The expression of cyclooxygenase-2 in human temporomandibular joint samples: an immunohistochemical study

The aim of this investigation was to evaluate the immunohistochemical expression of cyclooxygenase-2 (COX-2) in the temporomandibular joint (TMJ) and to compare it with that control specimens. Expression of COX-2 in the TMJ disc and the synovial membrane in 26 human TMJ samples (internal derangement of TMJ; n=16, and control; n=10) was measured by an immunohistological technique using paraffin-embedded tissue and specific antihuman COX-2 polyclonal antibody. There were obvious distinction of COX-2 immunoreactivity between the control specimens and internal derangement cases, in the region of posterior and/or anterior loose connective tissues. In particular, intensive COX-2 expression was detected in the synovial membrane of internal derangement cases. The findings of the present study suggest that COX-2 might be an important mechanism regulating inflammation in the synovial membrane with internal derangement of TMJ.     

The immunohistochemical distribution of vimentin in human temporomandibular joint samples

The aim of this investigation was to evaluate the immunohistochemical distribution of vimentin in the temporomandibular joint (TMJ) and to compare it with the control specimens. Immunohistochemical distribution in the disc and synovial membrane in 30 human TMJ (internal derangement of TMJ, n = 20; and control, n = 10) was studied immunohistologically using paraffin-embedded tissue and specific anti-human vimentin monoclonal antibody. Vimentin expression was distributed in chondrocyte-like cells, synovial cells and endothelial cells. There was an obvious distinction of vimentin immunoreactivity between the control specimens and internal derangement cases, in the posterior and/or anterior loose connective tissues. In particular, intensive vimentin expression was detected in the hypertrophic synovial membrane of internal derangement cases. The findings of the present study suggest that vimentin might be an important marker of pathological hypertrophy of the synovial membrane and/or connective tissue with internal derangement of TMJ.     

Immunohistochemical distribution of lymph capillaries and blood capillaries in the synovial membrane in cases of internal derangement of the temporomandibular joint

The distribution of lymph capillaries and blood capillaries in the synovial membrane was examined immunohistologically with anti–human collagen IV antibody and anti–human von Willebrand factor in 26 human temporomandibular joint (TMJ) samples comprising discs with adjoining synovial membrane from 10 control TMJs and from 16 TMJs with internal derangement. Three different distribution types were observed in the synovial membrane. In the control samples, the occurence of blood capillaries and lymph capillaries was rare. In mildly hyperplastic synovitis. lymph capillaries were observed just beneath the surface of the synovial membrane, whereas blood capillaries occurred in a little deeper layer of the synovia! membrane. In a severely hyperplastic synovitis. both lymph and Wood capillaries were observed frequently. The present results suggest that the different distribution patterns of lymph capillaries and blood capillaries reflect the degree of synovitis but can not be attributed to specific clinical symptoms.     

Isolation and characterization of synovial cells from the human temporomandibular joint

BACKGROUND: The synovial tissues with temporomandibular disorders (TMDs) often show chronic inflammatory changes and the synovial cells participate in the pathogenic processes of TMDs. The synovial membrane is composed of a synovial lining layer and a connective sublining layer. The synovial lining layer is made up of two kinds of cells: macrophage-like type A and fibroblastic type B cells. The aim of this study was to isolate and characterize synovial cells from the human temporomandibular joint (TMJ). METHODS: Synovial cells were isolated using an explant culture method. Then, we characterized the cultured synovial cells (SGA2 cells) using immunocytochemistry. RESULTS: SGA2 cells expressed the fibroblastic markers vimentin and prolyl 4-hydroxylase; they also expressed laminin and heat shock protein 27, all of which are markers of type B cells. However, some cells expressed the macrophage marker CD68. These CD68-positive cells simultaneously expressed laminin. CONCLUSIONS: We isolated and cultured synovial type B cells from the human TMJ, and identified the presence of intermediate type synovial lining cells, having the phenotypic properties of both type A and type B cells, among the synovial lining cells.     

