Temporomandibular Joint In Children Research Articles

Growth Evaluation After Costochondral Graft Combined With Functional Appliance in Children With Temporomandibular Joint Ankylosis.

The treatment of temporomandibular joint (TMJ) ankylosis in children is a great challenge for surgeons. Costochondral graft (CCG) is a common method of reconstructing the TMJ in children. However, the growth pattern of CCG is unpredictable. In this study, we introduced a surgical-orthodontic approach and evaluated the growth results of the mandible and maxilla in children with TMJ ankylosis through 3-dimensional computed tomography measurements. A prospective cohort study was conducted on child patients diagnosed as having TMJ ankylosis between September 1, 2018 and June 1, 2020. Computer-aided virtual mandibular position guided the CCG, and removable functional appliance was used after surgery. The maximal incisal opening (MIO), the maxilla height, and the length of mandibular ramus were determined. Paired t test was performed to analyze the differences among various stages. Six patients (3 females, 3 males; aged 6-9y) were included in this study. MIO was 12.4mm before surgery and improved to 36.8mm after 42.8 months' follow-up. Mandible length increased by 5.1mm in the affected side and by 5.3mm in the unaffected side, without significant difference. The affected maxilla height increased by 6.7mm, which was more than 5.0mm in the unaffected side. In conclusion, continued growth of mandible and maxilla can be achieved through CCG combined with functional appliance treatment for children TMJ ankylosis.

Panoramic imaging may detect morphologically abnormal temporomandibular joints in children with juvenile idiopathic arthritis

Panoramic imaging may detect morphologically abnormal temporomandibular joints in children with juvenile idiopathic arthritis

MRI of the temporomandibular joint in children with juvenile idiopathic arthritis: protocol and findings.

Contrast-enhanced magnetic resonance imaging (MRI) is the technique of choice for diagnosis and monitoring of temporomandibular joint (TMJ) disorders in patients with juvenile idiopathic arthritis (JIA), as it is able to visualize both soft tissue and osteochondral changes. Approximately 40% of children with JIA develop inflammatory and chronic osteochondral changes observable on imaging, which if left untreated can lead to significant facial growth impairment, including facial asymmetry and retrognathia. MRI of the TMJ plays a paramount role in diagnosis and treatment monitoring in JIA since early signs of TMJ involvement are difficult to detect clinically and with physical examination. Findings of TMJ arthritis may be classified into acute and chronic domains. Early or acute manifestations include joint effusion, bone marrow edema, synovial thickening, and increased joint enhancement. With disease progression, there are characteristic osteochondral changes, including deformity of the mandibular condyle with shortening of the mandibular ramus, bone erosions, and disk abnormalities. In this pictorial essay, we describe a consensus MRI protocol for the study of the TMJ and illustrate the degree of normal and pathological MRI findings using currently available MRI scoring systems of the TMJ developed for JIA.

Research progress on CBCT of temporomandibular joint morphology in children with malocclusion in mixed dentition

Malocclusion is an abnormal development and deformity of maxillofacial structure caused by congenital factors or acquired factors. The morphology and structure of the temporomandibular joint with various malocclusion deformities have their own characteristics, which can seriously affect the physical and mental health of children. With the continuous development of society and economy and the gradual improvement of people's living standard, malocclusion malocclusion in children during dental replacement period has received more attention. CBCT is one of the important imaging methods to examine the morphology and structure of temporomandibular joint. In order to intervene early in children with malocclusion during mixed dentition and to understand the morphological and structural characteristics of temporomandibular joint, imaging is used to review the morphological and structural characteristics and differences of temporomandibular joint in children with different types of malocclusion during in mixed dentition.

Foramen tympanicum prevalence in the population of Southeast Brazil: a morphological study in computed tomography scans.

