人颞颌关节降钙素基因相关肽阳性神经纤维的分布

目的 :观察降钙素基因相关肽阳性神经纤维在人颞下颌关节的分布。方法 :利用免疫组化技术 ,观察正常成人 12人 ( 12侧 )颞下颌关节新鲜组织中 ,降钙素基因相关肽阳性神经纤维在关节的盘周附着和关节囊的内、外、前、后壁及关节盘中央的分布 ,并比较各个区神经纤维密度的异同。结果 :除关节盘中央外 ,关节囊及盘周组织均有丰富的降钙素基因相关肽阳性神经纤维 ,其中各个区密度分别是 :前部盘周附着和关节囊 ( 4 48.7± 78.5 )mm2 、后部 ( 4 2 6.7± 5 5 .9)mm2 、内侧 ( 2 0 5 .2± 3 9.9)mm2 、外侧 ( 2 95 .0± 3 6.6)mm2 。结论 :降钙素基因相关肽阳性神经纤维广泛分布于颞下颌关节软组织中 ,是感觉神经的一部分。     

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.     

Cytokines in temporomandibular joint arthritis

As the article in the current issue by Shinoda and colleagues shows, during the last two decades, there has been a dramatic increase in the understanding of basic biology behind chronic temporomandibular joint (TMJ) pain, inflammation and destruction. The involvement and contribution of cytokines to TMJ pain and inflammation must now be considered as established, evident and fundamental. Based on the present knowledge, it is now possible to design and investigate novel therapeutic strategies. These new and very encouraging approaches include manipulation of cytokine function, immune reactivity and the behaviour of inflammatory cells while maintaining the integrity of the affected tissue.     

关节镜辅助治疗陈旧性颞下颌关节脱位临床疗效研究

目的探讨借助关节镜采用微创的方法治疗陈旧性颞下颌关节脱位的临床价值。方法对2007年3月至2011年5月在中国医科大学口腔医学院口腔颌面外科手术治疗的19例陈旧性颞下颌关节脱位患者,按就诊顺序随机分为A、B两组,A组(10例)采用关节镜辅助微创手术治疗,B组(9例)采用传统的开放性手术治疗。通过术后随访及问卷调查来评价关节镜在治疗陈旧性颞下颌关节脱位的应用价值。结果经过术后6个月至2年的随访发现,两组患者在面瘫、颞下颌关节紊乱病(TMD)的发生率以及创口预后满意度和疼痛程度方面差异有统计学意义(P<0.05),在复发方面差异无统计学意义(P>0.05);关节镜辅助治疗组术后满意度高于传统手术组,而并发症远远低于传统手术组。结论关节镜辅助治疗陈旧性颞下颌关节脱位的方法安全可行。因其创伤小,并发症少,更适用于高龄患者。     

Distribution of substance P-like immunoreactive nerve fibers in temporomandibular joint soft tissues of monkey

Abstract — The distribution of substance P-immunareactive and silver impregnated nerve fibers in the temporomandibular joint soft tissues of the Macaca fascicularis monkey was investigated in frozen sections. The pattern of substance P-immunoreactive structures in the soft tissues and periosteum of the temporomandibular joint was compared with the distribution of silver impregnated nerve fibers within these tissues. Presence of substance P-immunoreactive fibers was demonstrated in the temporomandibular joint capsule, disc attachments, fascia, adjacent periosteum and within the interfascicular connective tissue of the lateral pterygoid muscle. The overall distribution corresponded to that of silver impregnated nerve fibers. Substance P-immunoreactive nerve fibers were found in the adventitia of arteries in all vascularized temporomandibular joint soft tissues but could not be found in the adventitia of veins. No substance P-immunoreactive or silver impregnated nerve fibers were seen in the dense collagenous tissue forming the disc. Substance P is suggested to influence the major features of inflammation and to play a role in acute and chronic pain conditions.     

