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PubMed2002

[Evaluation of mandibular movement after condylar fracture].

BACKGROUND: The purpose of this work was to compare results of two treatments for fracture of the mandibular condyle: functional therapy and intermaxillary block. MATERIAL AND METHODS: Forty patients were assessed: 32 unilateral fractures and 8 bilateral fractures. Half of the patients were given functional treatment and half had intermaxillary fixation for 40 days. Mouth opening amplitude, protrusion/retraction, and lateral movements were measured at inclusion, day 15, 30 and 180 for patients in the first group and at inclusion and on day 180 for the blocked patients. RESULTS: Movement amplitude at the end of treatment was always greater in patients given functional treatment. This difference was found for all types of movement. And was even more marked in patients with bilateral fractures. Occlusion was restored in all patients given intermaxillary fixation, but 2 patients in the functional treatment group had an occlusal impairment due to insufficient compliance with the treatment protocol. DISCUSSION: Functional treatment is more adapted than intermaxillary fixation for fractures of the mandibular condyle, particularly for bilateral fractures. Careful surveillance is nevertheless required to avoid malocclusion. An endobuccal device may be helpful in selected cases.

Adult↗
PubMed1985

Endochondral ossification of the condyle in rats on a strontium or low-calcium diet.

The mechanism of abnormal endochondral ossification induced by administration of strontium salts was studied in the mandibular condyles of rats by radiographic, histologic, and histochemical methods. It was shown by radiographic and histologic findings that ossification of the mandibular ramus was clearly inhibited in rats fed a low-calcium diet and rats fed a strontium diet. The change in appearance of the mandibular condyles of the rats fed strontium was more severe than that in those fed low amounts of calcium. From the histochemical findings, it was suggested that the metabolic dysfunction of chondroitin sulfate, periodic acid-Schiff positive materials, and collagen in the hypertrophic zone of the condylar cartilage (or in the part corresponding to trabecular bone of the mandibular ramus) was one factor inhibiting normal endochondral ossification.

Animals↗
PubMed2026

Comparative safety and operative efficiency of surgical approaches for open reduction and internal fixation of mandibular condylar fractures: a systematic review and network meta-analysis.

BACKGROUND: The optimal surgical approach for mandibular condyle fractures remains controversial, particularly regarding the trade-off between facial nerve safety and surgical efficiency. METHODS: Our systematic review and frequentist NMA analyzed studies evaluating open reduction and internal fixation (ORIF) for mandibular condyle fractures. The primary safety outcome was transient or persistent (≥6 months) facial nerve weakness. The efficiency outcome was operative exposure time. Surgical approaches were categorized, and random-effects NMAs estimated odds ratios (ORs) and mean differences (MDs). Treatments were ranked using P-scores, and clustered rankings explored safety-efficiency relationships. RESULTS: Overall, 121 studies (n = 6659 patients) were included. For facial nerve safety, endoscope-assisted (EA), preauricular transmasseteric anteroparotid (PATMA), and high submandibular (HSMA) approaches ranked highest, while the retromandibular transparotid (RMTA) approach carried a higher risk. Analyses restricted to persistent weakness yielded consistent results. For exposure time, submandibular (SM), HSMA, and retromandibular transmasseteric anteroparotid (RMTMA) approaches were most efficient. Clustered ranking analysis identified HSMA and RMTMA as achieving the best overall balance between safety and efficiency. Subgroup analyses confirmed the overall hierarchy, though evidence for high-level and intracapsular fractures remains limited. CONCLUSIONS: HSMA and RMTMA offer an optimal compromise between safety and efficiency for extracapsular condylar fractures, while EA may minimize nerve injury risk where technical expertise allows. High-quality comparative trials - particularly for intracapsular fractures - are warranted.

Humans↗
PubMed2002

Three-dimensional evaluation of positional change of the condyle after mandibular setback by means of bilateral sagittal split ramus osteotomy.

