Articular Eminence Research Articles

Flattening of the articular eminence is associated with the loss of occlusal support: radiological study.

Degenerative changes in the temporomandibular joint might be associated with ageing and/or with the loss of occlusal support. The aim of the study was to evaluate whether the inclination of the posterior slope of the articular eminence changes in association with: (i) ageing in patients with maintained occlusal support zones (OSZs); and (ii) the loss of OSZs in elders. In this retrospective radiological study, selected orthopantomograms were allocated into the following groups: I-age 18-35, maintained OSZs, II-age 36-60, maintained OSZs, III-age >60, at least one OSZ per side maintained, IV-age >60, loss of all OSZs. The inclination of the articular eminence was measured relative to the Frankfort plane. The mean values of the inclination of the slope of the articular eminence amounted 34.05°±5.17°, 36.68°±5.65°, 34.86°±6.26° and 26.31°±5.12° for group I, II, III and IV respectively. There were no significant differences between the groups I to III. Group IV differed significantly from each of the previous groups. Flattening of the articular eminence is associated with the loss of OSZs rather than ageing.

Relationship between mandibular condyle and articular eminence cortication with mandibular cortical index on cone-beam CT.

Mandibular condyle development can be evaluated with radiographic evaluation of subchondral cortical bone. The aim of this study is to investigate mandibular condyle cortication (MCC), articular eminence cortication (AEC) and mandibular cortical index (MCI) according to age and gender on CBCT, and relationship between each other. CBCT scans of 520 patients (312 male and 208 female, age range 7-84) were retrospectively investigated to evaluate MCC, AEC and MCI. MCC and AEC were examined in sagittal section and MCI in panoramic reformatted image. MCC and AEC were classified as Type I, Type II and Type III according to density difference between the cortical bone enclosing condyle and articular eminence. Categorical variables were tested by Chi square. When MCC, AEC and MCI were compared, a significant relationship was detected (p < 0.05). According to age, there was a significant difference between MCC, MCI and AEC types with each other (p < 0.05). No significant discrepancy was found between gender and MCC, AEC and MCI (p > 0.05). This study evaluated the distribution of MCC, AEC, MCI according to age and gender and detected that these cortications were correlated. This result may be caused by anatomical proximity bone components and functional stimuli. Knowledge of these cortications can be important for accurate diagnosis of TMJ disorders and may also be helpful for prediction of osteoporotic changes.

Morphometric characteristics and correlation relationships of bone structures of TMJ-jaw joint in extending concepts of individually typological variability

The structural characteristics of the morphometric characteristics of the bones of the temporomandibular joint were studied on 103 passported sculls of adults, and the patterns of individual typological variability determining the type of its structure were also determined. According to the results of the study, the main dimensional characteristics of the mandibular fossa, articular tubercle and head of the lower jaw were established. Depending on the ratios of the selected parameters, three forms of the head of the lower jaw, seven forms of the mandibular fossa and seven forms of the articular tubercles are distinguished. Of the presented forms, the most common are the medium-wide head of the lower jaw, the medium-deep medium-wide mandibular fossa and the medium-high medium-wide articular tubercle. The results of the study can be claimed by dentist’s orthopedists and orthodontists when planning the treatment of patients with dentoalveolar anomalies and deformities, as well as patients with full adentia.

The Role of Magnetic Resonance Imaging of the Temporomandibular Joint to Investigate Tinnitus in Adults with Temporomandibular Joint Disorder: A Comparative Study.

Introduction The prevalence of tinnitus is higher in individuals with temporomandibular joint disorder (TMD) than in the general population. Magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ) is the method of choice for investigation, and it has been hypothesized that specific MRI findings might be observed in TMD with comorbid tinnitus. Objective To comparatively describe MRI findings in patients with TMD with and without tinnitus, identifying the most common TMJ alterations and determining whether a correlation exists between severity of TMD and tinnitus. Methods A cross-sectional study of 53 adult patients with bilateral or unilateral TMD (30 with and 23 without tinnitus). The association between tinnitus and morphological aspects of TMD (changes in condylar morphology, articular eminence morphology, and disc morphology), disc displacement (with/without reduction), condylar translation, and intra-articular effusion was analyzed on MRI images. Results The mean patient age was 46.12 ± 16.1 years. Disc displacement was the most common finding in both groups (24 patients with tinnitus versus 15 without; p = 0.043). Only the frequency of disc displacement with reduction was significantly different between groups. Conclusion Additional imaging techniques should be explored to detect specific aspects of the relationship between tinnitus and TMD.

