TMJ Pathology Research Articles

Investigation of the impacts of temporomandibular joint pathology and antemortem tooth loss on three‐dimensional craniofacial shape

This study investigated the effects of TMJ disorder and alveolar resorption accompanying antemortem tooth loss on the 3D morphology of the human skull. Coordinate data were digitized 68 cranial landmarks to capture skull shape in two samples: individuals exhibiting TMJ disorder or alveolar resorption secondary to tooth loss, and non-pathological specimens from the same populations. The raw data from these specimens were divided into different anatomical subsets, including the basicranium, palate, upper face, and temporal bone, and registered using a Generalized Procrustes Analysis. To determine whether statistically significant differences existed between the pathological and comparative samples in cranial shape, Procrustes ANOVA was performed, Procrustes and Mahalanobis distances calculated and compared, Discriminant Function Analysis run, and a Principle Components Analysis. Both alveolar resorption and TMJ pathology were found to significantly affect cranial structure. The shape of the mid and upper face including the zygomatic and nasal regions, was substantially altered in individuals with alveolar resorption. Individuals with TMJ pathology exhibited significant changes in palatal morphology, suggesting remodeling of alveolar bone, likely due to the altered masticatory patterns observed in individuals with this condition. Grant Funding Source: NSF BCS-0622570 and the Wenner-Gren Foundation (Grant #7499)

High resolution ultrasound investigation of the temporomandibular joint in patients with chronic polyarthritis

40 patients with chronic polyarthritis were investigated prospectively. The TMJ was investigated to detect clicking, crepitation, and pain. High resolution ultrasound (HR-US) assessed destructive changes, effusion, and disc dislocation. The results of the clinical investigation and the HR-US investigation were compared using the χ(2) test. The statistical calculation of the correlation between the HR-US results and the clinical TMJ investigation by the χ(2) test showed a significant correlation between TMJ sounds, destructive changes and disc dislocation. A significant correlation between TMJ joint effusion, TMJ pathology and TMJ pain was detected using the χ(2) test. Pain on palpation of the masseter and temporal muscle correlated significantly with TMJ effusion. There was significant correlation between TMD and the HR-US diagnosis of destructive changes and effusion. The significant correlation between TMJ effusion and actual TMJ pain and TMJ pain on palpation shows the ability of HR-US to detect acute TMJ affection with high significance. There was a significant correlation between effusion and pain on palpation of the masticatory muscles, which could be interpreted as the ability of HR-US to determine acute TMD. That any TMD correlated significantly with destructive changes and TMJ effusion suggests that HR-US could detect chronic and acute TMD.

The Use of MRI Diagnostics in Orthognathic Surgery

Occasionally, undesirable post-surgical symptoms of temporomandibular disorder (TMD) and pain have been observed. The aim of this paper is to show how often and to which degree TMJ pathologies occur in orthognathic surgery candidates before surgery, making it recommendable to consider these TMJ pathologies during treatment planning. Between 2002 and 2004, Magnetic Resonance Imaging (MRI) of the TMJ were made in 58 randomly chosen orthognathic surgery patients. 69% of the patients were female, 31% were male. Age averaged 31.6 years (16-61 years). Gender and malocclusion (Class I, II and III) were looked at during analysis of the data (n = 58 patients, n = 116 TMJs). MRI scans were made at the beginning of treatment. We wanted to investigate the TMJ condition before surgery. The largest patients group of this study were the female Class II patients (n = 25). Most patients displayed an Angle Class II (53.4%). The Class III patients followed (32.8%). A Class I molar relationship was found in 13.8% of the studied patients. A similar distribution could be observed in the parameters we studied: 1. condyle (position, degeneration), 2. disc (position, degeneration, prolapse and reduction). 76% of the TMJs (66.7%) showed dorsocranial condylar displacement. 26 of the 114 studied condyles (22.8%) were dorsally displaced. 108 of the studied joints (94.7%) showed condylar displacement. In 31 TMJs (28,4%) we found moderate, in 25 joints (22.9%) severe and in 26 joints (23.9%) we observed slight condylar degeneration. Most discs were displaced ventrally (31%). 22 of the studied 113 discs (19.5%) were displaced medially. 93% of the studied discs were not positioned correctly. 58 of the studied discs (58.6%) displayed flattening, in 8 (8%) we observed both flattening and disc adhesions. Two each of the studied TMJs had discs with perforations and adhesions or only perforations. In 57 (50.4%) of the studied discs we observed partial disc prolapse. Disc prolapse was total in 42.5% (n = 48 TMJs) of the TMJs. Eight TMJs (7%) of the 113 TMJs we analyzed showed no disc prolapse. Disc reduction was total in 71 (62.8%) of the studied TMJs. 15% (n = 17 TMJs) showed a partially reduced disc. 25 (22.1%) of the studied joints showed no disc reduction. Apparently, MRI scans of the TMJ are necessary in almost all potential orthognathic surgery patients to achieve optimal surgical results. Female Class II patients recruited the largest patient group among the studied collective. It is this group that deserves the greatest caution before and after surgery (TMJ pathologies!). In patients with jaw discrepancies, a TMJ examination should be made prior to surgery in order to be able to include the condition of the TMJs in the planning of treatment. This examination best includes Magnetic Resonance Imaging (MRI) and Manual Functional Analysis (MFA).