Angiogenesis in the human temporomandibular joint studied by immunohistochemistry for CD34 antigen

The CD34 antigen is a sensitive marker of vascular endothelium and angiogenesis. Thus, we examined the expression of CD34 in 20 human temporomandibular joint (TMJ) samples with internal derangement and in 10 control specimens by an immunohistological technique using paraffin-embedded tissue and specific anti-human CD34 monoclonal antibody. In the control specimens, CD34 was observed sporadically within the TMJ discs. On the other hand, in the internal derangement specimens, CD34 was found frequently in the walls of blood capillaries within the TMJ discs. In the synovial membrane, CD34 was detected frequently in the walls of many blood capillaries in both the controls and the internal derangement specimens. Indeed, CD34 expression in internal derangement specimens was more intense than in control specimens. In the posterior loose connective tissue of the bilaminar zone, and in the anterior loose connective tissue between the upper and lower lamellae of the anterior capsular wall, CD34 was detected in abundance in the walls of blood capillaries both of the controls and the internal derangement specimens. Generally, CD34 was found rarely in the walls of large blood vessels. The presence of CD34 is suggested to be correlated with the process of angiogenesis induced by internal derangement of the TMJ.     

The expression of tenascin mRNA in human temporomandibular joint specimens

The expression of mRNA of tenascin in the temporomandibular joint (TMJ) disc and synovial membrane was examined in 20 human TMJ samples from patients with internal derangement of the TMJ and 10 control specimens by in situ hybridization technique using paraffine-embedded tissue, and antisense and sense cRNA probes. In control specimens, tenascin mRNA was not expressed. However, we were able to find tenascin mRNA expression in the surgical specimens. In 15 of 20 samples, ranging numbers of synovial cells expressed tenascin mRNA in the hypertrophic synovial membranes. Also, in 6 of 20 samples, tenascin mRNA was identified in fibroblasts. In four specimens, vascular endothelial cells were positive for the mRNA. In internal derangement cases, histopathological findings are often found such as synovitis, new capillary growth and fibrosis. The present study demonstrates that tenascin is produced specifically in synovial cells, vascular endothelial cells and fibroblasts affected in the portion of TMJ with internal derangement.     

The localization of matrix metalloproteinase-3 and tenascin in synovial membrane of the temporomandibular joint with internal derangement

OBJECTIVES: The aim of this investigation was to study the immunohistochemical localization of MMP-3 and tenascin in the temporomandibular joint and to compare it with control specimens. MATERIALS AND METHODS: Localizations of matrix metalloproteinase-3 (MMP-3) and tenascin in the temporomandibular joint disc and the synovial membrane in 26 human temporomandibular joint samples (internal derangement of TMJ; n = 16, and control; n = 10) by an immunohistological method with monoclonal antibodies specific to human MMP-3 and tenascin. RESULTS: MMP-3 was not distributed in control specimens while it was observed in the internal derangement cases. MMP-3 showed two staining profiles: (1) diffuse staining was observed within the stroma of severely deformed disc with osteophyte and/or disc displacement (three of 16 specimens); and (2) the localization was specifically detected on the surface of severely hypertrophic synovial membrane (six of 16 specimens). The latter localization pattern resembled that of the tenascin on the surface of the severely hypertrophic synovial membrane. CONCLUSION: Comparative localization of MMP-3 and tenascin revealed intense staining for both in the synovial membrane presenting inflammation, proliferation and hypertrophy. These findings suggest that tissue repair and remodeling in the temporomandibular joint disc and the inflammatory hypertrophic reaction in the synovial membrane might proceed at the same time.     

Synovial osteochondromatosis accompanying an ossified articular disk in the temporomandibular joint: a case report

A 51-year-old woman was referred for pain in the right temporomandibular joint (TMJ) and the trismus. Conventional radiography showed a radiopaque area in the disk, which suggested calcification. At surgery, multiple, round-to-ovoid cartilagenous nodules were found in the joint cavity. Synovectomy and diskectomy were carried out via a pre-auricular incision to remove the nodules. Examination under light microscopy confirmed the diagnosis of synovial osteochondromatosis (SOC). The disk contained a large ossified mass. To our knowledge, this is the first reported example of SOC accompanied by ossification of a large part of the disk.     

