兔颞下颌关节盘前移位的X线研究

目的　通过影像学检查了解颞下颌关节盘前移位的病理变化过程,证实关节盘前移位与退行性改变之间的关系。方法　在手术组动物一侧关节区显露颞骨颧突根部,用丝线垂直穿过关节盘前带的延伸部并拉缝线向前并固定,使颞下颌关节盘前移位。手术对照组的手术步骤与手术组相同,但不缝合关节盘前带的延伸部,也不将关节盘位向前方。正常对照组5只,手术组和手术对照组动物术后1、2、4、8、10、12和16周分别处死。拍摄关节X线片,观察38只兔颞下颌关节X线表现。将兔左、右关节区锯成组织块,肉眼观察兔关节盘的位置。结果　手术组关节盘位置与形态均发生了改变,13侧为部分关节盘前移位,完全性关节盘前移位为11侧,关节盘穿孔为9侧。部分关节盘前移位出现关节间隙狭窄或消失,髁状突骨密度增高。完全性关节盘前移位与关节盘穿孔表现为髁状突骨质增生、破坏及肥大,关节结节磨平以及硬化。结论　颞下颌关节盘前移位可导致关节骨质改变。完全性关节盘前移位和关节盘穿孔与骨关节病的关系密切。     

颞下颌关节盘穿孔的外科治疗

颞下颌关节盘穿孔是颞下颌关节紊乱病骨关节病中的一种病症，多因外伤、关节盘前移位和骨关节病导致关节盘后带与双板区交界处和双板区穿孔，以及关节盘本体穿孔或破裂。临床上常伴有关节组织的退行性改变。颞下颌关节盘穿孔的治疗有保守治疗和手术治疗，以下重点介绍颞下颌关节盘穿孔的外科治疗。     

颞下颌关节盘前移位和穿孔的关节内窥镜研究

目的 :探讨颞下颌关节内窥镜下颞下颌关节盘移位和关节盘穿孔的病理改变特征。方法 :76例 84侧临床诊断为颞下颌关节盘前移位以及关节盘穿孔的病例进行颞下颌关节内窥镜检查。结果 :可复性关节盘前移位的病例出现滑膜炎 ,关节腔内有絮状物 ,关节结节表面有纤维形成。不可复性关节结节表面纤维形成 ,关节软骨软化 ,软骨剥脱 ,同时伴有纤维粘连。关节盘穿孔大多数位于双板区与后带。关节盘穿孔出现滑膜增生 ,关节窝及关节结节表面纤维形成 ,软骨剥脱甚至骨质暴露。结论 :关节内窥镜检查可诊断关节盘前移位与关节盘穿孔 ,并能发现病理性改变 ,如滑膜炎 ,滑膜增生 ,纤维变性 ,软骨软化 ,关节内粘连等。在不可复性盘前移位病例中发现关节退行性改变 ,关节盘穿孔为严重的骨关节病。     

锥形束CT颞下颌关节上腔造影在诊断关节盘病变中的应用

目的探讨颞下颌关节（TMJ）骨关节病中关节盘前移位、穿孔及髁突骨质改变类型的关系。 方法选择中山大学附属口腔医院颞下颌关节专科就诊的96例骨关节病患者共145侧TMJ行锥形束CT（CBCT）关节造影检查,分为关节盘穿孔组和非穿孔组,两组病例以CBCT按照关节盘移位及髁突骨质改变类型进行分类比较,应用SPSS 18.0对关节盘穿孔与关节盘移位类型进行Pearson χ²独立性检验,两组间骨质分型构成比进行χ²检验。 结果所有关节发生关节盘前移位,其中123侧为不可复性盘前移位、22侧为可复性盘前移位。86侧TMJ发生关节盘穿孔,59侧关节造影未检出穿孔。关节盘是否发生穿孔与关节盘前移位类型存在相关性（χ²= 6.866,P= 0.015）,关节盘穿孔组不可复性盘前移位发生率（91.86%）高于非关节盘穿孔组（76.3%）。 结论TMJ骨关节病患者均存在不同程度的关节盘移位,关节盘移位类型与关节盘穿孔相关,髁突骨质改变类型与关节盘是否穿孔无明显相关性。     

