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PubMed1999

Condyle position as a predictor of temporomandibular joint internal derangement.

STATEMENT OF PROBLEM: The significance of the position of the mandibular condyle in the glenoid fossa remains a controversial subject. PURPOSE: This study evaluated the relationship between condyle position and disk displacement. MATERIAL AND METHODS: Fifty-two asymptomatic volunteers and 130 symptomatic patients underwent linear tomography and bilateral temporomandibular joint magnetic resonance scans. RESULTS: There was a higher prevalence of distal condyles in symptomatic patients with disk displacement compared with asymptomatic volunteers (P <.05). Distally positioned condyles identified joints with disk displacement with reduction, disk displacement without reduction, or a symptomatic normal joint with a sensitivity of 0.64, 0.56, and 0.33, respectively. Distally positioned condyles identified joints with disk displacement with reduction, disk displacement without reduction, or a symptomatic normal joint with a specificity of 0.56, 0.65, and 0.55, respectively. CONCLUSION: There were more distal condyles in symptomatic subjects with disk displacement, but the reliability of a distal condyle to predict the presence or absence of disk displacement was low.

Cephalometry↗
PubMed2005

The effect of condyle fossa relationships on head posture.

Although it is commonly accepted that there is an interrelationship between the temporomandibular joint (TMJ) and head posture, few, if any, previous studies have quantified this effect. The purpose of this study is to quantify the effect of a change in the condyle fossa relationship of symptomatic temporomandibular joints on head posture. Charts of 51 patients (N=10 men and N=41 women) with symptomatic TMJ pathology were reviewed. The condyle fossa relationships were measured pre- and posttreatment using sagittal corrected hypocycloidal tomography. The amount of slant between the shoulder and external auditory meatus (EAM) was measured in pre- and posttreatment photographs as an indicator of forward head posture; less slant indicates better posture. Subjects ranged in age from 13-74 years (mean=43.1) and had been treated for an average of 5 months. Comparisons with pre-treatment measures showed that after treatment, the amount of retrodiskal space was significantly increased by an average of 1.67 mm on the left side (t=-10.11, p<0.0001) and 1.92 mm on the right (t=-9.62, p<0.0001). Comparisons also showed that after treatment, the amount of slant between the shoulder and EAM decreased by 4.43 inches on average which was also significant (t=13.08, p<0.0001). Improvement in the condyle fossa relationship was related to decreased forward head posture. This suggests that optimizing mandibular condyle position should be considered in the management of forward head posture (adaptive posture).

Adolescent↗
PubMed1980

Fracture of glenoid fossa following mandibular trauma.

A case of glenoid fossa fracture secondary to mandibular trauma is reported. Subjectively, this injury is characterized by pain in the temporomandibular region of the injured side and by mandibular function impotence. Objectively, there is disappearance of the mandibular condyle from the pretragic region, mandibular lateral deviation toward the fractured side, and premature occlusal contacts on the injured side. The injury can be definitively diagnosed only with a temporomandibular joint radiographic examination of them, which includes a lateral and front-back projection stratigraphy. The surgical techniques currently used in these cases are also discussed.

Adult↗
PubMed2005

Significance of a glenoid fossa approach for management of extensive lesions in the lateral skull base.

OBJECTIVE: This article is designed to relate our experiences with a glenoid fossa approach for exposing the outer border of extensive lesions in the lateral skull base. MATERIALS AND METHODS: In this series, there were five large paragangliomas with the longest diameter of 6.5 cm in length, one large jugular schwannoma with extratemporal components, and one severe case of petromastoiditis with otogenic pachymeningitis, edema of the temporal lobe, and mental disorder. All lesions of these cases were treated via a glenoid fossa approach combined with other reasonable approaches. RESULTS: The glenoid fossa approach resulted in crucial advantages: 1) it effectively exposes the outer border of extensive lesions in the lateral skull base; 2) it provides safe distal control of the facial nerve and internal carotid artery in the skull base; 3) it obviates the need for anterior transposition or rerouting of the facial nerve; and 4) it obviates sacrifice of the intact middle ear or section the mandibular condyle. There is no postoperative mandibular dysfunction because the mandibular articular capsule and articular tubercle are kept intact. CONCLUSION: On the basis of our experiences, the glenoid fossa approach is a safe, quick, and useful design for adequate exposure of the outer border of extensive lesions in lateral skull base surgery.

