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[The pathology of temporomandibular joint luxations--anatomical studies on temporomandibular joint preparations].

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.

Humans

Relationship between radiographic signs in the temporomandibular joint and hand joints.

The temporomandibular joints of 64 patients and the hand joints of 62 patients with mandibular pain and/or dysfunction were exposed in oblique lateral transcranial, transmaxillary, and dorso-volar projections. The relationship between radiographic signs generally ascribed to osteoarthrosis was investigated. Indices were constructed to quantify the radiographic findings in the two joints. In the temporomandibular joint statistically significant age-independent correlations were found between flattening of the lateral part of the condyle, subcortical sclerosis of the condyle and reduced joint space. In the hand joints statistically significant age-independent correlations were found between osteophytes, subcortical sclerosis, eroded/absent cortical outlining, reduced/obliterated joint space and dislocations. No statistically significant correlation could be found between radiographic findings in the temporomandibular and hand joints. It is concluded that the radiographic signs in the temporomandibular joint of reduced joint space, subcortical sclerosis of the condyle and flattening of the lateral part of the condyle are interrelated and probably characteristic of osteoarthrosis, and that these relationships are similar to those that occur in the hand joints.

Adolescent

[The synovial membrane of the temporomandibular joint. Histological and morphometric studies on 106 temporomandibular joints].

Thickness of synovial lining cell layers, cytological appearance of synovial cells, the grade of fibrosis, the distance between subsynovial blood vessels and synovial surface, possible inflammatory infiltrations etc. have been controlled in synovial preparates of 106 mandibular joints. The age dependent fibrosis of the synovial tissue has been demonstrated.

Adult

An approach to the management of temporomandibular joint dysfunction.

Temporomandibular joint dysfunction may result from a number of causes. Perhaps the commonest is muscular hyperactivity of central origin. Consequently, the dentist has to widen his investigations to take into account the life style of the patient and to deal with the expression of mental stress as muscular tension.

Health Education, Dental

Subluxation of the temporomandibular joint.

The temporomandibular joint in actual function does not resemble other joints in the body in that the condyles leave their fossae with maximal opening and in some subjects with only a 35 mm. opening. The term subluxation, with its implication of abnormality, does not seem applicable to a normal movement. While significant problems, such as dislocation, locking, and loud clicking, can occur with such anterior-to-the-fossae movements, they are relatively rare. Most temporomandibular problems are associated with confinment of the condyles to their fossae with limited or no translatory condylar movement. A recognition of the normal range of condylar movement would lessen iatrogenic abuse of this area.

Humans

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

The radiologic findings in synovial chondromatosis (chondrometaplasia) of the temporomandibular joint.

Synovial chondromatosis or chondrometaplasia is a rare disease in which foci of cartilage may develop in the synovial membrane, usually of the large diarthroidal joints. However, the temporomandibular joint may be affected, with less than 15 such cases documented. It is the purpose of this presentation to define the radiologic findings in synovial chondromatosis of the temporomandibular joint, not previously recorded, which allow for definitive diagnosis. These radiologic findings are: 1) widening of the joint space; 2) limitation of motion; 3) irregularity of joint surfaces; 4) presence of calcified loos bodies (cartilage); and 5) sclerosis of the glenoid fossa and mandibular condyle.

Adult

Rehabilitating children with temporomandibular joint ankylosis.

Although the probability of ankylosis following injury of the temporomandibular joint is small, patients, especially children with temporomandibular joint ankylosis, are greatly handicapped. Of the 42 cases of ankylosis seen in our clinic, six occurred in the adult, and 36 in children under 14 years of age. Treatment in all cases was surgical, and the results were beneficial, although the greatest difficulty in the treatment had been the early recurrence of ankylosis. Based on our experience, osteoarthrotomy for temporomandibular joint ankylosis in children has been advocated.

Adolescent

Anatomical and physiological considerations regarding the temporomandibular joint.