OBJECTIVE: The aim of this study was to evaluate condylar displacement in 3 dimensions by means of computed tomography after mandibular setback by sagittal split ramus osteotomy with rigid fixation and to compare these results with those from patients with mandibular advancement. STUDY DESIGN: Thirty Korean subjects with skeletal class III malocclusion who had undergone mandibular setback by sagittal split ramus osteotomy had computed tomographs taken. Tomographs were taken to evaluate the temporomandibular joint 1 month before and approximately 1 month after surgery. The position and angulation of the condyle were measured on axial or sagittal views. These measurements were analyzed to determine any correlations between the amount of mandibular movement and condylar displacement. RESULTS: The results of this study show that the condyle tends to move inferiorly and rotate inward on the axial view and backward on the sagittal view by a statistically significant amount. CONCLUSION: The positional change of the condyle after sagittal split ramus osteotomy was not correlated with the amount of the setback.

Adolescent↗
PubMed1983

[Mandibular hypercondylosis. Signs and diagnosis].

Mandibular condyle hyperplasia is typically characterized by an hypertrophy and an increased growth activity of one of the mandibular condyles (except, in the rare cases of bilateral involvement). The homo-lateral descent of the molar occlusal plane, leads to generalised adaptive alterations of the maxilla and the entire facial skeleton, which justifies pre-pubescent condylar surgery. Thus, the early diagnosis of the affliction is preferable, based on a thorough knowledge of these clinical signs.

Adolescent↗
PubMed1993

Early surgical correction of unilateral TMJ ankylosis and improvement in mandibular symmetry with use of an orthodontic functional appliance--a case report.

Early ankylosis of the temporomandibular joint (TMJ) can be a deterrent to normal mandibular growth. The frequency of occurrence is rare in the population of young patients who undergo orthodontic treatment. Early diagnosis of TMJ ankylosis is important and early surgical intervention is now an accepted mode of treatment. Ankylosis infers minimal, if any joint function. Caldwell argues that restoration of joint function at an early age is necessary to activate as much growth potential as possible. Laboratory and clinical studies have supported the theory that the mandibular condyle is adaptable under function and perhaps even the most deformed condylar head may exhibit growth when released and placed in function. The purpose of this article is to present a case report of surgical release of TMJ ankylosis followed by radiographic and clinical evidence of unilateral condylar growth. The surgical procedure involved maintenance of the condyle, the disk and majority of fibrocartilage covering the mandibular condyle. Aggressive postoperative physical therapy and the employment of a functional orthodontic appliance appeared to have assisted in a more symmetric growth pattern and maintenance of appropriate function.

Ankylosis↗
PubMed2006

The change of stress distribution on the condyle after mandibular setback surgery.

The rigid-body spring model (RBSM) theory was incorporated into a model as a discrete method for analysing problems of limit, such as the stress distribution on the condyle. The purpose of this study was to evaluate the two-dimensional RBSM for determining stress on the temporomandibular joint (TMJ) in patients after orthognathic surgery. Thirty-two patients (five males and 27 females, mean age 21.4 +/- 4.9 years) with mandibular prognathism underwent bilateral sagittal split ramus osteotomy (SSRO) and setback; 48 subjects were recruited as controls. Anatomical landmarks were traced from pre- and post-operative lateral cephalograms and the information was processed using the Fortran analysis program. The force vector on the condyle, its degree, its direction, and the displacement co-ordinates (x, y) and rotation (theta) at the gonial angle were calculated. When muscular power was assumed to be 1, the post-operative degree of the force vector was higher than the pre-operative value (P < 0.05). The X co-ordinate, x, and rotation, theta, of the displacement vector in the pre-operative patients with mandibular prognathism were significantly higher than those in the control subjects (P < 0.05). There were still significant differences between the displacement values post-operatively between the patients and controls (P < 0.05). The results suggest that the degree and direction of the force vector and the resulting displacement co-ordinates can be used as parameters in a surgical model. The RBSM may also be useful in evaluating the pre- and post-operative skeletal morphology of jaw deformities.

Adult↗
PubMed1999

Condylar cartilage response to continuous passive motion in adult guinea pigs: A pilot study.

