Desordens hiperostóticas em American Bully / Hiperostotic disorders in american bully

O complexo de desordens hiperostóticas é uma condição rara e autolimitante, que tem as mesmas características histopatológicas, que cursa com proliferação óssea de caráter não neoplásico. Acomete cães jovens de raças distintas, com variabilidade quanto ao tipo de proliferação óssea e quanto aos ossos acometidos. O complexo é composto pela osteopatia craniomandibular, hiperostose da calota craniana e osteodistrofia hipertrófica. Podendo estar presente nos ossos da calota craniana, mandíbulas, coluna cervical e esqueleto apendicular. O presente relato, descreveu o quadro de uma cadela, da raça American Bully, não castrada, três meses de idade, que foi atendida com queixa de aumento de volume doloroso das mandíbulas, hiporexia e sialorreia há 15 dias, apresentando ao exame físico, amplitude de movimento diminuída e sensibilidade dolorosa da articulação temporomandibular, espessamento firme bilateral do crânio em região de fossa temporal, espessamento palpável de consistência firme das mandíbulas e crepitação respiratória. Após avaliação clínica e realização de exames complementares, chegou-se ao diagnóstico presuntivo, de complexo de desordens hiperostóticas. Foi instituído como conduta terapêutica o suporte analgésico, sendo eficaz para a manutenção das necessidades fisiológicas até a paciente alcançar a fase adulta. O prognóstico para esta paciente foi considerado bom, uma vez que não havia indícios de anquilose da articulação temporomandibular e/ou manifestações neurológicas.

The complex of hyperostotic disorders is a rare and self-limiting condition, which has the same histophatological characteristics, which courses with non-neoplastic bone proliferations. It affects young dogs of different breeds, with variability the bones affected. The complex is composed of craniomandibular osteopathy, calvarial hyperostotic syndrome and hypertrophic osteodystrophy. It may be present in the bones of the skullcap, jaws, cervical spine and appendicular skeleton. The present report describes the condition of a female dog, American Bully breed, entire, three months old, with a complaint of painful swelling of the jaws, hyporexia and drooling for 15 days, presenting on physical examination, reduced amplitude and pain of the temporomandibular joint, bilateral firm thickening of the skull in the temporal fossa region, palpable firm-consistent thickening of the mandibles and respiratory crackle. After clinical evaluation and complementary tests, a presumptive diagnosis of hyperostotic disorders complex was reached. It was instituted pain management as a treatment, being effective for the maintenance of physiological needs until the patient reaches the adulthood. The prognosis for this patient was considered good, since there was no evidence of temporomandibular joint ankylosis and/or neurological manifestations.

Terapias físicas en pacientes con trastornos de la articulación temporomandibular / Physical therapies in patients with temporomandibular joint disorders

RESUMEN Introducción: Se denomina trastorno temporomandibular al conjunto de condiciones musculoesqueléticas que afectan la articulación temporomandibular, los músculos de la masticación y las estructuras anatómicas adyacentes. Objetivo: Evaluar la efectividad de las terapias físicas en pacientes con trastornos de la articulación temporomandibular. Métodos: Se efectuó una intervención terapéutica en la Clínica Estomatológica Provincial Docente Mártires del Moncada de Santiago de Cuba, desde junio de 2016 hasta febrero de 2020. La muestra quedó conformada por 264 pacientes distribuidos en 4 grupos con 66 integrantes cada uno, a quienes se les aplicaron diferentes terapias físicas, tales como ultrasonido, laserterapia, magnetoterapia y técnica de estimulación eléctrica transcutánea, respectivamente. Se analizaron las siguientes variables: edad, grado de trastorno de la articulación temporomandibular y efectividad terapéutica. Se empleó el porcentaje como medida de resumen y el estadígrafo de Ji al cuadrado con un nivel de significación de 0,05. Resultados: Predominó el sexo femenino en todas las terapias aplicadas con más de 75,0 % y el grupo etario de 40 - 49 años. Al finalizar el tratamiento se observó que en los grupos donde se empleó ultrasonido, láser y magneto, la respuesta fue efectiva en más de 90,0 % de los pacientes, con primacía del primero (96,6 %); sin embargo, en el grupo donde se utilizó la técnica de estimulación eléctrica transcutánea solo se logró en 89,4 % de los afectados. Conclusiones: La ultrasonoterapia fue más efectiva en pacientes con trastornos de la articulación temporomandibular.

