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Andrabi SW, Malik AH, Shah AA. Clinical factors affecting the outcome of arthocentesis. J Korean Assoc Oral Maxillofac Surg 2019; 45:9-14. [PMID: 30847291 PMCID: PMC6400700 DOI: 10.5125/jkaoms.2019.45.1.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/12/2018] [Accepted: 03/05/2018] [Indexed: 11/07/2022] Open
Abstract
Objectives This study aimed to evaluate the effect of clinical factors on the outcome of arthrocentesis in the treatment of temporomandibular joint (TMJ) internal derangement. Materials and Methods Fifty patients with TMJ internal derangement underwent arthrocentesis using ringer's lactate. The present study evaluated the contribution of the clinical variables of age, time since onset, visual analogue scale (VAS) pain level, and range of motion (ROM) on the outcomes of TMJ arthrocentesis: age (≤25 years, >25 and ≤40 years, >40 and ≤60 years), VAS pain level (≤5, >5 and ≤7, >7 and ≤10), and ROM (<25 and ≥25 mm). Odds ratios (ORs) were used to describe the proportional benefit of each variable the on successful outcome of arthrocentesis. For the OR to be clinically relevant or even clinically noticeable, we assumed that the OR would need to be larger than 2. Results Mean preoperative pain score was 6.49±1.560 and at 6 months postoperative was 0.46±1.147 with an average decrease of pain score 6 (P<0.001). The mean preoperactive maximum mouth opening was 26.14±4.969 mm and mean maximum mouth opening at 6-month inerval was 38.92±3.392 mm. The mean increase in the mouth opening was a mean difference of 12.78 mm (P<0.001). Logistic regression showed that the maximum benefit occurred in patients aged <25 years (OR, 12.01; P=0.012), a VAS pain level of >7 (OR, 11.25; P=0.039), and a maximum vertical opening of <25 mm (OR, 7.70; P=0.038). Conclusion Lavage of the superior joint space with ringer's lactate resulted in significant reduction in pain and improvement in mouth opening. Patients with a greater inflammatory component and younger patients benefitted more from arthrocentesis. Evaluation of these clinical variables helped in predictive modelling, which may provide clinicians with the opportunity to identify "at-benefit" patients early and initiate specific treatment.
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Affiliation(s)
- Syed Wakeel Andrabi
- Department of Oral and Maxillofacial Surgery, Government Dental College, Srinagar, India
| | - Altaf H Malik
- Department of Oral and Maxillofacial Surgery, Government Dental College, Srinagar, India
| | - Ajaz A Shah
- Department of Oral and Maxillofacial Surgery, Government Dental College, Srinagar, India
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de Alcântara Camejo F, Azevedo M, Ambros V, Caporal KST, Doetzer AD, Almeida LE, Olandoski M, Noronha L, Trevilatto PC. Interleukin-6 expression in disc derangement of human temporomandibular joint and association with osteoarthrosis. J Craniomaxillofac Surg 2017; 45:768-774. [PMID: 28341537 DOI: 10.1016/j.jcms.2017.02.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 01/31/2017] [Accepted: 02/16/2017] [Indexed: 12/01/2022] Open
Abstract
The inflammatory process is a coordinated response that protects host after infection or trauma, involving several molecular reactions. Once the inflammation is closely linked to the process of destruction of the temporomandibular joint, this study aims to examine, by immunohistochemistry, the expression of interleukin-6 (IL-6), an important inflammatory marker, in temporomandibular articular discs of patients with anterior disc displacement with (ADDwR) and without reduction (ADDwoR) and its association with osteoarthrosis (OA). Thirty-eight (n = 38) articular discs were divided into two cutoffs: 1) analysis 1: 4 control (acute pathology), 17 ADDwR, 17 ADDwoR; and 2) analysis 2: without OA (n = 21) and with OA (n = 17). The area of immunostaining was compared statistically between groups (p < 0.05). In the disc samples, no significant differences were observed between the groups ADDwR and ADDwoR, and with and without OA, in respect to the expression of IL-6 by immunohistochemical examination. Future studies should be conducted with a larger sample size, which could clarify the association of the inflammatory mediator IL-6 with temporomandibular joint dysfunction.
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Affiliation(s)
| | - Marina Azevedo
- School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Viviane Ambros
- School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | | | - Andrea Duarte Doetzer
- School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | | | - Marcia Olandoski
- School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Lucia Noronha
- School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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3
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Israel HA. Internal Derangement of the Temporomandibular Joint. Oral Maxillofac Surg Clin North Am 2016; 28:313-33. [DOI: 10.1016/j.coms.2016.03.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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4
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Is the incidence of temporomandibular disorder increased in polycystic ovary syndrome? Br J Oral Maxillofac Surg 2014; 52:822-6. [DOI: 10.1016/j.bjoms.2014.07.100] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Accepted: 07/18/2014] [Indexed: 11/22/2022]
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5
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Israel HA, Davila LJ. The Essential Role of the Otolaryngologist in the Diagnosis and Management of Temporomandibular Joint and Chronic Oral, Head, and Facial Pain Disorders. Otolaryngol Clin North Am 2014; 47:301-31. [DOI: 10.1016/j.otc.2013.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Arthroscopic surgery has been widely used for treatment of temporomandibular joint (TMJ) internal derangements and diseases for the last 40 years. Although 626 articles have been hit by Pubmed search in terms of "TMJ arthroscopic surgery", this review article is described based on distinguished publishing works and on my experiences with TMJ arthroscopic surgery and related research with an aim to analyse the rationale of arthroscopic surgeries of the temporomandibular joint. With arthrocentesis emerging as an alternative, less invasive, treatment for internal derangement with closed lock, the primary indication of arthroscopic surgery seems to be somewhat limited. However, the value of endoscopic inspection and surgery has its position for both patient and physician with its long-term reliable results.
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Affiliation(s)
- KenIchiro Murakami
- Oral and Maxillofacial Surgery, Ako City Hospital, Hyogo 678-0232, Japan
- Visiting Professor, Kanagawa Dental College, Yokosuka, Japan
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7
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Palconet G, Ludlow JB, Tyndall DA, Lim PF. Correlating cone beam CT results with temporomandibular joint pain of osteoarthritic origin. Dentomaxillofac Radiol 2011; 41:126-30. [PMID: 22116122 DOI: 10.1259/dmfr/60489374] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The purpose of this study was to determine whether bony changes in temporomandibular joint (TMJ) osteoarthritis (OA) is correlated with pain and other clinical signs and symptoms. METHODS Clinical data and cone beam CT (CBCT) images of 30 patients with TMJ OA were analysed. The criteria of Koyama et al (Koyama J, Nishiyama H, Hayashi T. Follow-up study of condylar bony changes using helical computed tomography in patients with temporomandibular disorder. Dentomaxillofac Radiol 2007; 36: 472-477.) and Ahmad et al [Ahmad M, Hollender L, Anderson Q, Kartha K, Ohrbach R, Truelove EL, et al. Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107: 844-860.] were used to classify the condyles observed on the CBCT. Clinical measures included self-reported pain, mandibular range of motion, TMJ sound, pain on palpation of the TMJ and masticatory muscles, and pain on jaw function. Generalized linear modelling was used to correlate the clinical and radiographic findings and Spearman's rho was used to correlate the two classification systems. RESULTS There was poor correlation between the maximum condyle change and pain rating (Koyama: r² = 0.1443, p = 0.3995; Ahmad: r² = 0.0273, p = 0.9490), maximum mouth opening (Koyama: r² = 0.2910, p = 0.0629; Ahmad: r² = 0.2626, p = 0.0951), protrusion (Koyama: r² = 0.0875, p = 0.7001; Ahmad: r² = 0.1658, p = 0.3612), right lateral motion (Koyama: r² = 0.0394, p = 0.9093; Ahmad: r² = 0.0866, p = 0.6877) and left lateral motion (Koyama: r² = 0.0943, p = 0.6494; Ahmad: r² = 0.1704, p = 0.3236). Strong correlation was observed between Koyama et al's and Ahmad et al's classifications for average (r = 0.9216, p < 0.001) and maximum (r = 0.7694; p < 0.0001) bony change. CONCLUSIONS There was poor correlation between condylar changes (as observed on CBCT images), pain and other clinical signs and symptoms in TMJ OA.
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Affiliation(s)
- G Palconet
- University of North Carolina, Chapel Hill School of Dentistry, NC 27599-7455, USA
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Kirk WS, Kirk BS. A biomechanical basis for primary arthroplasty of the temporomandibular joint. Oral Maxillofac Surg Clin North Am 2009; 18:345-68, vi. [PMID: 18088837 DOI: 10.1016/j.coms.2006.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Biomechanical principles of temporomandibular joint (TMJ) loading are unique, particularly in an orthopedic system that exhibits curvilinear general plane motion. Certain type-specific derangements can be surgically challenging and may primarily require open arthrotomy techniques rather than arthroscopy. This article discusses the basic biomechanical principles in normal and pathologic function. Three-dimensional preoperative imaging of TMJs is necessary for appropriate assessment of all patients and when open techniques are necessary as the initial surgical procedure.