Association between TMJ pathology and craniofacial morphology in patients with malocclusion

Association between TMJ pathology and craniofacial morphology in patients with malocclusion

P.439 Mandibular fractures: TMJ pathology and surgical correction

P.439 Mandibular fractures: TMJ pathology and surgical correction

Unilateral condylar bone change, inclination of the posterior slope of the articular eminence and craniofacial morphology

The purpose of this study was to investigate the association of frontal and lateral craniofacial morphology with the inclination of the articular eminence and TMJ pathology, in orthodontic patients with TMJ disorders and unilateral condylar bone change, using helical CT scans. Fifty-nine female patients were divided into a unilateral condylar bone change (UBC) group (39 subjects) and a no condylar bone change (NBC) group (20 subjects). Lateral and frontal cephalograms and panoramic radiographs were taken to evaluate their craniofacial morphology, and condylar and ramal heights. All subjects had CT scans taken to evaluate their TMJs. The inclination angle of the posterior slope of the articular eminence was then measured using National Institute of Health software. CT and cephalometric measurements showed that articular eminence inclination was significantly smaller on the affected side than on the non-affected side ( p < 0.0001), and that the mandible deviated to the ipsilateral side in UBC, with decreased condylar height and more inclined frontal maxillary, interocclusal and gonial planes ( p < 0.0001). The difference in articular eminence inclination was correlated significantly with UBC ( p < 0.05). These results suggested that asymmetrical frontal craniofacial morphology could be clinical indicators of unilateral condylar bone change and remodeling of the articular eminence.

Free-grafting of mandibular condyle fractures: clinical outcomes in 10 consecutive patients

“Free-grafting” of the superior segment, either alone or in combination with a posterior ramus osteotomy, is occasionally required when managing displaced condylar neck fractures. This allows ideal reduction and fixation, but carries the risk of proximal segment resorption, possibly requiring secondary reconstruction. The purpose of this study was to evaluate the clinical and radiographic outcomes of this technique in all patients who underwent this procedure during a seven-year period at a tertiary care centre. Ten patients who had undergone 11 free graft procedures were included in the study. Three patients required secondary costochondral reconstruction due to advanced resorption of the free-grafted condylar segment, this occurring from 3 to 9 months following the initial trauma surgery. All but one of the remaining patients exhibited varying degrees of condylar resorption/flattening radiographically, occurring within the first year only. However, no occlusal changes occurred in this group either objectively or subjectively during this year or during the subsequent follow-up period. The mean inter-incisal opening was 47 mm (range 40–56). With the exception of one patient that had a non-painful reciprocal click of the treated side, no patients demonstrated either objective or subjective signs of TMJ pathology. No patients reported dietary limitations, and all reported satisfaction with treatment to date. Based on objective and subjective evaluation, free grafting of the fractured condylar segment in this patient population had a 70% success rate. All failures occurred within 9 months and required secondary costochondral reconstruction.

