TMJ Pain Research Articles

Outcomes of bilateral temporomandibular joint arthroscopy: an international multicentric prospective study including 524 joints.

This study aimed to evaluate the efficacy of bilateral TMJ arthroscopy in patients with different Wilkes stages, comparing the results obtained in different arthroscopic levels on a larger scale, unifying similar populations. A multicentric prospective clinical study was conducted in three TMJ departments performing temporomandibular joint surgery in Portugal and Brazil, with an enrolling window active from January 1, 2019, to December 1, 2022. The primary clinical outcome was TMJ pain evaluated through a visual analogue scale. The secondary clinical outcome was the maximum mouth opening (MMO). TMJ arthroscopy was performed with a 1.9-mm arthroscope, including a video system with a 2.8-mm outer protective cannula. 262 patients, representing a total of 524 operated joints were enrolled. The mean age was 35.3 years. A significant decrease postoperatively in VAS pain was observed for all Wilkes stages. The lowest value of VAS pain was observed in Wilkes II compared to Wilkes III and IV. In the secondary outcome, MMO was observed to have a significant improvement in all Wilkes stages. In this multicentric study, bilateral TMJ arthroscopy was shown to be an effective procedure to reduce pain and increase maximum mouth opening in patients with different Wilkes stages, representing a valid minimally invasive solution.

Patients’ reasons for consulting a general practitioner at the time of having dental problems: a qualitative study

IntroductionMany patients consult general practitioners instead of dentists for their oral and dental problems every year. This study aims to find the reasons why patients consult general practitioners when they have dental problems.MethodsThe sample consisted of patients visiting dentists and general practitioners in Kerman, Iran. A thematic interview guide, semi-structured questions, and a mind map that allowed for structured and open-ended questions were prepared and used for the interviews. All interviews were recorded and transcribed verbatim by a final-year student. Data collection, transcription, and analysis were conducted simultaneously to allow for new topics to be raised and theoretical saturation to be reached. When researchers determined that sufficient information was available for analysis and understanding of patient opinions and beliefs, the interview process was stopped. As all audio conversations were recorded with the participant’s permission, no note-taking was done during the interviews, which allowed for greater focus on the participants’ conversation. The obtained data was analyzed using the content analysis.ResultsA total of 52 patients were included in this study. The codes related to patients participating in this research, along with the number of respondent groups related to each code were as follows: patient’s perceptions of general practitioner(GP) and dental practitioner’s scope of work [21], flawed dental system (34), dental anxiety [28], financial considerations [25], and more accessibility to GPs (31). Dental abscesses and dental pain were reported as the most common reasons for consulting GPs.ConclusionMost participants agreed that dental problems are more effectively treated by dentists. Reasons for visiting a general practitioner included lack of a specific dentist, dissatisfaction with dental treatments, lack of a dentist nearby, absence of emergency dental care, and familiarity with a physician. The most common reasons for visits were toothache and dental abscesses. Patients also sought treatment for TMJ pain, referred nerve pain, wisdom tooth pain, numbness and tingling in the jaw, gum inflammation, oral lesions, and ulcers. Furthermore, other factors such as opening hours, appointment systems and waiting time can also affect patient’s consult behaviors regarding dental problems.

The Effect of Bruxism on the Severity of Temporomandibular Dysfunction and Chewing Functionality: A Cross-Sectional Study

Objective: The study was conducted to investigate the effect of bruxism on Temporomandibular Dysfunction (TMD) severity and chewing functionality in individuals with TMD. Methods: This cross-sectional study was conducted with 91 individuals diagnosed with TMD. TMJ pain was assessed with the Numeric Pain Scale (NPS), maximum mouth opening (MMO) was evaluated with a ruler, TMD severity was assessed with the Fonseca Anamnestic Questionnaire (FAQ), and chewing functionality was considered with the Jaw Functional Limitation Scale-20 (JFLS-20). Results: 65 (71.4%) of the individuals were female, and the median age was 29.0 (20-55) years. Individuals were divided into two groups: self-reported bruxism (Group 1: 63) and non-reported bruxism (Group 2: 28). When the groups with and without bruxism were compared, NPS (p=0.002), MMO (p=0.007) FAQ (p=0.000) and JFLS-20 (p=0.000) results were significantly worse in the group with bruxism. TMD severity was significantly higher in the group with bruxism (p=0.000). The probability of having moderate-severe TMD increased statistically significantly 16.236 times (95% CI: 3.485-75.651) with bruxism (p=0.000). Limitation in chewing functionality was significantly increased 4.364 times (95% CI: 1.127- 16.906) in the presence of bruxism (p=0.033). Conclusion: The study results showed that pain, TMD severity, and chewing functionality limitation were higher in individuals with TMD accompanied by bruxism. It should be considered that knowing the bruxism and its effects that may accompany TMD, which is very common and increasing in number and severity daily, in the evaluation or treatment phase is essential in improving rehabilitation success.

