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Zhang Y, Yu F, Long X, Fang W. Imaging features of temporomandibular joint synovial chondromatosis with associated osseous degenerative changes. Int J Oral Maxillofac Surg 2024; 53:311-318. [PMID: 37840000 DOI: 10.1016/j.ijom.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/17/2023]
Abstract
Synovial chondromatosis (SC) of the temporomandibular joint (TMJ) is a rare benign disease associated with the formation of multiple cartilaginous nodules in the synovial tissue of the TMJ. This can result in pain, swelling, clicking, limited mouth opening, and osseous degenerative joint changes. A retrospective cross-sectional study was performed to summarize the clinical features, radiographic findings, and surgical and histopathological findings of TMJ SC patients who underwent open surgery over a 24-year period. A radiographic scoring system was used to evaluate osseous changes and correlate condyle and joint fossa degeneration. The study included 38 patients and focused on 38 joints. All 38 of these joints showed degenerative changes in the condyle, while 37 showed osseous degenerative changes in the articular fossa. The degree of condylar degenerative changes was related to the duration of the chief complaints (r = 0.342, P = 0.036) and the histopathological stage of the TMJ SC (r = 0.440, P = 0.006), while the degree of joint fossa degenerative changes was associated with the radiographic extent of the SC (r = 0.504, P = 0.001), type of calcification (r = 0.365, P = 0.024), and the histopathological stage (r = 0.458, P = 0.004).
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Affiliation(s)
- Y Zhang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China; Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University, Shandong Key Laboratory of Oral Tissue Regeneration, and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, Shandong, China
| | - F Yu
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - X Long
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China; Department of Oral and Maxillofacial Trauma and Temporomandibular Joint Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
| | - W Fang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China; Department of Oral and Maxillofacial Trauma and Temporomandibular Joint Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China.
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Xu J, Wang D, Yang C, Wang F, Wang M. Reconstructed magnetic resonance image-based effusion volume assessment for temporomandibular joint arthralgia. J Oral Rehabil 2023; 50:1202-1210. [PMID: 37391274 DOI: 10.1111/joor.13551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 03/01/2023] [Accepted: 06/27/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Joint effusion is often noticed in magnetic resonance image (MRI) and its diagnostic value for arthralgia of the temporomandibular joint (TMJ) remains obscure. OBJECTIVE To develop a method for quantitatively evaluating the joint effusion revealed in MRI and its diagnostic value for arthralgia of the TMJ. METHODS Two-hundreds and twenty-eight TMJs, 101 with arthralgia (Group P) and 105 without (Group NP) from 103 patients, and 22 TMJs (Group CON) from 11 asymptomatic volunteers were examined by using MRI. The effusion volume was measured after constructing a three-dimensional structure of the joint effusion revealed in MRI by using the ITK-SNAP software. The diagnostic capabilities of the effusion volume on arthralgia were evaluated with receiver operating characteristic (ROC) curve analysis. RESULTS Totally 146 joints showed MRI signs of joint effusion, including nine joints from Group CON. However, the medium volume was greater in Group P (66.65 mm3 ), but was much similar in Group CON (18.33 mm3 ) to Group NP (27.12 mm3 ). The effusion volume larger than 38.20 mm3 was validated to discriminate Group P from Group NP. The AUC value was 0.801 (95% CI 0.728 to 0.874), with a sensitivity of 75% and specificity of 78.9%. The median volume of the joint effusion was larger in those with than without bone marrow oedema, osteoarthritis, Type-III disc configurations, disc displacement and higher signal intensity of the retrodiscal tissue (all, p < .05). CONCLUSION The present method for evaluate joint effusion volume well discriminated painful TMJs from non-pain ones.
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Affiliation(s)
- Jiali Xu
- Department of stomatology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Dongmei Wang
- Department of stomatology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Chunhua Yang
- Department of Magnetic Resonance, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Fangfang Wang
- Department of Magnetic Resonance, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Meiqing Wang
- Department of stomatology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
- Department of TMD, Shanghai Stomatological Disease Centre, Fudan University, Shanghai, China
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3
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Xu L, Chen J, Qiu K, Yang F, Wu W. Artificial intelligence for detecting temporomandibular joint osteoarthritis using radiographic image data: A systematic review and meta-analysis of diagnostic test accuracy. PLoS One 2023; 18:e0288631. [PMID: 37450501 PMCID: PMC10348514 DOI: 10.1371/journal.pone.0288631] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023] Open
Abstract
In this review, we assessed the diagnostic efficiency of artificial intelligence (AI) models in detecting temporomandibular joint osteoarthritis (TMJOA) using radiographic imaging data. Based upon the PRISMA guidelines, a systematic review of studies published between January 2010 and January 2023 was conducted using PubMed, Web of Science, Scopus, and Embase. Articles on the accuracy of AI to detect TMJOA or degenerative changes by radiographic imaging were selected. The characteristics and diagnostic information of each article were extracted. The quality of studies was assessed by the QUADAS-2 tool. Pooled data for sensitivity, specificity, and summary receiver operating characteristic curve (SROC) were calculated. Of 513 records identified through a database search, six met the inclusion criteria and were collected. The pooled sensitivity, specificity, and area under the curve (AUC) were 80%, 90%, and 92%, respectively. Substantial heterogeneity between AI models mainly arose from imaging modality, ethnicity, sex, techniques of AI, and sample size. This article confirmed AI models have enormous potential for diagnosing TMJOA automatically through radiographic imaging. Therefore, AI models appear to have enormous potential to diagnose TMJOA automatically using radiographic images. However, further studies are needed to evaluate AI more thoroughly.
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Affiliation(s)
- Liang Xu
- The School of Stomatology, Fujian Medical University, Fuzhou, Fujian, China
- Department of Stomatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Jiang Chen
- The School of Stomatology, Fujian Medical University, Fuzhou, Fujian, China
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian, China
| | - Kaixi Qiu
- Fuzhou No. 1 Hospital Affiliated with Fujian Medical University, Fuzhou, Fujian, China
| | - Feng Yang
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, Fujian, China
| | - Weiliang Wu
- The School of Stomatology, Fujian Medical University, Fuzhou, Fujian, China
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de Oliveira LRLB, Alves IDS, Vieira APF, Passos UL, Leite CDC, Gebrim ES. Temporomandibular joint: from anatomy to internal derangement. Radiol Bras 2023; 56:102-109. [PMID: 37168044 PMCID: PMC10165975 DOI: 10.1590/0100-3984.2022.0072-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/12/2022] [Indexed: 05/13/2023] Open
Abstract
The temporomandibular joint can be affected by various conditions, such as joint dysfunction, degenerative changes, inflammatory processes, infections, tumors, and trauma. The aim of this pictorial essay is to help radiologists identify and describe the main findings on magnetic resonance imaging evaluation of the temporomandibular joint, given that the correct diagnosis is essential for the appropriate treatment of patients with temporomandibular joint disorders.
