A retrospective study of temporomandibular joint ankylosis secondary to surgical treatment of mandibular condylar fractures

We investigated the incidence of ankylosis of the temporomandibular joint (TMJ) after open operations for fractures of the mandibular condyle, and analysed possible risk factors in a total of 385 patients with 492 condylar fractures who had been operated on in our department from 2001 to 2010. Sixteen patients developed postoperative ankylosis of the TMJ with 26 joints (5%) affected during a follow-up of 6 months–10 years. Of the 492 condylar fractures, the most common ones that were associated with postoperative ankylosis were those of the condylar head (20/248), followed by the condylar neck (6/193). Subcondylar fractures did not cause postoperative ankylosis (0/51). Among the 16 patients with postoperative ankylosis, 13 had associated anterior mandibular fractures. Long-screw (bicortical screw) fixation of fractures of the condylar head seemed to be associated with a lower incidence of postoperative ankylosis than fixation by miniplate and wire or removal of the fractured fragment. The articular discs were damaged in all ankylosed joints, and the remaining fractured fragment was found in 10 ankylosed joints after fractures of the condylar head. The results suggest that fractures of the condylar head are more prone to lead to postoperative ankylosis of the TMJ, and that the possible risk factors seem to include the technique used for fixation and damage to the disc, together with an anterior mandibular fracture with the fractured fragment remaining.     

Costochondral grafts in reconstruction of the temporomandibular joint after condylectomy: an experimental study in sheep

The purpose of this study was to investigate the effect of costochondral grafts in the temporomandibular joint (TMJ) in sheep. Five pure-bred adult Merino sheep were used. The condyle alone was resected and replaced with a costochondral graft from the 13th rib. The sheep were killed 3 months after operation. The range of jaw movements before and after operation and at death were recorded. The joints were examined radiologically, macroscopically, and histologically. A new condylar head with normal configuration and function developed. Histologically, the chondrocytes were arranged in a fashion similar to that of a normal joint. All inferior joint spaces showed fibrous adhesions between the condylar head and disc. This study showed that, when such grafts are used to replace the condyle in an otherwise normal sheep TMJ, they fused to the ramus and reconstituted a nearly normal, fully functional joint.     

正畸治疗对下颌髁突肥大术后颞下颌关节的影响

目的:评价正畸治疗对下颌髁突肥大术后颞下颌关节的影响,并探讨其术后关节的稳定性。方法:下颌髁突肥大高位切除术后转诊患者20例,男8例,女12例,年龄17~34岁,平均21.2岁,采用固定或隐形正畸治疗,种植钉压低患侧上颌后牙。术前、术后及正畸后进行颞下颌关节功能对比,常规拍摄锥形束CT(CBCT),头颅定位侧位片,Tc99m_MDP颌骨计算机体层扫描(SPECT)检查,着重测量关节间隙的改变。结果:术前患侧和健侧比较关节间隙(包括前间隙、上间隙及后间隙)无统计学差异,手术后及正畸后各关节间隙手术侧与非手术侧差异有统计学意义。结论:髁突高位切除术联合术后正确的正畸治疗可以有效改善患者由于髁突肥大导致的颜面及错牙合畸形以及由此引发的颞下颌关节障碍,正畸治疗后髁突回到关节窝正常位置,患侧髁突改建,稳定性较好。     

Post-surgical unilateral temporomandibular joint dislocation treated by open reduction followed by orthodontic treatment

A case of prolonged unilateral temporomandibular joint (TMJ) dislocation, which was treated by open surgical reduction and post-surgical orthodontic therapy, is presented. A 58-year-old woman presented complaining of facial asymmetry and malocclusion. She had received surgery for a malignant tumour in the right retromolar region 7 years previously. It was considered that contraction of the pterygoid muscle by surgical injury caused anterior meniscal displacement and TMJ dislocation. Since manual manipulation failed, direct open reduction was performed after separation of the lateral pterygoid muscle from the condylar head and removal of the intra-articular scar tissues. Although the condylar head was returned to the glenoid fossa, optimal occlusion was not obtained because of compensatory tooth movement and inclination. Satisfactory occlusion and symmetric facial appearance were brought about by post-surgical orthodontic therapy.     

