Temporomandibular Joint Injury Research Articles

Physical therapy for injuries of the temporomandibular joint

injuries of the temporomandibular joint (TMJ) pose significant challenges to patients' well-being and require comprehensive treatment strategies. Physical therapy has emerged as a vital component in the management of TMJ injuries, with its efficacy increasingly recognized in clinical practice. This review provides a thorough summarize of physical therapy interventions for TMJ injuries, focusing on their role in restoring joint function and improving patient outcomes. Additionally, this review explores emerging trends and future directions in TMJ physical therapy, including advancements in technology and novel treatment modalities. Through a synthesis of current research and clinical evidence, the review explores various physical therapy modalities, including exercises, manual therapy techniques, and patient education programs. Additionally, the review discusses the mechanisms of action underlying physical therapy interventions and their impact on TMJ mobility, pain reduction, and overall quality of life. The relevance of physical therapy in the multidisciplinary approach to TMJ injury management is emphasized, highlighting its potential to complement other treatment modalities such as pharmacotherapy and surgical interventions. Furthermore, the review addresses considerations for optimizing physical therapy protocols, including patient selection, treatment duration, and therapist expertise. Overall, this review underscores the importance of physical therapy in the comprehensive care of TMJ injuries and provides insights into its implementation for clinicians and researchers alike. Considerations for patient-centered care and shared decision-making are also addressed, recognizing the importance of individualized treatment plans tailored to patient preferences and goals. By providing a comprehensive overview of physical therapy for TMJ injuries, this review aims to inform clinicians, researchers, and policymakers about the evolving landscape of TMJ management and promote evidence-based practice for improved patient outcomes and quality of life.

Developing and Validating an Intelligent Mouth-Opening Training Device: A New Solution for Restricted Mouth Opening.

Restricted mouth opening (trismus) is one of the most common complications following head and neck cancer treatment. Early initiation of mouth-opening exercises is crucial for preventing or minimizing trismus. Current methods for these exercises predominantly involve finger exercises and traditional mouth-opening training devices. Our research group successfully designed an intelligent mouth-opening training device (IMOTD) that addresses the limitations of traditional home training methods, including the inability to quantify mouth-opening exercises, a lack of guided training resulting in temporomandibular joint injuries, and poor training continuity leading to poor training effect. For this device, an interactive remote guidance mode is introduced to address these concerns. The device was designed with a focus on the safety and effectiveness of medical devices. The accuracy of the training data was verified through piezoelectric sensor calibration. Through mechanical analysis, the stress points of the structure were identified, and finite element analysis of the connecting rod and the occlusal plate connection structure was conducted to ensure the safety of the device. The findings support the effectiveness of the intelligent device in rehabilitation through preclinical experiments when compared with conventional mouth-opening training methods. This intelligent device facilitates the quantification and visualization of mouth-opening training indicators, ensuring both the comfort and safety of the training process. Additionally, it enables remote supervision and guidance for patient training, thereby enhancing patient compliance and ultimately ensuring the effectiveness of mouth-opening exercises.

Allogenic umbilical cord tissue for temporomandibular joint injuries

The temporomandibular joint (TMJ) is crucial for functions of daily living such as mastication and articulation. Common TMJ issues include osteoarthritis, internal derangement, and myofascial pain dysfunction. Conservative methods such as physical therapy and medications are used, with surgical options such as arthroscopy and replacement for severe cases. Emerging regenerative medicine explores non-surgical treatments using human stem cells from umbilical cord derivatives, showing potential for tissue regeneration in TMJ disorders. A systematic search was conducted across PubMed, Embase, Scopus, and Web of Science databases, adhering to PRISMA guidelines, aiming to identify relevant articles published in English until August 2023. The search used specific terms to target in vitro, preclinical, and clinical studies on umbilical cord (UC)-derived tissue and mesenchymal stem cells (MSCs) for treating TMJ disorders. The search was extended to three clinical trial registries for on-going investigations related to UC tissue and MSCs for TMJ disorder management. The studies included in this article report the safety and efficacy profiles of allogenically acquired, umbilical cord-derived tissues and associated mesenchymal stem cells for temporomandibular joint ailments, future adequately powered, randomized controlled trials are warranted to conclusively justify the clinical use of this biologic therapy.

The Role of Mouthguards in Preventing Temporomandibular Joint Injuries During Contact Sports: A Prospective Study.

