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Signs and symptoms of TMJ dysfunction in patients with mandibular condyle fractures.

Signs and symptoms of TMJ dysfunction in a total of 52 mandibular fracture patients comprising 15 with condylar fractures (Group I), 22 with combined condylar and mandibular body fractures (Group II), and 15 with mandibular body fractures (Group III) were examined an average of 44 months after injury. In terms of the Helkimo dysfunction index, it was shown that more severe subjective and objective dysfunctions were observed in the Group II, in which condylar fracture patients were treated with long-term intermaxillary fixation (IMF) and in which the patients' injuries were caused by more energetic impacts. There was, nevertheless, a tendency for the dysfunction to be graded as milder as the time elapsing since the injury increased.

Adolescent↗

Changes in mandibular condyle morphology related to tooth wear in a prehistoric human population.

The exact relationship between tooth wear and changes in the shape of the articulating surface of the mandibular condyles is unknown. It is assumed that to some degree these changes are in response to the loads on the joint generated during chewing. Excavated skeletal remains from sites of primitive human habitation provide an opportunity to study the masticatory system of human beings in their natural context, with the features of form and function expressed to their full potential. Accurate measurements of the condylar head can also be made on such remains. A collection of skulls from an excavation site known as Oakhurst on the South African coast provided material for this study. Occlusal wear was measured using the scale devised by Molnar; approximal wear was assessed by measuring the size of the wear facet between the first and second molars. The width of the condyles were measured directly, and a method was devised to measure changes in the proportion of medial and lateral articulating facets. An increase in the size of the lateral facet of the condyle was found to be associated with increased tooth wear. It is suggested that the direction of condylar remodelling may give an indication of the reaction at the joint to optimal mastication.

Adult↗

The effects of ethylene-1-hydroxy-1, 1-diphosphonate on the developing mandibular condyle -- a light microscopic study.

The effects of high doses of ethylene-1-hydroxy-1, 1-diphosphonate (EHDP), a potential mineralization inhibitor, were studied in the developing mandibular condyle of the rat. The animals were given one injection of EHDP/day for four consecutive days. One group of animals received 30 mg and another group 50 mg EHDP/day. Animals from each group were killed either the day after or three days after the last EHDP-injection. EHDP-administration resulted in a failure of mineralization of the cartilage and osteoid, a widening of the hypertrophic zone, an appearance of cells in lacunae at the cartilage-methphyseal junction and in an inhibited capillary invasion. There was little evidence of a resumed mineralization in rats left to survive for three days after the last EHDP-injection. The results indicate additional effects of EHDP besides an inhibition of calcium phosphate crystallization, and also that EHDP may be a useful tool in the study of mechanisms of cellular hypertrophy and capillary invasion in mineralizing cartilage.

Animals↗

Laminagraphic study of mandibular condyle position when recording centric relation.

Laminagraphs were made of each temporomandibular joint of 20 subjects (1) with the mandible forcefully retruded to centric relation and (2) with the mandible positioned by a closing force while an anterior guidance prosthesis was being used. The radiographs were compared by measurements of condylar position; results indicated the condyles to be significantly more superior in the glenoid fossa when anterior guidance was used. The difference in anterior-posterior positioning of the condyles appeared to occur randomly. Measurements of the joint spaces with the mandible in centric relation using anterior guidance indicated that mandibular condyles were not centered in the fossae. There seemed to be a range in the size of the space that could be considered normal.

Dental Occlusion↗

Resorption of the postero-superior corner of the lateral part of the mandibular condyle correlates with progressive TMJ internal derangement.

The purpose of this study was to test the hypothesis that resorption of postero-superior corner of lateral part of the mandibular condyle (RLC) occurs with the advancement of TMJ internal derangement (ID). One hundred and sixty-seven TMJs in 122 patients were studied. RLC was assessed on plane radiographs of frontal oblique projection. The correlation between the prevalence of RLC and radiological stage of ID was analysed and clinical correlations to the radiological stage of ID and the prevalence of RLC were discussed. The higher prevalence of RLC in joints with advanced ID was statistically significant (Mann-Whitney U-test, P< 0.05). There was no correlation between the prevalence of RLC and neither OA on the articular surface of the condyle nor clinical symptoms/signs. The result of this study suggests that RLC appears to occur in joints with advanced ID as a result of remodelling changes secondary to ID.

