Correlation of condylar mobility and arthrotomography in patients with internal derangements of the temporomandibular joint

The objective of this clinical study was to determine the relationship between condylar translation on plain tomographic radiographs and internal derangements assessed by a clinical and arthrographic evaluation. One hundred two joints in sixty-two patients were evaluated by linear tomography in closed versus opened positions and classified according to the type of internal derangement depicted by arthrotomography in sixty-two cases. A decrease in condylar translation was noted in patients diagnosed as having meniscus displacement without reduction. Patients who had meniscus displacement with reduction (painful clicking) were found to have hypermobility of the condyle on the symptomatic side. Meniscus displacement without reduction, which appears to be an advanced stage of internal derangement, is a serious sequela leading to marked restriction of condylar motion.

[A giant-cell tumor of the mandibular condyle]

The authors present a case of a giant cell tumor of the mandibular condyle, which is a very rare condition. Clinical history and symptoms suggested a disease of the ear. There was a destruction of the cortex of the condyle an invasion of the joint cavity, and an erosion of the adjacent temporal bone.

Centric relation determinations: clinical and radiographic comparisons

This study investigated variations in occlusal prematurities and condylar positions using different methods of determining centric relation. Thirty patients were randomly placed into three groups of 10. In Group I a clinical analysis of occlusal patterns using bilateral mandibular manipulation (BMM) was compared to results with a chin point (CPM) method. Group II compared CPM to an anterior guidance jig (CPJ) method. Group III compared BMM to CPJ. Standardized transcranial oblique radiographs were taken of each temporomandibular joint using CPM and BMM on 10 patients. Condylar position was determined with tracing evaluations and direct measurements of the radiographs. Clinical results indicated that the initial point of contact was located most accurately with CPJ. Both initial contact points and secondary points were disclosed with CPM. The BMM disclosed the most tooth contacts. Contacts were most prevalent on the premolars. Radiographic analyses of condylar positions were inconclusive.

Polycycloidal corrected tomography of the temporomandibular joint

Historically, radiographic evaluation of the temporomandibular joint has been of limited value. A step-by-step technique which is more correct anatomically is suggested. This technique involves polycycloidal corrected tomography of the temporomandibular joint. Radiographic samples are presented, as well as the results of a random sampling of 300 cases. Fifty-seven percent of the cases showed radiographic changes, and the reasons and limitations of these results are interpreted.

The importance of radiography in the diagnosis of TMJ dysfunctions. A comparative evaluation of transcranial radiographs and serial tomography

Eight men and 22 women with TMJ pain-dysfunction syndrome were selected. After clinical examination, TR and serial tomography were performed in 5 to 7 different planes. In 27 patients, TR showed a condylar displacement. This was confirmed by serial tomography, which also showed that the apparent position may vary from the medial to the lateral aspects due to rotation in some patients. Changes in shape were a common feature and did not necessarily occur in the same manner on each side or in the different sections of the same condyle. In these patients, the TR shape was generally more similar to that of the middle and lateral tomographic planes. The relationship between remodeling pattern and condylar position was confirmed. Degenerative lesions were present in some patients but could only be clearly detected by serial tomography. This study confirms the important role of the TMJ in dysfunctions and the validity of radiography in diagnosis.

[Primary mandibular condyle tumors. Osteomas, chondroma, fibrosarcoma, giant cell tumor (author's transl)]

Six out of 11 cases of primary condylar tumors treated in the Department of stomatology and Maxillofacial Surgery were analyzed. They included 3 patients with osteomas, and one case each of fibrosarcoma, chondroma, and multinucleated giant cell tumor. Typical signs were lateral displacement of the mandible (2 cases), reduction in the buccal opening (3 cases), and pain (3 cases) and swelling (3 cases) in the pretragal region. Swelling is never observed with osteomas, which develop antero-internally. The presence of the tumors was confirmed by radiological examination in all cases. Usual treatment is condylectomy, by means of C. Hosxés approach, confirmation of diagnosis requiring pathological examinations.

Condylar displacement after sagittal splitting of the mandibular rami. A short-term radiographic study

In a radiographic follow-up study the extent, frequency and direction of condylar displacement after surgical correction of bite anomalies by sagittal splitting of the mandibular rami was investigated. 35 patients were involved in the study. Pre- and post-operatively P.A.-views of the skull, linear tomograms and individualized lateral oblique radiographs of each temporomandibular joint were taken. Postoperative changes of condylar position were measured on the lateral oblique radiographs. The results indicate that condylar displacements are found frequently after sagittal splitting of the rami. Most of them are combined with rotation or tilting of the axis of the condyle or the condylar neck. Method of osteosynthesis and direction of movement of the tooth bearing fragment seem to influence the direction and amount of condylar displacement.