This article reports on the development and testing of a continuous passive motion device suitable for experimental animals and on the effect of 1 week of continuous passive motion on the thickness of the condylar cartilage in adult guinea pigs. Continuous passive motion is currently used for postsurgical joint therapy and consists of moving a synovial joint passively and constantly through its normal range of motion. In this study continuous passive motion was applied to the temporomandibular joints of two experimental animals for 7 hours per day for 5 days. Two animals were restrained for the same amount of time that the experimental animals were on the continuous passive motion machines (control group 1), and two animals were allowed normal cage activity (control group 2). Six weeks later all animals were sacrificed. Each mandibular condyle was sectioned sagitally, and routine histologic sections were prepared with hematoxylin-eosin stain. Microscopic examination of the mandibular condylar cartilage of the animals placed on continuous passive motion showed a marked increase in thickness compared with the condylar cartilage found on the control animals. The condylar cartilage of the animals placed on continuous passive motion averaged 345 microm, and the controls averaged 232 microm. These findings demonstrate the application of continuous passive motion in an experimental model and provide interesting information regarding the response of the mandibular condyle to increased motion. More studies are necessary to further investigate the effect of continuous passive motion on the condylar cartilage.

Animals↗
PubMed1997

Preserving the posterior superior synovial recess during allograft TMJ diskal condylar transplantation in the adult goat.

OBJECTIVE: The purpose of the study was to test the hypothesis that sparing the posterior superior synovial recess during the resection of temporomandibular joint condyle and disk would maintain a critical mass of synovium necessary to predictably achieve a successful allograft joint reconstruction. STUDY DESIGN: A group of 15 adult goats underwent unilateral resection of their temporomandibular condyle and meniscus. The fossa and posterior superior synovial recess were left intact. They were immediately reconstructed with cryogenically preserved allograft mandibular condyles and temporomandibular joint disk harvested from 15 adult donor goats. The animals were evaluated clinically and radiographically at 6 and 12 months and histologically at 12 months. RESULTS: Of the 15 animals, 13 met all the criteria to be declared a success and retained the posterior superior synovial recess. CONCLUSION: Immediate joint reconstruction using cryogenically preserved mandibular condyles and temporomandibular joint disk can have a high rate of success if the native posterior superior synovial recess remains intact.

Animals↗
PubMed1999

In situ hybridisation study of type I, II, X collagens and aggrecan mRNas in the developing condylar cartilage of fetal mouse mandible.

The aim of this study was to investigate the developmental characteristics of the mandibular condyle in sequential phases at the gene level using in situ hybridisation. At d 14.5 of gestation, although no expression of type II collagen mRNA was observed, aggrecan mRNA was detected with type I collagen mRNA in the posterior region of the mesenchymal cell aggregation continuous with the ossifying mandibular bone anlage prior to chondrogenesis. At d 15.0 of gestation, the first cartilaginous tissue appeared at the posterior edge of the ossifying mandibular bone anlage. The primarily formed chondrocytes in the cartilage matrix had already shown the appearance of hypertrophy and expressed types I, II and X collagens and aggrecan mRNAs simultaneously. At d 16.0 of gestation, the condylar cartilage increased in size due to accumulation of hypertrophic chondrocytes characterised by the expression of type X collagen mRNA, whereas the expression of type I collagen mRNA had been reduced in the hypertrophic chondrocytes and was confined to the periosteal osteogenic cells surrounding the cartilaginous tissue. At d 18.0 of gestation before birth, cartilage-characteristic gene expression had been reduced in the chondrocytes of the lower half of the hypertrophic cell layer. The present findings demonstrate that the initial chondrogenesis for the mandibular condyle starts continuous with the posterior edge of the mandibular periosteum and that chondroprogenitor cells for the condylar cartilage rapidly differentiate into hypertrophic chondrocytes. Further, it is indicated that sequential rapid changes and reductions of each mRNA might be closely related to the construction of the temporal mandibular ramus in the fetal stage.

Aggrecans↗
PubMed1998

Biomechanical considerations of mandibular lengthening and widening by gradual distraction using a computer model.