ABSTRACT Introduction: A temporomandibular disorder is a group of musculoskeletal conditions that affect the temporomandibular joint, the mastication muscles and the adjacent anatomical structures. Objective: To evaluate the effectiveness of the physical therapies in patients with temporomandibular joint disorders. Methods: A therapeutic intervention was carried out in Mártires del Moncada Teaching Provincial Stomatological Clinic from Santiago de Cuba, from June, 2016 to February, 2020. The sample was formed by 264 patients distributed in 4 groups with 66 members each one, to whom different physical therapies were applied, such as ultrasound, laser therapy, magnetotherapy and technique of transcutaneous electric stimulation, respectively. The following variables were analyzed: age, grade of dysfunction of the temporomandibular joint and therapeutic effectiveness. The percentage as summary measure and the chi-squared test were used with a significance level of 0.05. Results: There was a prevalence of the female sex in all the therapies applied with more than 75.0 % and the 40 - 49 age group. When concluding the treatment it was observed that in the groups where ultrasound, laser and magneto was used, the response was effective in more than 90.0 % of the patients, with primacy of the first one (96.6 %); however, in the group where the technique of transcutaneous electric stimulation was used it was just achieved in 89.4 % of the affected patients. Conclusions: The ultrasonotherapy was more effective in patients with temporomandibular joint disorders.

Prevalence of Temporomandibular Disorders and its Correlation with Stress and Salivary Cortisol Levels among Students

ABSTRACT Objective: To evaluate the prevalence of temporomandibular disorders (TMD) in students and to evaluate if any relationship existed between the stress levels, salivary cortisol levels, and TMD. Material and Methods: A total of 348 students, 187 female, and 161 male students, participated in this cross-sectional study. Students were evaluated based on the Research Diagnostic Criteria for TMD. The stress levels were evaluated using the Perceived Stress Scale. The students were divided into the control and TMD groups. Salivary cortisol levels in the salivary samples were analyzed. Results: The prevalence rate of TMDs was 30.7% in the study population. Of the female students, 61% had TMD compared with 46% of male students. Muscle disorders were the most predominant disorder in 14.2% of the students with TMD. The TMD group showed significantly higher salivary cortisol and stress levels than the control group. The TMD group also showed a moderate positive correlation between cortisol and stress levels (p=0.01). Conclusion: The study showed a strong association between salivary cortisol levels, stress, and temporomandibular disorders. Salivary cortisol could be used as a prognostic biomarker for stress while assessing the severity of TMJ problems in stressed individuals.

Alterações craniomorfológicas em pacientes adultos com bruxismo avaliados por meio de tomografia computadorizada de feixe cônico / Craniomorphological changes in adult patients with bruxism assessed through cone-beam tomography

