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Imaging Science in Dentistry Jun 2024This report showed a case of temporomandibular joint (TMJ) ankylosis suspected to be associated with ankylosing spondylitis based on the observation of bony ankylosis of...
This report showed a case of temporomandibular joint (TMJ) ankylosis suspected to be associated with ankylosing spondylitis based on the observation of bony ankylosis of the cervical spine on computed tomography (CT) images. A 53-year-old man presented with a chief complaint of difficulty in opening his mouth. His medical history indicated that in his 20s, he became aware of the difficulty in moving his neck. CT revealed marked osteoarthritic changes in the right mandibular condyle, suggesting fibrotic TMJ ankylosis. In addition, bony ankylosis of the cervical vertebral body and facet joints from the axis (C2) to C5 in continuity was observed. CT of the entire spine also showed bony deformity of the sacroiliac joints and bony ankylosis. Based on these findings, ankylosing spondylitis was suspected. The possibility of an ankylosing spondylitis complication should be considered in cases of TMJ ankylosis if bony ankylosis of the cervical spine is observed.
PubMed: 38948191
DOI: 10.5624/isd.20230243 -
Journal of the Korean Association of... Jun 2024Ankylosis of the temporomandibular joint (TMJ) is a condition in which the mandibular condyle fuses with the mandibular fossa through fibrous or bone tissue. It is a...
Ankylosis of the temporomandibular joint (TMJ) is a condition in which the mandibular condyle fuses with the mandibular fossa through fibrous or bone tissue. It is a debilitating pathology that interferes with chewing, speaking, and oral hygiene. Currently, alloplastic reconstruction is considered the gold standard for treating severely compromised TMJs, such as in ankylosis. The article describes a patient with a history of facial trauma, with bilateral ankylosis of the TMJs, inability to open his mouth, and poor dental condition. Due to a long period of immobilization of approximately 40 years, the initial treatment plan was to remove the ankylosis bilaterally and install customized PMMA (polymethylmethacrylate) spacers. The patient gained mouth opening and improved chewing quality with one year of customized spacer use prior to definitive alloplastic replacement with stock-type TMJ prostheses. Customized joint spacers are a provisional treatment option when definitive alloplastic reconstruction is not indicated. Spacers provide the patient with progressive jaw function and mobility gains.
PubMed: 38940654
DOI: 10.5125/jkaoms.2024.50.3.166 -
Journal of Oral Biosciences Jun 2024The present study aimed to elucidate the pathogenesis of temporomandibular joint (TMJ) osteoarthritis (TMJ-OA) in a mouse model. We investigated morphological and...
OBJECTIVES
The present study aimed to elucidate the pathogenesis of temporomandibular joint (TMJ) osteoarthritis (TMJ-OA) in a mouse model. We investigated morphological and histological changes in the head of mandible cartilage and early immunohistochemical (IHC) changes in transforming growth factor (TGF)-β, phosphorylated Smad-2/3 (p-Smad2/3), a TGF-β signaling molecule, and asporin.
METHODS
TMJ-OA was induced in a mouse model through unilateral partial discectomy. Micro-computed tomography (micro-CT) and safranin-O staining were performed to morphologically and histologically evaluate the degeneration of the head of mandible caused by TMJ-OA. IHC staining for TGF-β, p-Smad2/3, and asporin was performed to evaluate the changes in protein expression.
RESULTS
In the experimental group, three-dimensional (3D) morphometry revealed an enlarged head of mandible and safranin-O staining showed degeneration of cartilage tissue in the early stages of TMJ-OA compared to the control group. IHC staining revealed that TGF-β, p-Smad2/3, and asporin expression increased in the head of mandible cartilage before the degeneration of cartilage tissue, and subsequently decreased for a short period.
CONCLUSION
The findings suggested a negative feedback relationship between the expression of asporin and the TGF-β/Smad transduction pathway, which may be involved in the degeneration of the head of mandible in the early stages of TMJ-OA. Asporin is a potential biomarker of the early stages of TMJ-OA, which ultimately leads to the irreversible degeneration of TMJ tissues.
PubMed: 38936470
DOI: 10.1016/j.job.2024.06.009 -
Journal of Clinical Medicine Jun 2024: Defects of the ascending ramus of the mandible, including the condylar head and neck or the whole temporomandibular joint (TMJ), are difficult to reconstruct....