Objectives: Injuries to the maxillofacial region during contact sports is a well-known issue. Protective measures have been advised to prevent and reduce these problems. Awareness regarding the role of mouthguards in preventing temporomandibular joint (TMJ) injuries during contact sports, is limited. The aim of the present study was to assess awareness regarding the use of mouthguards during contact sports and incidence of TMJ injuries in sportspersons. Materials and Methods: Eighty-six individuals training in contact sports were enrolled in the present study based on our inclusion and exclusion criteria. A questionnaire and clinical examination were used to assess TMJ pain, clicking, deviation, mouth opening, and locking. Results: The percentage of sportspersons aware of various protective gears was 23.8%. The awareness of TMJ injuries following contact sports was 6.9%, and 70.3% of the sportspersons were estimated to wear mouthguards. Clinical assessment of sportspersons using mouthguards revealed pain in 18.6% and clicking in 17.4% of the study subjects. The incidence of TMJ pain and clicking in individuals who did not use mouthguards were 81.4% and 82.6%, respectively. Conclusion: Application of mouthguards can reduce the incidence of TMJ injuries in contact sports. They also contribute significantly to the overall dental health of the athletes, as well as improving their overall athletic performance and decreasing the likelihood of other types of oral and facial injuries.

Bulk RNA-seq analyses of mandibular condylar cartilage in a post-traumatic TMJ osteoarthritis rabbit model.

The temporomandibular joint (TMJ) is anatomically comprised of the mandibular condylar cartilage (CC) lined with fibrocartilaginous superficial zone and is crucial for eating and dental occlusion. TMJ osteoarthritis (OA) leads to pain, joint dysfunction and permanent loss of cartilage tissue. However, there are no drugs clinically available that ameliorate OA and little is known about global profiles of genes that contribute to TMJ OA. Furthermore, animal models that recapitulate the complexity of signalling pathways contributing to OA pathogenesis are crucial for designing novel biologics that thwart OA progression. We have previously developed a New Zealand white rabbit TMJ injury model that demonstrates CC degeneration. Here, we performed genome-wide profiling to identify new signalling pathways critical for cellular functions during OA pathology. Temporomandibular joint OA was surgically induced in New Zealand white rabbits. Three months following injury, we performed global gene expression profiling of the TMJ condyle. RNA samples from TMJ condyles were subjected to sequencing. After raw RNA-seq data were mapped to relevant genomes, differential expression was analysed with DESeq2. Gene ontology enrichment analysis and Kyoto Encyclopedia of Genes and Genomes pathway analysis were conducted. Our study revealed multiple pathways altered during TMJ OA induction including the Wnt, Notch and PI3K-Akt signalling pathways. We demonstrate an animal model that recapitulates the complexity of the cues and signals underlying TMJ OA pathogenesis, which is essential for developing and testing novel pharmacologic agents to treat OA.

Therapeutic effects of kartogenin on temporomandibular joint injury by activating the TGF-β/SMAD pathway in rats.

Patients with temporomandibular dysfunction (TMD) usually suffer from pathology or malpositioning of the temporomandibular joint (TMJ) disk, leading to the degenerative lesion of condyles. Kartogenin can promote the repair of damaged cartilage. This study aimed to explore whether intra-articular injection of kartogenin could alleviate the TMJ injury induced by type II collagenase. We measured the head withdrawal threshold and found that kartogenin alleviated the pain around TMD induced by type II collagenase. We observed the morphology of the condylar surface and found that kartogenin protected the integration of the condylar surface. We analyzed the density of the subchondral bone and found that kartogenin minimized the damage of TMJ injury to the subchondral bone. We next explored the histological changes and found that kartogenin increased the thickness of the proliferative layer and more collagen formation in the superficial layer. Then, to further ensure whether kartogenin promotes cell proliferation in the condyle, we performed immunohistochemistry of proliferating cell nuclear antigen (PCNA). The ratio of PCNA-positive cells was significantly increased in the kartogenin group. Next, immunofluorescence of TGF-β1 and SMAD3 was performed to reveal that kartogenin activated the TGF-β/SMAD pathway in the proliferative layer. In conclusion, kartogenin may have a therapeutic effect on TMJ injury by promoting cell proliferation in cartilage and subchondral bone. Kartogenin may be promising as an intra-articular injection agent to treat TMD.

