Unilateral Temporomandibular Joint Research Articles

Zurich pediatric distractor for ramal condylar unit distraction in temporomandibular joint ankylosis

Temporomandibular joint (TMJ) Ankylosis is an extremely disabling condition characterized by difficulty or inability to open the mouth resulting in facial asymmetry, malocclusion and dental problems. Surgical excision of the ankylosed mass is the only treatment option available to gain mouth opening. The loss in vertical height of ramus following release of ankylosis is difficult to manage in both unilateral and bilateral TMJ ankylosis. Out of all the methods to restore this height Distraction Osteogenesis (DO) is gaining popularity because of predictable gain in the length without any associated morbidity. Recurrent bilateral TMJ ankylosis in a 32 year old male was treated by osteoarthrectomy and temporal fascia interpositioning arthroplasty. Bilateral reconstruction of ramal condylar unit (RCU) was carried out by Zurich paediatric distractor (KLS Martin, Tuttlingen Germany). Following a latency period of 7 days distraction was carried out at a rate of 1mm/day for 8 days. Distractors were removed after 12 weeks of consolidation period. The case was followed up for 12 months during which the mouth opening was maintained at 38 mm and there was no anterior open bite.

Interpositional Gap Arthroplasty by Versatile Pedicled Temporalis Myofascial Flap in the Management of Temporomandibular Joint Ankylosis- A Case Series Study.

Temporomandibular Joint (TMJ) ankylosis is a situation in which the mandibular condyle is fused to the glenoid fossa by bone or fibrous tissue. The management of TMJ ankylosis has a complicated chore and it is challenging for the maxillofacial surgeon because of technical hitches and high rate of re-ankylosis. Interpositional gap arthroplasty is one of the modalities for its management. A range of inter-positional materials have been used to avert recurrence after gap arthroplasty in TMJ ankylosis. The aim of this series was to evaluate the effectiveness of the temporomyofacial flap in the treatment of TMJ ankylosis as an interpositional gap arthroplasty. A total of 10 cases with unilateral TMJ ankylosis were treated by interpositional gap arthroplasty by pedicled temporalis myofacial flap and evaluated with a follow-up of 6 months to 5 years (Mean 3.3 years) for the functional stability of TMJ. All the patients were successfully treated. There were no signs of recurrence in any patients up to last follow up visit. The result showed that temporalis myofascial flap is a preferable choice for inter-positional gap arthroplasty which proves its versatility as an inter-positional material.

Temporomandibular Joint Ankylosis as a Complication of Neonatal Septic Arthritis: Report of two cases.

Temporomandibular joint (TMJ) ankylosis as a complication of neonatal septic arthritis is rarely reported in the literature. We report two clinical cases of unilateral TMJ ankylosis occurring in paediatric patients subsequent to neonatal septic arthritis. The first case was a 15-month-old male infant who presented to the Sultan Qaboos University Hospital, Muscat, Oman, in May 2010. According to the published English scientific literature, he is the youngest person yet to be diagnosed with this condition. The second case was a five-year-old female who presented to the Al-Nahda Hospital, Muscat, Oman, in October 2011. Both cases presented with facial asymmetry and trismus. They subsequently underwent gap arthroplasty and interpositional temporalis muscle and fascia grafts which resulted in an immediate improvement in mouth opening. Postoperatively, the patients underwent active jaw physiotherapy which was initially successful. Both patients were followed up for a minimum of two years following their surgeries.

Pre-arthroplastic and simultaneous mandibular distraction for correction of facial deformity in temporomandibular joint ankylosis

IntroductionIn cases of temporomandibular joint (TMJ) ankylosis, interposition arthroplasty allows return of functional jaw movements. In order to improve the facial appearance, distraction osteogenesis is the treatment of choice, and may be timed either as a pre-arthroplastic, simultaneous or post-arthroplastic procedure. This study was planned to compare the treatment outcomes of pre-arthroplastic distraction (PAD) and simultaneous arthroplastic distraction (SAD) to establish the better treatment modality in terms of improvement in function and aesthetics. Materials and methodsThis prospective randomized experimental study included 20 children and adolescents suffering from facial deformity due to long standing unilateral TMJ ankylosis. They were randomly allocated to the two surgical groups with ten in each group. ResultBoth groups resulted in good facial symmetry and aesthetics. Initially, during the distraction period, mouth opening of SAD group scored less than that of PAD group but became comparable in 30 days. More pain at the distraction site and over the normal TMJ was observed in PAD group. The excursive movements were almost comparable in both the groups. ConclusionWe conclude that both procedures are effective in correcting the post-ankylotic deformity and improving function. Although PAD has better control over movement of the distracting segment, the contralateral TMJ may experience pain. SAD requires a shorter management period but is associated with a temporary decrease in function. Also, control of distraction may be difficult and chances of reankylosis are always there.