The foramen tympanicum is located on the anteroinferior region of the external acoustic meatus and posteromedial to the temporomandibular joint in children between the 1st and the 5th year of life. It is considered an anatomical variation when it persists in adults. The aim of this study was to verify the prevalence as well as to characterise the foramen tympanicum in computed tomography (CT) scans of the population from southeastern part of Brazil. A total of 78 CT scans of dry human skulls (20 female and 58 male) were used, which were selected randomly regarding the ages, ranged from 15 to 100 years. The foramen tympanicum was identified in the images of the axial plane and confirmed in the images of the coronal and sagittal planes. The largest diameter (in mm) was obtained. The descriptive statistics (in %), Fisher's test and χ2 test were performed to compare the prevalence of foramen tympanicum between sexes and sides. The probability value ≤ 0.05 was defined as a level of significance. Descriptive statistics were performed to verify the mean diameter of the foramen on the right and left sides of the skulls. The prevalence of foramen tympanicum was higher in females (p = 0.0070), bilaterally, as the absolute values of females were lower in relation to males. Fisher's exact test showed that the prevalence of foramen tympanicum was significantly higher in females (45%) than in males (15.52%). On the right side, the mean axial diameter was 2.23 mm (range 0.93-3.75 mm). On the left side, the mean axial diameter was 2.22 mm (range 0.9-3.61 mm). The knowledge of anatomical variations is extremely valuable for an accurate diagnosis, treatment plan and prognosis and a thorough preoperative assessment.

Temporomandibular Joint Acoustic Emissions in Children With Juvenile Idiopathic Arthritis Differ From Those in Healthy Children

Articulation of the temporomandibular joint (TMJ) generates sounds with specific characteristics known as joint acoustic emissions (AEs). The purpose of this project was to determine if AEs as described by the joint health score (JHS) in children with juvenile idiopathic arthritis (JIA) differ from AEs in healthy children. The investigators implemented a cross-sectional study with age- and sex-matched controls to compare AEs from 4 groups: (1) healthy subjects without TMJ sounds, (2) healthy subjectswith TMJ sounds, (3) subjects with JIA without TMJ sounds, and (4) subjects with TMJ sounds. Predictor variables were JIA status (ie JIA/healthy) and joint sounds (present/absent). The outcome variable was AEs. Subjects wore a specialized headset and performed specific jaw movements that generated AEs. AEs were recorded and analyzed using an aggregated decision tree classification model that calculates a JHS for each group. JHSs were compared using a receiver operating characteristic curve and classification accuracies. The study team used a 2-tailed unpaired t-test to determine if score distributions were different. Significance was P<.05. A total of 51 subjects (102 TMJs; 37 females) with an average age of 13.1years (range, 7 to 18) participated. Children with JIA and TMJ sounds had AEs with large repetitive clicks. Children with JIA without sounds had smaller repetitive clicks. Healthy children had grinding sounds with lower amplitude. The receiver operating characteristic curve had a classification accuracy of 71.6%. This accuracy compares against the gold standard clinical assessment for placing these patients into their groups (JIA vs healthy). JHSs of children with TMJ sounds and children with JIA and TMJ sounds were statistically significant (P<.0001). In our sample, the AE of TMJs in healthy children may be different than that in children with JIA. Assessment of an AE is a promising and noninvasive technique to determine involvement of TMJs in children with JIA.

Relationship of Malocclusions with Disorders of the Temporomandibular Joint in Children of CALI-Colombia.

The aim of this study was to determine the relationship of malocclusion with the presence and severity of temporomandibular disorders (TMDs) in children. A clinical examination was performed in 87 patients (from 4 to 14 years of age) who attended the dentistry clinics of Universidad del Valle. The 77 patients studied had malocclusions; 55 patients had TMD and 67.3% were female. The most frequent symptom of TMD was articular unilateral noise with 33.8%, followed by pain in at least one masticatory muscle with 26%. TMJ pain was observed in 24.7% of the patients. There was a statistically significant relationship between the presence and severity of TMD with type of dentition and transverse malocclusion, respectively. The presence of TMD in children with malocclusion presented in a high frequency. TMD depends on the type of dentition and its severity is dependent on transverse malocclusion.

