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1.
The aim of this work was to define the diagnostic value of a method for 3D reconstruction of MRI images for the assessment of temporomandibular joint. Sixty subjects, 42 diagnosed with unilateral temporomandibular disorders (TMD) with disc displacement and 18 without signs or symptoms of TMD (control group) were included. All subjects had both temporomandibular joints scanned by MRI. Three-dimensional imaging reconstructions of temporomandibular joint were generated by segmentation software, allowing visualization of the components of temporomandibular joint (articular disc, condyle and temporal bone) on arbitrary planes. Disc displacement was observed in 83% of 3D reconstruction and 81% of conventional MRI. The agreement between 3D diagnosis and MRI findings was significant and high. The present analysis suggested that 3D reconstruction is a useful and accurate method for the assessment of the temporomandibular joint in TMD ID.  相似文献   

2.
It is essential to know the normal and pathological changes of ageing in the temporomandibular joint (TMJ) because of the frequency of pathology in this joint and the increased duration of life in current populations. A study was done on 70 TMJs harvested from 35 subjects older than 75 years. These joints were studied macroscopically, radiologically and histologically. Degenerative pathology of the TMJ affected more than 50% of the subjects studied and the disc was perforated in 7%. Ageing of the TMJ without any degenerative pathology is marked by radiographic signs which are not specific to the TMJ (cortical thinning, demineralisation). Histologically, amyloid degeneration was present in nearly 50% of TMJs studied.  相似文献   

3.
PurposeMost of the reports on instrumentalists'' experiences of temporomandibular disorders (TMD) have been reported not by clinical examinations but by subjective questionnaires. The aim of this study was to investigate the clinical signs and subjective symptoms of TMD in a large number of instrumentalists objectively.ResultsOverall, 453 participants (61.3%) reported having one or more symptoms of TMD. The most frequently reported symptom was a clicking or popping sound, followed by temporomandibular joint (TMJ) pain, muscle pain, crepitus, and mouth opening limitations. Compared with lower-string instrumentalists, a clicking or popping sound was about 1.8 and 2 times more frequent in woodwind and brass instrumentalists, respectively. TMJ pain was about 3.2, 2.8, and 3.2 times more frequent in upper-string, woodwind, and brass instrumentalists, respectively. Muscle pain was about 1.5 times more frequent in instrumentalists with an elevated arm position than in those with a neutral arm position. The most frequent diagnosis was myalgia or myofascial pain (MFP), followed by disc displacement with reduction. Myalgia or MFP was 4.6 times more frequent in those practicing for no less than 3.5 hours daily than in those practicing for less than 3.5 hours.ConclusionThe results indicate that playing instruments can play a contributory role in the development of TMD.  相似文献   

4.
Aim: Inflammatory idiopathic myopathies (IIMs) are inflammatory processes affecting skeletal musculature and extramuscular organs. Temporomandibular disorders (TMD) involve jaw muscles and temporomandibular joint. The aim of this observational study was to investigate the prevalence of the main TMD symptoms and signs as well as oral implications in IIM patients.Methods: The study group included 54 patients (42 women and 12 men), 22 of whom affected by dermatomyositis (DM), 29 by polymyositis (PM) and 3 by inclusion body myositis (IBM). A group of 54 patients not affected by this disease, served as CG. Oral and TMD signs and symptoms were evaluated by means of a questionnaire and through clinical examination.Results: About oral symptoms, the study group complained more frequently dysgeusia, with loss of taste or unpleasant taste (p<0.0001) and feeling of burning mouth (9.4% versus 0 controls). Xerostomia was more prevalent in the study group respect to the CG (p<0.0001). Dysphagia was reported by 48.1% of IIM patients while was absent in CG (p<0.0001). About oral signs, cheilitis (p<0.05) and oral ulcers (p<0.05) were significantly more frequent in CG. As regard to TMD symptoms, arthralgia and tinnitus didn''t showed significant differences between the two groups, while neck/shoulders and masticatory muscle pain was significantly more referred in IIM patients than in the CG (p<0.05). About TMJ signs, sounds were overlapping in the two groups: click=11.1% in both IIM patients and CG (p>0.05), crepitation in 11.1% of IIM and 9.3% of controls (p>0.05). No significant difference was detected about deflection (9.3%, p>0.05), while deviation was wider in CG (p<0.05). Active opening and lateralities showed no significant differences, while endfeel was significantly increased in IIM group for a higher presence of muscular contracture. Bruxism was present only in CG.Conclusion: The data collected from this observational study seem to support the existence of a relationship between the prevalence of TMD symptoms and signs as well as oral features in patients with myositis. A remarkable reduction of salivary flow and dysphagia were more frequent and severe in IIM patients, as well as muscle contracture and myofacial pain evoked by palpation, this result being highly significant.  相似文献   