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Ratcliffe A, Grelsamer RP, Kiernan H, Saed-Nejad F, Visco D. High levels of aggrecan aggregate components are present in synovial fluids from human knee joints with chronic injury or osteoarthrosis. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/17453679509157664] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Anthony Ratcliffe
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Columbia University, Columbia Presbyterian Medical Center. 630 West 168th Street, New York, NY, 10032
| | - Ronald P Grelsamer
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Columbia University, Columbia Presbyterian Medical Center. 630 West 168th Street, New York, NY, 10032
| | - Howard Kiernan
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Columbia University, Columbia Presbyterian Medical Center. 630 West 168th Street, New York, NY, 10032
| | - Fatemeh Saed-Nejad
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Columbia University, Columbia Presbyterian Medical Center. 630 West 168th Street, New York, NY, 10032
| | - Denise Visco
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Columbia University, Columbia Presbyterian Medical Center. 630 West 168th Street, New York, NY, 10032
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Emshoff R, Rudisch A. Temporomandibular Joint Internal Derangement and Osteoarthrosis: Are Effusion and Bone Marrow Edema Prognostic Indicators for Arthrocentesis and Hydraulic Distention? J Oral Maxillofac Surg 2007; 65:66-73. [PMID: 17174766 DOI: 10.1016/j.joms.2005.11.113] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Revised: 07/27/2005] [Accepted: 11/23/2005] [Indexed: 11/24/2022]
Abstract
PURPOSE Arthrocentesis and hydraulic distention of the temporomandibular joint (TMJ) has proven to be an effective modality in treating patients exhibiting clinical findings consistent with the diagnosis of disc displacement without reduction. The purpose of this study was to investigate whether the magnetic resonance imaging (MRI) variables of effusion and/or bone marrow edema may predict treatment outcomes of arthrocentesis and hydraulic distention of the TMJ. PATIENTS AND METHODS The study group comprised 37 consecutive patients with TMJ pain, who were assigned a unilateral clinical TMJ disorder of TMJ pain associated with an internal derangement (ID) type III (disc displacement without reduction) and a TMJ pain side-related MRI diagnosis of disc displacement without reduction associated with osteoarthrosis (OA). Bilateral sagittal and coronal MRI images were obtained immediately before the operation to establish the presence or absence of ID, OA, TMJ effusion, and bone marrow edema. Pain level and mandibular range of motion (ROM) were assessed preoperatively and compared with the respective 2-month follow-up findings. Outcome criteria for success were a ROM >or=35 mm and pain reduction >50%. A logistic regression analysis was used to compute the odds ratio for TMJ effusion and bone marrow edema for successful outcomes (n = 21) versus unsuccessful (n = 16) outcomes. RESULTS At the 2-month follow-up, clinical evaluation showed a significant reduction in TMJ pain during function (P = .000), a significant reduction in clinical diagnoses of TMJ disorders (P = .016), and a significant increase in ROM (P = .000). A significant increase in the risk of an unsuccessful outcome of ROM <35 mm and/or pain reduction >or=50% occurred with MRI findings of effusion (odds ratio 1:10.8 = 0.09; P = .007). CONCLUSIONS TMJ effusion may prove to be an important prognostic determinant of successful arthrocentesis. However, the data re-emphasize the concept that the prediction of a specific outcome is not a matter of simple linearity, in which the presence of 1 factor may equate with predictive ability, but rather is a function of a complex interaction among different biological variables.
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Affiliation(s)
- Rüdiger Emshoff
- Department of Oral and Maxillofacial Surgery, University Clinic Innsbruck, Innsbruck, Austria.
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11
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Arthrocentesis—Incentives for Using This Minimally Invasive Approach for Temporomandibular Disorders. Oral Maxillofac Surg Clin North Am 2006; 18:311-28, vi. [DOI: 10.1016/j.coms.2006.03.005] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Fujita Y, Hara Y, Nezu Y, Yamaguchi S, Schulz KS, Tagawa M. Direct and indirect markers of cartilage metabolism in synovial fluid obtained from dogs with hip dysplasia and correlation with clinical and radiographic variables. Am J Vet Res 2005; 66:2028-33. [PMID: 16379642 DOI: 10.2460/ajvr.2005.66.2028] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare activities of interleukin (IL)-1beta, IL-6, tumor necrosis factor (TNF)-alpha, and matrix metalloproteinase (MMP)-3 and contents of sulfated glycosaminoglycan (S-GAG) in joint fluid obtained from dogs with hip dysplasia (HD) and clinically normal dogs, evaluate correlations among these markers in joint fluid obtained from dogs with HD, and evaluate correlations between each marker and clinical and radiographic variables. Animals-26 dogs with HD (clinical group) and 43 clinically normal Beagles (control group). PROCEDURE Joint fluid was aseptically collected from the hip joints of all dogs. For each dog in the clinical group, age, duration of lameness, radiographic osteoarthritis (OA) score, and Norberg angle in each affected joint were recorded. Activities of IL-1beta, IL-6, TNF-alpha, and MMP-3 and S-GAG contents were measured. Values were compared between groups by use of Mann-Whitney U tests, and the Spearman rank correlation test was used to evaluate correlations among markers and between each marker and clinical or radiographic variables. RESULTS Values of all markers were significantly higher for the clinical group, compared with values for the control group. There was a moderate positive correlation between lameness duration and IL-6 activity and a strong negative correlation between the Norberg angle and IL-1beta activity. CONCLUSIONS AND CLINICAL RELEVANCE Analysis of our results indicated that there was a significant increase in markers of OA in dogs with HD. Activities of IL-1beta and IL-6 in joint fluid of dogs with HD may be influenced by the severity of laxity in the hip joint and lameness duration, respectively.
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Affiliation(s)
- Yukihiro Fujita
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Animal Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
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Emshoff R. Clinical factors affecting the outcome of arthrocentesis and hydraulic distension of the temporomandibular joint. ACTA ACUST UNITED AC 2005; 100:409-14. [PMID: 16182161 DOI: 10.1016/j.tripleo.2004.12.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2004] [Revised: 11/04/2004] [Accepted: 12/23/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Significant psychosocial distress and substantial cost are associated with the diagnosis and management of chronic temporomandibular joint (TMJ) pain conditions. Successful intervention based on identified risk factors has potential functional and financial benefits. Arthrocentesis and hydraulic distension of the TMJ has been described as an effective modality in the treatment of patients demonstrating clinical findings consistent with the diagnosis of disc displacement without reduction. The purpose of this study was to investigate whether clinical variables such as age, gender, time since pain onset (TSO), visual analog scale (VAS) pain level, and mandibular range of motion (ROM) may predict treatment outcomes of arthrocentesis and hydraulic distension of the TMJ. STUDY DESIGN The study comprised 64 consecutive patients presenting with TMJ pain, who were diagnosed with a unilateral clinical TMJ disorder of "TMJ pain associated with an internal derangement (ID) type III (disc displacement without reduction)." TMJ pain level of function and mandibular range of motion were assessed initially and then compared with the respective 2-month follow-up findings after arthrocentesis and hydraulic distension. Outcome criteria of success included an absence of signs and symptoms characteristic of a diagnosis of ID type III. A multiple logistic regression analysis of pretreatment data was used to compute the odds ratio for variables of age, gender, TSO, VAS pain level, and ROM for successful outcomes (n = 34) vs nonsuccessful (n = 30) outcomes. RESULTS At 2-months follow-up, clinical evaluation showed a significant reduction in TMJ pain during function (P < .001), a significant reduction in clinical diagnoses of TMJ disorders (P < .001), and a significant increase in mandibular range of motion (P < .001). For the outcome criteria of "absence of ID type III," there was a significant difference between the clinical outcome groups for the variables of age (P = .029) and VAS pain level (P < .001). Significant increase in benefit of a successful outcome occurred with an age of < or = 25 years (11.8 odds ratio; P = .044), a VAS pain level of > 75 mm (6.5 odds ratio; P = .026), and an ROM of < 25 mm (6.9 odds ratio; P = .029). CONCLUSION Clinical variables predicted TMJ "ID type III and pain" patients who went on to show successful treatment outcomes of arthrocentesis and hydraulic distension. Predictive modeling may provide clinicians with the opportunity to identify "at-benefit" patients early and initiate specific treatments.
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Affiliation(s)
- Rüdiger Emshoff
- Department of Oral and Maxillofacial Surgery, University of Innsbruck, Austria.
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Dimitroulis G. The role of surgery in the management of disorders of the Temporomandibular Joint: a critical review of the literature. Part 1. Int J Oral Maxillofac Surg 2005; 34:107-13. [PMID: 15695036 DOI: 10.1016/j.ijom.2004.06.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2004] [Indexed: 11/21/2022]
Abstract
Despite the controversy surrounding the role of surgery in the management of Temporomandibular Disorders (TMD), studies in peer review journals continue to support the role of surgery as a legitimate means of treating pain and dysfunction in the Temporomandibular Joint (TMJ). To better understand the role of surgery in the management of TMJ disorders, a critical review of the literature will be presented in two parts. Part 1 reviews the evolution of TMJ surgery together with the biological evidence for surgical disease. History teaches us that we are destined to repeat the mistakes of the past if we fail to properly reflect on what has already been achieved and where the failures have occurred. With the help of molecular biology, the future of TMD management may comprise more carefully targeted and less radical treatment modalities.