SSRI Induced Sleep Bruxism and Jaw Muscle Dystonia- Management with Low Dose Quetiapine Along with Occlusal Guards (D9944, D9945)- Two Case Reports

Background: Long term use of SSRIs (selective serotonin re uptake inhibitors) sometimes induces a problem called nocturnal or sleep bruxism which is nothing but uncoordinated jaw muscle movements which leads to grinding and clenching of teeth. The undesired effect of SSRIs produces a muscle stiffness, jaw and neck muscle tenderness, continuous toothache, hypersensitivity, tooth fracture and TMJ pain. Different treatment modalities are there to manage this kind of problem without hampering the psychiatric prognosis of the patient. Here two cases of SSRI induced sleep bruxism along with successful managements are discussed which will throw some light to the potential treatment approaches of such rare disorders.

Recommendations for Management of Chronic Pain Associated With TMJ Pain

Recommendations for Management of Chronic Pain Associated With TMJ Pain

Occlusal Features and Temporomandibular Joint Disorder: A Cross-Sectional Study.

Understanding the correlation between temporomandibular joint disorder (TMD) parameters and various occlusal features can play a significant role in diagnosing and treating occlusal problems and their potential consequences on TMD. To investigate the relationship of occlusal features and some of the TMD parameters. Study Design and Sampling. The current cross-sectional study was conducted on 200 TMD patients seeking dental treatment at different dental centers in Baghdad city, aged 18-35 years. All participants underwent assessment for occlusal features, which were molar and canine classifications, overjet, posterior buccal or lingual crossbites, and overbites, and TMD parameters (muscle pain, TMJ pain, and clicking) using the Chi-square test for statistical analysis. Regarding molar classification, there were strong positive correlations between subjects with TMD and having different molar classifications (class I, II, and III) bilaterally or unilaterally; furthermore, there were strong positive correlations between subjects with TMD and having different canine classifications. Moreover, there were significant correlations between subjects with increased, normal, or decreased overjet and the TMD parameters. In addition, there were weak positive correlations between TMD occurrence and buccal or lingual posterior crossbite. On the other hand, there were significant correlations between subjects with a decreased overbite and the presence of TMD parameters. TMD had a multifactorial background rather than dependability on a specific molar or canine classification type. There was also a correlation between overjet and TMD muscle pain, while decreased overbite was correlated to muscle and TMJ pain. Conversely, there is no vital correlation between posterior buccal or lingual crossbite occurrence and TMD parameters.

Prevalence of Temporomandibular Disorders Among Dental Students of College of Dentistry-Hawler Medical University.

Background: Temporomandibular disorders (TMD) are a group of conditions affecting the jaw joint and the muscles that control jaw movement, can cause pain and discomfort in the jaw, face, and neck, and affect a person's ability to speak, chew, and swallow. Aim: The present study aims to specify the prevalence of temporomandibular joint disorder among dental students of Hawler Medical University. Method: The research conducted involved a group of 120 dental students, with an equal number of males and females from Hawler Medical University. The required data were collected by developing a particular questionnaire by modifying Fonseca's questionnaire. The study was performed during a period of one month from January to February. Visual Analogue Scale (VAS) was used to determine the severity of the pain and dysfunction in the participant's muscles. Results: More than 75% of the participants had no deviation. In 65.8% of the students, class 1 occlusion was observed. Trauma was observed in just 12.5% of the participants. Bite and bruxism habits were observed in 24.2% and 10% of the students respectively. Moreover, 30% of students had disturbed sleep. Severe TMJ pain was reported in 4.2% and 0.8% of females and males respectively. Conclusions: The occurrence of TMD among males was less than among females. Most of the participants had mild TMJ pain. There was a significant association between symptoms of TMD and para-functional habits. Keywords: Temporomandibular disorder, Temporomandibular joint, Fonseca's questionnaire.

