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1.
J Craniomaxillofac Surg ; 49(2): 126-134, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33451941

RESUMEN

This study aims to show our institute's experience in the treatment of HH and its associated facial deformities in adults and growing adolescents and to investigate condylar remodeling and volumetric changes and long-term stability of orthognathic surgery in adults. The study included consecutive patients with clinical and radiological features of HH who underwent high condylectomy with or without simultaneous orthognathic surgery from 2013 to 2018. The clinical outcomes were assessed based on functional activities, TMJ pain, and recurrence. Postoperative 3D condylar remodeling and orthognathic stability were evaluated with the use of ITK-Snap and 3D Slicer. Thirteen patients (8 females and 5 males) with a mean age of 26.3 ± 5.79 years (range; 13-34 years) were included with facial asymmetry as the chief complaint. The patients were followed up for a minimum of 12 months and a maximum of 4 years (mean; 16.85 ± 10.04). There were no postoperative complications, and all patients achieved a satisfactory functional and aesthetic outcome using a one-stage surgical procedure. There was no incidence of recurrence or further asymmetries, with long-term stability at the selected points showing a mean difference of less than ±1 mm. The affected condylar volume was significantly reduced following high condylectomy, with mean changes between T1 and T2 of -144. 80 mm3 (p = .012). However, the contralateral condylar volume remained stable, with a mean change of 2.54 mm3 (p = .881). One-stage high condylectomy and orthognathic surgery is a viable measure for the treatment of HH and associated deformities in adults. High condylectomy in early adolescence could result in termination of the disease, and aesthetic improvement with further constant orthodontist-surgeon follow-up is required.


Asunto(s)
Cóndilo Mandibular , Procedimientos Quirúrgicos Ortognáticos , Adolescente , Adulto , Estética Dental , Asimetría Facial/diagnóstico por imagen , Asimetría Facial/patología , Asimetría Facial/cirugía , Femenino , Humanos , Hiperplasia/patología , Hiperplasia/cirugía , Masculino , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/patología , Cóndilo Mandibular/cirugía , Adulto Joven
2.
Med. oral patol. oral cir. bucal (Internet) ; 25(5): e683-e690, sept. 2020. tab
Artículo en Inglés | IBECS | ID: ibc-196525

RESUMEN

BACKGROUND: This study aims to evaluate whether the uptake difference by the condyles evaluated using single photon emission computed tomography (SPECT) examination is useful for predicting the activity of the feature and the advance of this pathology. MATERIAL AND METHODS: An observational and prospective study has been carried out on nine patients affected by unilateral condylar hyperplasia (UCH) with complete bone maturation, with a follow-up over 18 months. At the beginning of the study, a test-battery was conducted including dental casts, articular examination, teleradiography and cephalometry, computed tomography and SPECT, creating two groups of patients from a difference in uptake between both condyles greater than 10% over the follow-up period. Evolution of data obtained with the rest of the diagnostic tests were compared to confirm UCH activity predicted by SPECT. RESULTS: The comparison of both groups did not show hardly any significant differences, with little clinical significance. Deviation of the mandibular line, the size of the branches or condyles behaved similarly in both study groups. CONCLUSIONS: From the data obtained in our study, we can conclude that the use of the difference in uptake between both condyles by applying the SPECT technique is not a valid approach for predicting clinical activity in cases of UCH


No disponible


Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Adulto Joven , Adulto , Hiperplasia/diagnóstico por imagen , Cóndilo Mandibular/diagnóstico por imagen , Enfermedades Mandibulares/diagnóstico por imagen , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único/métodos , Hiperplasia/patología , Cóndilo Mandibular/patología , Enfermedades Mandibulares/patología , Estadísticas no Paramétricas , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/patología , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados
3.
PLoS One ; 15(7): e0236425, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32726330