5.
The purpose of this study was to evaluate the relationship of the temporomandibular joint (TMJ) internal derangement and lateral pterygoid muscle (LPM) by magnetic resonance imaging (MRI). In this study, 115 subjects with TMJ internal derangement (total 230 TMJs) and 21 subjects without clinical symptoms (total 42 TMJs) were included. TMJ disc position and LPM were evaluated using MRI. LPM attachments were categorized into two different types: type 1, where fibers of the superior head of the LPM (SLPM) were attached to the disc and fibers of the inferior head of the LPM (ILPM) were attached to condyle, and type 2, where fibers of the SLPM were attached to the disc and condyle, and fibers of the ILPM were attached to condyle. The presence of muscle atrophy and degeneration were also evaluated. LPM attachments were observed in two different parts. Disc displacements were common in the muscle attachments of both types. Type 1 muscle attachments were seen in 85.9% of all the anterior disc displacement without reduction (ADD) TMJs (total 64 TMJs). Atrophy was seen in a higher proportion (43.7%) in TMJs with ADD (28/64) than in TMJs with normal and anterior disc displacement with reduction (ADDR). Out of 74 TMJs with atrophy, 68 had type 1 muscle attachment. Four TMJs had atrophy in both superior and inferior heads of the lateral pterygoid. However, atrophy was not present only in the ILPM. It has been concluded that since the SLPM only attached to the disc in type 1, the disc may displace anteriorly very easily. Therefore, this situation will reduce the function of the SLPM. Reduced muscle function may cause muscle atrophy. The activity of the SLPM may be more reduced since the disc permanently dislocated in TMJs with ADD. Finally, spasm of the LPM causes disc displacement and atrophy and then the degeneration of the LPM may follow disc displacement.  相似文献   

6.

Introduction

To establish the skeletal pattern in subjects with malocclusions and temporomandibular disorders (TMD); to assess the relationship between craniofacial skeletal structures and TMD in subjects with malocclusions.

Material and methods

Sixty-four subjects with malocclusions, over 18 years of age, were included in the study. Temporomandibular disorders were clinically assessed according to the Helkimo Anamnestic Index. Subjects underwent a lateral cephalogram. Subjects were grouped according to the sagittal skeletal pattern (ANB angle) into class I, II and III. Parametric Student tests with equal or unequal variations were used (variations were previously tested with Levene test).

Results

Twenty-four patients with TMD (experimental sample); 40 patients without TMD (control group); interincisal angle was higher in class I and II (p < 0.05) experimental subjects; overjet was larger in experimental subjects; midline shift and Wits appraisal were broader in the experimental group in all three classes. In class III subjects, the SNB angle was higher in the experimental group (p = 0.01). Joint noises followed by reduced mandible mobility, muscular pain and temporomandibular joint (TMJ) pain were the most frequent symptoms in subjects with TMD and malocclusions.

Conclusions

Temporomandibular joint status is an important factor to consider when planning orthodontic treatment in patients with severe malocclusions; midline shift, large overjet and deep overbite have been associated with signs and symptoms of TMD.  相似文献   