Non-joint effusion is associated with osteoarthritis in temporomandibular joints with disk displacement.

The aim of this study was to examine the possible association between different grades of joint effusion (JE) and osteoarthritis (OA) in temporomandibular joint (TMJ) anterior disk displacement without reduction (ADDwoR). A sample of 101 female patients 20-40 years of age with unilateral TMJ ADDwoR were retrospectively reviewed. JE and OA were diagnosed with magnetic resonance imaging (MRI). JE was subdivided into three different grades: grade 0, no or minimal effusion; grade 1, moderate effusion; and grade 2, extensive effusion. Eight categories of degenerative changes were used for screening for the existence of OA. Cases with no less than one type of degenerative change were diagnosed as OA. In all, 71 patients (70.3%) were diagnosed as having OA in the joints with disk displacement. In the univariate analysis, the proportion of subjects with non-JE (grade 0) was higher in the OA group (p = 0.003), while the proportion of subjects with extensive effusion (grade 2) was lower in the OA group (p = 0.02). In the multivariate logistic regression analysis, non-JE was independently associated with the development of OA (odds ratio = 5.68, 95% confidence interval = 1.10-29.37, P = 0.04). The results suggested that non-JE was associated with OA in the joints with ADDwoR.

Incremental increase in percentage mouth opening after coronoidectomy in temporomandibular joint ankylosis

The aim of this study was to evaluate the incremental improvement in mouth opening following coronoidectomy. Twenty-three patients with unilateral temporomandibular joint (TMJ) ankylosis (Sawhney types I–III) were assessed preoperatively; physical and radiological examinations were done (panoramic radiography and computed tomography). Data including demographic and clinical parameters were recorded. Patients with bilateral ankylosis, recurrent cases, and those with Sawhney type IV TMJ ankylosis were not included. The improvement in mouth opening was measured after ostectomy, after ipsilateral coronoidectomy, and after contralateral coronoidectomy. The improvements in mouth opening at each stage were analysed using the Student's t-test and Pearson's correlation coefficient. There was a marked improvement in maximal incisal opening (MIO) from 5.7±4.2mm to 23.7±5.9mm after removal of the ankylotic bony mass. MIO was significantly increased after ipsilateral coronoidectomy (31.6±7.4mm), and after contralateral coronoidectomy, a mean MIO of 39.4±11.2mm was achieved. At more than 1 year of follow-up, all patients showed improved mouth opening. In conclusion, coronoidectomy plays an important role in improving mouth opening in the treatment of TMJ ankylosis.

Condylar hyperplasia following unilateral temporomandibular joint replacement

Total joint replacement of the temporomandibular joint (TJR) can be associated with intraoperative and postoperative complications. We report herein the occurrence of a postoperative open bite malocclusion, the result of condylar hyperplasia affecting the non-operated joint at 1 year after unilateral total joint replacement.

Traumatic long‐standing unilateral dislocation of TMJ – a case report

AbstractThis article aims to report a rare case of traumatic long‐standing unilateral dislocation of temporomandibular joint (TMJ). To the best of our knowledge, this is the first reported case of unilateral TMJ dislocation in the paediatric population. A healthy 15‐year‐old boy presented to our department complaining of facial pain around the TMJ region. A diagnosis of unilateral left TMJ dislocation associated with myofacial pain was made based on history, clinical and radiographic examinations. Manual reduction alone was not successful to keep the reduced left condyle within the glenoid fossa. Intermaxillary fixation was needed to improve the treatment outcome. Non‐steroidal anti‐inflammatory drug was prescribed for myofacial pain. The management of this case was challenging contributed to the nature of clinical presentations.

