Tempromandibular Joint Research Articles

Michigan Medicine: The University of Michigan Head and Neck Anesthesiology and Advanced Airway Management Fellowship

Michigan Medicine: The University of Michigan Head and Neck Anesthesiology and Advanced Airway Management Fellowship

Clinical, ultrasonographic and multidetector computed tomography features of temporomandibular joint in rheumatoid arthritis and psoriasis patients

Background: The incidence of Tempro Mandibular Joint (TMJ) involvement in inflammatory arthritis is underestimated. It is more common in Rheumatoid Arthritis (RA) than in Psoriatic Arthritis (PsA). TMJ affection could presented by headache, pain, click difficulty in mouth opening. Different imaging modalities disclose TMJ; conventional radiography, musculoskeletal ultrasound (MSUS), Multi Detector Computed Tomography (MDCT) and Magnetic resonance imaging Due to variability of the complaints, Temporo Mandibular Disorder (TMD) is diagnosed mainly by signs and symptoms. As there are no criteria to attain a numeric value to decide the severity of TMD, indices play an important role to determine the prevalence of this disorder in a specified population. Patients and methods: 75 patients were enrolled; 50 RA according to ACR/EULAR criteria and 25 PsA according to Caspar criteria. TMJ questionnaire was assessed according to Helkimo score. Also MSUS and MDCT scores were done. Results: Clinical TMJ affection was found in 42 RA and in 10 psoriasis patients. According to Helkimo score 84% of RA and 40% of PsA were found. By MSUS 72% of RA patients and 32% of PSA patients were affected. By MDCT 66% of RA patients and only 3% of PsA patients were noticed. There were positive correlation between duration of illness and disc displacement (r=0.4, P=0.0008) and also between morning stiffness with osteophyte and effusion (r=0.3,p=0.03, r=0.4,p=0.01). In PSA there were positive correlations between tender swollen joints with US effusion and erosion (r=0.5 P=0.01, r=0.6 p=0.002, r=0.5 p=0.006, r=0.5 p=0.006) respectively In RA patients, RF positivity was positively correlated with MDCT of impaired mouth opening (r=0.3, p=0.04), and Anti-CCP positivity was positively correlated with MDCT of increased joint space (r=0.4, p=0.01). Conclusion: There was correlation between severity of TMJ dysfunction and disease activity as well as severity in RA and PSA.

Evaluation of Functional Therapy Vs Intermaxillary Fixation in Condylar Fracture Treatment

Purpose: To compare the outcomes after rigid intermaxillary fixation (IMF) versus functional therapy (FT) in patients with mandibular condylar fractures (CFs). Patients and Methods: A prospective comparative study with 3 follow-ups (FU) at 1, 3 and 6 months was undertaken in 2 groups, which exclusively privileged either surgical or conservative treatment due to different therapeutic agendas. Patients from Group1 (GI) received IMF for 10 days, followed by physiotherapy, whereas those in Group2 (GII) had undergone FT for 21 days via guiding elastics. In both groups, all concomitant fractures (if present) were treated by open reduction and internal fixation (ORIF). Patients with unilateral CFs, with or without concomitant mandibular fractures showing one or more of the following conditions were included: adult patients (>18 years of age) indicated for closed treatment, and sufficient dentition for arch bars application. Previous history of tempromandibular joint (TMJ) dysfunction, severe pre-traumatic skeletal dysgnathia, and mid face fractures was excluded. Results: 12 patients (6 in GI and 6 in GII) were included. The clinical TMJ Dysfunction Index of Helkimo (CTDI-H) was equal in both groups at 1 month FU, it became worse in GI than in the GII at 3 month FU, corresponding to better function on the short-term. At the 6 month FU, there were better values in the GII. The Magnetic Resonance Imaging (MRI) scans revealed that the trauma caused disc displacement for 33.3% of GI and 66.7 % of GII. At 6 months FU, 33.3% of GI had improvement in the degree of the disc displacement, but they still had internal derangement with reduction. In GII, 2 out of 4 retained the normal position of the disc and the others had improvement in the disc displacement degree only. Conclusion: Both treatment options may yield acceptable results, however, FT seems to be the appropriate treatment for rapid recovery of range of mandibular motion (ROMM), relief of pain during palpation of masticatory muscles, and recovery of disc position during FU. Its success depends on the passive maneuver of physiotherapy if there is no restricted maximum interincisal opening (MIO) and it should be in a forcible manner in case of restricted MIO.

