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Fernández-Ferro M, Fernández-González V, Salgado-Barreira Á, Santos-Armentia E, Valdés-Sarmiento P, Fernández-García A, Gómez-Rey D, Fernández-Sanromán J. Correlation between the main clinical, imaging, and arthroscopy findings in patients with temporomandibular disorders. Int J Oral Maxillofac Surg 2023; 52:237-244. [PMID: 35985912 DOI: 10.1016/j.ijom.2022.08.007] [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: 01/07/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 01/11/2023]
Abstract
The purpose of this work was to prospectively correlate the most characteristic clinical symptoms of temporomandibular disorders, such as pain and limitation of mouth opening, with the findings of magnetic resonance imaging (disc position, degenerative changes, and effusion) and arthroscopy findings (roofing, synovitis, chondromalacia, adhesions, and perforations). These examinations were performed in 298 patients diagnosed with internal derangement refractory to conservative treatment. The mean age of the patients was 38.59 years; 92.6% were female. The t-test and one-way analysis of variance (ANOVA) were used to correlate the findings. Significant relationships were found between pain and disc displacement without reduction (P = 0.033) and effusion (P = 0.003) on MRI, coinciding with correlations between pain and roofing of 0-25% (P = 0.016) and synovitis (P = 0.001) on arthroscopy. A significant relationship was also observed between mouth opening limitation and the presence of osteoarthrosis (P = 0.018) on MRI, and between mouth opening limitation and synovitis (P = 0.022), chondromalacia (P = 0.002), and adhesions (P < 0.001) on arthroscopy. All of these findings were observed in patients with a poor initial clinical situation, which highlights the considerable potential of correlating these data with imaging and arthroscopy findings.
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Affiliation(s)
- M Fernández-Ferro
- Department of Oral and Maxillofacial Surgery, Ribera Povisa Hospital, Vigo, Pontevedra, Spain; Povisa University School of Nursing, University of Vigo, Vigo, Pontevedra, Spain; Galicia Sur Health Research Institute, Álvaro Cunqueiro Hospital, University of Vigo, Vigo, Pontevedra, Spain.
| | - V Fernández-González
- Department of Oral and Maxillofacial Surgery, Ribera Povisa Hospital, Vigo, Pontevedra, Spain
| | - Á Salgado-Barreira
- Galicia Sur Health Research Institute, Álvaro Cunqueiro Hospital, University of Vigo, Vigo, Pontevedra, Spain
| | - E Santos-Armentia
- Department of Radiology, Ribera Povisa Hospital, Vigo, Pontevedra, Spain
| | - P Valdés-Sarmiento
- Povisa University School of Nursing, University of Vigo, Vigo, Pontevedra, Spain
| | - A Fernández-García
- Povisa University School of Nursing, University of Vigo, Vigo, Pontevedra, Spain
| | - D Gómez-Rey
- Department of Family Medicine and Community Health, Santiago de Compostela University Clinical Hospital, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - J Fernández-Sanromán
- Department of Oral and Maxillofacial Surgery, Ribera Povisa Hospital, Vigo, Pontevedra, Spain; Povisa University School of Nursing, University of Vigo, Vigo, Pontevedra, Spain; Galicia Sur Health Research Institute, Álvaro Cunqueiro Hospital, University of Vigo, Vigo, Pontevedra, Spain
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Martins IS, Radaic P, Marchi L, Barreto G, Pastore GP. Assessment of postoperative pain in patients undergoing temporomandibular joint arthroscopy with infiltration of dexamethasone disodium phosphate in different concentrations. A randomized controlled trial. J Craniomaxillofac Surg 2023; 51:89-97. [PMID: 36774309 DOI: 10.1016/j.jcms.2023.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 01/23/2023] [Accepted: 02/03/2023] [Indexed: 02/05/2023] Open
Abstract