PURPOSE: Experience using distraction osteogenesis for limb lengthening has shown the importance of appliance orientation. Although successful results of mandibular lengthening using osteodistraction have been reported, optimal orientation of the distractors relative to the mandible has not been determined. The purpose of this study was to evaluate the biomechanical effects of linear distractors placed parallel to the body of the mandible or parallel to the axis of distraction. MATERIALS AND METHODS: A two-dimensional model of the human mandible was generated for computer simulation of mandibular osteodistraction. Linear distractors were then analyzed based on their orientation, either parallel to the body of the mandible or parallel to the axis of distraction. In addition, two types of distraction osteogenesis procedures for mandibular reconstruction were analyzed: 1) bilateral mandibular lengthening, and 2) bilateral mandibular lengthening in combination with midline mandibular widening. RESULTS: Distractors oriented parallel to the body of the mandible caused a lateral displacement of the posterior components of the distraction devices and a reduction of the midline distraction gap during mandibular lengthening. These effects were eliminated when the device was oriented parallel to the axis of distraction. Midline symphyseal widening created axial rotation of the mandibular condyles regardless of the orientation of the distractors. CONCLUSIONS: Distraction appliances must be oriented parallel to the axis of distraction to prevent adverse biomechanical effects during bilateral mandibular lengthening. Additional ramus osteotomies, using hinged devices for angular correction, may be necessary to compensate for rotational movements of the mandibular condyles secondary to midline osteodistraction.

Biomechanical Phenomena↗
PubMed2006

Ultrasonographic findings in normal temporomandibular joints.

The purpose of this study was to determine some ultrasonographic standards of temporomandibular joints with normally positioned discs. Nineteen patients from 18 to 45 years old (average age: 27.4 years; 16 females and 3 males), with history of orofacial pain, but without clinical or radiological signs of disc displacement, underwent ultrasonography (US) and magnetic resonance imaging (MRI) for the examination of their joints. In 30 joints, the distance between the most lateral point of the articular capsule and the most lateral point of the mandibular condyle (lateral capsule-condyle distance) was measured, as well as the distance between the most anterior point of the articular capsule and the most anterior point of the mandibular condyle (anterior capsule-condyle distance). In the closed-mouth position, the average values found for the lateral capsule-condyle distance were 1.4 mm and 1.6 mm, respectively in the longitudinal (coronal) and transverse (axial) scans. In the open-mouth position, the average distance was 1.2 mm, in both longitudinal (coronal) and transverse (axial) scans. The average values found for the anterior capsule-condyle distance were 2.3 mm in the closed-mouth position and 1.1 mm in the open-mouth position, both in transverse (axial) scans. Intra-examiner agreement, measured in terms of the intraclass correlation coefficient, varied from 0.83 to 0.93. We believe that this study can contribute to the validation of US as a diagnostic method for temporomandibular joint disorders, provided that the obtained measurements be used in future studies as normal reference values.

Adolescent↗
PubMed2000

Synthesis of mRNAs for cathepsins L and K during development of the rat mandibular condylar cartilage.

Cathepsins are cysteine proteinase family members which are known to degrade proteoglycan and collagen, components of several extracellular matrices. Their functions in the condylar cartilage during skeletal development have not yet been fully clarified. In this study, we investigated the mRNA expression of cathepsins L and K in the growing rat mandibular condylar cartilage, as compared to that in the rat long bone cartilage, by in situ hybridization, reverse transcription polymerase chain reaction (RT-PCR) and Southern blotting analysis. In the condylar cartilage, cathepsin L mRNA expression was widely observed throughout the zones of maturative and hypertrophic chondrocytes at embryonic day (E) 17 and postnatal day (P) 1. The signal was restricted to maturative and upper hypertrophic chondrocytes at P7, and finally it became undetectable by P28. In the long bone cartilage, cathepsin L was not expressed in the chondrocytes at any stage. Cathepsin K mRNA was not, however, detected either in the mandibular condylar cartilage cells or in the long bone cartilage cells but it was selectively detected in osteoclasts in calcified cartilage and bone in both tissues. RT-PCR also showed a similar mRNA expression pattern of cathepsins L and K. These results indicate that cathepsins L and K may be involved in the skeletal development of both the long bone and the mandibular condyle. Furthermore, cathepsin L may play an important role in the degradation of the cartilaginous extracellular matrix in maturative and hypertrophic cell layers during successive developmental stages of the mandibular condyle.

