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Millón Cruz A, Martin-Granizo R, Barone S, Pérez Rodríguez LM, Menéndez SM, Falahat Noushzady F, Arias Díaz J. Reliability of magnetic resonance for temporomandibular joint disc perforation: A 12 years retrospective study. J Craniomaxillofac Surg 2024; 52:548-557. [PMID: 38627190 DOI: 10.1016/j.jcms.2024.04.005] [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: 10/22/2023] [Revised: 03/11/2024] [Accepted: 04/08/2024] [Indexed: 05/18/2024] Open
Abstract
The aim of this study was to evaluate the reliability of magnetic resonance imaging (MRI) in detecting disc perforations in the temporomandibular joint (TMJ), and to establish diagnostic criteria for this purpose. The retrospective analysis included patients who had undergone preoperative MRI and TMJ arthroscopy at the same hospital. Direct and indirect signs of disc abnormalities on MRI were compared with arthroscopic findings of disc perforation. Out of 355 joints evaluated in 185 patients, arthroscopy confirmed disc perforations in 14.7% of cases. Several MRI findings were significantly associated with disc perforation, including anterior disc displacement without reduction (ADDwoR), signal alterations in the mid-disc area, disc deformity (SAMD), retrocondylar disc fragments, osteophytes, condylar bone marrow degeneration (CBMD), and joint effusion in both joint spaces (ESJS-EIJS). Regression analysis revealed that SAMD, osteophytes, and CBDM were strongly associated with disc perforation. The ROC curve showed that MRI had an AUC = 0.791, with a sensitivity of 88.5% and a specificity of 61.5%. Two diagnostic methods, one based on three findings (osteophytes, ADDwoR, and SAMD) and one based on two direct signs (ADDwoR and SAMD), yielded high sensitivity and specificity values of 80.4% and 69.8%, and 84.3% and 62.5%, respectively. In conclusion, MRI demonstrated acceptable accuracy in the detection of TMJ disc perforations, with specific diagnostic criteria offering high sensitivity and specificity. Significant MRI indicators of disc perforation included SAMD, osteophytes, and CBDM. This study provides valuable information on the use of MRI as a diagnostic tool for TMJ disc perforations.
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Affiliation(s)
- Alejandrina Millón Cruz
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - Rafael Martin-Granizo
- Department of Oral and Maxillofacial Surgery, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Simona Barone
- Department of Neurosciences and Reproductive and Dental Sciences, Federico II University of Naples, Naples, Italy.
| | | | | | - Farzin Falahat Noushzady
- Department of Oral and Maxillofacial Surgery, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Javier Arias Díaz
- Department of Surgery, School of Medicine, Universidad Complutense, Madrid, Spain
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Liu Y, Jiao Z, Yao B, Li Q. A Three-branch Jointed Feature and Topology Decoder guided by game-theoretic interactions for temporomandibular joint segmentation. Comput Biol Med 2024; 173:108373. [PMID: 38564851 DOI: 10.1016/j.compbiomed.2024.108373] [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: 01/14/2024] [Revised: 03/04/2024] [Accepted: 03/24/2024] [Indexed: 04/04/2024]
Abstract
Segmentation of the temporomandibular joint (TMJ) disc and condyle from magnetic resonance imaging (MRI) is a crucial task in TMJ internal derangement research. The automatic segmentation of the disc structure presents challenges due to its intricate and variable shapes, low contrast, and unclear boundaries. Existing TMJ segmentation methods often overlook spatial and channel information in features and neglect overall topological considerations, with few studies exploring the interaction between segmentation and topology preservation. To address these challenges, we propose a Three-Branch Jointed Feature and Topology Decoder (TFTD) for the segmentation of TMJ disc and condyle in MRI. This structure effectively preserves the topological information of the disc structure and enhances features. We introduce a cross-dimensional spatial and channel attention mechanism (SCIA) to enhance features. This mechanism captures spatial, channel, and cross-dimensional information of the decoded features, leading to improved segmentation performance. Moreover, we explore the interaction between topology preservation and segmentation from the perspective of game theory. Based on this interaction, we design the Joint Loss Function (JLF) to fully leverage the features of segmentation, topology preservation, and joint interaction branches. Results on the TMJ MRI dataset demonstrate the superior performance of our TFTD compared to existing methods.
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Affiliation(s)
- Yuzhao Liu
- Institute of Microelectronics of the Chinese Academy of Sciences, No. 3 Beitucheng West Road, Beijing, 100029, Beijing, China; University of Chinese Academy of Sciences, Zhongguancun South Road, Beijing, 100020, Beijing, China.
| | - Zixian Jiao
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, Shanghai, China.
| | - Bin Yao
- Institute of Microelectronics of the Chinese Academy of Sciences, No. 3 Beitucheng West Road, Beijing, 100029, Beijing, China; University of Chinese Academy of Sciences, Zhongguancun South Road, Beijing, 100020, Beijing, China.
| | - Qing Li
- Institute of Microelectronics of the Chinese Academy of Sciences, No. 3 Beitucheng West Road, Beijing, 100029, Beijing, China; University of Chinese Academy of Sciences, Zhongguancun South Road, Beijing, 100020, Beijing, China.
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Zhao Y, Li C, Hu S, Wang C, Bian X, Kang H, Zhou P, Bao G. In vitro differentiation of human induced pluripotent stem cells into temporomandibular joint disc like cells. Heliyon 2024; 10:e23937. [PMID: 38192844 PMCID: PMC10772246 DOI: 10.1016/j.heliyon.2023.e23937] [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: 06/29/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 01/10/2024] Open
Abstract
Temporomandibular joint discs (TMJ discs) are unable to repair themselves in disease states, while induced stem cell differentiation is a common method to repair tissue defects. Nowadays, kinds of stem cells are attempted for tissue regeneration of TMJ disc, but these methods have several downsides, which limit their wide application. The proliferation and differentiation ability of human induced pluripotent stem cells (hiPSC) provides a new research direction for TMJ disc tissue regeneration. In this study, we investigated the feasibility of induced differentiation of hiPSC into TMJ disc cells in vitro and the differentiation efficiency of different methods to clarify the possibility and conditions of hiPSC application in TMJ disc tissue engineering. We collected sheep TMJ disc cells cultures for adding in hiPSC culture environment and treated hiPSC by both direct induction and Transwell co-culture for 7 days, 14 days and 21 days. The secretion of extracellular matrix in TMJ disc cells was detected by Sirius Red and Safranin O staining. Collagen Ⅰ and Collagen Ⅱ were qualitatively detected by immunohistochemical staining. The expression of extracellular matrix genes (type I collagen (COL1A1), type II collagen(COL2), glycosaminoglycan (GAG)), chondrogenic differentiation gene SOX9 and pluripotency gene OCT4 were detected by RT-qPCR. Our results showed that hiPSC had the ability to differentiate to TMJ disc cells by direct induction in TMJ disc cell culture medium and by Transwell co-culture method. The highest degree of differentiation was observed after 14 days of direct induction, while Transwell co-culture showed significant differentiation at different times and with different major directions. Meanwhile, Transwell co-culture not only differentiates hiPSC but also promotes the growth and proliferation of TMJ disc cells. Our study is valuable to investigate the possibility of differentiation of hiPSC toward TMJ disc cells and to determine the time of differentiation. It provides new ideas for the selection of seed cells for TMJ disc tissue engineering.