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Affiliation(s)
| | | | | | | | - Claudia da Costa Leite
- Department of Radiology and Oncology, Faculdade de Medicina da Universidade
de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Eloisa Santiago Gebrim
- Hospital Sírio-Libanês, São Paulo, SP, Brazil
- Department of Radiology and Oncology, Faculdade de Medicina da Universidade
de São Paulo (FMUSP), São Paulo, SP, Brazil
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Mohamed HN, Ashmawy MS, Ekladious MEEY, Farid MM. Analysis of the relationship between condylar changes and anterior disc displacement with reduction: a preliminary study. Oral Radiol 2023; 39:154-163. [PMID: 35556200 PMCID: PMC9813084 DOI: 10.1007/s11282-022-00617-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/14/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To predict temporomandibular joint (TMJ) anterior disc displacement with reduction (ADDWR) from condylar shape, position, and dimensions obtained from CBCT images. METHODS This cross-sectional study was performed on 17 patients suffering from temporomandibular disorders diagnosed by history taking according to the chart of the American Association of orthodontists, clinical examination according to the Helkimo index and MRI. CBCT and MRI examinations were performed within one-week interval. Disc position, diagnosed by MRI was used as the gold standard. TMJs with posterior disc displacement or anterior disc displacement without reduction were excluded. Qualitative and quantitative analyses were performed on CBCT images to find the correlation between condylar variables and ADDWR. A logistic regression model was created to estimate ADDWR from condylar dimensions (height, width and depth). RESULTS Condylar shape and condylar position in the glenoid fossa were significantly correlated with ADDWR (P < 0.05). Condylar width, height and depth were significantly smaller in condyles with ADDWR compared to condylar dimensions in normal disc position. Logistic regression analysis could be used to predict the probability of anterior disc displacement with reduction from condylar dimensions. CONCLUSION Condylar shape, position, and dimensions assessed by CBCT are significantly correlated with ADDWR of the TMJ. Substituting the values of condylar width, height and depth in the equation suggests the probability of ADDWR.
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Affiliation(s)
- Hadeer Nasser Mohamed
- grid.7269.a0000 0004 0621 1570Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Ain Shams University, Monazamet El Wehda El Afriqeya St., Cairo, Egypt
| | - Mostafa S. Ashmawy
- grid.7269.a0000 0004 0621 1570Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Ain Shams University, Monazamet El Wehda El Afriqeya St., Cairo, Egypt
| | | | - Mary Medhat Farid
- grid.7269.a0000 0004 0621 1570Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Ain Shams University, Monazamet El Wehda El Afriqeya St., Cairo, Egypt
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Murahashi M, Ntege EH, Higa M, Maruyama N, Kawano T, Shimizu Y, Nakamura H. Management of temporomandibular joint diseases: a rare case report of coexisting calcium pyrophosphate crystal deposition and synovial chondromatosis. BMC Oral Health 2022; 22:662. [PMID: 36587200 PMCID: PMC9805689 DOI: 10.1186/s12903-022-02695-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/22/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The coexistence of calcium pyrophosphate dihydrate crystal deposition (CPP) and synovial chondromatosis (SC) in the temporomandibular joint (TMJ) is rarely reported. CPP disease (CPPD) is complex arthritis synonymous with excessive pyrophosphate production and variable aberrations in mineral and organic phase metabolism of the joint cartilage, leading to local inundated CPP and crystal deposition of partially deciphered predispositions. Meanwhile, SC is a rare benign synovial joint proliferative disease of unclear etiology and has a low risk of malignant transformation. However, SC manifests severe joint disability and dysfunction because of connective tissue metaplasia of the synovial membrane, which forms cartilaginous nodules with or without calcifications or ossifications. These nodules often detach and form intra-articular loose bodies and very rarely within extraarticular spaces. CASE PRESENTATION We report the case of a 61-year-old man to expand the body of literature on these unusual coexisting arthropathies of the TMJ. The patient presented to our hospital in 2020 with complaints of pain in the right TMJ and trismus for over 6 months. Radiographic assessments of the TMJ provided a preoperative provisional diagnosis of SC. However, the histopathology of the open biopsy revealed tumor-like lesions comprising several deposits of rhomboid and rod-shaped crystals that displayed positive birefringence in polarized light, confirming a coexistence of CPPD. A second-stage operation was performed for the complete removal of the loose bodies and chalk-like lesions including synovectomy. No evidence of recurrence was recorded after a follow-up of nearly 1.5 years. CONCLUSIONS Isolated CPPD and SC of the TMJ are prevalent in the literature however, monoarticular coexistence of these diseases is rare, due to the lack of consistency in the diagnostic criteria in clinical practice. Moreover, optimal treatment depends on several considerations. This report delineated the molecular etiopathology and underscored the need for continued deciphering of the causal mechanisms of coexisting CPPD and SC of the TMJ. In addition, the importance of confirmatory testing for accurate diagnosis, and appropriate management of these diseases were discussed.
