Immunohistochemical study of temporomandibular joint disturbance syndrome]

In this paper, condylar cartilages of 10 temporomandibular joint disturbance syndrome (TMJDS) patients were studied by means of immunofluorescence and immunogold staining to clarify if there are immune complexes. We also detected the antibodies to type II collagen in synovial fluids and sera of the TMJDS patients with passive hemagglutination. Through these studies, we found: there are autoimmune responses in articular tissues in TMJDS; these responses are caused by the exposure of sequestered antigens and taken place mainly in the involved joints, and may participate in the destruction of TMJ.     

Preliminary study of autoimmune reaction in temporomandibular joint disturbance syndrome

Antibodies to type II collagen in the synovial fluids of fourteen patients who were suffered from temporomandibular joint disturbance syndrome (TMJDS) were assayed with passive hemagglutination. Five of the fourteen patients were positive in the test and the others were negative. Among the five positive patients, two patients were in the stage of structural disturbance (internal derangement); the rest in the stage of substantial destruction (osteoarthritis). We also assayed the sera from four patients with the same method. They were all negative. The result showed that autoimmune reaction may take part in the course of TMJDS because of the exposure of some sequestered antigens. So in addition to the traditional etiologic theories of TMJDS, such as occlusal factor, psychologic factor, et al, the autoimmune factor also plays some roles in the disease.     

强的松龙抑制肿瘤坏死因子对兔颞下颌关节破坏的研究

为探讨强的松龙治疗颞下颌关节紊乱综合征的机理，对１２只家兔进行了研究。首先在家兔右侧颞下颌关节腔内注射肿瘤坏死因子（ｔｕｍｏｒｎｅｃｒｏｓｉｓｆａｃｔｏｒ，ＴＮＦ）２～３次，９．０万ｕ／次；再注射强的松龙１～２次，２ｍｇ／次，光镜检查。结果：本组动物的关节组织损害明显减轻，关节软骨只有表面层轻微的改变或接近正常。结论：强的松龙能够抑制ＴＮＦ对兔颞下颌关节组织的损害，这可能是临床上糖皮质激素治疗颞下颌关节紊乱综合征有效的原因之一。     

封闭疗法结合咬合板治疗颞下颌关节紊乱综合征器质性破坏类的临床观察

采用封闭疗法结合咬合板治疗颞下颌关节紊乱综合征器质性破坏类患者５２例，男１２例，女４０例，年龄１４～７３岁，平均４０岁。关节下腔注射地塞米松和利多卡因混合液，根据病因选用前方调位咬合板或稳定型咬合板，治疗６个月后显效４６例（８８．５％）、有效６例（１１．５％），Ｘ经片示原骨质破坏处有修复出现，认为封闭与咬合板相结合是针对症状和病因的综合治疗方法，该方法治疗效果明显，无不良反应，有普及应用价值。     

伴有偏侧咀嚼习惯的颞下颌关节紊乱病患者全口义齿修复后髁状突位置变化的观察

目的：观察有偏侧咀嚼习惯的颢下颌关节紊乱病患者全口义齿修复前后髁状突位置的改变。方法：对34例偏侧咀嚼伴颞下颌关节紊乱病患者行重新全口义齿修复,于治疗前后拍摄双侧颞下颌关节薛氏位片,进行关节间隙测量。结果：治疗前关节前、上、后间隙（左／右）分别为1．10mm／3．76mm、1．24mm／1．87mm、5．54ram／1．98mm;治疗后分别为2．43mm／1．7mm、2．47mm／2．76ram、3．06mm／2．99mm。其中关节前、中、后间隙改变有统计学意义（P〈O．05）。结论：全口义齿重新修复治疗偏侧咀嚼伴颞下颌关节紊乱病的无牙颌患者,恢复其正常的垂直距离利于恢复髁状突在关节凹中的正常位置。     

颞颌关节紊乱综合征发病危险因素的研究——临床病例对照研究

对８１例诊断为颞颌关节紊乱综合征的患者进行了配对病例对照研究，选用自评式量表分析临床病例中人格、焦虑、抑郁、重大生活事件和社会支持等因素与ＴＭＪＤＳ的关系，结果表明，焦虚与抑郁可能是ＴＭＪＤＳ发病的危险因素之一。     

伴有偏侧咀嚼习惯的颞下颌关节紊乱病患者全口义齿修复后髁状突位置变化的观察

目的：观察有偏侧咀嚼习惯的颢下颌关节紊乱病患者全口义齿修复前后髁状突位置的改变。方法：对34例偏侧咀嚼伴颞下颌关节紊乱病患者行重新全口义齿修复,于治疗前后拍摄双侧颞下颌关节薛氏位片,进行关节间隙测量。结果：治疗前关节前、上、后间隙（左／右）分别为1．10mm／3．76mm、1．24mm／1．87mm、5．54ram／1．98mm;治疗后分别为2．43mm／1．7mm、2．47mm／2．76ram、3．06mm／2．99mm。其中关节前、中、后间隙改变有统计学意义（P〈O．05）。结论：全口义齿重新修复治疗偏侧咀嚼伴颞下颌关节紊乱病的无牙颌患者,恢复其正常的垂直距离利于恢复髁状突在关节凹中的正常位置。     

