Temporomandibular Joint Area Research Articles

Management of Temporomandibular Joint Arthritis using Low Level Laser Therapy method

Background: Many studies have recommend using low-level laser therapy (LLLT) in pain reduction in acute and chronic musculoskeletal pain. Objective: To clinically evaluate the effectiveness and validity of (LLLT) for management symptoms of temporomandibular joint (TMJ) arthritis. Methodology: A clinical study included patients with TMJ arthritis signs and symptoms, were randomly categorized into two groups of ten patients each. Patients of the first group were subjected to pre adjusted (LLLT) over four weeks together with NSAIDs. Patients were evaluated clinically according to following groups: (T1) before any treatment (T2) after six sessions of laser therapy application. (T3) after 12 laser therapy sessions applications. (T4) one month after the last session application. The second group received only (NSAIDs). They were evaluated at the same time intervals of the first group. Evaluation criteria were: • Maximum mouth opening which measured in mm using ruler. • Presence or absence of pain at TMJ area. The VAS method was used to quantify pain at TMJ area with palpation. Results: Evaluation of maximum mouth opening in mm showed highly marked significant clinical improvement In (LLLT and NSAIDs) group. The same clinical improvement was noted in (NSAIDs) group.Comparison of results between the two groups showed a marked significant clinical improvement in pain reduction in favor of the (LLLT and NSAIDs) group during all evaluation periods. Same clinical improvement in pain reduction in favor for (LLLT and NSAIDs) group was noted in (VAS).Conclusion. (LLLT) in patients with TMJ arthritis is safe and effective technique to be used.

Assessing Safety and Clinical Effectiveness of New Approaches to Planning and Integrated Implementation of Full-Mouth Reconstruction.

Objectives Planning, adequate preparation, and further prosthodontic management are the most important steps in the treatment of this population of patients with dental and mandibular anomalies. The purpose of the article is the improvement of safety and clinical effectiveness of prosthodontic rehabilitation of patients after full-mouth reconstruction. Materials and Methods A single-center open prospective nonrandomized study, examination, and treatment of 198 patients with partial or total absence of teeth were performed. Higher safety and clinical effectiveness of the treatment were found in the patients of the main group who showed a significant reduction in the rate of complications relative to the comparison group. In the main group, the number of aesthetic defects and cases of repeated prosthetics decreased in comparison with the corresponding occurrence rate of such cases in patient groups. Results It showed statistically significantly reduction in the rates of occurrence of the complications when using the proposed algorithm: the rate of inflammation of the marginal periodontium and peri-implant tissues in the main group was 2.9 times less frequent and loosening of the supporting implants was 3.9 times less frequent. The rate of polymer chipping or abrasion in the area of the incisal edge or masticatory surface was two times lower in the main group of patients, short crowns were found 1.9 times less often, sores in the area of the dental pontic in the main group were 1.8 times less frequent than in the comparison group, and no fractures of bridgework were found in the main group. The frequency of neuralgic facial pain in the patients of the main group was 5.2 times less than in the comparison group, complaints about pain in the temporomandibular joint area were 8.4 times less frequent, increased abrasion of antagonist teeth was 3.9 times less frequent, and phonetics disorders were 8.4 times less frequent. The effectiveness of the algorithm developed by us is also confirmed by the fact that the number of aesthetic defects and cases of the need for repeated prosthetic treatment was reduced in comparison with the corresponding frequency of such cases in groups of patients where standard approaches to prosthetics were applied. In particular, aesthetic defects found in the main group of patients were 2.5 times less frequent than in the comparison group, and repeated prosthetics was performed 2.7 times less frequently. Conclusion Application of the developed comprehensive approach to planning of prosthodontic rehabilitation provides for significant reduction in the frequency of complications and aesthetic defects, as well as cases of repeated need for prosthetics.

