Objective To retrospectively analyze the advantages and disadvantages of radiographic methods commonly used for diagnostic of condylar fractures.Methods From Jan 2002 to Nov 2013,290 patients (405 condylars) in the temporomandibular joint (TMJ) division of Ninth People's Hospital Shanghai Jiao Tong University School of Medicine were diagnosed as condylar fractures.Panoramic films and CT were taken in all patients to check and count the amount of condylar fractures,including intracapsular condyle fracture (type A,B,C and M),condylar neck fracture and subcondylar fracture.MRI was also taken in 119 patients with 174 condylar fractures to check the position of TMJ disc.The data were analyzed and compared among the three examinations in the diagnosis of the condylar fractures.Results Panoramic films showed 79.8％ (323/405) condylar fractures.Among condylar fractures,intracapsular condylar fractures,condylar neck fractures and subcondylar fractures accounted for 48.9％(198/405),20.3％(82/405) and 10.6％(43/405)respectively.CT showed 64.0％ (259/405) intracapsular condylar fractures,24.0％ (97/405) condylar neck fractures and 12.1％(49/405) subcondylar fractures.Among intracapsular condylar fractures,Type A fracture was the most common type of ICF,which accounted for 48.7％(126/259),followed by Type B fracture,which accounted for 30.9％(80/259) and Type M fracture,12.4％(32/259).Type C fracture was the least type which accounted for 8.1％ (21/259).According to the diagnostic criteria of CT,there were 10 condylar neck fractures misdiagnosed with intracapsular condylar fractures.MRI showed 94.9％ (129/136) TMJ disc displacement in intracapsular condylar fractures,53.6％ (15/28) in condylar neck fractures and 60.0％ (6/10) in subcondylar fractures.Among intracapsular condylar fractures,there were 95.3％(61/64) TMJ disc displacement in type A,95.2％(40/42) in type B,89.0％(8/9) in type C,and 95.2％(20/21) in type M.There was significant difference of TMJ disc displacement between intracapsular condylar fractures and condylar neck fractures or subcondylar fractures (P＜0.05),and no significant difference between condylar neck fractures and subcondylar fractures (P＜0.05).There was also no significant difference among various type of intracapsular condylar fractures.Conclusions Panoramic films can initially diagnose condylar fractures but with the high misdiagnosis rate for intracapsular fractures,minor fractures and fractures without fragment displacement.CT,especially coronal CT,should be considered for positioning fracture lines and confirming the displacement angle of fragment.MRI should also be used to determine the position of TMJ disc in intracapsular condylar fractures.

Objective:To introduce the design, manufacture and clinical application of the custom-made temporomandibular joint (TMJ)-skull base combined prosthesis and evaluate its safety, effectiveness and accuracy.Methods:The patients diagnosed with the TMJ-skull base lesion in Department of Oral Surgery, Shanghai Ninth People′s Hospital from October 2016 to November 2020 were recruited in this study. The maxillofacial CT data for all the patients were obtained and transformed into the Mimics 18.0 software preoperatively. The custom-made TMJ-skull base combined prosthesis, included four components, was designed based on the anatomy, stress distribution and movement of the TMJ and skull base, and fabricated by three-dimensional printing and 5-axis milling technologies. The TMJ-skull base lesion was excised completely with the help of digital templates from modified preauricular and/or post and submandibular incisions. The combined prosthesis were implanted and fixed after the lesion resection. The examinations including general situation, cranio-maxillofacial structure and function were taken during and after surgery to assess its using effect.Results:Ten patients [6 females and 4 males, (43.2±13.6) years old] were included and all prostheses were positioned accurately and fixed excellently. After (29.4±17.3) months follow-up, the occlusion relationship was stable and no adverse symptoms such as dizziness, headache, meningeal irritation and permanent facial nerve injury occurred. The pain, diet, mandibular movement function, lateral movement to diseased side and mouth opening had significant improvements. The forward movement and lateral movement to normal side were not improved significantly. There were no prosthesis displacement, loosening and fracture in X-ray and CT postoperatively. With the pre and postoperative craniomaxillofacial model merging, the maximal implanted error was (0.52±0.17) mm for fossa and condyle and (1.62±0.26) mm for skull base and mandibular handle in surface deviation analysis.Conclusions:The custom-made TMJ-skull base combined prosthesis with customized design and 3D printing fabrication is safe, effective and precise in clinical application.

Objective : To survey the current situation and analyze the relevant influencing factors of sleep quality in adolescent patients with temporomandibular joint anterior disc displacement. Methods: This study has been reviewed and approved by the Ethics Committee, and informed consent has been obtained from patients. A convenience sampling method was used to investigate 120 adolescent patients with temporomandibular joint anterior disc displacement in the outpatient department of stomatology in a grade A tertiary hospital in Shanghai using the general data questionnaire, the Pittsburgh sleep quality index scale (PSQI), the Chinese middle school student mental health scale (MMHI-60) and the pain visual analog scale (VAS). Descriptive analysis, single factor analysis, correlation analysis and multiple regression analysis were used to explore the relevant influencing factors. Results: The PSQI score of adolescent patients with temporomandibular joint anterior disc displacement in this study was 7.77 ± 4.63. There was a statistically significant difference in sleep quality among patients with different academic pressures and levels of sleep bruxism (P<0.05). The sleep quality score was positively correlated with the pain score (r = 0.45, P<0.001) and positively correlated with the psychological score (r = 0.74, P<0.001). The degree of pain can affect the patient's sleep quality, and those with good mental health have better sleep quality. The results of regression analysis showed that academic stress (OR = 2.511, 95% CI =1.307 ~ 4.828), bruxism (OR = 3.694, 95% CI = 1.394 ~ 9.791), pain score (OR = 2.104, 95% CI =1.095 ~ 4.041) and psychological score (OR = 1.039, 95% CI = 1.021 ~ 1.058) were statistically significant. Conclusion The sleep quality of adolescent patients with temporomandibular joint anterior disc displacement is generally poor. Academic pressure, sleep bruxism, pain and mental health are the influencing factors of sleep quality.

Temporomandibular joint (TMJ) diseases are common clinical conditions. The number of patients with TMJ diseases is large, and the etiology, epidemiology, disease spectrum, and treatment of the disease remain controversial and unknown. To understand and master the current situation of the occurrence, development and prevention of TMJ diseases, as well as to identify the patterns in etiology, incidence, drug sensitivity, and prognosis is crucial for alleviating patients′suffering.This will facilitate in-depth medical research, effective disease prevention measures, and the formulation of corresponding health policies. Cohort construction and research has an irreplaceable role in precise disease prevention and significant improvement in diagnosis and treatment levels. Large-scale cohort studies are needed to explore the relationship between potential risk factors and outcomes of TMJ diseases, and to observe disease prognoses through long-term follw-ups. The consensus aims to establish a standard conceptual frame work for a cohort study on patients with TMJ disease while providing ideas for cohort data standards to this condition. TMJ disease cohort data consists of both common data standards applicable to all specific disease cohorts as well as disease-specific data standards. Common data were available for each specific disease cohort. By integrating different cohort research resources, standard problems or study variables can be unified. Long-term follow-up can be performed using consistent definitions and criteria across different projects for better core data collection. It is hoped that this consensus will be facilitate the development cohort studies of TMJ diseases.