The main aim of this work was to evaluate the effect of intra-articular, sub-synovial steroid injections (IASSSI) with different doses during temporomandibular joint (TMJ) arthroscopy. Using a single-blind, randomized clinical trial, the investigators enrolled a sample of subjects who underwent TMJ arthroscopy with vs. without IASSSI for treating TMJ disorder (TMD). The predictor variable was the treatment group classified as no treatment (A - without IASSSI) or active treatments (IASSSI (B) with 2 mg or (C) 4-mg dexamethasone). Study medications were randomly assigned. Only subjects were blinded to treatment assignment. The main outcome variables included the following: 1) pain assessed up to postoperative day 30 with the McGill Pain Questionnaire and visual analog scale (VAS); 2) maximum mouth opening (MMO); and 3) analgesic and anti-inflammatory drug consumption. Other variables were demographic (age, sex) or pathologic (disease manifestations and classifications). Descriptive and bivariate statistics were computed. Statistical significance was set at p ≤ 0.5, one-tailed test of hypothesis. The sample comprised 36 patients (n = 12 per study group). In the active group with 4 mg corticosteroids, pain reduction measured by VAS (odds ratio [OR] = 0.18; p = 0.013) and McGill scale scores (OR = 0.15; p = 0.048) was significantly higher than in the control group. The McGill scale scores significantly decreased in both IASSSI groups, compared to the control group, at the final follow-up (all p < 0.012), and IASSSI was significantly associated with reduced analgesic consumption at postoperative days 7 and 14 (p = 0.003). However, there was no significant difference regarding MMO among the three groups. Within the limitations of the study, it seems that intra-articular, sub-synovial steroid injections (IASSSI) with 4 mg dexamethasone should be preferred whenever appropriate when pain relief is the priority of the procedure. Brazilian Registry of Clinical Trials (ReBec)- 28yb2g.
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Affiliation(s)
- Ivan Solani Martins
- Hospital Sírio Libanês, São Paulo, Brazil; Instituto Vita, São Paulo, Brazil.
| | - Patricia Radaic
- Hospital Sírio Libanês, São Paulo, Brazil; Instituto Vita, São Paulo, Brazil
| | | | - Gustavo Barreto
- Hospital Sírio Libanês, São Paulo, Brazil; Instituto Vita, São Paulo, Brazil
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Celotti C, Martín-Granizo R, De La Sen Ó. Correlation of arthroscopic findings with clinical-radiological signs and symptoms of temporomandibular joint dysfunction: retrospective study of 829 joints. Int J Oral Maxillofac Surg 2022; 51:1069-1073. [PMID: 35115221 DOI: 10.1016/j.ijom.2022.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 10/31/2021] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
Abstract
Temporomandibular joint (TMJ) arthroscopic findings are difficult to predict based on clinical criteria. Few studies have attempted to correlate signs, symptoms, and characteristics of patients with the final arthroscopic findings. The aim of this study was to assess the correlation between clinical-radiological signs and symptoms and arthroscopic findings in patients with TMJ dysfunction undergoing arthroscopy. A retrospective study was performed involving 487 patients (829 joints) with TMJ dysfunction who underwent TMJ arthroscopy between 2000 and 2019. The clinical-radiological variables recorded were pain, maximum mouth opening, joint noises, Wilkes classification, and disc displacement. The arthroscopic findings evaluated were synovitis, chondromalacia, adhesions, disc perforation, disc displacement, and roofing. Pain symptoms were significantly associated with the intensity of synovitis (P = 0.005) and disc displacement evaluated arthroscopically (P < 0.001). A statistically significant relationship was observed between Wilkes stage and the level of synovitis (P < 0.001) and chondromalacia (P < 0.001). Mouth opening was negatively correlated with adhesions (P < 0.001). Based on this study, pain symptomatology was associated with the intensity of synovitis and disc displacement evaluated arthroscopically, the Wilkes stage was a good predictor of the severity of synovitis and chondromalacia, and mouth opening was negatively correlated with adhesions.