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Affiliation(s)
- G Dimitroulis
- St. Vincent's Hospital Melbourne, Suite 5, 10th Floor, 20 Collins Street, Melbourne, Vic. 3000, Australia.
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Emshoff R, Rudisch A. Determining predictor variables for treatment outcomes of arthrocentesis and hydraulic distention of the temporomandibular joint. J Oral Maxillofac Surg 2004; 62:816-23. [PMID: 15218559 DOI: 10.1016/j.joms.2003.12.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Arthrocentesis and hydraulic distention of the temporomandibular joint (TMJ) has been described as an effective modality in the treatment of patients demonstrating clinical findings consistent with the diagnosis of disc displacement without reduction. The purpose of this study was to investigate whether the clinical variable of TMJ pain chronicity and the magnetic resonance (MR) imaging variable of osteoarthrosis (OA) may predict treatment outcomes of arthrocentesis and hydraulic distention of the TMJ. PATIENTS AND METHODS The study consisted of 29 TMJ pain patients, who were assigned a unilateral clinical temporomandibular disorder (TMD) of "TMJ pain associated with an internal derangement (ID) type III (disc displacement without reduction)," and a TMJ pain side-related MR imaging diagnosis of disc displacement without reduction. Bilateral sagittal and coronal MR images were obtained immediately preoperatively to establish the presence or absence of ID and OA. TMJ pain level of function and mandibular range of motion were assessed preoperatively and compared with the respective 2-month follow-up findings. Outcome criteria of success were 1). an absence of signs and symptoms characteristic of a diagnosis of ID type III and/or 2). a reduction in pain level of 85% or greater. A multiple logistic regression analysis was used to compute the odds ratio for TMJ pain chronicity (duration >6 months and <2 years) and OA for successful outcomes versus nonsuccessful outcomes. RESULTS The pretreatment data revealed no significant relationship between the clinical disorder "TMJ pain associated with ID type III" and the MR imaging finding of OA (P =.103). At 2-month follow-up, clinical evaluation showed a significant reduction in TMJ pain during function (P =.000), a significant reduction in clinical diagnoses of TMDs (P =.000), and a significant increase in mandibular range of motion (P =.000). Significant increase in risk of a nonsuccessful outcome (pain reduction <85%) occurred with TMJ pain chronicity (odds ratio of 41.0) (P =.018). Significant increase in benefit of a successful outcome (absence of ID type III) occurred with TMJ OA (odds ratio 1:16.7, P =.06) (P =.044). CONCLUSIONS Arthrocentesis in chronic TMJ pain patients was less successful than in nonchronic patients with regard to treatment outcome of pain reduction. Arthrocentesis in patients with TMJ OA was more beneficial with regard to the disappearance of ID type III than in non-OA patients. Predictive modeling may provide clinicians with the opportunity to identify "at-benefit" patients early and initiate specific treatments.
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Israel HA. Discussion. J Oral Maxillofac Surg 2003. [DOI: 10.1016/s0278-2391(03)00677-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Tomida M, Ishimaru JI, Miyamoto K, Mizui T, Esaki Y, Hayashi T, Murayama K, Era S, Shibata T. Biochemical Aspects of the Pathogenesis of Temporomandibular Joint Disorders. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s0915-6992(03)80020-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Brandlmaier I, Grüner S, Rudisch A, Bertram S, Emshoff R. Validation of the clinical diagnostic criteria for temporomandibular disorders for the diagnostic subgroup of degenerative joint disease. J Oral Rehabil 2003; 30:401-6. [PMID: 12631164 DOI: 10.1046/j.1365-2842.2003.01035.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Research is needed to assess the validity of the Clinical Diagnostic Criteria for Temporomandibular Disorders (CDC/TMD). The purpose of this study was to test the reliability of the clinical diagnosis of temporomandibular joint (TMJ) degenerative joint disease (DJD) as compared with the magnetic resonance imaging (MRI) 'gold standard'. The TMJ DJD group comprised 48 joints in 24 consecutive patients who were assigned a clinical bilateral diagnosis of TMJ DJD. The TMJ non-DJD group consisted of 82 joints in 41 consecutive patients without a TMJ-related diagnosis of TMD. Bilateral sagittal and coronal MR images were obtained subsequently to establish the corresponding diagnosis of degenerative joint changes. An MRI diagnosis of osteoarthrosis (OA) was defined by the presence of flattening, subchondral sclerosis, surface irregularities, and erosion of the condyle or presence of condylar deformities associated with flattening, subchondral sclerosis, surface irregularities, erosion and osteophyte. For the CDC/TMD interpretations, the positive predictive of DJD for OA was 67%, and for the presence of degenerative joint changes 88%. The overall diagnostic agreement for DJD was 44.6% with a corresponding K-value of 0.01. Most of the disagreement was due to false-negative interpretations of asymptomatic joints. The results suggest CDC/TMD to be predictive for degenerative joint changes but insufficient for determination of OA. Patients assigned a clinical TMJ-related diagnosis of DJD may need to be supplemented by evidence from MRI to determine the presence or absence of OA.
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Affiliation(s)
- I Brandlmaier
- Department of Oral and Maxillo-Facial Surgery, University of Innsbruck, A-6020 Innsbruck, Austria
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Emshoff R, Brandimaier I, Bertram S, Rudisch A. Magnetic resonance imaging findings of osteoarthrosis and effusion in patients with unilateral temporomandibular joint pain. Int J Oral Maxillofac Surg 2002; 31:598-602. [PMID: 12521314 DOI: 10.1054/ijom.2002.0314] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to investigate the relationship between the presence of temporomandibular joint (TMJ) pain and the magnetic resonance (MR) imaging findings of osteoarthrosis (OA), and effusion. The study comprised 112 consecutive TMJ pain patients. Criteria for including a patient were report of unilateral pain near the TMJ, with the presence of unilateral TMJ pain during palpation, function, and/or unassisted or assisted mandibular opening. Bilateral sagittal and coronal MR images were obtained to establish the presence or absence of TMJ OA, and/or effusion. Comparison of the TMJ side-related data showed a significant relationship between the clinical finding of TMJ pain and the MR imaging diagnoses of TMJ OA (P=0.000), and TMJ effusion (P=0.000). Further, there was a significant relationship between the MR imaging diagnosis of TMJ OA and TMJ effusion (P=0.000). Use of the Kappa statistical test indicated poor diagnostic agreement between the presence of TMJ pain and the MR imaging diagnosis of TMJ OA (K=0.22), TMJ effusion (K=0.29), and TMJ 'OA and effusion' (K=0.30). The study's findings suggest that while clinical pain is correlated to TMJ-related MR imaging findings, clinical pain in and of itself, is not reliable for predicting the presence of TMJ OA and/or effusion. Validation of MR imaging diagnoses would involve the investigation of cross-sectional and longitudinal evidence to assess decisive differences in terms of prognosis and/or treatment outcome.
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Affiliation(s)
- R Emshoff
- Department of Oral and Maxillo-Facial Surgery, University of Innsbruck, A-6020 Innsbruck, Austria.
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Emshoff R, Innerhofer K, Rudisch A, Bertram S. Clinical versus magnetic resonance imaging findings with internal derangement of the temporomandibular joint: an evaluation of anterior disc displacement without reduction. J Oral Maxillofac Surg 2002; 60:36-41; discussion 42-3. [PMID: 11757004 DOI: 10.1053/joms.2002.29071] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The purpose of this study was to investigate whether the clinical finding of anterior disc displacement without reduction (ADWOR) and pain in the temporomandibular joint (TMJ) is correlated to the magnetic resonance imaging (MRI) findings of TMJ internal derangement (ID). PATIENTS AND METHODS The TMJ group was composed of 55 TMJ pain patients who were assigned a clinical diagnosis of unilateral ADWOR. The control group consisted of 58 nonpainful TMJ patients. Sagittal and coronal MR images were obtained to establish the incidence and type of ID. RESULTS Using chi-square analysis, the results showed a significant relationship between the presence of pain and the MRI diagnosis of ID (P =.000) and its type (P =.000). Use of the kappa statistical test indicated poor diagnostic agreement between the presence of pain and the MRI diagnosis of ID (kappa = 0.37) and disc displacement with reduction (kappa = 0.20). The diagnostic agreement for disc displacement without reduction was 78.8%, with a corresponding kappa-value of 0.58, indicating fair agreement between the clinical and the MRI diagnosis. CONCLUSION The results suggest that TMJ pain associated with ADWOR is correlated with MRI diagnoses of ID and the ID type. These data confirm the use of the clinical diagnostic criteria for disc displacement without reduction as a reliable method of predicting similar MRI diagnoses.
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Affiliation(s)
- Rüdiger Emshoff
- Department of Oral & Maxillofacial Surgery, University of Innsbruck, Innsbruck, Austria.