: Defects of the ascending ramus of the mandible, including the condylar head and neck or the whole temporomandibular joint (TMJ), are difficult to reconstruct. Reconstruction is mainly based on the use of alloplastic joint prosthesis, costochondral grafting, distraction osteogenesis of the dorsal part of the mandibular ramus, or osseous microvascular flaps of various origin. With the objective of developing a method that overcomes the restrictions of these methods, we recently introduced a sequential chimeric flap consisting of a lateral femoral condyle flap (LFC) and deep circumflex iliac artery flap (DCIA) for reconstruction of up to half of the mandible and the condylar head and neck. : The chimeric flap was used in four patients with the following diagnoses: therapy-refractory osteomyelitis, extended recurrent odontogenic keratozyst, Goldenhar syndrome, and adenocarcinoma of the parotid gland. After a diagnostic workup, LFC and DCIA flaps were harvested in all patients and used in a sequential chimeric design for the reconstruction of the mandibular body and condylar head and neck. : Follow-up from at least 24 months up to 70 month after surgery showed a successful reconstruction in all four patients. The LFC provided a cartilaginous joint surface, allowing for a satisfactory masticatory function with a stable occlusion and unrestricted mouth opening and preserved or regained lateral and medial excursions in all patients. The DCIA allowed for a bony reconstruction anatomically resembling a non-atrophied mandibular body. No flap-related complications were observed. : The sequential chimeric LFC and DCIA flap is an appropriate method for reconstructing up to half of the mandible and the condylar head and neck. It is suitable in cases where alloplastic joint replacement cannot be used or where other methods have failed. Due to the necessity of harvesting two flaps, the burden of care is increased, and a careful indication is required. The technique is reserved for maxillofacial surgeons who have already gained significant experience in the field of microsurgery.
PubMed: 38930140
DOI: 10.3390/jcm13123613 -
BMC Oral Health Jun 2024This study was conceived to assess the postoperative stability of condylar position following fixation with miniplates and lag screws after bilateral sagittal split... (Comparative Study)
Comparative Study
BACKGROUND
This study was conceived to assess the postoperative stability of condylar position following fixation with miniplates and lag screws after bilateral sagittal split osteotomy (BSSO).
METHODS
This retrospective study included a cohort of 20 patients undergoing BSSO using the Obwegeser-Dal Pont modification. The bony segments were stabilized using either miniplates with two 2.0-mm monocortical screws per segment or three 2.0-mm bicortical lag screws along the mandible's superior border. Pre- and postoperative (7-day interval) spiral computed tomography scans were conducted to assess skeletal changes across both groups. Data analysis employed Wilcoxon signed-rank and Wilcoxon rank-sum tests (α = 0.05).
RESULTS
No statistically significant difference was observed between the pre-and postoperative condylar position parameters (P>0.05). However, the lag screw group showed a marginal significant increase in the left condyle's angulation (preoperative: 24.83 ± 6.37 vs. postoperative: 32.5 ± 4.93; P = 0.04). Changes in condylar height, length, and width were not statistically significant before and after BSSO in either groups (P>0.05). Nor was any statistically significant difference found between the miniplates and lag screws groups regarding condylar position parameters (P>0.05).
CONCLUSION
The results indicated that both lag screw and miniplate fixation methods can be effectively employed in BSSO procedures without impacting condylar position parameters. Thus, either fixation method can be chosen depending on factors such as the surgeon's preference and clinical outcomes.
Topics: Humans; Mandibular Condyle; Bone Screws; Bone Plates; Retrospective Studies; Male; Female; Adult; Osteotomy, Sagittal Split Ramus; Young Adult
PubMed: 38918762
DOI: 10.1186/s12903-024-04499-w -
BMC Oral Health Jun 2024The aim of the study was to investigate the changes occurring in the mandibular condyle by using mentoplate together with rapid maxillary expansion (MP-RME) treatment in...
BACKGROUND
The aim of the study was to investigate the changes occurring in the mandibular condyle by using mentoplate together with rapid maxillary expansion (MP-RME) treatment in the correction of skeletal class III relationship, using fractal analysis (FA).
METHODS
The sample consisted of 30 individuals (8-11 years) diagnosed with skeletal Class III malocclusion who underwent MP-RME treatment. Archival records provided cone-beam computed tomography (CBCT) images taken at two intervals: before MP-RME treatment (T0) and after treatment (T1). The CBCT images were obtained using standardized settings to ensure consistency in image quality and resolution. The trabecular structures in the bilateral condyles at both T0 and T1 were analyzed using FA. The FA was performed on these condylar images using the Image J software. The region of interest (ROI) was carefully selected in the condyle to avoid overlapping with cortical bone, and the box-counting method was employed to calculate the fractal dimension (FD). Statistical analysis was conducted to compare the FD values between T0 and T1 and to evaluate gender differences. The statistical significance was determined using paired t-tests for intra-group comparisons and independent t-tests for inter-group comparisons, with a significance level set at p < 0.05.