Ⅳ型胶原在病变颞下颌关节盘组织中的表达

颞下颌关节盘前移位和穿孔是临床上常见的颞下颌关节紊乱病 ,病理学变化主要是关节组织的退行性改变。Ⅳ型胶原是一种基膜胶原 ,主要存在于上皮和内皮的基板或基膜上。我们利用免疫组织化学方法检测在病变关节盘和盘后组织中Ⅳ型胶原的表达 ,探讨Ⅳ型胶原与颞下颌关节紊乱病之间的关系。1.材料和方法 :19例为ＴＭＪＤ包括不可复性盘前移位 3例 ,盘前移位伴关节盘穿孔 5例 ,骨关节病伴关节盘穿孔 11例。男 4例 ,女 15例 ,年龄 2 4～ 6 0岁。经手术切除部分病变的ＴＭＪ盘与盘后组织 ,另 1例为正常关节盘与盘后组织作为对照。 2 0例标本经生理…     

组织蛋白酶D在病变颞下颌关节盘组织中的表达

组织蛋白酶Ｄ与颞下颌关节破坏性疾病有关。本研究用免疫组织化学方法 ,检测组织蛋白酶Ｄ在病变颞下颌关节盘和盘后组织中的表达 ,以探讨组织蛋白酶Ｄ与颞下颌关节紊乱病病变之间的关系。1 材料和方法 :19例颞下颌关节紊乱病患者 ,其中 3例不可复性盘前移位 ,5例盘前移位伴关节盘穿孔 ,11例骨关节病伴关节盘穿孔。男 4例 ,女 16例 ,年龄 2 4～ 6 0岁。经手术切除部分病变的颞下颌关节盘与盘后组织 ,另外 1例为正常关节盘与盘后组织作为正常对照。 2 0例标本经常规固定、脱水、石蜡包埋、切片 ,每例标本切片 4张。 1张进行常规ＨＥ染色 ,另外…     

颞下颌关节盘前移位和穿孔的关节内窥镜研究

目的：探讨颞下颌关节内窥镜下颌下颌关节盘移位和关节盘穿孔的病理改变特征。方法：７６例８４例临床诊断为颞下颌关节盘胶移位以及关节盘穿孔的病例进行颞下颌关节内窥镜检查。结果：可复性关节盘前移位的病例出现滑膜炎，关节腔内有絮状物，关节结节表面有纤维形成。不可复笥关节结节表面纤维形成，关节软骨软化，软骨剥脱，同时伴有纤维粘连。     

牙颌面专用CT颞下颌关节造影的临床应用

目的　探讨牙颌面专用CT颞下颌关节 (temporomandibularjoint ,TMJ)造影对关节盘移位及关节骨结构的诊断效果。方法　对 10 9例 (119侧 )TMJ行牙颌面专用CT关节造影检查 ,将关节盘移位分为 5型 ,髁突骨质改变分为 4型。结果　① 119侧关节均有不同类型的关节盘移位 ,其中 84侧仅有关节盘前移位 ;另 35例则为关节盘旋转移位和侧向移位。②骨关节病的发生率 :男性、女性分别为 6 0 0 %和 6 1.7% ;骨关节病的发生率与关节盘移位类型无关 (χ2 =1.5 6 ,P >0 .0 5 )。③ 73侧骨关节病关节中 ,4 9侧 (6 7.1% )病变发生于髁突外侧 ,8侧病变发生于髁突内侧 ,另有 5侧髁突骨质改变部位不能确定。结论　TMJ造影牙颌面专用CT技术可同时多层面显示关节盘及关节骨性结构的病变 ,尤其是可对关节盘旋转移位及侧向移位、关节盘穿孔等作出准确诊断 ,因而明显优于常规关节造影     

