Temporomandibular Joint Range Of Motion Research Articles

Effectiveness and safety of hominis placental pharmacopuncture for chronic temporomandibular disorder: A multi-center randomized controlled trial

BackgroundHominis placental (HPP) extract has been approved by the Ministry of Food and Drug Safety in Korea for treating chronic liver diseases and postmenopausal syndrome. However, its efficacy and safety for treating chronic temporomandibular disorder (TMD) remains unclear. We aimed to assess the effectiveness and safety of HPP for treating chronic TMD compared with physical therapy (PT). MethodsThis study is a 2-arm parallel, multi-center, randomized controlled trial. We enrolled 82 chronic TMD patients from 2 Korean medicine hospitals between December 2019 and January 2021. We included patients with chronic TMD and randomly assigned them to undergo HPP or PT. The primary outcome was the difference in the scores for temporomandibular joint (TMJ) pain at baseline and week 6. The secondary outcomes were the scores for TMJ pain and bothersomeness, TMJ range of motion, the Korean version of Beck's depression index-Ⅱ, jaw functional limitation scale (JFLS) score, patient global impression of change (PGIC) scores, EuroQoL 5-dimension 5-level score, and short form-12 health survey (SF-12) scores. ResultsCompared with PT, HPP showed significantly superior effects on TMJ pain and bothersomeness, protrusive movement pain, JFLS (verbal, emotional, and global), SF-12, and PGIC scores at week 6 (P < 0.05). Compared with the PT group, the HPP group showed a significantly higher recovery rate (≥50 % reduction in the scores for TMJ pain at the 24-week follow-up). ConclusionHPP was more effective than PT managing pain and improving function and quality of life. Our findings demonstrate the effectiveness and safety of HPP for TMD treatment. Trial registrationThis study has been registered at clinicalTrials.gov (NCT04087005), Clinical Research Information Service (CRIS) (KCT0004437), and Ministry of Food and Drug Safety (No. 31886).

İNMELİ HASTALARDA EKSPİRATUAR KAS EĞİTİMİNİN STOMATOGNATİK SİSTEME ETKİSİ

Objective: The aim of this study was to assess the effect of expiratory muscle training on the stomatognathic system in patients with stroke.&#x0D; Method: A total of 31 patients with stroke were included in the study: 16 patients with stroke (age=66.63±8.38, height=166.38±8.59, BMI=28.09±4.81) as the control group and 15 patients with stroke (age=65.60±7.62, height=168.20±8.78, BMI=28.95±6.92) as the study group. Temporomandibular joint range of motion and dysfunction, pressure pain threshold of masticatory muscles, facial asymmetry existence, head posture, oral hygiene, oral hygiene habit, masticatory performance, intraoral pH, deglutition, and deep neck flexor muscle endurance of the patients with stroke were assessed. Assessment methods were in order by digital caliper, the Fonseca Questionnaire, algometry, labial commissure and craniocervical angle measurement, general oral health assessment index, and questionnaire, sieve test, digital pH gauge, repetitive saliva swallow test, Eating Assessment Tool, and deep neck flexor endurance test. Patients with stroke in the study group were enrolled in an expiratory muscle training program consisting of 5 sets of 10 repetitions daily for three weeks in addition to conventional physiotherapy; the control group enrolled in the conventional physiotherapy program. Patients with stroke in the study group were called twice a week to assess their compliance with the expiratory muscle training.&#x0D; Results: In intragroup comparison significant increase was found in the inferior portion of the left masseter, mandibular protrusion, and a decrease in labial commissure angle and Fonseca Questionnaire score of the control group (p

Physiotherapy for pain, jaw mobility, and oral health-related quality of life in patient with trismus following radiation therapy for jaw cancer: A case report