RESULTS
The analysis revealed no statistically significant differences in the trabecular structures of the condyles between T0 and T1 (p > 0.05). However, a significant gender difference was observed in FA values, with males exhibiting higher FA values in the left condyle compared to females at both T0 and T1 (p < 0.05). Specifically, the FA values in the left condyle increased from a mean of 1.09 ± 0.09 at T0 to 1.13 ± 0.08 at T1 in males, whereas in females, the FA values remained relatively stable with a mean of 1 ± 0.09 at T0 and 1.03 ± 0.11 at T1.
CONCLUSION
The findings indicate that MP-RME therapy does not induce significant alterations in the trabecular structure of the mandibular condyle. These results suggest the treatment's safety concerning the structural integrity of the condyle, although the observed gender differences in FA values warrant further investigation.
Topics: Humans; Mandibular Condyle; Malocclusion, Angle Class III; Female; Male; Cone-Beam Computed Tomography; Child; Palatal Expansion Technique; Fractals
PubMed: 38915000
DOI: 10.1186/s12903-024-04506-0 -
Cureus May 2024The human mandible plays a significant role in personal identification due to its unique morphological characteristics. The coronoid process, condyle, and sigmoid notch...
Distinctive Anatomical Patterns of the Mandibular Coronoid Process, Condyle, and Sigmoid Notch: Cone Beam Computed Tomography (CBCT) Imaging for Advanced Personal Identification.
INTRODUCTION
The human mandible plays a significant role in personal identification due to its unique morphological characteristics. The coronoid process, condyle, and sigmoid notch exhibit variations that can be utilized for forensic and anthropological purposes. This study aims to analyze the morphological diversities of these mandibular features in our ethnic group using cone beam computed tomography (CBCT) imaging.
MATERIALS AND METHODS
A retrospective analysis was conducted using 100 CBCT images obtained from the archives of the Department of Oral Medicine and Radiology. The images were captured using Carestream 9600 machines (Carestream Dental LLC, Atlanta, GA) with standard exposure parameters. Curved slicing screenshots were utilized for tracing the morphological variations of the coronoid process, condyle, and sigmoid notch.
RESULTS
Out of 100 CBCT images analyzed (corresponding to 200 sides), the shape-wise distribution of the coronoid process revealed that a triangular shape was most commonly observed in 59% (118) of cases. The condyle exhibited a predominantly round shape in 38.7% (77) of cases based on shape parameter-wise distribution. Similarly, the sigmoid notch displayed a round shape in 40.5% (81) of cases based on shape-wise distribution.
CONCLUSION
Personal identification using radiographs has gained significance in the current scenario due to its feasibility. Cone beam computed tomography imaging has become a reliable and accurate method for revealing hidden details in forensic odontology, especially when antemortem records are available. This research sheds light on the morphological variations of the mandibular coronoid process, condyle, and sigmoid notch within our ethnic cohort, enhancing personal identification practices. Further research encompassing larger sample sizes and diverse populations would enhance the applicability of these findings in forensic and anthropological contexts.
PubMed: 38910783
DOI: 10.7759/cureus.60978 -
Scientific Reports Jun 2024Condylar resorption occurs in some cases after orthognathic surgery, and the risk factors associated with postoperative condylar head resorption have been extensively...
Condylar resorption occurs in some cases after orthognathic surgery, and the risk factors associated with postoperative condylar head resorption have been extensively described. Nevertheless, even in cases with a combination of risk factors, postoperative condylar resorption may not appear. This study analyzed the microstructure and three-dimensional positional change of the condylar bone via imaging in patients who have undergone bimaxillary orthognathic surgery to determine whether the microstructure or condylar position differs between patients with and without postoperative condylar resorption. Among asymptomatic patients who underwent bimaxillary surgery between April 2021 and March 2022 at our department, 17 patients were analyzed, limited to "female," "skeletal Class II," and "high-angle cases," which are known risk factors for mandibular head resorption. Multidetector computed tomography was performed on these patients before and 6 months after surgery, and the bone microstructure of the condylar head and the three-dimensional positional changes of the condylar bone and the proximal bony fragments were compared with the presence of postoperative condyle resorption using the bone morphology software TRI/3D-BON. Patients with condylar bone abnormalities before surgery and those with high trabecular bone density can develop postoperative resorption if the condyle is misaligned by surgery.
Topics: Humans; Female; Mandibular Condyle; Male; Adult; Bone Resorption; Orthognathic Surgical Procedures; Young Adult; Orthognathic Surgery; Multidetector Computed Tomography; Imaging, Three-Dimensional; Postoperative Complications
PubMed: 38902369
DOI: 10.1038/s41598-024-65077-2 -
Cureus May 2024Introduction Head and neck cancer with mandibular invasion often necessitates composite resection, leading to defects requiring reconstruction. Microvascular fibula free...
