Efficiency of arthroscopic lysis and lavage for internal derangement of the temporomandibular joint correlated with Wilkes classification.

OBJECTIVES: To compare the outcome of arthroscopic lysis and lavage of TMJ with internal derangement of Wilkes stages II, III, IV, and V. STUDY DESIGN: Arthroscopic lysis and lavage was performed in 45 TMJ of 39 patients with internal derangement. The cases were divided into 4 groups corresponding to Wilkes stages II, III, IV, and V. Two parameters were compared pre- and postoperatively: pain and mouth opening. Statistical significance was determined using the chi(2) test. RESULTS: Overall success rate was 86.7% (Wilkes stage II 90.9%, Wilkes stage III 92.3%, Wilkes stage IV 84.6%, Wilkes stage V 75%). There were no statistically significant differences between the success rates for Wilkes stages II, III, IV, and V. CONCLUSION: Arthroscopic lysis and lavage should be performed as a standard operation for internal derangement of the TMJ after failure of conservative treatment in all Wilkes stages.     

Expression of capsaicin receptor TRPV-1 in synovial tissues of patients with symptomatic internal derangement of the temporomandibular joint and joint pain.

OBJECTIVE: To elucidate expression of capsaicin receptor TRPV-1 in synovial tissues of the human temporomandibular joint (TMJ) with internal derangement and discuss its relationship with joint pain. STUDY DESIGN: Fifty-four TMJs in 54 patients were examined using an immunohistochemical technique. As controls, 10 TMJs with habitual dislocation without pain were also examined. RESULTS: TRPV-1 was expressed mainly in the blood vessels beneath the lining cells in synovial tissues from 31 of the 54 joints with internal derangement and from 8 of the 10 control joints. The extent score of TRPV-1-stained cells with internal derangement was not significantly higher than that of controls. The extent score of TRPV-1 showed no correlation with joint pain. CONCLUSIONS: TRPV-1 was detected in the region of the posterior disk attachment of synovial tissues from the TMJ in patients with internal derangement and controls. TRPV-1 may play a role in maintenance of the physiologic condition of the TMJ.     

Resection of the disc and suspension of the lateral wall with the temporal fascia in advanced internal derangement of the temporomandibular joint.

The abnormal relation between the disc, the condyle, and the temporal bone indicates internal derangement of the temporomandibular joint. The primary symptoms and findings are: limited and painful opening of the jaw, preauricular pain, and clicking sounds or crepitus. We operated on 11 patients admitting for advanced temporomandibular dysfunction. The abnormally stretched disc was tightened by resection of a wedge of tissue from the posterior of the disc and suturing of the edges. A pedicled flap of temporal fascia was turned on to the joint and its surroundings to mimic a lateral joint capsule. All patients were satisfied with the results as they had less pain and improved mouth opening. The procedures provided satisfactory symptomatic relief and supportive findings.     

Expression of interleukin 8 in synovial tissues in patients with internal derangement of the temporomandibular joint and its relationship with clinical variables.

OBJECTIVES: The objectives of this study were to assay interleukin 8 (IL-8) in synovial tissues of the temporomandibular joint (TMJ) with symptomatic internal derangement, and to assess its relationship with clinical variables. STUDY DESIGN: Forty-six joints in 44 patients were examined using an immunohistochemical technique. As controls, 8 joints in 7 subjects with habitual dislocation without pain were also examined. RESULTS: IL-8 was expressed mainly in the blood vessels beneath the lining cells in 37 of the 46 joints (80%) with internal derangement and in 2 of the 8 control joints. The percentage of IL-8-positive cells was significantly higher in the internal derangement group than in the control group (P = .004). The percentage of IL-8-positive cells showed no correlation with joint pain or number of infiltrating cells. CONCLUSIONS: IL-8 was up-regulated in inflamed synovial tissues in patients with internal derangement. Because IL-8 has no significant correlation with clinical variables, IL-8 may play a secondary role in the pathogenesis of the internal derangement of the TMJ.     