Soft tissue ossification and condylar cartilage degeneration following TMJ disc perforation in a rabbit pilot study

There are limited clinical treatments for temporomandibular joint (TMJ) pathologies, including degenerative disease, disc perforation and heterotopic ossification (HO). One barrier hindering the development of new therapies is that animal models recapitulating TMJ diseases are poorly established. The objective of this study was to develop an animal model for TMJ cartilage degeneration and disc pathology, including disc perforation and soft tissue HO. New Zealand white rabbits (n = 9 rabbits) underwent unilateral TMJ disc perforation surgery and sham surgery on the contralateral side. A 2.5 mm defect was created using a punch biopsy in rabbit TMJ disc. The TMJ condyles and discs were evaluated macroscopically and histologically after 4, 8 and 12 weeks. Condyles were blindly scored by four independent observers using OARSI recommendations for macroscopic and histopathological scoring of osteoarthritis (OA) in rabbit tissues. Histological evidence of TMJ condylar cartilage degeneration was apparent in experimental condyles following disc perforation relative to sham controls after 4 and 8 weeks, including surface fissures and loss of Safranin O staining. At 12 weeks, OARSI scores indicated experimental condylar cartilage erosion into the subchondral bone. Most strikingly, HO occurred within the TMJ disc upon perforation injury in six rabbits after 8 and 12 weeks. We report for the first time a rabbit TMJ injury model that demonstrates condylar cartilage degeneration and disc ossification, which is indispensible for testing the efficacy of potential TMJ therapies.

Distraction osteogenesis for correction of post ankylosis mandibular deformities.

Temporomandibular joint ankylosis, a debilitating disease mainly affecting children, is characterized by progressive restriction of mouth opening and maxilla-mandibular developmental deformities. Craniofacial distraction osteogenesis has been developed as a standard surgical strategy for rectification of craniofacial deformities. The purpose of this study was to assess mono-planar distraction devices for the correction of various mandibular asymmetries in patients with unilateral temporomandibular joint ankylosis who developed restricted mouth opening and mandibular retrognathia. All patients were treated using one-stage distraction osteogenesis followed by temporalis fascia interpositional arthroplasty under general anesthesia. A significant increase in mandibular ramus and base length was observed. Although an increase in anterior lower facial height was observed, it was not significant statistically. A decrease in posterior lower facial height and corpus was observed. Oblique distraction with angular osteotomy allowed lengthening of both the ramus and corpus, yielding satisfactory results and hence eliminating the need of secondary surgery. In conclusion, univector internal distractors are effective for correction of multi-planar mandibular deficiencies by optimizing its placement through meticulous planning.

Local application of Aqua Titan improves symptoms of temporomandibular joint muscle disorder: a preliminary study

Aqua Titan (AT), comprising microscopic titanium particles dispersed in water, has been reported to have beneficial effects on muscle tissue. This study investigated the effects of local application of AT on symptoms in patients with muscle disorders of the temporomandibular joint (TMJ) compared to patients with joint disorders of the TMJ. Sixteen patients with unilateral masseter muscle pain during motion (muscle disorder group) and six patients with unilateral TMJ pain during motion (joint disorder group) applied an AT-permeated patch over the painful area every night for 2 weeks. Symptoms were evaluated clinically at the initial visit and 1 and 2 weeks later. Clinical symptoms in the joint disorder group showed no tendency towards improvement after 2 weeks. In contrast, mouth opening range with/without pain, visual analogue scale (VAS) scores for pain during mouth opening and eating, and activities of daily living (ADL) scores in the muscle disorder group were improved significantly after 2 weeks. Multiple comparison tests in the muscle disorder group showed significant improvements in the VAS for eating and ADL score after 1 week. These results suggest that the AT patch has a potential supplementary role in the treatment of patients with muscle disorders of the TMJ.

Chewing movements altered in the presence of temporomandibular joint internal derangements

Aims:The objectives were to find specific factors that are mathematically distinct between the chewing timings, movement pattern shapes, variability, and movement velocities of: (1) normal asymptomatic subjects and (2) a group of subjects with verified temporomandibular joint (TMJ) internal derangements.Methodology:Left- and right-sided chewing movement recordings of 28 subjects (34·5±14·0 years) were randomly selected from a large database of patients exhibiting verified unilateral or bilateral TMJ internal derangements. The chewing movements of an age- and gender-matched control group of 20 asymptomatic subjects (32·5±11·6 years, P>0·60) with verified normal TMJ function were also recorded. Means and standard deviations of the opening, closing, turning point, terminal chewing position, and velocity patterns were calculated. A two-tailed Student’s t-test with unequal variances was used to compare the parameters between the two groups (alpha = 0·05).Results:The dysfunctional group functioned significantly slower and with greater variability than the control group. The vertical dimension was consistently smaller in the dysfunctional group (P<0·00001). The terminal chewing position was significantly less precise in the dysfunctional group (vertical: P<0·002 and lateral: P<0·037). The maximum lateral width was significantly less (P<0·0071), and the peak and the average velocities were significantly lower (P<0·00001 for both) in the dysfunctional group.Conclusions:This group of dysfunctional subjects exhibited significantly slower, smaller, and more variable chewing patterns than the control group. The functional pattern of mastication appears to be significantly altered in the presence of an internal derangement of the TMJ.