术前正畸对颞下颌关节关节盘及髁突位置和形态的影响

目的 探讨术前正畸对颞下颌关节关节盘及髁突位置和形态的影响。方法 选择骨性错畸形患者30例,在颞下颌关节磁共振图像上进行测量。通过关节间隙测量,判定髁突位置;通过髁突头长度、宽度和高度测量,判定髁突形态;关节盘位置和形态由直接观察判定,采用SPSS 24.0软件包对所得数据进行统计学分析,比较骨性Ⅰ、Ⅱ和Ⅲ类畸形患者在术前正畸前、后关节盘及髁突位置和形态变化。结果 术前正畸前、后关节间隙和关节间隙指数,髁突头长度、宽度和高度、关节盘前移角及关节盘形态差异均无统计学意义（P>0.05）。结论 术前正畸治疗不会导致骨性错畸形患者关节盘及髁突位置和形态改变。     

Mandibular condyle morphology in relation to malocclusions in children

Recent studies show that forces applied to the mandible during treatment with functional appliances and other orthodontic therapies produce changes in the TMJ. Specific malocclusions might also apply forces that can produce changes in the morphology of the TMJ. This study examined 104 orthodontic patients (44 males and 60 females) prior to treatment. The size and location of the condyle was determined on submento-vertex and tomographic films which was related to clinical findings including age, sex, malocclusion type, facial type, TMJ symptoms, tooth eruption sequence, crossbites and midline discrepancies. The medio-lateral width of the condylar head correlated positively with the patients age (p less than 0.001) and sex (p less than 0.001). Also the antero-posterior widths of the condyle were correlated with age (p less than 0.05). The condylar size in males was found to be greater than in females. Midline discrepancy significantly altered the increase in condylar size during growth. Transversel anomalies had a markedly greater influence on condylar growth compared to other characteristics of occlusion. The major change in condylar size during growth occurred in medio-lateral dimension as compared to the antero-posterior. In addition, the medio-lateral width was affected by midline discrepancy but not the antero-posterior width.     

Condylar fractures of the mandible. III. positional changes of the chin.

Positional changes of the chin (symphysion = sy) following unilateral condylar fractures of the mandible were studied in 21 children and 20 adults by means of repeated radiographic examinations. On each occasion and for each individual the actual position of the sy was related to an estimated normal position. In those children in whom the remodeling processes in the temporomandibular joint (TMJ) resulted in normal skeletal relation, the result of the subcondylar fractures seemed to be a deviation of the sy towards the nonfractured side. In cases of condylar head and neck fractures a deviation towards the fractured side frequently occurred. In four of the five children in whom normal skeletal relation in the TMJ was not obtained, the sy deviated towards the condylar fracture side. In the majority of the adulsts, a deviation towards the condylar fracture side occurred irrespective of the level of the condylar fracture.     

Orthodontic finishing after TMJ disk manipulation and recapture

Orthodontic treatment has as its goal in most patients to achieve a cosmetic and functional result. There are functional goals for all orthodontic treatment and in some few cases the functional outweigh the cosmetic; an example would be a cleft-palate case. Orthodontic finishing to a specific condylar position is not routinely a goal of orthodontic care. The reason for this is that only patients who have pain, dysfunction and a negative change in quality of life from their temporomandibular apparatus need this tangential type of treatment. Research has shown that most patients suffering from a temporomandibular disorder (TMD) have displacement of the temporomandibular disk(s). Research has shown that when the mandibular condyle is repositioned to the Gelb 4/7 position that the temporomandibular joint disk is recaptured to a normal position between 85% and 96% of the time. The Gelb 4/7 position has been equated to the physiologic position of the mandibular condyle in the glenoid fossa. TMJ condyle repositioning to the physiologic position has been correlated to disk recapture proven by magnetic resonance imaging (MRI). A case is shown in which a displacement without reduction is manipulated into reduction and maintained with orthodontic correction. TMJ disk displacement without reduction is usually preceded by TMJ disk displacement with reduction. Pumping of the upper joint compartment can assist in reducing the TMJ disk displacement without reduction. Magnetic resonance imaging before and after the manipulation and after orthodontic treatment are shown. A detailed method of orthodontic finishing that maintains a specific condylar position and TMJ disk recapture is shown.     