Diffuse-type tenosynovial giant cell tumor of the temporomandibular joint with skull base invasion: a report of 22 cases with literature review

The aim of this study was to retrospectively analyze the clinical characteristics, surgical treatment, and prognosis of patients with diffuse-type tenosynovial giant cell tumor (D-TGCT) involving the temporomandibular joint (TMJ) and the skull base. A retrospective study was performed in patients with D-TGCT involving the TMJ and the skull base at our institute from April 2009 to August 2018. Data on clinical characteristics, surgical treatment, and prognosis were collected and analyzed. A literature search on D-TGCT involving the TMJ was conducted and the data analyzed. The study included 22 patients (14 males and 8 females), with an average age of 44 years. The main symptoms were headache and hearing limitation, accompanied by a swelling in the TMJ area. Magnetic resonance imaging (MRI) showed low signals on T1- and T2-weighted images. All lesions were completely removed. Temporal bone flap, titanium mesh, and temporal muscle flap were used for reconstruction. The recurrence rate was 4.5%. In the literature, 115 cases were reported. Surgery alone was performed in 88 cases; postoperative radiotherapy was performed in 19 cases; the tumor recurrence rates were 9.1% and 15.8% for the 2 procedures, respectively. All patients were alive at the end of the follow-up period. D-TGCT involving the TMJ and the skull base is a locally aggressive but benign lesion necessitating complete resection and has a good prognosis.

Correlation between spatial resolution and ball distortion rate of panoramic radiography

BackgroundThe purpose of this study was to analyze the correlation between spatial resolution and ball distortion rate of panoramic radiography and to elucidate the minimum criterion for ball distortion rate, which is very relevant to clinical readability.MethodsHorizontal and vertical spatial resolution and ball distortion rates were calculated in the same position, such as the incisor, premolar, molar, and temporomandibular joint area with various object depths corresponding to 48 mm. Three devices were evaluated. A region showing spatial resolution above the reference standard was selected, and the ball distortion rate corresponding to the same region was divided into horizontal and vertical phantom groups.The mean and standard deviation of the obtained ball distortion rates were calculated. Student’s t-test was used to statistically analyze the mean difference in ball distortion rates between vertical and horizontal phantom groups.ResultsIn all devices, the horizontal line pair phantom, but not the vertical line pair phantom, was readable in all areas measured at the line pair value of at least 1.88 lp/mm. The line pair value tended to be higher toward the center and lower toward the outside. The ball distortion rate tended to decrease closer to the center and increased further away. In addition, ball distortion rates could not be measured at some areas as they were not recognized as balls due to the high degree of distortion at the outermost and innermost sides. The number of balls satisfying the reference value using the horizontal line pair phantom was 102 (mean of ball distortion rates, 20.98; standard deviation, 15.25). The number of balls satisfying the reference value using the vertical line pair phantom was 49 (mean of ball distortion rates, 16.33; standard deviation, 14.25). However, mean ball distortion rate was not significantly different between the two groups.ConclusionsImage layer of panoramic radiography could be evaluated by the spatial resolution using horizontal and vertical line pair phantoms and by assessing ball distortion rates through a ball-type panorama phantom. A ball distortion rate of 20% could be used as a threshold to evaluate the image layer of panoramic radiography.

Is Otalgia be a symptom of anxiety in children?

One of the common causes of ear pain (Otalgia) in children is the pain felt in the temporomandibular region due to bruxism, usually accompanied by stress and anxiety. The diagnosis and treatment of anxiety at an early age will affect the future lives of children. Our aim in the study was to investigate the presence and subtypes of anxiety in children with otalgia due to bruxism. In our study, 86 children aged between 6 and 16years old who had ear pain and whose pain and tenderness were detected in the temporomandibular joint area and 40 healthy children were included as the control group. The children in both study groups were administered the Spence Children's Anxiety Scale (SCAS) test by the clinical psychologist. There was no statistical correlation between the children with bruxism and normal children (p>0.05). While anxiety rate was 82% in children with bruxism, this rate was found to be 12.5% in normal children, this result was also statistically significant (p<0.01). According to the SCAS test, when the subscales of anxiety detected in children with bruxism were evaluated, According to the SCAS test, when the subscales of anxiety detected in children with bruxism were evaluated, it was observed that the performance anxiety was high in the 6-12 and 12-16 age group. However, obsessive symptoms were mostly observed in the 12-16 age group while separation anxiety was detected in children in the 6-12 age group.

