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Concept: Temporomandibular joint

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BACKGROUND: In the last years, several methods and devices have been proposed to record the human mandibular movements, since they provide quantitative parameters that support the diagnosis and treatment of temporomandibular disorders. The techniques currently employed suffer from a number of drawbacks including high price, unnatural to use, lack of support for real-time analysis and mandibular movements recording as a pure rotation. In this paper, we propose a specialized optical motion capture system, which causes a minimum obstruction and can support 3D mandibular movement analysis in real-time. METHODS: We used three infrared cameras together with nine reflective markers that were placed at key points of the face. Some classical techniques are suggested to conduct the camera calibration and three-dimensional reconstruction and we propose some specialized algorithms to automatically recognize our set of markers and track them along a motion capture session. RESULTS: To test the system, we developed a prototype software and performed a clinical experiment in a group of 22 subjects. They were instructed to execute several movements for the functional evaluation of the mandible while the system was employed to record them. The acquired parameters and the reconstructed trajectories were used to confirm the typical function of temporomandibular joint in some subjects and to highlight its abnormal behavior in others. CONCLUSIONS: The proposed system is an alternative to the existing optical, mechanical, electromagnetic and ultrasonic-based methods, and intends to address some drawbacks of currently available solutions. Its main goal is to assist specialists in diagnostic and treatment of temporomandibular disorders, since simple visual inspection may not be sufficient for a precise assessment of temporomandibular joint and associated muscles.

Concepts: Masseteric nerve, Camera, Joint, Motion capture, Mandible, Temporomandibular joint disorder, Temporomandibular joint

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Central odontogenic fibroma (COF) is a rare benign tumor that accounts for 0.1% of all odontogenic tumors. A case of COF (simple type) of the mandible in a four-year-old boy is described in this report. The patient showed asymptomatic swelling in the right inferior border of the lower jaw for one week. A panoramic radiograph showed a poorly-defined destructive unilocular radiolucent area. Cone-beam computed tomography showed expansion and perforation of the adjacent cortical bone plates. A periosteal reaction with the Codman triangle pattern was clearly visible in the buccal cortex. Since the tumor had destroyed a considerable amount of bone, surgical resection was performed. No recurrence was noted.

Concepts: Bone, Temporomandibular joint, Tomographic reconstruction, Mandible, Tumor, Oncology, Jaw, Benign tumor

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Ankylosing spondylitis (AS) is a chronic inflammatory disease with multiple articular and para-articular involvement that has a predilection for the axial skeleton. In spite of its high prevalence, ankylosis secondary to AS is a rare condition.

Concepts: Joints, Infection, Temporomandibular joint, Joint, Ankylosing spondylitis, Skeletal system

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The design of a diving regulator’s mouthpiece increases the risk of a temporomandibular disorder (TMD) in scuba divers. The total weight of a diving regulator is reflected directly on the temporomandibular joint, causing articular and periarticular disorders. In the current study, the prevalence of TMD in scuba divers triggered during diving certification training is investigated. We also aimed to determine the factors that lead to TMD during diving training and clarify the observation that there is an increased incidence of TMD in inexperienced divers. The study was held between 2006 and 2011. Ninety-seven divers were referred with the complaint of pain around temporomandibular area. The divers were classified according to their diving experience. Symptoms and signs of TMD were graded. Fourteen divers were diagnosed with TMD. Temporomandibular disorder was seen more frequently in inexperienced divers than in experienced divers (P = 0.0434). The most prevalent symptom was an increased effort for mouthpiece gripping. Temporomandibular joint tenderness and trigger point activation were the mostly seen physical signs. Thirteen divers had an improvement with therapy. The increased effort for stabilizing the mouthpiece is a recognized factor in TMD development. Attention must be paid to an association of scuba diving with TMDs, especially in inexperienced divers having a scuba certification training.