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Affiliation(s)
- C Celotti
- Department of Oral and Maxillofacial Surgery, Hospital Clínico San Carlos, Madrid, Spain.
| | - R Martín-Granizo
- Department of Oral and Maxillofacial Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | - Ó De La Sen
- Department of Oral and Maxillofacial Surgery, Hospital Clínico San Carlos, Madrid, Spain
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Derwich M, Lassmann L, Machut K, Zoltowska A, Pawlowska E. General Characteristics, Biomedical and Dental Application, and Usage of Chitosan in the Treatment of Temporomandibular Joint Disorders: A Narrative Review. Pharmaceutics 2022; 14:pharmaceutics14020305. [PMID: 35214037 PMCID: PMC8880239 DOI: 10.3390/pharmaceutics14020305] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 02/06/2023] Open
Abstract
The aim of this narrative review was to present research investigating chitosan, including its general characteristics, properties, and medical and dental applications, and finally to present the current state of knowledge regarding the efficacy of chitosan in the treatment of temporomandibular disorders (TMDs) based on the literature. The PICO approach was used for the literature search strategy. The PubMed database was analyzed with the following keywords: (“chitosan”[MeSH Terms] OR “chitosan”[All Fields] OR “chitosans”[All Fields] OR “chitosan s”[All Fields] OR “chitosane”[All Fields]) AND (“temporomandibular joint”[MeSH Terms] OR (“tem-poromandibular”[All Fields] AND “joint”[All Fields]) OR “temporomandibular joint”[All Fields] OR (“temporomandibular”[All Fields] AND “joints”[All Fields]) OR “temporo-mandibular joints”[All Fields]). After screening 8 results, 5 studies were included in this review. Chitosan presents many biological properties and therefore it can be widely used in several branches of medicine and dentistry. Chitosan promotes wound healing, helps to control bleeding, and is used in wound dressings, such as sutures and artificial skin. Apart from its antibacterial property, chitosan has many other properties, such as antifungal, mucoadhesive, anti-inflammatory, analgesic, antioxidant, antihyperglycemic, and antitumoral properties. Further clinical studies assessing the efficacy of chitosan in the treatment of TMD are required. According to only one clinical study, chitosan was effective in the treatment of TMD; however, better clinical results were obtained with platelet-rich plasma.
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Affiliation(s)
- Marcin Derwich
- ORTODENT, Specialist Orthodontic Private Practice in Grudziadz, 86-300 Grudziadz, Poland
- Correspondence: ; Tel.: +48-660-723-164
| | - Lukasz Lassmann
- Dental Sense, Dental Private Practice in Gdansk, 80-283 Gdansk, Poland;
| | - Katarzyna Machut
- Department of Endodontic Dentistry, Medical University of Gdansk, 80-210 Gdansk, Poland; (K.M.); (A.Z.)
| | - Agata Zoltowska
- Department of Endodontic Dentistry, Medical University of Gdansk, 80-210 Gdansk, Poland; (K.M.); (A.Z.)
| | - Elzbieta Pawlowska
- Department of Orthodontics, Medical University of Lodz, 90-419 Lodz, Poland;
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Frenkel B, Abu Shqara F, Rachmiel A. Proinflammatory cytokines levels in patients with temporomandibular joint disorder undergoing arthroscopy. Oral Maxillofac Surg 2021; 26:575-580. [PMID: 34716857 DOI: 10.1007/s10006-021-01014-1] [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: 01/25/2021] [Accepted: 10/07/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Biomarkers represent objective indicators of normal processes, pathology, or responses to therapeutic intervention. The purpose of this study is to evaluate the levels of proinflammatory cytokines in synovial fluid of the temporomandibular joint (TMJ) and to investigate whether there is a correlation between elevated levels and disease progression. MATERIALS AND METHODS This is a prospective study that included patients who were diagnosed with internal derangement according to magnetic resonance imaging and were classified according to Wilkes's classifications. After failing to improve with conservative treatment, they were referred for TMJ arthroscopy. During arthroscopy, synovial fluid was collected for biomarker analyses that included the investigation of levels of proinflammatory cytokines: tumor necrosis factor (TNF-α), interleukin 6 (IL-6), and vascular endothelial growth factor (VEGF). The Mann-Whitney U test was used for differences between subgroups for TNF-α, IL-6, and VEGF. RESULTS During the study period, 22 patients presented with a TMJ disorder and met the criteria of the study. There was a statistically significant correlation between the levels of VEGF, TNF-a, and osteoarthritis (P < 0.05). There was also a statistically significant correlation between TNF-a levels and a higher degree of chondromalacia (P = 0.019). CONCLUSION An increase in inflammatory cytokines coupled with chondromalacia propose a more aggressive degenerative disease.