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Affiliation(s)
- Yiqing Zhao
- School of Stomatology, Lanzhou University, No.199 Donggang West Road,Chengguan District, Lanzhou, 730000, China
| | - Ce Li
- School of Stomatology, Lanzhou University, No.199 Donggang West Road,Chengguan District, Lanzhou, 730000, China
| | - Siyang Hu
- School of Stomatology, Lanzhou University, No.199 Donggang West Road,Chengguan District, Lanzhou, 730000, China
| | - Chunya Wang
- School of Stomatology, Lanzhou University, No.199 Donggang West Road,Chengguan District, Lanzhou, 730000, China
| | - Xueru Bian
- School of Stomatology, Lanzhou University, No.199 Donggang West Road,Chengguan District, Lanzhou, 730000, China
| | - Hong Kang
- School of Stomatology, Lanzhou University, No.199 Donggang West Road,Chengguan District, Lanzhou, 730000, China
| | - Ping Zhou
- School of Stomatology, Lanzhou University, No.199 Donggang West Road,Chengguan District, Lanzhou, 730000, China
| | - Guangjie Bao
- Key Lab of Stomatology of State Ethnic Affairs Commission, Northwest Minzu University, No.1 Northwest Xin Cun, Chengguan District, Lanzhou, 7300030, China
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Donahue RP, Kallins EG, Hu JC, Athanasiou KA. Characterization of the Temporomandibular Joint Disc Complex in the Yucatan Minipig. Tissue Eng Part A 2023; 29:439-448. [PMID: 37073459 PMCID: PMC10440658 DOI: 10.1089/ten.tea.2023.0011] [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: 01/31/2023] [Accepted: 04/17/2023] [Indexed: 04/20/2023] Open
Abstract
The temporomandibular joint (TMJ) disc complex (i.e., the TMJ disc and its six attachments) is crucial to everyday functions such as mastication and speaking. The TMJ can be afflicted by many conditions, including disc displacement and defects. Pathologies of the TMJ disc complex most commonly present first as anterior disc displacement, which the field hypothesizes may implicate the two posterior attachments. As a result of anterior disc displacement, defects may develop in the lateral disc complex. Tissue engineering is poised to improve treatment paradigms for these indications of the TMJ disc complex by engineering biomimetic implants, but, first, gold-standard design criteria for such implants should be established through characterization studies. This study's objective was to characterize the structural, mechanical, biochemical, and crosslinking differences among the two posterior attachments and the lateral disc in the Yucatan minipig, a well-accepted TMJ animal model. In tension, it was found that the posterior inferior attachment (PIA) was significantly stiffer and stronger by 2.13 and 2.30 times, respectively, than the posterior superior attachment (PSA). It was found that collagen in both attachments was primarily aligned mediolaterally; however, the lateral disc was much more aligned and anisotropic than either attachment. Among the three locations, the PSA exhibited the greatest degree of heterogeneity and highest proportion of fat vacuoles. The PIA and lateral disc were 1.93 and 1.91 times more collagenous, respectively, by dry weight (DW) than the PSA. The PIA also exhibited 1.78 times higher crosslinking per DW than the PSA. Glycosaminoglycan per DW was significantly higher in the lateral disc by 1.48 and 5.39 times than the PIA and PSA, respectively. Together, these results establish design criteria for tissue-engineering of the TMJ disc complex and indicate that the attachments are less fibrocartilaginous than the disc, while still significantly contributing to the mechanical stability of the TMJ disc complex during articulation. These results also support the biomechanical function of the PIA and PSA, suggesting that the stiffer PIA anchors the disc to the mandibular condyle during articulation, while the softer PSA serves to allow translation over the articular eminence. Impact Statement Characterization of the temporomandibular joint (TMJ) disc complex (i.e., the disc and its attachments) has important implications for those aiming to tissue-engineer functional replacements and can help elucidate its biomechanical function. For example, the findings shown here suggest that the stiffer posterior inferior attachment anchors the disc during articulation, while the softer posterior superior attachment allows translation over the articular eminence.
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Affiliation(s)
- Ryan P. Donahue
- Department of Biomedical Engineering, University of California, Irvine, Irvine, California, USA
| | - Eston G. Kallins
- Department of Biomedical Engineering, University of California, Irvine, Irvine, California, USA
| | - Jerry C. Hu
- Department of Biomedical Engineering, University of California, Irvine, Irvine, California, USA
| | - Kyriacos A. Athanasiou
- Department of Biomedical Engineering, University of California, Irvine, Irvine, California, USA
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Magnetic resonance imaging and fractal analysis findings in temporomandibular joints with disk perforation. Oral Surg Oral Med Oral Pathol Oral Radiol 2023:S2212-4403(23)00002-0. [PMID: 36890079 DOI: 10.1016/j.oooo.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/23/2022] [Accepted: 01/01/2023] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This study compared magnetic resonance imaging (MRI) findings and fractal dimension (FD) values in the temporomandibular joints (TMJs) of study patients with disk perforation vs control patients. STUDY DESIGN Of 75 TMJs examined with MRI for characteristics of the disk and condyle, 45 were included in the study group and 30 in the control group. MRI findings and FD values were compared for significance of differences between the groups. The frequency of subclassifications was analyzed for differences between the two forms of disk configuration and grades of effusion. Mean FD values were analyzed for differences among subclassifications of MRI findings and between groups. RESULTS Examination of MRI variables revealed that the study group had significantly greater frequencies of flattened disks, disk displacement, flattening and combined defects in condylar morphology, and grade 2 effusion (P = .001) Joints with perforated disks had a large percentage of normal disk-condyle relationships (73.3%). Significant differences were discovered between biconcave and flattened disk configuration in the frequencies of internal disk status and condylar morphology. FD values of all patients varied significantly among the subclassifications of disk configuration, internal disk status, and effusion. Mean FD values were significantly lower in the study group with perforated disks (1.07) compared with the control group (1.20, P = .001). CONCLUSIONS MRI variables and FD can be useful in investigating intra-articular TMJ status.