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Emshoff R, Innerhofer K, Rudisch A, Bertram S. The biological concept of "internal derangement and osteoarthrosis": a diagnostic approach in patients with temporomandibular joint pain? ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2002; 93:39-44. [PMID: 11805776 DOI: 10.1067/moe.2002.117451] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES We sought to investigate whether the finding of temporomandibular joint (TMJ)-related pain may be linked to magnetic resonance (MR) imaging findings of TMJ internal derangement and TMJ osteoarthrosis. STUDY DESIGN The study consisted of 194 consecutive TMJ patients. Criteria for including a patient with a painful TMJ were as follow: report of orofacial pain in the TMJ, with the presence of unilateral or bilateral TMJ pain during palpation, function, and unassisted or assisted mandibular opening. Criteria for including a patient with a nonpainful TMJ were as follow: absence of a TMJ with pain during palpation, function, and unassisted or assisted mandibular opening. Application of the criteria resulted in a study group of 150 patients with unilateral TMJ pain, 10 with bilateral TMJ pain, and 34 without TMJ pain. Bilateral sagittal and coronal MR images were obtained to establish the presence or absence of TMJ internal derangement or osteoarthrosis, or both. RESULTS A comparison of the TMJ-related data showed a significant relationship between the clinical finding of TMJ pain and the MR imaging diagnoses of TMJ internal derangement (P =.002) and TMJ osteoarthrosis (P =.004). Significant increases in risk of pain occurred with "disk displacement without reduction and osteoarthrosis" (P =.000), "disk displacement without reduction and absence of osteoarthrosis" (P =.000), and "disk displacement with reduction and osteoarthrosis" (P =.036). CONCLUSIONS The results suggest that TMJ-related pain is correlated with TMJ-related MR imaging diagnoses of internal derangement and osteoarthrosis. The data confirm the biological concept of "internal derangement and osteoarthrosis," yet re-emphasize that internal derangement and osteoarthrosis may not be regarded as the unique and dominant factors in the definition of TMJ pain.
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Affiliation(s)
- Rüdiger Emshoff
- Department of Oral and Maxillo-Facial Surgery, University of Innsbruck, Austria.
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Emshoff R, Rudisch A, Innerhofer K, Bösch R, Bertram S. Temporomandibular joint internal derangement type III: relationship to magnetic resonance imaging findings of internal derangement and osteoarthrosis. An intraindividual approach. Int J Oral Maxillofac Surg 2001; 30:390-6. [PMID: 11720040 DOI: 10.1054/ijom.2001.0068] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to investigate whether in patients with a clinical unilateral temporomandibular joint (TMJ)-related finding of internal derangement type (ID)-III (disk displacement without reduction) in combination with TMJ-related pain, the intraindividual variable of 'unilateral TMJ ID-III pain' may be linked to subject-related magnetic resonance (MR) imaging findings of TMJ ID, and TMJ osteoarthrosis (OA). The study comprised 48 consecutive TMJ pain patients, who were assigned a clinical unilateral TMJ pain side-related diagnosis of ID-III. Bilateral sagittal and coronal MR images were obtained to establish the presence or absence of TMJ ID and/or OA. Comparison of the TMJ side-related data showed a significant relationship between the clinical finding of TMJ ID-III pain and the MR imaging diagnoses of TMJ ID (P=0.000) and TMJ ID type (P=0.000). There was no correlation between the clinical finding of TMJ ID-III pain and the MR imaging diagnosis of TMJ OA (P=0.217), nor between the MR imaging diagnosis of TMJ OA and that of TMJ ID (P=0.350). Regarding the diagnostic subgroups of TMJ ID, a significant relationship was found between the presence of TMJ OA and the MR imaging diagnoses of TMJ ID type(P=0.002). Use of the Kappa statistical test indicated a fair diagnostic agreement between the presence of TMJ ID-III pain and the MR imaging diagnosis of disk displacement without reduction (DDNR) (K=0.42). The results suggest that TMJ ID-III pain is related to TMJ-related MR imaging diagnoses of ID. Further, the data confirm the biological concept of 'DDNR and OA' as an underlying mechanism in the etiology of TMJ-related pain and dysfunction.
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Affiliation(s)
- R Emshoff
- Department of Oral and Maxillo-Facial Surgery, University of Innsbruck, Austria.
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Suenaga S, Abeyama K, Hamasaki A, Mimura T, Noikura T. Temporomandibular disorders: relationship between joint pain and effusion and nitric oxide concentration in the joint fluid. Dentomaxillofac Radiol 2001; 30:214-8. [PMID: 11681483 DOI: 10.1038/sj.dmfr.4600610] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To evaluate the relationship between joint effusion, contrast enhancement of effusion, nitric oxide concentration in TMJ fluid and TM joint pain. METHODS Nonenhanced T1- and T2-weighted and gadolinium-enhanced T1-weighted spin-echo sequences were performed in 77 patients with TMD. The nitric oxide concentration in TMJ fluid was analysed spectrophotometrically by the Griess reaction. RESULTS Some or marked effusion was seen in five (9%) of the 56 asymptomatic joints and in 55 (56%) of the 98 symptomatic joints. The prevalence of contrast enhancement of joint effusion was significantly higher in the joint pain group than in the joint sound or asymptomatic joint groups (chi2 test, P<0.001). On postcontrast T1-weighted images, there was no evidence of synovial proliferation in patients with TMD. Anterior disk displacement without reduction was detected in 93% of the TMJs with marked effusion. The degree of joint pain correlated with raised nitric oxide concentration (Spearman's rank correlation, P<0.05). CONCLUSIONS Painful joints are more likely to demonstrate contrast enhancement of joint effusion. Nitric oxide concentration in TMJ fluid is closely associated with inflammatory changes and painful TM joints.
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Affiliation(s)
- S Suenaga
- Department of Dental Radiology, Kagoshima University Dental School, Sakuragaoka, Kagoshima City, Japan
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Ishimaru JI, Ogi N, Mizuno S, Goss AN. Quantitation of chondroitin-sulfates, disaccharides and hyaluronan in normal, early and advanced osteoarthritic sheep temporomandibular joints. Osteoarthritis Cartilage 2001; 9:365-70. [PMID: 11399101 DOI: 10.1053/joca.2000.0397] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the relationship between synovial fluid, chondroitin sulfate disaccharide and hyaluronic acid to differing degrees of experimental temporomandibular joint (TMJ) osteoarthritis (OA). DESIGN Twenty-four merino sheep were divided into three groups and had different TMJ surgical procedures to produce OA. Group I; control (six sheep), Group II; disc perforation (nine sheep) and Group III; disc perforation and articular damage (nine sheep). Synovial fluid was collected initially and at sacrifice at 3 months. Chondroitin 4-sulfate, chondroitin 6-sulfate and hyaluronic acid were measured and correlated to the OA histologic score. RESULTS The chondroitin-sulfate levels were significantly increased (Group I to Group II P< 0.001; Group I to Group III P< 0.001), the hyaluronic acid levels decreased (Group I to Group II P< 0.01; Group I to Group III P< 0.01) with the increasing OA score. CONCLUSION Chondroitin-sulfate and hyaluronic acid show a correlation with surgically created TMJ osteoarthritis in sheep model.
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Affiliation(s)
- J I Ishimaru
- Department of Oral and Maxillofacial Surgery, Gifu Prefectural Gifu Hospital, Japan.
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Srinivas R, Sorsa T, Tjäderhane L, Niemi E, Raustia A, Pernu H, Teronen O, Salo T. Matrix metalloproteinases in mild and severe temporomandibular joint internal derangement synovial fluid. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2001; 91:517-25. [PMID: 11346728 DOI: 10.1067/moe.2001.115136] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The first objective of this study was to verify the presence of and identify the molecular forms of matrix metalloproteinases (MMPs), including collagenases (MMP-1, MMP-8, and MMP-13) and gelatinases (MMP-2 and MMP-9), in the synovial fluid (SF) of mild and severe temporomandibular joint internal derangement (TMJ-ID). Another objective was to evaluate whether the SF MMPs are potential diagnostic markers that reflect the stage of intra-articular inflammation in the TMJ. STUDY DESIGN The subjects were 44 patients with mild (n = 16) or severe (n = 28) TMJ-ID; they were classified on the basis of subjective symptoms, clinical and radiographic findings, and surgical observations. The patients were surgically treated, and SF samples were collected immediately before the operation. The collagenase activity of SF samples was analyzed by means of a type I collagen degradation assay. The levels and molecular forms of the SF MMPs as well as the tissue inhibitors of MMPs (TIMP-1 and TIMP-2) were analyzed with Western immunoblotting and gelatin zymography. RESULTS The SF of both the mild and the severe TMJ-ID patients exhibited free collagenase activity and activity capable of further degrading the (3/4)(alphaA) fragments. Ninety-two-kilodalton proMMP-9 and its 121-kD complex form, as well as 72-kD proMMP-2 were significantly increased in the mild TMJ-ID group (P <.05 in all cases). Both 70- to 80-kD neutrophil type and 45- to 55-kD mesenchymal cell-type MMP-8 (corresponding to the latent and active forms) were observed in mild and severe TMJ-ID SF, but they predominated in mild TMJ-ID. Both MMP-1 and MMP-13 were observed in both groups, and in mild TMJ-ID SF the low-molecular weight forms of MMP-1 indicated activation of the enzyme. CONCLUSIONS The degradation of type I collagen in the TMJ is evidently due to the collective action of many collagenolytic MMPs present in the SF of patients with mild and severe TMJ-ID. The elevated levels of MMP-2, MMP-9, and MMP-8 in the SF of patients with mild TMJ-ID eventually reflect the active phase of TMJ destruction. These observations may have considerable diagnostic and therapeutic significance in the management of TMJ disorders.