O objetivo deste estudo foi avaliar as características craniomorfológicas de pacientes portadores de bruxismo (BX), por meio de imagens de tomografia computadorizada de feixe cônico (TCFC). Para tal, foram utilizados 70 exames de TCFC de arquivos de indivíduos com a faixa etária entre 18 e 44 anos de idade, adquiridos para finalidades ortodônticas, sob o mesmo protocolo (FOV de 17,0 x 22,0 cm e voxel de 0,4 mm, em um mesmo aparelho ICAT Next Generation - Imaging Science International, Hatfield, PA, EUA). Os exames foram divididos em dois grupos: 35 correspondentes à indivíduos apresentando BX ­ grupo bruxismo (GB) e 35 a indivíduos sem BX - grupo controle (GC) ­ todos verificados por meio de exame de clínico e físico específicos. Em ambos os grupos, foram avaliadas as seguintes características craniomorfológicas, obtidas pelo protocolo SYM: avaliação sagital; forma mandibular e a assimetria esquelética. Adicionalmente, foram avaliados: o volume das vias aéreas superiores (VAS) e os volumes condilares (VC), por meio de segmentação nas imagens de TCFC, pelo software ITK SNAP. Coletados os dados, serão aplicados testes estatísticos descritivos para cada parâmetro. E as diferenças dos grupos foram obtidas pelo teste t de Student com nível de significância de p < 0,01. De acordo com os resultados obtidos, o Ângulo Goníaco D e E (p <0,001) e S-N.Ocl (p=0,030) foram menores no GB, e Teto Fossa ­ Pl. Axial D (p=0,001) e E (p= 0,002) foram maiores no GB. Neste estudo, a imagem de TCFC 3D mostrou mudanças importantes e significativas na morfologia mandibular em pacientes adultos com BX em comparação com os sem BX.

The aim of this study is to evaluate the craniomorphological characteristics of patients who suffer from bruxism BX, through cone beam imaging (TCFC). In order to carry on the study, we will be using 52 cone beam computed tomography (TCFC) images from the subjects files whose ages range from 18 to 44, obtained to access orthodontic measurements under the same protocol (FOV ­ 17.0 x 22.0 cm and voxel = 0.4 mm, using the same equipment which was the ICAT Next Generation - Imaging Science International, Hatfield, PA, EUA). The study group will be divided in two groups: 31 corresponding to the subjects presenting BX ­ Bruxism Group (GB) and 21 subjects who did not present this condition, called the Control Group (GC) ­ all evaluated through specific clinical and physical assessment. The following craniomorphological characteristics will be evaluated in both groups, obtained through the SYM protocol: saggital evaluation; mandibular shape and skeletal asymmetry. The volume of the upper airways (VAS) and condylar volumes (VC) were also additionally evaluated through the TCFC imaging segmentation, using the software called ITK SNAP. As soon as the data collection, statistically descriptive tests will be used for each parameter. And the group differences will be obtained through the I Student Test with a significance level of p < 0.01. There GB showed the gonial angle right and left (p<0,001) and S-N.OcI (p=0,030) decreased, in other hand, "Teto Fossa"-Pl.Axial right (p=0,001) and left (p=0,002) increased. In this study the CBCT 3D image showed important and significant changes in mandibular structure in bruxers compared with non-bruxers.

Disfunción temporomandibular en pacientes con síndrome de Sjögren / Temporomandibular dysfunction in patients with Sjögren's syndrome

Introducción: El síndrome de Sjögren es una enfermedad reumática, inflamatoria y crónica caracterizada por dolor articular y resequedad de las mucosas. La articulación temporomandibular (ATM) y las glándulas parótidas y salivales suelen estar afectadas. Objetivo: Determinar la prevalencia de la afectación de la articulación temporomandibular en pacientes con síndrome de Sjögren. Métodos: Estudio básico, no experimental, descriptivo y de corte transversal que incluyó a 78 pacientes con diagnóstico de síndrome de Sjögren atendidos en la Unidad Móvil número 2 de Alausi entre 2017 y 2019. Para identificar la afectación de la ATM se realizaron ecosonografías. Se usó la prueba de correlación de Pearson para establecer la relación entre las características de la enfermedad y la presencia de afectación articular. Resultados: El promedio de edad fue de 46,18 años. Predominaron los pacientes entre 40 y 60 años (62,82 por ciento), el sexo femenino (85,90 por ciento), y el tiempo de evolución de la enfermedad entre 3 y 5 años (50,00 por ciento). El 79,49 por ciento presentó síndrome de Sjögren secundario, y la artritis reumatoide fue la causa más frecuente (54,84 por ciento). El 65,38 por ciento tenía algún tipo de afectación de la ATM, y el hallazgo más común fue la disminución del espacio articular (56,86 por ciento). Conclusiones: Existió una elevada prevalencia de afectación de la ATM en los pacientes con síndrome de Sjögren, y el hallazgo principal fue la disminución del espacio articular. Se encontró una correlación positiva media entre el tiempo de evolución de la enfermedad y la presencia de afectación de la ATM(AU)

