颞下颌关节内压力的研究进展

关节内压是衡量关节功能状态与病理进程的客观标准之一,它参与了各关节多项生理和病理过程。本文综述了关节内压的影响因素及其对关节各组织成份的生理意义,着重说明关节内压改变与关节疾病的相互关系和它在颞下颌关节中的研究现状和应用前景。     

颞下颌关节的压力的研究进展

关节内压是衡量关节功能状态与病理进程的客观标准之一,它参与了各关节多项生理和病理过程。本文综述了关节内压的影响因素及其对关节各组织成份的生理意义,着重说明关节内压改变与关节疾病的相互关系和它在颞下颌关节中的研究现状和应用前景。     

颞下颌关节腔内压测定的临床应用

目的：测定颞下颌关节疾病患者的关节内压。方法：对１６ 例２０ 侧关节在局部麻醉下测定了开口位及闭口位关节上腔内压值。结果：在闭口位,关节上腔内压平均为：（２．４１６±１．９７２） ｋ Ｐａ（ｎ＝ １８）;开口位为：（２．８３７±２．５４３） ｋ Ｐａ（ｎ＝１８）。与正常人相比颞下颌关节疾病患者关节内压升高（ Ｐ＜ ０．０５）。结论：颞下颌关节上腔内压测定方法简便易行,可用于反映颞下颌关节的功能状态。     

山羊颞下颌关节腔内压测定及其意义

目的　研究山羊颞下颌关节上腔内压在5种运动状态下的变化规律。方法　采用Mingograf7型多道生理记录仪对15只健康成年雌性山羊颞下颌关节测量在休息位、小开口位、大开口位、咀嚼及侧向运动时关节内压的值。结果　在休息位时,颞下颌关节上腔内压为负值,开口过程中负压值下降,在咀嚼、侧向运动等周期性运动中,关节上腔内压处于负压与正压交替的周期性变化中。结论　关节上腔内压可用于反映颞下颌关节的功能运动状态。     

颞下颌关节软组织损伤研究进展

作为颞下颌关节（TMJ）功能性整体一部分的囊内软组织（包括关节盘、滑膜和盘后双板区），其伴或不伴髁突骨折而出现的损伤情况一直没有被搞清楚。本文就近年来这方面所取得的研究进展做一文献综述，并探讨了TMJ软组织损伤的治疗及其引起关节强直的可能机理。     

颞下颌关节紊乱病关节腔内压测量与关节镜外科

关节内压 (intra articularpressure,IAP)实际上是关节腔内流体的压力 ,IAP作为关节病诊治中的量化指标之一 ,其生理功能及病理过程中的作用为越来越多的学者所重视。颞下颌关节 (temporomandibularjoint,TMJ)内压的研究自196 4年开始报道[1] 。我们在研究IAP测量过程中 ,发现IAP变化与关节内镜下改变有一定联系。因此 ,我们进行了一系列研究 ,探讨了IAP分型与关节镜下所见的相互联系 ,并应用于临床 ,提出了关节内压“调压治疗”的新概念。现分别介绍如下。一、TMJ内压变化规律及其意义1.IAP测量的目的与意义 :我们对TMJIAP进行…     

润滑功能与颞下颌关节紊乱病

颞下颌关节是具有复杂运动的联动关节，其长期的健康状态与润滑功能密不可分。其有关的润滑机理包括滑液、关节盘和关节软骨等方面。关节内自由基过多可以导致润滑功能障碍，颞下颌关节紊乱病与润滑功能障碍密切相关。     

润滑功能与颞下颌关节紊乱病

颞下颌关节是具有复杂运动的联动关节,其长期的健康状态与润滑功能密不可分。其有关的润滑机理包括滑液、关节盘和关节软骨等方面。关节内自由基过多可以导致润滑功能障碍,颞下颌关节紊乱病与润滑功能障碍密切相关。     

颞下颌关节化脓性关节炎研究进展

颞下颌关节化脓性关节炎常见于成年人，多为血源性感染，病源菌主要为金黄色葡萄球菌，成人颞下颌关节化脓性关节炎症状具有不典型性，诊断较困难，治疗不及时可引起后遗症。作者对该病的发病特点，临床表现及诊疗现状的最近研究进展作一综述。     

颞下颌关节软组织损伤研究进展

作为颞下颌关节(TMJ)功能性整体一部分的囊内软组织(包括关节盘、滑膜和盘后双板区),其伴或不伴髁突骨折而出现的损伤情况一直没有被搞清楚。本文就近年来这方面所取得的研究进展做一文献综述,并探讨了TMJ软组织损伤的治疗及其引起关节强直的可能机理。     

颞下颌关节腔注射治疗的研究进展

颞下颌关节腔注射治疗已经有20多年的历史,是治疗颞下颌关节紊乱病的重要方法,但仍存在药物作用时间短,需要重复注射等问题。近年来,学者从不同角度进行了研究,力图提高颞下颌关节腔注射的治疗效果。本文就该方面的研究进展作一综述。     

