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The aim of this study was to examine the Temporomandibular Joint of the thirty-eight adolescent subjects with Temporomandibular Joint Dysfunction Syndrome by means of Fuji Computed Radiography System (FCR). The following results were obtained: 1) It was indicated that the frequency of occurrence of the backward on the condyle position to fossa in the group with signs of TMJ Dysfunction was higher than the group without signs. Also it was suggested that the central position was a good position as the goal for improved position. 2) The revealed frequency of morphological abnormality of condyle in the group with signs was higher than the group without signs. 3) Internal derangement of meniscus was associated with signs of TMJ Dysfunction. In particular, sound and pain was definitely associated with the internal derangement. 4) The organic abnormal change (morphological abnormality of the condyle and internal derangement of meniscus) in the TMJ of adolescent patients with the TMJ Dysfunction Syndrome was found.
Temporomandibular joint dysfunction is often the cause of a variety of symptoms throughout the head and neck. Because such dysfunction plays an integral part in head pain and earache, differential diagnosis should include an evaluation of the temporomandibular joint. Dentists are the primary professionals involved in temporomandibular joint evaluation and treatment, but they are mainly concerned with nonmovable radio-opaque parts. Physical therapists, then, must learn more about this joint so they can assist dentists in restoring function to it. Principles of joint evaluation are presented relative to the temporomandibular joint so physical therapists can apply their expertise in joint and soft tissue management to assist dentists in restoring function to the temporomandibular joint.
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Temporomandibular joint arthrography has been helpful in selecting patients for reconstructive surgery who have severe temporomandibular joint dysfunction. Structural abnormalities of the soft tissues can be demonstrated where only minimal osseous changes are seen on tomography. The normal arthrographic anatomy of the joint is reviewed and normal and pathological joints are illustrated.
Temporomandibular joint (TMJ) abnormalities cannot be reliably assessed by a clinical examination. Magnetic resonance imaging (MRI) may depict joint abnormalities not seen with any other imaging method and thus is the best method to make a diagnostic assessment of the TMJ status. In patients with temporomandibular joint disorder (TMD) referred for diagnostic imaging the predominant TMJ finding is internal derangement related to disc displacement. This finding is significantly more frequent than in asymptomatic volunteers, and occurs in up to 80% of patients consecutively referred for TMJ imaging. Moreover, certain types of disc displacement seem to occur almost exclusively in TMD patients, namely complete disc displacements that do not reduce on mouth opening. Other intra-articular abnormalities may additionally be associated with the disc displacement, predominantly joint effusion (which means more fluid than seen in any asymptomatic volunteer) and mandibular condyle marrow abnormalities (which are not seen in volunteers). These conditions seem to be closely related. Nearly 15% of TMD patients consecutively referred for TMJ MRI will have joint effusion, of whom about 30% will show bone marrow abnormalities. In a surgically selected material of joints with histologically documented bone marrow abnormalities nearly 40% showed joint effusion. Disc displacement is mostly bilateral, but joint effusion seems to be unilateral or with a lesser amount of fluid in the contralateral joint. Abnormal bone marrow is also mostly unilateral. Many patients have unilateral pain or more pain on one side. In a regression analysis the self-reported in-patient TMJ pain side difference was positively dependent on TMJ effusion and condyle marrow abnormalities, but negatively dependent on cortical bone abnormalities. Of the joints with effusion only one fourth showed osteoarthritis. Thus, there seems to be a subgroup of TMD patients showing more severe intra-articular pathology than disc displacement alone, and mostly without osteoarthritis. It should, however, be emphasized that patients with TMJ effusion and/or abnormal bone marrow in the mandibular condyle seem to constitute only a minor portion (less than one fourth) of consecutive TMD patients referred for diagnostic TMJ imaging. The majority of patients have internal derangement related to disc displacement, but without accompanying joint abnormalities. In patients with rheumatoid arthritis and other arthritides TMJ involvement may mimick the more common TMDs. Using MRI it is possible, in most cases, to distinguish these patients from those without synovial proliferation.