Management of temporomandibular joint arthritis in children and adolescents: An introduction for orthodontists

Juvenile idiopathic arthritis (JIA) is the most common inflammatory rheumatic disease of childhood. JIA can affect any joint and the temporomandibular joint (TMJ) is one of the joints most frequently involved. TMJ arthritis impacts mandibular growth and development and can result in skeletal deformity (convex profile and facial asymmetry), and malocclusion. Furthermore, when TMJs are affected, patients may present with pain at joint and masticatory muscles and dysfunction with crepitus and limited jaw movement. This review aims to describe the role of orthodontists in the management of patients with JIA and TMJ involvement. This article is an overview of evidence for the diagnosis and treatment of patients with JIA and TMJ involvement. Screening for the orofacial manifestation of JIA is important for orthodontists to identify TMJ involvement and related dentofacial deformity. The treatment protocol of JIA with TMJ involvement requires an interdisciplinary collaboration including orthopaedic/orthodontic treatment and surgical interventions for the management of growth disturbances. Orthodontists are also involved in the management of orofacial signs and symptoms; behavioural therapy, physiotherapy and occlusal splints are the suggested treatments. Patients with TMJ arthritis require specific expertise from an interdisciplinary team with members knowledgeable in JIA care. Since disorders of mandibular growth often appear during childhood, the orthodontist could be the first clinician to see the patient and can play a crucial role in the diagnosis and management of JIA patients with TMJ involvement.     

颞下颌关节脱位手术治疗的回顾性研究

目的 回顾分析颞下颌关节脱位的手术治疗病例,评价其治疗效果。方法 选择2012年5月—2016年4月间收治的颞下颌关节脱位患者17例,包括陈旧性脱位（ID）8例和习惯性脱位（RD）9例。分别进行关节镜下滑膜下硬化剂注射术5例9侧,钛板植入关节结节增高术7例12侧,髂骨移植关节结节增高术1例1侧,Medpore植入关节结节增高术3例6侧,关节结节切除术1例2侧。术后1~5年随访,统计各手术方法的成功率。结果 关节镜下滑膜硬化术的治愈率为 77.8%（7/9）,有效率100%;钛板植入关节结节增高术治愈率75%（9/12）,有效率100%;Medpore植入关节结节增高术的治愈率为100%（6/6）,髂骨移植关节结节增高术和关节结节切除术均治愈（1/1,2/2）。结论 应根据病情轻重来选择术式,对手术后复发者可选用Medpore植入关节结节增高术,该术式疗效确切,创伤相对较小、操作较简单。     

牙周炎患者龈沟液中P物质和降钙素基因相关肽的变化

目的：测定正常人和重度牙周炎患者龈沟液中神经肽P物质和降钙素基因相关肽，以了解两种神经肽与牙周炎的关系。方法：应用放射免疫技术测定正常对照组、广泛型重度牙周炎、局限型重度牙周炎患者正常部位、牙周炎部位龈沟液中神经肽P物质和降钙素基因相关肽的含量，并计算出其浓度。结果：龈沟液中P物质的含量和浓度在四组间均有显著差异，而牙周炎部位的降钙素基因相关肽与牙周健康部位相比，检出率明显下降，有统计学意义。结论：神经肽如P物质、降钙素基因相关肽与牙周炎的发生及发展可能有一定的关系。     

