Management of temporo-mandibular joint ankylosis in growing children.
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Although temporo-mandibular joint (TMJ) ankylosis is one of the most common pathologies afflicting the facial skeleton, it is also the most overlooked and under-managed problem in children. The TMJ forms the very cornerstone of cranio-facial integrity and hence its ankylosis in growing children adversely affects the growth and development of the jaws and occlusion. Impairment of speech, difficulty in mastication, poor oral hygiene, rampant caries and acute compromise of the airway pose a severe psychologic burden on the tender minds of children. The aim of this article is to present an overview of efficient management strategies, based on a case report, so as to increase its awareness among all dental surgeons involved in the treatment of children. (+info)
Synovial chondromatosis of the temporomandibular joint: a clinical, radiological and histological study.
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Synovial chondromatosis (SC) is a cartilaginous metaplasy of the mesenchymal remnants of the synovial tissue of the joints. It is characterized by the formation of cartilaginous nodules in the synovium and inside the articular space (loose bodies). SC mainly affects to big synovial joints such as the knee and the elbow, being uncommon the onset within the TMJ, where 75 cases have been published. The main symptoms are pain, inflammation, limitation of the movements of the jaw and crepitation. Different methods of diagnosis include panoramic radiograph, CT, MR and arthroscopy of the TMJ. We report a new case of unilateral SC of the TMJ, including diagnostic images, treatment performed and histological analysis. (+info)
Bifid condyle: case report.
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The double headed mandible condyle is a rare alteration that is frequently diagnosticated as an incidental finding in a panoramic radiograph. The different theories about its etiology are explained in this article. Symptoms described with bifid condyles vary from case to case, but in most instances are absent. Computer tomography is the ideal imaging method to evaluate the condyle morphology and to role out any degenerative process to achieve the differential diagnosis. Treatment is conservative for symptomatic patients with TMJ disorders, surgical treatment is described in literature in TMJ ankylosis that develops in bifid condyles secondary to trauma. (+info)
Condylar disk plication for temporomandibular joint internal derangement treatment: surgical technique and results.
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OBJECTIVE: To report six cases submitted to the TMJ condylar disk plication technique. STUDY DESIGN: All patients presented a limitation of mandibular movements, severe pain and failure of previous clinical treatment. A definitive diagnosis of irreducible anterior disk displacement was made by MRI (Magnetic Resonance Imaging). Clinical evaluation consisted of the following: measurement of maximal mouth opening, movement to the left and right and protusion; presence of deviation during mouth opening; clicking during mouth opening or closing; presence of pain and personal satisfaction following surgery. RESULTS: While all patients had preoperative pain, only one had severe pain; in the others, the pain was less intense at the end of the period of follow-up. Stomatognatic function was improved and has been maintained since the conclusion of this study. CONCLUSIONS: On the basis of the follow-up of these patients, the proposed technique proved to be effective for disk stabilization, leading to a decrease in pain and an improvement in mandibular movements. (+info)
Accelerated osteoarthritis in the temporomandibular joint of biglycan/fibromodulin double-deficient mice.
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OBJECTIVE: To investigate whether the absence of biglycan and fibromodulin, two proteoglycans expressed in cartilage, bone and tendon, resulted in accelerated osteoarthritis in the temporomandibular joint (TMJ). METHODS: Histological sections of TMJ from 3-, 6-, 9- and 18-month-old wild-type (WT) and biglycan/fibromodulin double-deficient (DKO) mice were compared. Immuno-stainings for biglycan, fibromodulin and proliferating cell nuclear antigen (PCNA) were performed. RESULTS: Biglycan and fibromodulin were highly expressed in the disc and articular cartilage of the TMJ. At 3 months of age, both WT and DKO presented early signs of cartilage degeneration visible as small acellular areas under the articular surfaces and superficial waving. From 6 months of age, DKOs developed accelerated osteoarthritis compared to WT. At 6 months, small vertical clefts in the condylar cartilage and partial disruption of the disk were visible in the DKO. In addition, chondrocytes had lost their regular columnar organization to form clusters. At 9 months, these differences were even more pronounced. At 18 months, extended cartilage erosion was visible in DKOs when by comparison the thickness of the articular cartilage in WT controls was basically intact. PCNA staining was stronger in 3-month-old WT TMJ fibrocartilage than in 3-month-old DKO TMJ fibrocartilage suggesting that chondrocyte proliferation might be impaired in DKOs. CONCLUSION: The biglycan/fibromodulin double knock-out mouse constitutes a useful animal model to decipher the pathobiology of osteoarthritis in the TMJ. (+info)
Dentofacial changes and oral health status in mentally challenged children.
