UK temporomandibular joint replacement database: report on baseline data

Our goal is to establish the long-term collection of data on temporomandibular joint replacement from all centres in the UK where this is done. Currently, 16 surgeons have been identified, and 13 of them had entered data when this paper was being prepared. Data are entered online through the Snap Survey and then analysed annually. We report on 402 patients (332 (83%) female and 70 (17%) male) who had 577 joints inserted between 1994 and 2012. The main diagnoses that resulted in total joint replacement were osteoarthritis, failed operation, ankylosis, and seronegative arthritis. Preoperatively, the median (IQR) maximal incisal opening was 20 (15–26) mm (mean 20) and the median pain scores on the visual analogue scale (VAS 0–10) were 8 for both joints. The median (IQR) baseline dietary score (liquid 0 – solid 10) was 4 (3–6). A total of 173 (43%) patients had had one or more open procedure(s) before total replacement, 177 (44%) had not had open operation, and 52 (13%) had no data entered. The 3 primary systems used were the TMJ Concepts System (Ventura, USA), the Biomet System (Biomet/Lorenz Microfixation, Jacksonville, USA), and the Christensen System (TMJ Implants, Golden, USA). The median (IQR) duration of inpatient stay was 3 (2–4) days (mean 3). Follow-up data will be collected to assess patient recorded outcome measures (PROM) and objective measurements of total joint replacements in the UK from 1994 onwards.     

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颞下颌人工关节经过近50年的发展已较为成熟,主要用于关节强直、髁突骨关节炎晚期、髁突肿瘤以及髁突特发性吸收等疾病的关节置换治疗。然而国内目前尚无相关产品。本文就国际主流人工关节置换系统的设计、类型和临床应用情况做一综述。     

Analysis of mandibular motion following unilateral and bilateral alloplastic TMJ reconstruction

The purpose of this study was to analyse the masticatory patterns and range of motion (maximal incisal opening (MIO), protrusion and lateral excursion) in patients who have had unilateral and bilateral temporomandibular joint (TMJ) replacement with an alloplastic prosthesis, and compare them to each other and to normal controls. Mandibular motion was examined in 18 patients, who had undergone alloplastic TMJ reconstruction, 13 with a bilateral prosthesis and 5 with a unilateral prosthesis, and in 13 normal controls. A statistically significant difference (P < 0.01) for MIO and maximum lateral excursion was observed between the bilateral group and the control group. Maximum protrusion was only statistically significantly different (P < 0.05) between the bilateral group and the control group. For the unilateral group, a statistically significant difference (P < 0.01) was seen only with maximum contralateral excursion when compared with controls. No statistically significant difference existed in MIO and protrusion between the unilateral and bilateral groups. Even though maximum ipsilateral lateral excursion was greater for the unilateral group than either left or right maximum lateral excursion by the bilateral group, this difference was not statistically significant. This study provided an in vivo analysis of mandibular motion following alloplastic TMJ reconstruction.     

One stage management of ankylosis of the temporomandibular joint with a custom-made total joint replacement system

Alloplastic joint prostheses have been used in the treatment of severe diseases of the temporomandibular joint (TMJ) for many years. Treatment of ankylosis of the TMJ has been difficult, with many surgical approaches being used that traditionally involved multistage procedures, long treatment times, and increasing expense. We report a single stage technique for replacement of an ankylosed joint using a custom-made prosthesis, and discuss the technical aspects of the procedure, including our use of a custom-made acrylic glenoid fossa template.     

颞下颌关节的3T磁共振高分辨扫描方法研究

目的：探索3T磁共振对颞下颌关节（TMJ）的成像方法与序列特点,并优化扫描参数。方法：采用Siemens3.0TTrio磁共振扫描机,8通道相控阵头线圈,对25例双侧TMJ分别行张口位、闭口位扫描。其中正常志愿者15例,TMD10例。结果：所有被检查者均一次扫描成功,分别取T1WI,T2WI,PWI以及T2WI,T1WI 3D容积成像,扫描方位以髁突为中心,分别做平行于髁突长轴的斜冠状位,垂直于髁突长轴的斜矢状位扫描,正常志愿者的双侧TMJ在优化后的扫描序列中充分而完整显示关节盘、关节间隙、关节窝、关节盘随张闭口改变而位置变化情况,关节周围软组织与骨组织亦充分清楚显示。10例TMD均完全显示出关节盘移位情况,与临床症状一致。结论：3T磁共振扫描机成像速度快,视野内成像矩阵高,解剖细节显示充分,组织分辨力高,对于TMJ等小关节的结构异常与细微病变的显示充分,是其它医学检查设备无法比拟的。     