Intraoperative comparison of single- and double-puncture techniques in temporomandibular joint arthrocentesis

The objective of this study was to compare techniques for temporomandibular joint (TMJ) arthrocentesis intraoperatively and to determine the ease of performance of these techniques for the physician. A total of 33 TMJ treatments were done using single-puncture arthrocentesis (SPA) type 1, SPA type 2, and double-puncture arthrocentesis (DPA) (n = 11 in each treatment group) between December 2013 and December 2017. A retrospective analysis of the duration of the procedure (minutes), occurrence of complications, number of cannula relocations, and ease of the procedure was performed. Ease of the procedure was measured using a Likert-type visual analogue scale (VAS; 0–10). All measurement variables were recorded intraoperatively, and related data were analyzed statistically. Significant differences were found between SPA type 2 and the other techniques in terms of procedure duration and ease of the procedure (P < 0.05). No significant differences were found in the occurrence of complications or number of cannula relocations between the techniques (P > 0.05). Compared to the other TMJ arthrocentesis techniques, SPA type 2 is easier, and physicians can perform it in a shorter time.     

颞下颌关节渗出液与关节疼痛关系的研究

目的:评价关节疼痛与渗出液的关系。方法:对44例单侧关节疼痛TMD患者88侧关节,完成闭口矢状位T2加权成像,以非疼痛侧作为自身对照,观察关节渗出液发生率;利用VAS进行疼痛程度的判定,比较疼痛侧渗出液组与无渗出液组有无差异。结果:44个疼痛关节中,26个关节(59.1%)存在渗出液;而44个非疼痛关节中,仅7个关节(15.9%)存在渗出液,经统计学分析,TMJ疼痛与渗出液有显著相关性(P<0.005),将少量渗出液视为无渗液,进一步统计分析发现疼痛与渗出液仍有相关性;在44个疼痛关节中,渗出液组患者及无渗出液组患者VAS平均值分别为46.5±25.1和39.7±22.8,经t检验两组间差别无统计学意义。结论:渗出液为关节疼痛原因之一,但其与关节疼痛程度无关。     

Loose joint bodies of the temporomandibular joint: a case report

Osteochondral loose bodies are an uncommon finding in the temporomandibular joint (TMJ), but occur relatively frequently in large joints such as the knee, elbow, hip, wrist, and ankle. Loose joint bodies can be divided in three groups: 1) synovial chondromatosis; 2) osteochondral fracture fragments and; 3) cases of degenerative arthritis or avascular necrosis. The most common clinical features of loose joint bodies are pain, swelling, joint noise and impaired joint movements. A case of loose joint bodies of the temporomandibular joint is presented. The pantomograph and lateral cephalograph revealed several irregularly shaped, variably sized radiopaque structures in the region of the right temporomandibular joint. CT and MR scans confirmed the initial diagnosis. The dimensions of the loose joint bodies varied from 1–2 to 5–6 mm. In this patient, the loose joint bodies may have been secondary to osteoarthritis, may have preceded and caused the degenerative changes, or may be only a coincidental finding.     

Reconstruction of ankylosed temporomandibular joint: Sternoclavicular grafting as an approach to management

A retrospective analysis of 15 cases of ankylosed temporomandibular joint (TMJ) reconstructed, with sternoclavicular joint graft (SCG), during the period 2002-2007 was undertaken. All cases were analyzed for functional adaptation of the graft, considering maximum interincisal opening, and protrusive and laterotrusive movement of the jaw. Significant improvement was noticed in all cases except one, although maximum improvement was seen 3-6 months postoperatively. Radiological evaluation was carried out at regular intervals for 2-3 years to assess the anatomical adaptation of the graft. No major postoperative complications were observed and all the cases showed complete regeneration of the clavicle during follow up. This finding indicates that reconstruction of ankylosed TMJ with sternoclavicular joint graft is a satisfactory method of treatment.     

