Meniscopexy for Internal Derangement of Temporomandibular Joint

The term internal derangement was first adopted to describe any pathologic entity that interfered with the smooth function of the temporomandibular joint (TMJ). The term is currently used exclusively to describe alterations in disc–fossa relations. Internal derangement of the TMJ does not always cause pain, although when the disc becomes displaced, noises and locking can occur and ligamentous, capsular or retrodiscal pain may dominate the clinical picture. Meniscopexy of TMJ was done in ten patients where clinical features suggest true internal derangement of the TMJ refractory to conservative treatment with restricted movement and pain identified as arising primarily from the joint. Magnetic resonance imaging was done to identify the cause of problem.     

颞下颌关节内紊乱与关节疼痛关系的研究

目的 :探讨TMJ疼痛与TMJID的关系。方法 :对 4 4例单侧关节疼痛TMD患者 88侧关节完成开闭口斜矢状位PDW成像 ,以非疼痛侧盘突关系做自身对照 ,评价关节疼痛与TMJID的关系。结果 :4 4个疼痛关节中 ,30个关节 (6 8.2 % )表现为TMJID ,其中ADDR为 11个关节 (2 5 % ) ,ADDWR为 19个关节 (4 3.2 % ) ;而 4 4个非疼痛关节中 6个关节 (13.6 % )表现为ADDR。经统计学分析 ,TMJ疼痛与TMJID及TMJID的类型有显著相关性 (P <0 .0 0 5 )。结论 :TMJID是颞下颌关节疼痛的原因之一     

Pterygoid Disjunction for Internal Derangement of Temporomandibular Joint

Aim  

The aim of this study was to clinically evaluate the outcomes of pterygoid disjunction (PD) carried out as the primary treatment modality for reducing disc displacement type of internal derangement (ID) of temporomandibular joint (TMJ) refractory to conservative management and arthrocentesis.     

Body Posture Evaluations In Subjects with Internal Temporomandibular Joint Derangement

Abstract

The aim of this study was to verify possible relationships between global body posture and temporomandibular joint internal derangement (TMJ-id), by comparing 30 subjects presenting typical TMJ-id signs to 20 healthy subjects. Body posture was assessed using the analysis of muscle chains on several photographs. Results show a higher frequency of lifted shoulders (p=0.04) and of changes in the antero-internal hip chain (p=0.02) in the test group, but no further differences were found significant between the control and test groups. The test group was then divided into three subgroups according to the Helkimo index of temporomandibular disorder severity. Again, no significant differences were found between the subgroups. However, there was a trend noticed in the group with the most severe dysfunction, to present a forward head and shoulders posture. Results are discussed in light of previous studies using the same sample.     

Arthrocentesis for the Treatment of Internal Derangement of the Temporomandibular Joint

Objective  

The study aims to evaluate the efficacy of arthrocentesis in the treatment of internal derangement of the temporomandibular joint (TMJ).     

Temporomandibular Joint Arthrocentesis for Internal Derangement with Disc Displacement Without Reduction

Temporomandibular joint (TMJ) disc derangement is defined as a malpositioning of the articular disc relative to the condyle and eminence. Arthrocentesis of the TMJ is a minimally invasive chair side procedure for the patients with TMJ internal derangement. This case report presents convincing results to keep arthrocentesis as an imperative procedure to relieve such patients of their acute symptoms. TMJ dynamics has also been discussed for an in-depth understanding of the pathology in cases with internal derangement.     

The Entrapped Greater Occipital Nerve and Internal Derangement of the Temporomandibular Joint

The general dentist is frequently overwhelmed with the abundance of new information, varying techniques, and divergent philosophies concerning internal derangements of the temporomandibular joint. Diagnosing an entrapped greater occipital nerve in connection with internal derangement will actually relieve the practitioner of some of the difficulties of treatment. Referring the patient to an appropriate medical specialist will assure that he or she receives a thorough examination, diagnosis, and treatment not only of the entrapped nerve, but also of any trismus and trigger points present in the area of the nerve. When this additional expertise is combined with the dentist's derangement treatment, it will provide a much more rapid resolution of the patient's symptoms.     

髁突髓腔信号异常与颞下颌关节内紊乱关系的研究

目的探讨裸突髓腔信号异常与颗下领关节内紊乱(In印D)的关系。方法利用核磁共振成像(MRI ),对 44例颜下领关节紊乱病(TMD)患者88侧关节完成开闭口T1、闭口位T2加权成像,判定TMD患者的盘突关系及髓腔信号变化。结果TMD患者14.8%(13/88)表现髓腔信号异常,水肿型为II个关节,硬化型及混合型各1个关节,84.6%(11/13)存在TMJID;而75个髓腔信号正常关节中,33.3%(25/75)存在TMJID;髓腔信号异常与TMAD有显著相关性(P < 0.05)。结论关节盘移位是导致髓腔信号异常的原因之一。     