A three-dimensional method of visualizing the temporomandibular joint based on magnetic resonance imaging in a case of juvenile chronic arthritis

Summary. Aim . The purpose of this study was to present a new visualizing method for temporomandibular joint (TMJ) pathology in 3D at several condylar positions and to apply the method to a case of juvenile chronic arthritis (JCA) with previously diagnosed bilateral TMJ disorder and to a subject without signs and symptoms from the TMJ.
Subject . The 20-year-old female patient had suffered from polyarticular JCA from the age of 6 years 8 months. The present study is based on a follow-up examination after the completion of orthodontic treatment with the Herbst appliance. Both TMJs were examined using magnetic resonance imaging (MRI) at closed and open mouth positions. The mandibular condyle, the glenoid fossa and the articular disc were segmented and 3D reconstruction of these structures was carried out.
Results. The condyle was characterized by an increased sagittal diameter with osteophyte-like formation at the anterior aspect of the condylar head and flattening of the superior surface. The depth of the glenoid fossa was reduced and the articular eminence was remarkably flat. The articular disc was markedly diminished and posteriorly placed on the condylar head. The distance of the condylar path during mouth opening was reduced and the curvature of the condylar path was quite flat. The disc moved slightly posteriorly on the condylar head and remained in the glenoid fossa during mouth opening.
Conclusion. The imaging modality described improves visualization of TMJ morphology and gains insight into the TMJ pathology of the JCA patient, adding to understanding of the clinical problems.     

Preliminary functional results of endoscope-assisted transoral treatment of displaced bilateral condylar mandible fractures

Temporomandibular joint (TMJ) function was evaluated following endoscope-assisted transoral open reduction and miniplate fixation of displaced bilateral condylar mandibular fractures. The transoral treatment of bilateral condylar fractures was performed in 13 patients from May 2000 to December 2004. Eleven of the 13 patients had additional mandibular fractures. Out of 26 fractures of the condylar process, 11 were located at the condylar neck and 15 were subcondylar. One, 6 and 12 months after surgery TMJ function was evaluated. Anatomic reduction was achieved using an endoscope-assisted transoral approach even when the condylar fragment was displaced medially and in fractures with comminution. Good TMJ function was noted 6 and 12 months after surgery. Mouth opening was measured to be more than 40 mm without deviation. Postoperative range of motion with a satisfying lateral excursion was found. Early rehabilitation and pre-injury TMJ function was achieved following minimally invasive anatomic fracture reduction.     

Long-term results of early condylar fracture correction: case report

Abstract –  Condylar fractures in childhood occur frequently, often with minimal pain and discomfort and therefore the diagnosis is not made at the time of injury. Management may be surgical or non-surgical. Non-surgical therapy in children is the method of choice if the condyle can translate normally. In fact, there is an excellent chance of regeneration and continued normal development after fracture in growing patients. The purpose of this article is to describe the long-term clinical and radiological evaluation of a conservatively treated unilateral condylar fracture, a result of trauma, in a 6-year-old patient. In addition, she presented a congenitally missing lower incisor ipsilateral to the fracture and a class II malocclusion. She was treated with functional jaw orthopedics using a splint and an activator and subsequent orthodontic treatment with fixed appliances [ J Orofac Orthop 5 (2002) 429]. The remodeling process of the condylar head and neck is clearly observed in the panoramic radiographs of the 12-year follow-up records presented.     

