Craniofacial asymmetry and temporomandibular joint internal derangement in female adolescents: a posteroanterior cephalometric study

Unilateral or bilateral pathology of the osseous components of the temporomandibular joint (TMJ) can result in pronounced facial asymmetry because of dissimilar size and shape of the right and left sides of the mandible. To date, it is unknown whether abnormalities of the soft tissues of the TMJ are associated with greater than normal craniofacial asymmetry. In this study, we investigated the amount of craniofacial asymmetry in female orthodontic patients with unilateral or bilateral TMJ internal derangement (TMJ ID) relative to the amount in female patients without TMJ ID. The total sample consisted of 80 female adolescents. Bilateral TMJ magnetic resonance images were used as a database for objectively scoring the severity of TMJ ID. Craniofacial asymmetry was measured from posteroanterior cephalograms. Females with bilateral TMJ ID had significantly greater asymmetry in the vertical position of the antegonion. If the TMJ ID was more advanced on the right side, the ipsilateral ramus was shorter, resulting in significant asymmetry in this region. In all other craniofacial regions, the amount of asymmetry was not significant between females with normal TMJs and those with TMJ ID. The results indicate that a female orthodontic patient with bilateral TMJ ID or unilateral right TMJ ID may present with or develop a vertical mandibular discrepancy.     

Amount and direction of temporomandibular joint growth changes in Herbst treatment: a cephalometric long-term investigation

The amount and direction of condylar growth, glenoid fossa displacement, and "effective" temporomandibular joint (TMJ) changes (a summation of condylar growth, glenoid fossa displacement, and condylar position changes within the fossa) were analyzed in 35 Class II, Division 1 malocclusions (23 boys and 12 girls) treated with the Herbst appliance. Lateral head films in habitual occlusion and with the mouth wide open from before (T1) and after 7.5 months of Herbst treatment (T2) as well as 7.5 months (T3) and three years (T4) after treatment were evaluated. As a control group, a sample of 12 untreated male Class II Division I malocclusions was used during a 7.5-month time period corresponding to the treatment period (T2-T1) of the Herbst cases. The results revealed that during the treatment period (T2-T1) condylar growth was directed posteriorly about twice the amount as in the control subjects, and the fossa was displaced in an anterior inferior direction. The effective TMJ changes showed a pattern similar to condylar growth but were more pronounced. During the first posttreatment period (T3-T2), all TMJ changes reverted. The glenoid fossa was displaced backward; the amount of condylar growth and effective TMJ changes was reduced, and the changes were more superiorly directed. During the second posttreatment period (T4-T3), all TMJ changes were considered physiological. Conclusion: During Herbst treatment, the amount and direction of TMJ changes (condylar growth, fossa displacement, and effective TMJ changes) were only temporarily affected favorably by Herbst treatment.     

Treatment of a case of skeletal class II malocclusion with temporomandibular joint disorder using miniscrew anchorage

At the present time, there are no reports in the literature on the treatment of temporomandibular joint disorder (TMD) by intrusion of molars using mini-screws. This case report describes the treatment for a female patient, aged 19 years seven months, with a TMD and an excessive lower anterior facial height. Overjet and overbite were +5.0 mm and +0.5 mm, respectively. The patient had a history of orthodontic treatment in which her first premolars were all extracted. During the first orthodontic treatment, a clockwise mandibular rotation was observed as a result of the increase of posterior dentoalveolar height. She had temporomandibular joint (TMJ) pain during mouth opening and complained of difficulty in eating due to masticatory dysfunction. The pretreatment Schuller views of both TMJ showed a posterior condyle position. In order to correct the overjet, molar relationship and the mandibular condyle position, a miniscrew was inserted into the palatal region of the upper first molar to intrude the upper posterior teeth. As the upper molars were intruded, the overjet was decreased, and a class I molar relationship was achieved by a counterclockwise mandibular rotation. After one year of treatment, an acceptable occlusion was achieved, and the condyle moved into centric position in the glenoid fossa. The patient's teeth continued to be stable, and she had no pain in TMJ after a retention period of three years. The result of this treatment showed that molar intrusion using miniscrew anchorage is effective for treatment of a TMD patient with a posterior condyle position.     