Management of temporomandibular joint recurrent dislocation using Dautery’s procedure: report and review

&lt;p class="abstract"&gt;Temporomandibular joint (TMJ) dislocation is an involuntary forward movement of the mandible beyond the articular eminence with the condyle remaining stuck in the anterior-most position which leaves the patient unable to close his mouth. Various surgical methods have been described in literature for the management of TMJ dislocation in patients where conservative measures are not successful and need surgical intervention. This case report highlights outcome of Dautrey’s method of surgical correction in three cases of recurrent bilateral TMJ dislocation. All the patients had history of manual reduction of lock jaw in the past and none was medically compromised. TMJ tomograms open mouth confirmed anterior dislocation of condyles beyond articular eminence in all three patients. Total six Dautrey’s procedures were performed. All the patients showed marked improvement in pain and TMJ function with no relapse at two years follow up. Post-operative mouth opening became normal in all the patients at one year follow up. No episode of pain, clicking, deviation or TMJ dislocation was seen in follow up period of 1, 3, 6, 12, 24 months. Hence, Dautery’s procedure serves as an effective management option for recurrent temporomandibular joint dislocation.&lt;/p&gt;

Assesment of morphological changes of articular eminence and condyle using CBCT

Objectives: To measure the inclination 1. Height of articular eminence using CBCT; 2. To measure the length and width of condyles using CBCT. 3. To evaluate and compare above changes in pain and non painful joints. Aim: The aim of the present study is to assess the morphological changes of articular eminence and condyle in temporomandibular joint disorder patients. Materials and Methods: This study was conducted on 50 patients (i.e.100 joints), in which 23 are males and the rest 27 are females. These 50 patients are divided into two groups, in which, patients with painful joints are considered as study group and non painful joints were kept as control group. Statistical Analysis and Results: Independent sample t-test was used to determine the differences in height and inclination of articular eminence and condylar length and width. Pearson correlation coefficient used to find the relation between two quantitative variables of articular eminence height and inclination with condylar width and length. There exists no difference in pain and non painful joints in TMJ patients (p>0.05). Conclusion: In the present study there were no significant changes in morphology of articular eminence and condyle in pain and non painful joints. Keywords: Articular eminence, Condyle, CBCT, TMDs, TMJ, Imaging.

HYPERMOBILITY OF THE ARTICULAR HEADS OF THE TEMPOROMANDIBULAR JOINT: PATHOLOGY OR VARIANT OF THE NORM?

Among the large contingent of patients with TMJ dysfunctions, there are persons with hypermobility of the joint heads of the lower jaw. Moreover, at present, the question of the frequency of occurrence of hypermobility of articular heads of the TMJ is not reflected. The aim of the work is to find out the frequency of occurrence of hypermobility of articular head among a healthy population and to evaluate the clinical, radiological, and electromyographic characteristics of the muscular-articular complex in these individuals. Surveys were conducted for 476 students aged 19 to 25 years. For people with revealed articular hypermobility of the articular heads, chewing and temporal muscle electromyography, TMJ aiming zonography in a lateral projection with open and closed mouth were performed with an assessment of the correspondence of the articular fossa of the temporal bone to the size of the articular head, the location of the articular heads relative to the apex of the articular tubercle. Of the examined 476 students, 95 people (20%) revealed hypermobility of the articular heads of TMJ. According to the results of clinical, functional and radiological studies of TMJ, we identified three degrees of hypermobility: light, moderately expressed, significant. With light to moderate degree of hypermobility, electromyography of the temporal and chewing muscles and TMJ zonography did not reveal a difference in performance compared to healthy ones. Most of the examined did not note functional discomfort from the joints. With a significant degree of hypermobility of the articular heads, electromyography of the temporal and chewing muscles revealed a lack of synergism in their work. On TMJ zonograms with an open mouth, the articular heads extended anteriorly beyond the tops of the articular tubercles almost under their outer base. It has been established that hypermobility of the joint heads of the TMJ, which does not cause signs of pathology in the form of masticatory function disorders, discoordination of the masticatory muscles and uncontrolled displacements of the lower jaw, the presence of a pain symptom should be considered as a variant of norm.

