Temporomandibular joint disorders are common diseases characterized by joint clicking, limited mouth opening and pain, which have a huge impact on the patients' daily life. Conservative methods include medicine, physiotherapy and occlusal application. With the advancement of medical technology, the arthroscopy is becoming popular for its minimally invasion and high efficiency. This review focuses on the common arthroscopic methods, and provides an outlook of the arthroscopic surgery.
Humans ; Temporomandibular Joint Disc/surgery* ; Range of Motion, Articular ; Temporomandibular Joint Disorders/surgery* ; Arthroscopy ; Temporomandibular Joint/surgery* ; Joint Dislocations ; Treatment Outcome

Humans ; Minimally Invasive Surgical Procedures ; Temporomandibular Joint Disc ; injuries ; surgery ; Temporomandibular Joint Disorders ; diagnosis ; surgery

Temporomandibular joint osteoarthritis (TMJOA) is mainly manifested as perforation of temporomandibular joint disc (TMJD) and destruction of condylar osteochondral complex (COCC). In recent years, tissue engineering technology has become one of the effective strategies in repairing this damage. With the development of scaffold material technology, composite scaffolds have become an important means to optimize the performance of scaffolds with the combined advantages of natural materials and synthetic materials. The gelling method with the minimally invasive concept can greatly solve the problems of surgical trauma and material anastomosis, which is beneficial to the clinical transformation of temporomandibular joint tissue engineering. Extracellular matrix scaffolds technology can solve the problem of scaffold source and maximize the simulation of the extracellular environment, which provides an important means for the transformation of temporo joint tissue engineering to animal level. Due to the limitation of the source and amplification of costal chondrocytes, the use of mesenchymal stem cells from different sources has been widely used for temporomandibular joint tissue engineering. The fibrochondral stem cells isolated from surface layer of articular cartilage may provide one more suitable cell source. Transforming growth factor β superfamily, due to its osteochondrogenesis activity has been widely used in tissue engineering, and platelet-rich derivative as a convenient preparation of compound biological factor, gradually get used in temporomandibular joint tissue engineering. With the deepening of research on extracellular microenvironment and mechanical stimulation, mesenchymal stem cells, exosomes and stress stimulation are increasingly being used to regulate the extracellular microenvironment. In the future, the combination of complex bioactive factors and certain stress stimulation may become a trend in the temporomandibular joint tissue engineering research. In this article, the progress on tissue engineering in repairing COCC and TMJD, especially in scaffold materials, seed cells and bioactive factors, are reviewed, so as to provide information for future research design and clinical intervention.
Animals ; Mesenchymal Stem Cells ; Temporomandibular Joint/surgery* ; Temporomandibular Joint Disc/surgery* ; Tissue Engineering ; Tissue Scaffolds

PURPOSE: The main aim is to provide clinical reference for the application of mini suture anchor in the reduction and fixation of displaced temporomandibular joint (TMJ) disc with intracapsular condylar fracture. METHODS: From October 2018 to October 2019, 21 patients (31 sides) with intracapsular condylar fractures and articular disc displacement from West China Hospital of Stomatology, Sichuan University were included. The selection criteria were: (1) mandibular condylar fractures accompanied by displacement of the TMJ disc, confirmed by clinical examination, CT scan and other auxiliary examinations; (2) indication for surgical treatment; (3) no surgical contraindications; (4) no previous history of surgery in the operative area; (5) no facial nerve injury before the surgery; (6) informed consent to participate in the research program and (7) complete data. Patients without surgical treatment were excluded. The employed patients were followed up at 1, 3, 6 and 12 months after operation. Outcomes were assessed by success rate of operation, TMJ function and radiological examination results at 3 months after operation. Data were expressed as number and percent and analyzed using SPSS 19.0. RESULTS: All the surgical procedures were completed successfully and all the articular discs were firmly attached to the condyles. The articular disc sufficiently covered the condylar head after the fixation. The fixation remained stable when the mandible was moved in each direction by the surgeons. No complications occurred. The functions of the TMJ were well-recovered postoperatively in most cases. CT scan revealed that the screws were completely embedded in the bone without loosening or displacement. CONCLUSION Mini suture anchor can provide satisfactory stabilization for the reduced articular disc and also promote the recovery of TMJ functions.
Humans ; Joint Dislocations/surgery* ; Mandible ; Mandibular Condyle ; Mandibular Fractures/surgery* ; Suture Anchors ; Temporomandibular Joint Disc/surgery*