Animals↗
PubMed2005

Biomineralization and adaptive plasticity of the temporomandibular joint in myostatin knockout mice.

Mice lacking myostatin (GDF-8), a negative regulator of skeletal muscle growth, show a significant increase in muscle mass versus normal mice. We compared wild-type and myostatin deficient mice to assess the postnatal effect of elevated masticatory loads due to increased jaw-adductor muscle activity and greater bite forces on mandibular condyle morphology. Microcomputed tomography (microCT) was used to provide details of internal condylar morphology and quantify bone density in three condylar regions. Biomineralization levels, as well as external mandibular dimensions, were used to characterize within-slice, within-joint, within-group and between-group variation. Dimensions of the mandible and mandibular condyle were similar between the myostatin knockout and normal mice. Knockout mice exhibited significantly more biomineralization on the outer surface of the condylar subchondral bone and along the condylar neck, most notably on the buccal side of the condylar neck. The buccal side of the inner aspect of the condyle was significantly less biomineralized in knockout mice, both for the pooled data and for the posterior and anterior condylar slices. Whilst normal mice had symmetric subchondral bone surfaces, those of knockout mice were asymmetric, with a lower, less convex surface on the buccal side versus the lingual side. This appears related to the ontogenetic effects of increased masticatory stress in the mandibles of knockout mice as compared to normal mice. Significant differences in biomineralization between normal and myostatin knockout mice, coupled with the lack of significant differences in certain external dimensions, underscores a need for information on the external and internal morphology of mineralized tissues vis-à-vis altered or excessive mechanical loads.

Adaptation, Physiological↗
PubMed2006

Effects of orthodontic treatment with fixed functional orthopaedic appliances on the disc-condyle relationship in the temporomandibular joint: a magnetic resonance imaging study (Part II).

OBJECTIVES: This study aimed to verify the effects that corrective treatment for skeletal Class II malocclusions with fixed functional orthopaedic appliances has on the relative positions of the articular disc and the mandibular condyle. METHODS: Orthodontic treatment progress was monitored in 20 patients by magnetic resonance imaging (MRI) at four defined points in time. Visual inspection of the temporomandibular joints (TMJs) was performed on three slices each (lateral, central, medial) of closed-mouth and maximum-open parasagittal MRI. Metric analysis was performed on the central slices of the images obtained in the closed-mouth position. To assess the positional relationship in the sagittal dimension between the articular disc and the mandibular condyle, both methods were used. RESULTS: The comparison of pre-treatment and post-treatment findings revealed in none of the joints that the disc-condyle relationship had been adversely affected as a consequence of the treatment. Rather, the outcome was an improved relationship in a total of eight joints. After groups of joints had been defined by disc position, metric analysis revealed a significantly improved positional relationship in those joints in which an anterior disc displacement had been found initially. CONCLUSION: Orthodontic treatment with a rigid, fixed functional appliance to correct skeletal distoclusion results in the following side effects on the disc-condyle relationship in the TMJ: the treatment does not have adverse effects on initially physiological disc-condyle relationships; in TMJs with initial partial or total anterior disc displacement, improved disc position can be achieved.

Adolescent↗
PubMed1990

Axial temporomandibular joint morphology: a correlative study of radiographic and gross anatomic findings.