Adult↗
PubMed2001

MR evidence of temporomandibular joint fluid and condyle marrow alterations: occurrence in asymptomatic volunteers and symptomatic patients.

The purpose of this study was to estimate the frequency and amount of temporomandibular joint (TMJ) fluid, as well as the frequency and type of condyle marrow alterations in asymptomatic volunteers and compare to patients with TMJ pain and dysfunction. Proton-density and T2 weighted magnetic resonance (MR) images of the TMJs of 62 asymptomatic volunteers and 58 symptomatic patients were analysed for fluid and condyle marrow alterations as well as disk position. The amount of fluid (increased T2 signal) was characterized as none, minimal, moderate or marked and related to the disk position. The differentiation between moderate and marked fluid was based on the maximum amount of fluid seen in the volunteers; more than this amount was categorized as marked fluid. The marrow of the mandibular condyle was categorized as normal, edema (increased T2 signal) or sclerosis (decreased proton-density and T2 signal) and related to fluid and disk position. In the 62 asymptomatic volunteers, 50 (81%) had none or minimal and 12 (19%) had moderate TMJ fluid. In the 58 symptomatic patients, 40 (69%) had none or minimal and 18 (31%) had moderate or marked fluid. Both in volunteers and patients, moderate fluid could be seen in joints with normal disk position, but was significantly associated with disk displacement. In the 62 volunteers, no signal abnormalities in the condyle marrow were found. In the 58 patients, six (10%) had abnormal bone marrow. These six patients had disk displacement and two had moderate or marked fluid. Marked fluid and condyle marrow abnormalities were therefore not encountered in any of the asymptomatic volunteers but in about 10% of the patients.

Adolescent↗
PubMed1999

An adjustable bone fixation system for sagittal split ramus osteotomy: preliminary report.

After sagittal split osteotomy, osteosynthesis for stabilization of the fragments is usually performed by means of rigid or semirigid fixation to avoid maxillomandibular fixation (MMF). Sometimes, this leads to malpositioning of the fragments with resulting 'immediate relapse' or disturbances of the temporomandibular joints (TMJs) such as progressive idiopathic condylar resorption, which is the worst effect. We have therefore developed a new bone fixation system that allows three-dimensional adjustment even after fixation of the fragments. The special configuration of the system avoids intraoperative dislocation of the mandibular condyle. We have used the method successfully in 40 patients, 27 of whom had mandibular retrognathism and 13 of whom had mandibular prognathism. In particular, there has been no evidence of resorptive changes. There were no postoperative complications.

Adolescent↗
PubMed2001

Early treatment of angle Class II, division 2 in combination with functional therapy of TMJ fracture.

Children who have sustained condylar fractures are treated with functional appliances because surgical repositioning of the condyle is more resource-intensive without producing better results. In cases with additional malocclusions it is practicable to combine the functional therapy of the fracture with skeletal Class II therapy. A 10-year-old boy suffering from a left condylar fracture and showing Class II, Division 2 malocclusion was treated with a skeletal functional appliance in combination with a utility arch for uprighting of the incisors. A modified transpalatal bar was then used to retain the incisor position. The remodeling process of the mandibular condyle following its fracture with dislocation signifies a high adaptability of the affected tissues. This reaction can be used simultaneously for effective sagittal repositioning of the mandible in certain cases of Class II malocclusion.

Athletic Injuries↗
PubMed2005

Architecture and mineralization of developing cortical and trabecular bone of the mandible.

Ossification of the presumptive trabecular bone in the mandibular condyle and the presumptive cortical bone in the mandibular corpus of the pig mandible was investigated during development, using micro-computed tomography (microCT). Three-dimensional architecture and mineralization characteristics were assessed from ten pigs of different developmental ages. In the condyle, increases in trabecular thickness and separation and a decrease in the trabecular number, led to an unchanged bone volume fraction. A conversion from rod-like into plate-like trabeculae was observed. Bone volume and trabecular thickness were always higher in the corpus, where an increase in bone volume fraction was caused by an increase in the trabecular thickness and a decrease in separation. A transition from a plate-like structure into a more compact structure took place. The average degree of mineralization in the condyle and the corpus increased with age. In the corpus, the degrees of mineralization were higher than in the condyle. The differences between the condyle and corpus and the changes with age could be explained by differences in the distribution of mineralization within the trabecular elements. Generally, the degrees of mineralization increased from the surface toward the centers of the trabecular elements, indicating growth of the trabecular elements by the surface apposition of new mineral.

