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Craniofacial abnormalities in a murine knock-out model of mucopolysaccharidosis I H: a computed tomography and anatomic study.

The genetic mucopolysaccharidoses are a group of lysosomal storage diseases in which mucopolysaccharides (glycosaminoglycans) accumulate as the result of a malfunction or lack of a lysosomal degradation enzyme. There are currently seven known forms of mucopolysaccharidoses. Type I results from an enzymatic deficiency of alpha-L-iduronidase. There are three subtypes of mucopolysaccharidoses I that are commonly recognized: Hurler syndrome, Hurler-Scheie syndrome, and Scheie syndrome. Of the three subtypes, Hurler syndrome has the most severe clinical picture. Craniofacial anomalies and cognitive impairment are some of the more pronounced features of Hurler syndrome. Hurler syndrome has been described in cats, dogs, mice, and human beings and is inherited as an autosomal recessive trait. The biochemical nature of the disease is preserved across species lines. Clinically, the disease has similar effects in human beings and animals. It has been difficult to reverse the phenotype of the disease even with replacement of the defective alpha-L-iduronidase enzyme. The purpose of this study is to characterize the cranio-facial differences in the murine knock-out model of Hurler syndrome objectively. Twenty-three measurements were taken from computed tomographic scans in a coronal and sagittal plane on 24 black C57/B6 knock-out Hurler syndrome mice. The seven statistically significant measurements are width of the cervical canal, height of the foramen magnum, width between the external auditory canals, width of the skull base at the mandibular condyles, midocular distance, spread of the mandibular condyles, and width of the zygoma at the maxilla. This information now provides researchers with objective data from living Hurler syndrome-affected mice that will allow them to follow therapies directed at improving craniofacial outcomes for any therapy over time.

Animals↗

Effects of estrogen on the condylar cartilage of the rat mandible in organ culture.

PURPOSE: The effects of estrogen on bone have been well documented. However, very little is known about the regulatory role of estrogen on cartilage and, in particular, the secondary cartilage of the mandibular condyle. The aims of this study were to determine whether estrogen receptors are present in the condylar cartilage of the rat mandible and to assess the effect of varying 17beta-estradiol (E2) concentrations on the proteoglycan content of this tissue. MATERIALS AND METHODS: Mandibular condyles of 16 female Sprague-Dawley rats were resected. Eighteen of these condyles were divided into three groups and the condylar cartilage was removed and placed in organ culture for 4 days with media containing different concentrations of estrogen: 10(-11) mol/L, 10(-8) mol/L, and 10(-6) mol/L. The cartilage then was analyzed for proteoglycan content along with six specimens not passed through the organ culture. Six intact mandibular condyles also were resected and placed in organ culture with the same varying E2 concentrations, and the condylar cartilage was analyzed for estrogen receptors along with two condyles not passed through the culture system. RESULTS: Estrogen receptors were evenly distributed within the chondroblastic and hypertrophic zones in the control group and the group with 10(-11) mol/L E2. With E2 concentrations of 10(-8) mol/L and 10(-6) mol/L, there was a qualitative decrease in hypertrophic chondroblasts, thickness of the condylar cartilage, and a significant decrease in proteoglycan content. CONCLUSIONS: This study shows the presence of estrogen receptors in the secondary cartilage of the rat mandibular condyle. Estrogen has the potential to cause a decrease in extracellular matrix and thickness of this cartilage.

Analysis of Variance↗

Trabecular structure of the condyle of the jaw joint in young and mature sheep: a comparative histomorphometric reference.

