过度张口颞颌关节软组织前列腺素E2的分泌及变化

为了深入认识过度张口对颞颌关节（ＴＭＪ）的损伤特点及其发病机制，运用免疫组化法对过度张口动物模型ＴＭＪ软组织前列腺素Ｅ２（ＰＧＥ２）的分泌及变化进行了观察。结果表明，过度张口ＴＭＪ软组织ＰＧＥ２免疫阳性反应主要发生在盘周组织中的肌肉附丽部、血管壁和滑膜组织，以盘周肌肉最为显著。由此提示盘周肌肉对过度张口刺激最敏感，可视为其最易受损部位。该文还对盘周组织中的神经纤维和关节盘中纤维母细胞的阳性反应进行了初步探讨。     

过度张口对颞下颌关节及咀嚼肌影响的组织病理学实验

本研究的目的在于探讨过度张口对颞下颌关节（ｔｅｍｐｏｒｏｍａｎｄｉｂｕｌａｒｊｏｉｎｔ，ＴＭＪ）和咀嚼肌的影响及其致病性。实验采用开口器造成小型猪的过度张口，首次建立了过度张口的动物模型并对其ＴＭＪ和咀嚼肌进行了组织病理学观察和研究。结果显示，过度张口可导致ＴＭＪ和咀嚼肌的损伤、增生、萎缩及退行性变且随过度张口次数和时间的增加而渐重。其中以髁突关节软骨，关节盘前后带及前伸部，翼外肌和颞肌较显著。本实验结果说明过度张口为颅颌紊乱症的致病因素之一，对该病的临床诊治和预防均有参考价值     

颞下颌关节软组织损伤的诊断和治疗──附280例临床分析

对颞下颌关节软组织损伤２８０例进行了总结分析,这类损伤性病变是ＴＭＪＤＳ的一种特殊类型,发生率占ＴＭＪＤＳ病人的１０．４２％,由外伤（如拳击伤、跌伤等）或内因性损伤（如咬硬物、大张口及咬合异常等）引起,主要病变为关节囊和韧带损伤、关节盘伸展过度或关节扭伤,临床表现主要是颞下颌关节区疼痛和张口受限。介绍了各种治疗方法,其中髁突颈部封闭法有显著疗效。对颞下颌关节软组织损伤的诊断和鉴别诊断、颞下颌关节解剖结构特点与损伤的关系等进行了讨论。     

大鼠多发性关节炎时期颞下颌关节的组织病理学研究

目的 观察大鼠多发性关节炎（ｐｏｌｙａｒｔｈｒｉｔｉｓ，ＰＡ）早期颞下颌关节（ｔｅｍｐｏｒｏｍａｎｄｉｂｕｌａｒ ｊｏｉｎｔ，ＴＭＪ）的组织病理学变化，为研究类风湿关节炎（ｒｈｅｕｍａｔｏｉｄ ａｒｔｈｒｉｔｉｓ，ＲＡ）早期对ＴＭＪ的影响提供实验依据。方法 用福氏完全佐剂建立大鼠ＰＡ模型，观察其踝关节和ＴＭＪ的组织病理学变化。结果 ①大鼠ＰＡ时，踝关节体积显著增大，关节指数明显增高；踝关节滑膜组织     

咬合与颞下颌关节功能紊乱综合征

何谓颞下颌关节［功能］紊乱综合征（ｔｅｍｐｅｒｏｍａｎｄｉｂｕｌａｒｊｏｉｎｔｄｙｓｆｕｎｃｔｉｏｎｓｙｎｄｒｏｍｅ，ＴＭＪＤＳ）？人在张口运动中感觉到：张口受限、或过大、或偏向一侧（左或右）；颞下颌关节弹响；疼痛（ＴＭＪ局部或颌面部肌肉）；只要有...     