Animals↗
PubMed1975

[Luxation-fractures of the temporomandibular process in orthopantomogram].

The orthopantomogram (according to Paatero) offers a first orientation survey for diagnosing a fracture-dislocation of the neck of the mandibular condyle. It is easy to take, does not cause any pain, and involves relatively little exposure to radiation. Its value for diagnosing should not, however, be overestimated, since the number of errors is outstandingly high as the present investigation has shown. Only in very few cases it may be sufficient for making the diagnosis. Generally, several radiograms taken in at least two different planes of the temporomandibular joint region are required for establishing an exact diagnosis of a fracture-dislocation of the condyle.

Humans↗
PubMed2000

Planar versus SPET imaging in the assessment of condylar growth.

The aim of this study was to compare two methods of quantifying 99Tc(m)-methylene diphosphonate uptake in the mandibular condyle. The study groups consisted of 23 patients with mandibular asymmetry and 16 normal volunteers aged 10-30 years. The accuracy and reproducibility of SPET using condyle-to-clivus ratios was compared with planar analysis using condyle-to-L4 (fourth lumbar vertebra) ratios. Quantitative analysis was correlated with semi-quantitative grading by three observers. Normal ranges for condyle-to-L4 and condyle-to-clivus ratios in individuals aged 11 years or over were determined. These ratios are useful in the serial monitoring of patients with condylar hyperplasia to establish when condylar growth has ceased and hence the type of surgery performed. Visual interpretation of condylar activity should use a combination of planar and SPET images and be performed in conjunction with quantitative analysis. Semi-quantitative grading on SPET images detected more subtle differences in condylar activity than planar images (using quantitative analysis as a standard).

Adolescent↗
PubMed1978

Treatment prostheses in TMJ dysfunction-pain syndrome.

Various types of acrylic resin therapeutic prostheses commonly used in the treatment of TMJ dysfunction-pain syndrome were described. Each design was related to recent data concerning optimum condylar positions in the fossae, the physiologic condylar suspension system, and individual treatment objectives for repositioning the mandibular condyles. For example, alteration of the vertical dimension of occlusion is a popular treatment procedure that is empirical in nature and is usually used without TMJ radiographs or a differential diagnosis. It can violate the physiologic requirements of the interocclusal distance or the speaking space and does not necessarily move the condyles forward as has been commonly thought. The dangers of empirical treatment procedures for a multicausal dysfunction syndrome have been pointed out. An example was cited where the mandible was moved forward for a long period of time with a repositioning prosthesis; this produced pathologic TMJ remodeling and continued pain. It was recommended that specific mandibular repositioning be based on the type of condylar displacement observed on the radiographs. Sometimes the condyles should be retruded, and other times they should be repositioned anteriorly or occasionally inferiorly on one side. Long-standing use of any acrylic resin repositioning prosthesis is contraindicated, particularly without close supervision. Acrylic resin anterior bite plates (with a minimum opening of 1 mm) were recommended for the relief of acute trismus or intractable pain. Usually the prosthesis is used in conjunction with heat and drug therapy. This type of prothesis can also be utilized to deprogram the muscles when a strong habit of eccentric occlusion develops as a result of missing teeth. (This should be confirmed by TMJ radiographs.) Occasionally atypical pain is present and a differential diagnosis can be established between TMJ dysfunction or neurologic etiology by the physiologic response to bite plate therapy. When it is necessary to reposition the mandibular condyles anteriorly the occlusion is adjusted to provide the planned anterior movement without increasing the vertical dimension of occlusion. A temporary acrylic resin prosthesis is used to retrain the muscle programming to the anterior therapeutic mandibular position. When the symptoms are relieved and the corrective condylar position is confirmed with TMJ radiographs, a more permanent repositioning prosthesis is made. The treatment of TMJ dysfunction-pain syndrome should be based on documented data including the pain history, TMJ radiographs, condylar position in the fossae, electromyographic evidence, and occlusal analysis. This information will help determine if the patient's centric relation is functional or dysfunctional and will indicate the recommended treatment procedures.

Acrylic Resins↗
PubMed1997

Case report: dentofacial orthopedic and surgical orthodontic treatment in hemifacial microsomia.

