Recurrent headaches in relation to temporomandibular joint pain-dysfunction.

Two groups of 80 patients, one referred because of mandibular dysfunction and one seeking dental treatment, completed questionnaires concerning recurrent headaches. The function of the masticatory system of all patients was afterwards examined clinically. The investigation showed that clenching of teeth was correlated to the severity of headache. The frequency and severity of headache varied also with the severity of mandibular dysfunction. Of the variables included in the dysfunction index, only masticatory musculature painful to palpation was found to have a distinct relationship to headaches. This implies that functional treatment is indicated in patients with headaches and tendernes of the masticatory musculature. Functional examination of the masticatory system should therefore be included in investigations of recurrent headaches.     

A clinical and tomographic study on temporomandibular joint osteoarthritis

One hundred and twenty two patients with temporomandibular joint (TMJ) disorders were examined by lateral and frontal tomograms. A comparison between clinical and radiographic findings was performed to confirm the clinical characteristics of TMJ osteoarthritis. The patients with radiographic abnormal or suspicious findings showed a significantly higher frequency of TMJ pain and limitation of mouth opening less than 29mm than the patients with normal findings. The TMJs with surface erosion also showed a significantly higher frequency of TMJ pain than the TMJs with normal findings. Therefore, these findings were thought to be one of the distinctive feature of TMJ osteoarthritis. However, 22 patients with unilateral clinically primary symptoms presented bilateral abnormal or suspicious findings and 7 patients with unilateral clinically primary symptoms presented abnormal or suspicious findings only in the TMJ opposite to the clinically primary symptomatic site. Therefore, the necessity of radiographic examination of the clinically unaffected TMJ was concurrently indicated for the treatment planning and for the further research. Dr. Yamada was the Professor of the Department of Oral Radiology April 1982–March 1991     

Single portal arthroscopic temporomandibular joint discopexy: Technique and results

The aim of the present study is to assess the outcomes of monoportal arthroscopic disc repositioning (discopexy) for disc displacement of the temporomandibular joint.A retrospective, single-institutional clinical study included patients with temporomandibular joint internal derangements diagnosed and treated by monoportal discopexy. Each patient was diagnosed as having anterior disk displacement with or without reduction. The arthroscopy treatment consists of one portal approach fixing the disc with a 3/0 nylon to the tragus cartilage without anterior liberation. Arthroscopy surgery was carried out with a 1.9-mm 0° arthroscope and only one simple cannula. We use a needle to pierce of the disc through the skin and retrieve the suture inside the joint using a blind method through the arthroscopic cannula. The evaluated variables included the maximum interincisal opening, the presence of clicking and pain score.A total of 19 patients, 21 joints, were included in the present study. Of the 21 joints, 16 were classified as disc displacement with reduction and 5 without. Visual analogue scale (VAS) values (0–10) decreased from 5.5 to 1.26 (p < 0.0001) 1 year after surgery. At the first review, all patients had a VAS of at least 4 points less than before the surgery, four patients showed a VAS of 0, and nine patients near to 1. Mouth opening increased from 36.6 (±8.09) mm to 39.37 (±4.35) mm, and no significant limitations in the mouth opening range were seen (p < 0.12) 1 year after surgery. Clicking disappeared in all patients and remained stable after 12 months of follow-up. Postoperative magnetic resonance imaging demonstrated a correct or improved position of the disc in all but one patient.A minimally invasive single portal arthroscopic discopexy is an effective technique to improve function and pain reduction in patients with anterior disk displacement with or without reduction.     

颞下颌关节紊乱指数临床应用评价

目的 探讨如何采用客观定量的方法评价颞下颌关节功能障碍程度和颞下颌关节紊乱病（temporomandibular disorders,TMD）的治疗效果。方法 分别采用Fricton颞下颌关节紊乱指数和Helkimo临床检查功能障碍指数，定量计算每例患者（共60例）的颞下颌关节紊乱指数，评价不同检查者获得的各项指数的一致性，并应用Fricton颞下颌关节紊乱指数定量评价TMD急性不可复性盘前移位的临床治疗效果。结果 （1）不同检查者获得的各项Fricton紊乱指数值相近；（2）Fricton紊乱指数可明确反映TMD急性不可复性盘前移位治疗后临床功能的改善。结论 评价TMD功能障碍程度或评价TMD治疗效果宜避免使用非客观的、描述性的报告，Fricton紊乱指数是一方便且有效的客观定量指标。     

颞下颌关节盘绞锁的自然病程探讨

目的 定期追踪随访颞下颌关节盘绞锁患者,初步了解关节盘绞锁的自然病程和转归.方法 初诊为关节盘绞锁的68例患者中,54例进行24个月的电话追踪随访.根据绞锁的病程发展分为:症状进展组(即发生不可复性盘前移位)、症状消失组、症状持续组,并用统计学方法分析组间年龄、性别、病程、有无疼痛和绞锁发生频率间有无差异.结果 54例随访患者中,症状进展组16例(30%),症状持续组32例(59%),症状消失组6例(11%);3组患者的性别、年龄、初诊时有无疼痛和绞锁发生的频率比较,差异均无统计学意义(P>0.05).结论 关节盘绞锁患者发生不可复性盘前移位的风险增大;关节盘绞锁发展为不可复性盘前移位与患者的性别、年龄、病程、有无疼痛和绞锁频率似无关,有待扩大样本量后进一步研究.