Paediatric Temporomandibular Joint Septic Arthritis: A Complication of Acute Mastoiditis

Septic Temporomandibular joint (TMJ) arthritis is an unusual complication of acute mastoiditis in children. This is a case of acute mastoiditis in a 7 years old child following an acute otitis media ear infection, which presented with ear discharge, trismus, mastoid area erythema and TMJ swelling and pain. CT scan showed opacification of mastoid temporal bone and TMJ area. Treatment included antibiotics and TMJ abscess surgical drainage. In this case report, we discuss the clinical picture, investigations, treatment and literature review for this case. Multidisciplinary approach (ENT, Paediatrics, and Oral and Maxillofacial surgeons) was mandatory to manage this unusual complication in children.

Influence of Psychosocial Factors and Parafunctional Habits in Temporomandibular Disorders: A Cross-Sectional Study.

Temporomandibular disorders (TMDs) are abnormalities affecting the temporomandibular joint, jaw muscles, or both. An intrinsic relationship reportedly exists between TMDs and psychosocial factors, including stress. Parafunctional habits such as bruxism and clenching are also known to be responsible for TMDs. To determine the association of anxiety, depression, and bruxism with TMD symptoms and their relationship with age and sex. Patients included in the study reported, as their chief concern, pain lasting for more than a week in the temporomandibular joint area and/or masticatory muscles. The patients were divided into age groups as follows: Younger than 20 years, 21 to 30 years, 31 to 40 years, 41 to 50 years, 51 to 60 years, and above 60 years. Patients were examined clinically and were asked to complete an anamnestic questionnaire (modified version of Helkimo Anamnestic Index) and the Hospital Anxiety and Depression Scale (HADS). Seventy-five patients (55 women, 20 men) were included in the study. The prevalence of TMDs was higher in female patients, of whom 33 (60%) had moderate to severe TMDs. Of the 20 male patients, 12 (60%) had signs and symptoms of moderate TMDs. Anxiety and depression scores were higher in female patients. No significant correlation was found between degree of malocclusion and TMDs. We found correlations between the degree of TMD with age, sex, parafunctional habits, and psychosocial factors. Symptoms of TMD seemed to increase in patients with parafunctional habits, from younger to older age groups, and with increased anxiety and depression scores. The degree of TMDs is higher in women, and TMDs are associated with higher anxiety and depression scores. Correlation between these factors paves the way for preventive actions aimed at those with moderate and severe signs of TMDs.

Evaluation of Temporomandibular Joint Dysfunction by A Mandibular Tracing System: A Case Report

Objective. The purpose of this case report is to present a digital mandibular tracing technique used to evaluate a patient with temporomandibular joint dysfunction (TMD). Clinical features. A 65-year-old Caucasian female patient presented with chronical jaw pain in her temporomandibular joint (TMJ) area. The patient describes a dental history of orthodontic and prosthodontic treatment. Orally patient exhibits super erupted teeth, multiply fractured restorations, facial gingival recession, and rotated teeth. The patient also had an uneven occlusal plane and non-working side contact at maxillary first and mandibular second molars. Evaluation and outcome. A digital mandibular tracing technique, cone beam computed tomography, and full-arch optical impressions were used to evaluate the patient's condition. The left condyle was slightly flat compared to the right one on the anterior surface. Limited protrusion and lateral movements and asymmetric border movements were detected. Apparently, an incomplete orthodontic treatment at the patient's early age, iatrogenic mandibular anterior restorations, and hit and slight effect are considered as causes for Temporo-mandibular joint problems. The recommended treatment plan sequence for this patient is an occlusal adjustment, replacement of defective restorations and fabrication of an occlusal guard for one of the arches. Conclusion. Digital mandibular tracing system can help the dentist to diagnose and analyze the causes of TMD patient specifically and individually. It also provides quick resolution and management for patients with TMD.

Validation of the effectiveness of ultrasonography as a diagnostic method for temporomandibular joint disorders and a comparison with MRI and CBCT

