Toshirou Kondoh

Prevalence of morphological changes in the surfaces of the temporomandibular joint disc associated with internal derangement

PURPOSEnThe purpose of this study was to determine the prevalence of morphological changes in the superior and inferior surfaces in the temporomandibular joint (TMJ) disc and relate them to disc displacement.nnnMATERIALS AND METHODSnThirty TMJs obtained from fresh cadavers were studied. The TMJs were dissected, and the superior and inferior surfaces of the disc were inspected and classified as intact, irregular, or perforated. These findings were corrolated to the position of the disc.nnnRESULTSnThere was a greater prevalence of morphologic changes in the inferior (57%) than in the superior surface (17%) of the disc (P < .001). This was found for joints both with normal disc position and those with disc displacement. There was no relationship between surface irregularities of the inferior surface and the position of the disc. Perforation was seen more frequently in joints with disc displacement than in those with normal disc position.nnnCONCLUSIONnMorphologic changes in the inferior surface of the TMJ disc are more prevalent than those in the superior surface, but this is not related to disc position. However, this needs to be considered when doing arthroscopy of only the superior joint compartment.

Complications of temporomandibular joint arthroscopy: A retrospective analysis of 301 lysis and lavage procedures performed using the triangulation technique

PURPOSEnThis study evaluated the complications of temporomandibular joint (TMJ) arthroscopic lysis and lavage performed using the triangulation technique.nnnPATIENTS AND METHODSnThe 202 consecutive patients (301 joints) who underwent arthroscopic lysis and lavage between 1992 and 1995 were retrospectively surveyed. The preoperative diagnosis of all patients was anterior disc displacement without reduction.nnnRESULTSnComplications were observed in 31 (10.3%) of 301 cases of arthroscopic lysis and lavage. Of these, otologic complications were found in 26 cases (8.6%): blood clots in the external auditory canal in 9; laceration of external auditory canal in 7; partial hearing loss in 5; ear fullness in 2; vertigo in 1; and perforation of tympanic membrane with laceration of external auditory canal in 1. Neurologic injuries were found in 5 cases (1.7%): fifth cranial nerve injuries in 3; and seventh cranial nerve injuries in 2. No other complications were observed.nnnCONCLUSIONSnA high level of understanding of the regional anatomy helps reduce the complications associated with arthroscopic lysis and lavage in the TMJ.

Association between arthroscopic diagnosis of temporomandibular joint osteoarthritis and synovial fluid nitric oxide levels.

OBJECTIVEnThe purpose of this study was to determine whether there is a relationship between synovial fluid levels of nitric oxide and clinical and arthroscopic findings of synovitis or cartilaginous degeneration.nnnSTUDY DESIGNnArthroscopic surgery was performed on 20 joints in 15 female patients with internal derangement and osteoarthritis of the temporomandibular joint. Synovial fluid aspirates were obtained immediately before arthroscopy. Synovial fluid was also obtained from 14 joints of 11 female asymptomatic volunteers. The concentration of nitrite in the fluid recovered from each temporomandibular joint was measured through use of a highly sensitive and specific chemiluminescence detection method, calibrated per 1 mg of synovial fluid protein and expressed as nitric oxide; the result was then compared with clinical and arthroscopic findings of synovitis and cartilaginous degeneration.nnnRESULTSnSignificantly higher levels of nitric oxide (median, 0.331 micromol/mg) were seen in the patients with internal derangement and osteoarthritis than in the control group (median, 0.001 micromol/mg; P<.0001). Synovial fluid from joints with pain in the joint area had significantly higher levels of nitric oxide than did fluid from joints without such pain. Synovial fluid from joints with degenerative changes (median, 0.467 micromol/mg) had significantly higher levels of nitric oxide than did fluid from joints without osteoarthritis (median, 0.057 micromol/mg; P<.05). Although the levels of nitric oxide in synovial fluid aspirates were markedly elevated in some joints with synovitis, there was no correlation between the levels of nitric oxide and the presence of synovitis.nnnCONCLUSIONSnThe findings indicate that increased levels of nitric oxide are involved in the pathogenesis of cartilaginous degeneration of the temporomandibular joint.

Immunohistochemical localization of inducible nitric oxide synthase in synovial tissue of human temporomandibular joints with internal derangement

The expression and distribution of inducible nitric oxide synthase (iNOS) was examined in 12 samples of human temporomandibular joint (TMJ) with internal derangement (ID) and four control specimens. In the diseased joints, strong or definite iNOS reactivity was expressed in synovial lining and endothelial cells; weaker activity was present in synovial fibroblasts. In contrast, although there was weak expression of iNOS in synovial fibroblasts and endothelial cells in the two control specimens, there was no iNOS staining in the synovial lining cell layers. This original report that iNOS is expressed in the synovial tissue of the temporomandibular joint indicates that nitric oxide is produced locally at least in the synovial lining in these joints when affected by internal derangement.