7.
AIMS: Psoriasis is a chronic, remitting and relapsing inflammatory disorder, involving the skin, nails, scalp and mucous membranes, that impairs patients'' quality of life to varying degrees. Psoriatic arthritis is a chronic seronegative, inflammatory arthritis, usually preceded by psoriasis. Temporomandibular disorders is a generic term referred to clinical conditions involving the jaw muscles and temporomandibular joint. The aim of this study was to assess symptoms and signs of temporomandibular disorders in psoriasis patients with and without psoriatic arthritis.METHODS: The study group included 112 patients (56 men, 56 women; median age 49.7±12 years) with psoriasis, 25 of them were affected by psoriatic arthritis. A group of 112 subjects without psoriasis (56 men, 56 women; median age 47.7±17 years) served as controls. Signs and symptoms of temporomandibular disorders were evaluated according to the standardized Research Diagnostic Criteria for Temporomandibular Disorders. Psoriasis patients were subgrouped according to the presence/absence of psoriatic arthritis and by gender, to assess the prevalence of traditional symptoms and signs of temporomandibular disorders.RESULTS: Patients with psoriasis, and to an even greater extent those with psoriatic arthritis, were more frequently affected by symptoms and signs of temporomandibular disorders, including an internal temporomandibular joint opening derangement than healthy subjects. A statistically significant increase in symptoms of temporomandibular disorders, in opening derangement, bruxism and sounds of temporomandibular joint was found in patients with psoriatic arthritis as compared with psoriasis patients without arthritis and controls.CONCLUSIONS: psoriasis seems to play a role in temporomandibular joint disorders, causing an increase in orofacial pain and an altered chewing function.  相似文献   

8.
Background: This study evaluated the prevalence of the signs and symptoms of temporomandibular joint disorder (TMD) among patients with TMD symptoms. Methods: Between September 2011 and December 2011, 243 consecutive patients (171 females, 72 males, mean age 41 years) who were referred to the Department of Prosthodontics, Faculty of Dentistry, Karadeniz Technical University, Trabzon were examined physically and completed a questionnaire regarding age, gender, social status, general health, antidepressant drug usage, dental status, limited mouth opening, temporomandibular joint (TMJ) sounds, and parafunctions (bruxism, clenching). The data were analyzed using the chi-square test and binary logistic regression model (alpha = 0.05). Results: With a frequency of 92%, pain in the temporal muscle was the most common symptom, followed by pain during mouth opening (89%) in both genders. TMJ pain at rest, pain in the masseter muscle, clicking, grinding, and anti-depressant use were significantly more frequent in females than males. Age (p=0.006; odds ratio 0.954; 95% CI 0.922-0.987) and missing teeth (p=0.003; odds ratio 3.753; 95% CI 1.589-8.863) had significant effects on the prevalence of TMD. Conclusion: Females had TMD signs and symptoms more frequently than males in the study population. The most common problem in both genders was pain.  相似文献   

9.
The aims were to investigate the effect of intravenous infusions of the tumor necrosis factor-alpha (TNF-alpha) antibody infliximab on symptoms and signs of temporomandibular joint (TMJ) involvement in relation to effects on synovial fluid and plasma proinflammatory TNF-alpha, interleukin-1beta (IL-1beta) and interleukin-6 as well as antiinflam matory soluble TNF receptor II (TNF-sRII), interleukin-1 receptor antagonist (IL-1ra), soluble IL-1 receptor II (IL-1sRII) and interleukin-10 (IL-10) in patients with active rheumatoid arthritis (RA). Nineteen patients with TMJ involvement taking methotrexate were included in the study. TMJ and general joint pain intensity as well as pain on mandibular movements, tenderness to digital palpation, pressure pain threshold and maximum mouth-opening capacity were assessed in a clinical examination. The effect of infliximab was assessed after 2 and 14 or 22 weeks. TMJ synovial fluid and venous blood were collected for cytokine analysis at all occasions while determination of erythrocyte sedimentation rate and C-reactive protein were performed at baseline and at long-term follow-up only. Reduction of TMJ pain was associated with raised levels of synovial fluid TNF-sRII and IL-1sRII as well as raised plasma levels of IL-1ra and IL-10. Decreased erythrocyte sedimentation rate was associated with decreased tenderness to digital palpation. Reduced general joint pain intensity was associated with reduced plasma levels of IL-6 and C-reactive protein. In conclusion, systemic treatment with a combination of infliximab and methotrexate reduces TMJ pain in RA in association with an increase in anti-inflammatory cytokines and receptors in synovial fluid and plasma.  相似文献   

10.

AIM:

To identify the relationship between anterior disc displacement and global posture (plantar arches, lower limbs, shoulder and pelvic girdle, vertebral spine, head and mandibles). Common signs and symptoms of anterior disc displacement were also identified.

INTRODUCTION:

Global posture deviations cause body adaptation and realignment, which may interfere with the organization and function of the temporomandibular joint.

