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García Martín I, Cariati P, Martínez-Sauquillo Rico A, Cabello Serrano A, García Medina B. Arthroscopic osteoplasty of the medial and anteromedial wall of temporomandibular joint: surgical technique and anatomical considerations. Br J Oral Maxillofac Surg 2023; 61:72-77. [PMID: 36535863 DOI: 10.1016/j.bjoms.2022.11.008] [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: 08/11/2022] [Revised: 10/19/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
Abstract
The anterior displacement of the articular disc is the most frequent cause of pathological alterations in the TMJ. Although it is an extremely common pathology, there is no certainty about the aetiopathogenesis of this disease. The main aim of the present report is to describe new anatomical findings that could help clarifying the aetiopathogenesis of this disease and determine a typology of treatment based on the cause of the disease. All the operative records of patients who underwent arthroscopic osteoplasty of the medial TMJ wall in our centre from January 2021 to September 2021 were reviewed and analysed to identify specific anatomical features observed in every procedure. Fifty-two joints were included for analysis in this study. Twenty-two joints were classified as Wilkes stages II-III and 30 as Wilkes stages IV-V. The most common complication observed in our sample was the dysaesthesias found in the temporal and preauricular regions. Other complications observed were frontal branch paresis (n = 2), intraoperative bleeding (n = 1), and postoperative malocclusion (n = 1). The compression of the superior head of pterygoid lateral muscle (SPLM) on the medial bony wall and the consequent muscle atrophy could be key for the aetiology of the anterior TMJ disc displacement. Therapeutic actions on the osseous and muscular component in this anatomical area could improve the outcomes of patients affected by TMJ internal derangement. A meticulous dissection of the fascia of the superior fascicle of the lateral pterygoid muscle allows a remodelling of the bone surfaces with minimal complications.
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Affiliation(s)
- Irene García Martín
- Department of Oral and Maxillofacial Surgery, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Paolo Cariati
- Hospital General Universitario de Albacete, Departamento de Cirugía Oral y Maxilofacial, Albacete, Spain.
| | | | - Almudena Cabello Serrano
- Hospital Universitario Virgen de las Nieves de Granada, Departamento de Cirugía Oral y Maxilofacial, Granada, Spain
| | - Blas García Medina
- Hospital Universitario Virgen de las Nieves de Granada, Departamento de Cirugía Oral y Maxilofacial, Granada, Spain
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Evaluation of morphological variations of petrotympanic fissure using computed tomography imaging of the temporal bone. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e643-e649. [PMID: 35738526 DOI: 10.1016/j.jormas.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/10/2022] [Accepted: 06/16/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE Petrotympanic fissure (PF) is important for both dentists and otolaryngologists to know the temporal anatomy well especially for pre-surgical radiological evaluations. Computed tomography (CT) is indispensable method for temporal bone imaging. The purpose of this study was to evaluate PF morphology and position using CT. METHODS CT scans of 300 patients (600 PFs) were retrospectively evaluated. PF types were recorded by dividing into 3 groups (Type 1,2 and 3). Length of the mandibular fossa (MF) and PF, vertical diameter (VD) of the PF at the MF level, midpoint and tympanic cavity (TC) level were measured. PF position types were subdivided as low, midline and high. RESULTS Type 1, 2 and 3 was found in 18.7%, 51.5% and 29.8% of the cases, respectively. The mean length of the MF and PF was 18.33 mm and 3.77 mm, respectively. The mean VD of the PF at the MF level, midpoint and TC level was 1.71, 0.98 and 0.97 mm, respectively. The low, midline and high position of PF was observed 14.5%, 54.3% and 31.2% of the cases, respectively. CONCLUSION Length of the MF and PF in males was significantly higher than females. VD of the PF at the MF level in Type 1 and Type 3 was significantly higher than type 2. In type 1,VD of the PF at the midpoint was significantly higher than type 2 and type 3. VD of the PF at the TC level in Type 1 and Type 3 was significantly higher than type 2.