Digital Occlusal Splint for Condylar Reconstruction in Children With Temporomandibular Joint Ankylosis

A costochondral graft (CCG) is usually used for condylar reconstruction in children with temporomandibular joint (TMJ) ankylosis. The aim of the present study was to introduce the application of a digital occlusal splint (DOS) in the assistance of CCG to treat ankylosis and mandibular deviation simultaneously. We designed and implemented a retrospective cohort study and enrolled a sample of growing pediatric patients with unilateral TMJ ankylosis and mandibular deviation who were treated for CCG at our department. The predictor variable was preoperative three-dimensional treatment planning and splint construction (DOS) compared with intraoperative treatment planning and splint fabrication (conventional occlusal splint [COS]). The primary outcome variables were the postoperative ramus height and chin deviation correction measured using Proplan CMF, version 1.3 software. The secondary outcome variable was the treatment time. Data from the 2 methods were compared using the Statistical Package for Social Sciences software package, version 13.0. A total of 8 children, 4 with a COS and 4 with a DOS were included in the present study. The treatment time was significantly longer in the COS group (mean 9.625 hours) than in the DOS group (mean 6.75 hours). The ramus height and chin deviation correction after surgery were more accurate in the DOS group (mean 2.09 mm and 1.29°, respectively) than in the COS group (mean 5.44 mm and 3.27°, respectively), but without significance (P > .05). The preoperative fabrication of DOSs compared with the intraoperative fabrication of COSs resulted in a shorter treatment time and improved mandibular deviation correction in the treatment of children with unilateral TMJ ankylosis.

Temporomandibular Joint Ankylosis:Evaluation of surgical outcomes

The study reviews surgical outcomes of 45 temporomandibular joint (TMJ) ankylosis patients that were treated in the maxillofacial and oral surgery unit of the University of the Western Cape, in South Africa.The aim of the study was to evaluate the outcomes of our protocol and to compare the outcomes unilateral and bilateral TMJ ankylosiscases. In this study the outcomes of TMJ ankylosiswere evaluated by using the following three parameters; preoperative maximal interincisal opening (preop MIO), intraoperative maximal interincisal opening (OP MIO) and the outcome Maximal interincisal opening (outcome MIO). The patient progress since surgery is calculated by subtracting Op MIO from the outcome MIO, and parameter is called postoperative change (Pop MIO). While the overall change is measured by subtracting preop MIO from the outcome MIO, and variable is called Overall change in MIO (OC MIO). The study showed that surgical release of TMJ ankylosis improved mouth opening by a mean OC MIO of 18.5mm. The study also showed that there was no difference in outcomes between unilateral and bilateral cases. Gap arthroplasty showed better outcomes than reconstruction with costochondral graft.

Combined genetic polymorphisms and environmental factors in the etiology of a chronic TMJD murine model