Much of the literature regarding arthrotic changes in the temporomandibular joint (TMJ) is based on the assumption, rather than the demonstration, that joint degeneration is pathologically and biochemically similar to that which has been described for other arthrodial joints. Understanding such changes is axiomatic of an understanding of the specific histomorphometric structure of the normal TMJ, in particular the condyle. Unfortunately, very little has been established about the trabecular bone patterns in the mandibular condyle as it develops. As a consequence of the obvious practical difficulties in investigations of the human TMJ, the sheep has been variously used as an animal model. In order to augment a fuller characterisation of this animal model, this study focuses on the quantitative histomorphometries of the trabeculae in the mandibular condyles of young and mature sheep. Quantitative histomorphometric analyses of condylar trabeculae were performed on histological sections prepared from mature and young sheep condyles. Lateral, central and medial sagittal sections, and anterior and posterior coronal sections of the condyle were analysed using a Quantimet 500MC image analysis system that had been programmed to provide structural index values of trabecular bone volume, surface, thickness, separation and number. Analysis of histoquantitation data revealed a significant concordance in bone structural index values between lateral, central and medial regions in young and mature sheep as well as anterior and posterior regions in young sheep. Moreover, there was little significant variation between similar regions in the respective age groups. This study provides the first comparative histomorphometric quantitative analysis of the trabeculae in the mandibular condyle of both young and mature sheep. The findings of this study reinforce the appropriateness of the sheep TMJ as a model in previous experimental studies of the bony architecture of the condyle.

Aging↗

Osteonecrosis of the temporomandibular joint: correlation of magnetic resonance imaging and histology.

PURPOSE: The aims of this study were to investigate whether osteonecrosis affects the mandibular condyle and to determine whether this condition could be diagnosed with magnetic resonance imaging (MRI). MATERIALS AND METHODS: The study was based on 50 temporomandibular joints in 44 patients in whom MRI and surgery were performed for painful internal derangements. At the time of surgery, a core biopsy specimen was obtained from the marrow of the mandibular condyles, and the histological observations were correlated to T1-(proton density) and T2-weighted MR images. RESULTS: Histological evidence of osteonecrosis was found in nine joints (18%). Bone marrow edema, which may be a precursor of osteonecrosis, was found in nine other joints. The MRI was 78% sensitive and 84% specific for the diagnosis of osteonecrosis of the mandibular condyle. However, the positive predictive value was only 54% because of a number of false-positive MRI diagnoses. CONCLUSION: Osteonecrosis can affect the mandibular condyle, and this condition can be diagnosed with MRI. A combination of edema and sclerosis of the bone marrow was the most reliable MRI sign of osteonecrosis. The cause, its clinical significance, and the need for treatment are unknown.

Adult↗

[Clinical, radiological and axiographic examination after conservative functional treatment of intracapsular temporomandibular joint fractures].

PURPOSE: The different lines of intracapsular fractures of the mandibular condyle were studied and their influence on the prognosis following close treatment was evaluated. METHODS: In 40 patients with 50 intracapsular fractures of the mandibular condyle the following evaluation was carried out after close treatment: clinical, radiological and axiographical follow-up. The examinations were performed between 0.5-5 years following treatment. Three types of intracapsular fractures were distinguished. Type A = fractures through the medial condylar pole, type B = fractures through the lateral condylar pole with loss of vertical height of mandibular ramus, type M = multiple fragments, comminuted fractures. RESULTS: Moderate to serious dysfunction was observed in 33% of the cases. Radiological examination of fracture types B and M revealed a reduction in the height of the mandibular ramus by up to 13% as compared to the contralateral side. Also with regard to deformation of the condylar head these two fracture types resulted in the most prominent pathological findings. Axiography revealed irregular excursions and a clear limitation of condylar movement in comminuted fractures by up to 74% as compared to the non-fractured side. CONCLUSION: The findings emphasize the severity of lesions to the osseo-disko-ligamentous complex of the TMJ caused by intracapsular fractures of the mandibular condyle. The poor functional and radiological results encountered in the fracture types B and M demonstrated the limits of conservative functional treatment. With regard to fracture type B it may be discussed whether surgical therapy would improve the results.

Adolescent↗

An experimental study on the growth of condylar cartilage, using a new vascularized mandible heterotopic transplant model.