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Petrotympanic Fissure Architecture and Malleus Location in Temporomandibular Joint Disorders. Tomography 2022; 8:2460-2470. [PMID: 36287803 PMCID: PMC9611230 DOI: 10.3390/tomography8050204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/17/2022] Open
Abstract
The aim of this research was to assess possible relationships between petrotympanic fissure (PTF) characteristics, malleus position, and temporomandibular joint disorders (TMD). A retrospective study was performed, including patients with TMD. Magnetic resonance imaging (MRI) and cone-beam computed tomography (CBCT) examination were used to evaluate temporomandibular joint (TMJ) disc position and condylar bone changes. Fifty-eight TMJs from twenty-nine patients (23:6 females: males) were assessed. Erosive changes (DDR-disc displacement with a reduction of 6 (24%), DDwR-disc displacement without a reduction of 8 (61.5%) vs. normal disc position 3 (15%), p = 0.012) and condyle osteophytes production (DDR 6 (24%), DDwR 9 (69.2%) vs. normal condyle 7 (35%), p = 0.012) were more frequent in subjects with disc displacement compared to normal disc position; malleus was closer to PTF in cases with erosive changes (median 2.15 interquartile range: (1.85–2.75) vs. 2.75 (2.25–3.15), p = 0.029) as well as those with condylar osteophytosis (2.25 (1.91–2.75) vs. 2.75 (2.33–3.32), p = 0.015); the PTF length was higher in cases with condylar osteophytosis compared to those without (4.45 (3.50–4.77) vs. 3.67 (3.34–4.28), p = 0.039). The disc position and disc shape were not related to PTF or malleus position. Malleus position and PTF dimensions were not associated with the PTF type. In cases with erosive changes and condylar osteophytosis, malleus was closer to PTF.
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Tang R, Zhang Z, Zhao L, Xu N, Wu Q, Xie J, Zhao P, Yin H, Yang Z, Wang Z. Radiological Evaluation of Tympanic Segment of Chorda Tympani Nerve in Normal Ears: An Ultra-High-Resolution CT Study. World Neurosurg 2022; 168:e34-e42. [PMID: 36126894 DOI: 10.1016/j.wneu.2022.08.155] [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: 05/01/2022] [Revised: 08/28/2022] [Accepted: 08/30/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND To visualize the course of the tympanic segment of chorda tympani nerve (CTN) using ultra-high-resolution computed tomography (U-HRCT). METHODS A hundred and fourteen ears with no evident otologic pathologies were included. The tympanic segment of CTN was divided into four portions: periannular, posteromalleal, malleal, and anteromalleal. The length of the periannular portion running along the tympanic annulus was recorded. Four points of interest (the beginning and end of the posteromalleal and anteromalleal portions) were selected to perform distance measurements relative to the tip of the malleus manubrium. Differences in lengths and distances were compared in terms of ear sides and sexes. RESULTS The length of the periannular portion was 2.49 ± 1.16 mm. The beginning of the posteromalleal portion was located more laterally on the right side than on the left side (mean: 4.09 mm vs. 3.92 mm, P = 0.016). The end of the posteromalleal portion was located more inferiorly on the right (mean: 2.11 mm vs. 2.26 mm, P = 0.018). The beginning of the anteromalleal portion on the right was located more laterally than that on the left (mean: 2.60 mm vs. 2.45 mm, P = 0.027). The start and end of the anteromalleal portion were more posteriorly located in women than in men (both Ps < 0.001). CONCLUSIONS The course of the tympanic segment of normal CTN was comprehensively visualized by U-HRCT. Preoperative evaluation of the tympanic segment of CTN might be helpful in avoiding iatrogenic injury during middle ear surgery.