Background: Trismus is a painful condition that restricts the temporomandibular joint range of motion (ROM) causing difficulty in eating, chewing, speaking, etc., affecting the oral health-related quality of life (OHRQOL). It often presents as a complication during pre-malignancy stage or after oral cancer treatment. Its prevalence is between 28% and 79%, and it is 8 times more common in edentulous patients. Case Presentation: The 57-year-old male complained of continuous tongue and jaw pain with difficulty in chewing, eating, and speaking 1 year before and gradually developed small ulcers over the right jaw. After complete investigation, the patient was diagnosed with jaw cancer and underwent radiotherapy for 2 months. This patient came with complaints of pain, difficulty in mouth opening to physiotherapy department, 3 months following radiotherapy, diagnosed as a case of trismus. A comprehensive physiotherapy protocol including LASER, mobilization, Myofascial release, active exercises for the period of 4 weeks was given. Outcomes for pain, jaw mobility, and OHRQOL were evaluated at baseline and 4 weeks. Conclusion: Four weeks of comprehensive physiotherapy protocol was found effective in reducing pain and improving jaw mobility and OHRQOL in patients with trismus following radiation therapy.

Evaluation of Temporomandibular Joint Dysfunction in Traumatic Brain Injury Patients.

The aim of this study was to evaluate the frequency of temporomandibular joint dysfunction and related factors in patients with traumatic brain injury. A total of 60 participants, 30 patients with traumatic brain injury and 30 healthy volunteers of similar age, have been included in this study, which was designed as a hospital-based cross sectional study. Fonseca questionnaire was used to evaluate and classify the temporomandibular joint dysfunction. Temporomandibular joint range of motion was evaluated with a digital caliper, and masticatory muscles pressure pain threshold was evaluated with an algometer. Labial commissure angle measurement was used to evaluate the severity of facial paralysis. Complications related to traumatic brain injury were recorded in patients with traumatic brain injury. According to Fonseca questionnaire score, 80% of traumatic brain injury patients and 16.7% of the control group had temporomandibular dysfunction (p < 0.001). In the intergroup comparison, a significant decrease was found in all temporomandibular range of motion and masticatory muscles pressure pain threshold parameters in favor of the traumatic brain injury group (p < 0.001). Labial commissure angle and Fonseca questionnaire scores were higher in the traumatic brain injury group (p < 0.001). The frequency of temporomandibular dysfunction was more common in traumatic brain injury patients with headache than in those without headache, as shown by the results of the Fonseca questionnaire (p=0.044). Compared to healthy controls, patients with traumatic brain injury experienced issues with the temporomandibular joint more frequently. Additionally, TBI patients with headaches had a greater frequency of temporomandibular joint dysfunction. Therefore, it is advised to check for temporomandibular joint dysfunction in traumatic brain injury patients during follow-up. In addition, the presence of headache in traumatic brain injury patients may be a stimulant for temporomandibular joint dysfunction.

Temporomandibular Joint Gape Angles in Normal and Painful Domestic Felines.

The purpose of this study was to determine and compare the gape angles (temporomandibular joint range of motion with mouth opening) of conscious and anesthetized domestic felines and to compare gape angles with and without evidence of oral pain. This prospective study evaluated the gape angle of 58 domestic felines. The cats were grouped into painful (n = 33) and nonpainful cohorts (n = 25) and gape angles were compared during conscious and anesthetized conditions. Gape angles were determined based on measurements of the maximal interincisal distance and lengths of the mandible and maxilla followed by calculation of the law of cosines. The mean feline gape angle (standard deviation) was determined to be 45.3° (8.6°) and 50.8° (6.2°) for conscious and anesthetized felines respectively. There was no significant difference between painful and non-painful feline gape angles during conscious (P = .613) or anesthetized (P = .605) evaluations. There was a significant difference between anesthetized and conscious gape angles (P < .001) for both painful and non-painful cohorts. This study determined the standardized, normal feline temporomandibular joint (TMJ) gape angle in both conscious and anesthetized states. This study suggests that the feline gape angle is not a useful indicator of oral pain. By determining the feline gape angle, which was previously unknown, further evaluation of its utility as a non-invasive clinical parameter for evaluation of restrictive TMJ motions as well as its use for serial evaluations may be pursued.