The patient showed bilateral agenesis of the mandibular condyle and glenoid fossa, rare features of hemifacial microsomia. The patient was treated with functional appliances to modify mandibular growth during active facial growth. After the pubertal growth spurt, treatment included rotational advancement of the mandible combined with alloplastic reconstruction of the condylar process and glenoid fossa.

Child↗
PubMed1975

Anatomy and histology of the human temporomandibular joint.

1. The anatomy and histology of the human temporomandibular joint indicates that the meniscus is firmly attached to the mandibular condyle and that during translatory movements the meniscus and condyle move concomitantly. The lateral pterygoid muscle, both inferior and superior heads insert into the meniscus and the pterygoid fovea of the condyle. 2. The structure of the gracilis and pars posterior indicate that these are the parts of the meniscus that are exposed to friction during jaw movement. It is suggested that during hinge movement the sagittal crest of the condyle moves from underneath the pars posterior to underneath the pars gracilis. 3. The restraining ligament for the articulation appears to be the lateral ligament. Its function is to keep the articular surfaces relatively close together during movement and to restrain lateral and posterior movements of the condyle. Its intimate association with the deep fibres of the masseter muscle appears to be important. 4. The fact that the meniscus is thicker medially than laterally would indicate that its major function is to smooth out the incongruities between the joint surfaces. 5. The sphenomandibular ligament as well as being a 'guy' ligament is intimately associated with the postero-superior medial capsular meniscal complex. The medial capsular complex would seem to contribute to the major part of the anterior ligament to the malleus. 6. Remodelling of the articular surfaces occur throughout life by progressive and regressive remodelling. However, if the remodelling processes increase, either the medio-lateral or antero-posterior dimensions of the joint an osteoarthritic condition prevails. 7. Excessive progressive remodelling appears to be due to abnormal positions of the condyle in the maximal intercuspal position. It can be caused by orthodontic procedures or by experimental displacement of the condyle. 8. The transitional zone appears to be important in the aetiology of osteoarthritis since when this zone comes under pressure proliferation of cartilage cells occur which may be transformed into bone, resulting in the hooked condyle.

Cartilage, Articular↗
PubMed1995

Mandibular skeletal changes induced by early functional treatment of Class III malocclusion: a superimposition study.

A superimposition study on mandibular stable structures was performed to evaluate changes in mandibular rotation and in the direction of condylar growth induced by early treatment of Class III malocclusion by a functional appliance (removable mandibular retractor). A sample of 18 children with treated Class III malocclusions, mean age at the first observation (immediately before the beginning of treatment) 5.47 +/- 1.14 years, mean age at the second observation 8 +/- 1.29 years, mean observation period 2.5 +/- 0.9 years, was compared with a control group of 18 children with untreated Class III malocclusions, mean age at the first observation 5.72 +/- 1.11 years, mean age at the second observation 7.86 +/- 1.44 years, mean observation period 2.27 +/- 0.92 years. No statistically significant difference between the two groups was recorded for positional (total) rotation of the mandible. A significant upward-forward direction of condylar growth was assessed in the treated group (p < 0.001). This therapeutically induced change in growth direction of the mandibular condyle was considered a skeletal sign of anterior morphogenetic rotation of the mandible, i.e., a mechanism compensating for excessive mandibular growth.

Adaptation, Physiological↗
PubMed2004

Three-dimensional changes in the condyle during development of an asymmetrical mandible in a rat: a microcomputed tomography study.

A rapidly growing postnatal animal model was used to study changes in the calcified tissue of the mandibular condyle during altered muscle function. A maxillary occlusal splint was designed to shift the mandible laterally (left) during closure. Groups of 5 Wistar rats were killed at 5, 9, 15, 21, 30, and 40 weeks (n = 30), with an equal number of controls. The experimental animals developed shorter, asymmetrical mandibles compared with the control animals. The left condyle became larger and thicker than the right condyle. Microcomputed tomography assessment of the left and right condylar trabecular bone indicated that both had less bone volume than the control condyle. The right masseter muscle significantly lost fiber size and type IIA oxidative fibers, suggesting that the right masseter muscle was used with less tension development. In contrast, the left masseter maintained its fiber size and was similar to the control masseter fiber diameters. Comparison in the sequence of changes indicated that the morphologic changes occurred first in the ramus (age, 5 weeks), before the corpus (age, 15 weeks), and before changes in masseter fiber size and composition (age, 9 weeks). This study showed that both the mandible and the condyle modified their shape and size, as well as the trabecular bone of the condyle, during shifting of the mandible to one side as it closed.