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Affiliation(s)
- Ruowei Tang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhengyu Zhang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ning Xu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qian Wu
- Department of Otolaryngology and Head & Neck, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jing Xie
- Department of Otolaryngology and Head & Neck, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Pengfei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hongxia Yin
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Fujiwara M, Watanabe Y, Kashiwagi N, Ohta Y, Sato T, Nishigaki M, Tomiyama N. Improved visualization of the chorda tympani nerve using ultra-high-resolution computed tomography. Acta Radiol Open 2021; 10:20584601211061444. [PMID: 34868664 PMCID: PMC8637724 DOI: 10.1177/20584601211061444] [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: 09/16/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022] Open
Abstract
Background Recognition of the anatomical course of the chorda tympani nerve (CTN) is
important for preventing iatrogenic injuries during middle-ear surgery. Purpose This study aims to compare visualization of the CTN using two computed
tomography (CT) methods: conventional high-resolution CT (C-HRCT) and
ultra‐high-resolution CT (U-HRCT). Materials and methods We performed a retrospective visual assessment of 59 CTNs in normal temporal
bones of 54 consecutive patients who underwent both C-HRCT and U-HRCT. After
dividing CTN into three anatomical segments (posterior canaliculus, tympanic
segment, and anterior canaliculus), two neuroradiologists scored the
visualizations on a four-point scale. Results On C-HRCT, the visual scores of the posterior canaliculus, tympanic segment,
and anterior canaliculus were 3.5 ± 0.7, 1.6 ± 0.6, and 3.1 ± 0.7,
respectively. The respective values were significantly higher in all
segments on U-HRCT: 3.9 ± 0.2, 2.4 ± 0.6, 3.5 ± 0.6 (p <
0.01). Although the difference in scores between methods was greatest for
the tympanic segment, the visual score on U-HRCT was lower for the tympanic
segment than for the anterior and posterior segments (p
< 0.01). Conclusion Ultra‐high-resolution CT provides superior visualization of the CTN,
especially the tympanic segment.
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Affiliation(s)
- Masahiro Fujiwara
- Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Otsu, Japan
| | - Nobuo Kashiwagi
- Future Diagnostic Radiology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yumi Ohta
- Otorhinolaryngology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takashi Sato
- Otorhinolaryngology, Osaka University Graduate School of Medicine, Suita, Japan
| | | | - Noriyuki Tomiyama
- Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Japan
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Molinari G, Yacoub A, Alicandri-Ciufelli M, Monzani D, Presutti L, Caversaccio M, Anschuetz L. Endoscopic Anatomy of the Chorda Tympani: Systematic Dissection, Novel Anatomic Classification, and Surgical Implications. Otol Neurotol 2021; 42:e958-e966. [PMID: 33741821 DOI: 10.1097/mao.0000000000003143] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HYPOTHESIS A transcanal endoscopic approach enables visualization of the variable course of the chorda tympani inside the middle ear. BACKGROUND The chorda tympani is the longest intrapetrous branch of the facial nerve. Despite having been investigated in several studies, a description of its tympanic tract from an endoscopic point of view is lacking in the literature. METHODS We performed transcanal endoscopic dissections of 44 human cadaveric head and ear specimens. The entry point of the chorda tympani into the middle ear was classified into four categories according to its location, and as covered or dehiscent according to its appearance. The chordal eminence (CE) was defined as absent, shallow, intermediate, prominent, or fused, based on its shape and extension. The relationship of the chorda tympani to adjacent bony and ligamental structures was assessed. RESULTS The tympanic tract of the chorda tympani was divided into three portions. The periannular segment was dehiscent in 54.5% of specimens, with type II being the most frequent entry point configuration (52.3%). In the interossicular segment, the nerve consistently passed lateral to the incus and medial to the malleus. The course of the intrapetrous segment was independent from the conformation of the tensor fold and supratubal recess. CONCLUSION The transcanal endoscopic approach allows a detailed description of tympanic segment of the chorda tympani. Novel anatomic classifications of the chorda tympani and CE are proposed herein to highlight their possible surgical implications during otologic procedures.