颞下颌关节盘前区的解剖学与组织学观察

为探索颞下颌关节盘前区在颞下颌关节紊乱综合征发病中的作用,作者利用47侧老年尸体颞下颌关节斜矢状面组织学切片,观察盘前区的解剖结构,并比较在盘位改变、骨质改变时盘前区的组织学变化.观察表明:①关节盘前区包括关节盘纤维向前延伸的部分、下颌前附着、颞前附着、盘前方附着间的疏松组织及与关节盘关系密切的翼外肌;②关节盘前区的这些组织确实存在可引起关节症状及加重关节退行性变的改变;③关节盘前移及盘穿孔的标本翼外肌上头就业性的发生率明显增高.因此,盘前区无论结构上还是功能上均对颞下颌关节有重要意义.     

不可复性关节盘前移位的颞下颌关节系统生物力学研究

目的：研究构建病理状态下的颞下颌关节系统三维有限元模型并进行力学分析,探讨不可复关节盘前移位后颞下颌关节系统的应力分布情况。方法：利用CT和MRI扫描,通过Mimics和Geomagic软件平台,构建病理状态下的颞下颌关节系统三维模型,并在其基础上进行力学分析。结果：建立了包括上、下颌骨,关节窝、全牙列及关节盘的颞下颌关节系统个体化三维数字模型。力学分析显示．正常关节盘的应力集中在中带外侧部,应力分布较均匀,而当关节盘前移位时,关节盘的中带出现应力集中现象．容易引起该部位关节盘变薄或穿孔：髁突表面应力主要分布在前斜面．而当关节盘前移位时,髁突受力增大．提示该部位易发生退行性变。结论：利用cT和MRI,能够实现对病理状态下的颞下颌关节系统的三维重建．且关节盘移位侧的关节盘、髁突应力峰值均大于正常侧关节。     

The efficacy of anterior repositioning splint therapy studied by magnetic resonance imaging

Magnetic resonance images (MRIs) were obtained of 52 temporomandibular joints (TMJs) of 30 patients with TMJ disease, before insertion of an anterior repositioning splint. Ten TMJs showed a normal disc-condyle relationship. Pathological findings were partial or complete anterior disc displacement with disc reduction (n = 18), without (n = 7), or with partial reduction (n = 4) or non-reducing joints combined with osteoarthrosis (n = 13). Associated clinical findings were joint clicking, painful TMJ movements with or without condyle limitation, deviation, or crepitus. The clinical evaluation when compared with the MRIs correlated in 75 per cent of cases. Immediate post-insertion MRIs showed recapture of discs with a protrusive splint in 15 out of 18 reducing displacements. Recapture of the disc was seen in only two out of four joints with anterior disc displacement with partial disc reduction. There was no recapture in non-reducing joints. In severe cases of internal derangement with a wide range of disc displacement combined with changes of the osseous joint surfaces, the recapturing of the articular disc with an anterior repositioning appliance was unsuccessful (0 of 13). The follow-up for pain relief after one week showed a significant reduction of symptoms, despite the fact that recapture of the dislocated disc occurred in only 17 of the 42 pathological TMJs. The possibility for disc recapture depends on the disc-condyle position and configuration, the integrity of the posterior attachment, and the degree of degenerative changes of the intra-articular structures, such as osteophytosis, condylar erosion, or flattening of the articular disc. This diagnostic information influences the method of treatment of TMJ disorders. In non-reducing joints or in the later stages of internal derangement of the TMJ, it is not possible to achieve a normal disc-condyle relationship using protrusive splints.     

Osteoarthritis and internal derangement of the temporomandibular joint: a light microscopic study

To describe osteoarthritic changes of the temporomandibular joint (TMJ) and their relation to internal derangements, 22 randomly selected TMJ autopsy specimens were dissected and studied by light microscopy. Normal disc position was seen in eight joints, partial anterior displacement of the discs in eight joints, and complete anterior displacement of the discs in five joints; one joint had a perforated disc. Degenerative changes, such as horizontal splitting, clustering of chondrocytes, bone marrow fibrosis, sclerosis, erosion, cyst formation, and reduction in TMJ size, were found in 11 of the 14 joints with displacement or perforation of the disc and in four of the eight joints with normal disc position. Internal derangement appeared to be associated with osteoarthritis. The relations between remodeling, aging, internal derangement, and osteoarthritis are discussed.     