EFFICACY OF ARTHROCENTESIS FOR TREATMENT OF INTERNAL POST-TRAUMATIC TEMPOROMANDIBULAR JOINT DISORDERS.

The aim: To study the consequences of temporomandibular joint injury and efficacy of arthrocentesis for treatment of post-traumatic internal temporoman-dibular disorders. Materials and methods: 24 patients who experienced trauma history in the head without jaw fractures underwent CT, ultrasound and/or MRI. TMJ ar¬throcentesis was performed according to a modified method of D. Nitzan (1991) under local anesthesia by means of blockade of the peripheral branch of the auricular-temporal nerve on the background of intravenous sedation. Results: The ages of the patients varied between 18 and 44 years, and mean was 32,58 years. The causes of trauma were diverse, as traffic accident - 3 (12,5%), assault 12 (50%), hit by materials 3 (12, 5%), and fall-down 6 (25%). According to clinical and radiological signs after traumatic temporomandibular disorders, patients were divided into two groups according to Wilkes classification (1989): 13 patients with stage II (early-middle) and 11 - with stage III (middle).The control ultrasound and MRI carried out 3-6 months after arthrocentesis showed no signs of hemarthrosis in 84.61% of patients with intra-articular disorders of the second degree, and in 72.72% of patients with internal disorders of the third degree, the position and function of the articular disc was restored. Conclusions: Arthrocentesis with TMJ lavage is a minimally invasive surgical manipulation that has proven itself in temporomandibular disorders of traumatic origin, in particular after fractures of the articular process of the mandible.

Evaluation of the Anti-inflammatory Effect of Intra-articular Injection of Chondroitin Sulfate and Sodium Hyaluronate in Mechanically Induced Temporomandibular Joint Injury in Rabbits

BACKGROUND: Degenerative arthritis is the most common form of arthritis, usually affecting the hands, feet, spine, knees, and temporomandibular joint (TMJ) as well. TMJ degenerative arthritis causes symptoms of painful joints, loss of joint function, limited mouth opening, joint instability, and clicking. Non-surgical symptomatic treatments can successfully be used to treat patients with degenerative arthritis. AIM: This study aimed to evaluate the anti-inflammatory effect of intra-articular injection of chondroitin sulfate and sodium hyaluronate in mechanically induced acute injury in TMJ of rabbits. METHODS: An animal study was conducted, all rabbits received a mechanical injury using a contra-angle handpiece with a speed of 120 rpm of a fissure bur 4 mm in diameter and 4 mm in depth extending to subchondral bone. Thirty-two rabbits were randomized into four groups: Control group, sodium hyaluronate “SH” group, chondroitin sulfate “CS” group, and “CS-SH” group. After 7 days, rabbits in the control group, “SH” group, “CS” group, and “CS-SH” group were respectively treated with normal saline, sodium hyaluronate, chondroitin sulfate, or combination of CS&SH injection in the TMJ. All animals were treated once weekly for 3 weeks. A histological evaluation was performed. RESULTS: Histological findings showed a significantly reduced inflammatory cell, bone resorption, and fibrosis in the CS-HA-treated group. CONCLUSION: CS-SH injection has an anti-inflammatory effect on TMJ degenerative arthritis and aids in the reparative process.

Surgical Treatment and Outcome of Acquired Midline Palate Defects in Cats.

Acquired midline palate defects (PDE) affect the hard palate and/or soft palate, and result from trauma, commonly falling from a height or being hit by a motor vehicle. Additional life-threating injuries and costs associated with the treatment may delay the surgical treatment. This retrospective study describes signalment, cause, and extent of the PDE, and treatment in 25 cats. In addition, the outcome of the surgical repair is described in 19 (76%) cats. All defects were repaired within 5 days of the injury. Twenty (80%) cats were 4 years of age or younger. The most common rostral extent of the PDE was to the level of the third premolar tooth (n = 8; 32%), incisor teeth (n = 7; 28%), and fourth premolar tooth (n = 5; 20%). The soft palate laceration was present in all cases. Surgical therapy was successful in all cases with follow-up. The most common techniques used for the closure of the hard palate defect were bilateral pedicle flaps with lateral releasing incisions (n = 8; 32%), direct apposition of the oral mucosa (n = 7; 28%), bilateral pedicle flaps with lateral releasing incisions and interquadrant splinting (n = 5; 20%), and unilateral pedicle flap with one lateral releasing incision (n = 4; 16%). A tension-free closure by direct apposition of the edges was possible for the soft palate laceration. No oronasal fistulae were identified at follow-up. The only complication was malocclusion. The interquadrant splinting was most often used for PDE extending to the rostral portion of the hard palate (p < 0.05). The cats that suffered postoperative malocclusion were significantly more likely to have sustained temporomandibular joint injury, underwent CT scan, or had a feeding tube placed before discharge. The results of this retrospective study indicate that the early treatment (within 5 days) of the acquired longitudinal defects in the midline of the hard and soft palates is highly successful.