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Affiliation(s)
- Makoto Murahashi
- Department of Oral and Maxillofacial Surgery, Chubu Tokushukai Hospital, 801 Higa, Kitanakagusuku, Nakagami-gun, Okinawa-ken 901-2393 Japan ,grid.267625.20000 0001 0685 5104Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nakagami, Nishihara, Okinawa 903-0215 Japan
| | - Edward Hosea Ntege
- grid.267625.20000 0001 0685 5104Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nakagami, Nishihara, Okinawa 903-0215 Japan ,grid.267625.20000 0001 0685 5104Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nakagami, Nishihara, Okinawa 903-0215 Japan
| | - Masaru Higa
- Department of Oral and Maxillofacial Surgery, Chubu Tokushukai Hospital, 801 Higa, Kitanakagusuku, Nakagami-gun, Okinawa-ken 901-2393 Japan
| | - Nobuyuki Maruyama
- Department of Oral and Maxillofacial Surgery, Chubu Tokushukai Hospital, 801 Higa, Kitanakagusuku, Nakagami-gun, Okinawa-ken 901-2393 Japan ,grid.267625.20000 0001 0685 5104Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nakagami, Nishihara, Okinawa 903-0215 Japan
| | - Toshihiro Kawano
- grid.267625.20000 0001 0685 5104Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nakagami, Nishihara, Okinawa 903-0215 Japan
| | - Yusuke Shimizu
- grid.267625.20000 0001 0685 5104Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nakagami, Nishihara, Okinawa 903-0215 Japan
| | - Hiroyuki Nakamura
- grid.267625.20000 0001 0685 5104Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nakagami, Nishihara, Okinawa 903-0215 Japan
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Zhang L, Shen L, Zhang L, Zhang C, Wang H. Dynamic 3D images fusion of the temporomandibular joints: A novel technique. J Dent 2022; 126:104286. [PMID: 36096297 DOI: 10.1016/j.jdent.2022.104286] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To demonstrate a procedure for fusing images from cone-beam computed tomography (CBCT), magnetic resonance imaging (MRI) and optical positioning tracking system to dynamically evaluate the relative motion of the temporomandibular joint (TMJ) for the diagnosis of temporomandibular disorders (TMD). METHODS CBCT data was collected from a patient wearing a fixation device with markers in the intercuspal position. The patient's mandibular movements were recorded using an optical positioning tracking system. The CBCT data were imported into a virtual simulation system to reproduce the mandibular movement. Five jaw positions were selected for 3D printing of the occlusal plate that the patient wore to undergo MRI. MRI scans were registered with the CBCT image for fusion and reconstruction. RESULTS The anatomical structures of the articular fossa, articular disc, and condyle were clearly displayed in the CBCT-MRI fused images. The spatial posture and relative position of the fossa-disc-condyle during mandibular movement could be reproduced dynamically using the 3D reconstruction model. CONCLUSIONS This method can visually display mandibular motion trajectories and the relative TMJ positions. Virtual reproduction provides a comprehensive understanding of the articular disc's morphology and position in different states from a 3D perspective. CLINICAL SIGNIFICANCE This method can be used in clinical studies of TMJ as an adjunct to the 3D dynamic diagnosis and assessment for complex patients with TMD and provide relevant data for doctors.
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Affiliation(s)
- Lu Zhang
- Department of Orthodontics, Tianjin Stomatological Hospital, School of Medicine, Nankai University, Tianjin 300041, China; Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin 300041, China
| | - Lin Shen
- College of Artificial Intelligence, Nankai University, Tianjin 300350, China; Institute of Intelligence Technology and Robotic Systems, Shenzhen Research Institute of Nankai University, Shenzhen 518081, China
| | - Linkun Zhang
- Department of Orthodontics, Tianjin Stomatological Hospital, School of Medicine, Nankai University, Tianjin 300041, China; Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin 300041, China
| | - Chunxiang Zhang
- Department of Orthodontics, Tianjin Stomatological Hospital, School of Medicine, Nankai University, Tianjin 300041, China; Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin 300041, China
| | - Hongpeng Wang
- College of Artificial Intelligence, Nankai University, Tianjin 300350, China; Central Laboratory, Tianjin Stomatological Hospital, School of Medicine, Nankai University, Tianjin 300041, China; Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin 300041, China; Institute of Intelligence Technology and Robotic Systems, Shenzhen Research Institute of Nankai University, Shenzhen 518081, China.
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8
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Fonseca FF, Politti F, Cunha T, Leonardis M, Carvalho L, de Paula Gomes CAF, Biasotto-Gonzalez DA. Prevalence of signs and symptoms of temporomandibular disorder in the metropolitan region of Rio De Janeiro: A population-based cross-sectional study. Cranio 2022:1-7. [PMID: 35770888 DOI: 10.1080/08869634.2022.2091099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Temporomandibular disorder (TMD) is a group of heterogeneous pathological conditions that affect the temporomandibular joint (TMJ), mastication muscles, and some associated structures. The aim of this study was to measure the prevalence of signs and symptoms of dysfunction, including knowledge of TMD in a stratum of the population. METHODS A population extract from Rio de Janeiro subdivided by conglomerates was interviewed through an online form. RESULTS The results showed that only 19% of the participants had no symptoms related to TMD. CONCLUSION The results showed that the symptom prevalence is directly related to knowledge and practices about the disorder and that its presence may be under-reported.
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Affiliation(s)
- Felipe Feitosa Fonseca
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Fabiano Politti
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Taisi Cunha
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Margarete Leonardis
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Leandro Carvalho
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
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Gharavi SM, Qiao Y, Faghihimehr A, Vossen J. Imaging of the Temporomandibular Joint. Diagnostics (Basel) 2022; 12:diagnostics12041006. [PMID: 35454054 PMCID: PMC9031630 DOI: 10.3390/diagnostics12041006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/01/2022] [Accepted: 04/14/2022] [Indexed: 12/14/2022] Open
Abstract
Temporomandibular disorder (TMD) is a common musculoskeletal condition that causes pain and disability for patients and imposes a high financial burden on the healthcare system. The most common cause of TMD is internal derangement, mainly secondary to articular disc displacement. Multiple other pathologies such as inflammatory arthritis, infection, and neoplasm can mimic internal derangement. MRI is the modality of choice for evaluation of the TMJ. Radiologists need to be familiar with the normal anatomy and function of the TMJ and MR imaging of the internal derangement and other less common pathologies of the TMJ.