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Amin LE, Gamily ME. Biological impact of curcumin on the healing of tempromandibular joint in experimentally induced arthritis. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2021. [DOI: 10.1016/j.ajoms.2020.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kim JY, Kim D, Jeon KJ, Kim H, Huh JK. Using deep learning to predict temporomandibular joint disc perforation based on magnetic resonance imaging. Sci Rep 2021; 11:6680. [PMID: 33758266 PMCID: PMC7988137 DOI: 10.1038/s41598-021-86115-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/08/2021] [Indexed: 12/22/2022] Open
Abstract
The goal of this study was to develop a deep learning-based algorithm to predict temporomandibular joint (TMJ) disc perforation based on the findings of magnetic resonance imaging (MRI) and to validate its performance through comparison with previously reported results. The study objects were obtained by reviewing medical records from January 2005 to June 2018. 299 joints from 289 patients were divided into perforated and non-perforated groups based on the existence of disc perforation confirmed during surgery. Experienced observers interpreted the TMJ MRI images to extract features. Data containing those features were applied to build and validate prediction models using random forest and multilayer perceptron (MLP) techniques, the latter using the Keras framework, a recent deep learning architecture. The area under the receiver operating characteristic (ROC) curve (AUC) was used to compare the performances of the models. MLP produced the best performance (AUC 0.940), followed by random forest (AUC 0.918) and disc shape alone (AUC 0.791). The MLP and random forest were also superior to previously reported results using MRI (AUC 0.808) and MRI-based nomogram (AUC 0.889). Implementing deep learning showed superior performance in predicting disc perforation in TMJ compared to conventional methods and previous reports.
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Affiliation(s)
- Jae-Young Kim
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Dongwook Kim
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Kug Jin Jeon
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Hwiyoung Kim
- Department of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong-Ki Huh
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea.
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Muñoz-Guerra MF, Rodríguez-Campo FJ, Escorial-Hernández V, Brabyn PJ, Fernández-Domínguez M, Naval-Gías L. Is There a Relationship Between Age, Personal Factors or Surgical Findings, and Outcome After Temporomandibular Joint Arthroscopy? J Oral Maxillofac Surg 2020; 79:1000-1008. [PMID: 33434521 DOI: 10.1016/j.joms.2020.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 12/10/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The variables involved in prognosis after treatment of internal derangement (ID) of the temporomandibular joint (TMJ) are unclear. The purpose of this study was to estimate the frequency and identify which factors are associated with treatment success (or failure) among patients with ID managed with arthroscopy. MATERIAL AND METHODS A retrospective cohort study was carried out of patients undergoing TMJ arthroscopy over a 9-year-period. The predictor variable was composed of a set of demographic, clinical, and operative findings, including, as primary variable, the patient's age. The primary outcome variable was based on the American Association of Oral and Maxillofacial Surgery (AAOMS) criteria of pain (measured by visual analogue scale (VAS)) and maximal interincisal opening (MIO) defined as VAS ≤ 3 and MIO greater 35 mm and grouped as success or failure. The improvement in pain and functional values were compared with the age by using the Pearson correlation coefficient, whereas categorical variables were tested using chi-squared analysis, and mean values were compared with Student t-test or ANOVA. Subsequently, a logistic regression model was used, and the odds ratios (OR) of the evaluated comparisons were calculated. RESULTS A total of 212 patients were included in this study. In terms of arthroscopic findings, the presence of severe chondromalacia, adhesions or disc perforation (P < .001), was related with older patients. However, there was no statistically significant correlation between age and the postoperative improvement referred to pain or MIO. According to the AAOMS criteria, the procedure was successful in 54.24% of the cases. Two factors were related with a favorable outcome in the adjusted regression analysis: a higher presurgical MIO (OR 0.91, P < .001) and the presence of adhesions (OR 0.41, P = .003). CONCLUSION Age has no influence on the outcome after arthroscopy. A higher presurgical MIO and the presence of adhesions provide, in the long-term, a favorable prognosis.
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Affiliation(s)
- Mario Fernando Muñoz-Guerra
- Staff Surgeon, Department of Oral & Maxillofacial Surgery, University Hospital La Princesa, Madrid, Spain; Staff Surgeon, Department of Oral & Maxillofacial Surgery, University Hospital Montepríncipe, Madrid, Spain.
| | | | | | - Philip James Brabyn
- Staff Surgeon, Department of Oral & Maxillofacial Surgery, University Hospital La Princesa-Madrid; Department of Oral & Maxillofacial, University Hospital Montepríncipe, Madrid, Spain
| | - Manuel Fernández-Domínguez
- Head, Department of Oral & Maxillofacial Surgery, University Hospital Montepríncipe (San Pablo CEU University), Madrid, Spain
| | - Luis Naval-Gías
- Head, Department of Oral & Maxillofacial Surgery, University Hospital La Princesa (Autónoma University), Madrid, Spain
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Donahue RP, Hu JC, Athanasiou KA. Remaining Hurdles for Tissue-Engineering the Temporomandibular Joint Disc. Trends Mol Med 2019; 25:241-256. [PMID: 30678888 PMCID: PMC6436948 DOI: 10.1016/j.molmed.2018.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/18/2018] [Accepted: 12/18/2018] [Indexed: 12/29/2022]
Abstract
The temporomandibular joint (TMJ) disc, a fibrocartilaginous structure between the mandible and temporal bone, is implicated in temporomandibular disorders (TMDs). TMDs symptomatically affect approximately 25% of the population, of which 70% have internal derangement of the disc. Treatments lack efficiency, motivating novel therapies, including tissue-engineering toward TMJ disc regeneration. Recent developments in scaffold-based or scaffold-free approaches, cell sources, and biochemical and mechanical stimulation have resulted in constructs exhibiting native tissue mechanics. Safety and efficacy of tissue-engineered implants have shown promising results in orthotopic animal studies. However, many hurdles need to be overcome in tissue-engineering approaches, and clinical and regulatory pathways. Future studies present an opportunity for clinicians and researchers to work together toward safe and effective clinical trials.