髁突运动异常的曲面断层观察

为研究髁突的运动度，用曲面断层张、闭口片对１４４例颞下颌关节紊乱综合征（ｔｅｍｐｏｒｏ－ｍａｎｄｉｂｕｌａｒｊｏｉｎｔｄｉｓｔｕｒｂａｎｃｅｓｙｎｄｒｏｍｅ，ＴＭＪＤＳ）患者的髁突与关节结节之间的位置关系进行分析。根据髁突与关节结节的关系及双侧运动是否一致将髁突的运动度分为６型，并对各型的性别与年龄组成、张口度与张口型、弹响与疼痛情况、病程及骨质改变进行了分析。结果说明下颌过大运动所造成的关节结构及下颌肌肉、韧带的急性损伤是产生ＴＭＪＤＳ的主要原因之一。     

合夹板对术后颞下颌关节修复改建作用的病理学研究

通过对恒河猴颞下颌关节（ＴＭＪ）重建术后的组织病理学观察，发现术后戴用夹板组的ＴＭＪ修复改建明显优于未戴夹板组者，提示夹板在ＴＭＪ术后的及时应用，有助于关节的修复改建。作者认为，夹板的应用平衡了双侧肌力，消除了手术造成的紊乱，减轻了术侧ＴＭＪ的压力，使关节在适当的机械生物压力刺激下得以修复改建。而关节下腔的保留，有效地防止了关节盘的继发性损伤，为ＴＭＪ器质性疾病手术后的进一步治疗提供了有利条件。     

颞下颌关节紊乱综合征患者关节液中前列腺素E_2的研究

前列腺素Ｅ２（ＰＧＥ２）是与颞下颌关节紊乱综合征（ＴＭＪＤＳ）相关的主要炎症介质。本研究选用临床上诊断为ＴＭＪＤＳ患者３０例，正常对照组５例，采用放射免疫法检测ＴＭＪ关节液中ＰＧ２水平，并经统计学处理。结果表明：ＴＭＪＤＳ患者关节液中ＰＧＥ２水平明显高于正常对照组，并且ＰＧＥ２的水平与ＴＭＪＤＳ病变程度密切相关。提示ＰＧＥ２在ＴＭＪＤＳ的发生、发展中起重要作用。     

常见颞颌关节紊乱综合征的正畸治疗

正畸治疗是去除牙位、颌位异常的错Ｈｅ所致颞颌关节紊乱综合征（ＴＭＪＤＳ）的有效而稳定的方法。作者通过对经治的８０例患者加以分析，探讨了正畸患者ＴＭＪＤＳ的特点及所采用的正畸治疗方法。８０例患者的平均年龄为１６．８岁，男女性别比４：６。其中，毛氏Ⅰ＾１患者最多，共５６例；关节症状以弹响多见，其次为张口受限、夜磨牙、关节脱位等。关节开闭口片见：３０例开闭口片见：３０例关节间隙有改变，２０列关节凹和关节     

咬合创伤对颞颌关节软组织P物质样免疫反应的影响

为了探讨咬合创伤在颅颌紊乱症发生及发展中的生化机制，作者首次运用免疫组化技术观察小型猪正常时颞颌关节（ＴＭＪ）软组织Ｐ物质（ＳＰ）样免疫阳性反应的分布及其在咬合创伤时的反应变化。结果显示，除关节盘中带中部外，ＴＭＪ软组织各部均有ＳＰ样阳性反应分布，其中以关节盘周围为多，滑膜表层较少。咬合创伤时ＴＭＪ软组织中ＳＰ样免疫阳性反应增强，盘周附着组织中最为显著，滑膜组织也较明显。去除咬合创伤后ＳＰ样阳性反应明显减弱。提示盘周附着和滑膜组织对咬合创伤较敏感，由此引起的ＴＭＪ炎症和疼痛有ＳＰ的参与机制。     

Veterinary and radiological evaluations of open and closed treatment of type B diacapitular (intracapsular) fractures of the mandibular condyle in sheep

The incidence of diacapitular (intracapsular) fractures of the mandibular condyle has increased in recent years, but their treatment remains inadequate, particularly of type B fractures. To evaluate and compare outcomes of open and closed treatments we created a sheep model of a type B fracture through an osteotomy. Eight sheep were randomly divided into two groups of four each to be given closed treatment or open reduction and internal fixation (ORIF) and were evaluated by veterinary and radiological examinations. Compared with before the osteotomy, there were significant reductions in maximum mouth opening (MMO) and left movement in the closed group, but no significant differences in the range of jaw movements in the ORIF group after 12 weeks of treatment. The two radiological scores that indicated the degree of osteoarthrotic changes and ankylosis of the temporomandibular joint (TMJ) in the ORIF group were significantly lower than those in the closed group. Anatomical observation confirmed the pathological changes in the right TMJ in the closed group and adaptive changes in the ORIF group. We conclude that ORIF is more efficient than closed treatment in restoring the function and shape of the TMJ to after a type B diacapitular condylar fracture.     