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Affiliation(s)
- Giulia Molinari
- Department of Otolaryngology Head and Neck Surgery, Inselspital, University Hospital and University of Bern
- Department of Otolaryngology Head and Neck Surgery, University Hospital of Modena, University of Modena and Reggio Emilia, Italy
| | - Abraam Yacoub
- Department of Otolaryngology Head and Neck Surgery, Inselspital, University Hospital and University of Bern
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Matteo Alicandri-Ciufelli
- Department of Otolaryngology Head and Neck Surgery, University Hospital of Modena, University of Modena and Reggio Emilia, Italy
| | - Daniele Monzani
- Department of Otolaryngology Head and Neck Surgery, University Hospital of Modena, University of Modena and Reggio Emilia, Italy
| | - Livio Presutti
- Department of Otolaryngology Head and Neck Surgery, University Hospital of Modena, University of Modena and Reggio Emilia, Italy
| | - Marco Caversaccio
- Department of Otolaryngology Head and Neck Surgery, Inselspital, University Hospital and University of Bern
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
| | - Lukas Anschuetz
- Department of Otolaryngology Head and Neck Surgery, Inselspital, University Hospital and University of Bern
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
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Evaluation of the human petrotympanic fissure using anatomized cadaveric specimens and multi-detector CT imaging. Surg Radiol Anat 2020; 42:337-346. [DOI: 10.1007/s00276-019-02346-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/14/2019] [Indexed: 10/26/2022]
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Runci Anastasi M, Macchi V, Vellone V, Nastro Siniscalchi E, Anastasi G, Morra A, Porzionato A, De Caro R, De Ponte FS, Cascone P. The discomallear ligament: anatomical, microscopical, and radiologic analysis. Surg Radiol Anat 2020; 42:559-565. [PMID: 31982932 DOI: 10.1007/s00276-020-02419-5] [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] [Received: 04/01/2019] [Accepted: 01/11/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Several anatomic relationships between the ear and the temporo-mandibular joint have been proposed to account for the presence of tinnitus during temporo-mandibular disorders. Among the otomandibular structures, the discomallear ligament (DML) is interposed between the malleus and the retrodiscal capsular complex. The aim of present paper was to study through dissection the frequency and morphology of DML, to characterize its type of collagen, and to evaluate the DML on routine computed tomography (CT). METHODS AND RESULTS The study has been conducted on five un-embalmed adult cadavers, and in all cases, the DML was present (100%). It was constituted mainly by fibers of collagen I, with abundant elastic fibers. On CT exams of 40 patients with no reported pathology of the ear, on axial images, a dense structure, going from the upper end of the petrotympanic fissure to the neck of the malleus, was present in all the cases. In 90%, it showed a triangular shape, in 5% a rectangular shape, and in 5% a curved course. The mean length of the antero-medial side was 2 ± 0.6 mm and that of the antero-lateral side was 1.63 ± 0.5, and the mean area was 1.29 ± 0.83 mm2. CONCLUSION The DML could represent an anatomical structure that joining the temporo-mandibular joint and the malleus may play a role in the otologic symptoms during temporo-mandibular disorders.
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Affiliation(s)
- Michele Runci Anastasi
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Veronica Macchi
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy.
| | - Valentino Vellone
- Department of Maxillo-Facial Surgery, University of Roma La Sapienza, Rome, Italy
| | - Enrico Nastro Siniscalchi
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Giuseppe Anastasi
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Aldo Morra
- Section of Radiology, Euganea Medica Center, Padova, Italy
| | - Andrea Porzionato
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy
| | - Francesco S De Ponte
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Piero Cascone
- Department of Maxillo-Facial Surgery, University of Roma La Sapienza, Rome, Italy
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Gorurgoz C, Orhan K, Sinanoglu EA, Avsever IH. Evaluation of mallear ligaments in different voxel resolutions using cone beam computed tomography. Dentomaxillofac Radiol 2019; 48:20180125. [DOI: 10.1259/dmfr.20180125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Cansu Gorurgoz
- Department of Dentomaxillofacial Radiology, Ankara University, Faculty of Dentistry, Ankara, Turkey
| | - Kaan Orhan
- Department of Dentomaxillofacial Radiology, Ankara University, Faculty of Dentistry, Ankara, Turkey
| | - Enver Alper Sinanoglu
- Department of Dentomaxillofacial Radiology, Health Sciences University, Gulhane Faculty of Dentistry, Ankara, Turkey
| | - Ismail Hakan Avsever
- Department of Dentomaxillofacial Radiology, Kocaeli University, Faculty of Dentistry, Kocaeli, Turkey