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Affiliation(s)
- Ryan P Donahue
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - Jerry C Hu
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - Kyriacos A Athanasiou
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA.
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10
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Lemos GA, da Silva PLP, Batista AUD, Palomari ET. Experimental model of temporomandibular joint arthritis: Evaluation of contralateral joint and masticatory muscles. Arch Oral Biol 2018; 95:79-88. [DOI: 10.1016/j.archoralbio.2018.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 07/05/2018] [Accepted: 07/07/2018] [Indexed: 12/16/2022]
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Izawa T, Hutami IR, Tanaka E. Potential Role of Rebamipide in Osteoclast Differentiation and Mandibular Condylar Cartilage Homeostasis. Curr Rheumatol Rev 2018; 14:62-69. [PMID: 29046162 PMCID: PMC5925868 DOI: 10.2174/1573397113666171017113441] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/23/2017] [Accepted: 09/28/2017] [Indexed: 12/27/2022]
Abstract
Background: Temporomandibular joint osteoarthritis (TMJ-OA) is a degenerative disease that involves changes in subchondral bone and progressive degradation of cartilage. Currently, rebamipide, a gastroprotective drug, is administered to protect gastric mucosa and accelerate ulcer healing. Objectives: Recent studies have shown that rebamipide also attenuates cartilage degeneration by suppressing oxidative damage and inducing homeostasis of the extracellular matrix of articular chondrocytes. Regarding the latter, reduced expression of cathepsin K, NFATc1, c-Src, and integrin β3, and increased expression of nuclear factor-kappa B, have been found to be mediated by the transcription factor, receptor activator of nuclear factor kappa-B ligand (RANKL). Methods: Treatment with rebamipide was also found to activate, mitogen-activated protein kinases such as p38, ERK, and JNK to reduce osteoclast differentiation. Taken together, these results strongly indicate that rebamipide mediates inhibitory effects on cartilage degradation and osteoclastogenesis in TMJ-OA. Results and Conclusion: Here, we highlight recent evidence regarding the potential for rebamipide to affect osteoclast differentiation and TMJ-OA pathogenesis. We also discuss the potential role of rebamipide to serve as a new strategy for the treatment of TMJ-OA.
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Affiliation(s)
- Takashi Izawa
- Department of Orthodontics and Dentofacial Orthopedics, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima 7708504, Japan
| | - Islamy Rahma Hutami
- Department of Orthodontics and Dentofacial Orthopedics, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima 7708504, Japan
| | - Eiji Tanaka
- Department of Orthodontics and Dentofacial Orthopedics, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima 7708504, Japan
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Kim JY, Jeon KJ, Kim MG, Park KH, Huh JK. A nomogram for classification of temporomandibular joint disk perforation based on magnetic resonance imaging. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:682-692. [PMID: 29574057 DOI: 10.1016/j.oooo.2018.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 02/08/2018] [Accepted: 02/15/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The aim of this study was to analyze risk factors and establish a prediction model for temporomandibular joint (TMJ) disk perforation by constructing a nomogram. STUDY DESIGN The study included a total of 282 joints in 274 patients. All patients underwent open TMJ surgery after obtaining magnetic resonance imaging (MRI), from 2005 to 2015. The presence or absence of disk perforation was confirmed during the operation. Patients were classified into 2 groups: perforation and nonperforation groups. We investigated demographic data and the characteristics of the disk, joint space, and bone on MRI. A logistic regression analysis was performed to analyze risk factors. A nomogram was constructed and validated internally and externally. RESULTS Risk factors for disk perforation were increased age, disk shape (eyeglass or amorphous), low bone marrow signal, abnormal joint space, and 2 or more bony changes in the condyle and fossa. The area under the receiver operating characteristic curve of the nomogram was 0.908 (95% confidence interval [CI] 0.869-0.946) in the internal validation and 0.889 (95% CI 0.804-0.973) in the external validation with good suitability. CONCLUSIONS We were able to predict the probability of disk perforation with analyzed risk factors and constructed a nomogram, which may be helpful in proper diagnosis and treatment.
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Affiliation(s)
- Jae-Young Kim
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Kug-Jin Jeon
- Department of Oral and Maxillofacial Radiology, Yongin Severance Hospital, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Myeong-Gyun Kim
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Kwang-Ho Park
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Jong-Ki Huh
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Republic of Korea.
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13
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Machon V, Levorova J, Hirjak D, Drahos M, Foltan R. Temporomandibular joint disc perforation: a retrospective study. Int J Oral Maxillofac Surg 2017; 46:1411-1416. [PMID: 30954090 DOI: 10.1016/j.ijom.2017.05.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 02/24/2017] [Accepted: 05/11/2017] [Indexed: 11/27/2022]
Abstract
The aim of this study was to evaluate disc perforation diagnosed in patients undergoing arthroscopy of the temporomandibular joint (TMJ). A retrospective analysis of 33 patients with disc perforation (35 joints) was performed. Patients and joints were divided into two groups: those with distal perforation (DP; perforation of the retrodiscal tissue, or the distal area of the disc at the site of ligament insertion into the retrodiscal tissue) and those with central perforation (CP; central and anterior part of the disc). The retrospective evaluation included aetiological factors, clinical symptoms, arthroscopic findings, and the effects of arthroscopic lavage. The most frequent aetiological factors in patients with disc perforation were stress and related parafunctional activities. The most frequent arthroscopic finding in both groups was hyperaemia of the bilaminar zone and synovial tissue. Other predominant arthroscopic findings were the presence of adhesions and anterior disc dislocation in the DP group and synovial hyperplasia in the CP group. Better outcomes of arthroscopic lysis and lavage were found in the CP group than in the DP group. At 12 months after arthroscopic lavage, the results showed that the therapy was satisfactory for 72% of the joints. The most common cause of distal perforation is anterior disc dislocation, whilst chronic inflammatory changes account for central perforation.
