Temporomandibular Joint Disc Perforation Research Articles

Reliability of magnetic resonance for temporomandibular joint disc perforation: A 12 years retrospective study

The aim of this study was to evaluate the reliability of magnetic resonance imaging (MRI) in detecting disc perforations in the temporomandibular joint (TMJ), and to establish diagnostic criteria for this purpose.The retrospective analysis included patients who had undergone preoperative MRI and TMJ arthroscopy at the same hospital. Direct and indirect signs of disc abnormalities on MRI were compared with arthroscopic findings of disc perforation. Out of 355 joints evaluated in 185 patients, arthroscopy confirmed disc perforations in 14.7% of cases. Several MRI findings were significantly associated with disc perforation, including anterior disc displacement without reduction (ADDwoR), signal alterations in the mid-disc area, disc deformity (SAMD), retrocondylar disc fragments, osteophytes, condylar bone marrow degeneration (CBMD), and joint effusion in both joint spaces (ESJS-EIJS).Regression analysis revealed that SAMD, osteophytes, and CBDM were strongly associated with disc perforation. The ROC curve showed that MRI had an AUC = 0.791, with a sensitivity of 88.5% and a specificity of 61.5%.Two diagnostic methods, one based on three findings (osteophytes, ADDwoR, and SAMD) and one based on two direct signs (ADDwoR and SAMD), yielded high sensitivity and specificity values of 80.4% and 69.8%, and 84.3% and 62.5%, respectively.In conclusion, MRI demonstrated acceptable accuracy in the detection of TMJ disc perforations, with specific diagnostic criteria offering high sensitivity and specificity. Significant MRI indicators of disc perforation included SAMD, osteophytes, and CBDM. This study provides valuable information on the use of MRI as a diagnostic tool for TMJ disc perforations.

A New Technique for Arthroscopic Discectomy of the Temporomandibular Joint Disc Perforation: A Technical Note

Disc perforation represents the result of the degenerative process in joint structures that may lead to pain, joint noise, restricted mouth opening, osteoarthritis, and even dentofacial anomalies. Even though discectomy has proven benefits, with promising outcomes reported, it is mainly described using an open approach. While some arthroscopic techniques have been published, they are limited to managing perforation, edge widening, and inflammation treatment and do not describe complete disc removal. We describe a novel step-by-step arthroscopic discectomy technique (ADT) utilizing two operative cannulas that completely remove non-functional cartilaginous tissue.

Perforation of the temporomandibular joint disc: cadaveric anatomical study

The aim of this human cadaveric study was to investigate the relationship between temporomandibular joint disc perforation and bony changes of the mandibular condyle. Overall, 135 cadaveric mandibles were used (69 male, 66 female; all White). Mean age at death was 78.7 years. Perforation of the disc was investigated. Differences in the area of the perforation according to the different types of bony change (erosion, flattening, osteophyte) were evaluated. Perforation of the disc was observed in 34.8% of all mandibles, occurring unilaterally in 53.2% of cases and bilaterally in 46.8%. The prevalence of perforation was 16.4% in cadavers <80 years old (67 heads) and 52.9% in those ≥80 years old (68 heads) (P < 0.001). Osteophyte formation was always identified along with other bony changes (21.7%) and never in isolation. The area of the perforation was significantly larger in the groups with bony changes (one, two, or three changes) than in the ‘no bony change’ group. The group with osteophyte formation showed a significantly larger perforated area than the group without osteophyte formation; likewise, the group with flattening showed a significantly larger perforated area than the group without flattening. Osteophytes and flattening are probably secondary bony changes that occur following disc perforation. Based on this study, disc perforation should be suspected when these findings are identified on imaging.

Application of modified articular disc anchorage in treating the perforation and rupture of temporomandibular joint disc.