Evaluation of pneumatic cavities surrounding temporomandibular joint by cone beam computed tomography

ObjectiveThe purpose of this study was to detect the prevalence and characteristics of pneumatization in the roof of the glenoid fossa (PRGF) and articular eminence (PAT) by using cone beam computed tomography (CBCT) images. Material and methodCBCT images of 378 patients (756 TMJ) were analyzed to determine the PRGF and PAT. Twenty-eight patients were excluded due to some reasons such as trauma, degeneration, previous surgical operation of temporomandibular joint (TMJ). Pneumatization was detected in 297 of 350 patients, but not pneumatization in 53 patients. Age, gender, laterality (unilateral, bilateral) and lacunarity (unilacunar, multilacunar) were recorded. Unilateral types were also noted as right and left localization. Chi-square test was used to evaluate relationship between pneumatization and gender, lacunarity and laterality. ResultsPRGF and/or PAT were diagnosed in 491 (70%) TMJ components whom 178 (51%) were male and 172 (49%) were female with mean age of 40.38±18.34 years. In total, 103 (35%) of the patients had unilateral and 194 (65%) patients had bilateral pneumatization. ConclusionCBCT provides reliable and precise images to detect pneumatization surrounding TMJ structure in comparison to 2D images. Evaluation of TMJ components accurately before surgical intervention is crucial to prevent complication or increase the success of therapy.

EVALUATION OF THE TEMPOROMANDIBULAR JOINT OSSEOUS CHANGES IN PATIENTS WITH ANTERIOR OPEN BITE: A RETROSPECTIVE STUDY

<h3>Background</h3> The temporomandibular joint (TMJ) has an important role in different human functions, including speech, mastication, and breathing. It has been found that osseous changes in the TMJ may stem from skeletal deformities of the head and neck. <h3>Objective(s)</h3> The aim of this study was to evaluate osseous changes in the TMJs of patients with an anterior open bite skeletal deformity using cone beam computed tomography (CBCT). <h3>Study Design</h3> Thirty-two female patients with skeletal anterior open bite and 32 age-matched normal females (skeletal class I) were included in this study. CBCT images were retrieved from the archives. In the CBCT scans, the presence of condylar deformities, including erosion, sclerosis, flattening, and condylar osteophytes, in addition to shape of condyle head in the sagittal and coronal view, were recorded. Moreover, inclination and height of the articular eminence were measured. Data were analyzed in SPSS version 24 software (SPSS Inc., Chicago, IL), with a confidence interval of 95%. <h3>Results</h3> The frequency of condylar head and articular eminence erosion was significantly higher in patients with open bite in comparison with the normal group (<i>P</i> < .05). A significant association was observed between the condylar head shape and the presence of open bite deformity in the coronal view, with the number of angular condylar shape being higher than that in the normal group (<i>P</i> < .05). In addition, inclination and height of the articular eminence was significantly higher in the normal group in comparison with the open bite group (<i>P</i> < .05). <h3>Discussion/Conclusions</h3> According to the present findings, osseous changes in the TMJ exist in patients with anterior open bite skeletal deformity. It was found that the shape of condyle was related to the presence of skeletal anterior open bite.

The temporomandibular joint: pneumatic temporal cells open into the articular and extradural spaces.

