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PubMed1995

The TMJ-ear connection.

This article documents the existence of three structures that traverse through the petrotympanic fissure. These structures are the mandibular malleolar ligament, the chorda tympani nerve and the anterior tympanic artery. The mandibular malleolar ligament or the disk-malleolar ligament originates on the anterior process of the mallous. It traverses through the petro-tympanic fissure and attaches to the posterior portion of the capsule and disk of the temporomandibular joint. The chorda tympani nerve supplies sensory feeling to the posterior two thirds of the tongue. The anterior tympanic artery supplies blood to the area of the tympanic membrane. Clinical experience with implants that impinge or cover ear problems and other symptoms. Removal of these implants and placements with devices that do not cover these structures often relieve these symptoms.

Arteries↗
PubMed2003

Motivation, characterization, and strategy for tissue engineering the temporomandibular joint disc.

The purpose of this review is to serve as the standard point of reference in guiding researchers investigating the tissue engineering of the temporomandibular joint (TMJ) disc. Tissue engineering of the TMJ disc is in its infancy, and currently there exists a gap between the tissue engineering community and the TMJ characterization community. The primary goal is to help bridge that gap by consolidating the characterization studies here as a reference to researchers attempting to tissue engineer the TMJ disc. A brief review of TMJ anatomy is provided, along with a description of relevant pathology, current treatment, and a rationale for engineering the TMJ disc. The biochemical composition and organization of the disc are reviewed, including glycosaminoglycan (GAG) and collagen content. The collagen of the disc is almost exclusively type I and primarily runs anteroposteriorly through the center and in a ringlike fashion around the periphery. The GAG content is approximately an order of magnitude less than that of hyaline cartilage, and although the distribution is not entirely clear, it seems as though chondroitin and dermatan sulfate are by far the primary GAGs. Cellular characterization and mechanical properties under compression, tension, and shear are reviewed as well. The cells of the disc are not chondrocytes, but rather resemble fibrocytes and fibrochondrocytes and may be of the same lineage. Mechanically, the disc is certainly anisotropic and nonhomogeneous. Finally, a review of efforts in tissue engineering and cell culture studies of the disc is provided and we close with a description of the direction we envision/propose for successful tissue engineering of the TMJ disc.

Animals↗
PubMed2006

Tissue Engineering of the TMJ disc: a review.

The potential impact of a tissue-engineered temporomandibular joint (TMJ) disc is immense. Currently, patients suffering from a severely dysfunctional TMJ have few options. Facing the general lack of safe, effective TMJ disc implants, many patients undergo discectomy, a procedure that removes the injured TMJ disc in hopes of reducing debilitating symptoms associated with severe TMJ disorders. This procedure may not be ideal as the TMJ is left without an important functional component. Tissue engineering is a promising approach for the creation of viable, effective implants. The first attempt to investigate TMJ disc cells on a biomaterial was conducted in 1991. The first TMJ tissue-engineered constructs to be tested biochemically and biomechanically were formed in 1994; however, in examining this study in retrospect, it is clear how little TMJ knowledge was available at that time. Within the last 10 to 15 years, multiple studies have investigated critical TMJ disc characteristics, and while this characterization is not complete, these data have created a solid foundation for tissue-engineering research. Thus, the last 5 years have yielded core studies investigating the principal elements of tissue engineering: scaffold, cell source, and biological/biomechanical stimuli. Although TMJ disc tissue engineering is still in its formative years, its future is quite promising. Key studies are now being conducted that will assist in the establishment of a solid TMJ disc tissue-engineering approach. As the challenges of tissue engineering are faced and met, the ultimate goal of creating a functional biological implant nears.

Animals↗
PubMed1976

Total joint replacement in extremities with below-knee amputations.

Patients with knee and hip joint diseases or fractures in a limb with a distal portion amputated were successfully treated with total joint arthroplasties. Two patients with below-knee amputations recieved total joint replacements. One underwent a total hip arthroplasty and the other had a total knee arthryplasty on the side of the amputation. Physical therapy was modified minimally for the two patients in comparison to other patients with total joint replacements. Prosthetic changes were required in both cases. With new prostheses, both patients were able to return to work.

Adult↗
PubMed1977

Rehabilitation program following polycentric total knee arthroplasty.

A rehabilitation program which has been used successfully in improving the postoperative range of motion of patient undergoing total knee arthroplasty is outlined. The specific objectives are strong quadriceps setting, straight leg raising, flexion of the knee to at least 90 degrees, and extension of the knee to 0 degrees. The program emphasizes the importance of early institution of exercises and early ambulation.

Aftercare↗
PubMed1988

Basal joint reconstruction in a punch injury of the hand.