Facial soft tissue injuries as an aid to ordering a combination head/facial CT in trauma patients

ever, no occlusal changes occurred either objectively or subjectively during this year or during the subsequent follow-up period. The mean interincisal opening was 47 mm (range, 40 to 56). With the exception of one patient who had a nonpainful reciprocal click of the treated TMJ, no patients demonstrated either objective or subjective signs of TMJ pathology. No patients reported dietary limitations, and all reported satisfaction with treatment to date. Conclusion: Based on objective and subjective evaluation, free-grafting of the condylar segment during ORIF of subcondylar fractures in this patient population has had a 67 percent success rate. All failures occurred within 9 months and required secondary reconstruction.

Non-neoplastic arthropathies of the temporomandibular joint

The pathologic conditions that involve the TMJ are similar to those conditions that involve other joints in the body. Therefore, many of the radiologic characteristics are also similar. Nevertheless, because of the complex structure and function of this small joint, it is essential to know the variety of diseases that can involve the temporomandibular joint. It is also important to understand that functionally both TMJ's act as a single unit and that any alteration in function caused by a pathologic process on one side may lead to dysfunction on the contralateral side. It is essential that the radiologist is familiar with the principles of TMJ function as well as TMJ pathology.

Custom-Made Total Joint Prostheses for Temporomandibular Joint Reconstruction

Jaw joint (temporomandibular joint or TMJ) disease is estimated to affect 30 million Americans, with approximately 1 million new patients diagnosed each year (1). Although many of these patients can be managed with nonsurgical therapies, some patients require surgical intervention. The TMJ is a unique joint in that it does not function independently but works in tandem with its contralateral joint. Therefore, disease affecting 1 joint can either directly or indirectly affect the functioning and health of the contralateral joint. When surgical intervention of the TMJ is required, the joint can often be reconstructed with autogenous tissues. However, certain TMJ conditions and pathology require reconstruction with a total joint prosthesis for predictable treatment outcomes. Some of these conditions include ≥2 previous TMJ surgeries; previous TMJ alloplastic implants containing Proplast/ Teflon (PT), Silastic, acrylic, or bone cements; inflammatory or resorptive TMJ pathology; connective tissue or autoimmune disease (i.e., rheumatoid arthritis, psoriatic arthritis, scleroderma, Sjogren's syndrome, lupus, and ankylosing spondylitis); fibrous or bony ankylosis; absence of TMJ structures due to pathology, trauma, or congenital deformity; and tumors involving the condyle and mandibular ramus area. Currently, the only TMJ total joint prosthesis approved by the Food and Drug Administration (FDA) is the custom-made device manufactured by TMJ Concepts, Inc. (Camarillo, Calif). The device was manufactured by the same company under the name Techmedica, Inc. from 1989 to 1993.

The use of arthroscopic surgery for treatment of temporomandibular joint disorders

Arthroscopy of the temporomandibular joint (TMS) is a minimally Invasive surgical procedure that has had a major impact on our understanding and management of patients with TMJ disorders. As a clinical modality, arthroscopic surgery has been shown to be a safe and effective technique that improves mandibular range of motion and decreases pain in patients with severe, recalcitrant symptoms related to TMJ pathology. It allows surgeons to directly diagnose and treat intraarticular pathology with a minimally invasive surgical technique that efficiently reduces the recovery time for patients. Arthroscopy has also enhanced our knowledge of TMJ pathology. Over the past decade, a research model has been developed using the combination of arthroscopy to directly visualize pathologic tissue morphology and to correlate it with biochemical analysis of the synovial fluid, and this has lead to major changes in our concepts of pathogenesis and treatment. Synovial fluid research and clinical experiences with arthroscopic surgery have played a major role in the emergence of several important basic principles: 1. The TMJ is a synovial joint that behaves according to the same biologic principles as other synovial joints 2. Articular cartilage and the synovial membrane are intra-articular connective tissues that have specific functions necessary for the maintenance of a healthy joint 3. External factors, such as excessive joint loading and lack of motion, lead to biochemical alter

Surgical management of TMJ pathology including an unusual disorder: “Hypertrofic bronchial myopathy”

Surgical management of TMJ pathology including an unusual disorder: “Hypertrofic bronchial myopathy”

Intra-articular disk displacement: its questionable role in TMJ pathology

Intra-articular disk displacement: its questionable role in TMJ pathology

Radiographic evaluation of TMJ pathology: Comparative study: tomography and panography: I. Irish and D. Hatcher, San Francisco: University of the Pacific, School of Dentistry, 1992

Radiographic evaluation of TMJ pathology: Comparative study: tomography and panography: I. Irish and D. Hatcher, San Francisco: University of the Pacific, School of Dentistry, 1992

Design, evaluation, and use of a temporomandibular arthrometric cephalostat, the Porta-Stat (an X-ray subsystem). Part II. Use.