Animals↗
PubMed2007

Histomorphology of the mandibular condylar cartilage in greater galagos (Otolemur spp.).

The functional morphology of the primate craniomandibular complex and temporomandibular joint (TMJ) components is frequently discussed in terms of gross skeletal structure. At the histomorphologic level, however, the TMJ has only been studied in Old World anthropoids. The present study is designed to describe the microanatomy of the condylar cartilage of the TMJ in two closely related species of greater galago: the exudativorous Otolemur crassicaudatus and the frugivorous O. garnettii. TMJs with intact joint capsules were harvested from adult, cadaveric specimens of these species (four O. crassicaudatus and five O. garnettii). The samples were decalcified, processed for paraffin sectioning, and sectioned at 10-18 microm in the coronal plane. The samples were then stained with hematoxylin/eosin, Gomori trichrome, and Alcian blue, and examined with a photomicroscope. Generally, condylar cartilage in O. crassicaudatus was thickest both laterally and centrally, while O. garnettii had the relatively thickest cartilage laterally. Both species displayed a superficial articular zone, a middle proliferative zone, and a deeply located hypertrophic zone in the condylar cartilage. O. crassicaudatus typically had the greatest cell density in each of these zones. In addition, O. crassicaudatus had focal concentrations of Alcian blue laterally and centrally, while O. garnettii had the greatest reactivity in the central portion only. These results suggest that O. crassicaudatus may be specialized to resist greater compressive force at the TMJ condylar cartilage in specific regions of the mandibular condyle.

Animals↗
PubMed1991

Transcranial radiography and linear tomography: a comparative study.

There is continual controversy concerning the use of radiographs to determine the position of the mandibular condyle within the glenoid fossa for the diagnosis and treatment of temporomandibular disorders. This study compared joint space measurements from transcranial radiographs and linear tomographs with the anatomic joint space to determine whether condylar position could be accurately recorded radiographically. Anterior, superior, and posterior joint space dimensions were measured from projected radiographs with a sonic digitizer, whereas anatomic joint space dimensions were recorded from the thickness of polyether impressions of the joint space. Posterior/anterior joint space ratios were used to classify relative condylar position as anterior, concentric, or posterior. The Pearson correlations (alpha = 0.05) were calculated to determine the consistency between radiographic and anatomic joint space ratios. The corrected and standard transcranial projections did not accurately reproduce the anatomic joint spaces or the relative condylar positions. Only the corrected tomographic projection accurately reflected the condyle-fossa relationships.

Arthrography↗
PubMed2005

The use of dermis grafts after discectomy for internal derangement of the temporomandibular joint.

PURPOSE: The aim of this retrospective clinical study was to review the outcomes of temporomandibular joint (TMJ) discectomy with autogenous dermis used as an immediate interpositional graft in patients with advanced internal derangement of the TMJ. PATIENTS AND METHODS: Thirty-five joints in 29 patients who presented with advanced internal derangement of the TMJ with degenerate and irreparable discs were identified and included in the study. All patients underwent a TMJ arthrotomy (including 6 bilateral TMJ procedures) that involved removal of the disc (discectomy) and immediate replacement with autogenous dermis graft. Patients were followed up for an average of 2 years. RESULTS: There was a mean +6.7-mm improvement in maximum interincisal opening, a 66% mean improvement in pain ( P < .001), and a 42% mean improvement in function ( P < .05) after TMJ discectomy with immediate dermis graft replacement. After an average follow-up period of 24.6 months, patients reported good to excellent improvement in their TMJ symptoms in 30 of the 35 joints (85.7%). All patients showed radiologic evidence of varying degrees of condylar remodeling at 6 months or later after surgery. Of the 7 patients who had magnetic resonance imaging (MRI) performed at 6 months or later after surgery, none showed any radiologic evidence of the dermis graft. No clinical evidence of joint sounds such as crepitus was found in 33 of the 35 operated joints. CONCLUSIONS: This study found that TMJ discectomy can have a significant positive effect on the management of patients with advanced internal derangement of the TMJ who fail to respond to less invasive measures such as splint therapy and TMJ arthroscopy. However, the only advantage of dermis grafts over no grafts seems to be that it can minimize or eliminate joint sounds such as crepitus in the discectomized TMJ. In this study, the dermis grafts did not prevent regressive remodeling of the mandibular condyles.

Adolescent↗