Temporomandibular Joint Capsule Research Articles

Transient contribution of the sphenoid ala major to the socket of the temporomandibular joint in near-term fetuses.

The temporomandibular joint (TMJ) is a complex structure that plays a vital role in the movement of the jaw. Some anatomy and dental textbooks show that, at the medial margin, the TMJ capsule attaches to a suture between the sphenoid ala major and the temporal bone squamosa. In near-term fetuses, the ala major extends posterolaterally to approach the TMJ. In this study, we aimed to investigate the contribution of the sphenoid ala major to the socket of the TMJ in near-term fetuses. We examined histological sections from 22 human fetuses (approximately 15-40 weeks). At midterm, the lateral and superior walls of the TMJ cavity were formed by the temporal bone squamosa, whereas the ala major was distant from the joint. However, at near-term, the ala major formed the medial wall of almost the entire part of the joint cavity. The top of the TMJ was attached to both the squamosa and ala major, with the condylar head consistently separated from the sphenoid by the joint disk. We observed a significant descent of the middle cranial fossa in near-term fetuses, which brought the ala major close to the TMJ. This transient position of the TMJ near the sphenoid is likely due to brain enlargement and posterolateral growth of the ala major. After birth, occlusion causes the anterior growth of the mandibular fossa of the squamosa, which moves the ala major away from the TMJ. Similarly, the lateral growth of the sphenoid toward the squamosa suture may also stop in children.

Gelatin methacryloyl hydrogel with and without dental pulp stem cells for TMJ regeneration: An invivo study in rabbits.

In the last decade, tissue-engineering strategies for regenerating the temporomandibular joint (TMJ) have been investigated. This may be a promising strategy for the minimally invasive restoration of joint integrity. To evaluate whether dental pulp stem cells (DPSCs) loaded in a light-occured hydrogel made of gelatin methacryloyl (GelMA) enhance the regeneration of osteochondral defects in the rabbit TMJ. Defects were filled with GelMA alone (control group; n = 4) or filled with GelMA loaded with rabbit DPSCs (experimental group; n = 4), In one group, the TMJ capsule was opened without creating a defect (sham group; n = 2). The following micro-CT parameters were analysed: bone volume to total volume ratio (BV/TV%) and bone mineral density (BMD). Histological evaluation was performed to assess cartilage regeneration features. A semi-quantitative scoring system was also used to evaluate the defects. All groups had no statistical difference regarding the micro-CT parameters. The highest mean healing score was found for the experimental group. After 4 weeks, there were no signs of hydrogel in either group or no signs of inflammation in the adjacent tissues. The tissue formed in the defect was dense fibrous connective tissue. Adding DPSCs to GelMA did not provide a regenerative enhancement in TMJ osteochondral defects. This resulted in similar micro-CT parameters after 4 weeks of healing, with improved signs of subchondral bone regeneration but no cartilage regeneration.

Clinical experience of 23 cases of adenoid cystic carcinoma of the external auditory canal.

Adenoid cystic carcinoma (ACC) of the external auditory canal (EAC) is a rare tumor. The present study aimed to describe the clinical features and survival of patients with ACC of the EAC. The present retrospective study included 23 patients (mean age, 51.4±15.4 years; 12 males) diagnosed with ACC of the EAC between January 2010 and September 2017 at The First Affiliated Hospital of The Third Military Medical University (Chongqing, China). The median disease course was 24 months. The presenting features were earache in 16 patients, otorrhea in 7 patients, hearing loss in 5 patients, feeling of aural fullness in 2 patients and EAC mass in 4 patients. Tumor stage was T1 in 13 patients, T2 in 3 patients, T3 in 3 patients and T4 in 4 patients. Among patients with T1 tumors, 5 underwent en bloc external EAC resection; 3 underwent local EAC resection; 1 underwent en bloc EAC resection and superficial parotidectomy; 1 underwent subtotal temporal bone resection for postoperative recurrence; Among patients with T4 tumors, 1 underwent extended temporal bone resection, right parotidectomy, right resection of middle cranial fossa tumors and right resection of temporomandibular joint capsule. 1 underwent subtotal temporal bone resection. Among these 15 patients who underwent surgery, 2 received postoperative radiotherapy, 1 received postoperative chemotherapy, 5 received postoperative chemo-radiotherapy, and 7 did not receive postoperative chemo-radiotherapy. The 3- and 5-year cumulative survival rates of the 23 patients were 47.8% and 17.4%, respectively. Survival may have been improved in patients who received postoperative chemo-radiotherapy and early diagnosis may be the key to improving survival.