Intra-articular pathologies detected by magnetic resonance imaging in patients with temporomandibular disorders undergone successful non-surgical treatments

ObjectiveThis study aimed to study on the MRI findings suggesting intra-articular pathologies in patients with temporomandibular disorders (TMD) undergone successful non-surgical treatments, and to discuss on their intra-articular pathological conditions with clinical symptoms. Patients and methodsOne-hundred eleven TMJs of the consecutive 80 TMD patients were enrolled in this study. These TMJs were classified into the following 3 Groups, Group I: Bilateral 62 TMJs of the 31 patients with masticatory-muscle (MM) symptoms without functional pain, Group II: Affected-side TMJs of the 31 patients with unilateral functional MM pain, Group III: Affected-side TMJs of the 18 patients with unilateral functional TMJ pain. The detection rates of joint effusion (JE), osteoarthritis (OA), and disc displacement (DD) on the MR images were investigated. The correlations of JE, OA, DD, age, and gender were also analyzed. ResultsIn each Group, the detection rates of JE, OA, and DD were more than 70%, and no findings of them were sometimes observed. The detection ratio of moderate/marked JE in Group II was significantly higher among the 3 Groups. The significant correlation of JE, OA, and DD was found, and that of OA and age was also observed. ConclusionsOur results suggest that intra-articular pathologies often occur even in the painless TMJs, and functional TMJ pain sometimes appear even in the TMJs with early-stage OA, which cannot be detected by MRI. Furthermore, the TMJ synovitis occurred in patients with functional MM pain may be more severe than that in the painful TMJ.

The "5Ts" screening tool: Enhancements and threshold values for effective TMD identification.

This study aimed to enhance the quintessential "five temporomandibular disorder (TMD) symptoms" (5Ts) screener by incorporating frequency options and distinguishing between TMJ and muscle pain. The diagnostic accuracy along with cut-off points for the effective identification of TMDs was also established. Participants, aged ≥18 years, were recruited from a university-based hospital. After completing surveys encompassing demographic data and the enhanced 5Ts (with frequency options [5Ts-F] and differentiation of TMJ/muscle pain [6Ts-F]), protocolized interviews and clinical examinations were performed following DC/TMD. The diagnostic accuracy and best cut-off points were determined with the area under the receiver operating characteristic curves (AUCs). 324 participants were recruited (mean age 30.0 ± 11.4 years). Among these, 86.4% had TMDs. 5Ts exhibited high diagnostic accuracy for detecting all TMDs (AUC = 0.92) with sensitivity/specificity values of 83.9%/88.6%. Both 5Ts-F and 6Ts-F had slightly better accuracy (AUCs = 0.95/0.96), comparable sensitivity, and superior specificity (97.7%) compared to 5Ts. The best cut-off points were 1.5 for 5Ts and 2.5 for 5Ts-F/6Ts-F. Although all three TMD screeners presented high diagnostic accuracy, 5Ts-F/6Ts-F had notably improved specificity. 5Ts scores of >1.5 and 5Ts-F/6Ts-F scores of >2.5 are to be applied for screening the presence of TMDs.

Дослідження взаємозв’язку психоневрологічних та дегенеративних порушень у пацієнтів при больовій дисфункції скронево-нижньощелепних суглобів.