Symptoms of Temporomandibular Joint Osteoarthrosis and Internal Derangement 30 Years After Non-Surgical Treatment

To evaluate the long-term condition of temporomandibular joints (TMJs) affected by osteoarthrosis and internal derangement, 99 patients treated non-surgically between 1958 and 1962 were recalled for follow-up. The patients, 16 men and 83 women (mean age 58.2 years) with either reducing or permanent disk displacement, were submitted to a structured interview concerning previous treatment, masticatory function, and the presence of symptoms of osteoarthrosis and internal derangement of the masticatory system, and of complaints of the musculoskeletal system in general. A control group, consisting of eight men and 27 women (mean age 58.9 years) without complaints of the masticatory system, matching the patient group for sex, age and state of dentition, was included in the study to avoid simply documenting age-related joint conditions. Satisfaction with the treatment outcome was high. Chewing ability of the patients did not differ from that of the controls, although patients more often expected pain and difficulty with opening the mouth wide. The main TMJ symptoms of the patients had decreased significantly; patients reported joint noises more often than controls. It is concluded that, despite some persisting symptoms, the non-surgical treatment approach of TMJ osteoarthrosis and internal derangement provides long-lasting satisfactory subjective results and is well-accepted by the patients.     

兔盘前移颞下颌关节的髁突软骨细胞中SOX9和MMP12的表达

目的 :研究Sox9基因、基质金属蛋白酶基因12(MMP12)在兔盘前移颞下颌关节的髁突软骨细胞中时空表达变化。方法:60只日本大耳白兔随机分为5组(对照组,1、2、4、8周组;每组12只),分别在颞下颌关节盘前移位建模后的1、2、4、8周处死,取出髁突软骨并将关节部位制成组织芯片,利用DNA微阵列技术、实时荧光定量PCR、免疫组化技术和IPP图像处理技术观察不同组内髁突软骨中Sox9、MMP12表达。结果:基因检测和rt PCR验证结果基本一致,显示为MMP12的表达在第1周达到最高值,之后随建模时间递减,在第8周达到最小值(表达下降),Sox9的表达第1周较低,随后略有上升,在第2、4、8周分别检测到其表达上升并存在统计学差异。结论:MMP12和Sox9同为骨性表达相关因子,在盘前移位颞下颌关节中,MMP12主要参与早期骨溶解破坏、炎症反应,Sox9主要参与后期软骨的修复重建。     

Synovial Chondromatosis of the Temporomandibular Joint

The dental profession's growing interest in the recognition, diagnosis, and treatment of TMJ disorders makes it important that clinicians be acquainted with synovial chondromatosis. Although it is rare in the temporomandibular joint, an increasing number of cases are being recorded. This article reports on a patient with this disease and looks at the radiological, surgical, and histologic findings. A review of the literature on this subject is also presented.

Trauma to the TM joint will cause displaced discal joint tissue to degenerate and remodel itself. We suggest that trauma in the retrodiscal zone may be a cause of metaplastic changes in the area, which can lead to synovial chondromatosis. For this reason, it is important that the clinician be aware of this disease and its pathogenesis to aid in detecting and possibly even preventing it.     

Superficial Vascularity of Temporomandibular Joint Retrodiskal Tissue: An Element of the Internal Derangement Process

Superficial vascular changes in the retrodiskal tissue are an aspect of the remodeling process during progressive anterior displacement of the temporomandibular joint (TMJ) disk. The salient portion of the remodeled retrodiskal tissue (RRT) is contained in a 3 x 3 grid of arthroscopic fields in the superior joint space, plus the tympanic portion of the remodeled retrodiskal tissue. A four-level vascularity classification system gives a statistically significant association between superficial avascularity of the remodeled retrodiskal tissue and progressive stages of disk derangement. In particular, simultaneous avascularity in both the tympanic remodeled retrodiskal tissue and the central arthroscopic field occurs with severe disk displacement without reduction. Analyses are based on 16 microscopic studies, 25 magnetic resonance imaging and tomographic imaging studies, and 26 arthroscopic studies.     

Histologic Grading of TMJ Tissues in Internal Derangement

Although the spectrum of degenerative TMJ disease has been characterized in previous studies, there have been few specific histopathologic studies offered. The object of this study is to characterize histologically the changes observed in TMJ arthroplasty biopsy material. Forty-one patients with TMJ pain that was not amenable to conservative therapy had conventional TMJ arthroplastic surgery. Biopsy material included the bony eminence, the posterior attachment and the disk proper. The major histologic criteria included perivascular inflammation, synovial membrane thickness and metaplastic changes of the disk and the bony eminence. With these criteria, surgical specimens were graded 0 to 6 with 6 representing the most severe degeneration. In all 41 cases, histologic change was noted to some degree and, therefore, appears to be representative of temporomandibular joint internal derangement.