Introduction: Sjögren's syndrome is a rheumatic, inflammatory and chronic disease characterized by the presence of joint pain and dryness of the mucous membranes. The temporomandibular joint and the parotid and salivary glands usually have a high frequency of involvement. Objective: To determine the prevalence of temporomandibular involvement in patients with Sjögren's syndrome. Methods: Descriptive, correlational and explanatory study that included 78 patients diagnosed with Sjögren's syndrome treated in the mobile unit number 2 of Alausi. Echocardiography of the temporomandibular joints was performed to identify the involvement of the joint. Pearson's correlation test was used to establish a relationship between the characteristics of the disease and the presence of joint involvement. Results: Average age of 46.18 years with a predominance of patients between 40 and 60 years of age (62.82 percent), of the female sex (85.90 percent) and with time of evolution of the disease between 3 and 5 years (50.00 percent). 79.49 percent of the cases presented secondary Sjögren's syndrome, rheumatoid arthritis being the most frequent disease (54.84 percent). 65.38 percent of the patients presented some type of involvement of the temporomandibular joint, with the decrease in joint space being the most frequent finding (56.86 percent). Conclusions: There was a high prevalence of temporomandibular joint involvement in patients with Sjögren's syndrome, with the decrease in joint space being the finding that was most frequently identified. A positive average correlation was found between the time of evolution of the disease and the presence of temporomandibular joint involvement(AU)

Interdisciplinary Approach to the Temporomandibular Joint Osteoarthritis-Review of the Literature.

Background and objectives: There are an increasing number of patients applying for dental treatment who suffer from temporomandibular joint osteoarthritis (TMJOA). Osteoarthritis may be the cause of the pain in the area of temporomandibular joints, but its course may also be absolutely asymptomatic. The aim of this study was to present an interdisciplinary approach to TMJOA, including current diagnostics and treatment modalities on the basis of the available literature. Materials and Methods: PubMed and Scopus databases were analyzed using the keywords: ((temporomandibular joint AND osteoarthritis) AND imaging) and ((temporomandibular joint AND osteoarthritis) AND treatment). The bibliography was supplemented with books related to the temporomandibular joint. After screening 2450 results, the work was based in total on 98 publications. Results and Conclusions: Osteoarthritis is an inflammatory, age-related, chronic and progressive degenerative joint disease. Magnetic resonance imaging (MRI) and cone-beam computed tomography (CBCT), together with clinical symptoms, play significant roles in TMJOA diagnosis. Current MRI techniques seem to be clinically useful for assessment of bony changes in temporomandibular joint (TMJ) disorders. Treatment of TMJOA requires a complex, interdisciplinary approach. TMJOA treatment includes the cooperation of physiotherapists, rheumatologists, gnathologists, orthodontists and quite often also maxillofacial surgeons and prosthodontists. Sometimes additional pharmacotherapy is indicated. Thorough examination of TMJ function and morphology is necessary at the beginning of any orthodontic or dental treatment. Undiagnosed TMJ dysfunction may cause further problems with the entire masticatory system, including joints, muscles and teeth.

Anquilosis de la articulación temporomandibular / Ankylosis of the temporomandibular joint