OBJECTIVES: This study aimed to use modified articular disc anchorage in treating old irreducible temporomandibular joint (TMJ) disc displacement with perforation and rupture, as well as to explore its efficacy. METHODS: A total of 31 patients (34 sides) with 47 TMJ disc perforations who underwent surgical treatment in the Affiliated Stomatolo-gical Hospital of Nanchang University from January 2018 to December 2021 were selected. According to the location of disc perforation, it has five types: posterior disc perforation (typeⅠ), anterior disc perforation (typeⅡ), lateral disc perforation (type Ⅲ), composite disc perforation, and destruction disc perforation. The modified methods of disc anchoring were divided into two types according to the location of the perforation. TypesⅠandⅢ disc perforation were trea-ted by posterior anchoring method. For posterior ancho-ring, a screw was implanted into the posterolateral side of the condylar neck, and the disc was fixed on the screw by horizontal mattress suture. TypeⅡdisc perforation and compo-site disc perforation combined typeⅡperforation were treated by anterior and posterior double-anchoring method. For anterior anchoring, anchor screws or holes were placed at the anterior edge of the condylar neck, and horizontal mattress suture was performed at the posterior edge of the anterior perforation with an anchor wire. The articular disc was then fixed on the anchor screws or holes. For the posterior anchoring method, it was the same as the previous one. Paired t test was used to analyze the visual analog scale (VAS), maximum interincisal opening (MIO), and TMJ disorder index (CMI) of the patient before surgery and 1, 3, and 6 months after surgery. Disk-condyle position relationship by magnetic resonance imaging and postoperative quality of life in postoperative were analyzed. RESULTS: The incidence of perforation was 41.2% (14/34) in typeⅠ, 11.8% (4/34) in typeⅡ, 8.8% (3/34) in typeⅢ, 29.4% (10/34) in composite type, and 8.8% (3/34) in destruction type. The VAS, MIO, and CMI at 3, 6 months after operation significantly improved compared with those before operation (P<0.05). The effective reduction rate of disc was 96.77% (30/31). The quality of life at 6 months after surgery was 47.22±2.13, and the rate of excellent evaluation was 96.4% (27/28). CONCLUSIONS Modified articular disc anchorage achieves a good curative effect for treating temporomandibular joint disc perforation and rupture. Nevertheless, its long-term effect requires further observation.
Humans ; Temporomandibular Joint Disc/surgery* ; Quality of Life ; Joint Dislocations/surgery* ; Temporomandibular Joint Disorders/surgery* ; Magnetic Resonance Imaging/methods* ; Temporomandibular Joint/pathology* ; Mandibular Condyle

OBJECTIVEThis study aims to evaluate the effectiveness of arthrocentesis on Wilkes III stage patients. Clinical examinations and magnetic resonance imaging (MRI) findings before treatment and six months after treatment were compared and analyzed.

METHODSA total of 137 outpatients diagnosed with temporomandibular joint internal derangement (TMJID) associated with Wilkes III stage through clinical examination and MRI findings from January 2013 to December 2013 were randomly included. All the patients were successfully treated with arthrocentesis. Moreover, all the patients accepted clinical and MRI examination before arthrocentesis treatment and six months after. Clinical examination included visual analogue scale and opening degree, whereas MRI examination included articular disc morphology and effusion in the upper compartments. Statistical analysis was performed using SPSS 20.0.

RESULTSResults showed that the average score of visual analogue scale six months after treatment was significantly lower than that before treatment (P < 0.05). The success rate was 78.1% (107/137). The rate of disc deformity after arthrocentesis treatment was higher than that before the treatment. By contrast, the positive rate of effusion after arthrocentesis was significantly lower than that before the treatment (P < 0.05). Bilaminar zone adaptive changes (disk-like) were found in seven cases (5.1%, 7/137) after treatment.

CONCLUSIONArthrocentesis could effectively relieve pain of the TMJID patients. Furthermore, MRI results indicated that arthrocentesis could significantly decrease articular effusion. Arthrocentesis was effective for the treatment of Wilkes III stage in the short term. Adaptive changes in bilaminar zone occurred in a few patients. However, serious disc deformity with the passage of time is a trend that has been observed.

Arthrocentesis ; Humans ; Joint Dislocations ; Magnetic Resonance Imaging ; Outpatients ; Range of Motion, Articular ; Temporomandibular Joint Disc ; pathology ; surgery ; Temporomandibular Joint Disorders ; diagnosis ; surgery ; Treatment Outcome ; Visual Analog Scale

The purpose of this review is to provide a reference for researchers in investigating the tissue engineering of the temporomandibular joint (TMJ) disc. Currently tissue engineering of the TMJ disc is in its infancy, and cell source is one of the key factors that define the development of the tissue engineering of TMJ disc. In this paper, 6 kinds of cells: the TMJ disc native cells, chondrocytes, dermal fibroblasts, bone marrow-derived mesenchymal stem cells, adipose-derived stem cells, and embryonic stem cells are introduced. In addition, the possibility that these cells can be used as cell sources for TMJ disc tissue engineering is described.
Animals ; Chondrocytes ; cytology ; Fibroblasts ; cytology ; Humans ; Joint Prosthesis ; Skin ; cytology ; Temporomandibular Joint Disc ; cytology ; pathology ; physiopathology ; Temporomandibular Joint Disorders ; rehabilitation ; surgery ; therapy ; Tissue Engineering ; methods ; trends

OBJECTIVETo investigate the patterns of condylar fractures associated with temporomandibular joint ankylosis (TMJA) and treatment methods and results based on the different types of ankylosis.

