Restricted Mandibular Movement Research Articles

Association between Clinical Manifestations in Temporomandibular Joint Disorders and Corresponding Radiographic Findings.

Background: Temporomandibular disorders are common conditions characterized by discomfort within the temporomandibular joints, acoustic changes, and restricted mandibular movement. Accurate diagnosis and subsequent treatment rely heavily on clinical examination, but it is often necessary to add radiological examinations to the diagnostics. Magnetic Resonance Imaging (MRI) is the gold standard for visualizing the disc, while cone-beam computed tomography (CBCT) is primarily used for evaluating condylar morphology. Ultrasound (US) serves as a real-time imaging modality for soft tissues. The objective of the present study was to explore the association between clinical manifestations observed in patients with temporomandibular joint disorders and corresponding radiographic findings. Methods: A total of 63 adult patients (51 female and 12 male) with temporomandibular joint disorders were included in this cross-sectional study. Each patient underwent a clinical examination, followed by appropriate radiological examinations (MRI, CBCT, or US). The level of statistical significance was set at an alpha of 0.05. The Shapiro-Wilk test assessed the normality of numerical variables. The Wilcoxon rank sum test compared two independent groups with non-normally distributed data. Relationships between categorical variables were evaluated using the Pearson chi-square test or Fisher's exact test. The Kendall tau (τ) method analyzed the correlation between two binary variables. Results: The analysis included 63 patients with TMD, predominantly females (80.95%). Ages ranged from 18 to 74 years with a median of 39 years. In the CBCT study, we observed rarefied changes in the left bone structures in patients with bruxism (p = 0.010). MRI and ultrasound imaging revealed changes in patients with limited jaw opening: erosions in the right mandibular head on ultrasound (p = 0.008) and abnormal right bone structures on MRI (p = 0.009). In CBCT, asymmetry in the left joint space was correlated with a high incidence of right side muscle tension (p = 0.004). Additionally, both CBCT and ultrasound showed a correlation between muscle tension and erosion (p = 0.040 in ultrasound, p = 0.020 in CBCT). Acoustic changes, when compared with radiological imaging, were evident in all three studies, like temporomandibular joint pain or palpation. Conclusions: Our study compared three radiographic imaging methods with clinical examinations to assess their correlation with clinical symptoms. Each imaging technique provided unique insights depending on the specific symptoms presented. The observed correlations varied, highlighting the unique contributions of each modality to the diagnostic process. This underscores the importance of employing multiple diagnostic approaches for a thorough assessment of the temporomandibular joint. However, a limitation of our study is the small sample size and the uneven distribution of participants among the groups. Additionally, not all patients underwent every imaging modality.

Prosthetic Rehabilitation of a Hemi-mandibulectomy Patient with Interim Mandibular Guide Flange and Maxillary Twin Occlusion: A Case Report

ABSTRACT In hemi-mandibulectomy patients, the fabrication of a successful prosthesis is a challenging task. Segmental resection of the mandible causes deviation toward the resected side resulting in facial disfigurement, difficulty in speech, mastication, swallowing, respiration, and restricted mandibular movements. Such a condition affects the daily life of the patient and might also result in a disturbed psychological state. The primary goal of treating these patients was to achieve facial aesthetics and restore function and phonetics. Such a scenario can be tackled more efficiently with good patient cooperation and a well-fabricated prosthesis.

Incidental findings involving the temporomandibular joint on computed tomography and magnetic resonance imaging.

The temporomandibular joint (TMJ) is frequently imaged in head and neck computed tomography (CT) and magnetic resonance imaging (MRI) studies. Depending on the indication for the study, an abnormality of the TMJ may be an incidental finding. These findings encompass both intra- and extra-articular disorders. They may also be related to local, regional or systemic conditions. Familiarity with these findings along with pertinent clinical information helps narrow the list of differential diagnoses. While definitive diagnosis may not be immediately apparent, a systematic approach contributes to improved discussions between clinicians and radiologists and better patient management.

Drug delivery systems for treatment of temporomandibular joint osteoarthritis.

The number of people suffering from temporomandibular joint osteoarthritis (TMJOA) has been increasing. TMJOA cause joint noise, pain on TMJ and/or masticatory muscles, and restricted mandibular movement, which disturb eating, laughing and conversation, and impose serious lifestyle impediments. Chondrocyte apoptosis, extracellular matrix degradation, synovitis, and subchondral bone remodeling are the main pathological features of TMJOA. Various drug delivery systems are developed to controlled release at specific activation sites with high bioactivity and inhibit rapid dilution to enable long-term therapeutic response, which present great potential for the treatment of TMJOA. This review focuses on recently developed drug delivery systems by different administration in the TMJOA treatment, and summarizes their effects, duration, safety, and limitations, which would pave the way for development of TMJOA therapy.