Clinical signs of temporomandibular joint internal derangement in adults. An epidemiologic study.

This study investigated the frequency and distribution of clinical signs of temporomandibular joint (TMJ) internal derangement in an adult non-TMJ patient population. Four hundred three persons who participated in an epidemiologic investigation were examined for clinical signs of TMJ internal derangement by four examiners who followed a standardized form. Clinical signs of internal derangement were found in 76 persons (19%). Twenty-nine persons (7%) had reciprocal clicking and 47 (12%) had a history of clicking replaced by limitation of mouth opening with deviation to the affected side. Reciprocal clicking was associated with TMJ pain during mouth opening and with limitation of jaw movement. A history of clicking replaced by limitation of mouth opening with deviation to the affected side was associated with pain during mouth opening, limitation of opening, and palpatory tenderness of the TMJ. The study indicates that clinical signs of TMJ internal derangement are present in nearly one fifth of non-TMJ patients. Those with clinical signs of internal derangement frequently also have subjective symptoms but they have not sought treatment for these symptoms.     

Expression of heat shock protein 27 (HSP27) in human temporomandibular joint discs of patients with internal derangement

Heat shock proteins (HSPs) are believed to represent a cellular stress response mechanism that protects intracellular proteins from damaging events. Some studies have demonstrated an enhanced expression of large-molecular-weight HSPs in diseased systematic joints. Small heat shock proteins, and among these HSP27, have been studied to a lesser extent. HSP27 has cytoprotective and biosynthetic functions within chondrocytes, and it is an estrogen-associated protein that is under hormonal modulation. To improve understanding at a molecular level of the pathophysiology of certain temporomandibular joint disorders, the authors carried out this immunohistochemical study to assess the presence of HSP27 in human TMJ discs. Twelve adult human TMJ discs (10 diseased and 2 healthy discs) and 5 TMJ fetal human discs were used in this study. Adult discs and TMJ tissues of human fetuses were fixed in 10% buffered formalin. Samples were then processed for histologic examination. Sections were immunohistochemically stained using the streptavidin-biotin detection method. No reaction product for HSP27 in the discs of fetuses was noted. HSP27 was weakly expressed in normal TMJ discs and highly up-regulated in discs of patients showing new vessel formation and chondroid metaplasia. Any correlation between gender and HSP27 was found in the sample, being the up-regulation of HSP27 related mostly to major histopathological changes. This different pattern of HSP27 immunostaining in human TMJ discs detected in the authors' specimens suggests that the expression of this small HSP is functionally modulated. In fact HSP27 up-regulates in internal derangement specimens with major histopathological changes; on the other hand, it is not expressed or only weakly expressed in TMJ discs of fetuses and normal TMJ discs.     

透明质酸钠治疗颞下颌关节绞锁的临床研究

目的探讨透明质酸钠在治疗颞下颌关节绞锁中的应用,对治疗效果进行评价。方法对颞下颌关节结构紊乱引起的颞下颌关节绞锁的36例患者（36侧关节）,采用关节上腔注射方法,注入透明质酸钠。通过测量患者治疗前后的张口度、侧向运动度以及关节区绞锁的数据化测定,判定临床疗效。结果32例患者张口度明显改善,达正常水平,仅有4例患者疗效不理想。治疗前后张口度、侧向运动度以及绞锁的数据化测定值均有显著差异（P〈0．001）。结论颞下颌关节上腔注射透明质酸钠能有效治疗因颞下颌关节绞锁出现的临床症状,该方法操作简单,便于推广。     