Communicating hydrocephalus induced by mechanically increased amplitude of the intraventricular cerebrospinal fluid pulse pressure: rationale and method

To elucidate some of the brain stem mechanisms involved in tongue motility, extracellular microelectrode recordings were made from single neurons in the region of the hypoglossal nucleus in 10 decerebrate and 23 anesthetized (chloralose) adult cats. The antidromic response characteristics and the synaptically evoked responses of 71 motoneurons that supplied tongue protrusive (P) or retrusive (R) muscles were documented. Protrusive motoneurons could be synaptically excited by temporomandibular joint (TMJ), glossopharyngeal (IX), and/or superior laryngeal (SLN) nerve stimuli, whereas R motoneurons could be activated by lingual and/or IX nerve stimulation. Conditioning effects revealed that the inhibition of the antidromic responses was shorter in duration than the inhibitory effects noted when synaptically evoked responses were conditioned. Conditioning stimuli delivered to the lingual, TMJ, IX, and SLN nerves were most effective in inhibiting the synaptically evoked responses of P and R motoneurons for conditioning-test intervals of as much as 400 ms. Those conditioning stimuli which also could synaptically activate a motoneuron tended to facilitate the cell's synaptically evoked responses at conditioning-test intervals of about 10 ms, whereas conditioning stimuli which did not synaptically activate the cell resulted in only the long-lasting inhibition.     

Transport distraction osteogenesis as a method of reconstruction of the temporomandibular joint following gap arthroplasty for post-traumatic ankylosis in children: a clinical and radiological prospective assessment of outcome

This clinical and radiographic study investigated the use of transport distraction osteogenesis in unilateral temporomandibular joint (TMJ) ankylosis patients. Six patients aged between 4 and 8 years were selected for the study; the mean preoperative maximal inter-incisal opening (MIO) was 3.5 mm without lateral and protrusive mandibular movements. The ankylotic mass along with the posterior border of the ascending ramus was exposed via ‘lazy-S’ incision. A gap arthroplasty was performed, followed by a ‘reverse L’ osteotomy on the posterior border of the ramus. In-house manufactured extraoral distraction devices were used for this prospective study. Follow-up clinical and radiographic evaluation was carried out for 13–27 months after completion of the activation period. After a mean follow-up of 19 months, the mean MIO was 29.1 mm and the lateral and protrusive movements changed from none to slight. Cone beam computed tomography images of all patients showed remodelled neocondyle created by transport distraction osteogenesis with no statistically significant differences observed for average cancellous bone density, trabecular number, and trabecular spacing between the neocondyle of the operated side (test) and the condyle of the non-operated side (control). Neocondyle formation by transport distraction osteogenesis using the in-house distraction device is a promising treatment option for TMJ reconstruction in ankylosis patients.     

Chondroma of the mandibular condyle-relapse of a rare benign chondroid tumour after 5 years' follow-up: case report

Chondroma of the mandibular condyle is rare and its signs and symptoms can mimic those of patients with more common disorders of facial asymmetry or dysfunction of the temporomandibular joint (TMJ). We report a case of chondroma of the mandibular condyle that presented as temporomandibular pain with malocclusion, and which relapsed 5 years after the initial treatment. To our knowledge only 7 cases of chondroma of the mandibular condyle have been reported in the last 70 years. This case is the eighth.     

Chondromalacia as pathological finding in arthroscopy of the temporomandibular joint: A retrospective study

Objective

The objective of this study was to describe the arthroscopic findings of chondromalacia and its relation with the internal derangement of the temporomandibular joint (TMJ).