Comparison of intraoral radiography and computed tomography in evaluation of formation of bone after grafting for repair of residual alveolar defects in patients with cleft lip and palate

For one year we studied postoperative computed tomograms (CT) and intraoral radiographs for 29 patients with unilateral alveolar clefts. Interdental bone height and the bony boundary on the nasal side were assessed on intraoral films and compared with the evaluation by CT. Twenty-four cases had adequate interdental bone height as assessed by intraoral films. However, 10 of these 24 cases showed insufficient anteroposterior depth on CT. Two of the remaining five cases were also overestimated by the intraoral radiograph. All cases had sufficient bony boundary on the nasal side on intraoral radiography. However, CT showed that bone formation on the nasal side of two cases was significantly worse than that on the non-cleft side. Consequently, about 40% of surgical outcomes may be overestimated by intraoral radiographs. CT therefore seems to give a better assessment of the clinical outcome than intraoral radiographs and should be considered as an adjunct in difficult clinical cases.

Regional differences of type II collagen synthesis in the human temporomandibular joint disc: immunolocalization study of carboxy-terminal type II procollagen peptide (chondrocalcin)

The purpose of this study was to determine the regional differences of distribution of the carboxy-terminal type II procollagen peptide (pCOL-II-C; chondrocalcin) as markers of cartilaginous expression in the human temporomandibular joint (TMJ) disc. Twelve human TMJ discs without morphologic abnormalities were obtained from 12 fresh cadavers. All specimens were analysed for pCOL-II-C expression using polyclonal rabbit anti-human pCOL-II-C antibody in avidin-biotin-peroxidase complex staining. The results were demonstrated that the percentage of pCOL-II-C immunoreactive disc cells was significantly higher in the outer part (the articular surfaces) than in the inner part (the deep central areas) of the disc. These findings suggest that the tissue heterogeneity of cartilaginous expression reflects the functional demands of the remodelling process in the human TMJ disc.

Magnetic resonance imaging findings and clinical symptoms in the temporomandibular joint in patients with mandibular continuity defects

PURPOSEnThis study explored the morphologic changes and clinical symptoms related to the temporomandibular joint (TMJ) associated with long-term lack of mandibular continuity.nnnPATIENTS AND METHODSnThe subjects were 20 patients (40 TMJs) who underwent mandibulectomy including the condyle or segmental mandibulectomy without mandibular reconstruction more than 6 months previous to the study. The 40 TMJs were classified into the following 3 groups: group I: TMJs with a major mandibular fragment including the mandibular body (n = 21), group II: TMJs with a minor mandibular fragment including only the condylar process or the mandibular ramus (n = 10), and group III: TMJs without a condyle (n = 9). All TMJs were examined with respect to disc position, condylar position, bony changes, and appearance of joint effusion on magnetic resonance imaging, as well as for the presence of joint or muscle pain and joint noise.nnnRESULTSnThe rate of anterior disc displacement was 28.6% in group I, 10.0% in group II, and 100% in group III. All condyles in group I were located in the glenoid fossa. Seven of 10 condyles in group II were dislocated anteriorly out of the glenoid fossa. However, these condyles were situated in the intermediate zone of the disc. Osteoarthritic changes was found in 1 joint in group II. Joint effusion was not observed in group I. However, joint effusion was detected in the posterior region of the upper joint compartment in 7 of 10 TMJs in group H and in 8 of 9 TMJs in group III. In group II, the 7 TMJs with joint effusion were the same joints with anteriorly dislocated condyles. Clinical symptoms of TMJ pain, TMJ noise, or muscular pain were not found in any patients.nnnCONCLUSIONSnPartial mandibulectomy does not affect the relationship between the disc and the condyle or the bony condition of the TMJ. The disc without a condyle will become anteriorly displaced with time. The condyle not connected to the mandibular body often dislocates anteriorly out of the glenoid fossa, while retaining a normal relationship with the disc. Joint effusion, which is detected in nonfunctional TMJs, is not associated with an inflammatory reaction in the joint compartment.