Severe temporomandibular dysfunction and joint destruction after intra-articular injection of triamcinolone

BACKGROUND: Steroid injections into joints are frequently used to control symptomatic pain. Risks associated with intra-articular steroid injections are not well documented. METHODS: We report the case of a 29-year-old woman who was referred to a dental surgeon because of a suspected relationship between persisting chronic back pain and an arthrosis of the temporomandibular joint (TMJ). RESULTS: The dental surgeon diagnosed capsulitis of the right TMJ and injected 40 mg triamcinolone into the joint. Within 4 months the patient developed progressive pain and trismus of the right TMJ and the intra-articular injection was repeated. An occlusal splint slightly improved the patients' symptoms but induced crepitus. Magnetic resonance imaging revealed a disk dislocation in the right TMJ and severe necrosis of the condyle. The patient had persisting pain and ankylosis. Surgical restoration of the TMJ revealed a bony apposition in the fossa deformed with the socket of the joint, extensive medial erosion of the condyle and complete destruction of the disk. CONCLUSION: This case report supports earlier observations that intra-articular glucocorticoid injections, if used in a wrong way, may cause severe destruction of a joint.     

Clinical diagnosis of temporomandibular joint arthritis

Evidence‐based clinical diagnostic criteria for temporomandibular joint (TMJ) arthritis are not available. To establish (i) criteria for clinical diagnosis of TMJ arthritis and (ii) clinical variables useful to determine inflammatory activity in TMJ arthritis using synovial fluid levels of inflammatory mediators as the reference standard. A calibrated examiner assessed TMJ pain, function, noise and occlusal changes in 219 TMJs (141 patients, 15 healthy individuals). TMJ synovial fluid samples were obtained with a push–pull technique using the hydroxycobalamin method and analysed for TNF, TNFsRII, IL‐1β, IL‐1ra, IL‐1sRII, IL‐6 and serotonin. If any inflammatory mediator concentration exceeded normal, the TMJ was considered as arthritic. In the patient group, 71% of the joints were arthritic. Of those, 93% were painful. About 66% of the non‐arthritic TMJs were painful to some degree. Intensity of TMJ resting pain and TMJ maximum opening pain, number of jaw movements causing TMJ pain and laterotrusive movement to the contralateral side significantly explained presence of arthritis (AUC 0.72, P < .001). Based on these findings, criteria for possible, probable and definite TMJ arthritis were determined. Arthritic TMJs with high inflammatory activity showed higher pain intensity on maximum mouth opening (P < .001) and higher number of painful mandibular movements (P = .004) than TMJs with low inflammatory activity. The combination TMJ pain on maximum mouth opening and Contralateral laterotrusion <8 mm appears to have diagnostic value for TMJ arthritis. Among arthritic TMJs, higher TMJ pain intensity on maximum mouth opening and number of mandibular movements causing TMJ pain indicates higher inflammatory activity.     

The efficacy of intra-articular sodium hyaluronate in patients with reducing displaced disc of the temporomandibular joint

In this clinical trial, we examined the efficacy of intra-articular hyaluronic acid (HA) treatment in 38 patients with reducing displaced disc of the temporomandibular joint (TMJ). Subjects received two unilateral upper space injections of HA or physiological saline solution with 1 week apart. Efficacy was based on the following measurements: pain and sound intensity of the joint measured by visual analogue scale (VAS), modified Helkimo's clinical dysfunction index and the intensity of joint vibration during opening and closing the mouth measured by accelerometers. These measurements were performed before the first injection and 1 and 6 months after the last injection. In the treatment group (n=19), all measurements improved significantly at month 1 and at month 6 compared with the baseline (P < 0.01). The same measurements, in the placebo group (n=19), did not show any change, except for the pain intensity which improved at month 1 and month 6 (P < 0.05). The change in baseline measurements of all of the efficacy criteria at month 1 and at month 6 in the treatment group was significantly better compared with the change obtained with placebo at the same time intervals. This study demonstrates that intra-articular sodium hyaluronate (Orthovisc) injection into the TMJ is an effective treatment for a reducing displaced disc.     

Aggrecanase analysis of synovial fluid of temporomandibular joint disorders

OBJECTIVES: To determine whether or not aggrecanase in synovial fluid can be used as a biochemical marker in the diagnosis of temporomandibular joint disorder (TMJD). MATERIALS AND METHODS: Forty-four samples of synovial fluid were obtained from 35 patients with internal derangement or osteoarthritis and 15 control samples from 10 asymptomatic volunteers. Aggrecanase in the synovial fluid was examined by immunoblotting. RESULT: The incidence of aggrecanase expression in TMJD group were significantly higher than that in the normal control group (P < 0.05). Those with severe OA and anterior disc displacement without reduction showed significantly high expression of aggrecanase compared with other disease subgroups (P < 0.05). CONCLUSION: These findings suggested that aggrecanase could be a potential biochemical marker for cartilage degeneration in the TMJD.     