Dental and Temporomandibular Joint Problems among SCUBA Divers in Jeddah, KSA

The recent increase in the popularity of scuba diving has emphasized the role of the dentist in the prevention and treatment of oralbarotrauma. Barotrauma is a physical injury that results from ambient pressure changes during flying, diving or hyperbaric oxygen therapy [1]. Pressure changes can induce otitis-media, sinusitis, headache or can be manifested as pain to the oral region [2]. Dental barotrauma can happen while ascending; upon surfacing after completing the dive, the diver may report that a tooth broke or has shattered [4]. Divers may also suffer from signs of tempromandibular disorder such as pain in tempromandibular joint (TMJ) and ears, TMJ clicking or crepitus, trismus and impaired TMJ mobility, headache and facial pain [5]. Hence, this article aims to Assessment of dental and TMJ problems in a sample of SCUBA divers in Jeddah Saudi Arabia,Assessment of dental complaints of divers, Assessment of TMJ problems associated with SCUBA diving and relate the previous problems to diving related characteristics such as the duration of practice, the number of dives and the frequency of diving per month. Material and methods: Divers at four dive centers at the Northern coast of Jeddah (Obhur) asked to complete a questionnaire that requested information regarding diving experience and facial pain and dental symptoms experienced during diving. Cross sectional study assessing the prevalence of dental and TMJ problems among divers. The total number was 60 SCUBA divers. Results: most of divers did not complain of sinusitis (75%). More than have of the sample complained of headache (65%). While facial pain was reported by (46.7%) of the sample. More than half did not experience dental pain (65%) while (35%) had dental pain during diving. More than half of the sample did not experience TMJ pain 70% while (30%) reported having TMJ pain during diving. Conclusions: Scuba diving is one of the fastest growing sports in the world. Since Jeddah is the main port of Saudi Arabia, diving has become an occupation as well a popular sport for many people. This attracted our attention to the importance of evaluating the oral problems related to this activity. It is inevitable that the general dental practitioner will have patients who participate in this sport and they should be aware of a number of problems that a diver can experience that are associated with the teeth and related structures. The dental team must educate the diver patient of the infectious potential of the mouthpiece and recommend using only a private one, and encourage maintenance by hygiene procedures after each use, similar to other removable oral devices. The diver should not dive in times of illness. Diving related TMD symptoms should be differentiated from barotitis symptoms.

Prevalence of Impacted Wisdom Teeth among Hawler Young People

Background: It is believed that the incidence of impaction is increasing in recent years due to the less functional activity of the Jaws.Aim of the study: The objective of this study is to know the prevalence of impacted wisdom teeth among Hawler young population Also to know the factors that are associated with the state of impaction.Material and Method: 1150 young people from college of dentistry were included from February to September 2005, age ranged between 17 -30 years old they were examined using special case sheet.Results: Out of 1150 people examined (517male .and 633female), (219 male and 285 female) were found to have one or more impacted wisdom teeth (43.82%).Only 73(32male and 41 female) had one or more congenitally missing third molar. A relation was found between impaction and habit of using chewing gum and singing, statistical relation were existed between impaction and type of food, tempromandibular joint (TMJ) trouble, emotional stress and fatigue.Conclusion: A strong association was found between impacted wisdom teeth and type of food and habits among Hawler young population.

Stabilization Splint (Night Guard, Mouth Guard) Comparative Research

This research compares between the effect of flexible and hard stabilization splint (night guard, mouth guard) in the treatment of patients with tempro-mandibular joint problems.Four different categories of patients are used for comparison, each composed of ten patients. Category number one and two are treated with flexible mouth guard, while category three and four are treated with hard type of mouth guard for the same periods of time, one month and three months respectively. Analysis of the results indicate that patient category treated with soft stabilization splints for longer period of time show improved treatment and the patients are more relived and willing to continue the treatment than those treated with hard splints.

