Objective: To explore the correlation between the attachment type of lateral pterygoid muscle (LPM) and the position of temporomandibular joint (TMJ) disc in patients with temporomandibular disorders (TMD) by using wireless amplified magnetic resonance imaging detector (WAND) coupled with conventional head and neck joint coil for high resolution imaging of TMJ. Methods: Eighty-five patients with TMD diagnosed by oral and maxillofacial surgeons of Guizhou Provincial People's Hospital from October 2019 to January 2022 were collected. A total of 160 TMJ were included. There were 16 males and 69 females, aged (32.7±14.2) years. All patients were scanned with open, closed oblique sagittal and coronal WAND coupled head and neck coils with bilateral TMJ. Based on TMJ and LPM high resolution imaging, to explore the correlation between LPM attachment types and the position of TMJ disc in TMD patients, and to evaluate the potential clinical value of LPM attachment types in TMD patients. χ² test and Pearson correlation analysis were used to evaluate the correlation between LPM attachment type and TMJ disc location. Results: There were three types of LPM attachment: type Ⅰ in 51 cases [31.9% (51/160)], type Ⅱ in 77 cases [48.1% (77/160)] and type Ⅲ in 32 cases [20.0% (32/160)]. There was a significant correlation between the type of LPM attachment and the position of articular disc (χ²=28.20, P=0.002, r=0.776). There was no statistical significance between the type of LPM attachment and the reversible displacement of articular disc (χ²=0.24, P=0.887, r=0.825). Conclusions: There is a correlation between the attachment type of LPM and the position of the disc in TMD patients. WNAD coupled with conventional head and neck joint coil TMJ high resolution scan can provide reliable imaging evidence for TMD patients in evaluating the type of LPM attachment and the location of disc.
Male ; Female ; Humans ; Temporomandibular Joint Disc/pathology* ; Pterygoid Muscles/pathology* ; Joint Dislocations ; Temporomandibular Joint Disorders/diagnostic imaging* ; Magnetic Resonance Imaging/methods* ; Temporomandibular Joint/pathology*

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

Objective: To investigate the imaging features of condylar cystic degeneration of temporomandibular joint (TMJ) by cone-beam CT (CBCT), spiral CT, MRI and radionuclide bone imaging. Methods: From January 2018 to December 2020, thirty-two patients with cyst-like lesions of condylein temporomandibular joint were examined by CBCT, spiral CT, MRI and radionuclide bone imaging at the Department of Oral and Maxillofacial Surgery in General Hospital of Chinese PLA. There were 12 males and 20 females involved, aged from 16 to 65 years with an average age of (33.9±12.5) years. The characteristics of CBCT, spiral CT, MRI and radionuclide bone imaging were analyzed. Condylar cyst like lesions were classified as type A and type B based on the presence or absence of surface bone defects. Condylar cyst like lesions were classified as type Ⅰ(yes) and type Ⅱ(no) according to the accompanying bone marrow edema-like lesions of the condyles. The incidence of condylar bone marrow edema, disc displacement and abnormal bone metabolism were analyzed. Results: A total of 64 joint images of 32 patients were included, including 34 sides with TMJ cyst-like lesion and 6 sides with multiple cyst-like lesions,the total cyst-like lesions were 42. The largest diameter of cyst-like lesion ranged from 1.0 to 12.4 mm, with an average length of (3.7± 1.8) mm. There were 24 cases of type A TMJ cyst like lesion and 10 cases of type B cyst-like lesion. The detection rate of CBCT was 95.2% (40/42) and that of spiral CT was 100% (42/42), there was no significant difference (Calibration Chi-square=0.51, P=0.474). The detection rate of nuclear magnetic resonance was 80.1% (34/42), and the detection rate of cyst-like lesions less than 2 mm was 3/11. In the cyst like lesion side, there were 9 sides with anterior disc displacement with reduction, 20 sides with anterior disc displacement without reduction. In the non-cyst like lesion side, 10 sides with anterior disc displacement with reduction and 6 sides with anterior disc displacement without reduction. There was a significant difference in the displacement of the disc between cyst-like and non-cystic lesion side (χ²=7.80, P=0.005). MRI showed that 6 cases of cystic side[17.6% (6/34)] had bone marrow edema-like lesions (all type A), 1 case of non-cyst like lesions side [3.3% (1/30)] had bone marrow edema-like lesion, there was no significant difference between cystic and non-cystic lesions (Calibration Chi-square=2.04, P=0.153). There was a significant difference between type A and B cystic lesions (Fisher exact probability method, P=0.024). Radionuclide bone imaging showed abnormal bone metabolism in 26 patients in the cyst-like lesion side and 5 patients in the non-cyst like lesion side (χ²=22.82, P<0.001). Conclusions Multi-slice Spiral CT could detect the cyst-like lesion of TMJ condyle in the early stage, which is different from the large joint. And the formation mechanism may vary from the different classifications.
Adolescent ; Adult ; Aged ; Cysts ; Female ; Humans ; Joint Dislocations ; Magnetic Resonance Imaging ; Male ; Mandibular Condyle/diagnostic imaging* ; Middle Aged ; Multimodal Imaging ; Temporomandibular Joint/diagnostic imaging* ; Temporomandibular Joint Disc ; Temporomandibular Joint Disorders/diagnostic imaging* ; Young Adult