UYKU BRUKSİZMİ OLAN MİYOFASYAL TEMPOROMANDİBULAR DİSFONKSİYON TANILI HASTALARDA MANUEL TEDAVİ İLE SPLİNT TEDAVİSİNİN KARŞILAŞTIRILMASI

Purpose: The aim of this study was to examine the effect of manual therapy on temporomandibular pain, range of motion, functionality level of the jaw, sleep quality, and patient satisfaction, and to compare the efficacy with splint therapy among female patients with myofascial temporomandibular dysfunction (M-TMD) accompanied by sleep bruxism (SB). Methods: A total of 29 female patients, aged 18-50 years, diagnosed with M-TMD were separated into two groups using a simple random sampling method as the manual therapy group (MT; n:15) and the splint therapy group (ST; n:14). All the patients were informed about bruxism and its effects and were given home exercises. The patients in the ST group were instructed to use a static splint for one month. The MT group patients received a total of 8 sessions, 45 minutes twice a week of treatment, including joint and soft tissue mobilizations to the temporomandibular joint (TMJ) and cervical region. Pain severity, symptoms, TMJ range of motion, jaw functionality, sleep quality, and patient satisfaction were evaluated. The evaluations were repeated after 4 weeks and compared with baseline values. Results: A statistically significant difference was determined in both groups in pain, TMJ range of motion, and sleep quality (p&amp;lt;0.05). In the comparison between the groups after treatment, the pain, TMJ range of motion values, and sleep quality were seen to be statistically significantly better in the MT group (p&amp;lt;0.05). The patient satisfaction measurements of mean general satisfaction, interpersonal attitude, mean healthcare services score, and general satisfaction total points were found to be statistically significant in the MT group (p&amp;lt;0.05). Conclusion: The applications of both MT and ST were seen to be effective in patients with M-TMD with bruxism. In the comparisons between the groups, the MT method was seen to be more effective than ST. It can be thought that the application of stabilization splint therapy together with manual therapy would significantly increase the treatment efficacy in patients with M-TMD.

Efficacy of low-intensity laser therapy in trigeminal neuralgia: a systematic review

IntroductionTrigeminal neuralgia (TN) is a highly prevalent cranial neuropathy, recognized as one of the main chronic orofacial neuropathic pain conditions. Low-intensity laser therapy (LILT) has been proposed as an analgesic alternative for treating neuropathic orofacial pain, although studies appear to be limited, without a consensus on dose. The study aim was to describe the efficacy of LILT in TN treatment.MethodsRandomized clinical trials and controlled trials were identified in the PubMed, Scopus, Web of Science, and ScienceDirect databases for May 8, 2021. Three independent researchers reviewed titles and abstracts to determine their eligibility. Risk of bias and quality were assessed with the RoB 2 tool (Cochrane) and PEDro scale. Decreased pain was considered the main outcome, and changes in the temporomandibular joint range of motion, strength, or disability were secondary outcomes.ResultsThe search yielded 1078 articles after eliminating duplicates, reduced to 13 when applying the selection criteria. Nine articles were ascribed a low risk of bias or remained without consensus (69.23%), obtaining an average score of 6 (PEDro). Thirteen trials showed pain reduction at the end of treatment and in follow-up, although with statistical significance for 8 articles only (p &lt; 0.005). A decrease in drug consumption and an increase in serotonin levels were observed in experimental groups, which supports the systemic analgesic effects of local and remote LILT.ConclusionsLILT is effective in reducing pain in TN. However, more research is needed to establish a referential dose consensus for TN and other neuropathic pain conditions.

Changes and Associations between Cervical Range of Motion, Pain, Temporomandibular Joint Range of Motion and Quality of Life in Individuals with Migraine Applying Physiotherapy: A Pilot Study.