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

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

Micronized palmitoylethanolamide reduces joint pain and glial cell activation.

Temporomandibular disorder (TMD) is a common painful condition in the temporomandibular joint (TMJ). Joint inflammation is believed to be a chief cause of pain in patients with TMD, through the release of pro-inflammatory cytokines that induce peripheral sensitization of nerve terminals followed by microglial stimulation. TMJ was induced in rats with the injection of complete Freund's adjuvant (CFA) emulsion into the left TMJ capsule. The present study would assess the effects of micronized palmitoylethanolamide (m-PEA) on glial activation and trigeminal hypersensitivity. Ten mg/kg m-PEA or corresponding vehicle was administered 1h after CFA and mechanical allodynia and edema were evaluated at 24 and 72h after CFA injection. CFA-injected animals showed TMJ edema and ipsilateral mechanical allodynia accompanied by a robust growth in GFAP protein-positive satellite glial cells and activation of resident macrophages in the TG. Moreover, m-PEA administration significantly reduced the degree of TMJ damage and pain, macrophage activation in TG and up-regulation of Iba1. The results confirm that m-PEA could represent a novel approach for monitoring pain during trigeminal nerve sensitization.

Difficulties in clinical staging of external ear canal carcinoma– a case report

Carcinoma of the external auditory canal (EAC) is known to be very rare with a rate of 1-6 per million people. It affects mostly people over the age of 50 regardless of gender. The most common type of carcinoma of EAC is squamous cell carcinoma (SCC). The aim of this paper is to present the case of a 56-year-old woman with carcinoma of EAC. She was admitted to otolaryngology clinic due to ear buzzing lasting for five months, periodic otorrhea and hearing deterioration in her right ear. In otoscopic examination a tumor in the right ear meatus was identified. It filled almost the entire canal. Biopsy confirmed the presence of squamous-cell cancer. Tumor advancement was diagnosed using computer tomography of the temporal bones, magnetic resonance imaging of the head and ultrasonography of the neck. Imaging examinations indicated T3 N0 stage. Doctors decided to perform lateral petrosectomy with elective neck dissection. During the operation, the results of histopathological examination of frozen specimens from marginal tissues revealed an invasion of the anterior wall of the ear canal, capsule of temporomandibular joint and parotid gland. The resection eventually included also parotid gland and temporo-mandibular joint with the caput of the mandible. After recuperation, the patient had complementary radiotherapy. The presented case shows that precise imaging is necessary before surgical treatment, but unfortunately the invasion of cancer may not be estimated properly. Based on literature, the best prognosis concerns wide resection with complementary radiotherapy, although the schedule of treatment is not determined.

Temporomandibular joint dislocation in an epileptic and mentally retarded patient: a case report.