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Lee JY, Lee ES, Kim GM, Jung HI, Lee JW, Kwon HK, Kim BI. Unilateral Mastication Evaluated Using Asymmetric Functional Tooth Units as a Risk Indicator for Hearing Loss. J Epidemiol 2018; 29:302-307. [PMID: 30344198 PMCID: PMC6614080 DOI: 10.2188/jea.je20180052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Some previous studies reported hearing ability can be reduced by impaired masticatory ability, but there has been little evidence reported of an association between hearing loss and unilateral mastication. Therefore, this study aimed to investigate the relationship between unilateral mastication (UM), estimated from individual functional tooth units (FTUs), and hearing loss in a representative sample of Korean adults. METHODS The analyzed data were obtained from 1,773 adults aged 40-89 years who participated in Korean national survey. Hearing loss was defined as a pure-tone average of >25 dB at frequencies of 0.5, 1, 2, and 4 kHz in either ear. In each subject, UM was calculated as the difference in the sums of the FTU scores, which is an index of posterior tooth occlusion, on the two sides of the oral cavity. The scores were used to classify the UM into low, moderate, and high. The adjusted odds ratios (aORs) and their 95% confidence intervals (CIs) were calculated in multivariable logistic regression analyses. RESULTS When controlling for sociodemographic factors, the aOR for hearing loss was 3.12 (95% CI, 1.21-8.03) for high UM relative to low UM. This association remained in a fully-adjusted model containing factors related to noise exposure (aOR 2.88; 95% CI, 1.12-7.46). CONCLUSION Adults with high UM as measured using FTUs showed a higher occurrence of hearing loss than those with low UM.
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Affiliation(s)
- Joo-Young Lee
- Department of Preventive Dentistry & Public Oral Health, Brain Korea 21 PLUS Project, Yonsei University College of Dentistry
| | - Eun-Song Lee
- Department of Preventive Dentistry & Public Oral Health, Brain Korea 21 PLUS Project, Yonsei University College of Dentistry
| | - Gyung-Min Kim
- Department of Preventive Dentistry & Public Oral Health, Brain Korea 21 PLUS Project, Yonsei University College of Dentistry
| | - Hoi-In Jung
- Department of Preventive Dentistry & Public Oral Health, Brain Korea 21 PLUS Project, Yonsei University College of Dentistry
| | - Jeong-Woo Lee
- Department of Preventive Dentistry & Public Oral Health, Brain Korea 21 PLUS Project, Yonsei University College of Dentistry
| | - Ho-Keun Kwon
- Department of Preventive Dentistry & Public Oral Health, Brain Korea 21 PLUS Project, Yonsei University College of Dentistry
| | - Baek-Il Kim
- Department of Preventive Dentistry & Public Oral Health, Brain Korea 21 PLUS Project, Yonsei University College of Dentistry.,Oral Science Research Institute, Yonsei University College of Dentistry
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De Greef D, Buytaert JA, Aerts JR, Van Hoorebeke L, Dierick M, Dirckx J. Details of human middle ear morphology based on micro-CT imaging of phosphotungstic acid stained samples. J Morphol 2015; 276:1025-46. [DOI: 10.1002/jmor.20392] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 03/08/2015] [Accepted: 03/13/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Daniel De Greef
- Laboratory of Biomedical Physics; Department of Physics, University of Antwerp, Groenenborgerlaan 171; 2020 Antwerp Belgium
| | - Jan A.N. Buytaert
- Laboratory of Biomedical Physics; Department of Physics, University of Antwerp, Groenenborgerlaan 171; 2020 Antwerp Belgium
| | - Johan R.M. Aerts
- Laboratory of Biomedical Physics; Department of Physics, University of Antwerp, Groenenborgerlaan 171; 2020 Antwerp Belgium
| | - Luc Van Hoorebeke
- UGCT, Department of Physics and Astronomy; Ghent University, Proeftuinstraat 86; 9000 Ghent Belgium
| | - Manuel Dierick
- UGCT, Department of Physics and Astronomy; Ghent University, Proeftuinstraat 86; 9000 Ghent Belgium
| | - Joris Dirckx
- Laboratory of Biomedical Physics; Department of Physics, University of Antwerp, Groenenborgerlaan 171; 2020 Antwerp Belgium
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Arai H, Sato I. Anatomical study of the human discomallear ligament using cone beam computed tomography imaging and morphological observations. Okajimas Folia Anat Jpn 2012; 88:89-101. [PMID: 22519068 DOI: 10.2535/ofaj.88.89] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In the present study, the human discomallear ligament (DML) was observed in structures at both macroscopic and cone beam computed tomography levels. Assessments were made regarding the distribution of calcitonin-gene-related peptide (CGRP), protein gene-product (PGP) 9.5, and substance P (SP) of the DML based on immunohistochemical analyses of the anatomical properties of jaw movements using 27 Japanese human cadavers (mean, 79.3 +/- 8.6 years; male, 74.9 +/- 8.0; female, 82.8 +/- 7.5). The DML of the anterior region was connected to the TMJ disc. The DML of the posterior region was attached to both the head and the anterior process of the malleus through the petrotympanic fissure, which formed a narrow channel. The structure of the petrotympanic fissure through the DML was attached to the malleus, and this structure was associated with the mobility of the malleus. In the anterior and posterior parts of the disc-associated connective tissue of the DML, CGRP-, PGP9.5- and SP-positive nerve fibers were located around numerous blood vessels, a condition which may be correlated with chronic pain syndrines disorders and the auditory system.