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*

Objective: MRI images were used to study the efficacy of anterior repositioning splint (ARS) in the treatment of different types of disc displacement with reduction (DDWR) in temporomandibular joint. Methods: From September 2020 to December 2021, 26 patients with DDWR were enrolled in the Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Zhengzhou University. There were 5 males and 21 females with an average age of (20.8±5.8) years. ARS was used for 3-6 months. The changes of joint clicking, opening type and joint pain before and after treatment were compared. The changes of disc position, disc-condyle angle and condylar bone mass before and after treatment were compared by MRI. Paired t-test was performed on the disc-condyle angle before and after treatment, Fisher's exact test was performed on the change of disk position, and other count data were expressed as rate (%). Results: After ARS treatment, the effective rates of joint clicking,abnormal opening, joint pain and disc displacement were 97%(35/36), 14/18, 7/9 and 95%(36/38). MRI analysis found that there was a significant difference between the disc position before and after treatment (P<0.001), MRI analysis showed that the anterior disc displacement (48%, 25/52) and the anterolateral disc displacement (17%, 9/52) were the most common before treatment. In contrast, the normal superior disc (75%, 39/52) and the anterior disc displacement (17%, 9/52) were the most common after treatment, no significant changes were seen after treatment in the anteromedial disc displacement. The disc-condylar angle was (36.09±19.02) ° before ARS treatment and (3.94±10.12) ° after ARS treatment(t=9.23, P<0.001). After treatment, 46% (12/16) of the patients showed new bone formation, and the height of the condyle recovered. Conclusions: The clinical efficacy of ARS in the treatment of anterior disc displacement and anterolateral displacement of temporomandibular joint is remarkable, which can restore the disc-condylar relationship of most patients with indications.
Adolescent ; Adult ; Arthralgia ; Female ; Humans ; Joint Dislocations/therapy* ; Magnetic Resonance Imaging ; Male ; Splints ; Temporomandibular Joint ; Temporomandibular Joint Disc/diagnostic imaging* ; Young Adult

Objective: To observe the different imaging manifestations of condylar sclerosis in temporomandibular joint osteoarthrosis and explore the imaging significance of condylar sclerosis. Methods: From January 2018 to December 2020, 50 patients with temporomandibular joint condylar sclerosis were examined by cone-beam CT (CBCT) and underwent spiral CT, MRI and radionuclide bone imaging at the Department of Oral and Maxillofacial Surgery in General Hospital of Chinese PLA. There were 15 males and 35 females aged from 16 to 65 years with age of (42.7±14.5) years. The imaging manifestations of CBCT, spiral CT, MRI and radionuclide bone imaging, joint disc displacement and abnormal bone metabolism of condylar sclerosis were analyzed. And the area of condylar sclerosis was graded according to the image of CBCT. Results: A total of 50 patients were included, including 38 unilateral condylar sclerosis, 12 patients with bilateral condylar sclerosis, the total condylar sclerosis were 66. There was no significant difference between the detection rate of further spiral CT (95.5%, 63/66) and CBCT (100.0%, 66/66) (corrected χ²=1.36,P=0.244). The area of condylar sclerosis was (35.5±4.5) mm², ranged from 1 to 100 mm². In addition, spiral CT showed more clearly condylar sclerosis than CBCT. Sclerosis can occur in all parts of condyle, mainly in the upper middle region (68.2%,45/66) in coronal position and in the upper front region (71.2%,47/66) in sagittal position. Fifty-seven condylar sclerosis were detected by MRI, including 4(4/19) condylar sclerosis less than 4 mm². There was significant difference in the displacement of temporomandibular joint disc between the sclerotic side and the non sclerotic side (χ²=10.09, P=0.006). MRI display the condylar sclerosis showed low signal (56/62), followed by high signal (5/62) and medium signal (1/62). Radionuclide bone imaging showed that 4 of the 38 patients with unilateral condyle sclerosis had symmetrical bone metabolism, 34 had abnormal bone metabolism, and 21 patients had concentrated on the non-sclerotic side. Radionuclide bone imaging showed that 4 of the 38 patients with unilateral condyle sclerosis had symmetrical bone metabolism and 34 had abnormal bone metabolism. Conclusions: Spiral CT is more accurate than CBCT in terms of condyle sclerosis through different imaging analysis, and the detection rate of both is higher than MRI. Most of condylar sclerosis showed different degrees of low signal on MRI. The condylar sclerosis side is usually manifested by abnormal bone metabolism.
Male ; Female ; Humans ; Mandibular Condyle/diagnostic imaging* ; Sclerosis/diagnostic imaging* ; Temporomandibular Joint/diagnostic imaging* ; Temporomandibular Joint Disorders/etiology* ; Temporomandibular Joint Disc/diagnostic imaging* ; Cone-Beam Computed Tomography ; Temporomandibular Joint Dysfunction Syndrome ; Osteoarthritis/etiology* ; Magnetic Resonance Imaging