METHODS

: Global posture evaluation was performed in a group of 10 female patients (20 to 30 years of age) with temporomandibular joint disc displacement and in a control group of 16 healthy female volunteers matched for age, weight and height. Anterior disc displacement signs, symptoms and the presence of parafunctional habits were also identified through interview.

RESULTS:

Patients with disc displacement showed a higher incidence of pain in the temporomandibular joint area, but there were no differences in parafunctional habits between the groups. In the disc displacement group, postural deviations were found in the pelvis (posterior rotation), lumbar spine (hyperlordosis), thoracic spine (rectification), head (deviation to the right) and mandibles (deviation to the left with open mouth). There were no differences in the longitudinal plantar arches between the groups.

CONCLUSION:

Our results suggest a close relationship between body posture and temporomandibular disorder, though it is not possible to determine whether postural deviations are the cause or the result of the disorder. Hence, postural evaluation could be an important component in the overall approach to providing accurate prevention and treatment in the management of patients with temporomandibular disorder.  相似文献   

11.
目的探讨基于影像学与解剖学构建颞下颌关节(temporomandibular joint,TMJ)骨骼肌肉系统三维有限元模型的可行性,为TMJ生物力学研究提供建模的新思路。方法采集第2代中国虚拟人男性第23号头颅CT图像、咀嚼肌及TMJ关节盘MRI图像,以DICOM格式导入Mimics软件进行三维重建,再通过Geomagic Studio软件配准模型、优化模型及构建关节软骨和关节囊,最后由ANSYS软件定义各组织的材料属性,建立TMJ骨骼肌肉系统的三维有限元模型。结果建立了一个包含关节盘、关节软骨、关节囊、上颌骨(包括颧骨及鼻骨)、下颌骨、颞骨(包括部分顶骨)、蝶骨、上牙列、下牙列、颞肌、咬肌、翼内肌、翼外肌、颞下颌韧带、蝶下颌韧带及茎突下颌韧带的TMJ骨骼肌肉系统的三维有限元模型。结论根据CT、MRI图像和解剖学,利用Mimics、Geomagic Studio及ANSYS可以精确、可行地构建TMJ骨骼肌肉系统的三维有限元模型。模型更加真实还原TMJ的生物力学环境,为TMJ生物力学研究提供新的建模方法,为临床上TMJ疾病的可视化治疗提供仿真平台。  相似文献   

12.
Temporomandibular joint disorders (TMD) are common dysfunctions of the masticatory region and are often linked to dislocation or changes of the temporomandibular joint (TMJ) disc. Magnetic resonance imaging (MRI) is the gold standard for TMJ imaging but standard clinical sequences do not deliver a sufficient resolution and contrast for the creation of detailed meshes of the TMJ disc. Additionally, bony structures cannot be captured appropriately using standard MRI sequences due to their low signal intensity. The objective of this study was to enable researchers to create high resolution representations of all structures of the TMJ and consequently investigate morphological as well as positional changes of the masticatory system. To create meshes of the bony structures, a single computed tomography (CT) scan was acquired. In addition, a high‐resolution MRI sequence was produced, which is used to collect the thickness and position change of the disc for various static postures using bite blocks. Changes in thickness of the TMJ disc as well as disc translation were measured. The newly developed workflow successfully allows researchers to create high resolution models of all structures of the TMJ for various static positions, enabling the investigation of TMJ disc translation and deformation. Discs were thinnest in the lateral part and moved mainly anteriorly and slightly medially. The procedure offers the most comprehensive picture of disc positioning and thickness changes reported to date. The presented data can be used for the development of a biomechanical computer model of TMJ anatomy and to investigate dynamic and static loads on the components of the system, which could be useful for the prediction of TMD onset.  相似文献   

13.
Wang J  Chao Y  Wan Q  Zhu Z 《Medical hypotheses》2008,71(4):564-567
Epidemiologic literatures suggest that temporomandibular joint disorders (TMD) are more prevalent in women than in men. It is affecting approximately 7-15% of the adult population in North America, and 80% of patients treated for TMD are women. The severity of symptoms is also related to the age of the patients. The gender and age distribution of TMD suggests a possible link between its pathogenesis and estrogen. It has been reported that estrogen could influence the development, restitution and metabolism of the temporomandibular joint and associated structures such as bone, cartilage and articular disc. Estrogen can also influence the regulative mechanism of pain. In this article, we will use the hypothesis that the overwhelming majority of patients treated for temporomandibular disorders are women and use the available literature to examine the role of estrogens in TMD.  相似文献   