Background and Objectives: The aim of this study was to assess the effects of physiotherapy with aerobic exercise together with temporomandibular joint range of motion exercises (supervised) and physiotherapy with aerobic exercise only (unsupervised), also to review the correlations between neck movements, pain, temporomandibular joint range of motion movements and quality of life in individuals with migraine. Methods: The flexion, extension and lateral flexion of the cervical spine were measured in degrees with a mechanical goniometer and pressure pain thresholds with algometer. Quality of life was assessed with the SF-36 questionnaire and temporomandibular joint range of motion with a centimeter. Results: The study showed statistically significant cervical flexion results in both groups (p < 0.05), masticatory muscle results and temporomandibular joint range of motion between the groups (p < 0.05). A correlation between left upper trapezius muscle pain and cervical lateral flexion was observed in the intervention group. Physical activity correlated with cervical extension, activity limitation due to physical ailments and general health. A correlation between temporomandibular joint and right-side masticatory muscles pain was found. A correlation between upper trapezius muscle pain and left- as well as right-side temporalis muscles were found in the control group. Strong correlations were found between pain and activity limitation due to physical ailments and emotional state. The temporomandibular joint range of motion strongly correlated with activity limitation due to physical ailments. Conclusions: Physiotherapy based on aerobic exercises together with temporomandibular joint exercises was more effective than physiotherapy based on aerobic exercise for decreasing pain, increasing pressure pain thresholds and cervical range of motion.

An Analysis of the Temporomandibular Joint Range of Motion and Related Factors in Children and Adolescents.

This study was designed to establish safe guidelines for pediatric dental practice regarding temporomandibular joint (TMJ) range of motion (ROM) and mouth area (MA). A total of 438 children aged 3–15 years old of homogenous ethnicity participated in the study; the distribution of participants was approximately equal (sex; n = 15; age, n = 30). Maximum mouth opening (MMO), body height, weight, and age of each participant were recorded, and the TMJ ROM including anterior and lateral movements, MA, and mouth width were documented. Males showed higher mouth width, MMO, and MA values than females. MMO and MA increased with age, height, and weight in a statistically significant manner. MMO of 40 mm is reached by the age of 5.2 years, at a height of 105.9 cm and a weight of 18.6 kg. MMO showed a moderate correlation with age, height, weight, and mouth width, and MA moderately correlated with mouth width. Anterior and lateral movements did not show any close relation to these aforementioned factors. The findings of this study suggest that forcible mouth opening over 40 mm should be more cautiously considered, especially in children shorter than 105 cm, lighter than 18 kg and in children under 5 years old.

Gape Angle in Asymptomatic Dogs with Normal Occlusion.

This study reports the gape angle (vertical temporomandibular joint range of motion for mouth opening) in conscious and anesthetized dogs. Mouth opening was reported as an angle in this study. Additionally, conscious and anesthetized measurements were compared to see if the state of anesthesia affected this measurement in asymptomatic patients. This prospective study evaluated 165 anesthetized dogs. Patients were placed in 1 of 2 groups: dental patients or non-dental patients. Only patients who were reported by owners to be asymptomatic for oral pain were included in the study. All dogs that met inclusion criteria had the maxillary length and interincisal distance measured. There was no difference (p = 0.590) between the mean (+/-SD) gape angle of conscious 44.0o (+/- 4.1+o) and anesthetized patients 43.9o (+/- 3.9o). No difference was seen in the gape angle between dental (44.2o) and non-dental patients (43.2o) (p = 0.183), or between conscious (43.8o) and anesthetized patients (43.7o) (p = 0.610). This study suggests that a consistent gape angle of 44o exists in dogs not exhibiting overt signs of oral pain and the gape angle is easy to measure in conscious patients and may be a useful tool during routine physical examination to identify patients with restricted range of motion. Immediate clinical application of this information can be used to monitor progress of treated patients affected by disorders that cause a decreased gape angle.