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Affiliation(s)
- Hiroshi Arai
- Department of Anatomy, School of Dentistry at Tokyo, Nippon Dental University, 1-9-20 Fujimi Chiyoda-ku, Tokyo, 102-8159, Japan
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Mérida-Velasco JR, de la Cuadra-Blanco C, Pozo Kreilinger JJ, Mérida-Velasco JA. Histological study of the extratympanic portion of the discomallear ligament in adult humans: a functional hypothesis. J Anat 2012; 220:86-91. [PMID: 22050648 PMCID: PMC3248666 DOI: 10.1111/j.1469-7580.2011.01447.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2011] [Indexed: 11/28/2022] Open
Abstract
This study was carried out on histological aspects of the extratympanic portion of the discomallear ligament (DL) in adult humans. The temporomandibular joint (TMJ) was dissected bilaterally in 20 cadavers; in 15 cases the articular disc (AD) and the retroarticular tissue were extirpated. The extratympanic portion of the DL had the shape of a base-down triangle, in relation to the AD, and an upper vertex, in relation to the petrotympanic fissure. In five cases, the base, measured bilaterally, had an average length of 6.4 mm, while the distance from the base to the upper vertex averaged 9.3 mm in length. The extratypanic portion of the DL is an intrinsic ligament of the TMJ, composed of collagen fibres and abundant elastic fibres. We propose that this ligament could act as a tensor of the synovial membrane in movements of the TMJ.
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Affiliation(s)
- J R Mérida-Velasco
- Departamento de Anatomía y Embriología Humana II, Facultad de Medicina, Universidad Complutense, Madrid, Spain.
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Monteiro JCC, Ennes JP, Zorzatto JR. Ossification of the petrotympanic fissure: morphological analysis and clinical implications. Cranio 2011; 29:284-90. [PMID: 22128668 DOI: 10.1179/crn.2011.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The petrotympanic fissure, a narrow slit in the temporal bone, allows the temporomandibular joint (TMJ) and the middle ear to communicate. Both the chorda tympani and the ligament cross the fissure between the posterior region of the joint disk and the malleolar ossicle. The parasympathetic fibers of the chorda tympani spread into the major salivary glands and are responsible for the taste sensibility on the anterior two-thirds of the tongue. After chronological identification of 30 human skulls, petrotympanic fissures were macroscopically and stereomicroscopically analyzed for the presence and disposition of ossification areas. Digitalized images were analyzed using computer program UTHSCSA ImageTool 3.0 (developed by the Department of Dental Diagnostic Science at The University of Texas Health Science Center, San Antonio, Texas). The total extension of the fissures and ossification areas was measured. The macroscopic analysis did not constitute an appropriated method for this evaluation and the ossification of the fissures increased with aging, suggesting its influence on the causes of otalgia in cases of TMJ dysfunction.