大鼠多发性关节炎早期颞下颌关节的组织病理学研究

目的　观察大鼠多发性关节炎 (polyarthritis,PA)早期颞下颌关节 (temporomandibularjoint,TMJ)的组织病理学变化 ,为研究类风湿关节炎 (rheumatoidarthritis,RA)早期对TMJ的影响提供实验依据。方法　用福氏完全佐剂建立大鼠PA模型 ,观察其踝关节和TMJ的组织病理学变化。结果　①大鼠PA时 ,踝关节体积显著增大 ,关节指数明显增高 ;踝关节滑膜组织增生 ,炎性细胞浸润 ,关节软骨及骨质受侵蚀 ,关节腔炎性渗出明显。②大鼠PA时 ,双侧TMJ均可见滑膜细胞显著增生 ;髁突表层胶元纤维松解 ,软骨细胞变性 ;关节腔可见蛋白渗出 ,细胞脱落 ,局部呈纤维性粘连。结论　大鼠PA早期双侧TMJ即有明显的炎性病变。建议临床医生对RA患者应注意其TMJ的早期检查与防治     

Jacob's disease associated with temporomandibular joint dysfunction: a case report

Jacob's disease is regarded a rare condition in which a joint formation is established between an enlarged mandibular coronoid process and the inner aspect of the zygomatic body. Chronic temporomandibular joint (TMJ) disk displacement has been proposed as etiological factor of coronoid process enlargement. We present a 23-year-old woman with long-standing TMJ dysfunction and restricted interincisal opening, who developed a progressive zygomatic asymmetry. The patient underwent treatment by intraoral coronoidectomy and homolateral TMJ arthroscopy in the same surgery. The histopathological diagnosis of the coronoid sample was cartilage-capped exostoses with presence of articular fibrous cartilage. Although the low prevalence of this entity, it should be considered as a possible diagnosis in patients with progressive limitation of mouth opening, although a TMJ syndrome may be present as a cause of this entity.     

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 expression of substance P in human temporomandibular joint samples: an immunohistochemical study

The expression of neuropeptide substance P was examined in 18 human temporomandibular joint (TMJ) samples with internal derangement of the TMJ, and in 10 control specimens. The examination was carried out using an immunohistological technique, using paraffin-embedded tissue and specific anti-human substance P polyclonal antibody. We noted five characteristic distribution patterns of substance P expression: at the nerves' fibre bundles in the connective tissues of the anterior and/or posterior attachment; around the blood vessels in the attachments; at the margin of the TMJ disc and synovial membrane layer; on the surface of hypertrophic synovial membranes with inflammation and proliferation; and around the newly formed capillaries in the TMJ discs. In TMJs with internal derangement associated with severe pain, we found distinct substance P expression in most of the specimens. The expression was particularly intense at the margin of the TMJ disc and synovial membrane layer, on the surface of hypertrophic synovial membranes and around the newly formed capillaries in the TMJ discs. The clinical symptoms of internal derangement of the TMJ are thought to be associated with the degree of synovitis. We conclude that the expression of substance P seems to be closely related to histopathological changes of the human TMJ with internal derangement.     

JOINT DISORDER: NONREDUCING DISC DISPLACEMENT WITH MOUTH OPENING LIMITATION – REPORT OF A CASE

The internal derangement of the temporomandibular joint (TMJ) represents 8% of all cases of temporomandibular disorders (TMD) posing difficulties to establish an accurate diagnosis and treatment because of its low prevalence. This article presents the case of an 18-year-old Caucasian female patient who came to our Orofacial Pain and TMD Outpatient Service with complaints of intense pain on the right TMJ and limitation of mouth opening (maximum interincisal opening of 29 mm) with deviation to right, which she had been experiencing for the past 3 years. After a detailed clinical interview, a diagnosis hypothesis of nonreducing disc displacement with mouth opening limitation was established. The proposed treatment consisted of intra-joint infiltration with anesthetic in the right TMJ followed by jaw manipulation to recapture the articular disc, which was impeding the complete translation movement of the affected TMJ. After jaw manipulation, a new evaluation was done and showed the re-establishment of jaw dynamics with mouth opening and closing without deviation to the right side, clicking, opening limitation or pain. The patient was followed up at 6 months intervals. Two years after treatment, the patient was reevaluated and her mandibular range of motion without aid increased to 54 mm with no clicking, deviation to right, trismus or pain on the TMJ, indicating success of the treatment approach without recurrence of the pathology.