Currently, a reevaluation of the subclassification of temporomandibular disorders is being demanded. Therefore, an accurate report on "the clinical guidelines for the temporomandibular disorders" of The Japanese Society for Temporomandibular Joint will be considered as the basic document, which will be revised in future.
Here we present the details of the meeting that was arranged to formulate "the clinical guidelines for the temporomandibular disorders" in the following order: the committee members; documents discussed in the meeting; the minutes; secretary meeting records; and records prepared by the councilor of the meeting/the board of directors records on "the ad hoc committee for the temporomandibular disorders" in the TMJ meeting (1984.12.15-1986.4.21), "the ad hoc committee for the name of disease" (1991.1.1-1995.12.31) in the scientific committee of The Japanese Arbitrary Society for Temporomandibular Joint, and "the ad hoc committee for the diagnostic procedure of temporomandibular disorders" (1995.12.15-2001.7.2).
In conclusion, the meeting has revealed the establishment process of "the clinical guidelines for the temporomandibular disorders".

View full abstract

Synovial chondromatosis is a monoarticular disease characterized by the presence of cartilage nodules within the synovial membrane or in the joint fluid. Synovial chondromatosis commonly occurs in large joints such as the knees and elbows, and rarely in the temporomandibular joint (TMJ). In this report, we describe a case of synovial chondromatosis of the right TMJ extending to the middle cranial fossa. A 72-year-old man visited our clinic because of right-sided TMJ pain and malocclusion of the molar teeth. The right-sided mandibular condyle was displaced anteriorly by a mass lesion. Severe bone resorption was observed from the glenoid fossa to the middle cranial fossa on simple X-ray and CT images, and T2-weighted MRI findings confirmed the presence of a large mass lesion near the cranial dura mater. Pathological examination of a biopsy specimen obtained under local anesthesia led to a diagnosis of synovial chondromatosis of the right TMJ. We therefore performed extirpation of the lesion through a temporo-preauricular incision under general anesthesia. The lesion was composed of cartilaginous tissue surrounded by a capsule. The lesion had penetrated the middle cranial fossa (around 1cm in diameter), but the cranial dura mater was intact. Both malocclusion and TMJ pain improved after surgery.

View full abstract

A clinical statistical study was conducted on 1,370 patients with temporomandibular joint disorders who visited our department over the 10-year period from January 1997 to December 2006. This study aimed to elucidate trends in these patients as well as their current condition. The results showed that the annual number of patients with temporomandibular joint disorders was approximately 170 during the five-year period from 1997 to 2001, but decreased from 2002. Patients comprised 364 men (26.6%) and 1,006 women (73.4%), and the male: female ratio was 1: 2.76. With regard to age distribution, a unimodal distribution centered around the 20s was observed in the first half of the study period (up to 2001), while a bimodal distribution with a smaller peak in the 50s was observed in the second half (from 2002). The mean age of patients was significantly higher in the second half than in the first half. The most common chief complaint at the initial visit was pain during mouth opening and closing, and the number of patients who had experienced symptoms for≥1 year was higher in the second half than in the first half of the study period. With regard to symptom type classification, the number of patients with symptoms of type IIIb was significantly lower in the second half than in the first half.

View full abstract

We report a case of chronic bilateral dislocation of the temporomandibular joint that was reduced under general anesthesia. The patient was a 55-year-old woman who had not received any medical consultation because she had no complaint, although her family had noticed a change in her facial configuration. Ten months later, when she visited a dental office to have a dental prosthesis fitted, she was diagnosed with bilateral temporomandibular joint dislocation and was recommended to consult the dentistry department of a general hospital. The dislocated temporomandibular joints could not be reduced manually at the general hospital, and the patient was subsequently referred to our hospital. We too attempted to first manually reduce the dislocated joints under local anesthesia, but the mandibular condyles could not be restored to the glenoid fossae. Therefore, we attempted reduction under general anesthesia. Since this reduction could not be performed easily, the bony region surrounding bilateral mandibular angles was dissected. Following this, wires were passed through the mandibular bones and the rami were retracted downward. This too however did not result in complete reduction of the mandibular condyles. Consequently, traction treatment with intermaxillary fixation and a chin cap was performed, and the mandibular condyles were finally restored. Intermaxillary fixation was implemented by inserting screws into the upper and lower jaws, which were retained for four weeks. Thereafter, there was no re-dislocation or any symptom of temporomandibular joint dysfunction. Further, interincisal mouth opening increased up to 37 mm, although deformities of the mandibular condyles could be seen on radiographs.

View full abstract