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Affiliation(s)
- R Srinivas
- Faculty of Medicine and Biomedicum, University of Helsinki, Helsinki, Finland
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Emshoff R, Innerhofer K, Rudisch A, Bertram S. Relationship between temporomandibular joint pain and magnetic resonance imaging findings of internal derangement. Int J Oral Maxillofac Surg 2001; 30:118-22. [PMID: 11405446 DOI: 10.1054/ijom.2000.0028] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In terms of clinical decision-making in instances of temporomandibular disorders (TMD) and orofacial pain, there is controversy in the literature over the diagnostic significance of the temporomandibular joint (TMJ)-related variable disk-condyle relationship (DCR). The purpose of this study was to investigate whether in patients with TMJ-related pain, the variable of TMJ pain may be linked to magnetic resonance (MR) imaging findings of internal derangement (ID). The study comprised 163 consecutive TMJ pain patients. Criteria for including a patient were report of orofacial pain referred to the TMJ, and the presence of uni- or bilateral TMJ pain during palpation, during function, and/or during unassisted or assisted mandibular opening. Bilateral sagittal and coronal MR images were obtained to establish the prevalence of TMJ ID types. Analysis of the data revealed the presence of TMJ pain to be associated with significantly more MR imaging diagnoses of ID than an absence of ID (P<0.001), and disk displacement without reduction than disk displacement with reduction (P<0.001). Using chi-square analysis, the results showed a significant relationship between the presence of TMJ-related pain and the MR imaging diagnosis of TMJ ID (P=0.001), and TMJ ID type (P=0.000). Use of the Kappa statistical test indicated poor diagnostic agreement between the presence of TMJ pain and the MR imaging diagnosis of ID (K=0.16). The results suggest that the clinical variable of TMJ pain may have a significant effect on the prevalences of MR imaging diagnoses of TMJ ID. The data confirm the biological concept of DCR as a diagnostic approach in patients with signs and symptoms of TMJ-related pain.
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Affiliation(s)
- R Emshoff
- Department of Oral and Maxillofacial Surgery, University of Innsbruck, Austria.
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Emshoff R, Puffer P, Rudisch A, Gassner R. Temporomandibular joint pain: relationship to internal derangement type, osteoarthrosis, and synovial fluid mediator level of tumor necrosis factor-alpha. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2000; 90:442-9. [PMID: 11027380 DOI: 10.1067/moe.2000.108801] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate whether patients with temporomandibular joint (TMJ)-related pain classified as capsulitis/synovitis may be linked to magnetic resonance imaging (MRI) findings of internal derangement, osteoarthrosis, or the synovial fluid aspirate findings of tumor necrosis factor-alpha (TNF-alpha) level. STUDY DESIGN The study comprised 23 patients with temporomandibular disorders (TMD), who had nonchronic pain (pain onset < or =6 months) and a unilateral TMJ-related diagnosis of capsulitis/synovitis. Bilateral sagittal and coronal magnetic resonance images were obtained to establish the presence or absence of internal derangement, osteoarthrosis, or both. TMJ synovial fluid aspirates were obtained from the pain and contralateral nonpain sides to determine the TNF-alpha level. RESULTS Comparison of the TMJ side-related data showed a significant relationship between the clinical TMD diagnosis of capsulitis/synovitis and the MRI diagnoses of TMJ internal derangement (P =.002) and of TMJ internal derangement type (P =.04). The mean TNF-alpha level in synovial fluid aspirates from TMJs assigned a clinical TMD diagnosis of capsulitis/synovitis was significantly higher than in those obtained from contralateral nonpain sides (P =.001). There was no correlation between the clinical diagnosis of capsulitis/synovitis and the MRI diagnosis of TMJ osteoarthrosis (P =.13) or between the MRI diagnosis of TMJ osteoarthrosis and that of TMJ internal derangement (P =.70) or TMJ internal derangement type (P =.33). CONCLUSIONS The results suggest that the TMJ pain condition of capsulitis/synovitis is related to TMJ-side specific MRI diagnoses of internal derangement and internal derangement type, and synovial fluid aspirate findings of TNF-alpha level. The data confirm the concept of elevated mediator level as a diagnostic approach for patients presenting with TMJ-related pain. MRI and synovial fluid aspirates may be used as diagnostic methods for evaluating TMJ-related pain conditions.
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Affiliation(s)
- R Emshoff
- University of Innsbruck, Department of Oral and Maxillofacial Surgery, Austria.
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Ishimaru JI, Oguma Y, Goss AN. Matrix metalloproteinase and tissue inhibitor of metalloproteinase in serum and lavage synovial fluid of patients with temporomandibular joint disorders. Br J Oral Maxillofac Surg 2000; 38:354-9. [PMID: 10922168 DOI: 10.1054/bjom.2000.0306] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We measured matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinases (TIMP) in temporomandibular joint (TMJ) disorders. All patients were fully investigated, by visual analogue pain scores, plain radiographs and double-contrast arthrotomograms. The patients were grouped according to whether or not they were in pain. There were 35 patients with painful joints; 16 painless crepitating joints and 10 with chronic closed locked joints. A further group of 9 volunteers with no symptoms of TMJ abnormalities were used as controls. We found that synovial fluid concentration of MMP-3 was significantly increased (1117.2 (164.0) ng/ml) (P< 0.05) in the painful group compared with controls (436.2 (94.8) ng/ml) and with the two groups with painless TMJ (475.0 (113. 0) ng/ml/crepitation, and 516.0 (115.1) ng/ml/closed locked joints). MMP-1 and TIMP-1 were not recordable in most joints, and the serum concentrations of MMP-1, MMP-3, and TIMP-1 were similar to those in controls in all groups. There was no correlationship between MMP-3 concentration and joint morphology as shown by plain radiographs and double contrast arthrotomograms. These findings indicate that the synovia of painful joints are inflamed.
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Affiliation(s)
- J I Ishimaru
- Department of Oral and Maxillofacial Surgery, Gifu Prefectural Gifu Hospital, Japan
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Emshoff R, Puffer P, Strobl H, Gaßner R. Effect of temporomandibular joint arthrocentesis on synovial fluid mediator level of tumor necrosis factor-α: implications for treatment outcome. Int J Oral Maxillofac Surg 2000. [DOI: 10.1016/s0901-5027(00)80088-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Takahashi T, Nagai H, Seki H, Fukuda M. Relationship between joint effusion, joint pain, and protein levels in joint lavage fluid of patients with internal derangement and osteoarthritis of the temporomandibular joint. J Oral Maxillofac Surg 1999; 57:1187-93; discussion 1193-4. [PMID: 10513864 DOI: 10.1016/s0278-2391(99)90483-4] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to investigate the relationship between the presence of joint effusion, joint pain, and protein levels in joint lavage fluid (JL) of patients with internal derangement (ID) and osteoarthritis (OA) of the temporomandibular joint (TMJ). PATIENTS AND METHODS Thirty-eight joints in 26 patients with ID and OA of the TMJ were studied. Magnetic resonance imaging (MRI) evidence of joint effusion was evaluated in T2-weighted images. Samples of JL were collected from the superior joint space during pumping manipulation, and the protein concentration was measured. The presence of pain was based on joint tenderness or a complaint of pain in the preauricular region during mouth opening or closing. RESULTS Joint effusion was demonstrated in 20 of 25 (80%) painful joints; a significantly higher incidence than in pain-free joints (5 of 13, 38.5%). The mean protein concentration (2.15 mg/mL) in JL from painful joints was significantly higher than in pain-free joints (1.22 mg/mL) (P < .05). Furthermore, the mean protein concentration (2.12 mg/mL) in JL from joints with effusion was significantly higher than in joints without joint effusion (1.27 mg/mL) (P < .05). CONCLUSIONS These data demonstrate that painful joints are more likely to show joint effusion on MRI, and the protein levels in JL recovered from these joints is higher than in pain-free joints. These data also suggested that joint effusion may be related to the inflammatory changes seen in patients with ID and OA.
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Affiliation(s)
- T Takahashi
- Division of Dentistry and Oral Surgery, Akita University School of Medicine, Akita City, Japan.