Objective : The objective of this study was to compare findings from ultrasonography imaging (USI) of the temporomandibular joint (TMJ) with those from magnetic resonance imaging (MRI) and cone-beam computerized tomography (CBCT). Methods : A total of 102 patients were included in this study. USI, MRI, and CBCT were performed in the TMJ area for all patients. Results : USI showed 100% sensitivity (Se), 82.76% specificity (Sp), 93.15% positive predictive value (PPV), 100% negative predictive value (NPV) and 94.85% accuracy relative to MRI for identifying anterior disc displacement (ADD), while the Se, Sp, PPV, NPV, and accuracy were 100% for identifying joint effusion, relative to MRI. Moreover, USI showed a high agreement with CBCT, which had 98.08% Se, 94% Sp, 94.44% PPV, 97.92% NPV and 96.08% accuracy for identifying condylar irregularities, while MRI showed a 100% Se, 56.86% Sp, 69.86% PPV, 100% NPV, and 78.43% accuracy for detecting condylar irregularities, relative to CBCT. Conclusions: High-resolution USI is a useful diagnostic method for detecting TMJ pathologies; USI can supplement clinical evaluations for patients with temporomandibular joint disorders (TMDs), and this imaging modality can be used as a diagnostic tool to identify internal derangement of the TMJ.

Ozone injections therapies for temporo-mandibular joint disorders/disfunctions [abstract

INTRODUCTION: Temporomandibular Joint Disorders/Dysfunctions (TMJD) were first described in ancient Egyptian literature. The condition has been reported in the medical/dental literature under a variety terms and syndromes. TMJD is the currently accepted term for a variety of conditions in the head, neck and temporomandibular joint areas.&#x0D; &#x0D; MATERIALS AND METHODS: A systematic review and search of the literature produced the following results:&#x0D; 1. TMJ Infection 2,080,000 Google&#x0D; 2. TMJ Injections 32,900 Google&#x0D; 3. TM Joint 24,839 PubMed&#x0D; 4. TMJ Disorders 16,511 PubMed&#x0D; 5. TMJ Dysfunction 6,439 PubMed&#x0D; The information obtained from these sources in conjunction with clinical training was the basis for the development of the currently described protocols.&#x0D; &#x0D; RESULTS: The current treatment protocols for TM Joint injections utilize homeopathic solutions, B vitamins, procaine and gaseous ozone. These protocols have been used and modified since 2001. The results have demonstrated a significant reduction in the pain levels and improved function of the TM Joint.&#x0D; &#x0D; CONCLUSIONS: Using gaseous ozone in therapeutic combinations of anesthetics, homeopathics and B vitamins have produced positive outcomes in the management of the majority of the very difficult to treat population of head, neck and TMJD patients

TEMPOROMANDIBULAR JOINT CAPSULAR AND PERICAPSULAR INJECTION OF SCLEROSING AGENT AND ITS EFFECT ON THE MOUTH OPENING (AN EXPERIMENTAL STUDY)

INTRODUCTION: Recurrent Temporomandibular Joint (TMJ) dislocation is a relatively common problem encountered in the oral and maxillofacial clinics. Multiple interventions and injections had been described in the literature for TMJ dislocation treatment. Ethanolamine Oleate is a sclerosing agent that can be used in the treatment of TMJ dislocation by creation of inflammatory reaction which induces fibrosis, formation of adhesion and scar formation in the surrounding soft tissues. OBJECTIVES: The aim of this study was to evaluate Ethanolamine Oleate injection in TMJ capsular and pericapsular tissue and its effect on the mouth opening in rabbits. MATERIALS AND METHODS: This experimental study was conducted on eight New Zealand rabbits (approximately 6 months old and weight 2-3 Kg). They were divided into two groups: Group One (Study Group): Eight of these rabbits were injected by Ethanolamine Oleate into their Temporomandibular Joints capsule and pericapsular tissues in the right side. (Group two): left side was acting as a control group. Each two rabbits were sacrificed at intervals of two, four, six and eight weeks. TMJ capsule and pericapsular tissues were dissected and prepared to evaluate the histopathologic changes. RESULTS: The pericapsular tissue area surrounding the Temporomandibular Joint area showed similar histopathologic aspects in all samples. In fact, the pericapsular area showed angiogenesis with presence of fiber, new formed bone and cartilaginous hyaline tissue confirming the diagnosis of fibroblastic activity followed by zone of endochondral ossification and trabecular bone mixed with bone structures. CONCLUSIONS: Ethanolamine Oleate injection is a safe, simple, cost effective treatment of TMJ dislocation with minimal post-operative complication and foreign body reaction.