This study aimed to use modified articular disc anchorage in treating old irreducible temporomandibular joint (TMJ) disc displacement with perforation and rupture, as well as to explore its efficacy. A total of 31 patients (34 sides) with 47 TMJ disc perforations who underwent surgical treatment in the Affiliated Stomatolo-gical Hospital of Nanchang University from January 2018 to December 2021 were selected. According to the location of disc perforation, it has five types: posterior disc perforation (typeⅠ), anterior disc perforation (typeⅡ), lateral disc perforation (type Ⅲ), composite disc perforation, and destruction disc perforation. The modified methods of disc anchoring were divided into two types according to the location of the perforation. TypesⅠandⅢ disc perforation were trea-ted by posterior anchoring method. For posterior ancho-ring, a screw was implanted into the posterolateral side of the condylar neck, and the disc was fixed on the screw by horizontal mattress suture. TypeⅡdisc perforation and compo-site disc perforation combined typeⅡperforation were treated by anterior and posterior double-anchoring method. For anterior anchoring, anchor screws or holes were placed at the anterior edge of the condylar neck, and horizontal mattress suture was performed at the posterior edge of the anterior perforation with an anchor wire. The articular disc was then fixed on the anchor screws or holes. For the posterior anchoring method, it was the same as the previous one. Paired t test was used to analyze the visual analog scale (VAS), maximum interincisal opening (MIO), and TMJ disorder index (CMI) of the patient before surgery and 1, 3, and 6 months after surgery. Disk-condyle position relationship by magnetic resonance imaging and postoperative quality of life in postoperative were analyzed. The incidence of perforation was 41.2% (14/34) in typeⅠ, 11.8% (4/34) in typeⅡ, 8.8% (3/34) in typeⅢ, 29.4% (10/34) in composite type, and 8.8% (3/34) in destruction type. The VAS, MIO, and CMI at 3, 6 months after operation significantly improved compared with those before operation (P<0.05). The effective reduction rate of disc was 96.77% (30/31). The quality of life at 6 months after surgery was 47.22±2.13, and the rate of excellent evaluation was 96.4% (27/28). Modified articular disc anchorage achieves a good curative effect for treating temporomandibular joint disc perforation and rupture. Nevertheless, its long-term effect requires further observation.

Using deep learning to predict temporomandibular joint disc perforation based on magnetic resonance imaging

The goal of this study was to develop a deep learning-based algorithm to predict temporomandibular joint (TMJ) disc perforation based on the findings of magnetic resonance imaging (MRI) and to validate its performance through comparison with previously reported results. The study objects were obtained by reviewing medical records from January 2005 to June 2018. 299 joints from 289 patients were divided into perforated and non-perforated groups based on the existence of disc perforation confirmed during surgery. Experienced observers interpreted the TMJ MRI images to extract features. Data containing those features were applied to build and validate prediction models using random forest and multilayer perceptron (MLP) techniques, the latter using the Keras framework, a recent deep learning architecture. The area under the receiver operating characteristic (ROC) curve (AUC) was used to compare the performances of the models. MLP produced the best performance (AUC 0.940), followed by random forest (AUC 0.918) and disc shape alone (AUC 0.791). The MLP and random forest were also superior to previously reported results using MRI (AUC 0.808) and MRI-based nomogram (AUC 0.889). Implementing deep learning showed superior performance in predicting disc perforation in TMJ compared to conventional methods and previous reports.

Morphological and histopathological evaluation of temporomandibular joint osteoarthrosis induced by perforation of articular disc in rats