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Fang L, Ye Y, Tan X, Huang L, He Y. Overloading stress-induced progressive degeneration and self-repair in condylar cartilage. Ann N Y Acad Sci 2021; 1503:72-87. [PMID: 33962484 DOI: 10.1111/nyas.14606] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/14/2021] [Accepted: 04/14/2021] [Indexed: 12/23/2022]
Abstract
Overloading stress-induced condylar cartilage degeneration acts as the main pathologic change in temporomandibular joint osteoarthritis (TMJ-OA). However, the progression of degeneration and the ability for self-repair remain poorly understood. Here, we explored the progression of cartilage degeneration by dividing pathological stages using a steady mouth-opening mouse model. Then, we observed changes of cartilage by removing the loading at different stages to test the potential self-repair after degeneration induced. Three-dimensional confocal microscopy combined with histology and micro-CT scanning was applied to examine TMJ at different stages of degeneration before and after self-repair. We found the cartilage underwent progressive and thorough degeneration as the overloading stress developed. During the initial adaptation stage, robust proliferation of posteromedial cartilage began at the area of direct loading. Subsequently, widespread chondrocyte apoptosis was found, followed by new chondrocyte proliferation in aggregates with matrix degradation and subchondral bone catabolism. Finally, with cartilage surface damage, the degeneration reached a point where the lesion could not be reversed by self-repair. While the cartilage nearly returned to normal when the interference was removed within 5 days. These results suggested overloading force induces a pathological process of successive degeneration in TMJ cartilage, which can be reversed by self-repair at early stages.
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Affiliation(s)
- Lingli Fang
- Department of Orthodontics, Stomatological Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Oral Disease and Biomedical Sciences, Stomatological Hospital of Chongqing Medical University, Chongqing, China
| | - Yusi Ye
- Chongqing Key Laboratory of Oral Disease and Biomedical Sciences, Stomatological Hospital of Chongqing Medical University, Chongqing, China
| | - Xi Tan
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Stomatological Hospital of Chongqing Medical University, Chongqing, China
| | - Lan Huang
- Department of Orthodontics, Stomatological Hospital of Chongqing Medical University, Chongqing, China
| | - Yao He
- Department of Orthodontics, Stomatological Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Stomatological Hospital of Chongqing Medical University, Chongqing, China
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11
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Hu W, Chen Y, Dou C, Dong S. Microenvironment in subchondral bone: predominant regulator for the treatment of osteoarthritis. Ann Rheum Dis 2021; 80:413-422. [PMID: 33158879 PMCID: PMC7958096 DOI: 10.1136/annrheumdis-2020-218089] [Citation(s) in RCA: 207] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 12/11/2022]
Abstract
Osteoarthritis (OA) is a degenerative joint disease in the elderly. Although OA has been considered as primarily a disease of the articular cartilage, the participation of subchondral bone in the pathogenesis of OA has attracted increasing attention. This review summarises the microstructural and histopathological changes in subchondral bone during OA progression that are due, at the cellular level, to changes in the interactions among osteocytes, osteoblasts, osteoclasts (OCs), endothelial cells and sensory neurons. Therefore, we focus on how pathological cellular interactions in the subchondral bone microenvironment promote subchondral bone destruction at different stages of OA progression. In addition, the limited amount of research on the communication between OCs in subchondral bone and chondrocytes (CCs) in articular cartilage during OA progression is reviewed. We propose the concept of 'OC-CC crosstalk' and describe the various pathways by which the two cell types might interact. Based on the 'OC-CC crosstalk', we elaborate potential therapeutic strategies for the treatment of OA, including restoring abnormal subchondral bone remodelling and blocking the bridge-subchondral type H vessels. Finally, the review summarises the current understanding of how the subchondral bone microenvironment is related to OA pain and describes potential interventions to reduce OA pain by targeting the subchondral bone microenvironment.
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Affiliation(s)
- Wenhui Hu
- Department of Biomedical Materials Science, Third Military Medical University, Chongqing, China
| | - Yueqi Chen
- Department of Biomedical Materials Science, Third Military Medical University, Chongqing, China
- Department of Orthopedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Ce Dou
- Department of Biomedical Materials Science, Third Military Medical University, Chongqing, China
- Department of Orthopedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Shiwu Dong
- Department of Biomedical Materials Science, Third Military Medical University, Chongqing, China
- Department of Orthopedics, Southwest Hospital, Third Military Medical University, Chongqing, China
- State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University, Chongqing, China
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12
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Arzi B, Vapniarsky N, Fulton A, Verstraete FJM. Management of Septic Arthritis of the Temporomandibular Joint in Dogs. Front Vet Sci 2021; 8:648766. [PMID: 33855056 PMCID: PMC8039310 DOI: 10.3389/fvets.2021.648766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/10/2021] [Indexed: 11/17/2022] Open
Abstract
Septic arthritis of the temporomandibular joint (TMJ) in dogs and other mammals is a rare condition. It is typically associated with notable pain, swelling, and difficulty in opening the mouth. Unlike degenerative TMJ disease, septic arthritis requires urgent intervention. The etiology of the condition may include penetrating trauma, an extension of local infection, such as otitis media, or the hematogenous spread of a pathogen. However, the precise cause may not always be identified. Diagnostic imaging with Computed Tomography (CT), cone-beam CT (CBCT), and/or Magnetic Resonance Imaging (MRI) are helpful for honing the definitive diagnosis and formulating a treatment plan. Subsequently, exploratory surgery may be required to obtain samples for culture and sensitivity and histology and to lavage the joint. In this “methods” article, we provide a detailed description of our approach to diagnosis and management of septic TMJ arthritis in four dogs.
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Affiliation(s)
- Boaz Arzi
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Natalia Vapniarsky
- Department of Pathology, Microbiology and Immunology School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Amy Fulton
- Aggie Animal Dental Center, Mill Valley, CA, United States
| | - Frank J M Verstraete
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
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Gilheaney Ó, Stassen LF, Walshe M. The epidemiology, nature, and impact of eating and swallowing problems in adults presenting with temporomandibular disorders. Cranio 2020; 40:476-484. [PMID: 32564703 DOI: 10.1080/08869634.2020.1781453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Temporomandibular disorders (TMDs) are the most common non-dental orofacial pain disorders. Research suggests that patients with TMDs experience eating and swallowing problems, although information is sparse, impacting effectiveness of management. Research aims were to investigate the epidemiology and impact of TMD-related eating and swallowing problems. METHODS A cross-sectional study was completed in two national Irish specialist centers, with 126 participants with TMDs assessed using a specifically-devised protocol. Descriptive and statistical analyses were completed. RESULTS Masticatory issues (95%), swallowing difficulties (53%), and weight loss (50%) were prevalent. Participants reported moderately severe eating and swallowing problems impacting participation and well-being across daily and social activities. DISCUSSION A variety of eating and swallowing problems are reported by adults with TMDs, which impact functioning and psychosocial well-being. The need to improve clinical practice and research is argued. Future research should refine the original assessment protocol developed in this study.