The Relationship of Tempromandibular joint disorders with Bony Exostosis in the Oral Cavity

The temporomandibular joint (TMJ) may be affected by inflammatory, traumatic, infectious, congenital, and developmental, as seen in other joints. However, the most common affliction of the TMJ and masticatory apparatus is a group of functional disorders with associated pain that occurs predominantly in women and was previously known as the TMJ pain dysfunction syndrome. Since 1978, there have been substantial changes in the study of etiologic factors, pathophysiology, diagnosis, and management of what are now called temporomandibular disorders (TMD).(1)The general perception that all symptoms in the head, face, and jaw region without an identifiable cause constitute a "TMJ" problem is clearly unfounded.Although some oral lesions, such as torus palatinus and torus mandibularis are normal variants, but require prompt diagnosis and sometime treatment to reduce the potential for serious complication and enhance prosthodontic treatment. The purpose of this study is to inspect the relation of TMJ dysfunction syndrome to the presence of oral exostosis, and find the prevalence of torus palatinus (TP) and torus mandibularis (TM)The sample consisted of 932 teachers, 301 males and 631 females were examined for the presence of TMD, TP and / or TM. Analysis was carried out according to age, gender, TMJ dysfunction and the presence of TP and TM.Results indicated that 123(16.1%) had at least one symptoms of TMD, where as 49 (5.3%) had TP; and 67 (7.2) had TM. The male: female prevalence ratios of TP and TM were 1: 3.42 and 1: 1.81 respectively. The results revealed that significant relationship between TMD and tori, and increase in percentage of mandibular tori with the presence of TMJ dysfunctional syndrome more than maxillary tori were found.TP and TM were more frequent in females and there is significant relation between the TP and TM with presence of TMJ dysfunction syndrome ( P< 0.05 ) especially TM , the presence of TM might be useful to look for sign of dysfunction.

Revascularization of Temporomandibular Joint After Surgical Intervention Using CT Volume Rendering Technique (Clinical Study)

The present study aimed to trace the arterial blood supply of Tempromandibular joint after open joint procedures using CT volume rendering technique. To achieve this goal six operated joints with residual symptoms radiographed one year post-operatively. Computed tomographic scanning with intravenous contrast, were examined. The direct volume rendering technique of CT images was used, and a data set of images to demonstrate the vasculature of the human Tempromandibular joint in three dimensions. After elaboration of the data through post-processing, the arterial supply of the Tempromandibular joint was compared to reference anatomy. The most commonly injured arteries are anterior tympanic, masseteric, superficial temporal arteries (detection rate 33%, 33%, 50% respectively). Furthermore, osteoarthritic changes, synovial and articular cartilage calcifications with detached bony fragments were noticed that could be attributed to vascular injury. Open joint procedures are associated with significant decrease in arterial supply to TMJ, which could be correlated with osteoarthritic changes noticed later on. The three-dimensional volume rendering technique of computed tomography angiography is an effective non-invasive diagnostic tool; it allows simultaneous evaluation of boney changes and residual vascularity in previously operated joints.

Association of midline discrepancy with tempromandibular joint disorder. A systematic review.

AimThe aim is to evaluate the association between midline discrepancies and tempromandibular disorders (TMDs).MethodsLiterature search was performed by using various search engines to include human studies in English. TMDs include a wide variety of signs and symptoms such as pain in and around TMJ, jaw muscles, clicking and locking of jaws, pain during mandibular movement and restricted mandibular movements. The etiology is multifactorial, including one or several of the following factors like severe malocclusions (increased overjet, retroclination of incisors, cross bite, CR CO discrepancies etc), stress and psychological factors, structural abnormalities as possible etiology. There are controversies concerning the association between different traits of malocclusion and TMDs. The aim of the present study was to find out any association between signs and symptoms of TMDs with midline discrepancies, which represent an important trait of malocclusion.ResultOf the seven studies evaluated in this systematic review for investigating the association between midline discrepancy and TMD, six had moderate grade (B) of evidence. Four studies of moderate grade evidence (B) showed a significant association between the presence of midline shift and TMDs, and the remaining studies (two) had non-significant association. Only one study had a strong grade of evidence (A) and interestingly it denies the presence of midline shift to be a causative factor for TMDs. So, it can be concluded that the results are inconclusive regarding the association of midline discrepancies with TMDs. Nonetheless, this requires concrete evidence which necessitates further long term research into this aspect.