METHODSForty-two joints of ankylosis in 31 patients with were categorized to four groups according to Sawhney's classification and undergone surgical treatment as follows: a joint release and disc reposition for Type I ankylosis, a dissection of bony block and disc reposition for Type II; a dissection of full-joint and employment of the temporal myofascial flap as interposition for Type III; a radically dissection of full joint followed by ramus distraction osteogenesis and genioplasty for Type IV. All of patients were followed up for 9 to 54 months with an average of 30 months. The range of mouth opening and temporomandibular joint (TMJ) function were assessed. Condylar fractures were retrospectively investigated on the patterns and the course of ankylosis development. Macroscopical visualization on the osseously ankylosed sites and disc displacement were analyzed in comparison with the radiological findings.

RESULTSCondylar sagittal and comminuted fractures were most susceptible to TMJA. Early fibrous ankylosis occurred usually at the 4th or 5th month post-traumatically with an average month opening of 18.3 mm. The articular discs were found displaced in all cases and early bony bridge formed at a limited area where there was no disc as cushion. During fellow-up, considerable improvement in mandibular movement was attained with a stable joint function and mouth opening range of over 30 mm except for two cases in which ankylosis relapsed.

CONCLUSIONSCondylar sagittal and comminuted fractures are most likely to cause ankylosis. Early surgical intervention could reduce the disc and avoid the later ankylosis.

Adolescent ; Adult ; Ankylosis ; classification ; etiology ; surgery ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Male ; Mandibular Condyle ; injuries ; surgery ; Mandibular Fractures ; complications ; surgery ; Middle Aged ; Temporomandibular Joint Disc ; injuries ; surgery ; Temporomandibular Joint Disorders ; classification ; etiology ; surgery ; Young Adult

OBJECTIVETo investigate clinical features of disk displacement during the course of condylar fracture and to explore the techniques of disk reposition and suturation.

METHODS32 patients (10 females and 22 males) who had disk displacements with condylar fractures were followed up. Reduction and reposition of the dislocated disks simultaneously with fixation of fractures were performed. 7 patients underwent intermaxillary fixation with elastic bands for 1 to 2 weeks.

RESULTSThe occlusions were satisfactory in all cases but one for the reason of ramus height loss. No TMJ symptom was found when examined 3 months post operation.

CONCLUSIONSAnterior disk displacements were most occurred with high condylar process fractures. Surgical reposition and suturation of disk play an important role for the later TMJ-function.

Adolescent ; Adult ; Female ; Fracture Fixation, Internal ; Humans ; Joint Dislocations ; etiology ; surgery ; Male ; Mandibular Condyle ; injuries ; Mandibular Fractures ; complications ; surgery ; Middle Aged ; Temporomandibular Joint Disc ; pathology

OBJECTIVE: To determine the distribution features of surface stress on the bilateral condyles of the normal mandible and the unilateral mandible model for 3 kinds of surgeries of temporomandibular joint ankylosis under normal occlusal strength. METHODS: The normal mandible 3-dimensional finite element model and the 3-dimensional finite element mandible model for 3 kinds of surgeries of unilateral temporomandibular joint ankylosis were built. The jaw triangle area and the condyle transverse ridge was fixed and bound at mid-point. And 100 N of load was applied to the first molars of the bilateral mandible to obtain a von Mises stress diagram of the condylar surface and the unit von Mises stress of the condylar surface. Statistical analysis was carried out. RESULTS: The transmission of von Mises stress at the operated side of fractured articular arthroplasty of the condylar was interrupted. The von Mises stress at the operated side of the condylar in the group of point-surface contact joint reconstruction was bigger than that of the normal group (P<0.05) whereas there was no significant difference between the group of surface-surface contact joint reconstruction group and the normal group (P>0.05). The von Mises stress of the condylar at the non-operated side in the group of fractured articular arthroplasty was bigger than that of the normal group (P<0.05), whereas there was no significant difference between the group of point-surface contact or surface-surface contact group and the normal group (P>0.05). CONCLUSION The surface-surface articular reconstruction is beneficial to the recovery of the masticatory function without increasing the burden for contralateral temporomandibular joint and is helpful to the joint. Thus this surgical method is recommended.
Ankylosis ; surgery ; Dental Stress Analysis ; statistics & numerical data ; Finite Element Analysis ; Humans ; Male ; Mandibular Condyle ; physiopathology ; Middle Aged ; Models, Biological ; Reconstructive Surgical Procedures ; methods ; Stress, Mechanical ; Temporomandibular Joint Disc ; surgery ; Temporomandibular Joint Disorders ; surgery