The pneumatisation of the articular tubercle (PAT) of the temporal squama isa rare condition that modifies the barrier between the temporomandibular joint(TMJ) space and the middle cranial fossa. During a routine examination of thecone-beam computed tomography (CBCT) files of patients who were scannedfor dental medical purposes, we identified a case with multiple rare anatomicvariations. First, the petrous apex was bilaterally pneumatised. Moreover, bilateraland multilocular PAT were observed, while on one side it was further found thatthe pneumatic cells were equally dehiscent towards the extradural space and thesuperior joint space. To the best of our knowledge, such dehiscence has not previouslybeen reported. The two temporomastoid pneumatisations were extendedwith occipital pneumatisations of the lateral masses and occipital condyles, thelatter being an extremely rare evidence. The internal dehiscence of the mandibularcanal in the right ramus of the mandible was also noted. Additionally, doublemental foramen and impacted third molars were found on the left side. Suchmultilocular PAT represents a low-resistance pathway for the bidirectional spreadof fluids through the roof of the TMJ. Further, it could add to a morphologicalpicture of hyperpneumatisation of the posterior cranial fossa floor, which couldsignify the involvement of the last four cranial nerves in the clinical picture of TMJpain.

Correlation between temporomandibular joint morphometric measurements and gender, disk position, and condylar position

The aim of this study was to correlate the morphometric measurements of the temporomandibular joint, including condylar size, joint space, and articular eminence size, with gender, disk position, and condylar position by using magnetic resonance imaging. Overall, 93 patients were evaluated (31.2% males and 68.8% females; age 18-81 years; mean age 41 years). Condylar size (D1), joint space (D2), and eminence size (D3) were measured. Correlations with gender, disk position, and condylar position were calculated. A statistically significant correlation was found between D2 and gender, with the joint space being significantly larger in the male group (P = .05). There were correlations between D2 and the position of the disk and the position of the condyle (P ≤ .05). The results indicate a correlation between male gender and larger joint space. In addition, we found that the joint space size influences the articular disk and condyle position, which can cause disk displacement.

COMPARATIVE STUDY BETWEEN 2 TYPES OF PROLOTHERAPY IN TREATMENT OF CHRONIC RECURRENT TEMPOROMANDIBULAR JOINT DISLOCATION

INTRODUCTION: Temporomandibular Joint (TMJ) dislocation when condyles travel anterior to articular eminence. It may be reducible or irreducible. Chronic recurrent TMJ dislocation was treated by surgical and nonsurgical methods. Minimally invasive methods include injection of sclerosing agents intra-articular and extra-capsular or botulinum toxin to the surrounding muscles. Prolotherapy is a method of strengthening lax ligaments by injecting various types of sclerosing or proliferant solutions such as ethanolamine oleate 5%, autologus blood and others. It is also known as ligament sclerotherapy or regenerative injection therapy OBJECTIVES: the study aimed to compare 2 types of prolotherapy (autologous blood & ethanolamine Oleate sclerosing agent) injection in treatment of chronic recurrent temporomandibular joint dislocation. MATERIALS AND METHODS: : this study was parallel, controlled, randomized, clinical trial. The study was conducted at Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University, Egypt. Thirty patients with chronic recurrent temporomandibular joint dislocation were chosen with certain inclusion and exclusion criteria. Fifteen participants were injected with ethanolamine oleate compared with fifteen patients were injected with autologous blood and were followed-up for six months. The participated patients were assessed at the pre- and post-treatment stages by evaluating pain and mandibular range of motion clinically and radiographically using Magnatic Resonance Imaging (MRI) to evaluate condyle-articular eminence relation in opening and closing mouth. RESULTS: There was no significant difference between both prolotherapies in treating chronic recurrent temporomandibular joint dislocation. CONCLUSIONS: Ethanolamine oleate and autologus blood injection are simple, safe and cost-effective treatment for management of chronic recurrent temporomandibular joint dislocation

Clinical protocol for managing acute disc displacement without reduction: a magnetic resonance imaging evaluation