Evaluation of the efficacy of platelet rich fibrin (I-PRF) intra-articular injections in the management of internal derangements of temporomandibular joints – a controlled preliminary prospective clinical study

BackgroundThe temporomandibular joint (TMJ) is one of the most complex joints in the body. Temporomandibular disorders (TMD) are among the most troublesome disorders for patients, as they can cause pain, affect oral functions and disturb dentists on the level of diagnosis and treatment. The most common symptoms of temporomandibular joint disorders are articulated sounds (such as clicking or TMJ crepitation), joint pain in comfort and function situations (jaw movements), pain or strain in masseter and jaw muscles and or restricted mandibular movements. One of the most modern biocompatible substances used to treat joint disorders, including the TMJ, is platelet-rich plasma (PRP) and injectable platelet-rich fibrin (I-PRF). This study aims to evaluate the efficacy of platelet-rich fibrin (I-PRF) intra-articular injections in managing internal derangements of temporomandibular.MethodsTwenty patients suffering from a unilateral click due to temporomandibular disorders were individually injected with 1 mL of (I-PRF) twice 1 week apart into the superior joint space of the TMJ with the internal disorder. Data were recorded and evaluated by the Helkimo index. This evaluation was conducted three times; 1 week after the first injection, 1 week after the second injection, and 6 months after the first injection.ResultsThe clicking disappeared entirely in 14 out of 20 patients after 1 week of getting the first injection, and in all patients after 1 week of getting the second injection, and returned to two of them after a six-month since the first injection.ConclusionPreliminary results showed the efficacy of the Injectable Platelet-Rich Fibrin (I-PRF) in managing articular clicking in patients with internal disorders of the temporomandibular joint. Injectable Platelet Rich Fibrin has significant clinical efficacy in treating the articular clicking resulting from internal temporomandibular joint disorders.

COMPARATIVE EVALUATION OF LOW-LEVEL LASER THERAPY (LLLT) VERSUS SODIUM HYALURONATE WITH ARTHROCENTESIS IN MANAGEMENT TEMPOROMANDIBULAR JOINT DISORDERS (TMD): A CLINICAL RANDOMIZED CONTROLLED STUDY

PURPOSE: Temporomandibular joint disorders are one of the most common cause of pain of non-dental origin in the orofacial region and is characterized by pain, joint sounds, and restricted mandibular movements. This disorder is known to be multifactorial. There are wide varieties of treatment for the TMD, including non-surgical and surgical treatments. Recently, the low-level laser therapy (LLLT) has been used as a treatment modality to the TMDs. AIM: The aim of this study was to compare and evaluate the effect of low-level laser therapy (LLLT) versus sodium hyaluronate with arthrocentesis in management symptoms of temporomandibular joint disorders (TMD). PATIENTS AND METHODS: This was a clinical randomized controlled study conducted on 40 patients with a total of 40 joints (3 males and 37 females) diagnosed with TMDs. The patients were randomly divided into 2 groups. Group A (Laser group) received active application of the low-level laser therapy (LLLT). Group B (Arthrocentesis group) received combined arthrocentesis and low molecular weight sodium hyaluronate intracapsular injection. RESULTS: When comparing the two groups, there were no statistically significant differences; between group A and group B regards changes in measuring pain on visual analogue scale (VAS) and maximum painless opening from pre-operative till post-operative at one month. While, there were statistically significant differences; between the two from pre-operative till post-operative at three months follow up periods. CONCLUSION: We can conclude from this study that the use of laser is successful when it is applied in a proper way.

FIBROUS ANKYLOSIS OF TEMPOROMANDIBULAR JOINT: PRESENTING WITH SUDDEN ONSET COMPLETE INABILITY TO OPEN MOUTH.

The temporomandibular joint makes it possible to open and close your mouth, as involving chewing, swallowing, speaking, and yawning activity. Ankylosis of the Temporomandibular joint which includes partial or complete fusion of the joint with resulting restricted opening of mouth, restricted mandibular movements (hypomobility) with deviation to the affected side on opening of the mouth. The pathology is multifactorial and restoration of function usually involves surgical intervention and dependence on the exact pathology situated at the root of pons. It is essential to evaluate the underlying pathology, its degree for proper planning of surgery and follow-up. 3-D CT scan of facial bones provide a reliable and consistent diagnosis and evaluation for temporomandibular joint ankylosis. 
 Keywords: TMJ, ankylosis, 3-D CT scan, facial asymmetry.