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Affiliation(s)
- V Machon
- Department of Oral and Maxillofacial Surgery, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - J Levorova
- Department of Oral and Maxillofacial Surgery, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic.
| | - D Hirjak
- Department of Oral and Maxillofacial Surgery, Ruzinov University Hospital, Bratislava, Slovakia
| | - M Drahos
- Department of Oral and Maxillofacial Surgery, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - R Foltan
- Department of Oral and Maxillofacial Surgery, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
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Salash JR, Hossameldin RH, Almarza AJ, Chou JC, McCain JP, Mercuri LG, Wolford LM, Detamore MS. Potential Indications for Tissue Engineering in Temporomandibular Joint Surgery. J Oral Maxillofac Surg 2015; 74:705-11. [PMID: 26687154 DOI: 10.1016/j.joms.2015.11.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 11/05/2015] [Accepted: 11/10/2015] [Indexed: 12/29/2022]
Abstract
PURPOSE Musculoskeletal tissue engineering has advanced to the stage where it has the capability to engineer temporomandibular joint (TMJ) anatomic components. Unfortunately, there is a paucity of literature identifying specific indications for the use of TMJ tissue engineering solutions. The objective of this study was to establish an initial set of indications and contraindications for the use of engineered tissues for replacement of TMJ anatomic components. FINDINGS There was consensus among the authors that the management of patients requiring TMJ reconstruction as the result of 1) irreparable condylar trauma, 2) developmental or acquired TMJ pathology in skeletally immature patients, 3) hyperplasia, and 4) documented metal hypersensitivities could be indications for bioengineered condyle and ramus TMJ components. There was consensus that Wilkes stage III internal derangement might be an indication for use of a bioengineered TMJ disc or possibly even a disc-like bioengineered "fossa liner." However, there was some controversy as to whether TMJ arthritic disease (e.g., osteoarthritis) and reconstruction after failed alloplastic devices should be indications. Further research is required to determine whether tissue-engineered TMJ components could be a viable option for such cases. Contraindications for the use of bioengineered TMJ components could include patients with TMJ disorders and multiple failed surgeries, parafunctional oral habits, persistent TMJ infection, TMJ rheumatoid arthritis, and ankylosis unless the underlying pathology can be resolved. CONCLUSIONS Biomedical engineers must appreciate the specific indications that might warrant TMJ bioengineered structures, so that they avoid developing technologies in search of problems that might not exist for patients and clinicians. Instead, they should focus on identifying and understanding the problems that need resolution and then tailor technologies to address those specific situations. The aforementioned indications and contraindications are designed to serve as a guide to the next generation of tissue engineers in their strategic development of technologies to address specific clinical issues.
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Affiliation(s)
- Jean R Salash
- Graduate Student, Bioengineering Graduate Program, University of Kansas, Lawrence, KS
| | - Reem H Hossameldin
- Oral Surgeon, Department of Oral and Maxillofacial Surgery, Faculty of Oral Medicine, Cairo University, Cairo, Egypt
| | - Alejandro J Almarza
- Associate Professor, Departments of Oral Biology and Bioengineering, McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Joli C Chou
- Clinical Associate Professor, The Craniofacial Center of Western New York, Buffalo, NY
| | - Joseph P McCain
- Clinical Associate Professor and Chief, Department of Oral and Maxillofacial Surgery, Herbert Wertheim College of Medicine, Florida International University, Miami; Department of Oral and Maxillofacial Surgery, Baptist Health Systems, Miami, FL
| | - Louis G Mercuri
- Visiting Professor, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL; TMJ Concepts, Ventura, CA
| | - Larry M Wolford
- Clinical Professor, Departments of Oral and Maxillofacial Surgery and Orthodontics, Texas A&M University Health Science Center, Baylor College of Dentistry, Baylor University Medical Center, Dallas, TX
| | - Michael S Detamore
- Professor, Department of Chemical and Petroleum Engineering and Bioengineering Graduate Program, University of Kansas, Lawrence, KS.
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Soft tissue ossification and condylar cartilage degeneration following TMJ disc perforation in a rabbit pilot study. Osteoarthritis Cartilage 2015; 23:629-39. [PMID: 25573797 PMCID: PMC4368469 DOI: 10.1016/j.joca.2014.12.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 11/29/2014] [Accepted: 12/15/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE There are limited clinical treatments for temporomandibular joint (TMJ) pathologies, including degenerative disease, disc perforation and heterotopic ossification (HO). One barrier hindering the development of new therapies is that animal models recapitulating TMJ diseases are poorly established. The objective of this study was to develop an animal model for TMJ cartilage degeneration and disc pathology, including disc perforation and soft tissue HO. METHODS New Zealand white rabbits (n = 9 rabbits) underwent unilateral TMJ disc perforation surgery and sham surgery on the contralateral side. A 2.5 mm defect was created using a punch biopsy in rabbit TMJ disc. The TMJ condyles and discs were evaluated macroscopically and histologically after 4, 8 and 12 weeks. Condyles were blindly scored by four independent observers using OARSI recommendations for macroscopic and histopathological scoring of osteoarthritis (OA) in rabbit tissues. RESULTS Histological evidence of TMJ condylar cartilage degeneration was apparent in experimental condyles following disc perforation relative to sham controls after 4 and 8 weeks, including surface fissures and loss of Safranin O staining. At 12 weeks, OARSI scores indicated experimental condylar cartilage erosion into the subchondral bone. Most strikingly, HO occurred within the TMJ disc upon perforation injury in six rabbits after 8 and 12 weeks. CONCLUSION We report for the first time a rabbit TMJ injury model that demonstrates condylar cartilage degeneration and disc ossification, which is indispensible for testing the efficacy of potential TMJ therapies.
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An SY, Jung JK. Fracture of the articular disc in the temporomandibular joint: two case reports. Dentomaxillofac Radiol 2014; 44:20140218. [PMID: 25308829 DOI: 10.1259/dmfr.20140218] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Disc fracture of the temporomandibular joint (TMJ) is a little-known pathological condition owing to its extreme rarity. We report two cases of elderly patients who were diagnosed with disc fracture of the TMJ based on MRI, and we review related reports. On physical examination, an incomplete bite and mild joint pain were observed on the affected side in both patients. An MRI showed a complete fracture in the intermediate zone of the articular disc in the TMJ; the posterior fragment was displaced posteriorly, causing occlusal change in the closed position of the condyle and an incomplete bite. Conservative treatment including manual manipulation, physical therapy and oral appliance had no effect on the occlusal abnormality. Although the inciting cause of the disc fracture remained unclear, the degenerative changes in the joint may have been a factor by increasing the brittleness and reducing the elasticity of the disc.