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Affiliation(s)
- Boaz Frenkel
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, 8 Ha'aliya St., Haifa, Israel
| | - Fadi Abu Shqara
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Institution of Technology, Haifa, Israel.
| | - Adi Rachmiel
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, 8 Ha'aliya St., Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Institution of Technology, Haifa, Israel
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Yu X, Hu Y, Zou L, Yan S, Zhu H, Zhang K, Liu W, He D, Yin J. A bilayered scaffold with segregated hydrophilicity-hydrophobicity enables reconstruction of goat hierarchical temporomandibular joint condyle cartilage. Acta Biomater 2021; 121:288-302. [PMID: 33238194 DOI: 10.1016/j.actbio.2020.11.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/10/2020] [Accepted: 11/18/2020] [Indexed: 12/27/2022]
Abstract
Temporomandibular joint (TMJ) supports chewing, talking or other daily oral activities. So far, it still remains a great challenge to treat the defected TMJ condyle cartilage through tissue engineering technology. Herein, a bilayered scaffold is designed to fully reconstruct the different cartilage matrices of TMJ condyle under same induction condition. The bilayered scaffold with segregated hydrophobicity-hydrophilicity in top and bottom layer is prepared from a low and high content of polyethylene glycol (PEG) crosslinked poly (L-glutamic acid)-g-polycaprolactone (PLGA-g-PCL). The hydrophobic aggregates in top layer support the adhesion and spread of bone mesenchymal stem cells (BMSCs), thus inducing the differentation towards fibrocartilage; while aggregates (spheroids) are formed on the hydrophlic bottom layer, showing a preferable hyaline differentiation pathway under same chondrogenic induction in vitro. After 14 d in vitro induction, the scaffold/BMSCs construct is implanted in goat TMJ condyle defects. The post-operative outcome after 2 months demonstrates that the defects are fully covered by neo-cartilage. And the regenerated hierarchical TMJ condyle cartilage perfectly consist of ordered fibrocartilage and hyaline cartilage, which is same as natural condyle cartilage. These results corroborate that this bilayered scaffold with segregated hydrophilicity-hydrophobicity carrying induced BMSCs is a promising for treatment of TMJ condyle cartilage defects.
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Gómez M, Mejia-Ortega L, Hernández-Andara A, Ortega-Pertuz AI, Villarroel-Dorrego M. Chronic mandibular hypomobility related to a unilateral accessory condyle. A case report. Cranio 2020; 40:502-508. [PMID: 32619391 DOI: 10.1080/08869634.2020.1788842] [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: 10/23/2022]
Abstract
BACKGROUND Chronic mandibular hypomobility is characterized by a long-standing limitation of the mouth opening related to multiple etiologies, including elongation of the coronoid apophysis. Unlike the most frequent pathologies that cause coronoid elongation, such as hyperplasia, osteoma (OM), and osteochondroma (OC), the accessory mandibular condyle (AMC) is a rare entity. Clinical Presentation: The AMC shows a configuration similar to a normal mandibular condyle with an articular surface covered by fibrocartilage that articulates with the temporal wall of the zygomatic bone, and histologically, does not show neoplastic growth. The patient was treated with a coronoidectomy, removing the coronoid apophysis as well as the AMC. CLINICAL RELEVANCE This case report presents a case of an AMC to describe the clinical, imaging, surgical, and histological characteristics, establishing its differential diagnosis with hyperplasia, OM, and OC of the coronoid apophysis.
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Affiliation(s)
- Marcos Gómez
- Cellular Therapy Unit, Venezuelan Institute for Scientific Research (IVIC), Distrito Capital, Miranda, Venezuela
| | - Laura Mejia-Ortega
- Dentistry Department, Military Hospital Dr. Vicente Salias Sanoja, Caracas, Venezuela
| | | | - Ana Isabel Ortega-Pertuz
- Forensic Dentistry Area, Research Institute, Faculty of Dentistry, University of Zulia, Maracaibo, Venezuela
| | - Mariana Villarroel-Dorrego
- Research Institute Raúl Vicenelli, Faculty of Dentistry, Central University of Venezuela, Caracas, Venezuela
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