Introduction Head and neck cancer with mandibular invasion often necessitates composite resection, leading to defects requiring reconstruction. Microvascular fibula free flap (FFF) surgery is a common approach for this purpose. In this study, we focus on our experience with condyle sacrifice, emphasizing treatment outcomes and functional results. Additionally, we highlight a contemporary perspective by discussing surgical techniques and radiographic outcomes based on a 3D analysis of neo-condyle placement on CT imaging. Methods We studied 23 patients who had undergone segmental mandibulectomy requiring FFF reconstruction between 2009 and 2020. These were all performed by the same surgeon (M.M.) at an academic tertiary care center. Twenty-three reconstructions included condyle sacrifice. Retrospective chart review was performed with a focus on treatment, functional outcomes, and surgical technique. Results A total of 23 patients were included in the study group (13 females and 10 males) with a mean age of 58.1 years. The most common surgical indication was for oncologic purposes (n=9; 39.1%). Twenty (87%) patients required tracheostomy, and all were decannulated. In terms of surgical complications, two (8.7%) patients had a degree of arterial insufficiency and two (8.7%) developed delayed infections. The average inpatient stay was 5.61 days, with a subsequent average clinic follow-up after 16.9 days. CT or MRI imaging was available for 21 (91.3%) patients, showing 14 (66.7%) neo-condyles within the glenoid fossa. Fifteen (71.4%) patients had some element of anterior displacement (average=6.27 mm), and seven (33.3%) patients had a component of lateral displacement (average=2.23 mm). Three (13%) patients died during the follow-up period. Eighteen (90%) of the surviving patients returned to an oral diet within an average of 24.9 days. All patients returned to normal interincisal distance by 12 months. All FFFs, with and without complications, remained viable. Conclusion We achieved favorable oral function outcomes in the majority of our patients. Intriguingly, although radiographic evidence revealed anterior and/or lateral displacement of the neo-condyle, there was no observed correlation with the resumption of oral diet, trismus, or crossbite among these patients.
PubMed: 38860069
DOI: 10.7759/cureus.60103 -
BMC Musculoskeletal Disorders Jun 2024Temporomandibular joint osteoarthritis (TMJOA) is a chronic degenerative joint disorder characterized by extracellular matrix degeneration and inflammatory response of...
OBJECTIVE
Temporomandibular joint osteoarthritis (TMJOA) is a chronic degenerative joint disorder characterized by extracellular matrix degeneration and inflammatory response of condylar cartilage. β-arrestin2 is an important regulator of inflammation response, while its role in TMJOA remains unknown. The objective of this study was to investigate the role of β-arrestin2 in the development of TMJOA at the early stage and the underlying mechanism.
METHODS
A unilateral anterior crossbite (UAC) model was established on eight-week-old wild-type (WT) and β-arrestin2 deficiency mice to simulate the progression of TMJOA. Hematoxylin-eosin (HE) staining and microcomputed tomography (micro-CT) analysis were used for histological and radiographic assessment. Immunohistochemistry was performed to detect the expression of inflammatory and degradative cytokines, as well as autophagy related factors. Terminal-deoxynucleotidyl transferase mediated nick end labeling (TUNEL) assay was carried out to assess chondrocyte apoptosis.
RESULTS
The loss of β-arrestin2 aggravated cartilage degeneration and subchondral bone destruction in the model of TMJOA at the early stage. Furthermore, in UAC groups, the expressions of degradative (Col-X) and inflammatory (TNF-α and IL-1β) factors in condylar cartilage were increased in β-arrestin2 null mice compared with WT mice. Moreover, the loss of β-arrestin2 promoted apoptosis and autophagic process of chondrocytes at the early stage of TMJOA.
CONCLUSION
In conclusion, we demonstrated for the first time that β-arrestin2 plays a protective role in the development of TMJOA at the early stage, probably by inhibiting apoptosis and autophagic process of chondrocytes. Therefore, β-arrestin2 might be a potential therapeutic target for TMJOA, providing a new insight for the treatment of TMJOA at the early stage.
Topics: Animals; Osteoarthritis; beta-Arrestin 2; Cartilage, Articular; Mandibular Condyle; Mice; Mice, Knockout; Temporomandibular Joint Disorders; Disease Models, Animal; Chondrocytes; Mice, Inbred C57BL; Apoptosis; Temporomandibular Joint; Male; X-Ray Microtomography; Autophagy
PubMed: 38844905
DOI: 10.1186/s12891-024-07558-z