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Affiliation(s)
- Órla Gilheaney
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Leo Fa Stassen
- Oral and Maxillofacial Surgery TCD, Dublin Dental University Hospital, Dublin, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
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Lesions of the lateral pterygoid muscle-an overestimated reason for temporomandibular dysfunction: a 3T magnetic resonance imaging study. Int J Oral Maxillofac Surg 2020; 49:1611-1617. [PMID: 32475707 DOI: 10.1016/j.ijom.2020.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 03/08/2020] [Accepted: 04/22/2020] [Indexed: 01/18/2023]
Abstract
The aim of this study was to examine the lateral pterygoid muscle (LPM) parenchyma, myotendinous junction, and tendon in temporomandibular disorder (TMD) patients using 3T magnetic resonance imaging (MRI). Results were compared with findings reported in the literature, in which the LPM has been attributed a major role in triggering TMD. 3T MRI was used for temporomandibular joint (TMJ) imaging. The MRI images of 63 patients were analysed for muscle contracture and atrophy, tendon rupture, signal alterations of the tendon, tendon contrast enhancement, and peritendinous fluid collection. Descriptive statistics and the coefficient estimate method were used for statistical analysis. Focus was placed on the association between LPM tendon pathology and TMJ lesions like osteoarthritis and disc displacement. Severe lesions of the LPM tendon and muscle parenchyma, like rupture or fibrosis, were detected in very few cases. Only moderate signs of tendinosis were found in TMD patients. In contrast, there was a clear correlation between tendon lesions and osteoarthritis or anterior disc displacement. These results indicate the need to discuss and question the role of the LPM and its tendon in TMD. Data suggest that LPM and tendon lesions are part of complex degenerative changes of the TMJ, and it seems less likely that a LPM disorder is causative in TMD.
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Derwich M, Mitus-Kenig M, Pawlowska E. Interdisciplinary Approach to the Temporomandibular Joint Osteoarthritis-Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E225. [PMID: 32397412 PMCID: PMC7279162 DOI: 10.3390/medicina56050225] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/28/2020] [Accepted: 05/06/2020] [Indexed: 02/07/2023]
Abstract
Background and objectives: There are an increasing number of patients applying for dental treatment who suffer from temporomandibular joint osteoarthritis (TMJOA). Osteoarthritis may be the cause of the pain in the area of temporomandibular joints, but its course may also be absolutely asymptomatic. The aim of this study was to present an interdisciplinary approach to TMJOA, including current diagnostics and treatment modalities on the basis of the available literature. Materials and Methods: PubMed and Scopus databases were analyzed using the keywords: ((temporomandibular joint AND osteoarthritis) AND imaging) and ((temporomandibular joint AND osteoarthritis) AND treatment). The bibliography was supplemented with books related to the temporomandibular joint. After screening 2450 results, the work was based in total on 98 publications. Results and Conclusions: Osteoarthritis is an inflammatory, age-related, chronic and progressive degenerative joint disease. Magnetic resonance imaging (MRI) and cone-beam computed tomography (CBCT), together with clinical symptoms, play significant roles in TMJOA diagnosis. Current MRI techniques seem to be clinically useful for assessment of bony changes in temporomandibular joint (TMJ) disorders. Treatment of TMJOA requires a complex, interdisciplinary approach. TMJOA treatment includes the cooperation of physiotherapists, rheumatologists, gnathologists, orthodontists and quite often also maxillofacial surgeons and prosthodontists. Sometimes additional pharmacotherapy is indicated. Thorough examination of TMJ function and morphology is necessary at the beginning of any orthodontic or dental treatment. Undiagnosed TMJ dysfunction may cause further problems with the entire masticatory system, including joints, muscles and teeth.
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Affiliation(s)
- Marcin Derwich
- Department of Orthodontics, Medical University of Lodz, 90-419 Lodz, Poland;
| | - Maria Mitus-Kenig
- Department of Prophylaxis and Experimental Dentistry, Jagiellonian University in Krakow, 31-007 Krakow, Poland;
| | - Elzbieta Pawlowska
- Department of Orthodontics, Medical University of Lodz, 90-419 Lodz, Poland;
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Morphology of the Temporomandibular Joints Regarding the Presence of Osteoarthritic Changes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082923. [PMID: 32340336 PMCID: PMC7215313 DOI: 10.3390/ijerph17082923] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 12/11/2022]
Abstract
(1) Osteoarthritis, the most common disease of the temporomandibular joints (TMJs), is diagnosed by clinical and radiographic examination. Cone beam computed tomography (CBCT) is a method of choice for the imaging of osteoarthritic changes. The objective was to compare the morphology of the TMJs in CBCT images regarding the number of the osteoarthritic changes diagnosed in the area of the condyle. (2) A total of 105 patients participated in the study; their 210 TMJs were allocated into one of three groups regarding the number of diagnosed osteoarthritic changes: 1 (none or 1 type), 2 (2 types), 3 (3 or more types). The morphology of the TMJ was examined for each TMJ in the CBCT images. Statistical analysis was performed with STATISTICA version 12.0. The statistical significance level was p = 0.05 for all the measurements included. (3) The articular surface flattening was the most common type of the osteoarthritic changes (90%). The condylar A-P dimension differed significantly among the groups (p = 0.0001). The bigger the number of osteoarthritic changes diagnosed in one joint, the smaller the condylar A-P dimension that was observed. (4) The temporomandibular joints’ osteoarthritic changes occur very often, even among asymptomatic patients. The increased number of osteoarthritic changes seems to have an impact on the condylar anteroposterior dimension.
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Santos CEM, Rodrigues VP, De Oliveira ICV, De Assis DSFR, De Oliveira MM, Conti CF. Morphological changes in the temporomandibular joints in women with fibromyalgia and myofascial pain: A case series. Cranio 2019; 39:440-444. [PMID: 31379267 DOI: 10.1080/08869634.2019.1650215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: This study investigated the temporomandibular joint (TMJ) morphological changes in women with fibromyalgia (FM) through clinical and tomographic evaluation.Methods: Ten women diagnosed with myofascial pain who were being treated for FM in a university hospital were included in this study. The data were collected through clinical examination and cone beam computed tomography evaluation of the TMJ in closed and open mouth positions.Results: All patients had crackling in the joint, a habit of grinding teeth during sleep, muscle stiffness, and tinnitus. The tomographic findings revealed a higher frequency of condylar bone wear, reduction of joint space, and posterior positioning of the mandibular condyle. The temporomandibular disorders with the highest prevalence were osteoarthritis and disc displacement with reduction.Conclusion: The findings suggest that women with FM have a high frequency of TMD related to the displacement of the articular disc, condyle position, and occurrence of osteoarthritis.
