic modalities, and therapeutic options. [Editorial comment: This unusual case presents unique aspects of the pathophysiology of osteomyelitis of the skull base.]

Aged↗
PubMed1990

Parotid gland malignancy presenting as temporomandibular joint pain or dysfunction.

Temporomandibular joint pain and dysfunction is a common complaint and a frequent cause of referral to oral and maxillofacial surgeons. The importance of considering malignant disease in the differential diagnosis is illustrated by the following cases of parotid gland neoplasia which were referred as temporomandibular joint dysfunction.

Aged↗
PubMed1986

Temporomandibular joint dysfunction in infancy.

Temporomandibular joint (TMJ) dysfunction describes a pain-dysfunction phenomenon that usually afflicts persons in their 4th or 5th decade. The syndrome can be produced by a variety of etiologic factors including occlusal disharmony, articular disorders, and muscle imbalance. It may cause severe otalgia and refer pain to the temple, occiput, nape of neck, and shoulders. Often, associated joint clicking or popping, aural fullness, vertigo, tinnitus, subjective hypoacusis, and nausea occur. As it has not been previously reported in infants, we would like to describe our experience with this disorder in an 11-month-old boy who was referred to our clinic with a presumed diagnosis of otitis media. The embryology of the temporomandibular joint is reviewed and appropriate treatment with anti-inflammatory analgesics, warm compresses, orthodontics, and external brace appliances is discussed. Because of referral patterns in the infant age group, the pediatric otolaryngologist should be similar with this entity and its presentation in children.

Diagnosis, Differential↗
PubMed1985

The phantom earache. Temporomandibular joint dysfunction in children.

Temporomandibular joint dysfunction is a benign, relatively uncommon childhood disorder and should be considered in children who have intermittent unilateral otalgia of three to four days' duration and whose audiographic, tympanometric, and clinical otologic examinations reveal normal findings. Most of the patients in our study had undergone orthodontic therapy during the year preceding the onset of temporomandibular joint dysfunction, and the vast majority of them had received orthodontic treatment within two weeks of each episode of otalgia. The diagnosis can be confirmed clinically by reproducing the pain associated with masticatory muscle spasm by palpation of the preauricular areas, intraotic manipulation, and palpation of the pterygoid muscles. Treatment consists of administering acetaminophen, applying hot compresses to the preauricular area, and opening and closing the mouth 30 to 40 times after each compress as an effort to interrupt the muscle spasm.

Adolescent↗
PubMed1990

Surgical correction of temporomandibular joint ankylosis.

The correction of temporomandibular joint ankylosis is frequently followed by re-ankylosis, occlusal disturbance and alteration of functional masticatory movements. A multitude of surgical procedures have been devised in an attempt to overcome the complication of re-ankylosis in particular, and to create a functioning pseudoarthrosis where distance between resected bone surfaces and/or interpositional autogenous, homologous or alloplastic material is relied upon to prevent re-ankylosis and facilitate functional joint activity. Success in preventing re-ankylosis is said also to depend on long-term patient compliance in undertaking frequent and usually painful mandibular movement exercises. Achieving a functioning joint often precludes the maintenance of the occlusion and depends on resection of large amounts of bone and the use of alloplastic implants. A surgical technique is presented whereby a minimal gap arthroplasty in the region of the obliterated temporomandibular joint is completed. This minimizes deviation of the mandible to the operated side with the formation of an anterior open bite. Separation of the resected bone surfaces is accomplished using a composite free auricular skin and cartilage graft in order to prevent re-ankylosis as efficaciously as possible, while allowing for the promotion of immediate postoperative mandibular function, continued growth and the construction of a joint similar in broad terms to the pre-existing joint. A two-stage correction of temporomandibular joint ankylosis and concomitant secondary maxillofacial deformity is recommended. The results in 13 patients (17 joints) with a follow-up range of 1.5 to 5.5 years show that in all but one instance (of fibrous re-ankylosis following postoperative joint infection), satisfactory postoperative mandibular function and mouth opening was achieved.

Adolescent↗
PubMed1998

Inverted, T-shaped silicone implant for the treatment of temporomandibular joint ankylosis.

Reconstruction of the ankylosed temporomandibular joint is a challenging task. Speech impairment, difficulties with mastication, poor oral hygiene, facial asymmetry, and mandibular micrognathia results in physical and psychologic disabilities. Various surgical techniques with varying success rates have been reported. Many autogenous and alloplastic materials have been proposed. The authors used an inverted, T-shaped silicone implant for the reconstruction of the temporomandibular joint after the release of the ankylosis in 10 patients without any complications in the postoperative period. The authors assert that the reconstruction of the ankylosed temporomandibular joint with an inverted, T-shaped silicone implant is a reliable and effective alternative. This technique can be used according to the special requirements of each patient and obviating the need for the fixation of the implant and is a safer and better way of using silicone for the treatment of temporomandibular joint ankylosis.

Adolescent↗