RESUMEN

Craniofacial asymmetry, mandibular condylar modeling and temporomandibular joint disorders are common comorbidities of skeletally disproportionate malocclusions, but etiology of occurrence together is poorly understood. We compared asymmetry, condyle modeling stability and temporomandibular health in a cohort of 128 patients having orthodontics and orthognathic surgery to correct dentofacial deformity malocclusions. We also compared ACTN3 and ENPP1 genotypes for association to clinical conditions. Pre-surgical posterior-anterior cephalometric and panometric radiographic analyses; jaw pain and function questionnaire and clinical examination of TMD; and SNP-genotype analysis from saliva samples were compared to assess interrelationships. Almost half had asymmetries in need of surgical correction, which could be subdivided into four distinct morphological patterns. Asymmetric condyle modeling between sides was significantly greater in craniofacial asymmetry, but most commonly had an unanticipated pattern. Often, longer or larger condyles occurred on the shorter mandibular ramus side. Subjects with longer ramus but dimensionally smaller condyles were more likely to have self-reported TMD symptoms (p = 0.023) and significantly greater clinical diagnosis of TMD (p = 0 .000001), with masticatory myalgia most prominent. Genotyping found two significant genotype associations for ACTN3 rs1671064 (Q523R missense) p = 0.02; rs678397 (intronic SNP) p = 0.04 and one significant allele association rs1815739 (R577X nonsense) p = 0.00. Skeletal asymmetry, unusual condyle modeling and TMD are common and interrelated components of many dentofacial deformities. Imbalanced musculoskeletal functional adaptations and genetic or epigenetic influences contribute to the etiology, and require further investigation.


Asunto(s)
Actinina/genética , Deformidades Dentofaciales/genética , Predisposición Genética a la Enfermedad , Hidrolasas Diéster Fosfóricas/genética , Pirofosfatasas/genética , Trastornos de la Articulación Temporomandibular/genética , Adulto , Mentón/diagnóstico por imagen , Modelos Dentales , Deformidades Dentofaciales/diagnóstico por imagen , Deformidades Dentofaciales/patología , Deformidades Dentofaciales/cirugía , Cara/diagnóstico por imagen , Femenino , Estudios de Asociación Genética , Humanos , Maxilares/diagnóstico por imagen , Masculino , Maloclusión/diagnóstico por imagen , Maloclusión/genética , Maloclusión/patología , Maloclusión/cirugía , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/patología , Cóndilo Mandibular/cirugía , Procedimientos Quirúrgicos Ortognáticos , Polimorfismo de Nucleótido Simple/genética , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/patología , Trastornos de la Articulación Temporomandibular/cirugía
4.
Int J Oral Maxillofac Surg ; 49(11): 1435-1438, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32653260

RESUMEN

The aim of this study was to describe the steps of a minimally invasive surgical technique used to perform a proportional intraoral condylectomy with a three-dimensionally (3D) printed cutting guide. The technique consists of two steps: virtual surgical planning and intraoral condylectomy. During virtual surgical planning, the mandibular ramus was measured bilaterally, the height of the proportional condylectomy was planned virtually, and a cutting guide was 3D printed. In the intraoral condylectomy, the mandibular condyle was approached intraorally, the 3D printed cutting guide was positioned in the sigmoid notch, and the proportional condylectomy was performed. The protocol reported in this technical note is the sum of knowledge acquired from a series of studies published previously by the authors, who have jointly developed a surgical technique that is both minimally invasive and accurate for the treatment of condylar hyperplasia.


Asunto(s)
Cóndilo Mandibular , Osteotomía , Asimetría Facial/patología , Humanos , Hiperplasia/patología , Mandíbula , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/patología , Cóndilo Mandibular/cirugía , Impresión Tridimensional
5.
J Oral Maxillofac Surg ; 78(11): 2072.e1-2072.e12, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32621806