Introducción: resulta de interés para médicos y especialistas el conocimiento sobre la incapacidad de la apertura de la cavidad oral debido a coaliciones entre los elementos óseos y fibrosos en la región glenoidea. Objetivo: revisar la literatura sobre las características de esta patología. Desarrollo: en el primer trimestre del año 2006, a fin de realizar una revisión bibliográfica no exhaustiva para localizar la información disponible sobre la anquilosis de la articulación temporomandibular, se realizó una búsqueda bibliográfica en Scielo, Medline, Isi Web of Knowlegde y Dialnet, buscando como palabras clave: anquilosis (ankylosis) y articulación temporomandibular (temporomandibular joint). Además de la búsqueda computarizada se realizó una búsqueda manual entre las referencias de los estudios seleccionados. Conclusiones: la anquilosis temporomandibular resulta una entidad clínica compleja, usualmente molesta para los pacientes dada la imposibilidad de alimentarse y nutrirse adecuadamente, además de las deformidades que desde el punto de vista estético afecta la esfera psicológica de las personas aquejadas. Su tratamiento es difícil, no obstante, una atención adecuada minimiza las consecuencias de las complicaciones que pueden aparecer como resultado de la técnica quirúrgica u otros factores no relacionados con ella. Se reconoce que una identificación y tratamiento oportuno del problema puede favorecer los buenos resultados de la conducta médica y la rápida integración del paciente a la sociedad(AU)

Introduction: it is of interest for physicians and specialist's knowledge about the inability of the opening of the oral cavity due to coalitions between the bone and fibrous elements in the glenoid region. Objective: to review the literature on the characteristics of this pathology. Development: in the first quarter of 2006, in order to perform a non-exhaustive literature review to locate the available information on ankylosis of the temporomandibular joint, a literature search was carried out in Scielo, Medline, Isi Web of Knowlegde and Dialnet, searching as key words: ankylosis (ankylosis) and temporomandibular joint (temporomandibular joint). In addition to the computerized search, a manual search was made among the references of the selected studies. Conclusions: the temporomandibular ankylosis is a complex clinical entity, usually annoying for patients given the impossibility of feeding and nourishing adequately, in addition to the deformities that from the aesthetic point of view affects the psychological sphere of the people afflicted. Its treatment is difficult, nevertheless, an adequate attention minimizes the consequences of the complications that can appear as a result of the surgical technique or other factors not related to it. It is recognized that an identification and timely treatment of the problem can favor the good results of medical behavior and the rapid integration of the patient into society(AU)

Intervención educativa en pacientes con bruxismo y disfunción temporomandibular / Educational intervention in patients with bruxism and temporomandibular dysfunction

El presente texto expone los resultados de un estudio prospectivo, del tipo de intervención comunitaria aplicado en la Clínica Estomatológica Docente La Vigía, provincia Camagüey, con el objetivo de instrumentar una estrategia educativa en pacientes con bruxismo y disfunción temporomandibular en el período de enero de 2017 a enero de 2018. Se diseñó y aplicó una estrategia educativa según la metodología utilizada por la Maestría Nacional de Educación para la salud. Predominó el sexo femenino y las edades comprendidas entre los 24 y 29 años, así como el nivel escolar universitario. Al finalizar la intervención, el nivel de conocimientos fue evaluado de bueno en casi todos los pacientes, la apertura bucal limitada, el dolor muscular y articular aparecieron en menos de la mitad de los individuos; el nivel de satisfacción respecto a la intervención fue alto. Se concluyó que la estrategia generó un impacto positivo en los pacientes estudiados(AU)

The present text exhibits the results of a pilot study, of the type of community intervention applied in the Dentistry University Clinic La Vigía, Camagüey province, with the objective to arrange an educational strategy in patients with bruxism and temporomandibular dysfunction in the period from January, 2017 until January, 2018. It was designed and applied an educational strategy as the methodology used by the National Mastery of Education for the health. It predominated over the feminine sex and the ages understood between 24 and 29 years, as well as over the university school level. On having finished the intervention, the knowledge level was evaluated of good in almost all the patients, the limited mouth opening, the muscular pain and to articulate appeared in less than half of the individuals; the satisfaction level with regard to the intervention was high. It was concluded that the strategy generated a positive impact in the studied patients(AU)