The structure and function of the human temporomandibular joint has concerned several investigators but still fundamental questions exist and require further examination. A profound knowledge of the normal anatomy and histology of the temporomandibular joint is necessary to understand its function and functional disturbances. It is also necessary for a good understanding of clinical findings and the interpretation of radiographs. In this paper a clinically orientated description has been given of the anatomy and histology of the mandibular head, the articular fossa and eminence, the articular disc, the capsule and ligaments, the synovial membrane, the innervation of the joint and the normal relationship between the different components. About the physiology of the temporomandibular joint many controversial theories exist. A lot of research has still to be done, especially in the field of the co-ordination of the function of both joints, the muscles and the dentition.

Cartilage, Articular

Results of a clinicopsychological study of diseases of the temporomandibular joint.

Patients' complaints relating to disorders of the temporomandibular joint appear to be becoming more frequent and to be occurring in younger age groups. In many cases no organic cause affecting the joint or the masticatory system can be identified as the sole cause of the symptoms. An investigation was therefore undertaken to determine whether psychological causes might also be implicated. Two questionnaires were used to establish a complete picture of patients from a number of countries who suffered from disorders of the temporomandibular joint. The first questionnaire sought particulars of the dental condition, family status, type of education, satisfaction with job and pay etc. The second was a personality questionnaire which had originally been prepared for the Olympic Games in Munich. Although the extensive data collected has not yet been fully evaluated it is clear that in addition to the well established dental causes such as shortened dental arches, deep overbite and cuspal interferences, a psychosomatic element is superimposed in many cases. It is hoped to develop a means by which those whose symptoms require a psychotherapeutic approach, either alone or in conjunction with dental treatment, can be identified.

Adolescent

Arthrotomographic evaluation of the temporomandibular joint.

Thirty-five arthrotomograms of the temporomandibular joint (TMJ) were done on 33 patients who had chronic pain and dysfunction of the TMJ. All patients were refractory to conservative treatment. Five arthrotomograms were normal; abnormalities were observed in 30. Abnormalities of the meniscus were anterior dislocation, anterior subluxation, perforation, tenting, and degenerative changes and adhesions. The significance of these abnormalities is discussed. Arthrotomography was found to be an integral part of the diagnosis and treatment of TMJ disorders.

Adolescent

Thickness of the soft tissue layers and the articular disk in the temporomandibular joint.

Out of 115 right temporomandibular joints from Swedish subjects aged 1 day to 93 years, 48 joints without any gross sign of arthrosis or deviation in form were examined histologically. The joint components were cut sagittaly, each into four parts. Histological sections were made of the condyle, the temporal component and of the articular disk. The total thickness of the soft tissue layers was measured in decalcified sections, cut from the medio-central and lateral parts of the condyle and the temporal component and from the medial, medio-central, latero-central and lateral regions of the disk. In the medio-central sections from the condyle and temporal component the thickness of the fibrous connective tissue layer i.e. the surface layer was also registered. The soft tissue layers were thickest in the condyle superiorly, about 0.4-0.5 mm, in the temporal component on the postero-inferior slope of the articular tubercle, about 0.5 mm, and in the disk posteriorly about 2.9 mm. In the roof of the fossa it was only 0.1 mm. The soft tissue layers on the condyle as well as the disk were thinner laterally while the corresponding tissue in the temporal component was thicker laterally. The thickness of the soft tissue layers seem to reflect the growth and functional load to which the joint is exposed.

Adolescent

Surgery for recurrent dislocation of the temporomandibular joint.

Chronic dislocation of the temporomandibular joint has been dealt with by a variety of conservative and surgical maneuvers. Two surgical procedures, the temporomandibular arthroplasty, and the temporal fascia flap, with a capsulorraphy, are described as reliable methods for dealing with this problem.

Adult

Condylar fractures of the mandible. II. a radiographic study of remodeling processes in the temporomandibular joint.