Long-standing luxation of the mandible. Report of a case and review of the Japanese literature

A case of a long-standing bilateral forward luxation of the temporomandibular joint is presented. A 79-year-old woman with a luxation of 2 month's duration was treated by the so-called Fink's method. In addition, 18 cases of prolonged luxation of the mandible reported in the Japanese literature are reviewed with respect to several clinical items.

Longitudinal study of transpharyngeal radiography in temporomandibular arthropathy

According to appearance of the condyle on transpharyngeal radiographs temporomandibular arthropathy has a destructive phase and a reparative phase terminating in the stable state of the joint. The destructive phase is characterized by erosion. No common trait of the healing process exists as the healed condyle varies from the normal to the most irregular appearance. Once it occurs, the healing is stable. Ongoing radiologic changes take place within 1-3 years. Some technical considerations including radiation doses of the transpharyngeal projection are presented.

Technique and use of "corrected-axis" tomograms of the mandibular condyles

In diagnosing and treating temporomandibular joint (TMJ) dysfunctions, the oral and maxillofacial surgeon can use the radiographic technique of "corrected-axis" lateral tomography of the mandibular condyles. The theory, technique, and equipment necessary for making "corrected-axis" lateral tomograms of the mandibular condyles are presented. Once familiar with this technique, the surgeon can educate the radiologist and technician if it is one with which they are unfamiliar.

Primary Ewing's sarcoma of the mandibular ramus: a case report

Primary Ewing's sarcoma of the mandible is an exceedingly rare finding in the practice of otolaryngology. A case of this neoplasm occurring as a parotid mass is presented. It represented a diagnostic dilemma because of its elusive histopathologic findings. The gross and clinical appearances, microscopic findings, differential diagnosis, and prognosis of this neoplasm are discussed.

Scanning electron microscopic and radiographic correlation of articular surface and supporting bone of the mandibular condyle

Specimens of mandibular condyle from human cadavers were employed for scanning electron microscopic and radiographic observations of the articulating surface and underlying bone. Smooth articular surface supported by smooth bone was most frequently observed. Craters and depressions in the articular surface were associated with resorption of underlying bone. Lateral radiographs proved to be of limited value in detecting defects of this type.

Condylar remodeling after occlusal therapy

Seven men and 15 women with TMJ pain dysfunction syndrome were selected. After clinical examination, polytomography of the TMJ was performed in centric occlusion in different planes. Open-mouth projections were also made in three patients, frontal tomography in one patient, and transcranial radiographs in 16 patients. Occlusal analysis was performed on the articulator. Twenty patients showed various patterns of condylar displacement with flattening of the anterior, superior, or posterior condylar walls in 11 patients, including three with arthritic lesions. Therapy included occlusal splints (21 patients), selective grinding (seven patients), prosthodontic rehabilitation (10 patients), and orthodontic treatment (two patients). After therapy, tomographic examination was repeated at intervals of 9 to 44 months. A distinct reshaping of the condyle was seen in seven patients. The new shape tended to be rounded. The three patients with degenerative changes before treatment showed regression of the lesions. No change was seen in condyles which were rounded before therapy.

Non ossifying fibroma of the mandible. A common lesion with unusual location

A first case of non-ossifying fibroma located in the mandibular condyle of a 20-year-old male is presented. Radiologic and histologic findings correspond in all details to those of non-ossifying fibromas of long tubular bones. The lesion's location within the condylar growth zone may strengthen the hypothesis that non-ossifying fibromas are disturbances in growth rather than true neoplasms.

Radiographic study of condylar position in centric relation and centric occlusion

The present study was conducted to compare the spatial relationship of the condyles to their fossae in the centric occlusion and centric relation positions. Right and left TMJ radiographs were obtained on 40 young adults in the two positions. Direct measurments of the anterior, posterior, and superior spaces between the condyles and their fossae were made on the radiographs. Results were statistically analyzed; the following findings and conclusions were derived: (1) In the centric relation position, both condyles were placed more posteriorly and superiorly in their fossae than in the centric occlusion position. (2) In the centric occlusion position, both condyles were symmetrically placed in their fossae with equal spatial distances anteriorly and posteriorly. (3) Greater spatial differences existed between the centric occlusion and centric relation positions on the left side, which was the orbiting (balancing)side in most subjects. (4) Further studies are needed to develop a more physiologic approach for correctly relating the mandible to the maxillae when reconstructing the occlusion in both dentulous and edentulous patients.

Arthorgraphy of the temporomandibular joint: review of current status

Arthrography of the temporomandibular joint is used principally in cases of pain and dysfunction, specifically clicking, popping, or locking joints. The procedure is effective and safe but technically difficult to perform.