In degenerative diseases of the temporomandibular joint the mandibular condyle demonstrates changes in contour, including flattening and enlargement, resulting in an increased diameter of the articular surface. The purpose of this study was to determine if such alterations in the shape of the mandibular condyle can be visualized in submentovertex (axial) radiographs and correlated with pathologic changes of the temporomandibular joint. Submentovertex radiographs of 18 human cadaver specimens were made. The radiographic condylar dimensions, morphologic condylar outline, and angle of the condylar axis with respect to the transmeatal line were determined. The specimens were dissected and disarticulated, and radiographic findings were compared to anatomic structure. Osseous abnormalities were found in 21 of the 36 joints studied (58%). Perforations of the disk were found in nine of 31 joints (29%) investigated. No statistically significant differences between the normal condyles and condyles displaying osseous abnormalities were found in any of the radiographic parameters studied.

Adult↗
PubMed1986

Growth and growth pressure of mandibular condylar and some primary cartilages of the rat in vitro.

To compare the in vitro development of the secondary cartilage of the mandibular condyle with that of primary cartilages, several cartilaginous explants derived from 4-day-old rats were cultured in a serum-free culture system. The following cartilages were used: the mandibular condylar cartilage, the distal epiphyseal cartilage (including the growth plate) of the third metatarsal, a fragment of costal cartilage (including the osteochondral junction) of the fourth rib, the spheno-occipital synchondrosis and the chondroepiphysis of the femoral head. In addition, with a specially designed, in vitro pressure registration system, the maximal growth pressures for each of the explants, except the femoral head, were determined. The results show an independent growth potential for the primary cartilages of the epiphyseal and costal growth plates with a maximal growth pressure of 9.5 and 7.8 g/mm2, respectively. The primary cartilage of the spheno-occipital synchondrosis, on the other hand, although it possesses an independent growth potential, could exert a maximum growth pressure of only 1.5 g/mm2. The secondary cartilage of the mandibular condyle showed a limited intrinsic growth potential, as well as a low maximal growth pressure (2.6 g/mm2). If calculated per dividing and/or matrix synthesizing cell (cells mainly responsible for the cartilage growth), the cells of the condylar cartilage showed the least growth potency (0.08 mg/cell in comparison to 1.9, 1.5 and 0.3 for epiphyseal, costal, and synchondroseal cartilages, respectively.

Animals↗
PubMed1997

Effects of transforming growth factor-beta 1 and interleukin-1 alpha on matrix synthesis in osteoarthritic cartilage of the temporo-mandibular joint in aged mice.

Osteoarthritic lesions were observed in the mandibular condyle cartilage of mice aged 7 months and older. These lesions appeared as fibrillations along the articular surface and were accompanied by reduced extracellular matrix synthesis and chondrocyte proliferation. Explants of mandibular condyle cartilage were cultured in serum-free BGJb medium supplemented with ascorbic acid (300 micrograms/ml), penicillin (100 U/ml) and streptomycin (100 micrograms/ml) for up to 72 h. Cultures were further supplemented with either hTGF-beta 1 (0.1-5.0 ng/ml) or human IL-1 alpha (40 U/ml). [3H]thymidine (2 microCi/ml) and [35S]SO4 (10 microCi/ml) were added to the culture medium for the last 24 h of culture and incorporation into DNA and sulfated proteoglycans, respectively, studied. The results indicated that protein and DNA contents, [3H]thymidine and [35S]SO4 incorporation, as well as the specific activity of alkaline phosphatase, were increased by TGF-beta 1. Addition of 1.0 or 5.0 ng/ml hTGF-beta 1 to the cultures for 48 h, had the most stimulatory effect on matrix synthesis and cell proliferation, whereas 0.1 ng/ml hTGF-beta 1 appeared to be inhibitory when compared to controls. Increased [35S]SO4 labeling of chondrocyte clusters was observed by autoradiography in tissue sections from cultures treated with TGF-beta 1 (1.0 and 5.0 ng/ml). In contrast, IL-1 alpha exerted inhibitory effects on cell proliferation and matrix synthesis. However, it induced the activity of acid phosphatase in these cultures. The results of the present study show that IL-1 alpha had catabolic effect on his tissue, while TGF-beta 1 enhanced proliferation and induced synthetic activity of the cartilage cells. Such action by TGF-beta suggests the existance of a possible repair process in osteoarthritic cartilage of the temporo-mandibular joint of aged mice.

Aging↗