Summary: An increase in the prevalence of painful dysfunctions of the temporomandibular joints (TMD), which, according to the modern views of the theory of combined pathogenesis, has neuromuscular, occlusive-articulation, psychophysiological, psychoemotional, and ischemic components, up to 82-87% among the general applications of dental patients profile indicates the need for new scientific research in this direction. And the increase in manifestations of the phenomenon of pain and its diversity in TMJ dysfunctions indicates that traditional therapy remains insufficiently effective and needs correction and improvement. The aim of this study is to study and compare the nature and degree of psychoneurological and degenerative-dystrophic disorders in patients with TMJ pain dysfunction. is to study and compare the nature and degree of changes in the electromyographic activity of the main and auxiliary masticatory muscles in patients with restored dentition defects during prosthetics using analog and digital methods. Research materials and methods. The representative contingent of patients included 48 people, of which 11 (22.9%) patients were male, 37 (77.1%) patients were female. The analysis of the dental status of the patients was carried out according to the data of the standard clinical examination, the standard and author’s questionnaire, the abbreviated «Hamburg» examination. The patients were diagnosed with defects of the teeth and dental rows, complicated by increased wear of the hard tissues of the teeth, secondary deformations, traumatic occlusion, TMJ dysfunction and parafunction of the masticatory muscles. To assess the patient’s psychoneurological condition, we used diagnostic methods of autonomic dysfunction syndrome, including segmental dysfunction. The intensity of the pain syndrome was assessed using visual analog scales. Personal and situational anxiety and depression were assessed. We determined situational and personal anxiety in patients with diseases of the maxillofacial apparatus according to the Spielberger-Hanin test (State-Trait Anxiety Inventory _ STAI)/ the severity of depression according to the L. Radloff depression scale, to which items from the A. Beck and W. Zung questionnaires were attached. The results Violations of central autonomic regulation were detected in the examined patients and were manifested by headache, unmotivated prolonged subfebrileness and syncopal states without signs of convulsive readiness on the encephalogram during encephalography. Vegetative dystonia with a paroxysmal course was diagnosed in 9 (18.8%) patients, vaginulid paroxysmal disorders – in 3 (6.3%) patients. TMJ dysfunctions and impaired vegetative activity of the nervous system against the background of stressful situations create an activating and maladaptive effect on regulatory mechanisms. Thus, among the studied group of patients, depression was diagnosed in 39 (81.3%) patients, including: mild degree – 21 persons (43.8%), medium degree – 14 persons (29.2%), severe degree – 4 persons (8.3%). Conclusions. As a result of our research, the feasibility of using the proposed complex diagnostic program for the functional state of the dento-maxillary, postural and autonomic nervous system of patients for the integrative assessment of the relationship between occlusal disorders of the jaws and postural disorders and vegetative dysfunction in patients with pathology of the temporomandibular joints was proven and substantiated. A multidisciplinary approach to treatment contributed to effective and quick rehabilitation of patients with TMJ pain dysfunction. The need for the proposed rehabilitation measures is related to the creation of individual treatment and rehabilitation algorithms, which necessarily take in to account the state of manifestation of the patient’s dental pathology, his general somatic condition, psychoneurological status, age and the state of the musculoskeletal system as a whole. Key words: temporomandibular joints, prosthetic dentistry, dentition defect, masticatory muscles, musculoskeletal system, psychoneurological condition, degenerative-dystrophic disorders, occlusion.

Recording the maxillomandibular relationship with the Aqualizer system prior to occlusal splint therapy for treating temporomandibular disorders: a randomized controlled trial

Temporomandibular disorders (TMD) present a public health issue and are one of the most common musculoskeletal conditions causing chronic pain. This study compares the outcomes of occlusal splint therapy in patients with TMD following two different maxillomandibular relationship (MMR) registration techniques. 40 TMD patients were randomly allocated to MMR registration with the Aqualizer system (AQU) or with chin point guidance (CPG) prior to fabricating occlusal splints. TMD symptoms, subjective pain intensity, and quality of life (QoL) were recorded at baseline and after 3 and 6 months. The treatment led to an overall reduction of TMD symptoms in both groups (Conover test, p < 0.00001). TMJ sounds, TMJ pain with palpation and muscle pain with palpation subsided regardless of the type of MMR registration method used (Cohen’s d > 0.8). AQU-based occlusal splints led to a better improvement of TMJ pain with maximum opening compared to CPG-based occlusal splints (Cohen’s d = 0.9; CPG d = 0.13). In both groups, occlusal splint treatment had little to no effect on correcting lateral mandible deviation or improving restricted jaw opening. After 6 months occlusal splints in both groups had a large effect on improving subjective pain intensity (Cohen’s d > 0.8), however, patients reported a higher QoL in the AQU group compared to the CPG group (Mann–Whitney-U-test, p < 0.05). The results of this study support the premise that occlusal splints are effective in relieving pain-related TMD symptoms. The Aqualizer can be considered for determining MMR in cases, where guided registration techniques are not possible.Trial registration: DRKS00031998.