The Relationship between Signs and Symptoms of Tempromandibular Joint Disorders (TMDs) and Primary Headache

The aims of this study are to investigate the relationship of the concurrent signs and symptoms of a painful TMD with primary headache (migraine and tension type headache) and whether tenderness and provocation of the masticatory system resulted in the headache. Methods and materials : The sample consists of 120 patients which were diagnosed as having temporomandibular joint disorder (TMD) included Research Diagnostic Criteria (RDC). The sample age range was between (18-50 years) . All patients oriented to com- plete the Research Diagnostic Criteria RDC\TMD .The questionnaire for TMD index was also applied to all patients to measure the severity of TMD . Then all patients were subjected to clinical examination (examination of masticatory muscles, joint palpation and deviation, clicking and limitation in mouth opening). Primary Headaches were assessed using a validated structured questionnaire captured information on distinguishing headache features and parallels the International Classification for Headache Disorders-II. Results : females were shown high prevalence of TMDs and headache more than male. The presence of the masticatory muscles pain, joint pain, limitation in mouth opening, clicking and bruxism as well as headache pain intensity and duration, increased to a relevant and statistically significant degree in both migraine and tension type headache patients in compare to other patients had no headache or patients with headache from TMDs. Conclusions: High prevalence of TMD in females and also females represent a majority of headache patients. Clinical pain charac- teristics and masticatory muscle tenderness of TMD are greater in patients with primary headache.

Non-Surgical Treatment for Tempromandibular Joint Disorder-A Review

To study about the relaxants are useful in treating the TMJ disorders. Various mechanism behind the relaxants like diazepam, metaxalone, alprazolam, carisprodol and cyclobenzaprine are useful in treating tempromandibular joint disorder. A is a drug which affects skeletal function and decreases the tone. It may be used to alleviate symptoms such as spasms, pain, and hyper reflexia. The term muscle relaxant is used to refer to two major therapeutic groups: neuromuscular blockers and spasmolytics. The relaxants are used in treating tempromandibular disorder are carisprodol, cyclobenzaprine, diazepam, metaxalone, alprazolam and tizanidine. Diazepam appears to reduce spasticity by enhancing the inhibitory effects of neurotransmitter GABA. It also exerts some supraspinal sedative effect. Diazepam has efficacy in patients with spinal cord injury, hemiplegia, and multiple sclerosis. Carisoprodol is a carbamate derivative. Since, tempromandibular disorder is a common disease, this study is aimed to treat the tempromandibular disorder using the relaxants and bring the overall awearness.

COMPARATIVE STUDY BETWEEN TWO DIFFERENT OSTEOSYNTHESIS DEVICES FOR FIXATION OF SUBCONDYLAR FRACTURE

Statement of problem: Management of subcondylar fracture with proper reduction of temporomandibular joint position and function is a challenge, different osteosynthesis devices are used with great diversity in their types, numbers, positions, and results.Purpose: Comparative study between the efficiency of single miniplate and single minidynamic compression plate in restoration of ramus height, condylar angulation, and tempromandibular joint function in subcondylar fracture cases.Material and Method: 14 patients indicated for open reduction and fixation of subcondylar fractures were divided into two groups each of 7 patients. Group A: subcondylar fractures were fixed using 2.0 single miniplate along posterior border of ramus. Group B: a single 2.0-mm minidynamic compression plates (DCP), were applied along posterior border of ascending ramus for fracture fixation in the other seven patients. Intermaxillary fixation for 10 days was applied for both groups. Clinical and radiograhic follow up were performed at 1, 3, 6 months using panorama and CT. Results: At 6 months postoperatively, there was an improvement of mandibular functions with improvement of inter-incisal opening from 19.1mm and 20.1 mm in group A and B respectively to 35.6mm and 30.8 mm. Which was significantly different (P value =0.04). The shortening in ramus height improved from 3.2mm and 5.2mm in group A and B to 0.8 mm and 0.6 mm, also sagittal angulation of condyle improved from 1.6o and 4.7o in both group respectively to 0.2o and 0.3o with no significant difference between two types of mini-plate. There were no signs of infection, malunion, nonunion or device failure in both groups. except for one case of group A, that suffered from malocclusion with displacements of the fractured segments immediately after the operations, that responded to elastic traction within 15 days.Conclusion: Single 0.2 mm miniplate or mini DCP aided by intermaxillary fixation are successful devices in fixation of subcondylar fracture without complication, with superiority of mini DCP in proper condylar reduction and stable fixation.