Objective: To establish the animal model of temporomandibular joint osteoarthrosis (TMJOA) in rats induced by perforation of articular disc and evaluate the morphological characteristics and histopathological changes of the condyle of temporomandibular joint (TMJ). Methods: Eight male SD rats, purchased from Chongqing Medical University, were marked from No. 1 to No. 8 according to a random number table. The eight numbered rats were then arranged according to their sizes from large to small. The first four rats were divided into the one-week group, while the last four were divided into the four-week group. In order to simulate a TMJ disc perforation, an oblique incision was created along the zygomatic arch of the left side (the model side) making the TMJ superior joint space exposed. The left disc was pulled out and artificially perforated by a dental round bur with 1.5 mm diameter at the postmedian part of TMJ disc. The disc of the right side (the control side) was kept intact. The rats were randomly euthanized respectively at 1 week or 4 weeks (n=4 for each time point) for further study. Morphological observation and imaging examination were used to assess the degree of articular cartilage degradation and the loss of subchondral bone. Immunohistochemicalstaining (IHC), safranin O and fast green staining, tartrate-resistant acid phosphatase (TRAP) staining and haematoxylin staining were performed to evaluate the histopathological changes of condylar cartilage. Results: In the morphological observation, significant redness and swelling were observed on the model side of the 1-week-group and the typical beak-like change of osteoarthropathy was observed on the model side of the 4-week-group. The heights of condylar process on the model sides in the 1-week-group and 4-week-group [(2.73±0.14) and (2.49±0.25) cm, respectively] were significantly lower than that in the control side [(3.30±0.09) and (3.30±0.12) cm, respectively] (P<0.01). Imaging examination showed obvious damage in trabecular microstructure on the model side of the 4-week-group. Safranin O and fast green staining showed that the amounts of proteoglycan on the model sides of the 1-week-group and the 4-week-group were significantly lower than that on the control sides (P<0.01). TRAP staining showed that the numbers of osteoclasts on the model side of the 1-week-group and the 4-week-group was significantly higher than that on the control sides (P<0.01). IHC staining and Haematoxylin staining showed that the mean optical densities of collagen on the model side of the 1-week-group and the 4-week-group was significantly reduced compared with that on the control sides (P<0.01), while the mean optical densities of matrix metalloproteinase increased significantly (P<0.01). Conclusions: After making a articular disc perforation, the condylar cartilage on the model side presented typical TMJOA pathological changes.

Gender and Age Differences of Temporomandibular Joint Disc Perforation: A Cross-Sectional Study in a Population of Patients With Temporomandibular Disorders.

The presence or absence of disc perforation (DP) has great value for the treatment planning of temporomandibular disorders (TMDs). Epidemiologic features of DP are limited in the literature. The present study investigated the epidemiologic features of DP by retrospectively reviewing 13,556 temporomandibular joint arthrographic examinations. Pearson Chi-squared test demonstrated that the rate of male patients who received the examinations more than once was significantly lower than that of female patients and the rate of DP in males was significantly lower than that in females. The age of all patients showed a bimodal distribution, with a 1st peak around 21 years of age, and a 2nd peak around 53 years of age. Linear regression analysis showed that the rate of DP was positively correlated with ages. The DP rate was increased by 0.3% for every 1 year of age. This retrospective cross-sectional study validated some findings about the gender and age differences of temporomandibular joint DP in the literature, and more importantly uncovered the exact relationship between the DP rate and the age in a large TMD patient population.

Temporomandibular joint disc perforation: a retrospective study

The aim of this study was to evaluate disc perforation diagnosed in patients undergoing arthroscopy of the temporomandibular joint (TMJ). A retrospective analysis of 33 patients with disc perforation (35 joints) was performed. Patients and joints were divided into two groups: those with distal perforation (DP; perforation of the retrodiscal tissue, or the distal area of the disc at the site of ligament insertion into the retrodiscal tissue) and those with central perforation (CP; central and anterior part of the disc). The retrospective evaluation included aetiological factors, clinical symptoms, arthroscopic findings, and the effects of arthroscopic lavage. The most frequent aetiological factors in patients with disc perforation were stress and related parafunctional activities. The most frequent arthroscopic finding in both groups was hyperaemia of the bilaminar zone and synovial tissue. Other predominant arthroscopic findings were the presence of adhesions and anterior disc dislocation in the DP group and synovial hyperplasia in the CP group. Better outcomes of arthroscopic lysis and lavage were found in the CP group than in the DP group. At 12 months after arthroscopic lavage, the results showed that the therapy was satisfactory for 72% of the joints. The most common cause of distal perforation is anterior disc dislocation, whilst chronic inflammatory changes account for central perforation.