14.
There is a need for systematic studies regarding the pathophysiology and pain mechanisms of somatosensory function in the temporomandibular joint (TMJ). So far, the effects on somatosensory functions of local anesthetics (LA) applied to the auriculotemporal (AT) nerve or intraarticularly (IA) into the TMJ have not been studied systemically. This study aimed to examine in a double-blinded, placebo-controlled manner the effects of LA on mechanical and thermal sensitivity in the TMJ area. Twenty-eight healthy subjects (27.4 ± 6.2 years) without temporomandibular disorders (TMD) participated. The subjects received an AT nerve block (n = 14) or an IA injection (n = 14) with LA (Bupivacaine, 2.5 mg/ml) on one side, and a placebo injection (isotonic saline) on the contralateral side. Mechanical (tactile and pin-prick) and thermal sensitivity (40 and 5°C) were assessed at 11 standardized points in the TMJ area before injections (baseline) as well as 30 min, 1 and 2 h after injections. All stimuli were rated by the subjects on a 0–100 numerical rating scale (NRS). TMJ pressure pain threshold (PPT) and pressure pain tolerance (PPTOL) were assessed laterally over both TMJs using an algometer. IA injections with LA were not associated with any changes in sensitivity of the TMJ or surrounding area. In contrast, AT nerve blocks with LA caused a decrease over time in the pin-prick sensitivity (P = 0.016), which however, did not differ significantly from saline, and an increase of the PPTs 30 min (P = 0.010) and PPTOLs 30 min, 1 h and 2 h (P < 0.05) after LA injections in comparison to saline. No other measures showed a significant change after the injections. Our results showed that IA bupivacaine injection in healthy subjects has no effect on the sensitivity of the TMJ or surrounding area, while AT nerve block has a more pronounced effect on deep mechanical, but not on superficial mechanical or thermal sensitivity. Further research to investigate the effect of LA on somatosensory functions in TMJ patients in comparison with this study results will give valuable information about the sensitivity in the TMJ area.  相似文献   

15.
Temporomandibular joint (TMJ) abnormalities cannot be reliably assessed by a clinical examination. Magnetic resonance imaging (MRI) may depict joint abnormalities not seen with any other imaging method and thus is the best method to make a diagnostic assessment of the TMJ status. In patients with temporomandibular joint disorder (TMD) referred for diagnostic imaging the predominant TMJ finding is internal derangement related to disc displacement. This finding is significantly more frequent than in asymptomatic volunteers, and occurs in up to 80% of patients consecutively referred for TMJ imaging. Moreover, certain types of disc displacement seem to occur almost exclusively in TMD patients, namely complete disc displacements that do not reduce on mouth opening. Other intra-articular abnormalities may additionally be associated with the disc displacement, predominantly joint effusion (which means more fluid than seen in any asymptomatic volunteer) and mandibular condyle marrow abnormalities (which are not seen in volunteers). These conditions seem to be closely related. Nearly 15% of TMD patients consecutively referred for TMJ MRI will have joint effusion, of whom about 30% will show bone marrow abnormalities. In a surgically selected material of joints with histologically documented bone marrow abnormalities nearly 40% showed joint effusion. Disc displacement is mostly bilateral, but joint effusion seems to be unilateral or with a lesser amount of fluid in the contralateral joint. Abnormal bone marrow is also mostly unilateral. Many patients have unilateral pain or more pain on one side. In a regression analysis the self-reported in-patient TMJ pain side difference was positively dependent on TMJ effusion and condyle marrow abnormalities, but negatively dependent on cortical bone abnormalities. Of the joints with effusion only one fourth showed osteoarthritis. Thus, there seems to be a subgroup of TMD patients showing more severe intra-articular pathology than disc displacement alone, and mostly without osteoarthritis. It should, however, be emphasized that patients with TMJ effusion and/or abnormal bone marrow in the mandibular condyle seem to constitute only a minor portion (less than one fourth) of consecutive TMD patients referred for diagnostic TMJ imaging. The majority of patients have internal derangement related to disc displacement, but without accompanying joint abnormalities. In patients with rheumatoid arthritis and other arthritides TMJ involvement may mimick the more common TMDs. Using MRI it is possible, in most cases, to distinguish these patients from those without synovial proliferation.  相似文献   