咬合重建对大鼠三叉神经节降钙素基因相关肽表达影响的研究

目的：研究咬合重建对大鼠三叉神经节降钙素基因相关肽（calcitonin gene—related peptide,CGRP）表达的影响。方法：Wistar雄性大鼠30只,随机分为3个实验组及相应的正常对照组,每组5只。实验组动物间断磨除右侧上、下颌磨牙牙冠至龈下,有二组分别于第3周、第9周停止磨牙,任其自行萌出,恢复咬合关系。双侧三叉神经节（trigeminal ganglia,TG）切片行CGRP免疫组化染色（SABC法）。光镜观察,并用Image Pro Plus 5．1图像分析软件进行测定。结果与对照组比较。进行统计学分析。结果：单侧咀嚼实验组咀嚼侧和非咀嚼侧TG内CGRP免疫阳性神经元百分比与对照组比较显著降低（p〈0．01,p〈0．05）,非咀嚼侧明显低于咀嚼侧（p〈0．01）。早期恢复咬合实验组TG内免疫阳性神经元百分比与对照组比较无差异（p〉0．05）,咀嚼侧与非咀嚼侧比较无差异（P〉0．05）。晚期恢复咬合实验组TG内免疫阳性神经元百分比与对照组比较显著降低（p〈0．01,p〈0．05）,非咀嚼侧明显低于咀嚼侧（p〈0．05）。结论：早期恢复咬合关系,TG内CGRP表达可恢复正常,晚期恢复咬合关系,CGRP表达不能恢复正常,CGRP参与了单侧咀嚼引起的颞颌关节病的病理变化过程。     

Deficient cytokine control modulates temporomandibular joint pain in rheumatoid arthritis

The aim was to investigate how endogenous cytokine control of tumor necrosis factor (TNF) influences temporomandibular joint (TMJ) pain in relation to the role of anti‐citrullinated peptide antibodies (ACPA) in patients with rheumatoid arthritis (RA). Twenty‐six consecutive patients with TMJ RA were included. Temporomandibular joint pain intensity was assessed at rest, on maximum mouth opening, on chewing, and on palpation. Mandibular movement capacity and degree of anterior open bite (a clinical sign of structural destruction of TMJ tissues) were also assessed. Systemic inflammatory activity was assessed using the Disease Activity Score in 28 joints (DAS28) for rheumatoid arthritis. Samples of TMJ synovial fluid and blood were obtained and analyzed for TNF, its soluble receptor, soluble TNF receptor II (TNFsRII), and ACPA. A high concentration of TNF in relation to the concentration of TNFsRII in TMJ synovial fluid was associated with TMJ pain on posterior palpation on maximum mouth opening. The ACPA concentration correlated significantly to the TNF concentration, but not to the TNFsRII concentration, indicating that increased inflammatory activity is mainly caused by an insufficient increase in anti‐inflammatory mediators. This study indicates that TMJ pain on palpation in patients with RA is related to a deficiency in local cytokine control that contributes to increased inflammatory activity, including sensitization to mechanical stimuli over the TMJ.     

Neuropeptides in temporomandibular joints with rheumatoid arthritis: a clinical study

Abstract— There is evidence that neuropeptides play a role in the development of arthritis. Synovial fluid from arthritic temporomandibular joints in patients with rheumatoid arthritis was therefore investigated for presence of the neuropeptides calcitonin gene-related peptide, substance P, neurokinin A and neuropeptide Y. All four peptides were found in the synovial fluid above plasma level, but calcitonin gene-related peptide showed the highest concentration and substance P the lowest.     

Salivary gland and temporomandibular joint involvement in rheumatoid arthritis: relation to disease activity

OBJECTIVES: To study temporomandibular joint (TMJ) involvement, salivary gland dysfunction and oral mucosal lesions in rheumatoid arthritis (RA), and to investigate the relationship to general disease activity. SUBJECTS AND METHODS: The TMJ dysfunction index (D(i)), mean salivary flow and disease activity score (DAS28), were calculated for 50 RA-patients, and 23 non-RA patients (controls). RESULTS: Median D(i) was 5.5 (range: 0-21) for the RA-patients compared with 2.0 (range: 0-9) for the controls (P < 0.0001). Pain on movement of the TMJ (P = 0.015), muscular pain (P = 0.006), TMJ pain (P = 0.019) and D(i) as a total (P = 0.009), significantly correlated with DAS28. Mean resting whole saliva (RWS) flow was 2.6 (s.d. 2.4) ml per 15 min for the RA-patients and 4.5 (s.d. 3.0) for the controls (P = 0.003). RWS correlated positively with haemoglobin (P = 0.021) and negatively with Westergren erythrocyte sedimentation rate (ESR) (P = 0.029). No major differences in frequency of oral mucosal lesions were seen between RA-patients and controls. CONCLUSIONS: Higher frequency of TMJ and salivary gland dysfunction in RA-patients compared with controls has been demonstrated. RA disease activity is associated with hyposalivation and TMJ dysfunction.     