CT characterisation and classification of feline temporomandibular joint trauma: a case series of 79 cats.

The aim of this study was to characterise and describe patterns of temporomandibular joint (TMJ) injuries occurring in cats using CT. A cross-sectional study was carried out in adherence with the STROBE guidelines. Among the medical and CT records of 79 cats, 158 TMJs were reviewed in a collaborative study between six institutions. TMJ injuries were most commonly unilateral, representing 70.9% of cases. The mandibular condyle was fractured in 88 cases (55.7%) of the 158 TMJs observed. Of those, 84.0% were intra-articular condyle fractures, with the medial half of the mandibular condyle over-represented. Luxations occurred in 32.9% of cases, which was 19.0% of all evaluated TMJs. Rostrodorsal luxations were most common representing 87.0% of all luxations. Temporal bone fractures were observed in 30.4% of all cases, which was 18.4% of TMJs. The majority of fractures were of an unknown cause. When the cause was determined, road traffic accident (RTA) was the most frequent, followed by animal interaction, other external forces (sharp or blunt force) and high-rise trauma. Bilateral injuries were 13.1 times more likely to occur in high-rise trauma (P = 0.01) and temporal bone fracture was significantly associated with RTAs (P = 0.016). No other significant associations were observed between cause of injury and the resulting TMJ injury pattern. Various TMJ injury patterns can occur in cats as a result of trauma. Intra-articular fractures of the medial half of the mandibular condyle occur most commonly. Although unilateral injuries are more frequent, high-rise trauma tends to present with bilateral lesions. Further studies with a larger sample size should be performed to better understand TMJ patterns of injury and how they relate to possible causes.

Assessment of Injuries of Tempo ro-Mandibular Joint by MRI

Abstract Background: The use of magnetic resonance imaging (MRI) in the assessment of temporomandibular joint (TMJ) injuries has been a mainstay. Since it can non-invasively showing major regional anatomic structures and revealing the presence of joint effusion and bone marrow signal-intensity abnormalities. Aim of Study: To elucidate the role of MRI in the diagnosis of TMJ injuries and for which extent MRI is able to detect its abnormalities. Patients and Methods: A total of 43 patients with TMJ injuries were included in the study. A 1.5 tesla MRI machine is used to assess the TMJs. The position of the disc, its configuration, the presence or absence of joint effusion, osteoarthritis, and the morphology of the mandibular condyle were all evaluated. Results: The clinical symptoms of the patients there were higher of symptoms in sensation of pain (86%); followed by limited mouth opening (44.2%). The patients anterior disc dislocation with reduction was higher value was found in patients' injuries of temporomandibular joint 17 patients (39.5%) with p-value

Temporomandibular joint trauma and disability assessment - A longitudinal exploratory study

BackgroundOrofacial trauma can encompass, isolated or not, several anatomical regions, namely facial, dental and temporomandibular joint (TMJ), one of the most complex joints in the human body. Evidence-based knowledge in the field of TMJ trauma and in temporomandibular joint disorders (TMD) diagnosis and treatment, provides the necessary data for medico-legal assessment. ObjectiveThe aim of this study is to bring up epidemiological data referring to TMJ injuries and sequelae, in order to present a medico-legal approach of TMJ disability. MethodsAn observational longitudinal exploratory study was performed in the database of the National Institute of Legal Medicine and Forensic Sciences, Portugal, between 2000 and 2017, regarding inclusion and exclusion criteria.Statistical significance was set as P‹0.05, Fisher's exact test, Binomial test and Goodman and Kruskal's test were used. ResultsPost-traumatic orofacial reports (n = 2622) included 234 TMJ-injury and 149 TMJ-sequelae.Epidemiological data was presented regarding age,gender, professional status and etiology. There was a statistically significant association between TMJ injury and TMJ sequela, despite a weak relation (ƛ = 0.170). No statistically significant association was identified between TMJ-injury/TMJ-sequelae and the professional status, etiology. ConclusionThe TMJ sequela group is smaller than the TMJ-injury, reflecting that 2/3 of the injuries have been cured without a monetary compensation value and without Health costs. The association between TMJ injury and TMJ sequelae reinforces the necessity of preventive measures in TMJ trauma, namely in physical violence context and in medico-legal impairment.