TEMPOROMANDIBULAR JOINT MORPHOLOGY AT ORTHOGNATIC B

The parameters of the temporomandibular joint normal structure make an important piece of knowledge in common dental practice, primarily because it is some kind of a benchmark that allows making correct judgment concerning changes in the temporomandibular joint occurring through various diseases and prosthetic events that entail new ratios not only in the dentition area, yet also in the temporomandibular joint area [1–12]. Aim of study To clarify the patterns of shape and size for the major morphological elements of the temporomandibular joint in case of the orthognathic bite.

Females have greater susceptibility to develop ongoing pain and central sensitization in a rat model of temporomandibular joint pain.

Temporomandibular joint osteoarthritis (TMJOA) is a prevalent source of temporomandibular joint disorder (TMD). Women are more commonly diagnosed with TMD and are more likely to seek care at tertiary orofacial pain clinics. Limited knowledge regarding mechanisms underlying temporomandibular joint (TMJ) pain impairs development of improved pain management strategies. In a rat model of unilateral TMJOA, monosodium iodoacetate (MIA) produces joint pathology in a concentration-dependent manner. Unilateral MIA produces alterations in meal patterns in males and females without altering overnight time spent eating or weight across 2 weeks. Monosodium iodoacetate (80 mg/mL)-treated males develop ongoing pain within 2 weeks after MIA injection. Females develop ongoing pain at a 5-fold lower MIA concentration (16.6 mg/m). Monosodium iodoacetate (80 mg/mL)-treated males show spread of tactile hypersensitivity across the face during the first week after injection and then to the fore paws and hind paws during the second week after injection, indicating development of central sensitization. At the lower dose, female rats demonstrate a similar spread of tactile hypersensitivity, whereas male rats do not develop ongoing pain or spread of tactile hypersensitivity outside the area of the ipsilateral temporomandibular joint. These observations indicate that females have a higher susceptibility to development of ongoing pain and central sensitization compared with male rats that is not due to differences in MIA-induced joint pathology. This model of TMJOA pain can be used to explore sex differences in pain processes implicated in development of neuropathic pain, ongoing pain, and central sensitization, allowing for development of individualized strategies for prevention and treatment of TMD joint pain.

The role of lateral pterygoid muscle in the traumatic temporomandibular joint ankylosis: A gene chip based analysis.

Traumatic temporomandibular joint ankylosis (TMJA) is a common disease and disorder of the temporomandibular joint (TMJ); however, its pathogenesis has yet to be completely elucidated. In the authors' previous studies, the lateral pterygoid muscle (LPM) was confirmed to exert a function in distraction osteogenesis (DO) during the healing of a condylar fracture, which resulted in the formation of excess bone. The aim of the present study was to investigate alterations in the expression of any associated genes via an Affymetrix GeneChip method. The traumatic TMJA model was fabricated by a condylar fracture in the TMJ area of sheep with either a dissected LPM (LPD) or normal (LPN). The untreated sheep served as a control. At 4- and 12 weeks post-surgery, the condylar zone was isolated to perform the gene chip analysis, which was performed according to a standard Affymetrix protocol. The validated genes were further evaluated by reverse transcription-quantitative polymerase chain reaction (RT-qPCR). The gene chip analysis indicated that the LPN gene expression pattern was similar compared with the DO process, while LPD was similar to that of normal bone fracture healing. The validated genes were collagen type II α1 chain, C-type lectin domain family 3 member A, interleukin 1A, cartilage oligomeric matrix protein, chondromodulin (LECT1), calcitonin receptor (CALCR), transforming growth factor (TGF)-β1, Fos proto-oncogene (FOS), bone γ-carboxyglutamate protein and bone morphogenic protein (BMP)7, among which, BMP7, LECT1, CALCR and FOS were confirmed by RT-qPCR. In conclusion, the present study demonstrated that LPM exerts a DO effect during the pathogenesis of traumatic TMJA, which may provide a novel target for preventing TMJA.

