Temporomandibular Joint Range Of Motion Research Articles

Effectiveness of dexamethasone iontophoresis for temporomandibular joint involvement in juvenile idiopathic arthritis

Temporomandibular joint (TMJ) involvement is common in juvenile idiopathic arthritis (JIA). Dexamethasone iontophoresis (DIP) uses low-grade electric currents for transdermal dexamethasone delivery into deeper anatomic structures. The purpose of this study was to assess the safety and effectiveness of DIP for the treatment of TMJ involvement in JIA, and to delineate variables that are associated with improvement after DIP. Medical records of all JIA patients who underwent DIP for TMJ involvement at a larger tertiary pediatric rheumatology center from 1997-2011 were reviewed. DIP was performed using a standard protocol. The effectiveness of DIP was assessed by comparing the maximal interincisor opening (MIO(TMJ) ) and the maximal lateral excursion (MLE(TMJ) ) before and after treatment. Twenty-eight patients (ages 2-21 years) who received an average of 8 DIP treatment sessions per involved TMJ were included in the analysis. Statistically significant improvement in the median MIO(TMJ) (P < 0.0001) was observed in 68%. The median MLE(TMJ) (P = 0.03) improved in 69%, and resolution of TMJ pain occurred in 73% of the patients who had TMJ pain at baseline. Side effects of DIP were transient site erythema (86%), skin blister (4%), and metallic taste (4%). Improvement in TMJ range of motion from DIP is associated with lower MIO(TMJ) , lower MLE(TMJ) , and absence of TMJ crepitus at baseline. In this pilot study, DIP appeared to be an effective and safe initial treatment of TMJ involvement in JIA, especially among patients with decreased TMJ measurements. Prospective controlled studies are needed.

Maxillomandibular Circular External Skeletal Fixation for Repair of Bilateral Fractures of the Caudal Aspect of the Mandible in a Dog

To describe the novel use of circular external skeletal fixation (CESF) for repair of bilateral fractures of the caudal aspect of the mandibles. Clinical report. A 5-month-old female Newfoundland. A 2-ring CESF was used to immobilize the mandible relative to the maxillae. Anatomic dental occlusion and reduction of the right hemimandible were achieved with mild malalignment of the left hemimandible. Fracture healing occurred within 20 days. Transient epistaxis and reduced temporomandibular joint range of motion occurred at the time of fixator removal but normal use of the mandible was reported 6 months postoperatively. CESF effectively immobilized the mandible permitting rapid fracture healing with minimal morbidity. Maxillomandibular CESF may represent a simple, effective option for the management of challenging fractures involving the caudal aspect of the mandible.

The lateral pterygoid release to restore normal jaw motion: a case report

This case reports a 31-year-old lady who experienced a closed-locked jaw for 1 year, noted upon waking. The patient's first recourse was to an Osteopath, who applied distractive mandibular techniques, which provided 1.5 cm of jaw opening. There was no further improvement for 11 months until conservative chiropractic treatment was applied intra-orally to the lateral pterygoid muscle. This immediately increased the temporo-mandibular joint (TMJ) range of motion a further 2.5 cm. This article focuses on the influence of the articular disc and lateral pterygoid muscle on TMJ range of motion. Attention is also given to outcomes of TMJ treatment and the evidence for conservative treatment of this joint.

Discriminant validity of temporomandibular joint range of motion measurements obtained with a ruler.

Prospective, descriptive study. To determine the discriminant validity and intrarater and interrater reliability of measurements of temporomandibular joint (TMJ) range of motion (ROM). Although ROM measurements are a routine part of the examination of patients with TMJ disorders, few studies have examined the validity of these measures for identifying pathology of the TMJ. Two groups of subjects were tested: 15 subjects (2 men, 13 women; mean age = 35.2 years) with a TMJ disorder and 15 subjects (3 men, 12 women; mean age = 42.9 years) without a TMJ disorder. Six motions were measured (opening, left excursion, right excursion, protrusion, overbite, and overjet) by 2 therapists. Mouth opening was the only TMJ ROM measurement to discriminate between subjects with and without TMJ disorders (mean 36.2 +/- 6.4 versus 43.5 +/- 6.1 mm). The technical error of measurement of the measures varied from .2 to 2.5 mm. Intrarater reliability coefficients (ICC 3,1) varied from .70 to .99. Interrater reliability coefficients (ICC 2,k) varied from .90 to 1.0. Although all TMJ ROM measurements tended to be reliable, only mouth opening was found to be valid in discriminating between patients with and without a TMJ disorder.

Temporomandibular joint range of motion: a ratio of interincisal opening to excursive movement in a healthy population.

Range of motion is used in the examination and diagnosis of many joints. A simple method to measure and record temporomandibular joint range of motion is presented. Correlation of mandibular movement to excursive or lateral movements for a healthy population is described. The maximum incisal opening and lateral movements of 75 subjects, aged 20-50 years, were recorded. The average of maximum opening to lateral movements was found to be 4.4 to 1. A significant correlation or ratio of mandibular movement for use in diagnoses and treatment planning is discussed.