PURPOSE: To clarify the influence of external and dynamic factors on the growth of mandibular condyle, we developed vascularized mandible heterotopic transplant (VMHT) model. In this report, we discuss histologic changes in the mandibular condylar cartilage in the absence of external factors, using VMHT models. MATERIALS AND METHODS: Thirty VMHT model using male Lewis rats aged 6 weeks were produced. Six VMHT rats were randomly selected for death at 1, 2, 4, 7, and 14 days after transplantation. We histologically investigated the mandibular condyles of the grafts and controls, the left mandibles of recipient rats. RESULTS: In the transplanted mandibular condyle of VMHT models, the cell arrangement became increasingly irregular with the passage of time, with a concomitant, irregular thickening or thinning of the cartilage layer. There was heterotopic fibrous ossification, extending horizontally under the proliferative cell layer in these regions of thin cartilage. After these events, cartilage cells had disappeared almost completely by 14 days after transplantation. CONCLUSIONS: This study indicated that external and dynamic factors are not necessary for the differentiation and proliferation of the condylar cartilage cells. Instead, these factors affect the maintenance of the orderly growth of the cartilage cells and may serve a critical role in the differentiation of undifferentiated mesenchymal cells into chrondroblasts.

Animals↗

Facial skeleton remodeling due to temporomandibular joint degeneration: an imaging study of 100 patients.

One hundred patients with recently acquired, externally visible mandibular deformity and no history of previous extraarticular mandible fracture were selected for retrospective analysis. All had been investigated clinically and with radiography, tomography, and high-field surface-coil MR imaging to determine the presence or absence and extent of temporomandibular joint degeneration. Temporomandibular joint degeneration was found in either one or both joints of each patient studied. Chin deviation was always toward the smaller mandibular condyle or more diseased joint, and many patients either complained of or exhibited malocclusion, often manifested by unstable or fluctuating occlusion disturbances. Three radiologically distinct forms of degenerative vs adaptive osteocartilaginous processes--(1) osteoarthritis, (2) avascular necrosis, and (3) regressive remodeling--involving the mandibular condyle and temporal bone were identified in joints most often exhibiting meniscus derangement. Osteoarthritis and avascular necrosis of the mandibular condyle and temporal bone were generally associated with pain, mechanical joint symptoms, and occlusion disturbances. Regressive remodeling was less frequently associated with occlusion disturbances, despite remodeling of the facial skeleton, and appears to result from regional osteoporosis. Forty patients (52 joints) underwent open arthroplasty procedures, including either meniscectomy or microsurgical meniscus repair, at which time major radiologic diagnoses were confirmed. Surgical and pathologic findings included meniscus displacement, disk degeneration, synovitis, joint effusion, articular cartilage erosion, cartilage healing/fibrosis, cartilage hypertrophy, osseous sclerosis, osteophyte formation, osteochondritis dissecans, localized or extensive avascular necrosis, and decreased mandibular condyle mass and vertical dimension. We conclude that temporomandibular joint degeneration is the principal cause of both acquired facial skeleton remodeling and unstable occlusion in patients with intact dentition and without previous mandible fracture.

Adolescent↗

Perspectives on the role of the lateral pterygoid muscle and the sphenomandibular ligament in temporomandibular joint function.

The lateral pterygoid muscle plays an important role in the movement of the mandible and has been studied from several points of view, including structural and functional anatomy. What matters clinically is the relative position of the muscle fibers attached medially to the mandibular condyle. In the following study, we observed not only the attachment of the lateral pterygoid muscle fibers to the articular disk, but also the relative position of the mandibular condyle to a base line set up on the mandibular condyle. According to our observations, the lateral pterygoid muscle fibers attach to the articular disk at the inner point of the medial pole. Based on this finding, we can say that the muscle fibers can both draw the articular disk anteriorly and balance it by supporting it posteriorly. That is to say, the lateral pterygoid muscle has two actions: to elevate the articular disk anteriorly and to support the articular disk. Furthermore, the sphenomandibular ligament has continuity with the articular disk tissue medially. This relationship suggests that the ligament fibers attached to the articular disk draw the disk posteriorly in its course of mandibular closing, thus enabling the articular disk to move smoothly.

Adult↗

The effect of different condylar positions on masticatory muscle electromyographic activity in humans.