颞颌关节内紊乱症滑膜病变的内窥镜检特征

滑膜组织在颞颌关节的生理及功能上起着重要的作用，滑膜组织的病变观察研究对于临床关节病的诊断、治疗有着重要的意义。本文应用颞颌关节内窥镜对经临床检查、Ｘ线及关节造影确诊为颞颌关节内紊乱综合症（ＴＭＪＩＤ）的连续４２例患者的４５个关节腔进行观察，对关节滑膜在该病的功能紊乱期、结构期及器质破坏期出现的各种病变特征进行了观察及描述，发现滑膜组织病变与ＴＭＪＩＤ的病变程度有关，并表明关节内窥镜检是关节滑膜病变诊断之有效而准确的手段。     

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。     

颞下颌关节紊乱综合征器质性改变类X线分型的初步探讨

本文分析了160例确诊为颞下颌关节紊乱综合征(TMJDS)器质性改变类病例的临床资料、X线平片和关节造影片,提出TMJDS器质性改变类可能存在一特殊类型,暂称之为侵蚀性颞下颌关节骨关节炎.其X线平片表现为,关节骨质局限性溶解、缺损、甚至较大范围的骨质侵蚀破坏,而无硬化增生改变.临床特征为;①青年女性多,30岁以下;②病史短,多在1年内;③多因咀嚼痛或/和张口痛求诊,临床检查关节区有明确的压痛;④一部分病人因疼痛而致开口受限;⑤严重骨质破坏者,多已发生了关节盘穿孔;⑥临床保守治疗效果差.     

Rhinoliths causing palatal perforation: case report and literature review

Rhinoliths are calcified masses formed within the nasal cavity because of the solidification of mucus, debris, or foreign objects by gradual accretion of mineral salts. They are mostly asymptomatic and incidentally diagnosed, although some patients may complain of nasal discharge and obstruction. Ulceration of the nasal mucosa, facial swelling, and bone destruction are less frequently observed but bring about difficulties for differential diagnoses with several pathologic entities. This article presents a case of a 54-year-old woman with a rhinolith causing palatal perforation, focusing on the diagnostic process and histopathologic characteristics.     

Postural and maximum activity in elevators during mandible pre- and post-occlusal splint treatment of temporomandibular joint disturbance syndrome

Electromyograms (EMGs) of the temporal and masseter muscles in sixty patients with temporomandibular joint disturbance syndrome (TMJDS) and thirty controls were recorded and integrated on-line in the postural position and during maximum clenching, before and after occlusal splint therapy. Contrasting with the controls, the myoelectrical activity of the patients was higher in the postural position and lower during maximum clenching, whilst the former in percentage terms increased when compared to the latter. After treatment, the EMG indexes in some patients returned partially, and in others completely, to a normal level. Tenderness in the mandibular elevators, deviated opening and organic change in the TMJ increased the postural myoelectrical activity, in percentage terms, against that of maximum clenching. The myoelectrical activity of the mandibular elevators in the postural position and during maximum clenching was smaller in patients with the occlusal splint than in those without. The results show that the mandibular elevators in the patients with TMJDS were hyperactive and tense, and that the occlusal splint was useful for treating such dysfunction.     

Ultrastructural study of cultured human gingival fibroblasts exposed to endotoxin

Our current concept of periodontal disease is that some mediators found in the gingival sulcus are able to penetrate the epithelial barrier and produce tissue destruction in the periodontium. Endotoxin, one such mediator, recently has been the subject of considerable study. The purpose of this investigation was to substantiate the role of endotoxin in the pathogenesis of periodontal disease by ascertaining its action on cellular and subcellular components. In order to accomplish this, cultured human gingival fibroblasts were exposed to media containing either 300 micrograms/ml or 500 micrograms/ml of endotoxin and untreated medium for a period of 24 hours. Cells were harvested and prepared for electron microscopy by conventional methods. Electron microscopic examination revealed alterations in mitochondria, Golgi apparatus, lysosomal-like bodies, cytofilaments and plasma membrane. Relationship of these alterations to pathologic processes is discussed.     

颞颌关节紊乱综合征保守治疗932例疗效分析

本文报告了932例颞颌关节紊乱综合征的患者,经过药物、药罐、局封、理疗、调整(牙合)关系几个方面的综合性保守治疗,随访了3月～8年,平均随访期4年。结果766例症状得到不同程度缓解,总有效率达82.19％。功能期的显效率明显比结构期、器质期高,P<0.01。器质期患者经治疗,虽显疗效较低,但总有效率达80.10％,故器质期亦应首选非手术综合治疗。     

Clinical, histologic and scanning electron microscopic study of the development of chronic candidiasis of the rat tongue

In order to examine the development of the chronic candidal lesion of the dorsal rat tongue, 210 rats were given a single oral inoculum of Candida albicans on Day 0 and were sequentially killed over a 20-wk period. Dorsal tongue changes were evaluated using clinical photographs, histologic sections and scanning electron microscopy (SEM). Clinically evident lesions became apparent at 2 wk post-inoculation, and inflammatory changes of the underlying connective tissue were observed by 3 wk post-inoculation. SEM showed a gradient of destruction of the dorsal tongue papillae at the periphery of the candidal lesions. Hyphae were seen infrequently on the lesional surface by SEM, a finding which correlated with the light microscopy.     