This study investigated the efficacy of a sequential combination of arthrocentesis, mandibular manipulation, and anterior repositioning splint (ARS) in the management of acute temporomandibular joint (TMJ) disc displacement without reduction (DDwoR). Twenty-one consecutive patients diagnosed with acute DDwoR by Diagnostic Criteria for Temporomandibular Disorders and magnetic resonance imaging (MRI) were recruited and managed with this method. Clinical and MRI data were obtained before and at 1 week after treatment. The disc–condyle relationship was determined by disc–condyle angle measurement. Condyle/disc positions were described as x–y coordinates with the summit of the articular fossa as the coordinate origin. Statistical analyses including independent/paired samples t-tests were conducted; significance was set at P<0.05. Clinical success was observed in 95.2% of patients (20/21) with 22 joints affected by acute DDwoR. After combined treatment and ARS insertion, TMJs with DDwoR showed (a) normal disc–condyle relationships with substantial forward and downward condyle movement and significant disc reduction in closed position, and (b) discs with an intermediate zone located between the condylar head and articular eminence in open position. The combined approach was highly effective in ‘unlocking’ acute TMJ DDwoR and achieving spatial full disc reduction and a normal disc–condyle relationship. The duration of acute DDwoR appears to be critical for success.

The relationship of articular eminence and mandibular fossa morphology to facial profile and gender determined by cone beam computed tomography

The aim of this study was to evaluate the relationship of the morphology of the articular eminence and mandibular fossa to facial profile and sex by using cone beam computed tomography (CBCT) images. CBCT examinations of 76 patients were conducted, and the patients were classified according to facial profile as dolichocephalic, mesocephalic, or brachycephalic. The inclination and height of the articular eminence and the inclination of the mandibular fossa of 152 temporomandibular joints were measured. Comparisons between these measurements and facial profile and gender were performed by 2-way analysis of variance with Tukey's post hoc test. Significance was established at α = 0.05. Males with brachycephaly presented significantly greater values of eminence inclination compared with those with other facial types and greater values than patients with dolichocephaly for the measurements of eminence height and inclination of the fossa posterior wall (P ≤ .05). Females with brachycephaly presented significantly greater eminence height values compared with those with other facial profiles (P ≤ .05). No significant differences were observed between males and females. The morphology of the articular eminence and the mandibular fossa is associated with facial profile, with males with brachycephaly showing greater inclination of the eminence and mandibular fossa. Articular eminence height in brachycephaly was greater in both sexes.

Temporal bone pneumatization in patients with dentofacial deformities: cone beam computed tomography study

Pneumatization in the osseous components of the temporomandibular joint (TMJ) may represent a complicating factor in TMJ surgery. This study determined the prevalence and characteristics of pneumatized articular eminence (PAE) and pneumatized glenoid fossa (PGF) using cone beam computed tomography (CBCT) scans of patients with and without dentofacial deformities. The CBCT of 587 asymptomatic patients (216 class I, 179 class II, 192 class III) were assessed to determine PAE and PGF. Age, sex, laterality, and type (uni/multilocular) of pneumatization were recorded. Differences were tested using the χ2 test and binary logistic regression models (P<0.05). Overall, 63.7% of patients presented some pneumatization: 15.5% presented both PAE and PGF, 0.9% presented only PAE, and 47.4% presented only PGF. The multilocular type was more frequent in both PAE and PGF (P<0.001). There was a significant difference regarding dentofacial deformity for PAE (P=0.021), with a higher frequency in class I. There were no differences according to sex, age, or laterality. The absence or lower frequency of pneumatization in class II and III patients may indicate continuous remodelling of the joint, which is submitted to abnormal occlusion forces. This knowledge is helpful for TMJ surgery planning, particularly as patients with dentofacial abnormalities may more often be candidates for TMJ surgery.

Ultrasonography: A step forward in temporomandibular joint imaging. A preliminary descriptive study.

Ultrasonography (USG) is a cost-effective and noninvasive imaging modality commonly employed for imaging the abdominal region and extremities. Currently, with the availability of higher frequency probes and higher resolution devices, USG imaging of the temporomandibular joint (TMJ) looks promising.The aim is to evaluate and demonstrate the role of USG as an imaging modality of TMJ by visualizing the static and dynamic relationship of the joint, assessment of joint space and eliciting reproducibility at both open and closed mouth positions.30 volunteers were selected based on the inclusion criteria in line with the research diagnostic criteria/temporomandibular disorders guidelines. High-resolution USG (≥12 MHz) of the right TMJ (chosen for uniformity) was done in the left decubitus position on (n=30) volunteers. The joint disc movement was directly visualized during opening and closing motions. The vertical joint space was assessed using the firmware and accurate reproducibility was checked. At the closed mouth position, the measured values ranged from 0.2 mm to 0.7 mm with a median of 0.05 cm and a mean of 0.4±0.15 mm. At the position of maximal mouth opening, the measured values ranged from 0.9 mm to 1.5 mm with a median of 1.1 mm and a mean of 1.1±0.17 mm. USG enables visualization of the dynamic relationship between joint structures, with particular importance to the condyle and disc position. The articular disc appears on the USG as a thin layer of hyperechogenicity surrounded by a hypoechoic halo, located between 2 hyperechoic lines viz, the condyle and the articular eminence We recommend ultrasonographic imaging as a noninvasive diagnostic technique with relatively high specificity for patients with temporomandibular disorders.