Temporomandibular joint (TMJ) dislocation is defined as an excessive forward movement of the condyle beyond the articular eminence with complete separation of articular surfaces and fixation in that position.' Theories regarding the pathogenesis of TMJ dislocation propose laxity of TMJ ligaments or capsule, excessive activity of the lateral pterygoid muscle (LPM)and erosion of the eminence'. TMJ dislocation can occur in an anterior, posterior, lateral and superior direction'. Clinical presentation of dislocated TMJ includes inability to close the mouth, deviation of the mandible away from the affected side in unilateral cases, hollowing in front of the tragus, spasm of muscles of mastication and severe pain of the TMt Radiographs show an empty condylar fossa with the condylar head located anterior to the articular eminence. Anterior TMJ dislocation usually follows excessive mouth opening during yawning, laughing, eclamptic fit and motor vehicle accident (MVA)'. Iatrogenic causes of TMJ dislocation are excessive mouth opening during dental treatment, intubation, and otorhinolaryngological procedures Some drugs are associated with TMJ dislocation, these include antiemetics such as metoclopramide and compazine which produce extrapyramidal effects' and neuroleptic drugs. Systemic connective diseases like Ehlers-Danlos and Marfan syndromes have also been implicated in TMJ dislocations The purpose of this article is to report management challenges of an epileptic and mentally retarded patient with recurrent TMJ dislocation.

Central Role of Protein Kinase A in Promoting Trigeminal Nociception in an In Vivo Model of Temporomandibular Disorders.

To investigate cellular changes in the spinal trigeminal nucleus (STN) and trigeminal ganglion (TG) associated with trigeminal nociception mediated by inflammation in the temporomandibular joint (TMJ). Male Sprague-Dawley rats (n = 86) were utilized to investigate cellular and behavioral responses to prolonged TMJ inflammation caused by bilateral injection of Complete Freund's Adjuvant (CFA) in the TMJ capsules. To investigate the cellular effects of protein kinase A (PKA) in the STN, rats were injected intrathecally with the selective PKA inhibitor KT5720 prior to injection of CFA into both TMJ capsules. Levels of calcitonin gene-related peptide (CGRP), active PKA, and ionized calcium-binding adapter molecule 1 (Iba1) in the STN and expression of phosphorylated extracellular regulated kinases (p-ERK) in the TG were determined with immunohistochemistry (n ≥ 3 experiments per test condition). Nocifensive head withdrawal responses to mechanical stimulation of the cutaneous tissue over the TMJ were monitored following CFA injection in the absence or presence of KT5720 (n = 7). Statistical analysis was performed using parametric analysis of variance (ANOVA) tests. Intrathecal injection of KT5720 significantly inhibited the stimulatory effect of CFA on levels of CGRP, PKA, and Iba1 in the STN. In addition, administration of KT5720 decreased the average number of CFA-induced nocifensive withdrawal responses to mechanical stimulation and the CFA-mediated increase in p-ERK expression in the ganglion. These findings provide evidence that elevated PKA activity in the STN promotes cellular events temporally associated with trigeminal nociception caused by prolonged TMJ inflammation.

Tumor necrosis factor-Alpha stimulates cytokine expression and transient sensitization of trigeminal nociceptive neurons

ObjectiveElevated levels of tumor necrosis factor- alpha (TNF-α) in the capsule of the temporomandibular joint (TMJ) are implicated in the underlying pathology of temporomandibular disorders (TMD). TMD are a group of conditions that result in pain in the TMJ and/or muscles of mastication, and are associated with significant social and economic burdens. The goal of this study was to investigate the effect of elevated TNF-α levels in the TMJ capsule on nocifensive behavioral response to mechanical stimulation of trigeminal neurons and regulation of cytokines within the trigeminal ganglion. DesignMale Sprague-Dawley rats were injected bilaterally in the TMJ capsule with TNF-α and changes in nocifensive head withdrawal responses to mechanical stimulation of cutaneous tissue directly over the capsule was determined using von Frey filaments. Cytokine levels in trigeminal ganglia were determined by protein array analysis at several time points post injection and correlated to nocifensive behavior. ResultsTNF-α caused a significant increase in the average number of nocifensive responses when compared to naive and vehicle treated animals 2h post injection, but levels returned to control levels at 24h. Based on array analysis, the levels of eight cytokines were significantly elevated above vehicle control levels at 2h following TNF-α injection, but all eight had returned to the vehicle control levels after 24h. ConclusionsOur findings provide evidence that elevated levels of TNF-α in the joint capsule, which is reported to occur in TMD, promotes nociception in trigeminal ganglia neurons via a mechanism that temporally correlates with differential regulation of several cytokines.