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Affiliation(s)
| | - Vandilson Pinheiro Rodrigues
- Dentistry Graduate Program, Federal University of Maranhão, São Luís, Brazil.,Department of Morphology, Federal University of Maranhão, São Luís, Brazil
| | | | | | | | - Cristiane Fiquene Conti
- Health Sciences Graduate Program, Federal University of Maranhão, São Luís, Brazil.,Department of Morphology, Federal University of Maranhão, São Luís, Brazil
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Treatments of tenosynovial giant cell tumours of the temperomandibular joint: a report of three cases and a review of literature. Int J Oral Maxillofac Surg 2018; 47:1288-1294. [DOI: 10.1016/j.ijom.2018.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 01/10/2018] [Accepted: 04/06/2018] [Indexed: 12/31/2022]
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Gilheaney Ó, Béchet S, Kerr P, Kenny C, Smith S, Kouider R, Kidd R, Walshe M. The prevalence of oral stage dysphagia in adults presenting with temporomandibular disorders: a systematic review and meta-analysis. Acta Odontol Scand 2018; 76:448-458. [PMID: 29320883 DOI: 10.1080/00016357.2018.1424936] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Temporomandibular disorders (TMDs) are the most commonly experienced non-dental orofacial pain disorders, with pain and dysfunction potentially resulting in oral stage dysphagia (OD). However, limited research has been conducted on this condition, with potential negative effects on clinical practice. Therefore, the aim of this study was to determine the prevalence of OD in adults presenting with TMDs, diagnosed as per the Research Diagnostic Criteria for Temporomandibular Disorders or the Diagnostic Criteria for Temporomandibular Disorders protocols. MATERIAL AND METHODS A systematic review of the literature was completed. Nine electronic databases were searched from inception to January 2017, with no date/language restriction applied. Grey literature, conference proceedings, and reference lists were also searched. Studies presenting original data regarding OD prevalence in adults presenting with TMDs were included if they investigated impaired swallowing, mastication, masticatory pain or fatigue, or weight loss. Study eligibility and quality were assessed by two independent reviewers. Methodological quality was assessed using the Down's and Black tool. RESULTS AND CONCLUSIONS This search yielded 20 eligible studies. Swallowing itself was impaired in only 9.3% of patients with TMDs. A range of additional OD signs and symptoms were also commonly reported (e.g. masticatory pain (87.4%) and fatigue (62%)). Study limitations included the small number of studies which were eligible for inclusion. As signs and symptoms of OD are frequently reported by patients with TMDs, psychometrically robust prospective research is warranted to determine current and optimal management of this condition.
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Affiliation(s)
- Órla Gilheaney
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Sibylle Béchet
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Patrick Kerr
- School of Medicine, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland
| | - Ciaran Kenny
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Shauna Smith
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Rita Kouider
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Rachel Kidd
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
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Larheim TA, Hol C, Ottersen MK, Mork-Knutsen BB, Arvidsson LZ. The Role of Imaging in the Diagnosis of Temporomandibular Joint Pathology. Oral Maxillofac Surg Clin North Am 2018; 30:239-249. [DOI: 10.1016/j.coms.2018.04.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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21
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Gilheaney Ó, Stassen LF, Walshe M. Prevalence, Nature, and Management of Oral Stage Dysphagia in Adults With Temporomandibular Joint Disorders: Findings From an Irish Cohort. J Oral Maxillofac Surg 2018; 76:1665-1676. [PMID: 29549021 DOI: 10.1016/j.joms.2018.01.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 01/18/2018] [Accepted: 01/31/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE Temporomandibular disorders (TMDs) are caused by changes in the structure and/or function of the temporomandibular joint, masticatory muscles, and/or osseous components. TMDs can result in oral stage dysphagia (OD) with potential effects on function and patient well-being. Little is known about the prevalence, nature, and management of TMD-related OD. The aims of the present study were to estimate the prevalence and nature of OD in adult TMD patients and to identify the common management techniques used to manage the signs and symptoms of TMD-related OD. PATIENTS AND METHODS An 18-item subjective questionnaire was adapted from existing tools and used to investigate TMD etiology, the symptoms and signs of TMD-related OD, and the intervention techniques used to manage these symptoms. This was disseminated to 178 TMD patients consecutively recruited over 6 months in 2016. Descriptive and statistical methods were used to analyze the data. RESULTS Of the 178 TMD participants, 99% reported at least one symptom or sign of OD. Individuals presenting with subluxation of the jaw (80%), degenerative joint disorder (67%), and myofascial pain disorder (40%) reported OD most frequently. Common symptoms included painful mastication (90%), masticatory fatigue (78%), difficulties swallowing (33%), and difficulties drinking liquids (28%). The use of a broad range of management techniques was reported, with these including both OD-specific techniques (eg, diet modifications [81%]), and non-OD specific techniques (eg, analgesia [79%] and oral splints [75%]). CONCLUSIONS OD is prevalent, and difficulties with mastication are common in those with TMDs. The interventions used were diverse, with varying objectives and disparate levels of evidence supporting their efficacy within this cohort. Further research should address the epidemiology of TMD-related OD, evidence-based interventions, and the promotion of collaboration across the disciplines responsible for managing TMD-related OD (eg, speech and language therapy, oral and maxillofacial surgery, dentistry, restorative dentistry, orthodontics, oral medicine).