Distribution of Misdiagnostic Maxillofacial Nonmalignant Lesions and Conditions in Salah Alden Government

Diagnosis is the corner stone &amp; entry to the treatment of lesions or conditions. Because misdiagnosis leads to incorrect treatment. It is very important to understand the distribution between the most common misdiagnosis nonmalignant lesions&amp; conditions in the maxillofacial region as apart of whole misdiagnosis. Decrease patient complaining. Evaluate the most common misdiagnosis lesions&amp; conditions in maxillofacial region. Decrease load to hospitals&amp; clinics&amp; decrease infections. The data collected by standardized formula for all patients&amp; different patient clinical, radiological examination &amp; methods used to confirm the diagnosis. Total no. are 30 patients, misdiagnosis lesions&amp; conditions 13% (Sinusitis or dental pain), 20% (submandibular Lymphadenitis. or Sialadenitis), 20% (Otalgia). 10%(Psychopath),10%(Trigeminal neuralgia) ,7%(migraine) ,7%( maxillary sinusitis),13%(submandibular saialidinitis). the true diagnosis was 13%,( Oroantral fistula),20%(oro-Cutaneous fistula),20%(Tmj pain),10%(Tmj dislocation),10%(dental pain),7%(dental pain),7%(Maxillary sinus cyst),13%(submandibular Salivary gland stone). The more unorganized medical &amp;or surgical branches interference within region may lead to these misdiagnosis results. Poor educated patients, doctor’s decision with inadequate examination&amp; investigation participate in increase patients complaining

Association of Tinnitus in The Patients with Cervical and Temporomandibular Dysfunction

Tinnitus is a phrase that refers to the conscious experience of an auditory sensation in the absence of a corresponding external stimulation. It is derived from the Latin verb tinnire, which means "to ring.’. In recent few years, it has been found that among 101 causes of tinnitus, cervical and TMJ disorders are one of the leading cause of it. The aim of this study is to evaluate the association and perception of tinnitus among the patients having pain in cervical and TMJ region. This study was cross sectional study and was conducted on the population of the ULTH, Gangaraam hospital. It includes both male and female patients. A survey was sent out through email to 145 patients. Their role was to complete an updated expert revised survey testing their association of tinnitus with cervical or TMJ region pain. Descriptive statistics was applied to conclude results.The mean age of population was 35.53 with the standard deviation ± of 12.176 of data. Out of 145 patients. 93 (64.1%) were males and 52 (35.9%) were females. The study reveals that association of tinnitus with cervical and TMJ pain was more common in males. Females had a low rate of tinnitus with cervical and TMJ painThe study reveals that association of tinnitus with cervical and TMJ pain was more common in males. Females had a low rate of tinnitus with cervical and TMJ pain. The Pearson chi square association is statistically significant (P=0.016).&#x0D;

The effectiveness of the self-care protocol in managing pain in Tempro-mandibular joint disordered patients: Scope review

Background: Temporomandibular Joint disorder (TMD) consists of a variety of conditions which affect the jaw joints, surrounding muscles and ligaments. It can be caused by trauma, improper bites, or arthritis. These conditions are usually associated with pain and dysfunction of the temporomandibular joint, masticatory muscles, and other bone structures. Self-care protocol is a non-invasive approach. Self-care is commonly an initial management method for temporomandibular disordered patients. Objectives: This review aims to assess the effectiveness of self-care in managing pain in TMJ-disordered patients when applied alone and in combination with other management methods. Contents: This is a rapid review of the literature. The review was done in the databases Science Direct, Pubmed and Google Scholar. Articles in English published between 2010 and 2022 were included. Twelve articles were selected. These articles were included in accordance with predetermined inclusion and exclusion criteria. Conclusion: There are two main goals in the management of temporomandibular disordered patients: the reduction of pain and the improvement of function. Self-care protocols are effective in achieving these two goals. TMJ-disordered patients present faster improvement in TMJ pain symptoms when self-care is combined with any other TMJ management methods.