Contemporary Imaging Modalities for Temporomandibular Joint

There are different imaging methods used in the evaluation of bone structure, disc, ligaments and muscles that make up Temporomandibular Joint (TMJ). The aim of this review is give information about choice of suitable imaging methods for TMJ diseases from past to present. In the past, conventional radiographs have often been used for TMJ imaging, but nowadays magnetic resonance imaging is the gold standard for soft tissue imaging and disc position determination. Another new technology, ultrasonography can be used for disc displacement, effusion, diagnosis of intraarticular defects. Cone beam computed tomography, it is used for the evaluation of cortical and trabecular structure of bone components of TMJ, developmental anomalies and traumatic injuries affecting TMJ, pathological changes such as osteophyte, erosion, fractures, ankylosis, glenoid fossa-condyle relationship. Nowadays, in parallel with the developing technology, a single imaging method is not used for TMJ imaging and evaluation is performed with several imaging methods. Imaging methods should be selected by evaluating the factors such as radiation dose, contribution to diagnosis and treatment plan, easy applicability.

Prevalence of, and disability approaches to, temporomandibular joint trauma: A 17-year cross-sectional study.

Sociodemographic, cultural and environmental factors play significant roles in orofacial trauma. The main aim of the present work was to study the epidemiological data regarding temporomandibular trauma, in the orofacial trauma context. Secondly, follow-up data between injury and sequelae were assessed, in the medico-legal approach for this disability. An observational, cross-sectional study, from 2000 to 2017, was performed, using the clinical reports of the National Institute of Legal Medicine and Forensic Sciences Institute of Portugal-Coimbra Central Branch. A descriptive analysis was performed. The injury group, 8.9% of the analysed population (2622 reports), included a majority of men (60.7%) with a mean age of 33.9years. They were mainly students or retired (38.9%) and reported physical violence as the main external cause (56.4%) and temporomandibular joint (TMJ) trauma occurred with dental and facial trauma (84.2%). The sequela group, 2.9% of the analysed population, included a majority of men (65.6%) with a mean age of 40.1years, focusing on a professional active population. They reported physical violence as the main external cause (46.3%) and TMJ (13.2%), soft tissues and teeth (12.8%) sequelae. Not all TMJ injuries corresponded to sequelae (63.4%). The sequela resulting from TMJ trauma encompass soft and hard tissues and TMJ sequelae, isolated or not. Physical violence was the primary external cause of TMJ injuries in both groups. Conversely, road accidents were the major external cause of isolated TMJ sequelae, highlighting the need to reinforce safety measures.

Low-Intensity Pulsed Ultrasound Alleviates Hypoxia-Induced Chondrocyte Damage in Temporomandibular Disorders by Modulating the Hypoxia-Inducible Factor Pathway.

Temporomandibular disorders are a common cause of chronic pain in the orofacial region and have a complex and multi-factorial pathophysiology. Mechanical loading or inflammatory conditions have been shown to decrease oxygen tension within the joint cartilage and activate the hypoxia-inducible factor (HIF) pathway, which in turn aggravates the pathological processes underlying temporomandibular joint (TMJ) disorders. We previously showed that low-intensity pulsed ultrasound (LIPUS) treatment effectively repairs TMJ injury induced by chronic sleep deprivation (CSD). Here, we explored the effects of LIPUS treatment on hypoxia-induced chondrocyte injury. We found that it effectively restored the proliferation capacity of mandibular chondrocytes under hypoxic conditions and lowered their rate of apoptosis. Chondrogenic capacity, as assessed by type II collagen levels, and mucin-positive areas were also significantly increased after LIPUS treatment. Levels of matrix metalloprotein-3 and interleukin-6 decreased in mandibular chondrocytes following this treatment, whereas the expression of tissue inhibitor of metalloproteinase-1 increased. We also found that HIF-1α expression was upregulated in mandibular chondrocytes under hypoxic conditions and was further enhanced by LIPUS treatment. Similarly, HIF-2α levels increased in mandibular chondrocytes under hypoxic conditions but decreased following LIPUS treatment. Subsequently, we established a CSD-induced TMJ injury model and found that LIPUS increased mucin-positive areas as well as HIF-1α expression and decreased HIF-2 level in the chondrocyte layer. Together, our results indicate that the protective effect of LIPUS on chondrocyte is partly associated with the HIF pathway.