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Affiliation(s)
- S-Y An
- 1 Department of Oral and Maxillofacial Radiology, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
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Shen P, Huo L, Zhang SY, Yang C, Cai XY, Liu XM. Magnetic resonance imaging applied to the diagnosis of perforation of the temporomandibular joint. J Craniomaxillofac Surg 2014; 42:874-8. [DOI: 10.1016/j.jcms.2014.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 10/06/2013] [Accepted: 01/03/2014] [Indexed: 10/25/2022] Open
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Bag AK, Gaddikeri S, Singhal A, Hardin S, Tran BD, Medina JA, Curé JK. Imaging of the temporomandibular joint: An update. World J Radiol 2014; 6:567-582. [PMID: 25170394 PMCID: PMC4147437 DOI: 10.4329/wjr.v6.i8.567] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 02/27/2014] [Accepted: 06/20/2014] [Indexed: 02/06/2023] Open
Abstract
Imaging of the temporomandibular joint (TMJ) is continuously evolving with advancement of imaging technologies. Many different imaging modalities are currently used to evaluate the TMJ. Magnetic resonance imaging is commonly used for evaluation of the TMJ due to its superior contrast resolution and its ability to acquire dynamic imaging for demonstration of the functionality of the joint. Computed tomography and ultrasound imaging have specific indication in imaging of the TMJ. This article focuses on state of the art imaging of the temporomandibular joint. Relevant normal anatomy and biomechanics of movement of the TMJ are discussed for better understanding of many TMJ pathologies. Imaging of internal derangements is discussed in detail. Different arthropathies and common tumors are also discussed in this article.
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Makdissi J, Pawar RR, Radon M, Holmes SB. Incidental findings on MRI of the temporomandibular joint. Dentomaxillofac Radiol 2013; 42:20130175. [PMID: 24005059 DOI: 10.1259/dmfr.20130175] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The aim of this study was to determine the prevalence of incidental findings in MRI of the temporomandibular joint (TMJ). METHODS MRI reports of 730 patients were assessed. The reports were analysed by one consultant and one clinical lecturer in dental and maxillofacial radiology. The prevalence of intracranial and extracranial incidental findings was recorded and categorized. RESULTS There were 53 (7.3%) incidental findings, of which 11 (1.5%) were intracranial and 42 (5.7%) were extracranial (divided into paranasal sinuses, mastoid air cells, muscle hypertrophy, lymphadenopathy and salivary glands). A total number of eight intracranial findings needed further dedicated imaging and/or specialist clinical opinion. Only one tumour (a meningioma) was found and required surgical intervention. CONCLUSIONS Incidental findings on TMJ MRI are rare but not unheard of. The clinical relevance of incidental findings can be significant, and it is therefore important to ensure that the full data set of images is inspected, including any scout slices. A close working relationship between the areas of dental and maxillofacial radiology and neuroradiology is essential in expediting a second opinion relating to intracranial findings. All incidental findings should be communicated to referring clinicians in a timely manner, based on their urgency and clinical significance.
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Affiliation(s)
- J Makdissi
- Dental and Maxillofacial Radiology, Institute of Dentistry, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Muñoz-Guerra MF, Rodríguez-Campo FJ, Escorial Hernández V, Sánchez-Acedo C, Gil-Díez Usandizaga JL. Temporomandibular joint disc perforation: long-term results after operative arthroscopy. J Oral Maxillofac Surg 2013; 71:667-76. [PMID: 23507320 DOI: 10.1016/j.joms.2012.12.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 12/11/2012] [Accepted: 12/13/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Disc perforation (DP) is one of the most important pathologic signs of intracapsular temporomandibular joint (TMJ) disease; however, few clinical studies have focused on the arthroscopic management of this feature. The purpose of the present study was to assess whether operative arthroscopy with abrasion of the perforation borders is effective for the treatment of this alteration of the internal derangement of the TMJ. PATIENTS AND METHODS Thirty-six patients (39 joints) who underwent TMJ arthroscopy under general anesthesia and presented with DP (Wilkes stages IV and V) from 1994 through 2006 were included in this study. The age range at the time of surgery was 14 to 59 years. DPs were classified into 3 groups according to size: small (SMA), medium (MED), or large (LAR). Pain (visual analog scale, scores 0 to 100), maximal interincisal opening, and lateral and protrusive excursions were assessed at 1, 3, 6, 12, 24 and 48 months after surgery. Preoperative and postoperative scores were compared and tested for statistically significant differences by the Student t test for paired data. The level of statistical significance was set at .05. Differences in the global, SMA, MED, and LAR groups were evaluated. RESULTS In the global group, the mean score of preoperative pain according to the visual analog scale was 53.97 mm, which decreased to 14.33 mm at 4-year follow-up. The maximal interincisal opening improved from a mean of 28.56 mm before surgery to 34.88 mm after the final follow-up. SMA perforations were found in 11 cases (28.20%), MED in 19 cases (48.71%), and LAR in 9 cases (23.07%). A significant decrease in pain (P < .01) was observed from the first postoperative month to the end of the follow-up period in the global and SMA groups. A statistically significant increase in mouth opening was observed in the global group from 6 months postoperatively; however, no significant differences were observed in the MED and LAR groups from before surgery to the different times of follow-up. After the final follow-up, 2 patients underwent open TMJ surgery owing to unfavorable results. CONCLUSIONS Operative arthroscopy of the TMJ is a reliable and effective procedure for the articular dysfunction associated with DP because this procedure alleviates pain and improves mouth opening. Patients with SMA perforations are better candidates for this surgical treatment.
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Affiliation(s)
- Mario Fernando Muñoz-Guerra
- Department of Oral and Maxillofacial Surgery, University Hospital La Princesa, University Hospital Monteprincipe, CEU-San Pablo University, Madrid, Spain.
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Juran CM, Dolwick MF, McFetridge PS. Shear mechanics of the TMJ disc: relationship to common clinical observations. J Dent Res 2012; 92:193-8. [PMID: 23166043 DOI: 10.1177/0022034512468749] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The temporomandibular joint (TMJ) is a complex hinge and gliding joint that induces significant shear loads onto the fibrocartilage TMJ disc during jaw motion. The purpose of this study was to assess regional variation in the disc's shear loading characteristics under physiologically relevant loads and to associate those mechanical findings with common clinical observations of disc fatigue and damage. Porcine TMJ discs were compressed between an axially translating bottom platen and a 2.5-cm-diameter indenter within a hydrated testing chamber. Discs were cyclically sheared at 0.5, 1, or 5 Hz to 1, 3, or 5% shear strain. Within the anterior and intermediate regions of the disc when sheared in the anteroposterior direction, both shear and compressive moduli experienced a significant decrease from instantaneous to steady state, while the posterior region's compressive modulus decreased approximately 5%, and no significant loss of shear modulus was noted. All regions retained their shear modulus within 0.5% of instantaneous values when shear was applied in the mediolateral direction. The results of the disc's regional shear mechanics suggest an observable and predictable link with the common clinical observation that the posterior region of the disc is most often the zone in which fatigue occurs, which may lead to disc damage and perforation.
