Healing following condylar shave in the monkey temporomandibular joint

The effect of gradual distraction of the mandible on the sheep temporomandibular joint

The effect of gradual distraction of the mandibular ramus on the condylar process of the temporomandibular joint (TMJ) was studied in 17 growing sheep. Gradual lengthening affected both operated and contralateral sides. An enhancement of the endochondral ossification was noticed with marked osteoblastic activity between the cartilaginous layer and the bone formed. The cartilage was thinner and the bone structure more dense than in nonoperated controls, and woven bone predominated. These changes seemed to be partly reversible in the long term.

A preliminary study of reconstruction of the monkey temporomandibular joint with autogenous tissues

PURPOSE

This study investigated the ability of autogenous pericranium-muscle and cranial bone to restore form and function of the temporomandibular joint (TMJ).

MATERIALS AND METHODS

A right TMJ discectomy, condylectomy, vertical ramus osteotomy with superior repositioning of the proximal fragment, and a cranial bone graft to the mandibular angle were performed in 12 cynomolgus monkeys. Clinical, histologic, and autoradiographic evaluation was done at intervals beginning at 3 days and continuing up to 78 weeks.

RESULTS

No significant postoperative sequela were identified in any of the monkeys. Jaw mobility and function were restored. Gross morphologic condylar changes were observed. The pericranium-muscle grafts did not differentiate into normal disc-like structures and a cartilage cap did not cover the condyle stump head.

CONCLUSIONS

The results of this study suggest that the previous TMJ function was restored. However, the histologic changes observed were consistent with advanced degenerative joint disease.

Enlargement of the rabbit mandibular condyle after experimental induction of anterior disc displacement: a histomorphometric study

PURPOSE

Clinical and autopsy studies have shown that patients with temporomandibular joint dysfunction are more likely to have enlargement and deformity of the condyle and subsequently occlusal disharmony. However, it is not known what causes this enlargement. This study was designed to test the hypothesis that surgical induction of anterior disc displacement (ADD) in the rabbit craniomandibular joint (CMJ) could lead to enlargement and deformity of the condyle.

MATERIALS AND METHODS

The right CMJ was exposed surgically, and the discal attachments were severed except for the posterior discal attachment (bilaminar zone). Then, the disc was repositioned anteriorly and sutured to the zygomatic arch. The left joint served as a sham-operated control. CMJ tissues then were removed after fixation at 24 hours (5 rabbits), 1 week (10 rabbits), 2 weeks (10 rabbits), or 6 weeks (10 rabbits), processed, and stained with hematoxylineosin. Histomorphometric assessment was used to evaluate changes in condylar volume, and thickness of the fibrous, reserve cell, and condylar cartilage layers.

RESULTS

The results showed a progressive enlargement of the condylar volume in all experimental joints compared with controls (P < .01). The enlargement was attributable to a significant increase in the cartilage thickness and surface area of the nonarticulating portion of the condyle in the 1-week group (P < .01). In the 2- and 6-week groups, there were significant, progressive increases in cartilage thickness and surface area of the articulating portion of the condyle (P < .01). In all animals, increased cartilage thickness was associated with a decrease in the thickness of the fibrous and the reserve cell layers (P < .01).

CONCLUSION

It is concluded that surgical induction of ADD in the rabbit CMJ causes enlargement of the condyle, which is in part caused by hyperplasia of the condylar cartilage.

Histological and immunohistochemical studies on the articular cartilage after experimental discectomy of the temporomandibular joint in rabbits

Total discectomy was performed experimentally in the rabbit temporomandibular joint (TMJ). In order to evaluate the injury and repair of the articular cartilage of the mandibular condyle after discectomy, both histologic and immunohistochemical observations were made. Immunohistochemical observation by using bromodeoxyuridine (BrdU) and its monoclonal antibody in vivo labelling method was used. The present study demonstrated that the cartilage on the articular surface of the condyle disappeared at 1 week post-operatively. This defect in the injured articular cartilage was not repaired by the cartilage, but was covered by a fibrous connective tissue at 6 weeks post-operatively, where the condylar recontouring by the adjacent articular cartilage, and flattening and hyperplasia of the condyle were observed. Thus, the cartilaginous repair following discectomy was characterized by the proliferation of the adjacent cartilage to the injured site and osteoblastic formation in the bone marrow at the exposed subchondral bone.

Effect of marrow perforation on the sheep temporomandibular joint

The effect of surgically perforating the mandibular condyle to allow synovial fluid to contact the marrow was examined in 5 sheep temporomandibular joints. The surgical defect showed replacement of the marrow with fibro-osseous tissue and subcortical cysts. A vertical, central osteophyte emerged from the perforation, causing attenuation or perforation of the disc and temporal surface proliferation. These changes were radiographically and histologically similar to advanced osteoarthritis. This supports the concept that intraarticular micro or macrofracture may result in osteoarthritis.

Functional stress modification after high condylectomy surgery

Surgical removal of the head of the condyles inevitably leads to radical redistribution of loads applied to the mandible. The nature of this redistribution can have important implications on the surgical approach and subsequent reconstructive procedures. The purpose of this investigation was to visualize photoelastically the functionally delivered stresses after high condylectomy surgery. Three identical models of a dentate human mandible were constructed from a photoelastic material. One mandible simulated a unilateral and the other simulated a bilateral high condylectomy. The third mandible had both condyles intact and served as basis for comparisons. Silicone implants were placed on the sectioned condylar heads. The condyles, with the silicone implants, were fitted into simulated fossae and the mandibles were loaded unilaterally and bilaterally. The resulting stresses were observed and photographed in the field of a circular polariscope. Substantial differences in load-generated stresses were observed as a result of both unilateral and bilateral condylectomies, compared to the normal case. The most severe stress conditions occurred with the unilateral condylectomy, where stresses associated with torsion were most evident.