16.
偏侧咀嚼对颞颌关节影响的超微结构研究   总被引:4,自引:0,他引:4  
目的 观察单侧后牙缺失偏侧咀嚼不同时期对双侧颞颌关节 (temporomandibularjoint,TMJ)的致病作用及其病理特征。方法 采取拨除Wistar雄性大鼠右侧上、下颌磨牙 ,人为造成偏侧咀嚼的动物模型 ,分别用于光镜、扫描电镜和透射电镜观察。结果 实验组TMJ出现明显的退行性改变。颞颌关节盘的胶原纤维及髁突骨小梁均出现裂隙 ,超微结构亦有明显变化。结论 长期偏侧咀嚼可引起TMJ发生病理性改变  相似文献   

17.
目的:探讨以TMJ音分析作为TMJ损伤及病变临床诊断和病理研究方法的可行性。材料和方法:利用线性谱分析和非线性分形分析两种方法对健康人和TMD患者的TMJ音进行分析。结论:结果表明,两种方法均能正确识别健康人和TMD患者的TMJ音,但谱分析法仍需依靠医生的临床经验。  相似文献   

18.
This study tested the hypotheses that (1) parafunctional clenching increases pain and can lead to a diagnosis of temporomandibular disorder (TMD) pain and (2) electromyographic (EMG) activity during parafunctional clenching is significantly and positively correlated with reports of pain. Fourteen individuals without TMD participated in 5 consecutive days of 20-min long EMG biofeedback training sessions of the left and right temporalis and masseter muscles. Subjects were randomly assigned to either a Decrease or Increase group and were instructed to maintain EMG activity below 2 microV or above 10 microV during training, respectively. Two Increase subjects and no Decrease subjects were diagnosed, by a blinded examiner, with TMD pain following training. Self-reported pain posttraining was significantly higher for the Increase group. Masseter EMG activity was strongly correlated with pain. Parafunctional clenching increases pain and can lead to a diagnosis of TMD in otherwise pain-free individuals. Pain reports are positively correlated with the activity of the masseter muscle.  相似文献   

19.
Temporomandibular joint (TMJ) is a complex, sensitive, and highly mobile joint. Millions of people suffer from temporomandibular disorders (TMD) in USA alone. The TMD treatment options need to be looked at more fully to assess possible improvement of the available options and introduction of novel techniques. As reconstruction with either partial or total joint prosthesis is the potential treatment option in certain TMD conditions, it is essential to study outcomes of the FDA approved TMJ implants in a controlled comparative manner. Evaluating the kinetics and kinematics of the TMJ enables the understanding of structure and function of normal and diseased TMJ to predict changes due to alterations, and to propose more efficient methods of treatment. Although many researchers have conducted biomechanical analysis of the TMJ, many of the methods have certain limitations. Therefore, a more comprehensive analysis is necessary for better understanding of different movements and resulting forces and stresses in the joint components. This article provides the results of a state-of-the-art investigation of the TMJ anatomy, TMD, treatment options, a review of the FDA approved TMJ prosthetic devices, and the TMJ biomechanics.  相似文献   

20.
颞下颌关节韧带的断层影像解剖研究   总被引:1,自引:0,他引:1  
目的:通过cT和MRI扫描,明确颞下颌关节韧带的形态、结构及其断层影像解剖特点。方法:选取60名健康志愿者分别行颞下颌关节CT、磁共振检查,观察颞下颌关节韧带的断层影像解剖特点。结果:颞下颌关节在cT图像中显示韧带呈等密度影,而钙化的韧带呈高密度影;在磁共振T1WI和T2WI图像中,翼下颌韧带、蝶下颌韧带、茎突下颌韧带、颞下颌韧带、下颌锤骨韧带(关节盘锤骨韧带)均显示为结构清晰的低信号影像,骨皮质在T1WI及T2WI图像中均显示为结构清晰的低信号影像,骨髓质均显示为结构清晰的高信号影像。结论:CT、磁共振成像可清楚地显示颞下颌关节韧带的断层影像解剖结构。  相似文献   

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