Radiological analysis of size of bone elements of the temporomandibular joint in children and adolescents with class II malocclusion

The aim of the study was to assess the ratio of bone elements of the temporomandibular joint (TMJ) in children and adolescents with distal occlusion according to cone-beam computed tomography (CBCT). CBCT of the TMJ was analyzed in 121 patients aged 12-18 years, which were divided into two age groups: group I - children aged 12-15 years (62 cases in total, of which 47 patients with distal occlusion and 15 patients with physiological occlusion) and II group - adolescents aged 15-18 years (59 cases, of which 48 patients with distal occlusion and 11 patients with physiological occlusion). CBCT of the temporomandibular joint was performed by the standard method in the position of habitual occlusion and maximally open mouth. The size of the TMJ joint space in the anterior, upper and posterior sections was determined by the method of Rabukhina N.A., the analysis of the ratio of the bone elements of the TMJ was carried out using the Craniometry program. The size of the joint space and the angle β of the temporomandibular joint in the anterior section on the right and left in children aged 12-15 with distal occlusion is increased compared to children with physiological occlusion in the position of habitual occlusion. In adolescents 15-18 years old with distal occlusion, the size of the TMJ joint space is increased in the anterior section on the right and left and reduced in the posterior section on the right, angle α is reduced on the right and left, angle β is reduced on the right, angle γ is increased on the right compared to adolescents with physiological occlusion. The revealed deviations indicate the presence of violations in the ratio of the bone elements of the TMJ, which are aggravated with age. Analysis of the results obtained during CBCT in children and adolescents allows us to correct the plan of orthodontic treatment and predict its results.

Diagnostics of the morphological and functional state of temporomandibular joint in children with distal occlusion

Nowadays it is important to improve the techniques to diagnose malocclusion class II which is very common in children. 24 patients with various maxillofacial anomalies were examined. The developed diagnostic tactics in children with various maxillofacial anomalies involves a set of sequential studies: teleroentgenography, cone-beam computed tomography, ultrasound, kinesiography and electromyography. The obtained results allow assessing the morphological and functional state of the temporomandibular joint in children with distal malocclusion.

Effects of motion correction, sampling rate and parametric modelling in dynamic contrast enhanced MRI of the temporomandibular joint in children affected with juvenile idiopathic arthritis

The temporomandibular joint (TMJ) is typically involved in 45–87% of children with Juvenile Idiopathic Arthritis (JIA). Accurate diagnosis of JIA is difficult as various clinical tests, including MRI, disagree. The purpose of this study is to optimize the methodological aspects of Dynamic Contrast Enhanced (DCE) MRI of the TMJ in children. In this cross-sectional study, including data from 73 JIA affected children, aged 6–15 years, effects of motion correction, sampling rate and parametric modelling on DCE-MRI data is investigated. Consensus among three radiologists determined the regions of interest. Quantitative perfusion parameters were estimated using four perfusion models; the Adiabatic Approximation to Tissue Homogeneity (AATH), Distributed Capillary Adiabatic Tissue Homogeneity (DCATH), Gamma Capillary Transit Time (GCTT) and Two Compartment Exchange (2CXM) models. Effects of motion correction were evaluated by a sum of least squares between corrected raw data and the GCTT model. The effect of systematically down sampling the raw data was tested. The sum of least squares was computed across all pharmacokinetic models. Relative difference perfusion parameters between the left and right TMJ were used for an unsupervised k-means based stratification of the data based on a principal component analysis, as well as for a supervised random forest classification. Diagnostic sensitivity and specificity were computed relative to structural image scorings. Paired sample t-tests, as well as ANOVA tests, were used (significant threshold: p < 0.05) with Tukeys post hoc test. High-level elastic motion correction provides the best least square fit to the GCTT model (percental improvement: 72–84%). A 4 s sampling rate captures more of the potentially disease relevant signal variations. The various parametric models all leave comparable residues (relative standard deviation: 3.4%). In further evaluation of DCE-MRI as a potential diagnostic tool for JIA a high-level elastic motion correction scheme should be adopted, with a sampling rate of at least 4 s. Results suggest that DCE-MRI data can be a valuable part in JIA diagnostics in the TMJ.

Acoustic emissions of the temporomandibular joint in children: proof of concept

Acoustic emissions of the temporomandibular joint in children: proof of concept

Evaluation of Dental Status and Temporomandibular Joint in Children With Generalized Joint Hypermobility.

