Comparison of the multiphasic dysfunction profile with lateral transcranial radiographs

Lateral transcranial radiographs of 926 patients were analyzed for condylar position, TMJ space, and obvious condylar morphologic changes. Differences in condylar position and joint space variations were noted between men and women. An increase in nonconcentric condylar position, joint space variations, and condylar morphologic changes were found with advancing age. There was a significant correlation of condylar position, joint space variations, and condylar morphology with mandibular dysfunction profile scores. Mandibular dysfunction is manifested by a wide range of signs and symptoms, none of which is always present with the disorder. Although TRs are limited in their total diagnostic value, their use in discerning major TMJ changes serves as an important adjunct in the examination and diagnosis of mandibular dysfunction.

Condylar position following mandibular advancement: its relationship to relapse

Forty-one patients who elected to receive a bilateral sagittal osteotomy to advance the mandible were examined clinically and radiographically to assess condylar position preoperatively and at three specific times postoperatively. Parameters designed to measure changes in condylar and distal fragment position were located on tracings and digitized for statistical analysis. Changes in distal fragment position included advancement and clockwise rotation during the surgical interval and significant posterior relapse with continued clockwise rotation during the period of maxillomandibular fixation. A small amount of counterclockwise rotation associated with interocclusal splint removal was seen following fixation release. No significant condylar movement was seen during the surgical interval. During the period of maxillomandibular fixation, both condyles exhibited a significant superior movement, and the left condyle also moved posteriorly. No changes in condylar position were noted following release of fixation. The clinical significance of these condylar movements is not clear. Despite minimal changes, 18 patients, six of whom had had no preoperative symptoms and one of whom had exhibited reciprocal clicking, complained of temporomandibular joint pain or noise postoperatively. This suggests that maintenance of condylar position during surgery may not prevent temporomandibular joint dysfunction. In addition, the observed 37% relapse in surgical advancement in the absence of significant condylar distraction implies the interaction of other factors in the relapse process.

Computerized skeletal scintigraphy for assessment of mandibular asymmetry

Normal standards of technetium-99m methylene diphosphonate (99mTc-MDP) uptake in the jaws of adults and growing children have previously been established. This study utilizes the technique of skeletal scintigraphy for diagnosis and treatment planning in 21 patients with mandibular asymmetry. Diagnoses included hemifacial microsomia (n = 6), condylar hyper or hypoplasia (n = 10), and generalized mandibular asymmetry (n = 5). 99mTc-MDP uptake was measured in the right and left condyle, ramus, and body. Uptake was then compared with the known age-adjusted standards. The data were used to determine 1) mandibular growth activity, 2) normal vs. abnormal side, and 3) the effects of operative and functional therapy. The presence of end stage deformity was predicted when mandibular uptake reached the adult norm.

Computed tomography of the temporo-mandibular joint

Computed tomography (CT) of the temporo-mandibular joint (TMJ) has only been occasionally reported. As CT techniques improve, more detailed information is available. Though conventional radiography of the TMJ can supply sufficient diagnostic detail, it may well be replaced by CT as a preliminary examination, as it is able to offer more information with less radiation and minimal patient discomfort.

Radionuclide bone scanning in the diagnosis and management of condylar hyperplasia

Four patients with maxillo-mandibular facial dysharmony and four controls were evaluated by 99Tcm-MDP (methyl diphosphonate) scintiscanning. The scintiscans in all patients with dysharmony showed positive uptake of the tracer indicating the increased degree of activity in the condylar region of the mandible. The significance of this is discussed.

Computerized tomography examination for the detection of positional changes in the temporomandibular joint after ramus osteotomies with screw fixation

Changes in the position of the temporomandibular joint following sagittal splitting osteotomy of the mandibular ramus with screw fixation were examined using computerized tomography. Ten patients were involved in the study. Rotational movement of the condyle-bearing fragment was most commonly seen in the transverse computer tomograms. However, the use of screw fixation seems to cause no major malpositioning of the condyle-bearing fragment.

Chip fractures of the mandibular condyle

Four patients suffered from trauma of the temporomandibular (TM) joints. They were examined by routine x-ray procedures. The x-ray films failed to demonstrate a chip fracture of the head of the mandibular condyle. A coronal computed tomographic (CT) view established the fracture shortly after the trauma in three patients. These patients improved clinically after physiotherapy. The fourth patient was retrospectively diagnosed as having a chip fracture of the mandibular head. She underwent CT scan 10 months posttrauma , and ankylosis of the TM joint was established. The mechanism and the clinical symptoms of this injury, which have not been previously described, are reported in this article.

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.

Radiography of the temporomandibular joint in female patients with TMJ pain or dysfunction. A seven year follow-up

One hundred and twenty-four patients with temporomandibular joint (TMJ) pain/dysfunction were examined radiographically and 54 of these patients were reexamined at a follow-up approximately after 7 years. The radiographic examination included submentovertical, oblique lateral transcranial and transmaxillary projections. Abnormalities of structure and shape of the bony components were found in 50% of the joints; cortical/subcortical erosion was recorded in 15%, sclerosis in 33% and deviation in shape in 48%. Abnormal condylar position was observed in 46% of the joints. The 20 patients examined only at the follow-up demonstrated a frequency of these findings similar to those observed in patients selected for examination during the treatment period. At the 7-year follow-up, a slight increase in number of all types of abnormalities was found as well as a slight progression of abnormalities present at the first examination.