Correlation Between the Oral Manifestations of Rheumatoid Arthritis Patients on Different Treatments with The Clinical Disease Activity

Objective:Toevaluate the oral findings and correlating the oral findings with the clinical disease activity index. Subjects, Materials and Methods:This cross- sectional studyincludedeighty-five rheumatoid arthritis patients. Twenty-five patients were on Methotrexate, thirty patients on Etanercept and thirty patients were on a combination of Methotrexate and Etanercept. Each patient was examined to calculate the clinical disease activity index and to detect any oral finding. Results: The highest summation of rheumatoid arthritis patients was presented with a high clinical disease activity index, while the number of those with low disease activity index was the lowest. Oral dryness showed to be the most common oral findings (60%) followed by tempromandibular joint disorders (31.8%) then aphthous ulcerations (9.4%) and glossitis (5.8%), while the lichenoid drug reaction, angular chelitis and geographic tongue were the less commonly seen findings (1.1% for each). Most of the oral findings were seen in patients treated with Etanercept or Methotrexate alone, while the patients treated with a combination of them had less oral side effects. A higher number of rheumatoid arthritis patients with oral findings were showing high and moderate disease activity. Conclusions: The oral dryness, tempromandibular joint disorders and aphthous ulcerations were the main oral manifestations found in rheumatoid arthritis patients. Angular chelitis positively correlate with the increasing in

Evaluation of the Involvement of the Tempromandibular Joint in Patients with Psoriasis using Computed Tomography for Detection of Psoriatic Arthritis Changes

Background: Tempromandibular disorders is a collective term, embracing several clinical roblems involving the muscles of mastica- tion, temporomandibular joint (TMJ), or both . Tempromandibular disorders is a symptom complex rather than a single condition. TMDs form a cluster of related disorders with common symptoms which include localized pain, limited or asymmetric movement, and clicks or grating on opening . Psoriatic arthritis is a chronic inflammatory arthropathy that affects patients with psoriasis . The clinical findings for Tempromandibular PSA are pain, tenderness, limitation of movement , joint stiffness, clicking as the jaw is opened or closed, difficulty in opening the mouth, locking of the jaw,and crepitations. These findings are essentially the same as for myofascial pain/dysfunction (3) . The objective of the study were to determine the extent of tempromandibular joint involve- ment in patients with psoriatic arthritis and to evaluate the correlation between clinical findings and radiographic finding. Materials and method: In this study 98 patients were selected ,50 male and 48 female, their age ranged between(18-68)years. They were collected at Al –yarmook teaching hospital/department of.They were diagnosed as having psoriatic arthritis by a derma- tologist according to (Moll and Wright diagnostic criteria 1973) (11) . These patients were subjected to rheumatoid factor test RF to exclude the presence of rheumatoid arthritic disease, then the patients were exposed to CT scanning for the Tempromandibular joint in Al-Yarmook teaching hospital for screening the involvement of TMJ with psoriatic arthritis by the presence of any radio- graphic changes such as erosion, flattening,osteophyte and sclerosis in the condylar head. Results: The result of the study showed that the mean age of psoriatic arthritic patients in TMJ was (44.2) years, and female per- centage was (48.4%) and male was(51.6%). Psoriatic arthritis in TMJ showed high significance in the unilateral side complaining (100%) and itwas significant in the positive family history (54.8%), and non significant in the right/left ratio (41.9%). Oligo type was found in twenty six patients (83.9%) with significant p-value. Clinically: all symptoms including clicking, tenderness and temproma- dibular joint pain were highly significant, limitation showed (54.8%), TMJ pain showed (64.5%) and tenderness showed (54.8%). Radiologically: CT scan showed sensitivity for erosion in TMJ (54.8%), for osteophyte (32.3%), for condylar flattening (16.1%) and for sclerosis (9.7%) while specificity for all were (100%). Association between clinical and radiological changes showed non significant correlation. Conclusions: Psoriatic arthritis of TMJ is unilateral (oligo type).Female/ male ratio is about 1:1. About 50% of patients have lim- itation in mouth opening. Most of the patients have positive family history. Duration of the disease is related to the development of psoriatic arthritis in TMJ. Plaque psoriasis is the most associated type with the psoriatic arthritis in TMJ. Most of patients with psoriatic arthritis show psoriatic nail changes. The most radiographic findings found in patients with psoritic arthritis was erosion in the condylar head. There is association between clinical and radiologic findings for psoriatic arthritis in TMJ.