The evaluation of temporomandibular joint disc position in TMJ disorders using MRI

The purpose of this study was to correlate disc position and the type of disc displacement, intra-capsular effusion and degenerative changes of the condyle as demonstrated in MRI studies. In this study, 126 temporomandibular joints (TMJs) of 63 patients with TMJ disorders were investigated using clinical examination and MRI. One hundred and twelve TMJs were found to have internal derangement as disc displacement. The angle between the posterior margin of the disc and the vertical line drawn through the centre of the condyle was measured on MRI for each TMJ. The positions of the discs were normal, 0 degrees-10 degrees, in 11.11%; slightly displaced, 11 degrees-30 degrees, in 37.30%; mildly displaced 31 degrees-50 degrees, in 15.08%; moderately displaced, 51 degrees-80 degrees, in 7.14% of the TMJs with anterior displacement with reduction (ADDR). The disc position was severely displaced anteriorly, as over 80 degrees, in all TMJs with anterior disc displacement without reduction (ADD), constituting 27.78% of all cases. We found that the smaller the degree of disc displacement the milder the internal derangement and that the intra-capsular effusion was more frequently associated with TMJ with ADDR. The degenerative condylar changes were more severe with an increased degree of anterior disc displacement.     

Histological changes in temporomandibular joints from elderly individuals. An autopsy study

Our aim was to study microscopically the disc position and structural tissue changes such as disc perforation of the temporomandibular joint (TMJ). An autopsy material comprising the right and left TMJ from 21 individuals with a mean age of 75 years was studied. Anterior disc position was found in 11 joints from 8 individuals. Discs in anterior position were most often of even thickness or convex, whereas most discs in normal position were concave. Perforation was found in the central dense part of the disc in one joint and in the posterior disc attachment of five joints. The latter five discs were in anterior position. Of the five joints with anterior disc position and perforation of the posterior attachment, four joints showed marked structural changes also in the condyle and temporal component. Such changes were found only in one of six joints with anterior disc position but without perforation. No signs of cellular inflammation were observed in any of the joints. Fibrous ankylosis was found in four joints from three individuals. Joints with anterior disc position comprised more than one fourth of the examined joints. In some of these joints there were no structural changes; in other of these joints disc perforation was combined with convex disc form and marked structural changes of the condyle and temporal component.     

Creation of disc displacement in human temporomandibular joint autopsy specimens.

The purpose of this study was to investigate the possibility of iatrogenically creating disc displacement in the human temporomandibular joint (TMJ). Fourteen fresh TMJ autopsy specimens with superior disc position were selected for the study. The upper and lower joint spaces were exposed via a preauricular incision and two to three superficial mediolateral incisions were made in the inferior surface of the posterior disc attachment (ie, retrodiscal tissue). After these incisions were made it was possible to manually displace the disc anteriorly. To maintain the disc in the anterior position the condyle was positioned against the posterior disc attachment in a manner corresponding to the closed mouth position. The joints were then fixed in this relationship and magnetic resonance imaging (MRI) was repeated using the same scanning plane and scanning parameters as before intervention. After imaging, the joints were cryosectioned to show the degree of disc displacement. Histologic analysis was made of the posterior disc attachment. Postoperative MR images and cryosections showed the disc to be displaced anteriorly in 12 of the 14 joints. Displacement of the disc was complete in eight joints (the entire mediolateral dimension of the joint) and partial (only in the lateral part of the joint) in four joints. The disc remained in a superior position in two joints. Cryosections and histologic analysis showed the incisions in the inferior aspect of the posterior disc attachment to be superficial. The results of this study suggest that the integrity of the inferior aspect of the posterior attachment of the disc to the condyle is essential for keeping the disc in its position superior to the condyle.(ABSTRACT TRUNCATED AT 250 WORDS)     