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Affiliation(s)
- Órla Gilheaney
- PhD Student, Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland.
| | - Leo Fa Stassen
- Professor and Chair, Department of Oral and Maxillofacial Surgery, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
| | - Margaret Walshe
- Associate Professor and Department Head, Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
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Temporomandibular Joint Septic Arthritis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1648. [PMID: 29464173 PMCID: PMC5811303 DOI: 10.1097/gox.0000000000001648] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 12/04/2017] [Indexed: 12/15/2022]
Abstract
Infection of the temporomandibular joint (TMJ) is a rare pediatric condition resulting from the introduction of pathogens into the joint by hematogenous seeding, local extension, or trauma. Early recognition of the typical signs and symptoms including fever, trismus, preauricular swelling, and TMJ region tenderness are critical in order to initiate further evaluation and prevent feared complications of fibrosis, ankylosis, abnormal facial structure, or persistence of symptoms. Contrast-enhanced computed tomography with ancillary laboratory analysis including erythrocyte sedimentation rate, C-reactive protein, and white blood cell count are beneficial in confirming the suspected diagnosis and monitoring response to therapy. Initial intervention should include empiric parenteral antibiotics, early mandibular mobilization, and joint decompression to provide synovial fluid for analysis including cultures. This report describes a case of TMJ bacterial arthritis in a healthy 6-year-old male who was promptly treated nonsurgically with intravenous antibiotics and localized needle joint decompression with return to normal function after completion of oral antibiotics and physical therapy.
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23
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Bayer T, Adler W, Janka R, Uder M, Roemer F. Magnetic resonance cinematography of the fingers: a 3.0 Tesla feasibility study with comparison of incremental and continuous dynamic protocols. Skeletal Radiol 2017; 46:1721-1728. [PMID: 28821929 DOI: 10.1007/s00256-017-2742-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 06/16/2017] [Accepted: 07/24/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To study the feasibility of magnetic resonance cinematography of the fingers (MRCF) with comparison of image quality of different protocols for depicting the finger anatomy during motion. MATERIALS AND METHODS MRCF was performed during a full flexion and extension movement in 14 healthy volunteers using a finger-gating device. Three real-time sequences (frame rates 17-59 images/min) and one proton density (PD) sequence (3 images/min) were acquired during incremental and continuous motion. Analyses were performed independently by three readers. Qualitative image analysis included Likert-scale grading from 0 (useless) to 5 (excellent) and specific visual analog scale (VAS) grading from 0 (insufficient) to 100 (excellent). Signal-to-noise calculation was performed. Overall percentage agreement and mean absolute disagreement were calculated. RESULTS Within the real-time sequences a high frame-rate true fast imaging with steady-state free precession (TRUFI) yielded the best image quality with Likert and overall VAS scores of 3.0 ± 0.2 and 60.4 ± 25.3, respectively. The best sequence regarding image quality was an incremental PD with mean values of 4.8 ± 0.2 and 91.2 ± 9.4, respectively. Overall percentage agreement and mean absolute disagreement were 47.9 and 0.7, respectively. No statistically significant SNR differences were found between continuous and incremental motion for the real-time protocols. CONCLUSION MRCF is feasible with appropriate image quality during continuous motion using a finger-gating device. Almost perfect image quality is achievable with incremental PD imaging, which represents a compromise for MRCF with the drawback of prolonged scanning time.
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Affiliation(s)
- Thomas Bayer
- Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 1, 91054, Erlangen, Germany.
| | - Werner Adler
- IMBE, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Rolf Janka
- Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 1, 91054, Erlangen, Germany
| | - Michael Uder
- Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 1, 91054, Erlangen, Germany
| | - Frank Roemer
- Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 1, 91054, Erlangen, Germany
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Gilheaney Ó, Zgaga L, Harpur I, Sheaf G, Kiefer L, Béchet S, Walshe M. The Prevalence of Oropharyngeal Dysphagia in Adults Presenting with Temporomandibular Disorders Associated with Rheumatoid Arthritis: A Systematic Review and Meta-analysis. Dysphagia 2017; 32:587-600. [PMID: 28508937 DOI: 10.1007/s00455-017-9808-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 05/10/2017] [Indexed: 01/03/2023]
Abstract
Temporomandibular disorders (TMDs) are the most frequent non-dental orofacial pain disorders and may be associated with rheumatoid arthritis (RA), resulting in oropharyngeal dysphagia (OD). However, clinicians' understanding of involvement with OD caused by RA-related TMDs is limited and the methodological quality of research in this field has been criticised. Therefore, the aim of this study was to systematically review the prevalence of oral preparatory and oral stage signs and symptoms of OD in adults presenting with TMDs associated with RA. A systematic review of the literature was completed. The following electronic databases were searched from inception to February 2016, with no date/language restriction: EMBASE, PubMed, CINAHL, Web of Science, Elsevier Scopus, Science Direct, AMED, The Cochrane Database of Systematic Reviews, and ProQuest Dissertations and Theses A & I. Grey literature and reference lists of the included studies were also searched. Studies reporting the frequency of OD in adults presenting with TMD and RA were included. Study eligibility and quality were assessed by three independent reviewers. Methodological quality was assessed using the Down's and Black tool. The search yielded 19 eligible studies. Typical difficulties experienced by RA patients included impaired swallowing (24.63%), impaired masticatory ability (30.69%), masticatory pain (35.58%), and masticatory fatigue (21.26%). No eligible studies reported figures relating to the prevalence of weight loss. Eligible studies were deemed on average to be of moderate quality. Study limitations included the small number of studies which met the inclusion criteria and the limited amount of studies utilising objective assessments. Valid and reliable prospective research is urgently required to address the assessment and treatment of swallowing difficulties in RA as TMJ involvement may produce signs and symptoms of OD.
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Affiliation(s)
- Órla Gilheaney
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, Ireland.