偏侧咀嚼对大鼠TMJ滑膜iNOS表达影响的研究

目的：研究偏侧咀嚼对大鼠颞下颌关节（TMJ）滑膜诱导型一氧化氮合酶（inducible nitric oxide synthase,iNOS）表达的影响。方法：30只大白鼠随机分为6组,实验1.2.3组,对照1.2.3组,每组5只。实验组间断磨除右侧上、下颌磨牙牙冠至龈下,对照组不做处理,饲养条件相同。分别于实验后4周、10周、16周末各处死实验组与对照组各1组动物,取其双侧TMJ切片免疫组化实验,与对照组比较。结果：实验1、2、3组双侧颞下颌关节滑膜iNOS表达增强。结论：偏侧咀嚼可引起颞下颌关节滑膜损伤,iNOS参与了其病理过程。     

Pigmented villonodular synovitis of the temporomandibular joint: a case report and the literature review

Pigmented villonodular synovitis (PVNS) is an uncommon benign proliferative disorder of synovium that may involve joints, tendon sheaths, and bursae. It most often affects the knees, and less frequently involves other joints. It presents in the temporomandibular joints (TMJs) extremely rarely. The authors report an elderly female patient with PVNS of the TMJ with skull base extension, who had traumatic history in the same site. It was diagnosed through core-needle biopsy, which was not documented in the literature. Radical excision and follow-up for 7-8 years was recommended because of the reported malignant transformation and high recurrence rate. This case and previously reported cases in the literature are reviewed and discussed.     

Complications and post-operative sequelae of temporomandibular joint arthrocentesis

Objective: To evaluate intraoperative complications and postsurgical sequelae associated with arthrocentesis of the TMJ, including injection of Sodium Hyaluronate.

Methods: This retrospective study evaluated 433 arthrocentesis procedures performed in 315 patients between January 2009 and August 2016. The authors reviewed the complications identified during the procedure and the follow-up period.

Results: Temporary swelling of the periarticular tissues (95.1%) or the external auditory canal (23.5%), ipsilateral temporary open bite (68.8%), frontalis and orbicularis oculis paresis (65.1%), preauricular hematoma (0.4%), and a case of vertigo (0.2%) were the complications detected.

Conclusions: TMJ arthrocentesis remains a procedure with a minimum number of important complications. If present, complications are generally temporary, caused by the anesthetic effect or by the soft tissue edema created by the fluid extravasation created by the irrigation procedure, and can be managed on an outpatient basis.     

Apoptosis in displaced temporomandibular joint disc with and without reduction: an immunohistochemical study

J Oral Pathol Med (2011) 40 : 103–110 Internal derangement (ID) of the temporomandibular joint (TMJ) is due to an abnormal relationship of the articular disc to the mandibular condyle, glenoid fossa and articular eminence. The two most common types of internal derangement are anterior disc displacement with (ADDwR) and without reduction (ADDwoR). Disc displacement is associated with degenerative tissue changes. The histological features of discs from patients with TMJ ID reflect a general remodelling caused by abnormal loading. A correlation has been demonstrated between TMJ ID and apoptosis. Few investigations have addressed the role of apoptosis or caspase activity in TMJ ID. The apoptosis activation process was studied in different areas of discs from 18 patients with ID (both ADDwR and ADDwoR) and four cadavers (controls), with emphasis on the expression of caspase 3, whose activation makes the death process irreversible. The results showed a greater proportion of caspase 3‐positive cells in ADDwR and ADDwoR than in control discs. Immunopositivity also varied between disc areas; in particular, in ADDwoR sections labelled cells were significantly more numerous (P < 0.01) in the posterior disc attachment than in the anterior and intermediate bands. In addition, a significantly greater proportion of labelled cells was seen in the anterior (+) and intermediate (++) band of ADDwR compared with ADDwoR discs both bands (P < 0.05). These data suggest the importance of programmed cell death in the progression of TMJ ID.     