Concepts: Diving mask, Professional diving, Temporomandibular joint, Scuba set, Disease, Temporomandibular joint disorder, Scuba diving, Underwater diving

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OBJECTIVE: Endoscope-assisted transoral open reduction and internal fixation (EAORIF) for mandibular condyle fractures has recently become popular because it is minimally invasive, provides excellent visibility without a large incision, and reduces surgical scarring and the risk of facial nerve injury. This report describes a retrospective clinical study that compared certain clinical parameters, including postoperative function, between the retromandibular (RM) approach and EAORIF. METHODS: Fifteen patients were treated by the RM approach, whereas 15 underwent EAORIF between July 2006 and September 2011 at Kyushu Dental College, Japan. Clinical indices comprised fracture line, fracture type, number of plates used, surgical duration, bleeding amount, and functional items, including maximum interincisal opening, mandibular deviation on the opening pathway, malocclusion, facial paresthesia, and temporomandibular joint pain and clicking. RESULTS: The areas subjected to either approach included lower neck and subcondyle. The RM approach was used for mandibular condyle fractures with dislocation of a small bone segment. Both groups used 2 plates in all cases. Surgical duration, maximum interincisal opening, mandibular deviation, occlusion, and temporomandibular joint function at 6 months after surgery were comparable between groups. The average bleeding amount in the EAORIF group was greater than in the RM group. One patient from the RM group developed facial paresthesia that persisted for 6 months after surgery. CONCLUSIONS: It was concluded that surgical treatment was suitable for fractures of the lower neck and subcondylar. Both procedures showed good results in the functional items of this study.

Concepts: Masseteric nerve, Bone, Temporomandibular joint disorder, Cranial nerves, Joint, Surgery, Mandible, Temporomandibular joint

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It has been suggested that third molars increase mandibular fragility because they do not contribute to its strength. For ethical reasons, a human study design that would permit the elucidation of this interference is not possible. This study evaluated the impact of the presence of erupted third molars on the mandibular angle of resistance when submitted to trauma. A three-dimensional (3D) mandibular model was obtained through finite element methodology using computed tomography (CT) with the geometry and mechanical properties to reproduce a normal mandibular structure. Human mandibles with no, one or two erupted third molars were evaluated. Whenever the third molar was present there was a greater concentration of tensions around the cervical part of its alveolus. Approximated Von Mises equivalent stress of the third molar region was 107.035MPa in the mandible with teeth and 64.6948MPa in the mandible without teeth. In the condylar region it was 151.65MPa when the third molar was present and 184.496MPa when it was absent. The digital models created proved that the mandibular angle becomes more fragile in the presence of third molars. When they are absent the energy concentrates on the lateral e posterior aspect of the condylar neck.

Concepts: Temporomandibular joint, Model, Concentration, Ludwig von Mises, Molar, The Fragile, Mandible, Teeth

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The purpose of this study was to investigate the correlation between articular eminence steepness and clinical dysfunction index (Di) in patients with temporomandibular joint dysfunction (TMD) using cone-beam computed tomography (CBCT).

Concepts: Joints, Joint, Temporomandibular joint disorder, Temporomandibular joint

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Stylohyoid complex ossification (SCO) can be associated with temporomandibular disorder (TMD). However, this subject is poorly investigated in epidemiological studies.

Concepts: Cultural studies, Temporomandibular joint, Case-control study, Temporomandibular joint disorder, Epidemiology

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The aim of this article is 3D analysis of the temporomandibular joint (TMJ) patient, who underwent surgery, during which the right TMJ was resected along with the ramus of mandible and consequently the joint was reconstructed with subtotal replacement. The main goal is to give a suitable formulation of mathematical model, which describes the changes of stresses in TMJ incurred after the surgery. The TMJ is a complex, sensitive and highly mobile joint which works bilaterally so each side influences the contralateral joint and because of this the distribution of the stresses is changed in the healthy joint as well. Detailed knowledge about function these are necessary for clinical application of temporomandibular joint prosthesis and also help us estimate the lifetime of the prosthesis a possibilities of alteration in the contra lateral joint components. The geometry for the 3D models is taken from the CT scan date and its numerical solution is based on the theory of semi-coercive unilateral contact problems in linear elasticity. This article provides medical part with case report, discretion of treatment, than the methods of mathematical modeling and his possibilities are described and finally results are reported.

Concepts: Temporomandibular joint disorder, Stylomandibular ligament, Temporomandibular joint, Mathematics