Efficacy, safety, and economic assessment of hominis placental pharmacopuncture for chronic temporomandibular disorder: a protocol for a multicentre randomised controlled trial

BackgroundTemporomandibular disorder (TMD) is a condition encompassing clinical symptoms of the temporomandibular joint, masseter muscle, and surrounding structures. Hominis placental pharmacopuncture (HPP), consisting of human placental extract, has been reported as effective for treating chronic musculoskeletal disorders, but a lack of well-designed randomised controlled trial s (RCTs) mean there is insufficient evidence to prove the efficacy of HPP.MethodsThis study is a two-arm parallel, assessor-blinded, multi-centre, randomised controlled trial. We will enrol 82 chronic TMD patients from rwo Korean Medicine hospitals in Axis 1, Group I according to RDC/TMD diagnostic criteria, and randomly allocate 41 patients each to an HPP group and a physical therapy (PT) group. Treatment will be administered in 10 rounds, after which there will be four follow-up visits 6, 9, 13, and 25 weeks from baseline. The primary end point is 6 weeks after baseline, and the primary outcome is the difference in Visual Analogue Scale (VAS) score for temporomandibular pain between baseline and week 6. Secondary outcomes will be Numeric Rating Scale (NRS) scores for temporomandibular pain and discomfort, temporomandibular joint range of motion, the Korean version of Beck’s Depression Index-II (K-BDI-II), Jaw Functional Limitation Scale (JFLS), Patient Global Impression of Change (PGIC) scores, and quality of life. Using data on adverse events and cost-effectiveness in the two groups, we will perform a safety assessment and a cost-effectiveness analysis (economic assessment).DiscussionThis study will assess the efficacy and safety of HPP for chronic TMD compared with PT. This RCT will provide evidence for the efficacy, safety, and economics of HPP.Trial registrationclinicaTrials.gov (NCT04087005) / Clinical Research Information Service (CRIS) (KCT0004437) / IRB (JASENG 2017–09–002-002, KHNMCOH 2019–08-002) / Ministry of Food and Drug Safety (No. 31886).

Improving Temporomandibular Range of Motion in People With Duchenne Muscular Dystrophy and Spinal Muscular Atrophy.

People with Duchenne muscular dystrophy (DMD) and spinal muscular atrophy (SMA) develop impaired oral function because of reduced temporomandibular joint range of motion (ROM), which affects feeding and oral hygiene activities of daily living (ADLs). To assess whether the TheraBite®, an intraoral stretching device, improves ROM. Case series, with intervention duration varying from 7 to 30 mo. Treatment frequency varied from weekly to consultative (several times per year). Varied depending on the ease of transportation for the participant and caregivers. Two participants were treated in an outpatient medical clinic. The other was provided consultative care during multidisciplinary medical clinics and completed a home program. Two adults with DMD and one with SMA. Stretching protocol using the TheraBite. Temporomandibular active ROM (AROM) was determined using a disposable TheraBite oral goniometer. Passive ROM (PROM) was determined using the adhesive scale on the TheraBite. Measures were taken at baseline, each intervention or consultation, and the end of care. ADL participation and caregiver burden were measured at the end of intervention. For participants with DMD, AROM remained unchanged, but PROM increased by 40%-65%. The participant with SMA demonstrated 33% and 47% improvements in AROM and PROM, respectively. Participants or caregivers reported improved feeding function, improved oral hygiene, or reduced fatigue. TheraBite may improve temporomandibular PROM in people with DMD and temporomandibular AROM and PROM in people with SMA. It may also improve ADL function and consequently reduce caregiver burden. Further investigation is warranted. Temporomandibular contracture in people with DMD and SMA contributes to reduced lifespan and loss of function. Use of the TheraBite with this population may preserve temporomandibular ROM and improve feeding, hygiene, and quality-of-life outcomes.