Increased risk of tinnitus following a trigeminal neuralgia diagnosis: a one-year follow-up study

BackgroundTinnitus due to hyperactivity across neuronal ensembles along the auditory pathway is reported. We hypothesized that trigeminal neuralgia patients may subsequently suffer from tinnitus. Using nationwide, population-based data and a retrospective cohort study design, we investigated the risk of tinnitus within 1 year following trigeminal neuralgia.MethodsWe used the Taiwan National Health Insurance Research Dataset, a claims database, to identify all patients diagnosed with trigeminal neuralgia from January 2001 to December 2014, 12,587 patients. From the remaining patients, we identified 12,587 comparison patients without trigeminal neuralgia by propensity score matching, using sex, age, monthly income, geographic region, residential urbanization level, and tinnitus-relevant comorbidities (hyperlipidemia, diabetes, coronary heart disease, hypertension, cervical spondylosis, temporomandibular joint disorders and injury to head and neck and index year). All study patients (n = 25,174) were tracked for a one-year period to identify those with a subsequent diagnosis of tinnitus over 1-year follow-up.ResultsAmong total 25,174 sample patients, the incidence of tinnitus was 18.21 per 100 person-years (95% CI = 17.66 ~ 18.77), the rate being 23.57 (95% CI = 22.68 ~ 24.49) among patients with trigeminal neuralgia and 13.17 (95% CI = 12.53 ~ 13.84) among comparison patients. Furthermore, the adjusted Cox proportional hazard ratio for tinnitus in the trigeminal neuralgia group was 1.68 (95% CI = 1.58 ~ 1.80) relative to the comparison cohort.ConclusionsWe found a significantly increased risk of tinnitus within 1 year of trigeminal neuralgia diagnosis compared to those without the diagnosis. Further studies in other countries and ethnicities are needed to explore the relationship between trigeminal neuralgia and subsequent tinnitus.

The Optimal Regimen for the Treatment of Temporomandibular Joint Injury Using Low-Intensity Pulsed Ultrasound in Rats with Chronic Sleep Deprivation.

Low-intensity pulsed ultrasound (LIPUS) is an emerging physical therapy for the treatment of early temporomandibular joint injury and has a good effect on promoting cartilage and subchondral bone tissue repair. However, the best LIPUS intensity and treatment duration remain unclear. This study is aimed at observing the preventive and therapeutic effects of different modes of LIPUS and at identifying the optimal LIPUS treatment regimen for temporomandibular joint injury. In the present study, rat models of temporomandibular joint injury were established using a chronic sleep deprivation (CSD) method, and the effect of LIPUS as intensities of 30, 45, and 60 mW/cm2 was observed at 7, 14, and 21 days. After CSD, the condylar cartilage of the rats demonstrated variable degrees of surface roughening, collagen fiber disarrangement or even partial exfoliation, decreased proteoglycan synthesis and cartilage thickness, decreased chondrocyte proliferation, decreased type 2 collagen (COL-2) expression, and increased matrix metalloproteinase- (MMP-) 3 expression at all three time points. When the rats with CSD received different intensities of LIPUS treatment, the pathological changes were alleviated to various extents. The groups receiving 45 mW/cm2 LIPUS showed the most significant relief of cartilage damage, and this significant effect was observed on days 14 and 21. These results demonstrated that LIPUS can effectively inhibit CSD-induced condylar cartilage damage in rats, and LIPUS treatment at an intensity of 45 mW/cm2 for at least 2 weeks is the optimal regimen for temporomandibular joint injury.