RESULTS OF THE ELECTROMYOGRAPHIC STUDY OF MASSETERS IN PATIENTS WITH HYPERMOBILITY OF HEADS OF THE MANDIBLE BY STANDARD TREATMENT AND USING TRANSCRANIAL ELECTRICAL STIMULATION

Aim. This research was designed to study the functional state of masseters in patients with hypermobility of heads of the mandible by the traditional treatment and using transcranial electrostimulation.Materials and methods. There was conducted the examination and treatment of 80 patients with hypermobility of heads of the mandible. All patients were divided into two groups: the 1st group (n=20) received standard treatment, the second group (n=60) received traditional treatment with the inclusion of myogymnastics, massage in the temporomandibular joint area, transcranial electrostimulation, use of the apparatus of A. Sidorenko that limits the movement of the lower jaw. The control group included 10 volunteers without the pathology in the temporomandibular joint. The masseters were studied by an electromyography method before the treatment, in 1 month and in 6 months after the treatment using the computer and Miokom electromyograph. The obtained results were processed with use of the "Statistica Statsoft" program version 6.1 and "Microsoft Excel 2010".Results. The analysis of the amplitude of bioelectric potentials of the masseters made it possible to establish that when using transcranial electrostimulation and the proposed intraoral apparatus of Sidorenko AN, limiting the amplitude of mouth opening, in 6 months after the end of the treatment in patients with hypermobility of the lower jaw the increased bioelectrical activity of the masseters in the state of relative physiological dormancy disappeared, the amplitude of their contractions (93.2%) normalized.Conclusion. The results of the electromyographic study of temporal and masseter muscles made it possible to conclude that use of the transcranial electrostimulation and the intraoral apparatus of Sidorenko AN, limiting the movement of the lower jaw, has a positive effect on the functional state of the muscular apparatus in patients with hypermobility of the mandible heads. In the state of relative physiological dormancy the bioelectric potentials of the temporal and masseter muscles decrease, the amplitude of the bioelectric potentials while chewing and maximum compression of the jaws increases.

Effect of low-level LASER therapy combined with conventional physiotherapy on pain and quality of life in patients with Myofascial pain dysfunction syndrome

Background: Temporomandibular Joint Disorders (TMDs) are considered the most commonchronic orofacial pain conditions. It is characterized by pain in the Temporomandibular Joint (TMJ)area, masticatory muscles and associated musculoskeletal structures with the affection of mouthopening. Conventional physiotherapy and Low-Level LASER Therapy (LLLT ) are safe and noninvasivemodalities that each therapist focuses on to relieve pain and increase the quality of life.Aim: The aim of this study was to investigate the effect of low-level LASER therapy combinedwith conventional physiotherapy on pain and quality of life in patients with Myofascial paindysfunction syndrome (MPDS).Methods: 60 patients (45 females and 15 males) with MFDS of TMJ were divided randomlyinto study and control groups. The study group received conventional physiotherapy consisting ofactive and stretching exercises for mandibular muscles with ultrasound and LLLT application onTMJ area. Control group received conventional physiotherapy only. Pressure pain threshold wasevaluated using hand-held pressure algometer and quality of life was evaluated using the WorldHealth Organization Quality of Life (WHOQOL-BREF) assessment instrument at baseline and 4weeks after the treatment.Results: There was a significant increase (p<0.05) in the quality of life, with a significantincrease (p<0.05) in pressure pain threshold for TMJ, masseter and anterior temporalis muscles atboth sides in the study group compared with control group.Conclusion: The combination of conventional therapy with LLLT was more effective in painrelief and improvement of the quality of life than the conventional therapy alone for patients withMPDS.

Transmasseteric Anterior Parotid Approach for Treatment of Mandibular Subcondylar Fractures.

This study demonstrated the application of transmasseteric anterior parotid approach for open reduction of mandibular subcondylar fractures depending on the basis of the anatomical study of the temporomandibular joint and parotid gland area. The anatomical study was performed on 5 Chinese adult cadavers fixed by 10% formalin. The temporomandibular joints and parotid regions were studied. In the clinical study, 26 patients with mandibular subcondylar fractures were recruited between July 2014 and December 2017. All 26 patients with mandibular subcondylar fractures received satisfactory occlusions and normal mouth opening: no postoperative facial paralysis occurred in these patients. It is crucial to know the anatomy of both temporomandibular joint and parotid region for reducing significantly the surgical trauma and complications. Transmasseteric anterior parotid approach is a feasible approach for the surgical treatment of the mandibular subcondylar fractures. This method can provide adequate exposure, minimal facial nerve injury, open reduction easily, and inconspicuous scarring.

The Immediate Effect of Therapeutic Touch and Deep Touch Pressure on Range of Motion, Interoceptive Accuracy and Heart Rate Variability: A Randomized Controlled Trial With Moderation Analysis.