Inflammatory cells and pocket epithelium in periodontitis cases. Transmission and scanning electron microscopic study

Epithelial pocket walls of 10 hopeless teeth were separated from root surfaces after extraction. The tissues were prepared for examination by transmission (TEM) and scanning electron microscopies (SEM). The study focuses on inflammatory cells and their possible pathologic effects on gingival tissues. TEM observations showed widening of intercellular spaces and interruption or even complete deterioration of basal lamina when macrophages and lymphocytes were recognized between epithelial cells. SEM findings showed scattered lymphocytes and polymorphonuclear leukocytes (PMNs) on the pocket wall surfaces with several perforations that corresponded to their size. These observations led to the conclusion that separation between epithelial cells and perforations on pocket wall surfaces by inflammatory cells may promote periodontal tissue destruction by passage of irritant and destructive substances into the underlying connective tissue.     

Correlation between arthroscopically observed changes and synovial light microscopic findings in osteoarthritic temporomandibular joints

The aim of this study was to determine the correlation between arthroscopically observed (ASC) changes in the synovial membrane and other joint components and synovial light microscopic (LM) findings in the temporomandibular joint (TMJ). Synovial membrane biopsies were obtained during unilateral arthroscopy in forty patients. Thirty-one patients were diagnosed with TMJ osteoarthritis (OA) and nine patients with non-osteoarthritic conditions of their TMJs. Correlations between ASC and synovial LM findings were analyzed with Cohen's Kappa and Spearman's rank correlation tests. Values for Kappa of 0.6 and higher and values for a correlation coefficient of 0.7 and higher were considered satisfactory. No correlations were found in the retrodiscal tissue biopsies. In the anterodiscal tissue biopsies, ASC hypervascularity correlated with LM intima cell shape and cell density. ASC lowered attachment to the anterior slope of the articular eminence correlated with the LM presence of a fibrous intima matrix. In several TMJs, a high concurrence was observed between ASC and LM pathologic changes. The severity of pathologic changes as observed by LM was, however, often less than was suggested arthroscopically.     

髁状突即刻再植后的扫描电镜观察

为了解髁状突即刻再植后早期表面细微结构破坏和修复情况,本研究以日本大耳白兔为实验对象,切下右侧髁状突后行即刻再植术。术后分期处死动物,扫描电镜观察髁状突和关节盘表面细微结构的改变。结果表明术后早期术侧髁状突表面凝胶状物消失,网状胶原原纤维暴露,8周以后逐渐恢复。作者认为,髁状突再植的术式可选择性地用于颞下颌关节的重建。     

Retrospective evaluation of pathologic fractures in medication related osteonecrosis of the jaw

The aim of this study was to focus on the MRONJ-related pathologic fractures, their incidence, and to analyze possible causative factors for their occurrence.Pathologic fracture in patients suffering frm MRONJ were identified, examined in detail, and the patient characteristics were evaluated. In 116 patients (73 female and 43 male; mean age 62.08 ± 13.6 years), pathologic fracture incidence was found to be 4.31%. Zoledronic acid was the most commonly used anti-resorptive drug (77.8%). Median antiresorptive usage was 24 months. Five patients had pathologic fractures in the mandible. Four fracture patients had metastatic prostate cancer, and one had metastatic renal cell cancer.This case series study can provide clinical insight into which factors are associated with pathologic fractures. Cancer type, medical comorbidities, additive toxicity of the combination of antiresorptive and antiangiogenic drugs, specific pathogens, and dento-alveolar surgical procedures may be some of the important factors that need to be considered. Since MRONJ-related pathologic fracture management can be complicated, it may be good to focus on the causative factors and prevent occurrence with regular follow-up as often as possible in line with these factors.     

低磷酸酯酶症乳牙的光镜和扫描电镜研究

目的 观察低磷酸酯酶症在乳牙结构上的表现。方法 应用光学显微镜和扫描电子显微镜研究，对胝磷酸酯酶症患儿的下颌第二乳磨牙、上颌乳中切牙和下颌乳尖牙进行观察。结果 大部分牙根表面无确定的牙骨持结构或公在局部偶风小岛状的牙骨质；牙根表面普遍存在牙本质吸收现象，吸收以根尖部为重；牙根表面未风确定的细菌构成膜性结构。结论 认为牙根牙骨质形成不全或发育不良是该病患儿乳牙过早脱落的根本原因。