髁状突游离再植颞下颌关节重建术治疗髁突颈部骨折

目的:介绍髁状突游离再植行颞下颌关节重建术治疗髁突颈骨折的方法与疗效。方法:对12例伤员16侧髁突颈骨折行髁状突游离再植克氏针内固定术,术后定期行X线片及CT检查。结果:全部伤口一期愈合,追踪1～4年无关节疼痛、弹响及明显功能障碍,有3例面神经颞支损伤,2例轻度错畸形,影像学示髁状突形态多稍小且不规则。结论:本方法操作简便、损伤较轻、复位准确、固定可靠,并发症较少且轻微,适用于有严重移位的髁突颈骨折,髁状突的形态改变与长期影响需继续观察     

术前正畸对骨性Ⅲ类错(马合)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。     

An adult case of TMJ osteoarthrosis treated with splint therapy and the subsequent orthodontic occlusal reconstruction: adaptive change of the condyle during the treatment.

This article reports treatment for a 21-year 11-month old female patient with severe osteoarthrosis of the TMJ with a special reference to adaptive changes of the condyle during the treatment. She had severe open bite with a Class II molar relationship; she had limited mouth opening, TMJ sounds, pain, and tinnitus. Lateral tomograms showed flattening and deep erosion on the left condyle, and an MRI revealed anterior disk displacement without reduction. By manipulation and splint therapy, TMJ pain and tinnitus were eliminated, then orthodontic treatment was initiated, maintaining the splint-induced position of the condyles. After 2 years of orthodontic treatment with a multibracket appliance, an acceptable occlusion was achieved with a Class I molar relationship. On lateral tomograms after treatment, bony deformation of the left condyle disappeared and adaptive remodeling was recognized with a uniform joint space in the left TMJ. However, repositioning of the disk was not achieved. Adaptive changes or functional remodeling experienced in this patient may be due to stable occlusion, uniform joint space, and the consequent biomechanical equilibrium in the TMJ.     

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。     

Condylar bony change and mandibular deviation in orthodontic patients – using helical CT and MRI

This study was designed to assess the relationship between condylar bony change and mandibular deviation in the orthodontic patient. Seventy‐one patients were examined with helical computed tomography and magnetic resonance imaging to assess the condylar bony change and/or disk displacement prior to acceptance for orthodontic treatment. They were grouped into no condylar bony change (NBC) and unilateral condylar bony change (UBC). Frontal and lateral cephalograms and panoramic radiographs were also utilized to evaluate craniofacial morphology, and condylar and ramal heights. The results revealed that TMJ sounds occurred more in the UBC than the NBC group at all ages; but, TMJ pain and difficulty of mouth opening did not show remarkable differences. Erosion, a characteristic feature in age 9–13 years in UBC, occurred with normal disk position or disk displacement without reduction. Flattening exhibited normal disk position in age 9–13 years but was accompanied with disk displacement in age 14–18 years and 19 years and above. Osteophyte formation was highly associated with disk displacement without reduction in all age groups. Moreover, the UBC group's mandible was deviated to the ipsilateral side with significantly shorter condylar height on the affected side. In all age groups of UBC, the difference of condylar height was highly correlated with anterior maxilla, occlusal and gonial planes and with mandibular deviation. All aforementioned results suggest that unilateral condylar bony change can occur with normal disk position or ahead of disk displacement in the young patients. It seems that unilateral condylar bony changes can cause not only mandibular deviation but can also affect the cant of maxillary basal bone, mandibular plane angle and lower dentition.     