Total Antioxidant Capacity, Catalase Activity and Salivary Oxidative Parameters in Patients with Temporomandibular Disorders.

Objectives:Temporomandibular disorders (TMD) are characterized by pain or discomfort in the temporomandibular joint, periauricular region, masticatory muscles, and neck on one or both sides. It may also be associated with joint sounds, restricted mandibular movements and mandibular deviation. Oxidative agents may have a deleterious role in the pathogenesis of joint diseases, and oxidative stress can lead to TMD. The aim of this study was to assess the oxidative stress biomarkers in the saliva of TMD patients and healthy controls.Materials and Methods:This case-control study was conducted on 30 patients with TMDs (5 males and 25 females) with a mean age of 30.7±13.2 years, and 30 healthy controls (5 males and 25 females) with a mean age of 29.16±11.2 years. Saliva samples were collected according to the standard protocol and the total antioxidant capacity of the saliva (non-enzymatic), catalase activity, and malondialdehyde (MDA) levels were measured using the ferric reducing ability of plasma, Aebi’s method, and high-performance liquid chromatography, respectively. Finally, The MDA levels were analyzed by the Mann-Whitney test. Other quantitative parameters were analyzed by independent t-test.Results:TMD patients had significantly higher salivary levels of MDA compared to the control group (P=0.001). But there were no significant differences in catalase (P=0.49) and total antioxidant capacity (P=0.22) of TMD patients and healthy controls.Conclusion:It seems that oxidative stress may be involved in the pathogenesis of TMDs.

Open Reduction Internal Fixation of Condylar Head/Diacapitular Fracture of Mandible: Case Series.

Surgical management of condylar head is largely deferred due to the lack of appropriate armamentarium or instrumentation, restricted surgical access and risk of iatrogenic complications. Here we delineate open reduction internal fixation of condylar head fracture with various fixation modalities using specialized instrumentation for visualization and providing access for reduction with minimal complications. A total of 21 patients were reported with condylar head fracture of mandible to the Department of Oral and Maxillofacial Surgery from January 2017 to June 2018. Three patients had bilateral condylar head fracture, making it a total of 24 fractures. All patients had clinical symptoms including deranged occlusion, limited mouth opening, jaw deviation and restricted mandibular movements. The radiological findings were dislocated or displaced condylar head medially or laterally. All patients were treated by open reduction internal fixation using lag screws or standard long screws. Among condylar head fractures, 19 of the study population were male and 2 were female. Distribution of age among the condylar head fractures ranges from 19 years to 40 years with the mean being 22 years. At the end of three-month follow-up, all patients had satisfactory results, both clinically and radiologically. The functional outcome of this study was found to be superior. We recommend open reduction internal fixation of condylar head for patients with high risk of ankylosis, and it is possible without complications due to the availability of minimally invasive surgical access system.

Polyphenols as Potential Agents in the Management of Temporomandibular Disorders

Temporomandibular disorders (TMD) consist of multifactorial musculoskeletal disorders associated with the muscles of mastication, temporomandibular joint (TMJ), and annexed structures. This clinical condition is characterized by temporomandibular pain, restricted mandibular movement, and TMJ synovial inflammation, resulting in reduced quality of life of affected people. Commonly, TMD management aims to reduce pain and inflammation by using pharmacologic therapies that show efficacy in pain relief but their long-term use is frequently associated with adverse effects. For this reason, the use of natural compounds as an effective alternative to conventional drugs appears extremely interesting. Indeed, polyphenols could represent a potential therapeutic strategy, related to their ability to modulate the inflammatory responses involved in TMD. The present work reviews the mechanisms underlying inflammation-related TMD, highlighting the potential role of polyphenols as a promising approach to develop innovative management of temporomandibular diseases.

Assessment of three pharmacological agents following arthrocentesis for the treatment of internal derangement of the temporomandibular joint; a clinical study