Temporomandibular joint (TMJ) dysfunction may cause facial or aural pain. Conventional roentgenograms are useful to define bony pathologic conditions. However, TMJ arthrotomography may disclose joint meniscus abnormalities in two thirds of patients with persistent dysfunction despite normal roentgenograms.
Temporomandibular joint (TMJ) internal derangement is fairly prevalent in patients presenting with facial pain. MR imaging has become the primary modality for the assessment of the temporomandibular joint. A review of the normal anatomy and the key imaging findings of the different pathologic entities affecting this joint are presented. A reading algorithm to facilitate a systematic interpretation of the TMJ imaging study also is provided.
Temporomandibular joint (TMJ) is one of the most intricate and complicate loading joints in the human body. Articular cartilage is characteristic of low infiltrative, porous viscoelastic material. In physiological condition, there is a stress-absorbing architecture system in the TMJ cartilage, which consists of collagen-proteoglycan-water gel network. TMJ disc is a specific connective tissue as stress concentration absorber between condyle and articular fossa, but it does not belong to fibrocartilage. Retrodiscal tissue has high compliance of which the role is to play volume-compensating mechanism in joint movement. Lateral wall is a complexed structure out of ligament and capsule with weak tensile strength and tensile rigidity. Therefore, prolonged oral parafunction will result in joint fatigue and failure.
Temporomandibular joint (TMJ) arthrography is a valuable diagnostic method to evaluate the pathology of soft tissue components of the TMJ. However, arthrography is more or less invasive technique. The aim of this study was to investigate the sort and content of injury following TMJ arthrography. The symptoms before and after the arthrography were compared. In 90 joints that underwent TMJ arthrography, complications such as pain and/or trismus were encountered in 39 joints within one month. Twenty six patients complained of the change of pain conditions including the discomfort. The most common one was the pain on mouth opening. In every joint the pain disappeared within one month without any treatment. There was a high frequency of exacerbated pain in patients with some pain before the arthrography. The change of the degree of maximum opening was recognized in 11 patients. The duration of that condition was somewhat longer than that of pain conditions. In 5 joints with late clicking, 3 developed closed lock. Other complications were swelling, disability of mastication, eczema, hearing impairment and facial paresthesia. All the symptoms disappeared within 1 week without any treatment. From these results it was suggested that TMJ arthrography has low possibility of severe damage to the TMJ although there is some possibility of injury to the bone and soft tissue by arthrographic procedures.
For studying the relationship between condylar hypermobility of the temporomandibular joint (TMJ) and osteoarthrosis (OA), 13 patients with bilateral condylar hypermobility were evaluated clinically and radiographically, 30 years after non-surgical treatment. The evaluation included range of motion, joint and muscle tenderness to palpation, joint sounds and masticatory function. Radiographs of the TMJs were evaluated for the absence or presence of degenerative changes. The hypermobile group (HG) was compared with a control group (CG) (n = 13). The CG was evaluated in the same way as the HG. Statistics included t-tests (to compare ranges of motion in the HG over time and to compare ranges of motion in HG and CG), non-parametric tests (to compare tenderness of muscles and joints, joint sounds, masticatory function and radiographic changes over time in the HG). The tests were also used to compare the same variables between the HG and CG group. The groups' only difference was the presence of radiographic signs of OA. In the HG the number of joints with radiographic degenerative changes increased significantly over time and was significantly higher than the CG. Clinically and functionally, the HG and CG did not differ. Therefore, it is concluded that TMJ hypermobility is a subsidiary factor in the development of TMJ OA.
Temporomandibular dislocation and subluxation are two pathological situations both characterized by hypermobility of the condyle. We believe that when luxation is recurrent and when subluxation becomes painful or is accompanied by disc dysfunction, surgical intervention is indicated. We are impressed by Gosserez and Dautrey's (1967) method of augmentation of the tubercle, or extra-articular obstruction, which is a modification of Leclerc and Girard's (1943) original procedure. The advantages of this technique are described and results are based on a series of 38 patients.
