Cranio
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There are many temporomandibular joint (TMJ) conditions that can cause pain, TMJ and jaw dysfunction, and disability. The most common of these conditions include: (1) articular disk dislocation; (2) reactive arthritis; (3) adolescent internal condylar resorption; (4) condylar hyperplasia; (5) osteochondroma or osteoma; and (6) end-stage TMJ pathology. These conditions are often associated with dentofacial deformities, malocclusion, TMJ pain, headaches, myofascial pain, TMJ and jaw functional impairment, ear symptoms, etc. ⋯ Open joint surgery provides direct access to the TMJ allowing manipulation, repair, removal and/or reconstruction of the anatomical structures that cannot be accomplished by other treatment methods. TMJ surgery and orthognathic surgery can be predictably performed during one operation with high success rates. This paper discusses the most common TMJ pathologies and presents the surgical management considerations to correct the specific TMJ conditions and associated jaw deformities.
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Temporomandibular Disorder (TMD) is a term generally applied to a condition or conditions characterized by pain and/or dysfunction of the masticatory apparatus. Its characterization has been difficult because of the large number of symptoms and signs attributed to this disorder and to variation in the number and types manifested in any particular patient. For this study, data on 4,528 patients, presenting over a period of 25 years to a single examiner for TMD treatment, was made available for retrospective analysis and determination of whether the TMD care-seeking patient can be profiled, particularly pain difficulties. ⋯ Clearly prevalence of pain disclosed by the symptoms and signs examinations was high. Patients showed variable prevalence and nonprevalence of eight categories of painful symptoms and seven categories of painful signs. Despite the variability, these might be developed in the future into TMD scores or indices for studying and unraveling the TMD conundrum.
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Fatigue is usually defined as the point at which a particular level of force can be no longer maintained. In the present study, surface EMG of the masseter and temporalis anterior muscles was measured in ten healthy young adults performing a unilateral molar (right side) clench. The subjects clenched on a bite force transducer at a fixed force level of 13 kg (127 N) as long as they could (endurance). ⋯ At T2, both masseter muscles and the right side temporalis had a significant modification in their median power frequency. Overall, the modifications were larger in the masseter than in the temporalis muscles (p=0.022, analysis of variance), without effects of side and no muscle x side interaction. In conclusion, a fixed submaximal muscular contraction provoked fatigue modifications in the EMG power spectra that were well comparable to those obtained in previous investigations using forces computed as percentages of individually assessed maximum bite forces The present protocol (endurance clenching at a fixed force level) could be used as both a research and a clinical tool that would allow an easier and less troublesome assessment of both healthy persons and patients.
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The purpose of this study was to clarify which direction of jaw movement is advantageous for releasing TMJ intermittent lock. The subjects included ten patients with TMJ intermittent lock who could not open their mouths fully in habitual opening paths (habitual opening), but could open fully in intentionally winding opening paths (winding opening). The following movements were analyzed: habitual opening, winding opening, lateral border opening to the contralateral side (contralateral opening), lateral border opening to the affected side and anterior border opening. ⋯ In addition to winding opening, the success rate in releasing locking of contralateral opening was significantly greater than that of habitual opening. The findings demonstrated that contralateral movements directed toward the nonaffected side are advantageous for releasing the intermittent lock. The patients will have a better chance of releasing the intermittent lock by themselves, when opening path shifted to the nonaffected side is recommended as the first choice.
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Comparative Study
Differences in initial symptom scores between myogenous TMD patients with high and low temporomandibular opening index.
The temporomandibular opening index (TOI) is a more useful measure of mandibular movement than linear mouth opening, since it is independent of age, gender, ramus length, and gonial angle. It is also useful when categorizing temporomandibular disorder (TMD) patients into diagnostic groups. Two subgroups of myogenous patients have been identified, one with a high and one with a low temporomandibular opening index. ⋯ These symptom scores were compared between the two subgroups using the Wilcoxon two sample test. There appeared to be a significant difference between the two groups (p = 0.0025). TMD patients with high temporomandibular opening index appeared to have more severe signs and symptoms of TMD than patients with a low index.