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The study was carried out on 69 mentally challenged individuals. They were subjected to detailed clinical evaluation for dentofacial abnormalities and oral health status. Of the 69 mentally handicapped individuals 27 had Downs syndrome and 42 had cerebral palsy. Characteristic facial abnormalities were seen in children with Downs syndrome. In cerebral palsy, fracture maxillary anteriors were more evident. All the Downs syndrome cases had abnormal TMJ movements but in cerebral palsy only 35.7% of individuals had abnormal TMJ movements. In both the groups, submandibular lymph adenopathy was reported. Present study revealed dental caries in 56.0% of the individuals. Fair clinical level of oral hygiene in 60% of the individuals was seen. (+info)
The relationship between temporomandibular joint disc morphology and stress angulation in skeletal Class III patients.
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The aim of this study was to examine the relationship between disc position and stress direction on the condyle by means of stress analysis using the rigid body spring model (RBSM) theory. The material consisted of 88 joints of 44 Class III dentofacial deformity patients, divided into symmetry and asymmetry groups on the basis of the Mx-Md midline position. The asymmetry group was identified by comparison with a reference midline vertical plane passing through a plane from ANS to Me. Asymmetry was diagnosed when the angle between these two planes was greater than 3 degrees. The geometry of the stress analysis model was based on sagittal tomography of the subject. The first molar, gonial angle, and the most anterior, superior, and posterior points on the condyle were plotted on a computer display, and stress angulation on the condyles was calculated with the RBSM program. In addition to anterior displacement with or without reduction, three types of disc position could be identified using magnetic resonance imaging (MRI): anterior, fully covered and posterior. In the asymmetric group, stress angulation was significantly higher (P < 0.05) at the deviation side compared with the non-deviation side. There was also a significant correlation between disc position and stress angulation (P < 0.05). In the asymmetry group, regression analysis indicated a significant correlation (P < 0.001) between the difference in stress angulation (between the deviation side and the non-deviation side) and the degree of asymmetry (measured by the angle of asymmetry). This study demonstrated that temporomandibular joint (TMJ) stress was associated with TMJ morphology in Class III patients whether or not they were asymmetric. (+info)
Activation of trigeminal intranuclear pathway in rats with temporomandibular joint inflammation.
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We examined the anatomical connections of trigeminal neurons between the trigeminal subnuclei interpolaris/caudalis (Vi/Vc) transition and caudal subnucleus caudalis/upper cervical dorsal horn (Vc/C(1,2)) zones in rats, using the fluorogold (FG) retrograde tracing method combined with Fos expression, a marker of neuronal activation, following temporomandibular joint (TMJ) inflammation. The head withdrawal threshold was also measured in rats 3 days after complete Freund's adjuvant (CFA)-induced TMJ inflammation. The head withdrawal threshold on the inflamed side was significantly decreased after CFA injection into the TMJ. FG was injected into the Vi/Vc transition zone and retrogradely labeled FG-positive cells were observed in the Vc/C(1,2) region. Numerous Fos protein-expressing cells were present both in the Vi/Vc transition zone and in the laminated Vc/C(1,2) zone. A population of cells was double-labeled with Fos and FG in the Vc/C(1,2) zone. Fos/FG cells were only observed in the deep laminae of the Vc/C(1,2) zone. These findings suggest that Vi/Vc transition zone activity is modulated by activation of the caudal laminated zone after orofacial tissue injury. (+info)