Influence of different treatment procedures on the temporomandibular joint after mandibular setback in skeletal class III - A retrospective study

The aim of this study was to clarify the effects of three different orthognathic surgical procedures on the temporomandibular joint after mandibular setback. Conventional sagittal split ramus osteotomy (SSRO) with segmental fixation (conv-SSRO), intraoral vertical ramus osteotomy (IVRO), or SSRO without fixation followed by the physiological positioning strategy (nonfix-SSRO) was performed for mandibular setback. Temporomandibular joint disorder (TMD) symptoms were clinically assessed, and the condylar head angle was measured. In total, 129 patients participated. Preoperative TMD and treatment procedure were related to postoperative TMD. A menton deviation of 3.43 mm was the cutoff for the risk of postoperative TMD. The incidence rate of postoperative TMD in the conv-SSRO group was higher than that in the IVRO (p = 0.0197) and nonfix-SSRO (p = 0.0001) groups in asymmetric cases. There was no significant postoperative change in the temporomandibular joint space in each group. In symmetric and asymmetric cases, the condylar head was rotated inwards by 5.82 ± 4.75° (p < 0.0001) and 5.44 ± 3.10° (p < 0.0001), respectively, in the conv-SSRO group, and outwards by ?7.98 ± 5.05° (p < 0.0001) and ?8.32 ± 6.38° (p < 0.0001), respectively, in the IVRO group, but it was almost stable in the nonfix-SSRO group. Within the limitations of the study it seems that nonfix-SSRO should be preferred over conv-SSRO and IVRO whenever appropriate.     

Effective temporomandibular joint growth and chin position changes: Activator versus Herbst treatment. A cephalometric roentgenographic study

In 138 successfully treated Class II division 1 patients (40 Activator and 98 Herbst) effective temporomandibular joint (TMJ) growth changes (a summation of condylar remodelling, glenoid fossa remodelling, and condylar position changes within the fossa), and their influence on the position of the chin and the rotation of the mandible were analysed retrospectively. Lateral head films in habitual occlusion from before and after an average treatment period of 2.6 years for the Activator patients and 0.6 years for the Herbst patients were evaluated. Two different treatment changes were assessed: (1) overall growth changes and (2) treatment effects (overall growth changes minus age-related normal growth values: Bolton Standards). The comparison between the Activator and the Herbst group revealed larger effective TMJ and chin changes during Activator therapy due to the longer observation period (2.6 years versus 0.6 years). The treatment effects showed marked group differences for both the amount and direction of effective TMJ changes. The changes were vertical and slightly anterior in the Activator group, and predominantly posterior in the Herbst group. Concerning the chin changes, the treatment effects for the Herbst group exceeded those for the Activator group in both directions, caudally and anteriorly. The Activator group showed an anterior rotation and the Herbst group a slight posterior rotation of the mandible. The present investigation revealed that the effective TMJ and chin changes were increased by both Activator and Herbst treatment. However, the Herbst appliance renders more favourable sagittally orientated treatment effects in a much shorter period of time compared with the Activator.     

Treatment of a class 2 skeletal malocclusion with degenerative arthritis of the condyles using custom-made temporomandibular joint replacements and genioplasty

This case report presents the use of custom-made temporomandibular joint prostheses in the treatment of a class 2 malocclusion secondary to juvenile idiopathic arthritis. The patient had degeneration of the mandibular condyles with associated arthropathy and dentofacial deformity. Conventional orthognathic treatment was considered, but would not address the arthropathy. The orthognathic movements were accounted for in the design of the prosthesis and the patient’s arthralgia, functional limitations and aesthetics were addressed.     

225例颞颌关节强直病例临床回顾性研究

目的：探讨颞下颌关节强直病因及发生特点。方法：通过对225例颞颌关节强直病案资料的调查,对颞颌关节强直发生年龄、性别、病因、强直类型等进行分析。结果：髁突骨折好发于10岁以内;间接损伤为主要病因,其次是感染;结论：对于儿童期颏部受伤的病例,应注意预防颞颌关节强直的发生。     

Dental occlusal wear and degenerative disease of the temporomandibular joint: a correlational study utilizing skeletal material from a contemporary population

Forty crania and mandibles with intact dentition exceeding twenty-six teeth and bilaterally intact condyle-fossa apparatus were evaluated for attrition and degenerative joint disease. The skeletal specimens all represent a twentieth-century contemporary American population from the Atkinson Skull Collection at the University of the Pacific School of Dentistry. While 23.1% of this sample exhibited some degree of erosive osseous degenerative wear involving the condyle or articular fossa and 76.3% exhibited occlusal tooth wear, no significant correlation between the degree of attrition and the severity of degenerative joint disease could be documented.     