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Clinical anatomy of the chorda tympani: a systematic review. The Journal of Laryngology & Otology 2011; 125:1101-8. [PMID: 21810294 DOI: 10.1017/s0022215111001873] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The chorda tympani is at risk of iatrogenic injury throughout its course. This paper reviews the clinical anatomy of the nerve in adults. DESIGN Systematic literature review. METHOD Relevant English-language articles were identified using five electronic databases and one search engine. Data from approximately 70 scientific papers were supplemented with information from selected reference texts. RESULTS The anatomy of the chorda tympani differs from standard descriptions, particularly regarding its exit from the middle ear and area of lingual innervation. Whilst it is known to convey taste sensation from the anterior two-thirds of the tongue and parasympathetic innervation to the submandibular and sublingual salivary glands, the chorda tympani probably has additional sensory and secretomotor functions. CONCLUSION A detailed understanding of the anatomy of the chorda tympani may help to reduce the risk of iatrogenic injury during head, neck and middle-ear surgery, and to explain the variable consequences of such injury.
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Rodríguez-Vázquez JF, Murakami G, Verdugo-López S, Abe SI, Fujimiya M. Closure of the middle ear with special reference to the development of the tegmen tympani of the temporal bone. J Anat 2011; 218:690-8. [PMID: 21477146 DOI: 10.1111/j.1469-7580.2011.01378.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Closure of the middle ear is believed to be closely related to the evolutionary development of the mammalian jaw. However, few comprehensive descriptions are available on fetal development. We examined paraffin-embedded specimens of 20 mid-term human fetuses at 8-25 weeks of ovulation age (crown-rump length or CRL, 38-220 mm). After 9 weeks, the tympanic bone and the squamous part of the temporal bone, each of which was cranial or caudal to Meckel's cartilage, grew to close the lateral part of the tympanosquamosal fissure. At the same time, the cartilaginous tegmen tympani appeared independently of the petrous part of the temporal bone and resulted in the petrosquamosal fissure. Subsequently, the medial part of the tympanosquamosal fissure was closed by the descent of a cartilaginous inferior process of the tegmen tympani. When Meckel's cartilage changed into the sphenomandibular ligament and the anterior ligament of the malleus, the inferior process of the tegmen tympani interposed between the tympanic bone and the squamous part of the temporal bone, forming the petrotympanic fissure for the chorda tympani nerve and the discomalleolar ligament. Therefore, we hypothesize that, in accordance with the regression of Meckel's cartilage, the rapidly growing temporomandibular joint provided mechanical stress that accelerated the growth and descent of the inferior process of the tegmen tympani via the discomalleolar ligament. The usual diagram showing bony fissures around the tegmen tympani may overestimate the role of the tympanic bone in the fetal middle-ear closure.
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Affiliation(s)
- José Francisco Rodríguez-Vázquez
- Department of Anatomy and Human Embryology II, Faculty of Medicine, Embryology Institute, University Complutense of Madrid, Spain
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Ramirez L, Ballesteros L, Sandoval G. Topical review: Temporomandibular disorders in an integral otic symptom model. Int J Audiol 2009; 47:215-27. [DOI: 10.1080/14992020701843137] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ramirez L, Ballesteros L, Sandoval G. Topical review: Temporomandibular disorders in an integral otic symptom model. Int J Audiol 2009. [DOI: https://doi.org/10.1080/14992020701843137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Şencimen M, Yalçin B, Doğan N, Varol A, Okçu K, Ozan H, Aydintuğ Y. Anatomical and functional aspects of ligaments between the malleus and the temporomandibular joint. Int J Oral Maxillofac Surg 2008; 37:943-7. [DOI: 10.1016/j.ijom.2008.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Revised: 12/27/2007] [Accepted: 07/11/2008] [Indexed: 11/17/2022]
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Classifications of tunnel-like structure of human petrotympanic fissure by cone beam CT. Surg Radiol Anat 2008; 30:323-6. [PMID: 18288438 DOI: 10.1007/s00276-008-0327-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Accepted: 02/07/2008] [Indexed: 10/22/2022]
Abstract