Effect of Short-Term Forward Head Posture Correction for Masseter Muscle Activity and Temporomandibular Joint Function for People with Upper Cross Syndrome

Background. In 1996, meta-analysis of studies was performed and it showed the connections between head posture changes and temporomandibular joint (TMJ) dysfunctions (Harrison et al., 1996), but the abnormalities of the mandibular usually were treated as the only pathology leading to poor clinical effect (Lee et al., 2017). Supposedly, occlusion problems are related not only to the position of the jaw and skull, but also to the shoulder and spine, which act as a biomechanical chain (Moreno, Aranza, 2013; Shousha et al., 2018). There is a lack of evidence how head posture correction changes stomatognathic system functions, that is why our study aimed to determine if a short-term head posture correction affects the system. Research aim. Determine the effect of short-term forward head posture correction for temporomandibular joint (TMJ) function. Research methods. Evaluation of posture, TMJ range of motion, jaw opening stereotype. Research results. After a short-term head posture correction, head inclination angle alteration was as follows: ScapularR = 5.65°, ScapularL = 3.9°. Jaw opening alteration was ScapularR 15.09 mm, ScapularL 15.58 mm. The difference between mandibular deviations decreased to ScapularR 0.32 mm; ScapularL 1.60 mm. Deviation during jaw opening reduced ScapularR 2.06 mm; ScapularL 2.38 mm. Conclusion. Short-term head posture correction signifcantly reduced head inclination angle, mandibular opening movement amplitude and deviation from the centre line in individuals with upper cross syndrome and asymmetric scapular position.Keywords: temporomandibular joint, head posture, upper cross syndrome.

Temporomandibular joint disorder determined by Fonseca anamnestic index and associated factors in 18- to 27-year-old university students

ABSTRACT Objective The aim of this study was to investigate temporomandibular disorder (TMD) and associated risk factors. Methods This study was conducted using 212 university students. Based on the Fonseca anamnestic index, the population was divided into two groups: those with TMD and those without TMD. The two groups were compared in terms of global body posture, craniohorizontal and craniovertebral angles, neck and temporomandibular joint range of motion, stress level, and sleep quality. Results Stress level, sleep quality, and left cervical rotation were found to have statistical differences between the groups (p = 0.00, 0.00, and 0.046, respectively). Sleep quality and stress level were found to be important risk factors for the presence of TMD (p = 0.017 and 0.00, respectively). Discussion In the prevention and treatment of TMD, a holistic approach that evaluates mechanical factors and psychosocial factors should be adopted.

Assessment of Temporomandibular Joint Dysfunction in Patients with Stroke

The aim of this study was to assess temporomandibular joint dysfunction in patients with stroke. Total of 100 participants, 50 healthy and 50 who had stroke, were recruited into this study. Digital caliper and algometer were used to assess temporomandibular joint range of motion and masticatory muscle pressure pain threshold. Labial commissure angle measurement was used for the assessment of facial paralysis severity. Fonseca questionnaire was used for temporomandibular joint dysfunction assessment and categorization. In addition, dominant mastication shift was measured by the question that asks the pre and poststroke dominant mastication side. In intergroup comparison, significant decrease was found in all temporomandibular range of motion parameters in favor of stroke group (P < .05). Despite the fact that no significant difference was found between groups for the pain threshold in masticatory muscles except for middle part of the left temporalis muscle, values were higher in healthy group (P > .05). As a result of intergroup examination of labial commissure angle degree, Fonseca questionnaire score, it was found that labial commissure angle and Fonseca questionnaire scores were higher in stroke group (P < .05). Intragroup examination of patients with stroke showed that dominant mastication side shift was seen in patients with stroke (P < .05). It was concluded that, temporomandibular joint dysfunction prevalence was higher in stroke group compared with healthy group and use of modalities specific to temporomandibular joint dysfunction treatment would be beneficial.

The effect of a short term conservative physiotherapy versus occlusive splinting on pain and range of motion in cases of myogenic temporomandibular joint dysfunction: a randomized controlled trial.