The aim of this study was to evaluate the dental status and temporomandibular diseases (TMDs)-related symptoms in children with generalized joint hypermobility (GJH) and compare them with healthy controls (HCs). This is a cross-sectional, observational study carried out between September 2016 and April 2017. A total of 124 children with GJH (n = 62) and HC (n = 62) were enrolled. The GJH was assessed with the Beighton hypermobility score. The subjects were screened for dental status and TMD-related symptoms. The assessment included the index for "decayed," "missing," and "filled teeth" (DMFT, dmft); plaque; gingival bleeding; tooth mobility; and temporomandibular joint (TMJ) evaluation. The mean Beighton hypermobility score was 6.3 ± 1.2 in the GJH group. Visible plaque index and gingival bleeding index scores were found to be significantly higher in children with GJH then in the HC (p = 0.031, p = 0.023). No differences were found regarding the DMFT scores between the groups (p = 0.16). Temporomandibular disorder-related symptom frequencies were significantly higher in children with GJH (p < 0.001). The most common clinically determined sign of TMD was clicking with a maximum active mouth-opening. Combined TMJ symptoms and TMD were observed in approximately one third of the children with GJH. The presence of GJH in a child may be indicative of future dental or TMJ problems, and it may cause dental problems due to increased gingival bleeding index and visible plaque index scores. Therefore, children with GJH require preventive dental and TMJ care.

Determination of Coronoid Process Hyperplasia of the Mandible Upon Ankylosing Diseases of the Temporomandibular Joint in Children

Purpose: Ankylosing diseases of the temporomandibular joint (ADTMJ) in children ─ bone ankylosis and secondary deforming osteoarthrosis (SDOA) lead to an increase in the coronoid process (CP) on average by 1.5 times. The slice computed tomography (SCT) allows fully determining the changes occurring in the bone structures of the joint with its ankylosing diseases. The purpose of the work was to determine the parameters coronoid process, which affects the limitation of mouth opening, and indications for its resection in the ADTMJ, based on the treatment of SCT data. Material and Methods: The subject of the study were 33 SCT in children aged 6 to 14 years with ADTMJ and without lesions of TMJ. Anthropometric measurements of CP in children of the three groups were performed according to the proposed modified scheme of Levandoski panographic analysis. Conclusion: The proposed scheme of anthropometric measurements of SCT allows us to mathematically substantiate the stage of hyperplasia coronoid process in children and to determine the necessity of its surgical correction.

Normal magnetic resonance appearances of the temporomandibular joints in children and young adults aged 2-18years.

Knowledge of normal appearances of the temporomandibular joint (TMJ) is paramount when assessing the joint for disease in juvenile idiopathic arthritis. Reliable features defining normal TMJs in children are limited. To establish reliable normal standards for the TMJ at magnetic resonance imaging (MRI). We included children and young adults aged 2-18years undergoing a head MRI for reasons not believed to affect the TMJs. We assessed TMJ anatomy and contrast enhancement using a high-resolution 3-D T1-weighted sequence. We noted joint fluid and bone marrow oedema based on a T2-weighted sequence. Three experienced radiologists read all examinations twice in consensus and defined intraobserver consensus agreement. We evaluated the TMJs in 101 children and young adults (45 female), mean age 10.7years (range 2-18years). The intraobserver consensus agreement for the assessment of anterior condylar inclination in the sagittal/oblique plane was moderate to good (Cohen κ=0.7 for the right side). Cohen κ for intraobserver consensus agreement for condylar shape in the coronal plane on a 0-2 scale was 0.4 for the right and 0.6 for the left. Intraobserver agreement for measurement of joint space height and assessment of bone marrow oedema was poor. There was a statistically significant increase in anterior inclination by age in the sagittal plane on a 0-2 scale (P<0.0001). Eighty percent of the condyles showed a rounded shape in the coronal plane while 20% showed mild flattening. Thirty-five of 36 right TMJs showed contrast enhancement (mild enhancement in 32 joints, moderate in 3 joints). Subjective assessment of the anterior condylar inclination in the sagittal/oblique plane and condylar flattening in the coronal plane can be considered precise features for describing TMJ anatomy in healthy children. There is an increasing anterior inclination by age. Mild contrast enhancement of the TMJs should be considered a normal finding.