Role of CT Scan in Early Diagnosis of Temporomandibular Joint Injury in Patients with Rheumatoid Arthritis

Early detection of rheumatoid injury in the temporomandibular joint using CT, which accurately detects bone changes before the clinical symptoms start appearing to protect the joint from irreversible damage, and the correlation of those radiological changes with the duration of rheumatoid arthritis disease. It included 45 people aged 27-74 years who reviewed the internal medicine and rheumatology clinics at Al-Mouwasat Hospital during 2016-2018 and are affected with rheumatoid arthritis according to the criteria American College of Arthritis (ACR) European League against Rheumatism (EULAR) 2010 criteria. The informed consent of the patient and the approval of the Scientific Research Council were obtained to conduct the research. Computed tomography revealed the radiological changes in the left and right side, respectively, in terms of p value <0.05: (1) Erosion of condyle (42.22-53.34%). (2) Decreased in the joint space (53.33-60.00%). (3) Mandibular subchondral cysts in both sides (77.14%). (4) Erosion of the articular fossa (48.89-57.78%). (5) Flattening of condyle (46.67-55.55%). (6) Effusion (2.22-4.44%). (7) Bone marrow edema (26.67-40.00%). (8) Subchondral sclerosis (60.00-73.33%). Conclusion and clinical significance: The occurrence of bone damage in the condyle and articular fossa of the temporomandibular joint despite the fact that the sample members have no clinical complaint indicates the ability of CT scan of early and accurate disclosure of rheumatoid injury in the temporomandibular joint.

Nonsurgical management of temporomandibular joint autoimmune disorders.

IntroductionTemporomandibular disorders (TMD) are observed in a number of autoimmune diseases but limited studies have assessed the effect of autoimmune diseases on TMD. Therefore, the present review article was conducted to determine the effect of autoimmune diseases on TMD.MethodsInternational databases, including Web of Sciences, PubMed and Scopus, were searched in order to find related articles. The search key words were; temporomandibular joint (TMJ) autoimmune disorders, TMJ, TMD, medical therapy and non-invasive, local and systemic management. Published articles from June, 2010 to June, 2019 were included in the review.ResultsA total of 11 related articles including rheumatoid arthritis (RA), lupus erythematosus and systemic sclerosis were found. All articles noted that TMJ has unique features that distinguishes it from other human body joints. Cases of TMJ injury and TMD require specific treatments. Therefore, early diagnosis of TMD is essential. It was also mentioned in the articles that the collagen-induced arthritis (CIA) method is a suitable method for investigating TMD and its relationship with RA. Treatment methods included oral steroids, Disease-modifying antirheumatic drugs, nonsteroidal anti-inflammatory drugs, methotrexate 75 mg, and combination therapy with methotrexate.ConclusionBased on the results of this study, TMD exists in some autoimmune diseases, including RA, lupus erythematosus and systemic sclerosis. Therefore, there should be an interdisciplinary collaboration between physicians and dentists in order to choose the best conservative treatment and medication therapy for TMD to reduce the progression and pain associated with this type of disorder.

Feline head trauma: a CT analysis of skull fractures and their management in 75 cats.

The aim of this study was to describe and evaluate the configurations and management of feline skull fractures and concurrent injuries following head trauma. Medical records and CT images were reviewed for cats with skull fractures confirmed by CT that were managed conservatively or with surgery. Details of signalment, presentation, skull fracture configuration, management, re-examination, and complications or mortality were recorded and analysed. Seventy-five cats (53 males, 22 females) with a mean age of 4.8 ± 3 years met the inclusion criteria. Eighty-nine percent of cats had fractures in multiple bones of the skull, with the mandible, upper jaw (maxilla, incisive and nasal bones) and craniofacial regions most commonly affected. Temporomandibular joint injury occurred in 56% of cats. Road traffic accidents (RTAs) were the most common cause of skull fractures, occurring in 89% of cats, and caused fractures of multiple regions of the skull. RTAs were also associated with high levels of concurrent injuries, particularly ophthalmic, neurological and thoracic injuries. A more limited distribution of injuries was seen in non-RTA cats. Equal numbers of cats were managed conservatively or surgically (47%). Mortality rate was 8% and complications were reported in 22% of cats. Increasing age at presentation and presence of internal upper jaw fractures were risk factors for development of complications. No risk factors were identified for mortality. RTAs were the most common cause of feline skull fractures and resulted in fractures in multiple regions of the skull and concurrent injuries occurred frequently. Problems with dental occlusion were uncommon post-treatment. An increased risk of implant loosening and malocclusion was seen with palatine and pterygoid bone fractures and hard palate injuries. This study provides useful additional information regarding feline skull fractures, concurrent injuries and management techniques following head trauma.