Bifid mandibular condyles: A systematic review

BACKGROUND: Bifid mandibular condyle (BMC) constitutes an extremely rare disorder characterized by a duplication of the head of the mandibular condyle. Its prevalence ranges from 0.31% to 1.82% in the published literature. OBJECTIVES: The primary objective was to describe the main etiological, clinical and radiological characteristics of patients with BMCs and the existent treatment options. The secondary objective was to simultaneously include the characteristics of two new cases of BMC. MATERIAL AND METHODS: An electronic search in Pubmed (MEDLINE), Scopus and The Cochrane Library was carried out by two independent reviewers until April 2018. Prospective or retrospective cohort studies, case series and case reports describing clinical and/or radiological characteristics of patients with BMC were included. Registered variables were demographic, etiological factors, diagnostic exam, clinical characteristics and treatment options. The results from the articles selected were organized in a Table along with the characteristics of two new cases of BMC provided by the authors. RESULTS: From a total of 431 articles found in the initial search, 68 articles were finally included. This systematic review included 216 patients and 270 BMC with an average age of 30.6 (SD=14.7) years and a women:men ratio of 1.4:1. Mediolateral condylar orientation was the most prevalent position (80.1%). Among cases with known etiology, 40.8% of cases had a history of traumatism, while 55.9% did not present any relevant medical background. Half of the symptomatic cases had history of trauma. The most common symptoms were hypomobility (22.7%), arthralgia (18.1%), articular noise (17.2%) and ankylosis (17.6%). Active monitoring and manufacturing an occlusal splint were the most frequent treatment options. CONCLUSIONS: BMC may have congenital or traumatic etiology. Hypomobility and arthralgia are the most frequent symptoms and treatment options are often conservative

Prevalence of Abnormal Morphology of the Temporomandibular Joint in Asymptomatic Subjects: A Retrospective Cohort Study Utilizing Cone Beam Computed Tomography.

PURPOSE: This retrospective cohort study in an asymptomatic nonpatient population evaluated the prevalence of specific morphologic changes usually associated with the presence of degenerative joint diseases (DJD) using cone beam computed tomography (CBCT) and examined the associations between DJD and age, sex, and number of teeth present. MATERIALS AND METHODS: CBCT images (268 TMJs) of 134 asymptomatic patients were studied. Patient data were obtained from clinical records, and calibrated examiners interpreted the CBCT images. The presence or absence of traditional radiographic signs of DJD (erosion, generalized sclerosis, osteophytes, and subchondral cysts) in the condyle and articular eminence of each TMJ were evaluated. The data were submitted to bivariate (chi-square and Fisher exact tests) and multivariate (Poisson regression) analyses (α = .05). RESULTS: The sample was primarily composed of men (52.24%) and individuals aged ≥ 61 years (55.64%); 61.94% were partially edentulous with ≤ 12 teeth in the oral cavity. The most common DJD diagnoses were mandibular condyle osteophytes (30.22%) and erosion (12.69%), followed by articular eminence erosion (8.58%) and mandibular condyle subchondral cysts (7.09%). The bivariate analysis showed a statistically significant association between women and subchondral cysts (P = .007), between edentulous individuals and subchondral cysts (P = .008), and between individuals with ≤ 12 teeth and mandibular condyle erosion (P = .005). In the adjusted Poisson regression analysis, a significant association was found between DJD and gender (P = .015). CONCLUSION: Despite the limitations of this study, the results show a high prevalence of morphologic changes usually associated with the presence of DJD in asymptomatic subjects. Osseous TMJ abnormalities were most present in women, individuals with a lower number of teeth, and older individuals.

Temporomandibular dysfunction

BACKGROUND: Orofacial pain is a common presentation in the primary healthcare setting and temporomandibular dysfunction represents one of the major causes. Its aetiology is multifactorial, caused by both masticatory muscle dysfunction and derangement within the temporomandibular joint. OBJECTIVE: The aim of this article is to provide an overview of temporomandibular dysfunction, its management and referral considerations for general practioners. DISCUSSION: Temporomandibular joint dysfunction affects a large number of adults. Conservative management involving non-pharmacological and pharmacological therapies is effective in the majority of cases.

Hemifacial microsomia (oculo-auriculo-vertebral spectrum) in an individual from the Teramo Sant'Anna archaeological site (7th-12th centuries of the Common Era, Italy).

