Jerold S. Goldberg

A comparison of clinical examination, history, and magnetic resonance imaging for identifying orthodontic patients with temporomandibular joint disorders

The temporomandibular joint (TMJ) status of 51 juvenile orthodontic patients was assessed with magnetic resonance imaging (MRI), clinical examination, and questionnaire data. The results of this study demonstrated that the prevalence of anterior displacement of the meniscus was 11.8% (6 of 51) as assessed by MRI. Clicking or pain in the TMJ area was found in 9.8% (5 of 51) of the subjects by clinical exam, and 19.8% (10 of 51) of the subjects had a history of pain or clicking of the TMJ. Three subjects had a positive MRI and a negative history and clinical examination. However, all subjects with positive MRI findings had a history of other risk factors known to be associated with TMJ internal derangement (TMJ-ID). Therefore practitioners should use a history form and a clinical examination technique that includes a broad range of signs and symptoms of temporomandibular disorders (TMD) to identify patients who may have abnormal condyle disk relationships and be at risk for TMD. Clicking and pain in the TMJ helped identify only one half of the patients with abnormal condyle-disk relationships in this study population. Future cephalometric studies will monitor the effects of abnormal condyle disk relationships on facial growth during orthodontic treatment.

Temporomandibular synovial fluid pressure response to altered mandibular positions

Hydrostatic synovial fluid pressure within the superior aspect of the temporomandibular joint space of the growing pig, Sus scrofa domesticus, was examined in response to various acute and chronic alterations of mandibular position. Bilateral measurements of pressure were recorded with chronically implanted wick catheters in three 8-week-old pigs before and at the time of appliance placement and then at 2-day intervals until the animals were 20 weeks old. Besides confirming the observations of a previous study, we noted that forward positioning of the mandible caused an increase in synovial fluid pressure that decayed to baseline levels within 2 hours. Posterior positioning of the mandible effected a larger increase in pressure that partially decayed over 2 hours but did not return to baseline levels over the entire course of the experiment. These results may have significance in the understanding of the physiology of the temporomandibular joint, local control mechanisms involved in the normal and treatment-aided growth of the mandible, and disorders of the temporomandibular joint.

The effects of the Le Fort I osteotomy on the periodontium

Two age-matched populations of equal size (n = 40), one having orthodontic therapy and the other combined orthodontic therapy and orthognathic surgery, were evaluated for their periodontal status 1 to 10 years posttherapy. The parameters investigated were plaque index, gingival index, tooth mobility, width of keratinized tissue, probing depth, gingival recession, and attachment level. No significant differences were found (P less than .05). Within the surgery group, patients with maxillary osteotomies segmentalized between the central incisors (n = 11) and between the canines and second premolars (n = 12) were evaluated using the same parameters and compared with their nonsegmental counterparts. No significant differences were found for patients with osteotomies segmentalized between the central incisors. However, a statistically significant increase in probe depth and loss of attachment level of up to 0.3 mm was found at the sites of osteotomies segmentalized between the canine and second premolar (P less than .05). This difference was not considered clinically significant.

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.

Osteochondroma of the mandibular condyle.

AbstractOsteochondroma of the mandibular condyle is rare. This article reports on a case of osteochondroma which “mimicked” displacement of the disk of the temporomandibular joint. This case demonstrates the importance of early radiographic evaluation in establishing a diagnosis related to TMJ complaints.

Phenytoin-induced agranulocytosis after treatment for a gunshot wound to the face

A case of phenytoin-induced agranulocytosis is presented. This syndrome is characterized by a decrease in the blood neutrophil count to very low levels. Patients are generally asymptomatic, but they may become febrile and develop an infection, which is frequently fatal. Practitioners treating trauma patients or other patients in whom phenytoin treatment is initiated should be aware of the potential development of agranulocytosis.

Effects of unilateral premature fusion of the zygomaxillary suture on the growth of nasomaxillary complex

Unilateral premature fusion of the zygomaxillary suture was produced in 2-week-old guinea pigs by immobilization with methyl-cyanoacrylate adhesive. The effects of sutural fusion on the growth of the nasomaxillary complex were evaluated by radiographic cephalometry with implants, and histologic assessment. The immobilization successfully constrained the anteroinferior displacement of the maxilla and zygomatic bone on the fused side. Compensatory responsive remodeling at adjacent sutures and in certain regions of the nasomaxillary complex was observed. Developmental asymmetry was found when the fused side was compared with the nonfused side. No gross anatomic asymmetry of the facial complex as a whole, however, was detected. Adaptive compensation involving periosteal bone deposition occurred at the junction of the lower maxillary process and the maxilla proper on the fused side. This, together with periosteal bone resorption in corresponding areas on the nonfused side served to offset any developmental asymmetry that might have occurred, thus leading to a compensatory preclusion of gross anatomic asymmetry.

Management of a patient with Factor VII deficiency

Several approaches to the dental treatment of patients with Factor VII deficiencies have been explained. The case of a patient with Factor VII deficiency who required dental extractions has been presented and the rationale for the treatment used in this case has been discussed.

The incidence of forceps delivery among patients with TMJ problems: A Preliminary study

AbstractThis article describes a preliminary study in which an attempt was made to investigate the relationship between obstetric extractions (forceps deliveries) and the incidence of temporomandibular joint problems. Two hundred and nineteen patients complaining of TMJ disorders were evaluated and compared to a control group of one hundred and eight normal subjects. Statistical analysis of the data obtained from this study showed a relationship between forceps deliveries and temporomandibular joint problems, subject to some qualifying considerations. It is hoped that these findings will be further examined by other investigators.

Migration of Kirschner wires used for rigid noncompressive fixation of the mandibular sagittal split osteotomy: Report of four cases

Four instances of migration of Kirschner wires have been reported in patients in whom bilateral mandibular sagittal splits were stabilized with rigid noncompressive pin fixation. Three of these cases demonstrated gross pin migration, and the fourth showed significant symptoms due to the loosening and extrusion of the Kirschner wires. Although this technique produces good clinical results, migration of the pins is a problem.