The validity of transcranial radiography in diagnosing TMJ anterior disk displacement

Two transcranial radiographic methods for determining anterior disk displacement in the TMJ were evaluated in comparison with results obtained from arthrography. Both transcranial radiographic methods could only accurately predict the presence of an anteriorly displaced disk in a range of 26% to 56% of the time (for example, the methods gave false-negative results 44% to 74% of the time). The methods were more valuable in correctly identifying joints that were free of disease, achieving this identification anywhere from 64% to 96% of the time. Although noninvasive, these two transcranial radiographic techniques produced results that lacked validity and, therefore, remain of questionable value to the clinician who is diagnosing anterior disk displacement.

Bifid mandibular condyle

Two cases of unilateral bifid mandibular condylar head are reported. A review of the literature showed that only four cases had been reported as occurring in living patients, although another twenty-two cases have been reported in dried skull or cadaver material. A brief discussion of the possible etiology is given.

Arthrographically guided splint therapy for recapturing the temporomandibular joint meniscus

Splint therapy for mandibular repositioning is an accepted method of treatment for patients with temporomandibular joint pain and dysfunction. An accurate method of registering the optimal mandibular position on the basis of meniscocondyle relationships depicted on arthrographs is described.

Diagnosis and treatment planning of skeletal asymmetry with the submental-vertical radiograph

The purpose of this study was to assess the reproducibility of landmarks visible in the submental-vertical radiographic projection. Ten subjects with at least a 2 mm apical base discrepancy as diagnosed by means of a posteroanterior headfilm were selected. Mean tracing and measurement error was found to be less than 1 mm for all landmarks. A system of patient orientation and radiographic technique is presented. The radiographs were made at 90 kVp, 15 mA, 1 second exposure, using Kodak Lanex X-D film with a speed of 600. A system of cephalometric analysis is presented for the assessment of skeletal asymmetry in the horizontal plane. This system of analysis uses landmarks within the cranial base, maxilla, and mandible to construct reference lines with which to assess asymmetry. These reference systems allow the assessment of asymmetry within each component part of the craniofacial complex as well as the relative relationship of these parts to one another. Examples are presented to demonstrate the use of this system in assessing skeletal asymmetry. These examples show how this system of analysis can be incorporated into the data base for a particular patient and how it can be useful in making treatment decisions for patients with skeletal asymmetries. This method lends itself to future incorporation into a three-dimensional computerized cephalometric analysis.

Dislocation of jaws

Pluri-directional tomographic and arthrotomographic findings are described in six patients with dislocation of the jaw severe enough to require medical assistance. A grooved defect along the posterior aspect of the condylar head was noted in two of the six patients. The arthrotomographic findings that were obtained in one patient that was dislocated at the time of the arthrogram did not suggest a meniscocondyle incoordination as a mechanism. However, arthrotomographic findings in the six reported cases suggest that significant intra-articular soft tissue damage may result.

Temporomandibular joint involvement in systemic lupus erythematosus

Temporomandibular joint involvement was studied in 37 systemic lupus erythematosus patients not selected with regard to this involvement. One-third had current complaints and two-thirds had a history of severe symptoms. Objective findings indicating systemic lupus erythematosus arthritis were locking or dislocation, tenderness to palpation, and pain on movement of the mandible. Such changes were found in 8 patients (22%) but in none of the healthy controls. Radiographic changes of the condyles, including flattenings, erosions, osteophytes, and sclerosis, were seen in 11 patients (30%), 4 of whom had deformity of other joints as well.

Radiographic, pathological and operative observations of cases with TMJ disturbance syndrome

A group of 30 operative cases (32 sides) with TMJ disturbance syndrome was included in the present study. The authors carried out a comparative study between radiographic, pathological and operative observations for these cases. Based on this study, we are confident that the nature of the organic destructive stage of the TMJ disturbance syndrome is essentially a secondary degenerative arthrosis, and that those cases showing transient PDS are probably functional and reversible; however, the indolent and deferred cases with internal derangement of TMJ actually belong to earlier manifestations of degenerative arthrosis.

Statistical study of the angle formed by the lateral part of the mandibular condyle and the horizontal plane

The angle between the LCA and frontal plane and the inclination of the lateral part of the mandibular condyle and the horizontal plane were measured in a sample of the skulls used in the study. Correlation between the two angles was found to be almost insignificant. Fifty-eight percent of the TMJs had an inclination of the lateral part of the condyle less than 15 degrees. The maximum value for this angle was found to be 45 degrees, and the minimum was -6 degrees.

Computed tomography of the temporomandibular joint meniscus

Fifteen patients with temporomandibular joint dysfunction were examined by computed tomography using standard CT techniques. The data obtained were evaluated and correlated with arthrographic findings or surgical observations. CT scans may become a valid alternative to the often painful procedure of arthrography for assessment of temporomandibular joint pathology if the potential pitfalls are avoided.

Double-contrast arthrotomography of the temporomandibular joint: introduction of an arthrographic technique for visualization of the disc and articular surfaces

A technique for double-contrast arthrotomography of the temporomandibular joint was developed. Iodine contrast medium and air were injected into both joint compartments of 105 patients. Lateral tomography using a multi-film cassette was performed. The double-contrast arthrotomography depicted, with good definition, the configuration and position of the disc, its attachments, and the articular surfaces. Postarthrographically, the patients experienced transient discomfort, but there were no serious complications. Double-contrast arthrotomography facilitates the diagnosis of internal derangements by improving the radiographic image of the intra-articular anatomy.

Internal derangements of the temporomandibular joint: an assessment of condylar position in centric occlusion

Subjects experiencing painful dysfunction of the TMJ and diagnosed by arthrography to have displacements of the meniscus were compared to normal or asymptomatic subjects to assess condyle-fossa relationships. The groups did not differ by linear or area determinations of the P/A ratio. The use of plain film alone is not adequate for diagnosis or assessment of treatment if abnormalities of meniscus function are the primary etiology.