Resection of the disc and suspension of the lateral wall with the temporal fascia in advanced internal derangement of the temporomandibular joint

The abnormal relation between the disc, the condyle, and the temporal bone indicates internal derangement of the temporomandibular joint. The primary symptoms and findings are: limited and painful opening of the jaw, preauricular pain, and clicking sounds or crepitus. We operated on 11 patients admitting for advanced temporomandibular dysfunction. The abnormally stretched disc was tightened by resection of a wedge of tissue from the posterior of the disc and suturing of the edges. A pedicled flap of temporal fascia was turned on to the joint and its surroundings to mimic a lateral joint capsule. All patients were satisfied with the results as they had less pain and improved mouth opening. The procedures provided satisfactory symptomatic relief and supportive findings.     

Internal derangement of the sternoclavicular joint.

Indirect injuries to the sternoclavicular joint can result in an internal derangement. The major injury is to the intra-articular disk. The condition is generally caused by indirect injury to the shoulder, and causes tenderness, mild swelling and a clicking sensation over the joint. An arthrogram may well prove helpful in diagnosis. The lesion is treated by simple disk excision.     

手法治疗颈源性颞颌关节紊乱综合征17例

颢颌关节紊乱是临床上较常见的综合征，常有不少患者同时伴有颈部僵硬，头痛等症。笔者近年来，将有上颈段关节紊乱伴本综合征的患者，进行手法治疗获得较满意的疗效，现报告如下。     

Magnetic resonance imaging findings of internal derangement, osteoarthrosis, effusion, and bone marrow edema before and after performance of arthrocentesis and hydraulic distension of the temporomandibular joint.

OBJECTIVES: To investigate whether temporomandibular joint (TMJ) internal derangement type III and capsulitis/synovitis are related to magnetic resonance imaging (MRI) diagnoses of internal derangement, osteoarthrosis (OA), effusion, and/or bone marrow edema (BME), and whether arthrocentesis is associated with changes in diagnoses of internal derangement, OA, effusion, and/or BME. STUDY DESIGN: The study comprised 28 patients with a clinical unilateral TMJ disorder of internal derangement type III and capsulitis/synovitis. Bilateral MRI was immediately performed preoperatively and at a 2-month follow-up. RESULTS: There was a significant relationship between TMJ internal derangement type III and capsulitis/synovitis and TMJ internal derangement (P = .000), effusion (P = .036), and BME (P = .002). MRI showed a significant decrease in diagnoses of TMJ BME ((P = .018). CONCLUSIONS: MRI variables of internal derangement, effusion, and BME were related to TMJ internal derangement type III and capsulitis/synovitis; however, arthrocentesis was only associated with a significant change in diagnoses of TMJ BME.     

Ultrasound assessment of internal derangement of the knee

In a prospective double-blind study we investigated internal knee disorders with ultrasound and compared the results with Magnetic Resonance Imaging (MRI) and arthroscopy. The aim was to determine the effectiveness of ultrasound in diagnosing Internal Derangement of the Knee (IDK) and to compare the results with MRI. Over an 18-months period, 81 patients were examined. All were male; they had a mean age of 35 years. For various technical reasons 21 patients were subsequently excluded from the study. After initial clinical examinations, patients had an ultrasound and MRI scan at the same visit. Arthroscopy was performed within a month of this. Different radiologists who were unaware of the clinical findings independently reported on the ultrasound and MRI. The surgeon performing the arthroscopy was made aware only of the MRI findings. Structures accessed were the lateral and medial menisci and the anterior (ACL) and posterior (PCL) cruciate ligaments. Arthroscopy was taken as the gold standard. Ultrasound showed good sensitivity, ranging from 76% for the ACL to 90% for the medial meniscus, and excellent specificity, ranging from 92% for the medial meniscus to 100% for the ACL. Accuracy ranged from 86% for the ACL to 98% for the lateral meniscus. These figures were comparable to the MRI findings. We concluded that ultrasound is a simple, accurate, inexpensive and non-invasive way of assessing internal knee disorders. There is a learning curve, but results are similar to MRI.