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Israel HA, Diamond B, Saed-Nejad F, Ratcliffe A. The relationship between parafunctional masticatory activity and arthroscopically diagnosed temporomandibular joint pathology. J Oral Maxillofac Surg 1999; 57:1034-9. [PMID: 10484103 DOI: 10.1016/s0278-2391(99)90321-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this investigation was to assess the relationship between parafunctional masticatory activity and arthroscopically visualized changes in patients with severe, unremitting symptoms caused by intra-articular temporomandibular joint pathology. The working hypothesis was that the presence of parafunctional activity leads to increased arthroscopically diagnosed pathology. MATERIALS AND METHODS Temporomandibular joint arthroscopy was performed on 124 joints in 83 patients (female:male, 5.4:1; mean age, 35 years; mean duration of symptoms, 49 months) with severe symptoms unresponsive to nonsurgical management. Preoperatively, the presence of parafunctional habits (bruxism, clenching) was assessed, and joints were classified as either with or without parafunctional influences. Joints were diagnosed arthroscopically and assessed for the presence or absence of osteoarthritis, synovitis, and adhesions. Analyses were performed to determine significant relationships between parafunctional activity and the presence of osteoarthritis, synovitis, and adhesions. RESULTS Parafunctional influences were present in 82 of 124 joints (66%). Clinically diagnosed osteoarthritis was present in 59 of 124 joints (48%) and arthroscopically diagnosed osteoarthritis was seen in 82 of 124 joints (66%). Arthroscopically, synovitis was diagnosed in 123 of 124 joints (99%) and adhesions in 93 of 124 joints (75%). Statistical analyses showed a significant relationship between parafunction and clinically diagnosed osteoarthritis, and suggested a close relationship between parafunction and arthroscopically diagnosed osteoarthritis. A significant association between clinically and arthroscopically diagnosed osteoarthritis and adhesions was also demonstrated. There also was no significant relationship detected between parafunction and the presence of synovitis or adhesions seen arthroscopically. CONCLUSIONS It was concluded that parafunctional masticatory activity and its influence on joint loading contribute to osteoarthritis of the temporomandibular joint. Such osteoarthritis is associated with adhesions of the joint. Arthroscopically diagnosed synovitis is not specifically associated with parafunction, and it appears that numerous other causative factors may contribute to its development in the TMJ. Because abnormal joint loading is a major causative factor in cartilage degradation, biochemical and biomechanical abnormalities, and intraarticular temporomandibular pathology, clinicians must identify and address parafunctional masticatory activity during nonsurgical, surgical, and postsurgical treatment regimens.
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Affiliation(s)
- H A Israel
- Division of Oral and Maxillofacial Surgery, Columbia University, New York, NY, USA.
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Takahashi T, Kondoh T, Ohtani M, Homma H, Fukuda M. Association between arthroscopic diagnosis of temporomandibular joint osteoarthritis and synovial fluid nitric oxide levels. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1999; 88:129-36. [PMID: 10468453 DOI: 10.1016/s1079-2104(99)70105-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The 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. STUDY DESIGN Arthroscopic 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. RESULTS Significantly 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. CONCLUSIONS The findings indicate that increased levels of nitric oxide are involved in the pathogenesis of cartilaginous degeneration of the temporomandibular joint.
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Affiliation(s)
- T Takahashi
- Division of Dentistry and Oral Surgery, Akita University School of Medicine, Japan
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Arthroscopic findings in osteoarthritic temporomandibular joints. J Oral Maxillofac Surg 1999. [DOI: 10.1016/s0278-2391(99)90670-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Zardeneta G, Milam SB, Lee T, Schmitz JP. Detection and preliminary characterization of matrix metalloproteinase activity in temporomandibular joint lavage fluid. Int J Oral Maxillofac Surg 1998; 27:397-403. [PMID: 9804207 DOI: 10.1016/s0901-5027(98)80072-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In this study, lavage fluid was fractionated from the superior joint space in patients with temporomandibular joint (TMJ) dysfunction. A hide powder azure protease assay was used to assess protease activity in lavage fluid. No correlation between a patient's pain and the level of protease activity was demonstrated. Latent as well as active proteases were detected in the sample lavage fluid. Latent matrix metalloproteinases (MMPs) were activated using trypsin. Stromelysin-1 was detected in an active form in lavage fluid by immunozymography. The presence of high molecular weight species with protease activity was also demonstrated. This study validates the presence of stromelysin-1 as well as other MMPs in TMJ lavage fluid and proposes a mechanism for their physiologic activation.
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Affiliation(s)
- G Zardeneta
- Department of Oral and Maxillofacial Surgery, The University of Texas Health Science Center at San Antonio 78284, USA
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Israel HA, Diamond B, Saed-Nejad F, Ratcliffe A. Osteoarthritis and synovitis as major pathoses of the temporomandibular joint: comparison of clinical diagnosis with arthroscopic morphology. J Oral Maxillofac Surg 1998; 56:1023-7; discussion 1028. [PMID: 9734762 DOI: 10.1016/s0278-2391(98)90246-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE The purposes of this investigation were to determine how common osteoarthritis and synovitis are in patients with severe, recalcitrant temporomandibular joint (TMJ) symptoms using clinical diagnostic criteria as well as arthroscopic examination, and to compare the accuracy of the clinical and arthroscopic diagnoses with respect to specificity and sensitivity. PATIENTS AND METHODS Clinical and arthroscopic diagnoses were established in 126 joints of 84 patients with severe TMJ symptoms recalcitrant to conservative therapy. All joints were classified as having osteoarthritis (OA) or no osteoarthritis (non-OA) and synovitis (syn) or no synovitis (non-syn) using clinical and arthroscopic criteria. Chi-squared analysis was used to determine whether there was a relationship between the clinical and arthroscopic diagnoses. Preoperative clinical diagnoses were compared with arthroscopic morphologic diagnoses to determine the specificity and sensitivity of the clinical diagnostic criteria for synovitis and osteoarthritis. RESULTS A preoperative clinical diagnosis of OA was established in 59 of 126 joints (47%) compared with an arthroscopic diagnoses of OA in 82 of 126 joints (65%). Chi-squared analysis showed a significant relationship between the clinical and arthroscopic diagnosis of OA. A clinical diagnosis of OA was associated with a high specificity (.977); however, there were 23 of 82 (.293) false-negative findings and a sensitivity of only .707. A preoperative clinical diagnosis of synovitis was established in 114 of 126 joints (90%), compared with an arthroscopic diagnosis of synovitis in 112 of 126 (89%). Chi-squared analysis did not show a significant relationship between the clinical and arthroscopic diagnosis of synovitis. A clinical diagnosis of synovitis was associated with a high sensitivity (.920); however, there were 11 of 14 false-positive findings (.786) associated with a low specificity (.214). CONCLUSIONS Although there was high specificity for the clinical diagnosis of OA, the sensitivity was very low. (Comparison of clinical and arthroscopic diagnoses showed that osteoarthritis frequently escapes clinical detection. The clinical diagnosis of synovitis showed that low specificity and symptoms may be caused by other pathoses.
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Correlation of inflammatory cytokines with arthroscopic findings in patients with temporomandibular joint internal derangements. J Oral Maxillofac Surg 1998. [DOI: 10.1016/s0278-2391(98)90447-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Shibata T, Murakami KI, Kubota E, Maeda H. Glycosaminoglycan components in temporomandibular joint synovial fluid as markers of joint pathology. J Oral Maxillofac Surg 1998; 56:209-13. [PMID: 9461147 DOI: 10.1016/s0278-2391(98)90871-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE This study investigated the correlation between temporomandibular joint (TMJ) disease and the composition of glycosaminoglycans (GAGs) components in the synovial fluid (SF). MATERIALS AND METHODS Synovial fluid (SF) was obtained from 30 TMJs of 28 female patients diagnosed as having a displaced disc with reduction (WR) (seven joints), a displaced disc without reduction (WOR) (13 joints), osteoarthritis (OA) (five joints), or rheumatoid arthritis (RA) (five joints) by MR imaging and clinical examination. After the SF was directly aspirated, It was digested with chondroitinase ABC and hyaluronidase, and the concentration of unsaturated disaccharide isomers of chondroitin 6-sulfate (delta di-6S), chondroitin 4-sulfate (delta di-4S) and hyaluronic acid (delta di-HA) were measured by high-performance liquid chromatography (HPLC) combined with fluorometry. The ratio of delta di-6S or delta di-4S to delta di-HA, and delta di-6S to delta di-4S, were calculated. RESULTS There were no significant differences in concentrations of delta di-6S, delta di-4S, or delta di-HA among the groups. The ratio of delta di-6S to delta di-4S was 2.7 +/- 1.4 in OA, 2.6 +/- 0.9 in joints with WOR, 2.9 +/- 1.2 in joints with WR, and 1.3 +/- 0.4 in RA synovial fluid. Differences in the delta di-6S: delta di-4S ratio between RA and the other conditions were statistically significant (P < .05). CONCLUSION These results suggest that the delta di-6S:delta di-4S ratio in the synovial fluid of the TMJ reflects the proteoglycan metabolism of the joint tissues, particularly of the articular cartilage and synovial tissue. This ratio could be used to diagnose joint diseases and to predict articular cartilage destruction or synovial proliferation caused by these diseases.