Quantitative analysis of substance P, neurokinin A and calcitonin gene-related peptide in pulp tissue from painful and healthy human teeth

AIM: The purpose of this study was to investigate the levels of substance P (SP), neurokinin A (NKA) and calcitonin gene-related peptide (CGRP) in painful and healthy human dental pulps. METHODOLOGY: Forty-six samples of pulp tissue were collected from extracted or endodontically treated painful teeth and 20 from clinically healthy teeth extracted for orthodontic reasons. All pulp samples were boiled in 0.5 m acetic acid for 10 min, centrifuged and the supernatant collected. SP, NKA and CGRP levels were measured using radioimmunoassay. RESULTS: Substance P and CGRP were present in all samples and NKA was detected in 96% of the pulps. CGRP was present in much higher concentrations than SP and NKA in both painful and non-painful teeth. The painful teeth had significantly higher concentrations of SP (P = 0.02), NKA (P < 0.001) and CGRP (P = 0.03) than non-painful teeth. The concentration of CGRP was significantly higher in the pulps of smokers compared with non-smokers (P = 0.02). CONCLUSIONS: Elevated levels of these neuropeptides in pulps from painful teeth indicate that they may play an important role in the process of pulpal inflammation and pain. Further investigation of the association between these neuropeptides and pulpal status may help to improve our understanding of pulpal inflammation and dental pain.     

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颞下颌关节强直是口腔颌面部一类严重的疾病,其临床分型主要依据颞下颌关节骨性融合情况及其周围附属结构受累情况而定。临床针对颞下颌关节强直的治疗主要以手术为主,术后加以功能训练。外科手术治疗颞下颌关节强直的主要途径可以概括为以下三方面：解除关节强直的解剖因素;恢复或重建关节基本结构;对继发畸形的治疗。目前针对以上三方面的多种治疗手段各有利弊,本文将对近年来常用的手术治疗方法予以分类介绍。     

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目的观察采用下颌升支垂直截骨上推术治疗真性颞颌关节强直的疗效。方法对2004年12月至2008年5月山西医科大学第一临床医院口腔颌面外科收治的19例真性颞颌关节强直患者采用下颌升支垂直截骨上推术治疗,并按期随诊,监测指标,观察其疗效。结果所有患者张口度均接近或达到正常,无关节疼痛及弹响症状,随访期内无一例复发。结论根据国内外文献及术后观察,下颌升支垂直截骨上推术是治疗真性颞颌关节强直的一种可选择的、有效的方法。     

Histologic evaluation of temporomandibular arthritis induced by mild mechanical loading in rabbits

BACKGROUND: We still lack knowledge of causative factors in arthritis related to temporomandibular disorders (TMD). The goal of the present study was to investigate whether applying a mechanical loading on the glenoid fossa can induce arthritis. METHODS: Coil springs were placed in 24 rabbits so as to exert a force of 100 g between the orbital edge and the antegonial notch. At 1, 2, 4 and 8 weeks after the surgery, six samples of the temporomandibular joint (TMJ) were removed for histologic examination. RESULTS: The results showed that mild synovitis began 1-2 weeks after the start of loading, and the degree of synovitis was significant at 4 weeks, and that morphologic changes occurred in the articular eminence and condyle, while type II collagen in the cartilage of the articular eminence degraded prior to that in the condyle. CONCLUSIONS: Our results revealed that mild, continuous mechanical loading to the glenoid fossa induces synovitis of the articular capsule, and induces organic changes of the articular cartilage without destroying these tissues.