Expression of chemerin in the synovial fluid of patients with temporomandibular joint disorders

The synovial membrane and fluid are significantly involved in the pathogenesis of temporomandibular joint (TMJ) disorders. This study aimed to investigate the relation between levels of chemerin in the synovial fluid (SF) of patients with TMJ disorder and their relationship. Sixty samples of SF were obtained from patients with an internal derangement (ID) or osteoarthritis (OA). Chemerin in the SF was examined by enzyme‐linked immunosorbent assay (ELISA). The results showed greater levels of chemerin in the SF of patients with OA than ID. While chemerin levels were positively correlated with pain scores, they were inversely correlated with MMO. Chemerin levels increased progressively as the disorder stage became more severe. The findings of this study suggest that chemerin in SF may play role as a predisposing factor and may represent a novel potential prognostic biochemical marker in the pathogenesis of TMJ disorders.     

Synovial fluid dynamics with small disc perforation in temporomandibular joint

Summary The articular disc plays an important role as a stress absorber in joint movement, resulting in stress reduction and redistribution in the temporomandibular joint (TMJ). The flow of synovial fluid in the TMJ may follow a regular pattern during movement of the jaw. We hypothesised that the regular pattern is disrupted when the TMJ disc is perforated. By computed tomography arthrography, we studied the upper TMJ compartment in patients with small disc perforation during jaw opening–closing at positions from 0 to 3 cm. Finite element fluid dynamic modelling was accomplished to analyse the pattern of fluid flow and pressure distribution during the movements. The results showed that the fluid flow in the upper compartment generally formed an anticlockwise circulation but with local vortexes with the jaw opening up to 2 cm. However, when the jaw opening–closing reached 3 cm, an abnormal flow field and the fluid pressure change associated with the perforation may increase the risk of perforation expansion or rupture and is unfavourable for self‐repair of the perforated disc.     

Loose joint bodies of the temporomandibular joint: a case report

Osteochondral loose bodies are an uncommon finding in the temporomandibular joint (TMJ), but occur relatively frequently in large joints such as the knee, elbow, hip, wrist, and ankle. Loose joint bodies can be divided in three groups: 1) synovial chondromatosis; 2) osteochondral fracture fragments and; 3) cases of degenerative arthritis or avascular necrosis. The most common clinical features of loose joint bodies are pain, swelling, joint noise and impaired joint movements. A case of loose joint bodies of the temporomandibular joint is presented. The pantomograph and lateral cephalograph revealed several irregularly shaped, variably sized radiopaque structures in the region of the right temporomandibular joint. CT and MR scans confirmed the initial diagnosis. The dimensions of the loose joint bodies varied from 1–2 to 5–6 mm. In this patient, the loose joint bodies may have been secondary to osteoarthritis, may have preceded and caused the degenerative changes, or may be only a coincidental finding.     

Arthroscopic management of intra-articular pigmented villonodular synovitis of temporomandibular joint

This retrospective study reports on four patients with intra-articular pigmented villonodular synovitis (PVNS) of the temporomandibular joint (TMJ) who were managed with arthroscopy between 2002 and 2009. There were three females and one male, with a mean age of 46 years at diagnosis. The common symptoms were trismus and pain. No pre-auricular swelling or mass was detected. Magnetic resonance imaging (MRI) and arthrography showed an anteriorly displaced disc, disc perforation, osteophyte of the condyle, or increased joint effusion. No neoplasm was suspected radiologically. Under arthroscopy, a yellow nodule and loose bodies were found in one patient, and a yellow or brown hyperplasia of the synovial membrane was noted in the other three patients. Degeneration of the articular cartilage was detected in two patients. The arthroscopic procedures used for every patient were partial synovectomy and debridement of articular surfaces with electric shaving and coblation. Arthroscopic disc repositioning was performed for the two young patients. Postoperative histological examination verified the diagnosis of PVNS of the TMJ. The average follow-up period was 57.4 months, and no recurrence was found. Arthroscopy has proved to be a useful method for the management of intra-articular PVNS of the TMJ.     

Isolation and characterization of synovial cells from the human temporomandibular joint

BACKGROUND: The synovial tissues with temporomandibular disorders (TMDs) often show chronic inflammatory changes and the synovial cells participate in the pathogenic processes of TMDs. The synovial membrane is composed of a synovial lining layer and a connective sublining layer. The synovial lining layer is made up of two kinds of cells: macrophage-like type A and fibroblastic type B cells. The aim of this study was to isolate and characterize synovial cells from the human temporomandibular joint (TMJ). METHODS: Synovial cells were isolated using an explant culture method. Then, we characterized the cultured synovial cells (SGA2 cells) using immunocytochemistry. RESULTS: SGA2 cells expressed the fibroblastic markers vimentin and prolyl 4-hydroxylase; they also expressed laminin and heat shock protein 27, all of which are markers of type B cells. However, some cells expressed the macrophage marker CD68. These CD68-positive cells simultaneously expressed laminin. CONCLUSIONS: We isolated and cultured synovial type B cells from the human TMJ, and identified the presence of intermediate type synovial lining cells, having the phenotypic properties of both type A and type B cells, among the synovial lining cells.