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Affiliation(s)
- T Shibata
- Department of Dentistry and Oral Surgery, School of Medicine, Yamagata University, Iidanishi, Japan
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Murakami KI, Shibata T, Kubota E, Maeda H. Intra-articular levels of prostaglandin E2, hyaluronic acid, and chondroitin-4 and -6 sulfates in the temporomandibular joint synovial fluid of patients with internal derangement. J Oral Maxillofac Surg 1998; 56:199-203. [PMID: 9461145 DOI: 10.1016/s0278-2391(98)90869-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE This study was conducted to measure the intra-articular levels of prostaglandin E2 (PGE2), hyaluronic acid, and chondroitin-4 and -6 sulfate in patients with temporomandibular joint (TMJ) internal derangement involving a closed lock, and to see if these levels correlate with the clinical or arthroscopic findings. PATIENTS AND METHODS Fifteen female patients (16 joints) with a mean age of 36.7 years were diagnosed as having a closed lock by clinical examination and diagnostic MR imaging. The patient's subjective pain was assessed by a visual analog scale (VAS) and a pain questionnaire (pain score), and the interincisal opening was measured. TMJ aspirates were obtained by washing of the joint with saline containing vitamin B12 as a marker for calibration of data. The samples were assayed for PGE2 with a radioimmunoassay, and the concentrations of unsaturated disaccaride isomers of hyaluronic acid (delta di-HA), chondroitin-4 sulfate (delta di-4S), and chondroitin-6 sulfate (delta di-6S) were measured by high-performance liquid chromatography. Immediately after collection of the synovial aspirates, diagnostic arthroscopy was performed on all but three joints to evaluate the severity of synovitis and cartilage degeneration. The degree of arthroscopic pathology was scored quantitatively. Intra-articular levels of PGE2, delta di-HA(HA), delta di-4S(C4S), and delta di-6S(C6S) were compared with patient's age, mouth opening, VAS rating, pain scores, and arthroscopic scores for synovitis and cartilage degeneration. RESULTS The PGE2 level did not correlate with the clinical or arthroscopic parameters. HA had a weak correlation with mouth opening (0.54). C4S and C6S were correlated with arthroscopic scores of TMJ degeneration (0.97, 0.89) and with age (0.75, 0.62). The ratio of C4S and C6S to HA was also correlated with the arthroscopic indices of degeneration (0.93, 0.8) and PGE2 level (0.74, 0.69), but not with age. CONCLUSION The PGE2 level in the TMJ synovial fluid does not specifically reflect the intensity of pain or synovitis, but the detection of high concentrations of C4S and C6S, compared with the amount of HA, is a possible marker of proteoglycan degradation in the TMJ.
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Affiliation(s)
- K I Murakami
- Department of Oral and Maxillofacial Surgery, Graduate School and Faculty of Medicine, Kyoto University, Japan
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Ratcliffe A, Israel HA, Saed-Nejad F, Diamond B. Proteoglycans in the synovial fluid of the temporomandibular joint as an indicator of changes in cartilage metabolism during primary and secondary osteoarthritis. J Oral Maxillofac Surg 1998; 56:204-8. [PMID: 9461146 DOI: 10.1016/s0278-2391(98)90870-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The specific aim of this investigation was to assess differences between primary and secondary osteoarthritis (OA) of the temporomandibular joint (TMJ) using clinical evaluation and synovial fluid analysis for proteoglycans. MATERIALS AND METHODS Arthroscopic surgery was performed on 101 TMJs from patients with significant pain or dysfunction and who had failed to respond to treatment. Joints were assessed for primary and secondary osteoarthritis. Synovial fluid aspirates were obtained and analyzed to determine the levels of keratan sulfate (KS) epitope and a novel 3B3(-) epitope by enzyme-linked immunosorbent assay (ELISA). RESULTS Fifty-four patients and 67 joints had OA diagnosed by both clinical examination and arthroscopy. Primary OA was diagnosed in 14 joints (20%), and the remaining 53 joints were regarded as having secondary OA. No differences were detected in the levels of KS in the synovial fluid from the primary and secondary OA joints. Furthermore, the 3B3(-) epitope was not detectable in the synovial fluid aspirates of any TMJ. CONCLUSION Secondary OA is a common disorder of the TMJ. However, there is no apparent difference in the metabolism of the joints with primary and secondary OA as assessed by proteoglycans in the synovial fluid. The apparent absence of the 3b3(-) epitope, in contrast to its presence in OA of other major synovial joints, suggests that there are some differences between the cartilage metabolism of the TMJ and these other joints during OA.
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Affiliation(s)
- A Ratcliffe
- Advanced Tissue Sciences, La Jolla, CA 92037, USA
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Takahashi T, Kondoh T, Fukuda M, Yamazaki Y, Toyosaki T, Suzuki R. Proinflammatory cytokines detectable in synovial fluids from patients with temporomandibular disorders. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1998; 85:135-41. [PMID: 9503445 DOI: 10.1016/s1079-2104(98)90415-2] [Citation(s) in RCA: 194] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To measure the levels of the proinflammatory cytokines, interleukin (IL)-1 beta, IL-6, tumor necrosis factor- (TNF) alpha, IL-8, and interferon- (IFN) gamma in synovial fluid samples taken from patients with temporomandibular disorders (TMD). STUDY DESIGN We studied 6 asymptomatic volunteers and 51 patients with TMD. The IL-1 beta, IL-6, TNF-alpha, IL-8, and IFN-gamma levels in temporomandibular joint synovial fluid were measured using enzyme-linked immunosorbent assay. RESULTS Measurable level of at least one cytokine in the synovial fluid was found in 40 (64.5%) of 62 joints in the patients: IL-1 beta and IFN-gamma were each detected in 18 (29.0%) of 62 joints; IL-6 in 13 (21.0%) of 62 joints; IL-8 in 11 (19.3%) of 57 joints; and TNF-alpha in only 5 (8.1%) of 62 joints. None of these cytokines was detectable in the synovial fluid in the control group. Furthermore, there was a strong correlation between the detection of IL-1 beta and pain in the joint area. CONCLUSIONS These data clearly demonstrate increased levels of several proinflammatory cytokines in certain patients with TMD and suggest that these cytokines may play a role in the pathogenesis of synovitis and degenerative changes of the cartilaginous tissue and bone of the temporomandibular joint.
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Affiliation(s)
- T Takahashi
- Division of Oral and Maxillofacial Surgery, Akita University School of Medicine, Japan
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Results of reoperation after failed modified condylotomoy. J Oral Maxillofac Surg 1997. [DOI: 10.1016/s0278-2391(97)90179-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Israel HA. The “Anchored disc phenomenon”: A proposed etiology for sudden-onset, severe, and persistent closed lock of the temporomandibular joint. J Oral Maxillofac Surg 1997. [DOI: 10.1016/s0278-2391(97)90336-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Flygare L, Wendel M, Saxne T, Ericson S, Eriksson L, Petersson A, Rohlin M. Cartilage matrix macromolecules in lavage fluid of temporomandibular joints before and 6 months after diskectomy. Eur J Oral Sci 1997; 105:369-72. [PMID: 9298370 DOI: 10.1111/j.1600-0722.1997.tb00254.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The purpose was to investigate if antigenic fragments of aggrecan and cartilage oligomeric matrix protein (COMP) are detectable by enzyme-linked immunosorbent assay in lavage fluids from the temporomandibular joint (TMJ) and to examine if the relative content of these cartilage markers changes during development of osteoarthrosis (OA) after diskectomy. Lavage fluid was obtained at surgery and 6 months postoperatively in 13 patients. Computed tomography or magnetic resonance imaging was without evidence of hard-tissue changes prior to surgery in all patients. In 9 of the patients, sufficient material for analysis was obtained at both examinations. Aggrecan and COMP were detectable in all but 2 fluids, in which the COMP levels were below detection limit. The aggrecan/COMP ratio increased in all 9 patients during the 6-month period, indicating increased release of aggrecan relative to COMP fragments. The changed aggrecan/COMP ratio possibly reflects increased cartilage turnover during development of OA. Changes compatible with OA were present on computed tomography in all cases at the 6-month follow-up. This study shows that the lavage procedure is feasible for obtaining synovial fluid from the TMJ for immunochemical analyses of tissue-derived macromolecules.
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Affiliation(s)
- L Flygare
- Department of Oral Radiology, Institute for Postgraduate Dental Education, Jönköping, Sweden.
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Zardeneta G, Milam SB, Schmitz JP. Elution of proteins by continuous temporomandibular joint arthrocentesis. J Oral Maxillofac Surg 1997; 55:709-16; discussion 716-7. [PMID: 9216503 DOI: 10.1016/s0278-2391(97)90583-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study was to determine whether specific proteins recovered from human temporomandibular joints (TMJs) by superior space arthrocentesis are eluted at different outflow volumes. MATERIALS AND METHODS Twenty subjects with unilateral TMJ pain and restricted mandibular range of motion underwent superior space arthrocentesis of the affected TMJ. Sixteen serial fractions of the arthrocentesis outflow volume were collected for analysis. The protein content of each fraction was determined by a BCA protein assay and analyzed by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). In addition, samples from each collected fraction were assayed for protease activity. RESULTS The average amount of protein recovered in the total 32 mL of collected arthrocentesis fluid was 1.5 mg (0.72 to 2.1 mg). Significant differences (P = .03) in total protein recovered from arthrocentesis fluid were observed between males (0.824 +/- 0.43 mg/20 mL) and females (1.389 +/- 0.54 mg/20 mL). In general, protein concentration declined serially in collected TMJ lavage fluid fractions. Specific proteins and proteases detected in the lavage fluid were eluted at different outflow volumes. CONCLUSIONS Although specific proteins are eluted from the TMJ at different outflow volumes during arthrocentesis, the procedure effectively reduces the protein concentration of the lavage fluid in a volume-dependent manner. Based on empirical assumptions, it is estimated that approximately 100 mL of total arthrocentesis volume is sufficient for a therapeutic lavage of the superior joint space of the human TMJ.