Background TNFR1 and TNFR2 are receptors for the pro-inflammatory chemokine TNFa. Inflammation of the temporomandibular joint (TMJ) and hypersensitivity were induced in mice lacking both TNFa receptors (TNFR1/R2 -/-). After recovery from this initial priming TMJ insult lasting less than a week, a gastrointestinal (GI) chemical irritation is administered 3 weeks later. This “double-hit” initiates a recrudescence of inflammation and hypersensitivity persisting at least 18 weeks. Materials and methods TNFR1/2 -/- and wildtype (WT) mice were given a unilateral TMJ injection of complete Freud’s adjuvant (CFA, 510 mL) to induce hypersensitivity of the overlying facial area. Mechanical hypersensitivity threshold was determined with graded nylon von Frey monofilaments. Heat hypersensitivity was determined by latency to response with the hotplate test (50°C). Three weeks later, mustard oil (0.5% in peanut oil; 50 μl) was infused into the colon. The prolonged inflammation and hypersensitivity that redeveloped only in the TNFR1/2-/- mice allowed testing of several different compounds for their efficacy to reduce chronic inflammation-induced mechanical and heat hypersensitivity. Proteomic analysis of serum was performed to study cytokine level differences in weeks 2 and 10. Results While mechanical thresholds and heat response latencies in WT mice returned to baseline after both insults, the TNFR1/R2 -/- mice developed chronic mechanical and heat hypersensitivity which persisted at least 18 weeks. NMDA receptor antagonist MK801, P2X7 inhibitor A438079, reactive oxygen species scavenger phenyl-N-tbutyl nitrone (PBN), and human TNFa neutralizing antibody Etanercept were tested to determine efficacy for reduction of the hypersensitivity. Both mechanical and heat hypersensitivity were attenuated by the test drugs with varying efficacies. A TRPV1 antagonist, capsazepine, did not alter established heat hypersensitivity. At weeks 2 and 18, the TNFR1/R2 -/- and WT mice had very different cytokine profiles. At 2 weeks when the initial inflammation-induced hypersensitivity had resolved, serum levels of TNFa, RANTES, and MIG were twice as high in TNFR1/ R2 -/- while CXCL11 was decreased compared to WT mice. After 18 weeks when hypersensitivity is chronic, GCSF, IFNg and TNFa serum levels in TNFR1/R2 -/- animals were significantly increased relative to the controls IL16 and CXCL9 were decreased compared to WT samples. Conclusions Utilizing a “double hit” inflammatory model we demonstrated that TMJ inflammation can be “re-ignited” by a minor GI insult to become a chronic condition in mice with TNF receptor deficits. High levels of TNFa were accompanied by different inflammatory mediators after the acute inflammation compared to those present chronically with the TMJD recrudescence.

Diurnal Difference between Mandibular Condyle Movement with Unilateral Temporomandibular Joint Clicking in the Morning and that in the Evening

Diurnal Difference between Mandibular Condyle Movement with Unilateral Temporomandibular Joint Clicking in the Morning and that in the Evening

Treatment of Temporomandibular Joint Ankylosis with Temporalis Superficial Fascia Flap, a case series

Background: Different interpositional materials have been used to prevent recurrence after gap arthroplasty in temporomandibular joint ankylosis. In this study, the temporalis superficial fascia flap was evaluated as an interpositional material after condylectomy.&#x0D; Â Materials and Methods: 9 Cases of unilateral or bilateral temporomandibular joint ankylosis were evaluated in this study with a follow-up of 12 months. The Al-khayat approach was used as the surgical technique with the inferiorly based temporalis superficial fascia flap.&#x0D; Â Results: 9 Patients (6 female and 3 male) had a preoperative maximal inter-incisal opening of 3 to 10 mm. During the last follow-up observation after surgery, patients had a maximum inter-incisal opening of 40 to 45 mm. Paresthesia or anesthesia of the temporal branch of facial nerve was absent in all cases. There were no signs of re-ankylosing in any of the patients.&#x0D; Â Conclusion: The findings of this study showed that the temporalis superficial fascia flap is a good alternative as an interpositional material in treatment of temporomandibular joint ankylosis.

Post-operative steroids in the management of capsulitis following TMJ arthroscopy

Post-operative steroids in the management of capsulitis following TMJ arthroscopy

Transport distraction osteogenesis as a method of reconstruction of the temporomandibular joint following gap arthroplasty for post-traumatic ankylosis in children: a clinical and radiological prospective assessment of outcome

This clinical and radiographic study investigated the use of transport distraction osteogenesis in unilateral temporomandibular joint (TMJ) ankylosis patients. Six patients aged between 4 and 8 years were selected for the study; the mean preoperative maximal inter-incisal opening (MIO) was 3.5mm without lateral and protrusive mandibular movements. The ankylotic mass along with the posterior border of the ascending ramus was exposed via ‘lazy-S’ incision. A gap arthroplasty was performed, followed by a ‘reverse L’ osteotomy on the posterior border of the ramus. In-house manufactured extraoral distraction devices were used for this prospective study. Follow-up clinical and radiographic evaluation was carried out for 13–27 months after completion of the activation period. After a mean follow-up of 19 months, the mean MIO was 29.1mm and the lateral and protrusive movements changed from none to slight. Cone beam computed tomography images of all patients showed remodelled neocondyle created by transport distraction osteogenesis with no statistically significant differences observed for average cancellous bone density, trabecular number, and trabecular spacing between the neocondyle of the operated side (test) and the condyle of the non-operated side (control). Neocondyle formation by transport distraction osteogenesis using the in-house distraction device is a promising treatment option for TMJ reconstruction in ankylosis patients.

Residents' journal review

Residents' journal review