The discomallear ligament (DML) runs through a narrow space of bony petrotympanic fissure, which joins the articular disc of the temporomandibular joint (TMJ) and the malleus in the tympanic cavity. Previous report suggest that an anatomical feature gives rise to TMJ pain and dysfunction. Recently, the movement of the malleus caused by hypertension on the discomallear ligament is important to the function of the TMJ. The purpose of this study is to define its morphological features using the cone beam CT (CBCT) and anatomical dissection of Japanese cadavers. Petrotympanic fissure and DML were observed in 14 cadavers (eight males and six females). It is revealed that a wide tunnel-like structure was found on CBCT images in the middle region of the petrotympanic fissure to the malleus in the tympanic cavity consisting of mainly three types: a wide tunnel-shaped structure (29.2%, 7/24, type 1), a tunnel-shaped structure widely open in the entrance of the petrotympanic fissure to the mandibular fossa and gradually thinning out in the tympanic cavity (20.8%, 5/24, type 2), and a tunnel-shaped structure widely open in the entrance of the mandibular fossa, middle region with flat-shaped tunnel structure and narrow exit in the tympanic cavity (41.7%, 10/24, type 3). These structures between the entrance of the petrotympanic fissure and the exit at the tympanic cavity are important to define the limited movement of the malleus. Therefore, morphological feature of the ligaments in malleus may relate to TMJ pain, dysfunction and hearing function.
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Cheng T, Gan RZ. Mechanical properties of anterior malleolar ligament from experimental measurement and material modeling analysis. Biomech Model Mechanobiol 2007; 7:387-94. [PMID: 17710457 PMCID: PMC8040535 DOI: 10.1007/s10237-007-0094-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Accepted: 07/11/2007] [Indexed: 12/26/2022]
Abstract
In this paper, mechanical properties of the anterior malleolar ligament (AML) of human middle ear were studied through the uniaxial tensile, stress relaxation and failure tests. The digital image correlation (DIC) method was used to assess the boundary effect in experiments and calculate the strain on specimens. The constitutive behavior of the AML was described by a transversely isotropic hyperelastic model which consists of a first-order Ogden model augmented by a I(4)-type reinforcing term. The material parameters of the model were estimated and the viscoelasticity of the AML was illustrated by hysteresis phenomena and stress relaxation function. The mechanical strength of the AML was obtained through the failure test and the mean ultimate stress and stretch ratio were measured as 1.05 MPa and 1.51, respectively. Finally, a linear Young's modulus-stress relationship of the AML was derived based on constitutive equation of the AML within a stress range of 0-0.5 MPa.
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Affiliation(s)
- Tao Cheng
- School of Aerospace and Mechanical Engineering and Bioengineering Center, University of Oklahoma, 865 Asp Avenue, Room 200, Norman, OK 73019, USA
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Mérida-Velasco JR, Rodríguez JF, de la Cuadra C, Peces MD, Mérida JA, Sánchez I. The Posterior Segment of the Temporomandibular Joint Capsule and Its Anatomic Relationship. J Oral Maxillofac Surg 2007; 65:30-3. [PMID: 17174760 DOI: 10.1016/j.joms.2005.11.099] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2005] [Revised: 04/20/2005] [Accepted: 11/11/2005] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this work was to clarify the arrangement of the posterior segment of the temporomandibular joint capsule and its pertinent relationships. MATERIALS AND METHODS The temporomandibular region was dissected bilaterally in 20 adult cadavers. Natural stained latex was injected into 16 cadavers through the external carotid artery to facilitate the dissection of the arterial vessels. RESULTS The posterior segment of the joint capsule is made up of the so-called "bilaminar zone" of the articular disc. The upper internal portion of the posterior segment of the capsule was reinforced by the discomalleolar ligament. The retroarticular space was filled with loose connective tissue and the anterior branches of the anterior tympanic artery were distributed throughout the posterior segment of the joint capsule. CONCLUSION The posterior segment of the temporomandibular joint capsule corresponds to the bilaminar zone of the articular disc. The structures of the retroarticular space are extracapsular.
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Affiliation(s)
- J Ramón Mérida-Velasco
- Instituto de Ciencias Morfofuncionales y del Deporte, Universidad Complutense de Madrid, Madrid, Spain.
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