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Affiliation(s)
- G Zardeneta
- Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at San Antonio 78284, USA
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Aghabeigi B, Haque M, Wasil M, Hodges SJ, Henderson B, Harris M. The role of oxygen free radicals in idiopathic facial pain. Br J Oral Maxillofac Surg 1997; 35:161-5. [PMID: 9212290 DOI: 10.1016/s0266-4356(97)90555-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Patients with chronic facial pain including those with facial arthromyalgia (TMJ dysfunction syndrome) were investigated for evidence of abnormal systemic and intra-articular free radical activity. Chronic facial pain patients showed significantly raised serum 2,3-dihydroxybenzoic acid after an oral dose of 1.2 g of aspirin which indicates increased systemic free radical activity. This was reflected in the TMJ aspirates of the facial arthromyalgia patients which contained thiobarbituric acid-reactive substance (TBA-RS) which is also a product of free radical activity. The synovial aspirates also contained high levels of the hyperalgesic eicosanoid 15-HETE. However, there was no difference between the painful and symptom-free joints, which suggested that in part the clinical features are probably determined by asymmetrical masticatory function or as yet unknown algesic factors such as local cytokine production.
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Affiliation(s)
- B Aghabeigi
- Department of Oral and Maxillofacial Surgery, Eastman Dental and University College London Hospitals, UK
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Israel HA, Diamond BE, Saed-Nejad F, Ratcliffe A. Correlation between arthroscopic diagnosis of osteoarthritis and synovitis of the human temporomandibular joint and keratan sulfate levels in the synovial fluid. J Oral Maxillofac Surg 1997; 55:210-7; discussion 217-8. [PMID: 9054908 DOI: 10.1016/s0278-2391(97)90526-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE The specific aims of this investigation were to determine if there is a relationship between an arthroscopic diagnosis of synovitis and osteoarthritis, and if the presence of synovitis influences the level of cartilage degradation, as evidenced by keratan sulfate levels in the synovial fluid. PATIENTS AND METHODS Arthroscopic surgery was performed on 114 temporomandibular joints in 88 patients who had significant pain or dysfunction and whose condition had failed to improve with conservative treatment. Synovial fluid aspirates were obtained immediately before arthroscopy and used for the determination of keratan sulfate levels. Arthroscopic examination included assessment of the presence or absence of osteoarthritis and synovitis. RESULTS Synovitis was present in 90% of joints, and osteoarthritis was present in 62% of joints examined arthroscopically. Both osteoarthritis and synovitis existed in 57% of the joints. Joints with an arthroscopic diagnosis of synovitis had significantly lower levels of keratan sulfate in the synovial fluid aspirates than joints with osteoarthritis. Synovial fluid aspirates from temporomandibular joints with osteoarthritis had significantly higher levels of keratan sulfate than synovial fluids from joints without osteoarthritis. CONCLUSIONS Osteoarthritis and synovitis are common diagnoses and are often present concurrently in patients with symptomatic temporomandibular joints. Osteoarthritis is associated with elevated keratan sulfate levels; however, the elevation of keratan sulfate is less in patients with concomitant synovitis.
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Kubota E, Imamura H, Kubota T, Shibata T, Murakami K. Interleukin 1 beta and stromelysin (MMP3) activity of synovial fluid as possible markers of osteoarthritis in the temporomandibular joint. J Oral Maxillofac Surg 1997; 55:20-7; discussion 27-8. [PMID: 8994464 DOI: 10.1016/s0278-2391(97)90438-9] [Citation(s) in RCA: 158] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE This study investigated the early signs of synovitis and cartilage degradation by means of synovial fluid analysis in temporomandibular joints (TMJs) with internal derangement (closed lock) or osteoarthritis (OA). PATIENTS AND METHODS Synovial fluid was obtained from 25 TMJs in 22 patients diagnosed with closed lock and from 15 asymptomatic TMJs of 12 normal controls. IL-1 beta concentrations were measured using enzyme-linked immunosorbent assay (ELISA), and proteinase activity was detected by means of gelatin enzymography. RESULTS Nine of the 25 TMJs with closed lock (CL group) exhibited osteolytic changes on the surface of the condyle. TMJs in the normal control group did not show any bony changes. Mean IL-1 beta concentration in the synovial fluid (SF) protein in the CL group was 330.1 +/- 347.7 pg per 100 micrograms protein, which was significantly higher than in the normal control (76.7 +/- 95.3 pg/100 micrograms SF-protein). Synovial fluid from the TMJs with osteolytic changes contained higher levels of IL-1 beta (531.8 +/- 379.6 pg/100 micrograms SF-protein) than those without bony changes (216.7 +/- 280.1 pg/100 micrograms SF-protein). Matrix metalloproteinase (MMP) activity with a molecular weight of 50 kd (stromelysin or MMP3) was detected in a highly augmented form in two synovial fluid samples of seven closed lock patients. CONCLUSION The results suggest that IL-1 beta levels in synovial fluid of the TMJ have a positive correlation with OA change. The MMP3 activity detected was greatly increased in patients with cartilage degradation. These findings suggest that both changes may be important markers of early bone deterioration in TMJs that are undetectable by radiograph imaging.
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Affiliation(s)
- E Kubota
- Second Department of Oral and Maxillofacial Surgery, Kanagawa Dental College, Yokosuka, Japan
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Takahashi T, Kondoh T, Kamei K, Seki H, Fukuda M, Nagai H, Takano H, Yamazaki Y. Elevated levels of nitric oxide in synovial fluid from patients with temporomandibular disorders. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1996; 82:505-9. [PMID: 8936513 DOI: 10.1016/s1079-2104(96)80194-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of this study was to measure nitric oxide activity in synovial fluid samples taken from patients with temporomandibular disorders. STUDY DESIGN We investigated six volunteers without symptoms and 56 patients with temporomandibular disorders. Nitric oxide activity was measured in temporomandibular joint synovial fluid with a highly sensitive and specific chemiluminescence detection method. RESULTS A detectable nitrite concentration was found in only 1 of 10 joints in the control group. Measurable levels (> 0.001 mol/l) of nitrites in the synovial fluid were found in 8 (72.7%) of 11 joints with disk derangement with clicking, 24 (85.7%) of 28 joints with disk derangement with locking, and all 26 (100%) joints with osteoarthritis. The mean nitrite concentrations in the temporomandibular joint synovial fluid in the disk derangement with clicking, disk derangement with locking, and osteoarthritis groups were significantly higher than that in the control group (p < 0.05, p < 0.001, p < 0.001, respectively). CONCLUSIONS These data clearly show increased nitric oxide production in certain temporomandibular disorders and suggest that nitric oxide may play a role in the pathogenesis of synovitis and degenerative changes of cartilaginous tissue and bone of the temporomandibular joint.
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Ali AM, Sharawy M. Histochemical and immunohistochemical studies of the effects of experimental anterior disc displacement on sulfated glycosaminoglycans, hyaluronic acid, and link protein of the rabbit craniomandibular joint. J Oral Maxillofac Surg 1996; 54:992-1003; discussion 1003-4. [PMID: 8765389 DOI: 10.1016/s0278-2391(96)90399-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to determine the effects of surgically induced anterior disc displacement (ADD) on sulfated glycosaminoglycans (GAGs) such as keratan sulfate (KS), chondroitin-4-sulfate (C4S), and chondroitin-6-sulfate (C6S), hyaluronic acid (HA), and link protein (LP) of the rabbit craniomandibular joint (CMJ) using histochemical and immunohistochemical techniques. MATERIALS AND METHODS The right joint of 20 rabbits was exposed surgically, and all discal attachments were severed except for the posterior attachment. The disc was then repositioned anteriorly and sutured to the zygomatic arch. The left joint served as a sham-operated control. Ten additional joints were used as nonoperated controls. Deeply anesthetized rabbits were perfused with 2% buffered formalin 2 weeks (10 rabbits) or 6 weeks (10 rabbits) after surgery. Discs, bilaminar zones, condyles, and articular eminences were excised. Condyles and articular eminences were decalcified in ethylenediaminetetraacetic acid (EDTA). All tissues were sectioned at 10 microns in a cryostat. Sections were incubated with alcian blue and monoclonal antibodies directed against KS, C4S, C6S, HA, or LP. After incubation in the appropriate fluorescein isothiocyanate (FITC)-labeled secondary antibodies, tissue sections were studied under the fluorescence microscope. RESULTS The results showed a reduction in alcian blue staining and KS, C4S, C6S, HA, and LP immunostaining in the disc and articular surfaces at 2 weeks after induction of ADD. This reduction was followed by an increase in their immunostaining at 6 weeks. Also, there was a progressive increase in alcian blue staining, and KS, C4S, C6S, and HA immunostaining in the bilaminar zone at 2 and 6 weeks. CONCLUSION It was concluded that surgical induction of ADD in the rabbit CMJ leads to alterations in KS, C4S, C6S, HA, and LP content, consistent with similar changes accompanying osteoarthritis of other synovial joints.
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Affiliation(s)
- A M Ali
- School of Medicine, Medical College of Georgia, Augusta, USA
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