Effect of temporomandibular joint disc perforation on expression of type Ⅰ collagen in temporomandibular joint disc cells

Objective: To investigate the effect of temporomandibular joint (TMJ) disc perforation on expression of type Ⅰ collagen in TMJ disc cells. Methods: The fibroblastic-like cells from the surgical removed TMJ disc tissue (disc perforation or TMJ condyle hyperplasia) were cultured. The cultured cells were identified as fibroblastic-like cells by toluidine blue and immunofluorescence staining. The expression of type Ⅰ collagen was detected with Western blotting and the content of type Ⅰ collagen was examined by enzyme linked immunosorbent assay (ELISA). Results: Fibroblastic-like cells were cultured from TMJ disc cells and the controls. The collagen-Ⅰ and collagen-Ⅱ were positive in both toluidine blue and immunofluorescence staining. In Western blotting, the expression of typeⅠcollagen in cells from joints with disc perforation was lower than that from normal joints. The content of collagen-Ⅰ was (1.62±0.52) μg/L from controls, and (0.85±0.33) μg/L from disc perforation respectively (P=0.0134). Conclusions: The disc cells from TMJ with disc perforation expressed lower type Ⅰ collagen than that from controls, which may be related to the lower content of collagen-Ⅰ in TMJ disc and the formation of TMJ disc perforation.

Micro-precise spatiotemporal delivery system embedded in 3D printing for complex tissue regeneration

Three dimensional (3D) printing has emerged as an efficient tool for tissue engineering and regenerative medicine, given its advantages for constructing custom-designed scaffolds with tunable microstructure/physical properties. Here we developed a micro-precise spatiotemporal delivery system embedded in 3D printed scaffolds. PLGA microspheres (μS) were encapsulated with growth factors (GFs) and then embedded inside PCL microfibers that constitute custom-designed 3D scaffolds. Given the substantial difference in the melting points between PLGA and PCL and their low heat conductivity, μS were able to maintain its original structure while protecting GF’s bioactivities. Micro-precise spatial control of multiple GFs was achieved by interchanging dispensing cartridges during a single printing process. Spatially controlled delivery of GFs, with a prolonged release, guided formation of multi-tissue interfaces from bone marrow derived mesenchymal stem/progenitor cells (MSCs). To investigate efficacy of the micro-precise delivery system embedded in 3D printed scaffold, temporomandibular joint (TMJ) disc scaffolds were fabricated with micro-precise spatiotemporal delivery of CTGF and TGFβ3, mimicking native-like multiphase fibrocartilage. In vitro, TMJ disc scaffolds spatially embedded with CTGF/TGFβ3-μS resulted in formation of multiphase fibrocartilaginous tissues from MSCs. In vivo, TMJ disc perforation was performed in rabbits, followed by implantation of CTGF/TGFβ3-μS-embedded scaffolds. After 4 wks, CTGF/TGFβ3-μS embedded scaffolds significantly improved healing of the perforated TMJ disc as compared to the degenerated TMJ disc in the control group with scaffold embedded with empty μS. In addition, CTGF/TGFβ3-μS embedded scaffolds significantly prevented arthritic changes on TMJ condyles. In conclusion, our micro-precise spatiotemporal delivery system embedded in 3D printing may serve as an efficient tool to regenerate complex and inhomogeneous tissues.