Practical evaluation of the lateral temporomandibular joint radiograph

The reevaluation of the lateral transcranial radiograph is needed because of the confusion that surrounds the diagnosis and treatment of TMJ dysfunction-pain. The lack of universal acceptance of the validity of the lateral TMJ radiograph contributes to the lack of progress of TMJ dysfunction-pain treatment and improved methods for the treatment of prosthodontic patients. The lateral transcranial TMJ radiograph was reevaluated for its duplicability (+/- 0.2 mm). The image was found to be a cross section of the lateral third of the condyle rather than a composite view of the condyle made at an angle. The condylar position in the fossa can be correctly evaluated in transcranial radiographs, because the relative condylar position in the fossa is similar in all sagittal views and the image is always of the same sagittal plane (lateral third). Soft tissue within or lining the fossa does not affect the evaluation of condylar position. Chronic osteoarthritic TMJ pathology can exist without subjective pain; therefore, routine use of initial TMJ radiographs with subsequent radiographs at 5-year intervals is suggested for all patients. Because condylar repositioning may be indicated before subjective pain symptoms appear, condylar repositioning should be contemplated whenever extensive prosthodontic treatment is needed. In addition, if chronic osteoarthritic lesions are observed initially, radiographs are indicated at more frequent intervals and anti-inflammatory agents should be considered for routine use depending on the rate and extent of the pathologic development. The existence of osteoarthritic lesions was confirmed by serial radiographs over 5 to 10 years. If an osteoarthritis is present, condylar repositioning (when condylar displacement is present) or changes in occlusion should be considered. There is some clinical evidence that condylar displacement is associated with pathologic remodeling and/or osteoarthritic lesions of the condyle and that condyle repositioning arrests the pathologic process. The principle of condylar concentricity , previously established for the treatment of TMJ dysfunction-pain syndrome and for functional centric relation in prosthodontics, was formulated by associating condylar position in the fossa with TMJ dysfunction-pain in many patients. This article suggests the value of the lateral TMJ radiograph as an important practical aid in the diagnosis and treatment of TMJ dysfunction pain and in the establishment of functional centric relation in prosthodontics.     

Axiographic evaluation of mandibular mobility in children with Angle Class-II/2 malocclusion (deep overbite)

Correction of the occlusion in Angle Class-II/2 patients is often more complicated and tedious than in Class-II/1 cases. Reasons given are the more comprehensive remodeling and functional adaptation processes of the temporomandibular joints (TMJ) since the articular tuberculum is more strongly developed in deep overbite, and a deep bite leading to a locked occlusion is dominant due to the steeper condylar path. Both characteristics are, however, considered to be the consequence of pronounced incisor retrusion. The present study covered 28 untreated Class-II/2 patients aged 8 to 12 years in whom functional TMJ adaptation to the retroclined maxillary incisors was studied with the help of electronic, 3D axiographic registrations of mandibular movements. Comparison with eugnathic age peers revealed increased mobility in mandibular protrusion and a somewhat steeper condylar path, although the latter was less pronounced than in adult patients. The results corroborate the concept of functional TMJ adaptation to incisor inclination and speak for early uprighting of maxillary incisors.     

安氏Ⅱ^2【错牙＋合】正畸治疗前后髁突位置的锥束CT观察

目的：通过锥束CT观测并评价安氏Ⅱ2错病例正畸治疗前后髁突位置的变化。方法：对17例安氏Ⅱ2错病例进行正畸治疗,分别于治疗前后拍摄双侧颞颌关节（TMJ）锥束CT片,进行t检验比较关节间隙的线性测量数值。结果：TMJ前间隙、后间隙在正畸治疗前后比较,有显著性差异（P〈0.05）;TMJ前、后间隙比值较治疗前明显缩小（P〈0.05）。患者主诉TMJ区不适症状缓解,髁突位置基本居中。结论：正畸治疗安氏Ⅱ2错,可使髁突向前下方移动,使得RCP与ICP2位者比例增加,恢复了、肌肉、关节正常的平衡关系,有利于改善TMJ功能。锥束CT的应用使TMJ结构的变化得以量化,能对正畸治疗效果进行客观评价。     

超声在颞下颌关节功能评价中的应用

颞下颌关节的功能状态关系到口腔颌面外科、正畸科和修复科等的治疗成败,超声作为颞下颌关节功能评价的一种新兴手段,以其无损伤性、经济、有效等特点得到了越来越广泛的应用。下面就超声在颞下颌关节盘位置检查、髁突运动轨迹和颞下颌关节音检测等方面的作用作一综述。