Severe hand trauma caused by an industrial accident resulted in composite tissue loss in the basal joint area of the right hand. The crushed metacarpal bone was replaced, and ligamentous and capsular reconstruction was performed with flexor carpi radialis tendon and additional tendon graft. We present our experience, with a follow-up of one year and eight months.

Accidents, Occupational↗
PubMed1976

The plastic surgical adhesive drape: an evaluation of its efficacy as a microbial barrier.

A microbial evaluation was made of adhesive plastic surgical drapes and cloth surgical drapes. These studies were done both during surgery and in the laboratory. The plastic drape does not allow bacterial penetration, lateral migration does not occur, skin bacteria do not multiply under the drape within the time periods studied and the patient drapes are held in place with their use. When wet, cloth drapes showed profuse bacterial penetration. Dry cloth showed less bacterial penetration as compared to wet cloth. Lateral migration under cloth drapes was not possible to assess due to a high level of penetration. The surface of cloth showed a higher level of bacterial contamination during the surgical procedures. Deep wound cultures collected just prior to closing showed 60% contamination when cloth was used compared to 6% when plastic was employed. The micro-organisms recovered from the various sites sampled were identified. Finally, in addition to the positive aseptic benefits afforded by plastic adhesive drapes, aesthetic features such as a more delineated operative field and elimination of towel clips make this product a useful adjunct to the surgeon's armamentarium.

Air Microbiology↗
PubMed1975

Kinematics of the knee after prosthetic replacements.

A method was developed for describing the flexion-extension motion of the knee joint in a sagittal plane, by employing ciné radiography and then plotting the loci of three points on the femur relative to the tibia. Normal knees displayed similar patterns, the curves were smooth, and flexion-extension curves superimposed. A standard knee outline with standard curves was defined, with which to compare the abnormal and prosthetic knees. Arthritic knee patterns differed significantly from the normals. The curves were irregular and the flexion-extension curves were different. Instability, joint surface irregularity and muscle spasm were thought to be the main causes. The curves for the MacIntosh tibial plateaus were abnormal in a similar way to the arthritics. This may have been due to residual instability and to the replacement of only one bearing surface. The condylar replacement prostheses (the uni-condylar, duo-condylar and Geometric) tended to produce close-to-normal knee patterns, probably due to restoration of a relatively normal geometry, and to replacement of both bearing surfaces. The knees with fixed hinge prostheses (Walldius, Shiers and Guépar) showed abnormalities of motion and of the relative postion of the femur on the tibia. These features would be undesirable for the correct functioning of soft tissues around the knee. The stabilo-condylar hinge, which did not require much bone resection, gave a motion comparable to the condylar replacements.

Adult↗
PubMed1975

A comparison of patellectomy with prosthetic replacement of the patella.

Eight adult mongrel dogs were used to compare patellectomy with prosthetic replacement of the patella. All of the dogs who underwent patellectomies displayed functional disturbances when examined four weeks postoperatively. None of the dogs with patellar prostheses displayed discernible functional disturbances. All but one of the dogs with patellectomies developed pathological alterations in the patellar bed of the femur. None of the dogs with patellar prostheses had pathological alterations in the patellar bed of the femur.

Animals↗
PubMedDate not supplied

MP implants for rheumatoid arthritis of the hand.

Rheumatoid arthritis is a devastating disease, which can incapacitate a person in activities of daily living. Only after all other methods have been exhausted, should patients undergo surgery for pain relief, mobility, and cosmetic reasons. A lengthy rehabilitative period following the placement of the metacarpophalangeal implants assures maximum mobility in the new joints. Nurses must be aware of their educational responsibilities to the patient before, during, and after the surgery for patient compliance.

Arthritis, Rheumatoid↗
PubMed1979

Proximal femoral focal deficiency: a clinical appraisal.

In patients with unilateral proximal femoral focal deficiency, the leg length inequality is almost always greater than five inches at skeletal maturity. Consequently, prosthetic management should be planned before the patient walks. A standard plan of treatment of the patient with unilateral PFFD is not possible at this time, primarily because of the varying percentage of femur missing and the controversy of management of the hip in patients with type A or B deformity. However, we found that ankle disarticulation with Syme flap closure combined with arthrodesis of the knee is a reasonable plan in many patients with unilateral PFFD. This allows correction of the knee and hip flexion contractures and gives the patient a functional, cosmetic stump. By the time he begins school, he is functioning as an above-knee amputee. This is not an undesirable goal, as one of us (E.G.R.) recently examined an above-knee amputee, a Captain in the United States Army, who continued his hobby of sky diving.

Adolescent↗