Temporomandibular joint atlas for detection and grading of juvenile idiopathic arthritis involvement by magnetic resonance imaging

Contrast-enhanced magnetic resonance imaging (MRI) is considered the diagnostic standard for identifying involvement of the temporomandibular joint by juvenile idiopathic arthritis. Early or active arthritis is shown as bone marrow oedema, joint effusion, synovial thickening and increased joint enhancement. Subsequent joint damage includes characteristic deformity of the mandibular condyle, bone erosion, disk abnormalities and short mandibular ramus due to impaired growth. In this pictorial essay, we illustrate normal MRI findings and growth-related changes of the temporomandibular joint in children. The rationale and practical application of semiquantitative MRI assessment of joint inflammation and damage are discussed and presented. This atlas can serve as a reference for grading temporomandibular joint arthritis according to the scoring systems proposed by working groups of OMERACT (Outcome Measures in Rheumatology and Clinical Trials) and the EuroTMjoint research network. Systematic assessment of the level of inflammation, degree of osteochondral deformation, and growth of the mandibular ramus by MRI may aid in monitoring the course of temporomandibular joint arthritis and evaluating treatment options.

Juvenile idiopathic arthritis and the temporomandibular joint: Acomprehensive review.

Juvenile idiopathic arthritis is the most common inflammatory rheumatic disease of childhood and represents a series of chronic inflammatory arthritides of unknown cause. Involvement of the temporomandibular joint has been reported in up to 87% of children with juvenile idiopathic arthritis when based on magnetic tomography imaging; it can be asymptomatic and may lead to severe long term complications. In this review a summary of the contemporary literature of imaging of the temporomandibular joint in children with juvenile idiopathic arthritis will be provided, including ultrasound which is a valuable method for guided joint injections, but does not necessarily allow detection of acute inflammation, cone beam computed tomography, which has emerged as a feasible and accurate low-dose alternative as compared to conventional computed tomography to detect destructive change, and magnetic resonance imaging which is considered the method of choice for assessing acute, inflammatory change, although the lack of normative standards remains a challenge in children.

Disk abnormality coexists with any degree of synovial and osseous abnormality in the temporomandibular joints of children with juvenile idiopathic arthritis

MRI manifestation of temporomandibular joint arthritis is frequently reported in children with juvenile idiopathic arthritis. However, little attention has been paid to temporomandibular joint disk abnormalities. To assess combinations of MRI findings in the symptomatic temporomandibular joint in children with juvenile idiopathic arthritis with focus on disk abnormalities. This was a retrospective study of 46 patients with juvenile idiopathic arthritis, mean age 12 years (range: 5-17 years). Mean disease duration was 70 months (standard deviation: 61 months). MR images of 92 temporomandibular joints were scored for thickness of abnormally enhancing synovium (synovitis), joint effusion, bone marrow oedema, abnormal bone shape, bone erosion and disk abnormalities. The 92 temporomandibular joints were categorized as A: No synovitis and normal bone shape (30/92; 33%), B: Synovitis and normal bone shape (14/92: 15%), C: Synovitis and abnormal bone shape (38/92; 41%) and D: No synovitis but abnormal bone shape (10/92; 11%). Thirty-six of the 46 patients (78%) had synovitis and 33/46 (72%) had abnormal bone shape, most frequently in combination (30/46; 65%). Disk abnormalities (flat disk, fragmented disk, adherent disk and displaced disk) were found in 29/46 patients (63%). Disk abnormalities were found in all categories of juvenile idiopathic arthritis involved temporomandibular joints (B: 8/14 [57%]; C: 25/38 [66%] and D: 7/10 [70%]). Disk displacement was found in half of the joints (7/14) in category B. Synovitis was most pronounced in this category. Disk abnormalities were frequent. Disk displacement also occurred in joints with early temporomandibular joint arthritis, i.e., with normal bone shape. Other disk abnormalities were found in joints with bone abnormalities. Attention should be paid to disk abnormalities both in early and long-standing temporomandibular joint arthritis in children with juvenile idiopathic arthritis.

