Progress of mandibular condyle lesions in juvenile rheumatoid arthritis.
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The defective bone resorption in the osteopetrotic op/op mouse brings about cranio-facial deformation and failure of tooth eruption. This study was conducted to elucidate the morphological changes of the condylar head and mandibular ramus in growing op/op mice. In normal mice, the condylar head is much broader than the ramus beneath it, enlargement and ossification of the condylar head begin after weaning, and the ramus becomes compact bone tissue. None of these changes were found in the op/op mice in the present observation. The condylar head was small, and its inner side was occupied by hypertrophic cartilage cells. In spite of the lack of bone resorption in op/op mice, the compaction of the mandibular ramus, which was composed of bone trabeculae, occurred later than that in normal mice. In view of recently studies reported evidence that local mechanical stress regulates the bone formation, we consider that undergrowth of the condylar head and the ramus in the op/op mouse results from not only a deficiency of osteoclasts but also insufficient mechanical stress from mastication.
On two acrylic copies of a cranium with mandibular prognathy, the mandible was moved back by sagittal cut of the ascending ramus. It is shown that with both methods of immobilization, circumferential and screw-osteosynthesis, the segments cause a change in the position of the condyles. There are no clear advantages or disadvantages of either method. Observed cases of circumferential wiring showed practically no arthrotic symptoms after 2-10 years, which indicated that the t.m. joint has a large degree of adaptability. However, such a statement can be made definitely only after an observation time of 20-30 years.
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The role played by cell addition, cell enlargement, and matrix deposition in the endochondral growth of the condyle was assessed in weanling rats by four approaches making use of the light microscope: morphometry, 3H-thymidine radioautography, 3H-proline radioautography, and immunostaining for the cartilage-specific type II collagen. From the articular surface down, the condyle may be divided into five layers made up of cells embedded in a matrix: 1) the articular layer composed of static cells in a matrix rich in fibers presumed to be of type I collagen, 2) the polymorphic cell layer including the progenitor cells from which arise the cells undergoing endochondral changes, 3) the flattened cell layer in which cells produce a precartilagenous matrix devoid of type II collagen while undergoing differentiation in two stages: a "chondroblast" stage and a short "flattened chondrocyte" stage when intracellular type II collagen elaboration begins, 4) the upper hypertrophic cell layer, in which cells are "typical chondrocytes" that enlarge at a rapid rate, actively produce type II collagen, and deposit it into a cartilagenous matrix, and 5) the lower hypertrophic cell layer, composed of chondrocytes at a stage of terminal enlargement while the cartilagenous matrix is adapting for mineralization. 3H-thymidine radioautographic results indicate that the turnover time of progenitor cells in the polymorphic cell layer is about 2.9 days. The time spent by cells at each stage of development is estimated to be 1.4 days as chondroblasts, 0.5 days as flattened chondrocytes, 2.3 days as the chondrocytes of the upper hypertrophic cell layer, and 1.1 days as those of the lower hypertrophic cell layer. Calculations referring to a 1 x 1-mm square-sided column extending from the articular surface to the zone of vascular invasion provide the daily rate of cell addition (0.0077 mm3), extracellular matrix deposition (0.0127 mm3), and cell enlargement (0.0302 mm3). Hence the respective contribution of the three factors to condyle growth is in a ratio of about 1:1.6:4. This result emphasizes the role played by cell enlargement in the overall growth of the condyle.
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This study was designed to investigate the long-term effects of transplanted clavicles to the temporomandibular joint (TMJ) in juvenile monkeys. Sixteen juvenile female monkeys (Macaca mulatta) were used in this experiment. Eight animals were used as controls and were allowed to grow undisturbed for an 18-month period (group control). Eight animals were divided into two groups and underwent bilateral condylar excision via extraoral vertical ramus osteotomies. Four of these animals had their condylar segments removed and immediately replaced to serve as surgical controls (group condyle). The other four underwent condylar replacement with the sternal end of their clavicles (group SCJ). Standardized lateral cephalometric radiographs with the aid of tantalum bone markers were used to evaluate maxillary and mandibular growth. One-way analysis of variance (ANOVA) was used to determine the significance of differences between groups. All animals showed good mandibular function and a class I molar relationship following an 18-month evaluation period. Statistical analysis showed there was no significant difference in maxillary or mandibular growth between any of the three groups. The results of this investigation show that the sternal end of the clavicle may be a viable option in mandibular condylar transplant surgery.
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The double-headed condylar process is rare. Radiographs of four patients with this type of anomaly and one skeletal specimen are described in this article. Histologic studies in rodents suggest a possible mode of pathogenesis: maldirected muscular pull may lead to the development of an extra mandibular capitulum.
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