Temporomandibular disorder (TMD) includes disorders of the temporomandibular joint (TMJ) and masticatory muscles and their associated structures. It is characterized by pain, joint sounds and restricted mandibular movement. Pharmacological agents commonly used for the treatment of TMDs include non-steroidal anti-inflammatory drugs (NSAIDs), opioids, corticosteroids, muscle relaxants, antidepressants, anticonvulsants and benzodiazepines.Objectives: In the present study, we compared the clinical outcome of intra-articular injections of NSAIDs, corticosteroids, Hyaluronic acid given after temporomandibular joint arthrocentesis. Materials and methods: Twenty-seven patients suffering internal derangement of the temporomandibular joint and not responding to conservative therapy were randomly classified into three equal groups. In group A joint lavage was followed by 1ml of piroxicam injection. In group B joint lavage followed by 1 ml of dexamethasone injection and in group C joint lavage was followed by 1 ml of Hyalgan injection. The treatment outcome was evaluated clinically by measuring the maximal mouth opening in mm at 2 weeks and 3 months postoperatively. Pain was measured using the Visual Analogue Scale at the study intervals. These data were statistically analyzed. Results: All drugs were able to demonstrate a reduction in pain intensity and improvement in mouth opening at 2 weeks and 3 months postoperatively. No significant differences in treatment success were found among the three groups (P > 0.05) through the study intervals. Conclusion: We concluded that arthrocentesis with Piroxicam, dexamethasone or Hyalgan are similarly effective and are promising methods in relieving the symptoms of TMJ with non-reducing disc displacement. Additional prospective studies are required to confirm the adequate dosage of each treatment protocol, frequency of the injections required and combination between those protocols and other modalities in order to achieve long-term results.

Digital impression in patients with limited mouth opening – a new approach for occlusal splint manufacturing

Limited mouth opening is one of the primary symptoms of masticatory dysfunction. It may be due to muscular pathology or special alterations within the TMJ. If the therapy is not undertaken or abandoned, restricted mandibular movement may persist and the condition will become irreversible. The patient should receive the occlusal splint as soon as mandibular abduction restriction is diagnosed. Taking the impression if the range of opening is between 10-20 cm is not feasible since the impression tray cannot be placed in the patient’s mouth. The application of the TRIOS 3Shape intra-oral scanner enables digital recording of the prosthetic base in the patient’s mouth in the form of a 3-D image. The dimensions of the intra-oral part of the scanner make it possible to scan dental arches even if the range of abduction is very limited. Digital impression can be sent on-line to the dental lab within minutes. With modern CAD/CAM technology, preparation of an occlusal splint takes much shorter than the traditional approach.

Association of midline discrepancy with tempromandibular joint disorder. A systematic review.

AimThe aim is to evaluate the association between midline discrepancies and tempromandibular disorders (TMDs).MethodsLiterature search was performed by using various search engines to include human studies in English. TMDs include a wide variety of signs and symptoms such as pain in and around TMJ, jaw muscles, clicking and locking of jaws, pain during mandibular movement and restricted mandibular movements. The etiology is multifactorial, including one or several of the following factors like severe malocclusions (increased overjet, retroclination of incisors, cross bite, CR CO discrepancies etc), stress and psychological factors, structural abnormalities as possible etiology. There are controversies concerning the association between different traits of malocclusion and TMDs. The aim of the present study was to find out any association between signs and symptoms of TMDs with midline discrepancies, which represent an important trait of malocclusion.ResultOf the seven studies evaluated in this systematic review for investigating the association between midline discrepancy and TMD, six had moderate grade (B) of evidence. Four studies of moderate grade evidence (B) showed a significant association between the presence of midline shift and TMDs, and the remaining studies (two) had non-significant association. Only one study had a strong grade of evidence (A) and interestingly it denies the presence of midline shift to be a causative factor for TMDs. So, it can be concluded that the results are inconclusive regarding the association of midline discrepancies with TMDs. Nonetheless, this requires concrete evidence which necessitates further long term research into this aspect.

Jacob's Disease: A Case Report and Literature Review

Although osteochondroma is the most common benign tumor of bone in the axial skeleton, it rarely involves the maxillofacial region. In the latter case, it mainly affects the mandible, particularly the condyle. Very occasionally, it may affect the coronoid process and lead to the formation of a pseudo joint with the zygoma, a condition termed Jacob’s disease. This results in restricted mandibular movement and often causes midfacial asymmetry. We herein report the case of an 18 year-old female patient with a history of limited mouth opening for several years. Computed tomography and 3D reconstruction showed an exophytic tumor in the coronoid process, and a close relationship between the coronoid process and the malar and zygomatic arch. Total resection of the tumor and coronoid process was performed. The histopathological diagnosis was osteochondroma, confirming diagnosis of Jacob’s disease.