Temporomandibular joint arthroscopy provides a minimally invasive surgical means of gaining access to the TMJ. It offers valuable diagnostic information and options in the treatment of TMJ dysfunction. Recovery and healing are more rapid, thereby reducing patient discomfort and rehabilitation time. It is estimated that there is an 85% to 90% success rate of this procedure. Patients with TMJ problems resulting from an emotional component can be helped, but their pain may persist because of related muscle tension.
The quality of life was assessed in 36 patients with painful dysfunction of the temporomandibular joint (TMJ) and 73 patients with TMJ dysfunctions suffering from rheumatoid arthritis. A more significant negative time course of the parameters was observed in patients with rheumatoid arthritis and more positive shifts in patients with isolated TMJ dysfunction without rheumatoid arthritis.
After a description of the published hypothesis of luxation and subluxation in the temporomandibular joint the preparations of five temporomandibular joints is described. The results refer to the movement of the discus and the capitulum mandibulae and to the effects of the musculus temporalis and of the facies articularis ossis temporalis. In addition a hypothesis is established according to which the temporomandibular-joint-luxation may be considered to occur in the menisco-condylar part of the joint.
OBJECTIVE: Fibrocartilage that bears tensile stress is typically fixed bilaterally to adjacent bone by collagenous fibres. For the temporomandibular joint, such disc fixations in the anterior and lateral regions have not been described, even in MRT findings of anterior disc dislocations without reduction. By observing collagenous fibres of the anterior and lateral discuss and capsule tissue, we sought to establish whether tensile load capacities typical for fibrocartilage also apply to the discuss articularis of the mandibular joint in sagittal direction. MATERIALS AND METHODS: Using dissection material from 20 adult and 10 newborn temporomandibular joint specimens, the position of the caput mandibulae in the fossa mandibularis or below the tuberculum articulare was ascertained. Serial sections were stained using alternately haemotoxylineosin and the Goldner method. RESULTS: Collagenous fibres from the medial and lateral discuss insert into the corresponding caput pole and form the limit of the lower joint cavity. In the anterior capsule region, two fibres may be seen coming in similar fashion from the pes disci to the retrodiscal bilaminary zone. They are denoted respectively as inferior and superior stratum anterior. They limit the upper and lower joint cavity in anterior direction. Depending on motion, both experience various tensile loads, together with the inferior and superior stratum posterior. The tensile loads exerted are described and clarified with drawings. CONCLUSION: Collagenous fibres coming anteriorly and laterally out of disc fibrocartilage provide evidence that sagittal tensile loads are also exerted on discs. Disc dislocations without reduction can only occur when the collagenous fibres coming from the disc also have ruptured. A more critical evaluation of anterior disc dislocations would seem to be called for.
Unilateral temporomandibular joint arthrography was performed in 40 healthy volunteers with asymptomatic and clinically normal temporomandibular joints. Thirty-four joints (85%) showed superior disk position, and six joints (15%) were radiographically abnormal with displacement of the disk. Thus, two showed anterior displacement, one showed rotational anterolateral displacement, one showed rotational anteromedial displacement, one showed sideways lateral and one showed sideways medial displacement. Thus, a negative clinical examination for temporomandibular joint internal derangements may involve a risk of being false-negative. All but one of the joints showed normalization of disk position during opening, and it is suggested that lack of functional disturbances accounts for the freedom of symptoms.
Diagnostic imaging plays an important role in the diagnosis of disorders of the masticatory system. The most frequent disorders are osteoarthrosis and internal derangements. The clinical diagnosis of these disorders may be confirmed by diagnostic imaging. In addition, diagnostic imaging contributes to the staging of the degenerative changes. Techniques for examination of the temporomandibular joint, including conventional (panoramic, transpharyngeal, transcranial) as well as more sophisticated techniques (tomography, fluoroscopy, arthrography, computed tomography, scintigraphy and magnetic resonance imaging) are briefly described. The interpretation of the radiological image of the joint in health and when affected by osteoarthrosis and internal derangement is presented.