In this study, we clinically and statistically investigated and reviewed the status of temporomandibular joint disorders (TMD) in children at our clinic, which appear to be on the rise.
Subjects consisted of 97 cases (20 boys and 77 girls) of children (15 years old or younger) among 1, 053 cases of TMD patients who visited the clinic over the six years from January 1997 to December 2002. The topics of investigation included (1) yearly change of the number of visits, (2) age distribution by sex, (3) distribution by symptom type, and (4) treatment and therapeutic process, which were retrospectively investigated based on medical records regarding the 97 cases of children of age 15 years old or younger.
In terms of yearly transition of the number of visits, a slight increase (7.5-11.8%) was observed over time. For the age distribution by sex, the youngest was 20 days old, and the oldest was 15 years old. There were more girls (average boy/girl ratio: 1: 4) in most age groups, with 14-year-olds as a peak, followed by 15-year-olds and 13-year-olds. As to distribution by symptom type, III a type represented the most (38 cases), followed by III b type (26 cases), II type (17 cases), I type (15 cases), and IV type (1 case). For treatment, physical therapy, includ ing lifestyle guidance, mastication guidance, and opening training, was the most common (76 cases; 78.4%), followed by splint therapy in addition to physical therapy (17 cases; 17.5%). Four patients (4.1%) were treated with pumping manipulation.
Regarding the therapeutic process, improvement was observed in 74 out of 97 cases (76.3%). In many cases that showed improvement, the term of treatment was one month or less.

View full abstract

In recent years, it has been recognized that there is indeed such an entity as non-odontogenic toothache. The diverse etiology of non-odontogenic toothache may arise from the following sources: maxillary sinus or naso-mucosal, neuropathic, myofascial, neurovascular, cardiac and psychogenic. A solid base of knowledge in both dental and medical sciences is vital for the correct diagnosis and proper management. The aim of this study is to determine the prevalence of non-odontogenic toothache and to report on such cases in order to assist diagnosis and treatment planning.
Subjects consisted of 50 patients with various orofacial pain conditions who presented to Tsurumi University on Friday clinic sessions between June and September, 2001. Patients were examined following a standard protocol, and initial diagnoses were based on clinical and radiographic findings. The final diagnosis was then compared with the working diagnosis after detailed examination by specialists from different departments. In addition, a one-year follow-up was performed, and by the end of this study the following results were obtained:
1. Twenty percent of the patients complained of orofacial pain.
2. The majority of the chief complaints were toothache (66%).
3. Initial diagnoses were different from the working diagnoses and at the one-year follow up in 8 patients (16%).
4. The drop out rate was 8% over a one-year period.
5. Three patients could not be diagnosed after a one-year treatment period, and we concluded that they had non-odontogenic pain.

View full abstract

In this report, we discuss the relationship between the configuration of the disc, with/without reduction, the degree of displacement and the duration of displacement.
Time of appearance of joint noise and limitation of mouth opening were identified by reviewing the patients' history. Subjects were 105 TMJs (50 TMJs with disc displacement with reduction and 55 TMJs with disc displacement without reduction), of which the configuration of the disc could be detected by MRI.
Two coronal section and three sagittal section images of TMJ were taken by 1.5 Tesla Superconductive MRI. The configuration of the disc was classified into the following groups according to Westesson's criteria: 1. biconcave, 2. biplanar, 3. reversed, 4. biconvex, 5. enlargement of posterior band (EPB). Biconcave disc was regarded as normal, and the others were regarded as deformities of the disc. The degree of displacement was classified as: 1. small (the portion of the thick posterior band is in contact with the mandibular head), and 2. large (the thick posterior band is in front of the mandibular head).
Deformities of the discs were observed in all cases with disc displacement without reduction, and in 56.0% in cases with disc displacement with reduction. In 22 out of 105 TMJs whose configuration of the disc was normal, 20 TMJs showed disc displacement with reduction, and a small amount of displacement. Furthermore, 6 TMJs showed the normal disc configuration after more than 60 months of the development of anterior disc displacement. All 6 TMJs showed disc displacement with reduction, and 5 out of 6 TMJs showed a small amount of displacement. The results suggest that with/without reduction and the degree of displacement are more responsible for the deformity of the disc than the duration of disc displacement.

View full abstract

We report a case of gap arthroplasty and coronoidectomy followed by costochondral graft with temporalis muscle flap reconstruction for temporomandibular joint (TMJ) ankylosis. A 58-year-old woman was referred to our department, complaining of limitation in mouth opening. Clinical examination revealed 10-mm range of motion. CT scan confirmed left TMJ bony ankylosis. The patient underwent the operation in May 2000 and started post-operative mouth opening exercise.
A satisfactory functional result was post-operatively achieved without any signs of re-ankylosis. A 40-mm range of motion was maintained and occlusion remained stable for 5 post-operative years.

View full abstract

Because of the high signal to noise ratio (S/N), images obtained using high-field magnetic resonance imaging (MRI) systems can be expected to provide high magnetic anatomical and contrast resolution. The purpose of this study was to evaluate the usefulness of 3.0 tesla (T) -MRI system imaging for the temporomandibular joint (TMJ), using a coil unit which we produced experimentally. The coil unit that we used in this study consisted of a dual 5-inch phased array surface coil and coil holder to achieve simultaneous imaging of bilateral TMJs.
The subjects were three males and one female volunteers. The sagittal bilateral TMJ images were taken simultaneously by using the 3.0 T-MRI system to decide the two fast-spin echo scan sequences. One sequence gave priority to image quality in a resting mouth position to examine the construction of TMJ in detail, and the other was to analyze the TMJ motion in a resting, mid-opening, and full-opening mouth position in a shorter imaging time.
The anatomical structures of TMJ such as disc, condyle, and posterior attachment were clearly delineated when using the sequence that gave priority to image quality. The scan time was shortened by almost half to obtain equal image quality of TMJ by using the 1.5 T-MRI clinical system under the sequence for analyzing TMJ motion.
As a result, it was concluded that the 3.0 T-MRI system with dual 5-inch surface unit was useful for imaging the anatomical structures of TMJ and for analyzing coordination of disc motion and condylar translation in several jaw positions. We expect this device will contribute to the diagnosis of TMJ disorders.

View full abstract

We herein report on the orthodontic management of a patient, a female of age 14 years and one month, who showed increased overjet and decreased overbite with mandibular backward rotation due to idiopathic condylar resorption (ICR) during orthodontic treatment in a private practice. She was referred to our clinic for improvement of her malocclusion. An Angle class II division 1 and open bite with mandibular backward rotation were present. The orthodontic retreatment continued with caution against overloading the TMJs. Currently, the occlusion has been stable for a 19-month retention period, and no functional problem has occurred at the TMJs. Monitoring of jaw growth and development until they cease, and observation of the change of dentition and occlusion, should be required.

View full abstract