The Efficacy of Platelets Rich Plasma Injection in the Superior Joint Space of the Tempromandibular Joint Guided by Ultra Sound in Patients with Non-reducing Disk Displacement.

The objective of this study was to determine average improvement during the rest and active mouth opening after ultrasound guided platelets rich plasma injection in the tempromandibular superior joint space for the patients complaining from non-reducing disk displacement. Thirty-four patients with non-reducing disk displacement underwent guided ultrasound injection of platelet rich plasma to the upper joint space. The extent of maximal mouth opening, chewing efficiency, sound intensity of the TMJ, and tenderness of the TMJ and the masticatory muscles at rest, motion and mastication were thoroughly assessed at the beginning of the study and scheduled for next follow-up at 1st, 3rd, and 6th months. Injection with platelets rich plasma was significantly more effective in improvements of the extent of maximal mouth opening, statistics result demonstrated a significant reduction in the VAS values of pain at rest, motion and mastication compared to the baseline VAS values. PRP injection to the upper temporomandibular joint space provided improvement in signs and symptoms of patient with non-reducing disk displacement of the temporomandibular joint.

Assessment of tempromandibular joint space and condylar position in patients with myofacial pain dysfunction syndromes by using cone beam computed tomography

Background and objective: Joint space assessment and condylar relation in the glenoid fossa is considered as integral component of the clinical assessment of the patient with tempromandibular joint disorder. Any variant from normal tempromandibular joint may affect the diagnosis and management of the case. Methods: Thirty patients with unilateral myofacial pain dysfunction syndrome were included in this study (14 male and 16 female). Joint space analysis was performed by cone beam computed tomography for all patients. Analysis of data for joint spaces (anterior, middle, posterior, medial and lateral) was performed by using t-test. Results: The joint spaces and condyle positions in anterior, superior and posterior regions showed less joint space and statistically significant difference (P <0.05) from same joint space of normal side. No statistically significant differences were found in space value between middle and lateral condylar space of the diseased side and normal side of the patient. The joint spaces in normal sides were between 2 to 3.2 mm. Age and gender variations showed no statistical differences. Conclusion: The use of cone beam computed tomography for examination of tempromandibular joint space in patients with myofacial pain dysfunction syndrome give a good diagnostic criteria for affected side.

Mechanical Stretching of Mouse Calvarial Osteoblasts In Vitro Models Changes in MMP-2 and MMP-9 Expression at the Bone-Implant Interface.

Bone to mechanical loading elicits a biological response that has clinical significance for several areas in dental medicine, including orthodontic tooth movement, tempromandibular joint disease, and endosseous dental implant osseointegration. Human orthopedic studies of failed hip implant sites have identified increased mRNA expression of several collagen-degrading matrix metalloproteinases (MMPs), while in vitro experiments have shown increases in MMP secretion after exposure to inflammatory mediators. This investigation evaluates the effects of mechanical deformation on in vitro osteoblasts by assessing changes in MMP gene expression and enzyme activity. We seeded mouse neonatal calvarial osteoblasts onto flexible 6-well plates and subjected to continuous cyclic mechanical stretching. The expression and activity of mRNA for several MMPs (2, 3, 9, and 10) was assessed. When subjected to mechanical stress in culture, only mRNA specific for MMP-9 was significantly increased compared to nonstretched controls (P < .005). Measurement of MMP activity by gelatin zymography demonstrated that none of the MMPs showed increased activity with stretching; however, MMP-2 activity decreased. Our results suggest that in response to stretch, MMP-2 responds rapidly by inhibiting conversion of a MMP-2 to the active form, while a slower up-regulation of MMP-9 may play a role in the long-term remodeling of extracellular matrix in response to continuous mechanical loading. This study suggests that the regulation of metalloproteinases at both the mRNA and protein level are important in the response of bone to mechanical stress.