Diagnosis and management of temporomandibular joint synovial chondromatosis: A systematic review

The aim of this study was to systematically review the diagnosis and management of temporomandibular joint synovial chondromatosis (TMJ-SC). Using a systematic study design based on the PRISMA guideline, the researchers implemented and analyzed a cohort of relevant publications indexed by PubMed, Embase, Medline, and LILACS between January 1990 and December 2022. The outcomes of interest were demographics of the primary studies, and Clinical, radiological, and therapeutic data associated with TMJ-SC. The study samples included 8 studies presenting 121 TMJ-SC cases (73.6% female; 100% unilateral; 53.7% left-sided; mean age, 43.3 ± SD 5,80 [range, 21–81]. Non-specific symptoms were mostly reported, including TMJ pain, noise and local inflammation, and/or malocclusion. Radiographically, loose bodies, masses with low-signal foci, and calcification were common charateristics. Until now, there has been no internationally accepted consensus on diagnosis and management of TMJ-SC. Arthroscopic surgery should be performed on masses confined to the superior TMJ space, while open arthroplasty is indicated in cases with the extra-articular extension. A combination of both treatment methods may be necessary, when the lesion locates extending beyond the medial groove of the condyle.

SOME ASPECTS OF THE ETIOLOGY, PREVALENCE AND DIAGNOSIS OF THE TEMPOROMANDIBULAR JOINT DYSFUNCTION (A REVIEW)

Background.Temporomandibular joint diseases (TMJ) occupy a special place among dental diseases due to the complexity of the clinical picture which often depends on within the professional competence of doctors of various specialties - otolaryngologists, neurologists, psychiatrists, rheumatologists, diseases whose complicate diagnosis and treatment. Painful TMJ dysfunction is a common disease that leads the patient to the dentist.&#x0D; Aim: to analyze modern publications devoted to the problem of pain dysfunction of the temporomandibular joint in terms of causes and diagnostic methods related to practical dentistry.&#x0D; Materials and methods. An analysis of data obtained during an information search in the online databases "PubMed", "SciELO", "Medcape" and "Science of Ukraine: access to knowledge" and official web-sites of Ukrainian education and scientific institutions was carried out using the keywords "pain dysfunction", "Costen's syndrome", "musculofascial syndrome", "temporomandibular joint".&#x0D; Results. Today, TMJ dysfunction is an unsolved problem of practical dentistry which has a significant number of points of contact with other specialties. The pain and psycho-emotional component of this disease can be a significant problem for the patient and negatively affect his quality of life. The complex etio-pathogenesis of TMJ dysfunction and confusing classification of conditions leads to frequent assumptions of diagnostic and treatment mistakes of dentists and other specialists. Today, further development and improvement of diagnosis and treatment methods of patients with TMJ dysfunction, including the development and modification of diagnostic protocols and expanding indications for the use of modern highly informative diagnostic methods. Quite often the rehabilitation of such a patient requires a team approach and may last for years.&#x0D; Conclusion. The organization of diagnosis, treatment and follow-up of patients with painful TMJ dysfunction needs further improvement and research.

Somatosensory tinnitus and temporomandibular disorders: A common association.

Although the association between tinnitus and temporo-mandibular disorders (TMD) has been frequently reported, their rate of association in the literature shows a great variability. We aimed to investigate the prevalence of TMD in patients with somatosensory tinnitus and, vice versa, the occurrence of somatosensory tinnitus in patients with TMD. The study included patients with somatosensory tinnitus (audiological group) and patients with TMD (stomatological group), evaluated at the audiologic and stomatologic clinics of the Policlinic Hospital of Milan, Italy. Common causes of tinnitus, such as hearing and neurological disorders, were excluded. A cervicogenic somatic tinnitus was also ruled out. Different TMD symptoms, including joint noise and joint pain, were considered. The collected data were analysed using descriptive statistical methods, and the Pearson's Chi-squared test was performed to study the prevalence of the different symptoms by clinical groups. Audiological group included 47 patients with somatosensory tinnitus. Overall, TMD was diagnosed in 46 patients (97.8%), including TMJ noise in 37 (78.7%), clenching in 41 (87.2%) and pain in 7 (14.8%) patients. Stomatological group included 50 patients with TMD, including joint noise in 32 (64.0%), clenching in 28 (56.0%) and TMJ pain in 42 (84.0%) patients. A somatosensory tinnitus was diagnosed in 12 (24.0%) patients. Our study showed a high prevalence of TMD in patients with tinnitus, as well as a not uncommon occurrence of tinnitus in patients presenting with TMD. The distribution of TMD symptoms, such as joint noise, and joint pain was different between the two groups.