Contrast-enhanced MRI of the temporomandibular joint: findings in children without juvenile idiopathic arthritis.

Contrast-enhanced magnetic resonance imaging (MRI) is highly sensitive for assessing temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA), but only sparse data exist on normal TMJ appearance in children. To determine normal MRI appearance and enhancement pattern of pediatric TMJ as basis for diagnosing early arthritis. In 27 children (age range, 1.2-16.8 years) without TMJ pathology undergoing head MRI, fat-saturated T2-weighted (T2W) and postcontrast fat-saturated T1-weighted (T1W) images sagittally aligned to the 54 TMJs, besides standard T1W and T2W images, were assessed for bony and soft tissue signal intensity (SI), the amount of perceptible joint fluid, and contrast enhancement (CE). Bone marrow SI and CE of the mandible were consistent with varying degrees of residual red marrow in 96% of joints. The mandibular condyles were mostly isointense to the ramus, but in 9% showed mild edema-like bone marrow SI and CE. Small amounts of intraarticular fluid were detected in 31% on T2W images without fat saturation and in 83% on T2W images with fat saturation as fine lines in the upper or lower joint compartment or as small dots in an articular recess. Seventy-nine percent of all TMJs showed intense joint enhancement on early images restricted to areas of intraarticular fluid. Small amounts of joint fluid with intense CE are a common MRI finding in TMJs of children without JIA and therefore should not be considered diagnostic for early arthritis.

Magnetic resonance imaging of temporomandibular joints in juvenile idiopathic arthritis

Magnetic resonance imaging (MRI) is considered essential for diagnosing early involvement of the temporomandibular joint (TMJ) in children with juvenile idiopathic arthritis (JIA). Assessment of the soft tissue joint components and contrast enhancement allows diagnosing and grading the severity of TMJ arthritis. An MRI grading system for synovial inflammation and deformity of the TMJ in children with JIA is proposed. Normal and arthritic MRI findings are illustrated. Magnetic resonance imaging (MRI) is considered essential for diagnosing early involvement of the temporomandibular joint (TMJ) in children with juvenile idiopathic arthritis (JIA). Assessment of the soft tissue joint components and contrast enhancement allows diagnosing and grading the severity of TMJ arthritis. An MRI grading system for synovial inflammation and deformity of the TMJ in children with JIA is proposed. Normal and arthritic MRI findings are illustrated.

Early detection of temporomandibular joint arthritis in children with juvenile idiopathic arthritis - the role of contrast-enhanced MRI.

Early treatment of temporomandibular joint (TMJ) arthritis is crucial in children with juvenile idiopathic arthritis (JIA) to prevent permanent functional impairment. As involvement of TMJs is often asymptomatic, contrast-enhanced MRI is regarded as the most sensitive noninvasive diagnostic tool. To evaluate the degree of contrast enhancement in TMJs of children and adolescents with JIA in comparison to normal controls from a previous study. Dynamic contrast-enhanced MRI of 50 children and adolescents with JIA (6.3 to 18 years of age; mean: 12 years) were retrospectively analysed. We assessed morphological abnormalities and postcontrast time-intensity curves of the soft joint tissue and the mandibular condyle. Ratios were calculated to quantify postcontrast signal intensities (SI) in relation to precontrast SI at initial (1 min postcontrast) and maximum (6 min postcontrast) increase. Time-intensity curves followed similar biphasic patterns in normal and pathological joints. In joints with morphological signs of arthritis, mean SI ratios were on average higher than in normal joints of the reference group, but ranges of values widely overlapped. Arthritis: mean initial increase of SI 62% (±2 S.D. 18-105%), mean maximum SI 106% higher than precontrast (±2 S.D. 46-166%). Normal: mean initial increase of SI 49% (±2 S.D. 14- 85%), mean maximum of SI 73% (±2 S.D. 23-123%). Given this considerable overlap of results in dynamic contrast-enhanced MRI, the degree of contrast enhancement alone did not allow differentiation between TMJs with and without signs of inflammation. Thickening of the soft joint tissue seems to remain the earliest sign to reliably indicate TMJ arthritis.