Synovial chondromatosis of the tempromandibular joint: Relationship between MRI information and potential aggressive behavior

PurposeTo evaluate the types of synovial condromatosis (SC) of tempromandibular joint (TMJ) on MRI and their potential aggressive behavior. Methods144 patients with pure SC of TMJ were included in. On MRI, 3 types of the lesion included loose body, homogeneous mass, and mixture of both loose body and homogeneous mass. Bony evaluations included 4 stages of erosion: without erosion, chondral breakdown, bony absorption and bony perforation. Results47 (32.6%) cases were categorized in the type of loose body, 71 (49.3%) cases in the type of homogeneous mass, and 26 (18.1%) cases in the type of mixture. 80% of bony perforation belonged to the type of homogeneous mass and 20% belonged to the type of mixture. 2 patients were found recurrence. ConclusionThe types of homogeneous mass and mixture of both on MRI were more aggressive. Homogeneous mass with bony erosion on MRI had potential recurrence.

Prevalence of Signs and Symptoms of Temporomandibular Disorders in Chennai, India: A Cross Sectional Survey

AIM: The aim of this survey was to evaluate the prevalence of TMDs. TMDs is a collective term that describes a sub-group of painful oro-facial disorders, involving complaints of pain on the Temperomandibular joint(TMJ) region and fatigue of the cranio-cervicofacial muscles, especially mastication muscles, limitation of mandibular movement and presence of articular clicking. Emotional stress, occlusal interferences, malpositioning or loss of teeth, postural changes, dysfunctions of the masticatory musculature and adjacent structures, extrinsic and intrinsic changes on TMJ structure and/or a combination of such factors are causes of TMDs. TMDs were assessed by three indicators like; clicking, tenderness and reduced jaw mobility (RJM). The tempromandibular joint is a hinge that connects your jaw to the temporal bones of the skull, which is in front of each ear. It lets to move the jaw up and down, side to side while talking, chewing and yawning.

Comparativestudy Between Tramadol Hydrochloride and Sodium Hyaloronatefor Management of Tempromandibular Joint Internal Derangement

Purpose. This study was conducted to evaluate the efficacy and safety of arthrocentesis with injection of tramadol hydrochloridefor management of tempromandibular joint with internal derangement compared with traditional method with sodium hyaloronate injection.Patient&methods.The study was conducted on forty patients classified as class ASA type I with chief complain of limited mouth opening, TMJ pain, and clicking sounds in the TMJ was included in this study. All patients included in the study was selected from the outpatient clinic oforal and maxillofacial department, faculty of dentistry, Suez canal university.The selected patients were divided randomly into two equal groups,group I:consists of 20 patients where arthrocentesis was performed for the affected joint followed by intraarticular injection of one ml, commercially available tramadolhydrochloride.GroupII: consisted of 20 patients where arthrocentesis was performed for the affected joint followed by intraarticular injection of one ml. commercially available sodium hyaloronate.Evaluation of the patients was done preoperatively, after1,3,6 months postoperativelywhich includedmaximal mouth opening, pain&clicking sound presence in TMJ.Results.patients with either disc displacement with reduction or without reductionwere benefited from the arthrocentesis procedure with injection of Sodium Hyaluronate and also with tramadol hydrochloride.Both treatments were able to reduce pain levels, increase maximal mouth opening and reduce clicking withstatistically significant difference. However, arthrocentesis with injection of tramadol hydrochloride was superiorto arthrocentesiswithinjection of sodium hyaluronate in terms oftreatment of internal derangements of the temporomandibular joint.Conclusion. It has been concluded arthrocentesis is an effective conservative procedure in treatment of temporomandibular joint internal derangement,clinical efficacy of arthrocentesis with tramadolhydrochloride in the temporomandibular joint internal derangements&safty of tramadolintraarticular injection in the temporomandibular joint.