Magnetic resonance imaging evaluation of the disc morphology of temporomandibular joint in patients with severe hemophilia.

This study aimed to assess the morphological differences in the articular disc (AD) between hemophilic patients and healthy individuals of the control group for further association with signs and symptoms. Fourteen severe hemophilic patients had their AD evaluated by magnetic resonance imaging (MRI). The morphological findings were compared to those of a control group consisting of 14 healthy individuals. MRI was used to evaluate all the components of the temporomandibular (TMJ), including the AD, resulting in sequential T1-weighted parasagittal images. All the images were acquired with teeth in maximum intercuspation position. Morphological alterations showed significant statistical differences (P-value = 0.0068), whereas no statistical differences were found in the other variables, including TMJ pain, headache, bruxism and mouth opening limitation. In the group of non-hemophilic individuals, only two (14.29%) presented AD with non-biconcave features, whereas in the group of hemophilic patients, nine (64.29%) presented AD with a morphology other than biconcave. In patients with severe hemophilia, there seems to be a pattern of morphological alterations in the articular disc over time. The standard biconcave morphology of AD tends to change into other ones, particularly biplanar, hemiconvex and folded.

Innsbruck-style Retromandibular Anterior Trans-parotid Approach for Condylar Fractures: A Retrospective Review of 39 Fractures

Background:The retromandibular anterior trans-parotid (RAT) approach and a triangular-positioned double mini-plate osteosynthesis (TDO) technique have been reported from Innsbruck Medical University. This minimally invasive technique involves direct visualization of the condyle and is associated with lower incidence of facial palsy.Methods:A retrospective review was performed on the RAT approach and TDO technique conducted by a surgeon and team at two hospitals in Tokyo during a period of 3 years and 10 months.Results:This technique was performed on 35 patients with 39 condylar fractures. Sixty-nine percent of cases were due to accidental fall, 17% to traffic accidents, and 9% to sports. Furthermore, 92% cases were condylar base fractures. Nighty-seven percent of cases achieved good occlusion. The mean maximum mouth opening was 49 ± 1.3 mm. Postoperatively, facial palsy developed in three patients (7.7%), and two of them developed Frey syndrome at approximately 2.5 years postoperatively (5.1%). All patients completely recovered within 3 months postoperatively. One case each of salivary fistula, visible scar, and condylar resorption was found (2.6%). No case of massive bleeding during surgery, hematoma, or TMJ pain after surgery was found.Conclusion:This technique could achieve good occlusion with low incidence of complications and could contribute to early social reintegration among patients.

TMJ degenerative joint disease: relationships between CBCT findings, clinical symptoms, and signs

Objectives The relationships between cone-beam computed tomography (CBCT) findings, Temporomandibular disorder (TMD) symptoms, and signs were investigated in patients with TMJ degenerative joint disease (DJD). Material and Methods Adult patients with Diagnostic Criteria for TMDs (DC/TMD)-defined intra-articular conditions were enrolled and subjected to CBCT assessment. The participants were organized into three groups, namely no (NT), early (ET), and late (LT) TMJ DJD based on radiographic findings. TMD symptoms/signs were appraised using the DC/TMD methodology. Statistical analyses were performed using Chi-square/non-parametric tests and Kappa statistics (α = 0.05). Results The mean age of the participants (n = 877) was 30.60 ± 11.50 years (86.6% women). NT, ET, and LT were observed in 39.7%, 17.0%, and 43.3% of the study sample. Significant differences in the prevalence of TMD symptoms (TMD pain, TMJ sounds, opening, and closing difficulty) and signs (TMD/TMJ pain, TMJ clicking/crepitus, and opening limitation) were discerned among the three groups (p ≤ .001). TMD/TMJ pain and opening difficulty/limitation were more prevalent in early rather than late degenerative changes. While moderate agreements between symptoms and signs were observed for TMD pain/opening limitation, the concurrence for TMJ sounds was fair. Conclusions Young adults with TMJ sounds and pain should be examined with CBCT to establish the extent/progress of osseous changes.