Ультразвуковая диагностика остеоартроза височно-нижнечелюстного сустава

<p class="p1"><span class="s1">The article describes the sensitivity, speci city and accuracy of ultrasound diagnostics of the early stages of of the temporomandibular joint (TMJ) osteoarthritis (OA). The study involved 16 patients with TMJ OA (1 man, 15 women; median age – 56,1±3, and 57 years) and 12 volunteers with normal TMJ (3 men, 9 women; median age – 25,4±2,7 years). Clinical, radiographic, and ultrasonic examination of the TMJ was conducted. The echogram detected thickening of the joint capsule to accompany the TMJ. The width of the front, middle and rear parts of the joint gap was narrower than in the comparison group. The width of the capsule-cervical space in the TMJ patients ranged from 0.5 to 4 mm. In 18.8% of patients with the TMJ capsule width-cervical space was more than 1.9 mm, which is an indirect sign of synovitis. In the descriptions of linear tomograms (TMG) and echogram in patients with TMJ OA were identi ed: subchondral sclerosis, of the joint space narrowing, attening of the limited mobility of the lower jaw head, marginal osteophytes, small subchondral cysts, effusion. The linear tomograms TMJ diagnostic accuracy is 79,2%. The Ultrasonic diagnostics is informative during at the early stages of the TMJ, the diagnostic accuracy was being 59%. TMG and ultrasonic diagnostics of the AO TMJ are not the alternative methods of research. When diagnosing the of early stages of TMJ OA, and determining secondary synovitis priority should be given to the ultrasound. </span></p>

Spontaneous Temporomandibular Joint Herniation into the External Auditory Canal through a Persistent Foramen Tympanicum (Huschke): Otologic Features

A persistent foramen tympanicum (Huschke) is an anatomic variation located in the anterior inferior portion of the bony external ear canal. We present a case of symptomatic temporomandibular joint (TMJ) herniation into the right external auditory canal though an enlarged osseous defect. The herniated retrodiscal temporo-mandibular joint (TMJ) tissue moved backward when the patient’s mouth was closed, and forward, when opened. Imaging findings were useful for differentiating TMJ herniation from salivary fistula or a true granuloma of the anterior bony canal wall near the tympanic membrane. The purpose of this presentation is to alert otologists that a large granuloma near the anterior inferior or anterior superior portion of the bony ear canal adjacent to the anterior superior tympanic membrane can be a herniation of either the parotid gland or in this case, the temporomandibular joint capsule. Several attempts at removal of this through the ear canal failed because of the initially incorrect diagnosis of a primary lesion of the ear canal. Only after considerable thought was it realized that this was a rare herniation of the temporomandibular joint capsule through a patent foramen of Huschke.

A case of extraskeletal chondroma of the temporomandibular joint capsule

Extraskeletal chondromas are rare benign cartilaginous tumors. Clinically, these tumors are most frequently found in the hands and feet. However, it is extremely rare for them to develop in the oral and maxillofacial regions. We present the case of a 50-year-old man with a tumor lesion of the temporomandibular joint capsule, which is a site that has not been described previously. Based on the physical examination and imaging study, the tumor was located in the joint capsule, and it was locally excised and pathologically diagnosed as extraskeletal chondroma. Postoperatively, residual disability and tumor recurrence were not observed.