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Affiliation(s)
- C M Juran
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611-6131, USA
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Wang XD, Kou XX, Mao JJ, Gan YH, Zhou YH. Sustained inflammation induces degeneration of the temporomandibular joint. J Dent Res 2012; 91:499-505. [PMID: 22427270 DOI: 10.1177/0022034512441946] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The temporomandibular joint (TMJ) undergoes degenerative changes among patients who suffer from arthritis, and yet the pathogenesis of TMJ osteoarthritis and rheumatoid arthritis is poorly understood. We hypothesized that sustained inflammation in the TMJ induces structural abnormalities, and accordingly characterized the disc and synovium in a novel model with double injections of complete Freund's adjuvant (CFA), using behavioral, morphological, cellular, and molecular assessments. Thirty-five days following double CFA injections in seven-week-old female Sprague-Dawley rats, the disc in the CFA-induced inflammation group demonstrated multiple degenerative changes, including marked thickening, opacity, and deformation. The discs in the CFA group further showed significantly greater wet and net weights, and elevated collagen, aggrecan, and total glycosaminoglycan contents. The synovium in the CFA-induced inflammation group showed marked infiltration of mononucleated cells and accumulated sub-synovial adipose tissue. Both the disc and synovium had significantly higher iNOS and IL-1β mRNA expression than controls (saline injections). These findings are consistent with our hypothesis that sustained TMJ inflammation, even within the presently observed 35 days, may be a predisposing factor for structural abnormalities. Insight into TMJ inflammation and degeneration is anticipated to improve our understanding of the pathogenesis of TMJ arthritis and help design clinically relevant strategies for tissue engineering.
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Affiliation(s)
- X D Wang
- Department of Orthodontics, Peking University School & Hospital of Stomatology, 22# Zhongguancun South Ave., Beijing, China
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Kai Y, Matsumoto K, Ejima KI, Araki M, Yonehara Y, Honda K. Evaluation of the usefulness of magnetic resonance imaging in the assessment of the thickness of the roof of the glenoid fossa of the temporomandibular joint. ACTA ACUST UNITED AC 2011; 112:508-14. [PMID: 21855373 DOI: 10.1016/j.tripleo.2011.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 05/11/2011] [Accepted: 05/13/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the usefulness of magnetic resonance imaging (MRI) in measuring thickness of the roof of the glenoid fossa (RGF) of the temporomandibular joint (TMJ). STUDY DESIGN Minimum RGF thickness in 95 TMJs of 59 patients with temporomandibular disorders were measured and compared on both sagittal-section MRI and cone-beam computed tomography (CBCT). RGF thickness on MRI was also compared with MRI, CBCT, and arthrographic findings. RESULTS Minimum RGF thickness was greater on MRI (1.46 mm) than on CBCT (0.90 mm). Spearman's correlation coefficient by rank for these 2 types of measurements was 0.63. RGF thickness on MRI differed significantly between those with and without degenerative joint changes (1.69 vs 1.32 mm; P < .01) and between those with and without disk displacement (1.58 vs 1.35 mm; P = .04), but showed no associations with disk deformity, joint effusion, or disk perforation. CONCLUSIONS MRI is useful in measuring RGF thickness from diagnostic as well as radiation protection standpoints.
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Affiliation(s)
- Yukiko Kai
- Department of Oral and Maxillofacial Radiology, Nihon University, School of Dentistry, Tokyo, Japan
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Yura S, Nobata K, Shima T. Diagnostic accuracy of fat-saturated T2-weighted magnetic resonance imaging in the diagnosis of perforation of the articular disc of the temporomandibular joint. Br J Oral Maxillofac Surg 2011; 50:365-8. [PMID: 21723011 DOI: 10.1016/j.bjoms.2011.05.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 05/28/2011] [Indexed: 12/12/2022]
Abstract
The accuracy of diagnosing a perforation of the articular disc of the temporomandibular joint (TMJ) is poor with conventional magnetic resonance imaging (MRI). We recently reported that a high signal-intensity area is usually found on fat-saturated T2-weighted MRI in the joint space between the articular disc and cartilage surface in joints in which the disc is displaced. A discrete image with an area of high signal-intensity in the middle of the articular disc may indicate perforation or rupture. The purpose of this study was to compare the accuracy of diagnosis of a perforated articular disc by fat-saturated T2-weighted MRI with that of arthroscopy. We studied 50 joints in 50 patients with closed lock of the TMJ who were examined with MRI and then by arthroscopy using an ultra-thin arthroscope. The agreement between the two methods of diagnosis was assessed using the κ coefficient. Evidence of perforation of the disc on MRI and arthroscopically was found in the same 7 joints; there was complete concordance (κ=1.00, p<0.001). The accuracy of diagnosis of perforation of a disc by fat-saturated MRI was therefore the same as that by arthroscopy using an ultra-thin arthroscope.
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Affiliation(s)
- Shinya Yura
- Department of Oral and Maxillofacial Surgery, Tonami General Hospital, 1-61, Shintomi-cho, Tonami-city, Toyama-ken 939-1395, Japan.
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Venetis G, Pilavaki M, Triantafyllidou K, Papachristodoulou A, Lazaridis N, Palladas P. The value of magnetic resonance arthrography of the temporomandibular joint in imaging disc adhesions and perforations. Dentomaxillofac Radiol 2011; 40:84-90. [PMID: 21239570 DOI: 10.1259/dmfr/13255885] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study attempted to validate MR arthrography (MRAr) of the temporomandibular joint (TMJ) in detecting the position, integrity and relations of the articular disc and retrodiscal tissue. METHODS A total of 20 TMJs from 10 patients with severe TMJ dysfunction underwent MRI and MRAr. A paramagnetic contrast medium was injected into the upper joint compartment to observe possible adhesions and/or leakage into the lower compartment. 15 TMJs were surgically or arthroscopically explored and restored. RESULTS MRAr was approximately in the same diagnostic value as MRI when locating position, but superior in detecting disc perforations (eight TMJs) and adhesions (seven TMJs) appearing together in four cases. Surgery confirmed radiological findings in all but one case, where arthroscopy and surgery failed to confirm a disc perforation indicated by MRAr. CONCLUSIONS TMJ MRAr may simultaneously reveal adhesions and perforations. Sensitivity and the probability of false-positive results require further study.