Quantification of translational and gliding components in human temporomandibular joint during mouth opening

OBJECTIVE: In humans, the opening movement of the mouth requires a complex combination of rotation in the lower temporomandibular joint compartment and of translation in the upper compartment. The aim of the current study was to quantitatively assess the percentage contribution of rotation and translation movements of the mandible at maximum mouth opening in normal, healthy individuals. DESIGN: Free, habitual movements of mouth opening were recorded in 12 men and 15 women aged 19-30 years using an optoelectronic three-dimensional motion analyser. All subjects had a sound, complete, permanent dentitions with Angle Class I jaw relationships, without cast restorations or cuspal coverage, TMJ or craniocervical disorders. For each subject, the mandibular movements at the interincisor point (occlusal plane) were reconstructed, and, using suitable mathematical algorithms, divided into their rotation and gliding components. The relative contribution of the two components to the total movement was calculated for each frame of motion. In particular, the situation at maximum opening was assessed. RESULTS: At maximum mouth opening, on average, men had significantly larger displacement of the mandibular interincisor point (56 mm versus 46 mm) and angle of rotation (34 degrees versus 32 degrees), than women. The percentage of mandibular movement explained by rotation at maximum mouth opening (77%) was not influenced by sex. The degree of rotation was significantly related to the displacement of the interincisor point: in women r2 = 87%, in men, r2 = 45%. CONCLUSIONS: Overall, in normal subjects with a healthy stomatognathic apparatus, mouth opening was more determined by mandibular rotation than by translation.     

Synovial entrapment in alloplastic temporomandibular joint replacement

Complications of alloplastic temporomandibular joint (TMJ) prostheses can lead to stress and anxiety for the patient and the surgical team, and prosthesis substitution is sometimes required. The aim of this case report is to describe the surgical finding of synovial entrapment with interposed fibrosis in a postoperative alloplastic TMJ revision, managed effectively with adequate surgical debridement. The authors believe that synovial entrapment needs to be considered as a possible postoperative complication of total joint replacement when no clear symptoms of infection, metal hypersensitivity, osteolysis, or heterotopic bone formation are present. The implications of synovial entrapment in TMJ alloplastic replacement remains relatively unpredictable and poorly understood.     

正常人牙尖交错位紧咬牙时颞下颌关节无单元-有限元耦合法三维生物力学研究

目的应用无单元—有限元耦合法探讨正常人牙尖交错位紧咬牙时颞下颌关节内的应力分布情况。方法利用中国可视化人体图像数据建立包括上下牙列、下颌骨、颞下颌关节在内的三维有限元模型和三维无单元—有限元耦合模型,用自行编制的耦合程序对已建立的正常颞下颌关节三维无单元—有限元耦合模型进行应力分析。结果无单元—有限元耦合模型与有限元模型所反映的颞下颌关节应力分布特点基本相同,但耦合模型对关节盘的应力分析更精细。颞下颌关节关节盘最薄弱的中间带区是应力最集中的地区,双板区也是高应力分布区,提示这两处是关节盘最易受损伤的区域。结论无单元—有限元耦合法是一种有效的数值模拟方法,计算过程大大简化,计算精度显著提高,在生物力学研究中有推广应用前景。     

单侧有症状的颞下颌关节紊乱病患者双侧关节间隙锥形束CT对比研究

目的探讨单侧有症状的颞下颌关节紊乱病患者双侧颞下颌关节在CBCT成像上可能存在差异的参考层面,为颞下颌关节紊乱病诊断和对比研究提供参考。方法选取一侧TMJ有症状的TMD患者87例,通过CBCT三维成像和重建,观察同一患者两侧TMJ重建后横断面的水平角;平行于髁突长轴的斜位关节间隙、髁突长轴径值、髁突垂直角;垂直于髁突长轴的斜位与矢状位的关节结节斜度和关节间隙,采用SPSS13.0软件包对每位患者上述各测量指标做两配对样本t检验。结果两侧TMJ在平行位120°、矢状位60°和90°、垂直位60°和120°时的关节间隙测量值差异均有统计学意义(P<0.05),其中矢状位90°关节间隙的差异更显著(P<0.01),其余值均无统计学差异。结论对于单侧有症状的TMD患者,矢状位或垂直位是较易观察到左右两侧有差异的位置,在垂直位和矢状位均观察到前间隙的增大,在这个层面重建对诊断和对比研究更有意义。