Abstract：

Objective To investigate the clinical natural course of temporomandibular joint(TMJ) intermittent closed lock(ICL) through 24 months follow-up. Methods Sixty-eight patients with ICL were included, and 54 patients finished 24 months follow-up. The disease duration, frequency of joint lock and joint pain were recorded at the patient′s first visit. Telephone interviews were taken for every month, and the frequency of joint lock and joint pain were recorded. According to the development of ICL, the patients were divided into 3 groups: symptom-worsened group, symptom-disappeared group, symptom-persisted group. Results There were 16 patients(30%) whose symptoms worsened into closed lock (disk displacement without reduction), 32 patients(59%) whose symptoms persisted during the 24 months follow-up, and 6 patients′(11%) symptoms disappeared. In symptom-persisted group,the frequency of joint lock decreased in 11/32(34%), increased in 4/32(13%), did not change in 17/32(53%).There was no significant difference in gender, age, frequency of joint lock and joint pain recorded at the first visit among these 3 groups(P>0.05).The disease duration in the symptom-disappeared group was much shorter than the other 2 groups (P<0.05). Conclusions ICL of TMJ was more likely to get worse into closed lock. There seemed no significant relation between the sequelaes of ICL and patients′ gender, age, disease duration, frequency of joint lock and joint pain, and larger sample studies were necessary.     

肋骨肋软骨移植在颞下颌关节重建中的应用进展

颞下颌关节疾病如骨折、强直、肿瘤等,常会造成髁突破坏或缺损,需进行颞下颌关节重建。目前,肋骨肋软骨移植已成为颞下颌关节重建的首选方法。20世纪20年代首次将肋骨肋软骨移植应用于颞下颌关节重建,之后诸多学者在肋骨肋软骨选择、术后肋软骨生长情况以及如何减少手术创伤等方面做了大量研究。本文主要从以上几个方面,对肋骨肋软骨移植重建颞下颌关节的现状作一综述。     

Background factors in craniomandibular disorders: reported symptoms in adolescents with special reference to joint hypermobility and oral parafunctions

Abstract— Correlations between craniomandibular disorders (CMD) symptoms and an inherited factor (general joint hypermobility) were studied in 193 adolescents (96 girls and 97 boys). They answered a questionnaire concerning CMD symptoms, oral parafunctions, head and jaw trauma and symptoms from other joints. Joint mobility was assessed by determining the Beighton score (0-9). Twenty-eight percent of the girls and 21% of the boys could perform four or more of the maneuvres. Twenty-two percent of the girls and 3% of the boys were extremely hypermobile (score ≥5). Eighty-nine percent were aware of some oral parafunction and the prevalences of oral habits were about the same in the two groups. Girls reported significantly more dysfunction symptoms than boys. No indication was found that oral parafunctions generally produced CMD but a systemic factor (joint hypermobility) seemed to play an important role when the masticatory system was exposed to local forces as in oral parafunction. This may be one explanation for the predominance of females among CMD patients.     

Treatment of end stage temporomandibular joint disorder using a temporomandibular joint total prosthesis: The Slovenian experience

Purpose

The aim of this study was to analyse treatment results after alloplastic temporomandibular joint replacement surgery.

Case of tuberculosis of the temporomandibular joint

Tuberculosis (TB) of the temporomandibular joint (TMJ) is rare and misdiagnosis is common. We describe an unusual case of the disease in a 27-year-old Zimbabwean woman.     

Ganglion cyst of the temporomandibular joint

We describe a case of a ganglion cyst of the temporomandibular joint (TMJ) and review the literature of this rare entity. Because of the rarity of such cysts in the TMJ, an accurate diagnosis is not usually made preoperatively. Treatment is surgical but, if a diagnosis can be made, a period of conservative management is justified.     

Morphometric analysis of temporomandibular joint elements

Purpose

To study the morphology of temporomandibular joint (TMJ) elements and examine the feasibility of a novel biofidelic articular disc casting technique.

The potential etiologic factors influencing tinnitus intensity in patients with temporomandibular disorders

Objectives: To investigate the potential relationships between the intensity of tinnitus associated with temporomandibular disorders (TMD) and potential etiologic factors, including age, gender, freeway space, sleep bruxism (SB), joint clicking, and headache.

Methods: The sample was comprised of 90 patients without any hearing loss, as confirmed by otorhinolaryngology, who self-reported subjective tinnitus and simultaneous TMD, based on the Research Diagnostic Criteria for TMD (RDC/TMD).

Results: The results showed a positive, weak correlation between the intensity of tinnitus and age (r = 0.225, p = 0.033). The presence of SB and headache were seen in higher proportions in the present sample, at 75.5% (n = 68) and 66.6% (n = 60), respectively.