Image diagnosis for internal derangements of the temporomandibular joint

Abstract1.Relationship of the articular disk to the condyle.This study consisted of 175 patients (181 joints) out of 203 patients reviewed. Thirty-eight joints showed anterior disk displacement with reduction, 76 joints showed anterior disk displacement without reduction and 40 joints showed anterior disk displacement with associated perforation of the posterior attachment of the disk.2.Capsular adhesions of internal derangements of the TMJ.Fifty-five joints (70%) had capsular adhesion in joints showing anterior disk displacement without reduction. Nine joints (21%) had capsular adhesion in joints showing anterior disk displacement with reduction. Arthrotomographically 9 patients were found to have only capsular adhesion without displacement of the disk.3.Osseous abnormalities of internal derangements of the TMJ.One hundred and one joints were studied. In the patients with anterior disk displacement without reduction, thirty-seven (67%) out of 55 joints had erosive bone changes on the condyle. Nine (17%) out of fifty-three joints with asymptomatic and clinically normal TMJ had erosive bone changes on the condyle.4.Comparison of double-contrast arthrotomography and MR imaging at 0.2 T.Both methods of evaluation provided highly reliable information regarding the disk. Double-contrast arthrotomography was superior to MR imaging in detecting capsular adhesion and perforation of the posterior attachment.5.Selection of routine radiographic techniques of the TMJ.The lateral tomograph produced the highest diagnostic accuracy (90%). The diagnostic accuracy of osseous changes of the TMJ is better with rotational panoramic radiography than with lateral oblique transcranial radiography.1. Relationship of the articular disk to the condyle. This study consisted of 175 patients (181 joints) out of 203 patients reviewed. Thirty-eight joints showed anterior disk displacement with reduction, 76 joints showed anterior disk displacement without reduction and 40 joints showed anterior disk displacement with associated perforation of the posterior attachment of the disk. 2. Capsular adhesions of internal derangements of the TMJ. Fifty-five joints (70%) had capsular adhesion in joints showing anterior disk displacement without reduction. Nine joints (21%) had capsular adhesion in joints showing anterior disk displacement with reduction. Arthrotomographically 9 patients were found to have only capsular adhesion without displacement of the disk. 3. Osseous abnormalities of internal derangements of the TMJ. One hundred and one joints were studied. In the patients with anterior disk displacement without reduction, thirty-seven (67%) out of 55 joints had erosive bone changes on the condyle. Nine (17%) out of fifty-three joints with asymptomatic and clinically normal TMJ had erosive bone changes on the condyle. 4. Comparison of double-contrast arthrotomography and MR imaging at 0.2 T. Both methods of evaluation provided highly reliable information regarding the disk. Double-contrast arthrotomography was superior to MR imaging in detecting capsular adhesion and perforation of the posterior attachment. 5. Selection of routine radiographic techniques of the TMJ. The lateral tomograph produced the highest diagnostic accuracy (90%). The diagnostic accuracy of osseous changes of the TMJ is better with rotational panoramic radiography than with lateral oblique transcranial radiography. Relationship of the articular disk to the condyle. This study consisted of 175 patients (181 joints) out of 203 patients reviewed. Thirty-eight joints showed anterior disk displacement with reduction, 76 joints showed anterior disk displacement without reduction and 40 joints showed anterior disk displacement with associated perforation of the posterior attachment of the disk. Capsular adhesions of internal derangements of the TMJ. Fifty-five joints (70%) had capsular adhesion in joints showing anterior disk displacement without reduction. Nine joints (21%) had capsular adhesion in joints showing anterior disk displacement with reduction. Arthrotomographically 9 patients were found to have only capsular adhesion without displacement of the disk. Osseous abnormalities of internal derangements of the TMJ. One hundred and one joints were studied. In the patients with anterior disk displacement without reduction, thirty-seven (67%) out of 55 joints had erosive bone changes on the condyle. Nine (17%) out of fifty-three joints with asymptomatic and clinically normal TMJ had erosive bone changes on the condyle. Comparison of double-contrast arthrotomography and MR imaging at 0.2 T. Both methods of evaluation provided highly reliable information regarding the disk. Double-contrast arthrotomography was superior to MR imaging in detecting capsular adhesion and perforation of the posterior attachment. Selection of routine radiographic techniques of the TMJ. The lateral tomograph produced the highest diagnostic accuracy (90%). The diagnostic accuracy of osseous changes of the TMJ is better with rotational panoramic radiography than with lateral oblique transcranial radiography.

MRI and arthroscopic findings in the temporomandibular joint after mandibulectomy including the unilateral condyle report of two cases

In this report, the MRI and arthroscopic findings in the temporomandibular joint (TMJ) of two patients who underwent partial mandibulectomy including the condyle are presented. The disc and superior joint compartment of the affected TMJs were preserved in both patients. MRI of the affected TMJs without condyle demonstrated that the intermediate zone of the discs was located anteriorly to the summit of the articular eminence. Joint effusion was detected in the superior joint compartment of one patient. Fibrous adhesions were observed arthroscopically in the superior joint compartment of both affected TMJs. In contrast, no specific findings were demonstrated in the contralateral TMJs connected with the residual mandibular fragment.

Ultrathin arthroscope for use in the lower compartment of the temporomandibular joint

Arthroscopy of the temporomandibular joint has been performed mainly in the upper joint space because the instruments available have been too thick to be safely inserted into the lower joint space. This article describes a newly developed ultrathin arthroscope with an outer diameter of 0.69 mm that has been specifically developed to be used in the lower space of the temporomandibular joint. This arthroscope can be inserted into the lower joint space with a standard 18-gauge needle. The article describes the arthroscope in its initial application to patient and cadaver material.