AbstractThis article documents the clinical use of a new device (Porta-Stat TMJ)designed to make clear and reproducible lateral transcranial TMJ radiographs. Anecdotal cases presented demonstrate the clinical usefulness of individually standardized TMJ radiographs. The device has proven useful in the management of cases needing reliable documentation of change in condylar position, as in mandibular fracture, orthognathic surgery, and TMJ diagnosis, treatment, and pathology.

Perforation of the intra-articular disc diagnosed by arthro-tomography of the temporomandibular joint

Arthrography was first used almost 40 years ago for evaluation of the non-osseous parts of the TMJ. It did not find wide application and only during the last decade have certain authors re-introduced its use as a diagnostic approach in TMJ pathology. Among the other pathological conditions which can be diagnosed, is a perforation of the intra-articular disc. Four such cases are presented and the value of this method is shown.

Practical evaluation of the lateral temporomandibular joint radiograph

The reevaluation of the lateral transcranial radiograph is needed because of the confusion that surrounds the diagnosis and treatment of TMJ dysfunction-pain. The lack of universal acceptance of the validity of the lateral TMJ radiograph contributes to the lack of progress of TMJ dysfunction-pain treatment and improved methods for the treatment of prosthodontic patients. The lateral transcranial TMJ radiograph was reevaluated for its duplicability (+/- 0.2 mm). The image was found to be a cross section of the lateral third of the condyle rather than a composite view of the condyle made at an angle. The condylar position in the fossa can be correctly evaluated in transcranial radiographs, because the relative condylar position in the fossa is similar in all sagittal views and the image is always of the same sagittal plane (lateral third). Soft tissue within or lining the fossa does not affect the evaluation of condylar position. Chronic osteoarthritic TMJ pathology can exist without subjective pain; therefore, routine use of initial TMJ radiographs with subsequent radiographs at 5-year intervals is suggested for all patients. Because condylar repositioning may be indicated before subjective pain symptoms appear, condylar repositioning should be contemplated whenever extensive prosthodontic treatment is needed. In addition, if chronic osteoarthritic lesions are observed initially, radiographs are indicated at more frequent intervals and anti-inflammatory agents should be considered for routine use depending on the rate and extent of the pathologic development. The existence of osteoarthritic lesions was confirmed by serial radiographs over 5 to 10 years. If an osteoarthritis is present, condylar repositioning (when condylar displacement is present) or changes in occlusion should be considered. There is some clinical evidence that condylar displacement is associated with pathologic remodeling and/or osteoarthritic lesions of the condyle and that condyle repositioning arrests the pathologic process. The principle of condylar concentricity , previously established for the treatment of TMJ dysfunction-pain syndrome and for functional centric relation in prosthodontics, was formulated by associating condylar position in the fossa with TMJ dysfunction-pain in many patients. This article suggests the value of the lateral TMJ radiograph as an important practical aid in the diagnosis and treatment of TMJ dysfunction pain and in the establishment of functional centric relation in prosthodontics.

Myofascial Pain Dysfunction Syndrome Involving Tumor Metastasis: Case Report

This report is an example of tumor metastasis to the temporomandibular joint and its effect on pain, restriction of jaw movement, and the subsequent inability of the patient to function normally. Neoplasm is not the usual etiology of myofascial pain dysfunctionsyndrome and the muscle sparm component of this patient's jaw dysfunction was emphasizedby the relief of symptoms from the use of symptomatic reversible type therapy (tranquilizer, muscle relaxant, and heat). There was an overlay of stress-tension factors in this case history that contributed to the muscle spasm symptoms of the patient. There canbe other etiological factors in jaw dysfunction associated with TMJ pathology such asdevelopmental anomalies, trauma, arthritis, and neoplasm, but as a group they comprise only about 5% of TMJ dysfunction problems (D.M. Laskin, personal communication).