Adolescent↗

[Osteochondroma of the mandibular condyle].

Osteochondroma is a common benign tumor of the axial skeleton. Despite its preference for long bones, osteochondroma may occur in any bone developing by endochondral ossification, therefore it concerns mandibular condyle as well. This lesion is more common in males than in females and it can occur singly or as a part of an autosomal dominant syndrome known as osteochondromatosis. Solitary osteochondroma has a low incidence of sarcomatous change (1%) while patients with osteochondromatosis have a higher risk of sarcomatous transformation (11%). Symptoms of this lesions are mandibular asymmetry, malocclusion with cross-byte, temporomandibular joint intermittent pain hypomobility, clicking, and the presence of a palpable painless mass in the temporomandibular area. Therapy needs a surgical treatment which can consist in a one-stage or in a two-stage surgical approach. Prognosis is generally favourable.

Adult↗

Age changes in the articular tissue of human mandibular condyles from adolescence to old age: a semiquantitative light microscopic study.

In a previous study (Luder, Anat. Rec., 1997;248:18-28), the articular tissue of the adult mandibular condyle was characterized semiquantitatively. However, questions about age changes of mature tissue were not answered, and the time course of tissue maturation from the end of condylar growth to the attainment of the adult appearance remained unknown. These issues are addressed in the present investigation. By using a light microscope, features of the superficial, intermediate, and deep articular tissue zones as well as of the subchondral bone were assessed at nine predetermined condylar sites. The frequencies of these features were recorded as scores from 0 (absent) to 10 (continuous) and were plotted against age. Analysis of covariance served for testing the significance of age and sex effects as well as intracondylar variability. Whereas almost all age-related changes in frequencies of tissue features were similar along the whole lateromedial dimension, changes at the putatively nonload-bearing, posterior slope differed significantly from those at the putatively load-bearing, anterior slope and zenith of the condyle. Two patterns of changes were noted. Frequencies of a first group of tissue features altered mainly during the age period from 15 years to 30 years and remained more or less stable thereafter. This course was characteristic for 1) a progressive cartilaginification of the superficial zone as well as 2) the disappearance of hypertrophic growth cartilage and 3) the appearance of grid-fibrous fibrocartilage in the deep zone, which were accompanied by 4) a decline in endochondral ossification and 5) the formation of a compact, subchondral bone plate. Frequencies of a second group of tissue features disclosed changes that continued up to middle and old age. This pattern was evident regarding 1) a decrease in the prominence associated with 2) a drop in cellularity and 3) progressive fibrosis or even cartilaginification of the intermediate zone. Among the age changes of condylar articular tissue, those affecting the superficial and deep zones as well as the subchondral bone are largely complete by about 30 years of age and seem to be related primarily to a gradual transition from growth to adulthood. In contrast, a second group of alterations, which progress to old age and involve mainly the intermediate zone, appears to be associated with continued maintenance and adaptive articular remodeling as well as possibly senescence. Both maturational and later age changes seem to depend markedly on articular load bearing.

Adolescent↗

Prediction of mechanical properties of the cancellous bone of the mandibular condyle.

The mechanical properties of cancellous bone depend on the bone structure. The present study examined the extent to which the apparent stiffness of the cancellous bone of the human mandibular condyle can be predicted from its structure. Two models were compared. The first, a structure model, used structural parameters such as bone volume fraction and anisotropy to estimate the apparent stiffness. The second was a finite element model (FEM) of the cancellous bone. The bone structure was characterized by micro-computed tomography. The calculated stiffnesses of 24 bone samples were compared with measured stiffnesses. Both models could predict 89% of the variation in the measured stiffnesses. From the stiffness approximated by FEM in combination with the measured stiffness, the stiffness of the bone tissue was estimated to be 11.1 +/- 3.2 GPa. It was concluded that both models could predict the stiffness of cancellous bone with adequate accuracy.

Aged↗