[Purpose] This study compared the effects of a short-term conservative physiotherapy program versus those of occlusive splinting on pain and range of motion in cases of Temporomandibular Joint Dysfunction. [Participants and Methods] This study included 112 male and female participants with ages ranging from 15–27 years. Outcome measures were pain assessed by the visual analogue scale and Temporomandibular Joint Range of Motion measured with the Temporomandibular joint opening index. Patients were randomly assigned to one of two groups. Conservative physiotherapy was provided to one group 3 days weekly while the other group received standard occlusive splinting. Splinting was used daily for the total period of treatment. Any adjustments for splints were done by the treating dentist. Both groups were treated for a total period of 6 weeks. [Results] Between group statistical analysis revealed a significant reduction in pain intensity and Temporomandibular joint opening index in favor of the conservative physiotherapy group. [Conclusion] Over a treatment period of 6 consecutive weeks, conservative physiotherapy could be a better initial treatment than occlusive splint in relieving pain and improving range of motion in cases of myogenic temporomandibular dysfunction.

Decreased Temporomandibular Joint Range of Motion in a Model of Early Osteoarthritis in the Rabbit

Analysis of mandibular biomechanics could help with understanding the mechanisms of temporomandibular joint (TMJ) disorders (TMJDs), such as osteoarthritis (TMJ-OA), by investigating the effects of injury or disease on TMJ movement. The objective of the present study was to determine the functional kinematic implications of mild TMJ-OA degeneration caused by altered occlusion from unilateral splints in the rabbit. Altered occlusion of the TMJ was mechanically induced in rabbits by way of a unilateral molar dental splint (n= 3). TMJ motion was assessed using 3-dimensional (3D) skeletal kinematics twice, once before and once after 6 weeks of splint placement with the splints removed, after allowing 3 days of recovery. The relative motion of the condyle to the fossa and the distance between the incisors were tracked. An overall decrease in the range of joint movement was observed at the incisors and in the joint space between the condyle and fossa. The incisor movement decreased from 7.0 ± 0.5 mm to 6.2 ± 0.5 mm right to left, from 5.5 ± 2.2 mm to 4.6 ± 0.8 mm anterior to posterior, and from 13.3 ± 1.8 mm to 11.6± 1.4 mm superior to inferior (P < .05). The total magnitude of the maximum distance between the points on the condyle and fossa decreased from 3.6 ± 0.8 mm to 3.1 ± 0.6 mm for the working condyle and 2.8 ± 0.4 mm to 2.5 ± 0.4 mm for the balancing condyle (P < .05). The largest decreases were seen in the anteroposterior direction for both condyles. Determining the changes in condylar movement might lead to a better understanding of the early predictors in the development of TMJ-OA and determining when the symptoms become a chronic, irreversible problem.

Bilateral Extracapsular Soft-Tissue Ossification Affecting Range of TMJ Motion in an Airedale Terrier

A 3 mo old female Airedale terrier presented with decreased range of motion of the temporomandibular joint (TMJ), which was first recognized at weaning. Computed tomography (CT) revealed abnormal, bilateral ossification of the soft tissues extending from the region of the tympanic bullae to the medial aspect of the angular process of each mandible. Those ossified structures most closely approximated the location of the lateral pterygoid muscles. The ossified structures were present at presentation and initially manifested as complete ossification on the right side. The condition progressed to complete bilateral ossification by 3 yr of age. The mandibular condyles associated with the temporomandibular joints were malformed. The patient had severe mandibular distoclusion with deviation of the mandible to the left. The left mandibular cheek teeth were positioned in a caudal cross bite. A single treatment of manual stretching and breakdown of the ossified muscle of mastication by placement of tongue depressors within the oral cavity resulted in no increase in TMJ range of motion as measured by the incisal opening. This is the first reported case of spontaneous false ankylosis of the TMJ in an Airedale terrier.

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.