Remodeling processes in 76 temporomandibular joints were studied on radiographs from 67 individuals sustaining condylar fractures. The indivuduals were ranged into four age groups: 3-11, 12-15, 16-19, and larger than or equal to 20 years of age at the time of fracture. The radiographic examinations were to be performed at the time of the trauma and 3, 6, 12, 24 and 36-48 months after the injury. In the age group 3-11 there was a complete return to normal skeletal relations in 20 of the 27 joints. Joints in teenagers (12-19) did not become normal to the same extent and in adults only minor remodeling was observed. In children the remodeling of the condylar process was extensive but indistinctly outlined. With increasing age there was a shift towards a more distinct apposition of bone on the posterior part of the condylar head visualized as a double contour. This contour first appeared in the late teens. In adults the remodeling processes seemed only to be part of the functional adjustment. Thus, the remodeling processes of the condylar process in a clinical sense may be looked upon as restitutional in children and adjusting or functional in adults. As regards the articular fossa, in children the remodeling processes were first observed as a double contour, of which the new one became more and more distinct, while the original roof gradually disappeared. The final results was a flattened fossa. In adults, a sclerosis of the roof of the fossa was found.

Adolescent

[Hirtz's incidence in the study of the manducatory apparatus. Application to temporomandibular joint affections (author's transl)].

Radiological examinations have always been considered of secondary importance during diagnostic investigations of temporomandibular joint affections because of the frequency with which negative results were obtained. For most authors its only value has been to establish a differential diagnosis from other lesions of the manducatory apparatus in which clinical manifestations are comparable. A systematic study of the manducatory apparatus in patients with temporomandibular joint affections was carried out by taking two films, one with the month open, the other with the month closed, according to Hirtz's incidence. The results showed that abnormalities of varying degrees of severity were present relatively frequently. They usually involved the temporomandibular joint, either morphologically or physiologically. The multiplicity of the abnormalities observed, their character, and their frequency raise the problem of defining their role in the genesis of the disorders described and strongly suggests that the place of radiological investigations in the diagnostic tests for temporomandibular joint affections has to be reconsidered. The examination described would be, because of its simplicity, the basic investigation in the radiological study, with other studies possibly following on later to complement it.

Diagnosis, Differential

Temporomandibular joint meniscectomy--effects on joint structure and masticatory function in macaca fascicularis.

The postoperative effects of unilateral temporomandibular joint meniscectomy on joint structure and masticatory function were evaluated in four mature Macaca fascicularis and compared with one control. Mandibular movement during mastication was monitored objectively with an optoelectronic tracking system within four months and again within twelve months postmeniscectomy in each animal. Temporomandibular joint structure was documented radiographically and histologically. Results showed that degenerative joint disease was produced in the postsurgical joint, and that the morphological changes were location-dependent. Fibrous ankylosis was observed histologically in three animals. The contralateral joints were not affected morphologically, except for bony resorption of the articular eminence noted microscopically in one animal. Radiographically, however, the joint appeared normal. Variable alterations in masticatory patterns were observed following unilateral meniscectomy. While there appeared to be an association between temporomandibular joint structure and masticatory function, radiographic and microscopic observation of morphological alterations in the joint did not result in predictable functional limitations in chewing pattern.

Animals

Degenerative disease of the temporomandibular joint in young persons.

The majority of cases of temporomandibular joint pain that are referred to the consultant dental surgeon are diagnosed as pain-dysfunction syndrome, a term first suggested by Schwartz (1959) and now probably the most widely accepted. Another relatively common problem is degenerative disease or osteoarthrosis, and although this generally affects an older age group than pain-dysfunction syndrome, its occurance in the younger patient is by no means a rarity and is further evidence that the two conditions are expressions of the same problem, that is repetitive overloading of the joint. It is proposed that this should be termed mandibular stress syndrome.

Adolescent