Soft tissue ossification and condylar cartilage degeneration following TMJ disc perforation in a rabbit pilot study

There are limited clinical treatments for temporomandibular joint (TMJ) pathologies, including degenerative disease, disc perforation and heterotopic ossification (HO). One barrier hindering the development of new therapies is that animal models recapitulating TMJ diseases are poorly established. The objective of this study was to develop an animal model for TMJ cartilage degeneration and disc pathology, including disc perforation and soft tissue HO. New Zealand white rabbits (n = 9 rabbits) underwent unilateral TMJ disc perforation surgery and sham surgery on the contralateral side. A 2.5 mm defect was created using a punch biopsy in rabbit TMJ disc. The TMJ condyles and discs were evaluated macroscopically and histologically after 4, 8 and 12 weeks. Condyles were blindly scored by four independent observers using OARSI recommendations for macroscopic and histopathological scoring of osteoarthritis (OA) in rabbit tissues. Histological evidence of TMJ condylar cartilage degeneration was apparent in experimental condyles following disc perforation relative to sham controls after 4 and 8 weeks, including surface fissures and loss of Safranin O staining. At 12 weeks, OARSI scores indicated experimental condylar cartilage erosion into the subchondral bone. Most strikingly, HO occurred within the TMJ disc upon perforation injury in six rabbits after 8 and 12 weeks. We report for the first time a rabbit TMJ injury model that demonstrates condylar cartilage degeneration and disc ossification, which is indispensible for testing the efficacy of potential TMJ therapies.

Treatment of temporomandibular joint disc perforation with injection of hyaluronic acid or disc repair

To assess the efficacy of injection of sodium hyaluronate in the treatment of patients with disc perforation by using cone- beam computed tomography (CBCT) and temporomandibular joint (TMJ) function. Twenty- eight patients (38 joints) with disc perforation observed through arthrography who received injection of sodium hyaluronate and other 20 patients (29 joints) who received disc repair were included in this study. Pain (visual analog scale, scores 0 to 100), maximal mouth opening, modified Helkimo's clinical dysfunction index and TMJ examinations with CBCT were obtained before and 3, 9 months after treatment. A statistically significant increase (P < 0.05) in TMJ clinical outcome was observed at each follow-up. The maximal mouth opening (MMO) increased 5.89 mm and 7.64 mm at 3 and 9 months follow-up in the hyaluronic acid (HA) group, and the MMO increased 2.75 mm and 6.10 mm at 3 and 9 months follow-up in the operation group. Osseous remodeling occurred in 66% (25 of 38 joints) of patients after HA injection and 55% (16 of 29 joints) of patients appeared bone remodeling after disc repair. Both injection of hyaluronic acid and disc repair are effective for treatment of temporomandibular joint disc perforation.

Temporomandibular Joint Disc Perforation: Long-Term Results After Operative Arthroscopy

Disc perforation (DP) is one of the most important pathologic signs of intracapsular temporomandibular joint (TMJ) disease; however, few clinical studies have focused on the arthroscopic management of this feature. The purpose of the present study was to assess whether operative arthroscopy with abrasion of the perforation borders is effective for the treatment of this alteration of the internal derangement of the TMJ. Thirty-six patients (39 joints) who underwent TMJ arthroscopy under general anesthesia and presented with DP (Wilkes stages IV and V) from 1994 through 2006 were included in this study. The age range at the time of surgery was 14 to 59 years. DPs were classified into 3 groups according to size: small (SMA), medium (MED), or large (LAR). Pain (visual analog scale, scores 0 to 100), maximal interincisal opening, and lateral and protrusive excursions were assessed at 1, 3, 6, 12, 24 and 48 months after surgery. Preoperative and postoperative scores were compared and tested for statistically significant differences by the Student t test for paired data. The level of statistical significance was set at .05. Differences in the global, SMA, MED, and LAR groups were evaluated. In the global group, the mean score of preoperative pain according to the visual analog scale was 53.97 mm, which decreased to 14.33 mm at 4-year follow-up. The maximal interincisal opening improved from a mean of 28.56 mm before surgery to 34.88 mm after the final follow-up. SMA perforations were found in 11 cases (28.20%), MED in 19 cases (48.71%), and LAR in 9 cases (23.07%). A significant decrease in pain (P < .01) was observed from the first postoperative month to the end of the follow-up period in the global and SMA groups. A statistically significant increase in mouth opening was observed in the global group from 6 months postoperatively; however, no significant differences were observed in the MED and LAR groups from before surgery to the different times of follow-up. After the final follow-up, 2 patients underwent open TMJ surgery owing to unfavorable results. Operative arthroscopy of the TMJ is a reliable and effective procedure for the articular dysfunction associated with DP because this procedure alleviates pain and improves mouth opening. Patients with SMA perforations are better candidates for this surgical treatment.