Temporomandibular joint morphology does not influence the presence of arthralgia in patients with disk displacement with reduction: a magnetic resonance imaging-based study.

The aim of this study was to compare, by using magnetic resonance imaging (MRI), temporomandibular joint (TMJ) morphology between patients with disk displacement with reduction (DDWR) with or without arthralgia and a control group and to identify which factors are associated with the concomitant presence of arthralgia in DDWR patients. In this investigation, 36 TMJ MRIs were divided into 3 groups. Group 1 (n = 12) comprised patients with DDWR and arthralgia; group 2 (n = 12) comprised patients with DDWR without arthralgia; and group 3 (n = 12) was the control group. Disk and mandibular condyle morphologies; articular eminence morphology and inclination; size of the mandibular fossa; joint space size; joint effusion; bone marrow of the mandibular condyle; and the relative signal intensity of retrodiscal tissue were evaluated. Fisher's exact test and 1-way analysis of variance (ANOVA) revealed no significant differences (P > .05) between groups for any variable. Logistic regression analysis showed that no anatomic variables were related to the concomitant presence of arthralgia in patients with DDWR (P > .05). As evaluated on MRI scans, no significant differences in the anatomic characteristics of the TMJ were detected between DDWR patients with or without concomitant arthralgia and the control group. There were no factors associated with the concomitant presence of arthralgia in patients with DDWR.

Locating the foramen ovale by using molar and inter-eminence planes: a guide for percutaneous trigeminal neuralgia procedures.

The first attempt to cannulate the foramen ovale is oftentimes unsuccessful and requires subsequent reattempts, thereby increasing the risk of an adverse event and radiation exposure to the patient and surgeon. Failure in cannulation may be attributable to variation in soft-tissue-based landmarks used for needle guidance. Also, the incongruity between guiding marks on the face and bony landmarks visible on fluoroscopic images may also complicate cannulation. Therefore, the object of this study was to assess the location of the foramen ovale by way of bony landmarks, exclusive of soft-tissue guidance. A total of 817 foramina ovalia (411 left-sided, 406 right-sided) from cranial base images of 424 dry crania were included in the study. The centroid point of each foramen ovale was identified. A sagittal plane through the posterior-most molar (molar plane) and a coronal plane passing through the articular eminences of the temporal bones (inter-eminence plane) were superimposed on images. The distances of the planes from the centroids of the foramina were measured. Also, counts were taken to assess how often the planes and their intersections crossed the boundary of the foramen ovale. The average distance between the molar plane and the centroid of the foramen was 1.53 ± 1.24 mm (mean ± SD). The average distance between the inter-eminence plane and the centroid was 1.69 ± 1.49 mm. The molar and inter-eminence planes crossed through the foramen ovale boundary 83.7% (684/817) and 81.6% (667/817) of the time, respectively. The molar and inter-eminence planes passed through the boundary of the foramen together 73.5% (302/411) of the time. The molar and inter-eminence planes intersected within the boundary of the foramen half of the time (49.4%; 404/817). The results of this study provide a novel means of identifying the location of the foramen ovale. Unlike the soft-tissue landmarks used in the many variations of the route of Härtel, the bony landmarks identified in this study can be palpated, marked on the face, appreciated fluoroscopically, and do not require any measurement from soft-tissue structures. Utilizing the molar and inter-eminence planes as cannulation guides will improve the approach to the foramen ovale and decrease the amount of radiation exposure to both the patient and surgeon.