OBJECTIVES: The purpose of this study was to determine a condylar position that permitted the greatest total temporalis and masseter muscle activity in maximum static clench. STUDY DESIGN: Twenty normal adults, 9 women and 11 men, were evaluated to determine masseter and temporalis activity in maximum static clench with mandibular condyles in different therapeutic positions. Bimanually manipulated, leaf gauge, centric occlusion, and neuromuscular condylar positions were studied. RESULTS: When mandibular condyles were placed anteroinferiorly in a neuromuscular position, total masticatory muscle recruitment was the greatest. In a bimanually manipulated or a leaf gauge position, mandibular condyles were positioned superoposteriorly, producing the least amount of muscle recruitment. CONCLUSIONS: The result of any therapeutic position should be an improvement in muscle function. With respect to balance and activation, a neuromuscular condylar position proved to be the position capable of recruiting the greatest motor unit activity when compared with a bimanually manipulated position, a leaf gauge position, and a neuromuscular position.

Adult↗

Fgfr mRNA isoforms in craniofacial bone development.

Mutations in genes encoding for fibroblast growth factor receptors (FGFRs) have been identified as causes of both chondrodysplasias and craniosynostoses, both of which cause abnormalities in the growth and development of the craniofacial region. FGFRs form mRNA splicing isoforms, each with distinct ligand binding specificity and tissue distribution. These confer specific biological functions on these isoforms. Although it is known that FGFRs are expressed at numerous locations during early mouse development, including the craniofacial area, relatively little is known about the expression of the splicing isoforms during craniofacial bone development. To address this, we have performed a detailed survey to detect these genes in the developing mouse craniofacial region. We have analyzed the developing mouse mandible, calvaria, and cranial base, in particular the spheno-occipital synchondrosis, a key centre of craniofacial growth. Fgfr1c was detected weakly in osteoblastic cells in both the developing calvarial and mandibular bones. Fgfr3b and Fgfr3c were found chiefly in proliferating chondrocytes of the cranial base synchondroses and the mandibular condyle. Fgfr2b transcripts were most notably detected in the perichondria of the mandibular condyle and the cranial base. Fgfr2c transcripts were detected with high intensity in differentiating osteoblasts at the sutural osteogenic fronts of the calvarial bones. In addition, Fgfr2c was also expressed in the perichondria of the mandibular condyle and the cranial base. These expression patterns suggest both differing and similar functions for -b and -c isoforms. The former is exemplified by Fgfr1 transcripts, which show distinct differences in their distribution, being mutually exclusive. Similar functions are suggested by the overlapping expression patterns of the -b and -c isoforms of both Fgfr2 and Fgfr3. Fgfr4 transcripts were found in developing muscles. These data help to explain the disturbances in craniofacial growth exhibited by both patients and the growing number of transgenic mice carrying mutations in genes encoding FGFRs/Fgfrs.

Animals↗

Revascularisation of costochondral grafts: an experimental study in domestic pigs.

Mandibular condyles are reconstructed immediately with costochondral grafts (CCGs) in children for several temporomandibular conditions, including ankylosis, benign neoplasia, and chronic arthritis. A prerequisite for growth of CCGs is that they are properly revascularised, but the revascularisation process has not to our knowledge so far been examined. The aim of the present study was therefore to investigate the revascularisation of CCGs when they were used for immediate reconstruction of the mandibular condyle in juvenile domestic pigs. Eleven mandibular condyles were experimentally resected and immediately reconstructed with CCGs. Microangiograms with an Indian ink solution were done 2, 4, 8, and 12 weeks after the reconstructions. The density of vessels was higher in measurement zones facing soft tissues than in those facing mandibular bone at all time points. Revascularisation of the growth plate originated from the surrounding recipient soft tissues and not from an endosteal blood supply from the host mandible ramus.

Animals↗

[Treatment of mandibular condylar hyperplasia in developmental age. Clinical case].