| | - Lina Zgaga
- Department of Public Health and Primary Care, Trinity College Centre for Health Sciences, Tallaght Hospital, Dublin 24, Ireland
| | - Isolde Harpur
- Library of Trinity College Dublin, Trinity College Dublin, Dublin 2, Ireland
| | - Greg Sheaf
- Library of Trinity College Dublin, Trinity College Dublin, Dublin 2, Ireland
| | - Liss Kiefer
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, Ireland
| | - Sibylle Béchet
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, Ireland
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25
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McKee JR. Redefining occlusion. Cranio 2017; 35:343-344. [PMID: 28956727 DOI: 10.1080/08869634.2017.1380235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- James R McKee
- a Past President, American Equilibration Society , Chicago , IL , USA.,b Visiting Faculty , Piper Education and Research Center , St. Petersburg , FL , USA.,c Resident Faculty , Spear Education , Scottsdale , AZ , USA
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Burgess A, Celerier C, Breton S, Van den Abbeele T, Kadlub N, Leboulanger N, Garabedian N, Couloigner V. Otogenic Temporomandibular Arthritis in Children. JAMA Otolaryngol Head Neck Surg 2017; 143:466-471. [PMID: 28253398 DOI: 10.1001/jamaoto.2016.3977] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance Septic arthritis of the temporomandibular joint (SATMJ) is a very rare but potentially severe complication of pediatric middle ear infections because it presents risks of TMJ ankylosis. Objective To describe the clinical, radiological, biological, and microbiological characteristics and evolution of SATMJ complicating middle ear infections (otogenic SATMJ) in children. Design, Setting, and Participants This multicenter retrospective study included all children younger than 18 years referred between January 1, 2005, and December 31, 2015, for otogenic SATMJ or for TMJ ankylosis that occurred a few months to a few years after an acute mastoiditis. Nine children were included in the study. Review of the children's medical charts was conducted from February 1, 2016, to April 1, 2016. Main Outcomes and Measures Patients' demographic characteristics and symptoms; radiological, biological, and bacteriological findings, including reanalysis of initial imaging; and treatment and outcome of SATMJ. Results Of the 9 children, 6 were boys and 3 were girls; the mean age was 2.1 years (range, 6 months to 4.7 years). In 7 cases (78%), the primary middle ear infection was acute mastoiditis. Clinically, 5 children (55%) had preauricular swelling and only 1 (11%) had trismus. Associated thrombophlebitis of the lateral sinus or intracranial collections was present in 7 cases (78%). An initial computed tomographic scan was performed for all but 1 patient, and second-line analysis detected clear signs of TMJ inflammation in all 8 children who had a computed tomographic scan. However, SATMJ was diagnosed in only 3 cases at the time of the initial middle ear infection, leading to the recommendation of TMJ physical therapy for several months. The most frequently involved bacteria was Fusobacterium necrophorum, which was found in 4 cases. Long-term ankylosis was identified in 6 cases (67%), and 5 of these children required surgical treatment. Conclusions and Relevance Clinicians and radiologists must thoroughly look for signs of SATMJ in children with acute mastoiditis to detect this complication, which can lead to disabling and hard-to-treat TMJ ankylosis.
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Affiliation(s)
- Alice Burgess
- Pediatric ENT Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Charlotte Celerier
- Pediatric ENT Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sylvain Breton
- Radiology Department, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | | | - Natacha Kadlub
- Maxillofacial Surgery Department, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Nicolas Leboulanger
- Pediatric ENT Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Noël Garabedian
- Pediatric ENT Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Vincent Couloigner
- Pediatric ENT Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
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Luscan R, Belhous K, Simon F, Boddaert N, Couloigner V, Picard A, Kadlub N. TMJ arthritis is a frequent complication of otomastoiditis. J Craniomaxillofac Surg 2016; 44:1984-1987. [DOI: 10.1016/j.jcms.2016.09.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/20/2016] [Accepted: 09/26/2016] [Indexed: 12/14/2022] Open
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[Chondromatose of the temporomandibular joint: Multicentric study and clarification from 14 cases]. ACTA ACUST UNITED AC 2016; 117:234-9. [PMID: 27531415 DOI: 10.1016/j.revsto.2016.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 07/13/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The aim of our study was to analyse a series of patients suffering from temporomandibular joint (TMJ) chondromatosis treated in 2 departments of stomatology and maxillofacial surgery (University hospitals of the Conception in Marseille and of Caen) and to make a general review of this disease. MATERIAL AND METHODS We conducted a retrospective study including all the patients treated for a TMJ chondromatosis in one of these 2 departments. Following parameters were analyzed: sex, ages at discovery and at surgery, symptoms, side, imaging, histology, recurrence and any other events considered as relevant. RESULTS Fourteen patients could be included: 85.7 % were women. Average age at diagnosis was 40.14 (σ = 13.82; IC95: 32.90-47.38) (41 for women [σ = 14.74; IC95: 33.28-48.72] and 35 years for men [σ = 5.66, IC95: 27.16-42.84]). Average age at surgery was 40.86 (σ = 14.18; IC95: 33.43-48.28). There was no predominance of side; 57.14 % of the patients had a joint syndrome, 57.14 % a tumor syndrome, 28.57 % had pain and 14.29 % had headaches. Panoramic X-ray was informative in 3 cases only. CT scan showed intra-articular calcifications in half of the cases only but arthrosic modifications in all the cases. Magnetic resonance imaging (MRI) constantly showed intra-articular cartilage fragments. When histology was performed, it found the synovial to be normal in one case and multiple nodules with clear cartilaginous differentiation in another case. One patient suffered from a second contralateral localization 10 years later. DISCUSSION Chondromatosis has a slow evolution and is asymptomatic for a long time. MRI allows to evoke the diagnosis and to locate precisely the osteochondromas. Diagnosis is confirmed by histology that highlights a synovial metaplasia and more or less calcified chondromas. The main differential diagnosis to be eliminated because of prognostic reasons is the synovial chondrosarcoma. Treatment consists in surgical removing of the chondromas. Evolution is usually favorable.
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Marquezan M, Figueiró C. Temporomandibular disorder treatment in a patient wearing removable prostheses: A case report. Cranio 2016; 35:122-127. [PMID: 27240163 DOI: 10.1080/08869634.2016.1187823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AIM The purpose of this intervention was to treat the patient, a 51-year-old woman, who was wearing a maxillary denture and a mandibular bilateral distal-extension partial denture (both unfit) and was suffering from temporomandibular disorder (TMD). METHODOLOGY The treatment suggested was to construct a superior repositioning splint (SRS), and after remission of the symptomatology, fabricate new dentures. RESULTS The occlusal splint was effective and the symptomatology ceased after about five months of treatment. The new dental prostheses were made and followed up for 10 years with no return of the pain. CONCLUSIONS SRS and subsequent construction of new dentures after remission of the symptomatology was an effective treatment for TMD in the case described.
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Affiliation(s)
- Mariana Marquezan
- a Department of Pediatric Dentistry and Orthodontics , Universidade Federal do Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil.,b Department of Restorative Dentistry , Universidade Federal de Santa Maria (UFSM) , Santa Maria , Rio Grande do Sul , Brazil
| | - Cláudio Figueiró
- b Department of Restorative Dentistry , Universidade Federal de Santa Maria (UFSM) , Santa Maria , Rio Grande do Sul , Brazil
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