Intricate Estimation and Evaluation of Mandibular Movements in Geriatric Patients Suffering from Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is an autoimmune disorder that usually affects joints and making them warm, painful, and swollen. The chief purpose of this study was to evaluate movements of mandible in geriatric patients suffering from RA with or without temporomandibular joint dysfunction. A total of 45 people were included in this study with age of 60 years and above. Partially or completely edentulous patients were divided into experimental and control group. Experimental group consists of 20 people suffering from arthritis and control group consists of 25 people without arthritis. Movements were recorded with or without prosthesis while mastication in both experimental and control group. Statistical evaluation of two studied groups showed decrease opening angle (p < 0.05) during mastication; however, insertion of new prosthesis showd a significant increase in values in both groups, with an increase in opening and closing angles. Positive correlation was found between arthritis and movements of the mandible in older people suffering from RA. Patients suffering from RA are having restricted mandibular movements thus imposing an overall negative impact however; presence of prosthesis has been shown to enforce a positive effect on mandibular movement.

Open reduction and internal fixation of severely dislocated fractures of condylar neck and base using bioabsorbable miniplate in children: A 3–10 years follow-up study

ObjectiveTo evaluate the long-term clinical and radiologic outcomes of treating severely dislocated fractures of condylar neck and base with the comminuted fractures of parasymphysis or mental foramen, specially with crown fracture of deciduous molar and permanent molar or dislocation of the teeth sustained in childhood using bioabsorbable miniplate with open reduction and internal fixation (ORIF). MethodsFive children (age ranged from 3 to 11 years old averaged 8.2 years; 3 boys and 2 girls) with severely (the condyle dislocated from the glenoid fossa) dislocated fractures of condylar neck or base with the comminuted fractures of parasymphysis or mental foramen, specially with crown fracture of deciduous molar and permanent molar or dislocation of the teeth were treated with ORIF using 1 or 2 bioabsorbable miniplates (through preauricular approach and an oral vestibular approach). All patients have been followed-up clinically and radiographically for a mean of 5.6 years (range, 3–10 years). ResultsAll patients were cured satisfactorily with excellent occluding relation without restricted mandibular movement, facial asymmetry, retrognathism and ankylosis. 3–10 years follow-up study did not occur any mandibular development disorder. ConclusionThe results suggested that ORIF using bioabsorbable miniplate was a reliable fixation technique for use in the treatment of severely dislocated fractures of the condylar neck and base with the comminuted fractures of parasymphysis or mental foramen, specially with crown fracture of deciduous molar and permanent molar or dislocation of the teeth in children when the non-invasive or occlusal therapies were ineffective.

Postoperative evaluation of jaw function with restricted mandibular movement resulting from hyperplasia of masticatory muscle aponeurosis

Postoperative evaluation of jaw function with restricted mandibular movement resulting from hyperplasia of masticatory muscle aponeurosis

Prevalence of signs and symptoms of temporomandibular disorders in young Nigerian adults.

The objective of this study was to determine the prevalence of signs and symptoms of TMD in young Nigerian adults and to establish a baseline for comparison with other studies. It consisted of a cross-sectional study at Obafemi Awolowo University, Ile-Ife, Nigeria in 1997. The subjects consisted of 308 medical and dental students (207 males and 101 females) randomly selected from a Nigerian University. Their ages ranged from 17 to 32 years with a mean age of 23 +/- 3.0 years. They were assessed according to the criteria of Helkimo (1974). Whilst 26.3 per cent of the subjects reported mild symptoms (Ai I) of TMD, only 2.9 per cent reported severe symptoms (Ai II). Similarly, 46 per cent showed mild dysfunction signs (Di I), whilst 16.5 and 0.3 per cent exhibited moderate (Di II) and severe (Di III) signs of TMD, respectively. No significant relationships were found between sex, anamnestic index, and the clinical dysfunction index scores. However, there were low but significant correlations between ananmestic index scores (Ai) and the recorded signs (Di), as well as the clinical dysfunction scores (CDS). There is some evidence to show that signs and symptoms of TMD occur amongst Nigerians, although restricted lateral and protrusive mandibular movements contributed significantly to clinical dysfunction scores. This report contrasts with what is found in western societies regarding the low prevalence of TMJ pain. Refereed Scientific Paper

Osteochondroma of the mandibular condyle: A case report

A 52-year-old woman presented with pain on the right temporal region, restricted mandibular movement and a gradually developing malocclusion. Osteochondroma of the mandibular condyle was suspected based on diagnostic imaging. Local resection with preservation of the condylar head resulted in complete resolution of symptoms.

Osteochondrmoma of the mandibular condyle. A case report

. A 52-year-old wmoman presented with pain on the right temporal region, restricted mandibular movement and a gradually developing malocclusion. Osteochondrmoma of the mandibular condyle was suspected based on diagnostic imaging. Local resection with preservation of the condylar head resulted in cmomplete resolution of symptmoms.