A case of hyperplasia of the mandibular condyle in a growing-up subject, observed at the Department of Maxillo-Facial Surgery of the University of Rome "La Sapienza", is described. Hyperplasia of the mandibular condyle is a facial asymmetry due to the unilateral overdevelopment of the mandibular bone. In this study the authors underline how bone scintigraphy, 3D tomography and electrognatographic analysis, associated with standard radiography and cephalometry, are important methods of diagnosis in order to make an early diagnosis of hyperplasia of the mandibular condyle and differential diagnosis with other pathologies. In particular, bone scintigraphy is a useful screening procedure to detect if the pathology is in an active phase or not. The 3D tomography is used in pre-surgery to evaluate precisely morphological and structural alterations of the craniofacial bones on a tridimentional base. Finally, the electrognatographic test records the mandibular activity both in physiological and pathological conditions. All these instrumental techniques allow to make a diagnosis and lead to a possible therapeutical approach.

Adolescent↗

Adipose differentiation of cartilage in vitro.

Xiphoids of newborn mice consist of young chondrogenic cells of primary cartilage. During in vitro cultivation, xiphoids showed, morphologically, characteristics of adipose differentiation. This process progressed with time and by day 21 of the culture most of the cells in the xiphoids represented morphological mature adipocytes. During this period, the level of mRNA of lipoprotein lipase, and adipocyte-characteristic gene, increased steadily, while the level of collagen type II mRNA decreased. Continuous DNA synthesis during the cultivation period, even in mature adipocytes confirmed the viability of the cells. Mandibular condyles of newborn mice obtain chondroprogenitor cells as well as young and mature chondroblasts and represent secondary cartilage. Under identical culture conditions mandibular condyles obtained from the same mice undergo osteogenic differentiation and form mature bone within 7 to 10 days. Common to both xiphoids and mandibular condyles is the capacity to transdifferentiate, but they show distinct, divergent differentiation pathways. These findings indicate that cartilagenous tissue of xiphoids undergoes transdifferentiation into adipose tissue in vitro.

Adipose Tissue↗

Clinical and radiological evaluation following surgical treatment of condylar neck fractures with lag screws.

It was the purpose of this study to evaluate the outcome of lag screw osteosynthesis in severely displaced fractures or fracture dislocations of the mandibular condyle as well as intra- and postoperative complications of this technique. From 1980 to 1996 a total of 492 patients with condylar fractures were treated with lag screw osteosynthesis. Clinical and radiological follow-ups were carried out in 230 patients with severely displaced fractures or fracture dislocations of the mandibular condyle. The period between surgery and follow-up was between 6 months and 2 years. The majority of the clinical results were satisfactory presumably due to the anatomically exact reduction of the fragment (93.4%). Extreme anatomic variations of the mandible (5.8%) and incorrect application of the technique (8.8%) resulted in reduced functional stability of lag screw osteosynthesis. Insufficient fragment reduction and postoperative complications (such as wound infection) entailed restriction of mandibular mobility and arthrotic deformations were seen as persistent radiological irregularities of the mandible. It has been possible to avoid complications and to achieve favourable functional results in complicated fractures of the mandibular condyle by applying strict indications for lag screw osteosynthesis and by considering the individual anatomical peculiarities.

Adolescent↗

Participation of Runx2 in mandibular condylar cartilage development.

OBJECTIVE: The purpose of this study was to investigate the expression pattern of Runx2 in mandibular condylar cartilage, a type of secondary cartilage. METHODS: Mandibular condyle of ddY mice were fixed from embryonic day 14 (E14) through just after birth (equivalent to E19). Samples were cut into 4 micro m serial sections through the central area of the mandibular condyle at the sagittal plane. Serial sections were examined using histological, immunohistochemical (IHC) and in situ hybridization (ISH) techniques. RESULTS: There are no developmental features of mandibular condyle. At the distal upper portion of developmental mandibular bone, mesenchymal cell proliferation and condensation without metacholomatic reaction to Toluidine blue (TB) were seen at E14. At E15, mandibular condylar cartilage was clearly evident, as TB metacholomasia. In IHC specimens at E14, expression of Runx2 peptide was observed in the nuclei and the cytoplasms cells of coagulating mesenchymal cells, both in the cytoplasm and nucleus. After E17, Runx2 appeared in the cells of the condylar cartilage sheath. In ISH examination at E14 and E15, expressions of Runx2 mRNA appeared in the cytoplasms of proliferating chondrocytes. From E16 to E18, Runx2 mRNA was detected throughout almost all cytoplasm in all layers. CONCLUSION: These IHC and ISH results suggest that Runx2 plays an essential role for mandibular condylar cartilage development, especially that Runx2 is essential for the onset of secondary cartilage differentiation.