BACKGROUND: This study is based in an analysis of the skeletal remains of an adult male from the Teramo Sant'Anna archaeological site (7th-12th centuries of the Common Era, Teramo, Italy). RESULTS AND DISCUSSION: The individual shows distinct abnormalities that principally involve asymmetric hypoplasia and dysmorphogenesis of the facial skeleton. The combination of these findings and the absence of abnormalities of the spine strongly suggest diagnosis of the congenital malformation known as hemifacial microsomia. This very heterogeneous syndrome affects primarily aural, ocular, oral and mandibular development. Despite the lack of clinical information and the absence of soft tissue, it was possible to perform a differential diagnosis for this palaeopathological case. Mastication was probably altered considering that the mandible is extremely asymmetric and lacks true condyles. The temporomandibular joints are present, but the right one is hypoplastic and abnormal in shape. There is evidence of bilateral dislocation, and the facial muscles are hypertrophic. CONCLUSIONS: This case represents an important contribution to the palaeopathological literature because this is an uncommon condition that has not been widely documented in ancient skeletal remains.

Functional disorders of the temporomandibular joints: Internal derangement of the temporomandibular joint.

Temporomandibular joint (TMJ) is one of the most complex joints of the human body. Due to its unique movement, in terms of combination of rotation and translator movement, disc of the joint plays an important role to maintain its normal function. In order to sustain the normal function of the TMJ, disc must be kept in proper position as well as maintain normal shape in all circumstances. Once the disc is not any more in its normal position during function of the joint, disturbance of the joint can be occurred which will lead to subsequent distortion of the disc. Shape of the disc can be influenced by many factors i.e.: abnormal function or composition of the disc itself. Etiology of the internal derangement of the disc remains controversial. Multifactorial theory has been postulated in most of previous manuscripts. Disc is composed of mainly extracellular matrix. Abnormal proportion of collagen type I & III may also leads to joint hypermobility which may be also a predisposing factor of this disorder. Thus it can be recognized as local manifestation of a systemic disorder. Different treatment modalities with from conservative treatment to surgical intervention distinct success rate have been reported. Recently treatment with extracellular matrix injection becomes more and more popular to strengthen the joint itself. Since multifactorial in character, the best solution of the treatment modalities should be aimed to resolve possible etiology from different aspects. Team work may be indication to reach satisfied results.

Diagnostic reliability of 3.0-T MRI for detecting osseous abnormalities of the temporomandibular joint.

We compared the diagnostic reliability of 3.0-T magnetic resonance imaging (MRI) for detection of osseous abnormalities of the temporomandibular joint (TMJ) with that of the gold standard, cone-beam computed tomography (CBCT). Fifty-six TMJs were imaged with CBCT and MRI, and images of condyles and fossae were independently assessed for the presence of osseous abnormalities. The accuracy, sensitivity, and specificity of 3.0-T MRI were 0.88, 1.0, and 0.73, respectively, in condyle evaluation and 0.91, 0.75, and 0.95 in fossa evaluation. The McNemar test showed no significant difference (P > 0.05) between MRI and CBCT in the evaluation of osseous abnormalities in condyles and fossae. The present results indicate that 3.0-T MRI is equal to CBCT in the diagnostic evaluation of osseous abnormalities of the mandibular condyle.

No association between types of unilateral mandibular condylar abnormalities and facial asymmetry in orthopedic-treated patients with juvenile idiopathic arthritis.