The Diagnostic Value of Pressure Algometry for Temporomandibular Disorders

The aim of this study is to determine the diagnostic value of pressure algometry in temporomandibular disorders. Two hundred volunteers aged 19.3 to 27.8 (mean 21.50, SD 0.97) participated in this study. An analogue pressure algometer was used for the evaluation of muscle tenderness of the following masticatory muscles: superficial and deep parts of the masseter muscle; anterior and posterior parts of the temporal muscle; and the tissues adjacent to the lateral and dorsal part of the temporomandibular joint capsule. Each patient described the algometry result for the individual components of the masticatory motor system, by selecting each time the intensity of pain on a 100 mm Visual Analogue Scale (VAS) ruler. The area under the receiver operating characteristic (ROC) curve, indicating the discriminatory efficiency for asymptomatic subjects and patients with temporomandibular dysfunction according to the dysfunction Di index, was the largest for the mean pain value (AUC = 0.8572; SEM = 0.0531). The 7.4 VAS cut-off point marked 95.3% specificity for this variable in identifying healthy subjects and 58.4% sensitivity in identifying patients with symptoms of dysfunctions (accuracy 68.1%). Assuming comparable sensitivity (74.9%) and specificity (74.2%) for a diagnostic test, there was test accuracy of 74.5% at the 4.2 VAS cut-off point.

A ganglion cyst of the temporomandibular joint.

A ganglion cyst of the temporomandibular joint.

A preliminary report on MRI findings one hour after autologous blood injection around the temporomandibular joint capsule for habitual temporomandibular joint dislocation

A preliminary report on MRI findings one hour after autologous blood injection around the temporomandibular joint capsule for habitual temporomandibular joint dislocation

The topographic anatomy of the masseteric nerve: A cadaveric study with an emphasis on the effective zone of botulinum toxin A injections in masseter

Botulinum toxin injections are previously reported to be a noninvasive alternative method for treating masseteric hypertrophy. However, there is a debate on finding an ideal place for injection. The aim of this study is to document the anatomical landmarks for defining the motor nerve entry points (MNEPs) of the masseteric nerve in the masseter for effective botulinum toxin injections. Twelve sides from six adult fixed cadavers were used for this study. The MNEPs of the masseteric nerve were defined according to standard landmark lines including the orbitomeatal line (OML) and the line (VL), which intersects the mid-distance of the OML to the tip of the angle of the mandible. All MNEPs were located 4.4 cm inferior to the OML. In addition, the average anterior distance of the MNEPs to the VL was 1.4 cm and the average posterior distance was 0.6 cm. The ideal site of Botox injection into the masseter is a rectangular area: 5 cm inferior to the OML, 1 cm anterior and posterior to the VL, and just above the periosteum. Based on the data of our study, injections to the parotid gland and branches of the facial nerve such as the marginal mandibular and buccal can be avoided. The masseteric nerve can easily be found approximately 1.0-1.5 cm inferior to the zygomatic arch, 1 cm medial to the temporomandibular joint capsule, and 1 cm superior to mandibular notch, which makes its use for facial reanimations more efficient.

Analysis of MRI findings in minimum invasive treatment for habitual temporomandibular joint dislocation by autologous blood injection around the temporomandibular joint capsule

The aim of this study was to investigate magnetic resonance imaging (MRI) findings following autologous blood injection (ABI) for habitual temporomandibular joint (TMJ) dislocation. MRI was performed one hour and four and twelve weeks after ABI, revealing three types of significant findings. The first type was similar to hematoma and/or joint effusion in the articular capsule of the TMJ (type I). The second showed sporadic and diffuse T2 emphasis around the TMJ capsule (type II). The third involved a decreased range of condyle movement compared to before ABI (type III). Furthermore, we analyzed the three types of significant MRI findings.At one hour after ABI, type I was Grade 0 in 0 of 14 patients, Grade 1 in 8, Grade 2 in 2, and Grade 3 in 4. Type II was seen in 9 of the 14 cases and type III in 8. After twelve weeks, all cases of type I were Grade 0, no type II cases were evident, and type III was seen in 11 cases. Injecting autologous blood into surrounding TMJ tissues is an important factor in ABI. Minimally invasive treatment for habitual TMJ dislocation using ABI around the TMJ capsule appears to represent a very effective and safe treatment.