Ankylosis of the temporomandibular joint caused by rheumatoid arthritis: a pathological study and review

Rheumatoid arthritis (RA) of the temporomandibular joint (TMJ) in a 59-year-old Japanese woman is reported, including details of clinical, histopathological and radiological findings. The patient had been diagnosed as having RA of the right knee joint 41 years previously, and suffered from arthralgia of the right TMJ. Radiological examination showed a radiopaque lesion of the mandibular head and mandibular fossa in the right TMJ and ankylosis of the right TMJ was diagnosed on the basis of the clinical and radiological findings. Condylectomy was performed. Pathological examination of material from the joint region revealed a marked increase of collagen fibers associated with slight capillary dilatation and hemorrhage. The final diagnosis was ankylosis of the right TMJ due to RA. The literature on TMJ ankylosis secondary to RA is reviewed and discussed.     

Osteosarcoma of the temporomandibular joint: report of 2 cases

The aim of this article is to report 2 cases of osteosarcoma of the mandibular condyle, a rare pathological condition, and to emphasize and discuss the usefulness of different imaging modalities in the diagnosis and evaluation of osteosarcoma of the temporomandibular joint. In our assessment of the different imaging modalities, we found that 2-dimensional computed tomograms provide excellent detection of tumor calcification, cortical involvement, and in most instances, soft tissue and intramedullary extension, whereas 3-dimensional computed tomography vascular protocol can help to define the extension of the lesion, improving the visualization of the lesion's relationship to the adjacent anatomical structures. Magnetic resonance imaging is more effective in demonstrating the intramedullary and extraosseous tumor components on T2 weighted images. Because metastasis from body tumors to the maxillofacial region occurs occasionally, it is useful to examine the oral cavity when symptoms first appear and devote special attention to the subtle changes that may indicate early metastatic involvement.     

颞下颌关节滑膜软骨瘤病2例报告

结合2例颞下颌关节滑膜软骨瘤病的临床表现,X线、CT和MRI特征,以及术中所见,分析发生于颞下颌关节的滑膜软骨瘤病的临床特点、诊断及治疗方法.2例患者术前均有关节区疼痛、肿胀,无开口受限.X线片见颞下颌关节间隙增宽,其中1例CT显示颞下窝关节面骨质破坏并硬化,MRI可见关节腔内多发小结节状影.术后未出现咬合紊乱及开口受限.颞下颌关节滑膜软骨瘤病少见,临床表现无特异性,好发于关节上腔,钙化性游离体是其影像学特征,组织病理学常见软骨结构样小体,伴周围组织慢性炎症及纤维增生,一般需手术治疗.     

Internal derangement of the temporomandibular joint: a histochemical study.

The purpose of this study was to correlate histologic findings in temporomandibular joint (TMJ) condyles and discs with their macroscopic appearance at surgery. The 24 patients with internal derangement of the joint included 20 women and 4 men (mean age, 37 years; range, 18 to 61 years). The tissue lesions varied in degree from mild soft-tissue fraying and bone remodeling to extensive resorption and new cartilage and bone formation with high phosphatase enzyme activities, and even to loss of articular soft tissue and breakdown of cortical bone. Reactions may arise in the hard tissues before they occur in the articular surface layers.     

术前正畸对骨性Ⅲ类错颌患者颞下颌关节影响的锥形束CT研究

目的 探讨术前正畸对行正畸-正颌联合治疗的骨性Ⅲ类错颌患者颞下颌关节（TMJ）的影响。方法 选取24例行正畸-正颌联合治疗的骨性Ⅲ类错颌患者,分别在术前正畸完成前后检查并记录关节症状,并行锥形束CT（CBCT）扫描,在三维方向测量髁突各径值（d）、髁突高度（h）、不同角度下关节间隙（L）、双侧髁突间距（R）及各髁突角度值,比较和分析不同时期TMJ症状及骨性结构的变化情况。结果 术前正畸前后关节症状无明显改变;颞下颌关节骨性结构在三维方向上的各测量指标均无显著变化（P>0.05）。结论 在正畸-正颌联合治疗过程中,术前正畸不会对患者TMJ产生明显影响。     

Diskectomy of the temporomandibular joint: a double-contrast arthrotomographic follow-up study

The manner in which temporomandibular joint soft-tissue structures remodel following diskectomy has been assessed by double-contrast arthrotomography. Pre- and postoperative arthrograms were compared in ten joints. The intra-articular soft-tissue cover of the bony components was frequently thicker 1 to 3 years after the operation. The most pronounced thickening was observed in the mandibular fossa, whereas a thinner cover was found on the condyle and the tubercle. Development of a thick soft-tissue cover on the articulating surfaces indicates that the temporomandibular joint has a capacity articulating surfaces indicates that the temporomandibular joint has a capacity for functional adaptation following diskectomy. This may be an essential factor for a favorable postoperative result.