Conclusions: In a population of patients with subjective tinnitus and TMD, no significant associations were found between tinnitus intensity and age, freeway space, SB, clicking presence, and headache, though gender did show a weak correlation with tinnitus intensity.     

术中CT在颞下颌关节强直疗效评价中的应用

目的 探讨术中CT在颞下颌关节（temporomandibular joint,TMJ）强直手术治疗效果评价中的应用价值。方法 回顾分析2016年7月—2018年12月完成的4例颞下颌关节强直患者的临床资料,分析一般资料特点、强直类型、扫描时间、CT引导的术中修正及术后效果。结果 在术中CT的引导下,4例（5侧）颞下颌关节强直手术均顺利完成。术中CT平均耗时（10.2±3.3）min,3例进行了术中修正,修正率75%。所有患者术后创口愈合良好,开口度平均38.8 mm,患者满意度100%。结论 术中CT提高了TMJ强直手术的精确性,保证了手术的安全性和可靠性。     

Risk factors for intraoperative dislocation of the total temporomandibular joint replacement and its management

Total replacement of the temporomandibular joint (TMJ) is an effective treatment for intractable pain and impaired function that is a consequence of end-stage joint disease. Prospective assessment of 138 joint replacements identified an 8% risk of intraoperative dislocation of the joint, which was associated primarily with coronoidectomy (30%) and inflammatory arthropathy (24%). Management included the use of intermaxillary elastic traction and treatment of masticatory dystonia when present. Of the 11 patients who had light elastic traction for one week, only one required further treatment for dislocation. Patients with no intraoperative dislocation did not require elastics, and joints remained stable postoperatively.     

Correlation between joint effusion and clinical symptoms,magnetic resonance imaging and arthroscopic findings in patients with temporomandibular joint disease

ObjectivesThe aim of this study was to evaluate the relationship between temporomandibular joint (TMJ) effusions and clinical, magnetic resonance imaging and arthroscopic variables.MethodsWe designed a retrospective cohort study of patients attending our Department who presented temporomandibular joint disease according to the Research Diagnostic Criteria for Temporomandibular Disorders. According to the presence of effusion in magnetic resonance imaging, the sample was divided into 2 groups: patients with or without joint effusion.ResultsA total of 203 patients fulfilled the inclusion criteria, of which 99 (48.8%) showed no joint effusion and 104 (51.2%) presented effusion. We found no significant differences between clinical variables and joint effusion. However, patients without effusion showed significantly longer duration of symptoms that patients with effusion (mean = 34.8 months, standard deviation = 43.41 vs 20.25, 23.76; p = 0.005). We found no significant differences in magnetic resonance imaging and arthroscopic variables associated with the presence of effusions. For both groups, there were statistically significant differences in values of mean pain scores and mean maximum interincisal distance between the different times of examination (before surgery and 3, 6 and 12 months after surgery).ConclusionJoint effusion is not associated with clinical, imaging or arthroscopic variables, but may be a clinical characteristic of early stages of temporomandibular joint disease.     

自体冠突移植在颞下颌关节强直关节重建术中的应用

目的：探讨自体冠突移植在颞下颌关节强直关节重建术中的应用及效果。方法：对2008年9月—2010年9月期间收治的9例颞下颌关节强直患者应用自体冠突移植关节重建术式治疗,间隙插补物采用自体关节盘或口腔生物膜,比较术前、术后开口度、咬合情况和锥形束CT检查结果。结果：术后随访12～24个月,术后最大开口度得到明显改善,咬合关系无改变,在随访期内, 所有患者无复发。锥形束CT显示,移植冠突与下颌支骨性愈合,移植的冠突顶端变圆钝,向髁突形态转变。结论：自体冠突移植关节重建术是治疗颞下颌关节强直的有效术式。     

Analysis of MRI findings in minimum invasive treatment for habitual temporomandibular joint dislocation by autologous blood injection around the temporomandibular joint capsule

The aim of this study was to investigate magnetic resonance imaging (MRI) findings following autologous blood injection (ABI) for habitual temporomandibular joint (TMJ) dislocation. MRI was performed one hour and four and twelve weeks after ABI, revealing three types of significant findings. The first type was similar to hematoma and/or joint effusion in the articular capsule of the TMJ (type I). The second showed sporadic and diffuse T2 emphasis around the TMJ capsule (type II). The third involved a decreased range of condyle movement compared to before ABI (type III). Furthermore, we analyzed the three types of significant MRI findings.At one hour after ABI, type I was Grade 0 in 0 of 14 patients, Grade 1 in 8, Grade 2 in 2, and Grade 3 in 4. Type II was seen in 9 of the 14 cases and type III in 8. After twelve weeks, all cases of type I were Grade 0, no type II cases were evident, and type III was seen in 11 cases. Injecting autologous blood into surrounding TMJ tissues is an important factor in ABI. Minimally invasive treatment for habitual TMJ dislocation using ABI around the TMJ capsule appears to represent a very effective and safe treatment.