INTRODUCTION: Dentofacial asymmetries are often observed in patients with juvenile idiopathic arthritis (JIA) and temporomandibular joint (TMJ) involvements. The aim of this split-face study was to associate types of radiologic TMJ abnormalities with the degree of dentofacial asymmetry in patients with unilateral TMJ involvements assessed with cone-beam computed tomography. METHODS: Forty-seven JIA patients and 19 nonarthritic control subjects were included in the study. Normal condylar radiologic cone-beam computed tomography appearance in at least 1 TMJ was the inclusion criterion for all patients with JIA. The contralateral TMJ was thereafter scored as either "normal," "deformed," or "erosive," consistent with predefined criteria. Based on the bilateral radiologic TMJ appearances, 3 JIA groups were assigned: normal/normal, normal/deformed, and normal/erosive. The severity of the dentofacial asymmetry was compared between the JIA groups and control subjects. Dentofacial asymmetry was expressed as interside ratios and angular measurements. RESULTS: Eighty-seven percent of the JIA patients were being treated or had previously received treatment with a functional orthopedic appliance at the time of the cone-beam computed tomography. Significantly greater dentofacial asymmetries were observed in the 2 groups of JIA patients with unilateral condylar abnormalities (deformation or erosion) than in the other groups. A similar degree of dentofacial asymmetry was observed in JIA patients with bilateral normal TMJs and in the nonarthritic control group. CONCLUSIONS: JIA patients with unilateral condylar abnormalities (deformation or erosion) exhibited significantly more severe dentofacial asymmetries than did the JIA patients without condylar abnormalities and the control subjects. We found the same degree of dentofacial asymmetry when dividing patients with condylar abnormalities into deformation and erosion groups.

Congenital Abnormalities of the Temporomandibular Joint.

Congenital deformities of the temporomandibular joint (TMJ) complex can present as a heterogeneous continuum of growth disturbances of the mandibular condyle, articular eminence, and temporal bone. This article describes several syndromes with congenital condylar deformity, including mandibulofacial dysostosis (Treacher Collins syndrome), hemifacial microsomia, oculoauriculovertebral syndrome, oculomandibulodyscephaly (Hallermann-Streiff syndrome), and Nager syndrome. Variations in the extent of TMJ deficiency seen in each individual case influence the timing and techniques of TMJ reconstruction.

Acquired Abnormalities of the Temporomandibular Joint.

Mandibular growth is a complex process that involves the "functional matrix," an interaction of the muscles of mastication, occlusion, and jaw function. Although not a typical growth center, the mandibular condyle has a significant effect on the ultimate size, shape and function of the mandible and secondarily on overall facial form. Acquired temporomandibular joint (TMJ)/condylar abnormalities, such as juvenile idiopathic arthritis, idiopathic condylar resorption, TMJ ankylosis, and condylar hyperplasia, often result in facial deformity and functional deficits. Accurate diagnosis is critical for the clinician to assess potential progression of deformity, predict prognosis, and plan treatment.

[Relationship between the mandibular hypoplasia and temporomandibular joint internal derangement in adolescents with skeletal class â ¡ malocclusion].

Mandibular hypoplasia is very common clinically. Studies have reported that temporomandibular joint internal derangement (TMJID) might manifest as mandibular retrusion, and whether there is a direct correlation between them remains controversial in academia. On the other hand, for adolescent patients with skeletal class Ⅱ malocclusion, the growth of mandible could be motivated by orthopedic force, and then the mandibular retrusion corrected. However, if TMJID is the direct cause of mandibular retrusion, orthopedic treatment will not have a significant effect on it. Base on literature review and analysis as well as our own research, this article will review the distribution of structural abnormalities of the temporomandibular joint in adolescents with mandibular hypoplasia and its association with skeletal class Ⅱ malocclusion, as well as the effect of TMJID on the treatment of skeletal class Ⅱ malocclusion in adolescents.

The relationship between a dolichofacial morphology and bone adaptation of the articular tubercle.

OBJECTIVES: Against the background of a possibly compromised functional adaptation, the relationship between the height of the articular tubercle was analyzed as a function of the amount of divergence between the maxilla and the mandible. DESIGN: These parameters were obtained retrospectively from orthopantomograms and lateral radiographs produced in a standard procedure before orthodontic treatment. RESULTS: The height of the articular tubercle appeared to be significantly smaller in a group of patients with a dolichofacial morphology, with respect of those with an average (mesofacial) morphology. Furthermore, there was a significant correlation between the height of the articular tubercle and the mandibular angle. CONCLUSIONS: These results suggest that bone remodeling in selected parts of the orofacial skeleton can be compromised giving rise to an altered craniofacial morphology.