Animals↗

Microscopic changes in the condyle and disc in response to distraction osteogenesis of the minipig mandible.

PURPOSE: Unilateral mandibular distraction osteogenesis (DO) has been shown to cause gross changes in the mandibular condyle and articular disc. The purpose of this study was to correlate histologic findings with these gross changes in a minipig distraction model. MATERIALS AND METHODS: Semiburied distractors were placed via submandibular incisions in 15 minipigs. Two unoperated animals served as controls. The protocol consisted of 0-day latency and rates of 1, 2, or 4 mm/day for a 12-mm gap. After the minipigs were killed (at 0, 24, or 90 days), ipsilateral and contralateral condyles and discs were harvested, decalcified, prepared for standard paraffin embedding, and evaluated to determine changes in 1) morphology and thickness of the articular cartilage and subchondral bone and 2) morphology of the disc. RESULTS: In control animals, there were no degenerative changes in the articular cartilage and underlying condylar bone; there were no significant differences in the mean articular cartilage thickness. The temporomandibular joint discs were normal. In experimental animals, distracted condyles showed increasing degenerative changes and mean articular cartilage thickness as the DO rate increased. The discs were thinner. These changes were present, but to a lesser degree, in the contralateral condyles. After 90 days, degenerative changes in the condyles and discs were reduced, after remodeling, except in the 4 mm/day DO group. CONCLUSIONS: Histologic changes in the condyles and temporomandibular joint discs in response to mandibular DO correlated with previously reported gross changes. These changes were greater at higher distraction rates and remodeling back to normal occurred in mandibular condyles distracted at 1 mm/day.

Animals↗

The costochondral graft: a solution or a source of facial asymmetry in growing children. A case report.

Costochondral grafts are most commonly used to restore severely affected mandibular condyles in growing children. Despite their world-wide use, the growth of costochondral grafts can vary, excess growth being the most consequential problem. A report is presented her of a patient who sustained facial asymmetry to the left as a consequence of retarded growth in the left mandibular condyle. A costochondral graft was used to replace the left mandibular condyle at the age of 12 years 8 months, but six years after the operation the initially pleasing postoperative appearance had given away to facial asymmetry to the right. This was clearly due to the excess growth of costochondral graft. Possible aetiological factors, intrinsic, functional or both, affecting the growth of costochondral grafts are discussed.

Adolescent↗

[Quantitative measuring method for fibers using image processing and analysis].

Previously, the radioisotope labeling and morphometric techniques have been used for the quantitative determination of growth of mandibular condyle by measuring the DNA synthesis or the increased number of cells. However, it is difficult to analyze the dynamics of ESFs (Elastic System Fibers) in the mandibular condyle related to aging, because of changes in the amount, distribution, number of fibers, and density of ESFs. In the present study, therefore, the video-scanning image analyzing technique was used for the quantitative measurement of ESFs in the mouse mandibular condyle. The objects under selected suitable illumination are scanned and focused by the TV camera and lens. The focused image is converted and amplified to obtain the most reliable electric signal by sequential scanning with the relative electronic beam. The original shaded image (electric signals) generated and converted by photo electric converter was filtered by the input slope (detective sensitivity) to detect the relative objects. Next, by inputted contrast, a secondary black-and-white image was detected. Meanwhile, a suitable compensation was also used to eliminate electric noise and dusts by inputting size discrimination. The next step was designed to obtain various quantitative data by measuring areas and diameters of the relative objects after treatment and analyzing of the secondary image, which was outputted from the photo electric converter. The connected LED display showed the measured and counted data, and at the same time the obtained data was automatically printed out for recording. There are many samples that are impossible to distinguish without using specific staining methods, like the ESFs.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