Dual orexin receptor antagonist 12 inhibits expression of proteins in neurons and glia implicated in peripheral and central sensitization

Sensitization and activation of trigeminal nociceptors is implicated in prevalent and debilitating orofacial pain conditions including temporomandibular joint (TMJ) disorders. Orexins are excitatory neuropeptides that function to regulate many physiological processes and are reported to modulate nociception. To determine the role of orexins in an inflammatory model of trigeminal activation, the effects of a dual orexin receptor antagonist (DORA-12) on levels of proteins that promote peripheral and central sensitization and changes in nocifensive responses were investigated. In adult male Sprague–Dawley rats, mRNA for orexin receptor 1 (OX1R) and receptor 2 (OX2R) were detected in trigeminal ganglia and spinal trigeminal nucleus (STN). OX1R immunoreactivity was localized primarily in neuronal cell bodies in the V3 region of the ganglion and in laminas I–II of the STN. Animals injected bilaterally with complete Freund’s adjuvant (CFA) in the TMJ capsule exhibited increased expression of P-p38, P-ERK, and lba1 in trigeminal ganglia and P-ERK and lba1 in the STN at 2days post injection. However, levels of each of these proteins in rats receiving daily oral DORA-12 were inhibited to near basal levels. Similarly, administration of DORA-12 on days 3 and 4 post CFA injection in the TMJ effectively inhibited the prolonged stimulated expression of protein kinase A, NFkB, and Iba1 in the STN on day 5 post injection. While injection of CFA mediated a nocifensive response to mechanical stimulation of the orofacial region at 2h and 3 and 5days post injection, treatment with DORA-12 suppressed the nocifensive response on day 5. Somewhat surprisingly, nocifensive responses were again observed on day 10 post CFA stimulation in the absence of daily DORA-12 administration. Our results provide evidence that DORA-12 can inhibit CFA-induced stimulation of trigeminal sensory neurons by inhibiting expression of proteins associated with sensitization of peripheral and central neurons and nociception.

Ganglion cyst of the temporomandibular joint

Ganglion cyst of the temporomandibular joint is a rare disease, which may arise from myxoid degeneration of the collagenous tissue of the temporomandibular joint capsule, without epithelial or endothelial lining. We report a case of cystic lesion in a 40-year-old female patient. The patient had a left pre-auricular oval-shaped swelling without any articular symptoms. The pathological analysis after surgical removal allowed diagnosing the lesion as a ganglion cyst of the left temporomandibular joint. We made a literature review and noted that this condition was predominant in female patients. We recommend using MRI for diagnostic purposes and surgery as the best therapeutic alternative.

Joint use of skull base surgery in a case of pediatric parotid gland carcinoma.

Parotid gland carcinoma is extremely rare in children. We report a case of pediatric parotid gland carcinoma with extensive infiltration into surrounding tissues including the skin and temporomandibular joint capsule at initial examination. Total resection of the parotid gland was conducted together with skull base surgery and mandibular dissection. The patient was a 14-year-old girl. In addition to the skin and temporomandibular joint, infiltration into the anterior wall of the external auditory meatus and masseter muscle was also seen, and T4N0M0 stage IV parotid carcinoma was diagnosed. Skin was resected together with the pinna, and temporal craniotomy and skull base surgery were performed to resect the temporomandibular joint capsule and external auditory meatus en bloc, and mandible dissection was conducted. Facial nerves were resected at the same time. Level I to level IV neck dissection was also conducted. A latissimus dorsi myocutaneous flap was used for reconstruction. The postoperative permanent pathology diagnosis was high-grade mucoepidermoid carcinoma with a low-grade component. Postoperatively, radiotherapy at 50 Gy alone has been conducted, with no recurrence or metastasis observed for over 4 years.