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

Objective To evaluate lateral pterygoid muscle(LPM)contraction in the patients with temporomandibular disorders(TMD)based on 3D-T2 weighted imaging(3D-T2WI).Multiplanar reconstruction(MPR)was employed to measure the length of LPM in the images taken in closed-and open-mouth positions. Methods Seventeen TMD patients [age of(29.82±10.70)years,males/females=8/9] and 13 normal volunteers [control,age of(23.54±3.31)years,males/females=6/7] received 3D-T2WI of the temporomandibular joints in closed-and open-mouth positions from November 2019 to April 2020 in Department of Radiology,Hainan Hospital of Chinese PLA General Hospital.According to the position of the discs,the subjects were classified into the following groups:TMD with disc displacement without reduction(TMD-DDwoR),TMD with disc displacement with reduction(TMD-DDwR),TMD without disc displacement(TMDwoDD),and normal control without disc displacement(NCwoDD).MPR was employed to measure the maximal length of the superior belly of LPM.One-way analysis of variance,receiver operating characteristic curve,and permutation test were employed for the statistical analyses. Results The contraction of LPM was significantly shorter in TMD-DDwoR group [(3.36±1.96)mm] than in TMDwoDD group [(7.90±3.95)mm],NCwoDD group [(8.77±3.13)mm](
Adult ; Female ; Humans ; Joint Dislocations ; Magnetic Resonance Imaging ; Male ; Muscle Contraction ; Pterygoid Muscles/diagnostic imaging* ; Temporomandibular Joint Disc ; Temporomandibular Joint Disorders/diagnostic imaging* ; Young Adult

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

Collagen is the building component of temporomandibular joint (TMJ) discs and is often affected by inflammation in temporomandibular disorders. The macromechanical properties of collagen are deteriorated by chronic inflammation. However, the mechanism by which inflammation influences disc function remains unknown. The relationship between the ultrastructure and nanomechanical properties of collagen in inflamed discs should be clarified. Seven-week-old female Sprague-Dawley rats were randomly divided into two groups. Chronic TMJ inflammation was induced by intra-articular injection of complete Freund's adjuvant, and samples were harvested after 5 weeks. Picrosirius staining revealed multiple colours under polarized light, which represented alternative collagen bundles in inflamed discs. Using atomic force microscopy scanning, the magnitude of Young's modulus was reduced significantly accompanied with disordered collagen fibril arrangement with porous architecture of inflamed discs. Transmission electron microscopy scanning revealed a non-uniform distribution of collagen fibres, and oversized collagen fibrils were observed in inflamed discs. Fourier transform infrared microspectroscopy revealed a decrease in 1 338 cm/amide II area ratio of collagen in different regions. The peak positions of amide I and amide II bands were altered in inflamed discs, indicating collagen unfolding. Our results suggest that sustained inflammation deteriorates collagen structures, resulting in the deterioration of the ultrastructure and nanomechanical properties of rat TMJ discs.
Animals ; Collagen ; ultrastructure ; Female ; Fibrillar Collagens ; ultrastructure ; Freund's Adjuvant ; adverse effects ; Inflammation ; chemically induced ; metabolism ; pathology ; Injections, Intra-Articular ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Temporomandibular Joint ; Temporomandibular Joint Disc ; physiopathology ; ultrastructure ; Temporomandibular Joint Disorders ; physiopathology