Functional magnetic resonance imaging of temporomandibular joint disorders

Fifty-eight temporomandibular joints (TMJs) from 40 patients with TMJ-related symptoms were examined by means of magnetic resonance scans with modified gradient echo sequences and a special double coil. This technique yielded a good spatial resolution of the intra-articular soft tissues, especially the articular disc and the bone structure of the TMJ. In combination with an incremental jaw opener, the disc-condyle complex was analysed in various closed and open mouth positions, depending on the clinical examination. Open mouth movement with differentiation of disc-condyle rotational and translation movement was demonstrated. Disturbances of TMJ motion showed interrupted condylar translation combined with mandibular deviation during open mouth movement (n = 8/58). Early phases of internal derangement of the TMJ with partial anterior disc displacement with (n = 12/58) or without (n = 2/58) reduction, total anterior disc displacement without reduction (n = 10/58), disc deformation (n = 10/58), disc adhesion (n = 2/58), condylar hypermobility (n = 6/58), condylar displacement (n = 8/58), and late phases of internal derangement of the TMJ with osteoarthrosis (n = 14/58) were clearly identified. Bilateral TMJ disorder was found in 72.5 per cent of the patients. By using motion-adapted, semi-dynamic magnetic resonance imaging (MRI), it is possible to improve the understanding of the complexity of TMJ movements.     

Osteoarthrosis of the temporomandibular joint following experimental disc perforation in Macaca fascicularis

The aim of this experiment was to study the sequela of experimental temporomandibular joint (TMJ) disc perforation. Each TMJ of four Macaca fascicularis adult monkeys was surgically exposed, and a 4- to 6-mm perforation at the posterolateral portion of the avascular disc was produced by electrosurgery. Four monkeys were used as controls. The animals were killed 11 weeks (two experimental and two controls) or 12 weeks (two experimental and two controls) after disc perforation. The perforations were increased in size in five joints, and healed in one joint. In addition, two joints of one animal showed complete loss of the disc, denudation of articular surfaces, and bone-to-bone contact. In contrast to control joints, the experimental joints exhibited the following changes histopathologically: thick, highly cellular and fibrillated fibrous coverings of articular surfaces (five joints); marked hyperplasia of synovial membrane; migration of synovial cells on the surfaces of the disc and margins of perforation; multiple adhesions of disc to articular surfaces; increase in cellularity and vascularity of discs; and chondrocytic clustering in temporal fibrous covering; and osteophytes of condylar and temporal components and focal or complete denudation of articular surfaces (2 joints). Most of these changes were consistent with the diagnosis of osteoarthritis. From this study, one can conclude that disc perforation can lead to osteoarthritis.     

Outcomes of anterior disc displacement and condylar remodelling for sagittal fracture of the mandibular condyle in children after closed treatment

The aim of this study was to evaluate the outcomes of temporomandibular joint (TMJ) anterior disc displacement and condylar remodelling for sagittal fracture of the mandibular condyle (SFMC) in children. Disc displacement was observed in 20 patients with 24 SFMCs (age 4–12 years) via magnetic resonance imaging. After 6 months of closed treatment (T1), the joints were categorized based on the displaced disc status as complete reduction (DCR) or incomplete reduction (DICR). Moreover, condylar remodelling was compared between the groups using cone beam computed tomography images of the TMJ obtained at T1 and at the 1-year follow-up (T2; 15 patients with 18 displaced SFMCs). At T1, 17 of 24 joints with SFMC were assigned to the DCR group and six to the DICR group; one unilateral SFMC case developed ankylosis. Condylar depth and height differed significantly between the groups at T1, but not at T2. Intra-group comparison exhibited significant changes in the condylar depth and height over time in the DICR group. Thus, most of the anteriorly displaced discs (17/24, 70.8%) achieved reduction following closed treatment. Although sustained anterior disc displacement was associated with an increased depth and reduced height of the condyle, no clinical impairment was noted unless ankylosis developed.