Background: There is paucity in the literature regarding the role of the interoceptive pathway through the insular cortex (IC), as well as heart rate variability (HRV) in relation to Osteopathic Manipulative Therapy (OMT) and deep-touch.Aims: The present study investigated whether both OMT treatment and deep-touch (a newly hypothesized treatment option) was effective at altering the interoceptive pathway and HRV, whilst OMT was only expected to be effective for increasing Range of Motion (ROM).Methods: Thirty-five healthy volunteers were randomly allocated into three conditions in a repeated measures crossover design; a control (laying supine on a plinth); deep-touch (head cradling); and an osteopathic mobilization therapeutic technique on the temporomandibular joint (TMJ). Interoceptive accuracy (IAc), HRV, as well as range of motion (ROM) for the TMJ area as well as the cervical spine (Csp) right and left measures were taken pre and post each condition setting.Results: Significant condition effects emerged from the deep-touch and mobilization interventions for IAc where increases were identified through planned comparisons. For the HRV measure (RMSSD), a significant effect emerged in the deep-touch condition (increase) but not in the mobilization or control conditions. ROM did not increase for any condition. IAc correlated with post-ROM outcomes in many cases and HRV moderated some of these relations.Conclusion: These results are discussed in the context of clinical practice, where cranial deep-touch maybe an effective treatment and modulator of the parasympathetic nervous systems, as well as the interoceptive system.

Calcium pyrophosphate dihydrate deposition disease in the temporomandibular joint: diagnosis and treatment

BackgroundCalcium pyrophosphate dihydrate deposition disease (CPDD) is a rare disease in the temporomandibular joint (TMJ) space. It forms a calcified crystal mass and induces a limitation of joint movement.Case presentationThe calcified mass in our case was occupied in the left TMJ area and extended to the infratemporal and middle cranial fossa. For a complete excision of this mass, we performed a vertical ramus osteotomy and resected the mass around the mandibular condyle. The calcified mass in the infratemporal fossa was carefully excised, and the segmented mandible was anatomically repositioned. Scanning electronic microscopy (SEM)/energy-dispersive X-ray spectroscopy (EDS) microanalysis was performed to evaluate the calcified mass. The result of SEM/EDS showed that the crystal mass was completely composed of calcium pyrophosphate dihydrate. This result strongly suggested that the calcified mass was CPDD in the TMJ area.ConclusionsCPDD in the TMJ is a rare disease and is difficult to differentially diagnose from other neoplasms. A histological examination and quantitative microanalysis are required to confirm the diagnosis. In our patient, CPDD in the TMJ was successfully removed via the extracorporeal approach. SEM/EDS microanalysis was used for the differential diagnosis.

An Investigation of the Morphology of the Petrotympanic Fissure Using Cone-Beam Computed Tomography.

ABSTRACTObjectivesThe purpose of the present study was: a) to examine the visibility and morphology of the petrotympanic fissure on cone-beam computed tomography images, and b) to investigate whether the petrotympanic fissure morphology is significantly affected by gender and age, or not.Material and MethodsUsing Newtom VGi (QR Verona, Italy), 106 cone-beam computed tomography examinations (212 temporomandibular joint areas) of both genders were retrospectively and randomly selected. Two observers examined the images and subsequently classified by consensus the petrotympanic fissure morphology into the following three types: type 1 - widely open; type 2 - narrow middle; type 3 - very narrow/closed.ResultsThe petrotympanic fissure morphology was assessed as type 1, type 2, and type 3 in 85 (40.1%), 72 (34.0%), and 55 (25.9%) cases, respectively. No significant difference was found between left and right petrotympanic fissure morphology (Kappa = 0.37; P < 0.001). Furthermore, no significant difference was found between genders, specifically P = 0.264 and P = 0.211 for the right and left petrotympanic fissure morphology, respectively. However, the ordinal logistic regression analysis showed that males tend to have narrower petrotympanic fissures, in particular OR = 1.58 for right and OR = 1.5 for left petrotympanic fissure.ConclusionsThe current study lends support to the conclusion that an enhanced multi-planar cone-beam computed tomography yields a clear depiction of the petrotympanic fissure's morphological characteristics. We have found that the morphology is neither gender nor age-related.