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Affiliation(s)
- G Venetis
- University Clinic of Oral and Maxillofacial Surgery, Thessaloniki, Greece.
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Alkhader M, Kuribayashi A, Ohbayashi N, Nakamura S, Kurabayashi T. Usefulness of cone beam computed tomography in temporomandibular joints with soft tissue pathology. Dentomaxillofac Radiol 2011; 39:343-8. [PMID: 20729183 DOI: 10.1259/dmfr/76385066] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE the aim of the study was to evaluate the usefulness of cone beam CT (CBCT) in temporomandibular joints (TMJs) with soft tissue pathology. METHODS 106 TMJs of 55 patients with temporomandibular disorder (TMD) were examined by MRI and CBCT. MR images were used for the evaluation of disc displacement, disc deformity, joint effusion and obscurity of temporal posterior attachment (TPA). CBCT images were evaluated for the presence or absence of osseous abnormalities. The chi(2) test was used to analyse the association between MRI and CBCT findings. RESULTS MRI of 106 TMJs revealed disc displacement, disc deformity, joint effusion and obscurity of the TPA in 68, 73, 28 and 27 joints, respectively. Of the 68 TMJs with disc displacement, anterior disc displacement without reduction (ADDWR) was seen most frequently (47/68). CBCT imaging found 65 TMJs were characterized by the presence of osseous abnormalities and were significantly associated with disc deformity and ADDWR (P < 0.05). There was no statistically significant association between the presence of joint effusion and obscurity of TPA and TMJ osseous abnormalities. CONCLUSIONS TMD patients with confirmed ADDWR or disc deformity on MRI are at risk of having osseous abnormalities in the TMJ and further examination with CBCT is recommended.
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Affiliation(s)
- M Alkhader
- Oral and Maxillofacial Radiology, Graduate School, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
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Iwasaki H, Kubo H, Harada M, Nishitani H, Ohashi Y. Temporomandibular joint and 3.0 T pseudodynamic magnetic resonance imaging. Part 2: evaluation of articular disc obscurity. Dentomaxillofac Radiol 2011; 39:486-93. [PMID: 21062942 DOI: 10.1259/dmfr/92017549] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study examined the relationship between temporomandibular joint (TMJ) dysfunctions and obscurity grades of interpreted anterior and posterior borders of the articular disc (Da and Dp, respectively) by 3.0 T pseudodynamic MRI. METHODS Da and Dp were classified into seven obscurity grades, and the Dp contour was classified into three types. The grades, types and TMJ function were compared by 3.0 T pseudodynamic MRI. RESULTS Unobscured Da images at condylar positions posterior to the articular eminence were associated with normal TMJ function (P = 0.046 < 0.05). Unobscured Dp images at condylar positions anterior to the articular eminence were associated with normal TMJ function (P = 0.033 < 0.05). In addition, unobscured Dp images following flap insertion were associated with normal TMJ function (P = 0.043 < 0.05). There was no statistical relationship between Dp contour types and TMJ movement, but any change observed in the Dp contour during mouth opening was associated with abnormal TMJ function (P = 0.040 < 0.05). CONCLUSIONS Grading of Da and Dp obscurity based on how well the areas were defined in the images, identifying the condylar positions in relation to the glenoid fossa and articular eminences, and observing the changes in Dp contour types were useful for diagnosing TMJ abnormalities.
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Affiliation(s)
- H Iwasaki
- Department of Oral and Maxillofacial Radiology, Institute of Health Bioscience (IHBS), The University of Tokushima Graduate School, 18-15 Kuramoto-3-Chome, Tokushima 770-8504, Japan.
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Iwasaki H, Kubo H, Harada M, Nishitani H. Temporomandibular joint and 3.0 T pseudodynamic magnetic resonance imaging. Part 1: evaluation of condylar and disc dysfunction. Dentomaxillofac Radiol 2011; 39:475-85. [PMID: 21062941 DOI: 10.1259/dmfr/29741224] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study describes an improved method for examining and diagnosing temporomandibular joint (TMJ) dynamics by 3.0 T pseudodynamic MRI. METHODS Clinical observation and conventional static MRI of volunteers (one without and eight with TMJ arthrosis) were followed by 3.0 T pseudodynamic MRI in positions ranging from the mouth closed to mouth fully opened. Condylar head (Cd), articular disc anterior border (Da) and articular disc posterior border (Dp) were digitized on sagittal images to determine trajectory and velocity patterns. RESULTS Patients were divided into three groups based on the presence or absence of dysfunction: Group 1, no dysfunction on the right or left side of the TMJ; Group 2, dysfunction on the right or left side of the TMJ; and Group 3, dysfunction on both the right and left sides of the TMJs. In 75% of patients (12 of 16 joints), pseudodynamic TMJ analysis was useful for determining a functional abnormality. Using a points system based on three trajectory and seven velocity patterns, discs with adhesion and perforation had significantly fewer points than discs with anterior displacement (with and without reduction) and discs with no abnormality (P = 0.019 < 0.05). CONCLUSIONS Trajectory and velocity patterns based on 3.0 T pseudodynamic MRI identified the affected side and determined the extent of morbidity in the Cd as well as the Da and Dp. The typical abnormal movement pattern of discs with anterior displacement (with and without reduction) and pathological structural changes of the articular disc (such as adhesion and perforation) could be identified.
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Affiliation(s)
- H Iwasaki
- Department of Oral and Maxillofacial Radiology, Institute of Health Bioscience (IHBS), The University of Tokushima Graduate School, 18-15 Kuramoto-3-Chome, Tokushima 770-8504, Japan.
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Yura S, Nobata K, Shima T. Hyperintensity signal in the joint space of the temporomandibular joint on fat-saturated T2-weighted magnetic resonance imaging. Br J Oral Maxillofac Surg 2010; 48:621-3. [DOI: 10.1016/j.bjoms.2009.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Accepted: 10/07/2009] [Indexed: 11/27/2022]
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MRI-Guided Injection Procedures of the Temporomandibular Joints in Children and Adults: Technique, Accuracy, and Safety. AJR Am J Roentgenol 2009; 193:1148-54. [PMID: 19770341 DOI: 10.2214/ajr.09.2473] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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