Relationship between temporomandibular joint disc perforation and clinical findings

Relationship between temporomandibular joint disc perforation and clinical findings

Experimental temporomandibular joint disc perforation in the rabbit: A gross morphologic, biochemical, and ultrastructural analysis

This study evaluates the progression of osteoarthritis (OA) in the adult New Zealand white rabbit temporomandibular joint following unilateral disc perforation. Thirty-seven animals were divided into five groups: control (n = 8), 6-week sham (n = 5), and experimental 6-, 12-, and 24-weeks (n = 8 each). Quantitative data was examined with two-way analysis of variance, and followed by Scheffe pair-wise comparisons. Transmission electron microscopy, acid phosphatase [AcP] activity, uronic acid content, and gross morphologic analysis indicated that disc perforation induced remodeling activity and degenerative changes in the condylar cartilage and bone as early as 6 weeks postoperatively. AcP activity of homogenized cartilage samples was significantly increased in experimental joints versus the side that did not undergo surgery at 6 and 12 weeks (P < .05). Uronic acid content was significantly greater in experimental joints versus the side that did not undergo surgery at 6 weeks (P < .05). Heightened cellular activity was present in the deep zone of osteoarthritic fibrocartilage of the 6- and 12-week experimental groups. Degenerating chondrocytes appeared to contain greater proportions of intracytoplasmic filaments and lysosome-like bodies. Disc perforation provided the impetus for degenerative or remodeling changes in the condylar cartilage of experimental joints, and is consistent with secondary OA. These dynamic events were most significant in the deep zone of articular fibrocartilage.

Dermal graft harvest technique for use in temporomandibular joint disc repair

The use of dermis as an interpositional graft material in the temporomandibular joint (TMJ) has been described previously.‘” Dermal grafts have been used for correction of ankylosis’ as well as for replacement and repair of perforated discs.2-5 A frequently used procedure for harvesting derma1 tissue is similar to that described by Meyer for harvesting grafts for TMJ disc perforation repairs.5 This technique involves the use of a dermatome to remove a split-thickness layer of skin over the graft harvest site. The skin flap is left attached at one end. The underlying dermal layer is then harvested using either a free-hand technique or by using the dermatome to remove a layer of tissue. In either case, the split-thickness skin flap is then fenestrated and sutured back in place to cover the graft harvest area. There are several disadvantages to harvesting dermis in this manner. If a dermatome is used, a large area of skin must be elevated in order to allow for a second pass with the dermatome. Moreover, the amount of dermis removed with the dermatome is generally excessive in area but often deficient in thickness. The use of a free-hand technique to remove the dermal tissue frequently results in an indentation in the dermal layer. In both cases, the surgical wound remaining after resuturing of the skin is inconvenient and cumbersome for the patient to maintain in the immediate postoperative period and leaves a significant cosmetic defect after healing. The following technique avoids these problems.

Synovial chondromatosis associated with experimental osteoarthritis in adult monkeys

This report describes the synovial response to temporomandibular joint disc perforation in an experimental animal model. Histologic examination revealed the presence of marked synovial membrane hypertrophy in all experimental joint recesses. Gradual transformation of synovial islands from a cellular to a metaplastic stage, with chondroid or even osteochondroid-containing tissue also was seen. The cartilage was arranged in a lobular pattern with intervening fibrous septae within the synovial islands. These synovial islands were observed in the anterior recess of three joints and in the posterior recess of another joint. The experimental findings suggest a relation between synovial chondromatosis and osteoarthritis.