MULTIFACTOR ANALYSIS OF MORPHOLOGICAL INDICES OF THE TEMPOROMANDIBULAR JOINT IN FETAL PERIODD

With the development of computed tomography and magnetic-nuclear-resonance tomography, it became possible to present an image in numerical form, without dissection to “look” into the layered structure of biological objects, dimensions, distances, diameters, the ratio of the components of the objects under study. Therefore, the use of new visualization methods is of great importance in the study of anatomical preparations.Objective. Determine the topographic-anatomical features of the temporomandibular joint in the fetal and neonatal periods of human ontogenesis according to the latest minimally invasive diagnostic methods.Material and methods. The study was conducted on 15 preparations of fetuses and 8 preparations of newborns by the methods of macroscopy, X-ray, computed tomography, morphometry, craniometry, statistical analysis. With the help of computed tomography scans on the software-hardware complex, the dimensions of the bone-cartilage components of the temporomandibular joint were established and their density in units of Hounsfield.Results. The study has shown that in the fetuses the mandibular fossa of the temporal bone is flat, its depth during the fetal period increases only 2.25 times and in newborns it is 0.717 ± 0.133 mm. The articular tubercle of the temporal bone is differentiated from the third trimester of intrauterine development in the form of an elevation on the lower surface of the base of zygomatic process. The typical form of the head of the lower jaw in the perinatal period is the roof-like. The width of the head of the mandible, during the fetal period, increases in size by 2.03 times and in a newborn is 0.454 ± 0.0568 cm.Conclusions. According to computed tomography, the density of the bone-cartilaginous tissue of the mandibular fossa of the temporal bone in the period of the II-III trimesters of intrauterine development and in newborns changes from 299 to 818 HU, the density of the bone-cartilage tissue of the mandible head - from 112 to 263 HU, which indicates intensive development of temporomandibular joint components. At the end of the 8th and the beginning of the 9th month of intrauterine development, the bone tissue of the head of the mandible is compacted compared to the density of the mandibular fossa of the temporal bone.

Arthrocentesis associated with viscosupplementation in a case of anterior disc displacement and attachment in temporomandibular joint

Introduction: Temporomandibular disorders (TMD) are a group of conditions that cause pain and dysfunction in temporomandibular joint (TMJ), masticatory muscles, and/or associated structures. Signs and symptoms include pain, joint sounds and/or joint dysfunction [1,2]. The aim of this study is to report the clinical case of a patient with TMD, articular disc sounds, associated with arthralgia. who underwent arthrocentesis with biodynamic irrigation and subsequent viscosupplementation in order to reestablish ATM biomechanics and promote pain relief. Materials and methods: Detailed clinical evaluation and examination of magnetic resonance imaging demonstrated an anterior displacement with the attachment of the TMJ disc to the posterior wall of the articular tubercle. This was accompanied by joint sound and severe pain (VAS =7), difficulty in chewing, as well as decreased interincisal distance (28.06 mm), which lingered for more than 5 years. Treatment consisted of arthrocentesis under local anesthesia without sedation, with two needles technique, using a total volume of 200 mL of saline solution followed by synovial fluid replacement with 10 mL of 0.5% 1200 kDa molecular weight sodium hyaluronate solution (Viscoseal®) under joint manipulation. After this procedure, 1 mL of 1% 1000-2000 kDa molecular weight sodium hyaluronate solution (Osteonil®) (viscosupplementation) was performed. Oral pharmacological control with non-steroidal anti-inflammatory and analgesic was also included. Results: Immediate results to therapy consisted of a increased mouth opening with a interincisal distance of 45.09 mm, reduction in joint sound, and restoration of mandibular movements. Supervised home physiotherapy was established in order to maintain function and mouth opening. The exercises were performed for 20 seconds, 3 times a day. After two months, significant progress was observed with gain of 17.03 mm in the interincisal distance, absence of pain (VAS = 0) and great decrease in right articular sound. Discussion and conclusions: Specifically in this case, this minimally invasive approach has shown successful clinical outcomes for arthralgia and biomechanical control of the temporomandibular joint. However, in the future, a larger case-control study is necessary to ascertain its promising potentialities