RESUMEN

PURPOSE: Facial asymmetry associated with unilateral condylar hyperplasia can benefit from condylectomy, which aims to arrest the pathologic condylar growth and restore an appropriate posterior height. However, there are several cases in which condylar hyperplasia is combined with various dentofacial deformities, for which joint surgery has to be accompanied by concomitant orthognathic surgery. The literature is relatively poor of examples in which virtual planning for orthognathic surgery includes the evaluation of condylectomy, which is often manually performed. The aim of this study was to present and discuss a workflow for 1-stage computer-guided customized management of skeletal asymmetry by simultaneous condylectomy and orthognathic surgery. MATERIALS AND METHODS: Five patients were enrolled in this study from 2018 to 2019. All patients underwent combined virtual planning of orthognathic surgery and condylectomy. Virtual surgery was translated into real surgical coordinates using patient-specific surgical guides and custom-designed osteosynthesis plates. RESULTS: All surgical procedures were uneventful, and in all patients, virtual planning was successfully brought into the operating room with high accuracy, as confirmed by superimposition analyses. Symmetrization of the face and achievement of correct occlusion were observed in all cases. CONCLUSIONS: The presented protocol is a reliable solution for the combined planning of orthognathic surgery and condylectomy. Virtual planning, surgical guides, and custom-designed plates allow computerized simulations to be replicated in the real patient.


Asunto(s)
Cirugía Ortognática , Procedimientos Quirúrgicos Ortognáticos , Asimetría Facial/diagnóstico por imagen , Asimetría Facial/patología , Asimetría Facial/cirugía , Humanos , Hiperplasia/cirugía , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/patología , Cóndilo Mandibular/cirugía
6.
Plast Reconstr Surg ; 146(4): 439e-445e, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32590515

RESUMEN

BACKGROUND: Facial asymmetry caused by unilateral condylar hyperplasia requires treatment to address facial and occlusal imbalances. There is no definitive evidence to suggest that a single intervention strategy (during either active condylar overgrowth or the burnt-out phase) results in better/more symmetric correction. This study sought to quantify preoperative and postoperative facial asymmetry in unilateral condylar hyperplasia patients comparing treatment for active versus burnt-out disease. METHODS: Preoperative and postoperative three-dimensional photographs were obtained. Images were compared to those of unaffected controls as a standard for normal facial symmetry. Facial asymmetry was assessed using root-mean-square deviation. Paired t tests were performed to compare the root-mean-square deviations of preoperative and postoperative images between the unilateral condylar hyperplasia groups and against controls. RESULTS: Forty patients were included (11 active, nine burnt-out, and 20 controls) and 60 three-dimensional images were evaluated. Preoperatively, patients in the burnt-out group had worse asymmetry than those with active unilateral condylar hyperplasia (p = 0.011). Both groups demonstrated significantly improved symmetry postoperatively (active, p = 0.0069; burnt-out, p = 1.74E-4). However, burnt-out patients remained with some residual asymmetry (p = 4.75E-4), whereas their active counterparts showed no significant difference compared to unaffected controls (p = 0.089). CONCLUSIONS: Patients with end-stage unilateral condylar hyperplasia have more severe facial asymmetry that is more difficult to normalize compared to earlier intervention during active unilateral condylar hyperplasia. These findings suggest that, if possible, corrective intervention is preferable during active unilateral condylar hyperplasia. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Asunto(s)
Asimetría Facial/cirugía , Cóndilo Mandibular/patología , Adolescente , Niño , Asimetría Facial/etiología , Femenino , Humanos , Hiperplasia/complicaciones , Masculino , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Adulto Joven
7.
Int J Oral Maxillofac Surg ; 49(11): 1397-1401, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32423691

RESUMEN

Unilateral condylar hyperplasia (UCH) causes progressive asymmetry of the mandible. The aetiology of this growth disorder is unknown. A two-centre prospective study was established, and 10 consecutive adult UCH patients scheduled for high condylectomy were included. The resected condylar tissue was divided into two parts, one for regular histopathology and one for DNA extraction. A panel of eight selected overgrowth genes (AKT1, AKT3, MTOR, PIK3CA, PIK3R2, PTEN, TSC1, TSC2) were sequenced using next-generation sequencing, with coverage of a minimum 500 times in order to be able to detect low-grade mosaicisms. Subsequently, untargeted whole exome sequencing (WES) was performed to detect variants in other genes present in three or more patients. No mutation was detected in any of the overgrowth genes, and untargeted exome sequencing failed to detect any definitively causative variant in any other gene. Ten genes had a rare variant in three or more patients, but these cannot be designated as causative without additional functional studies. The hypothesis that the cause in at least some patients with UCH is a somatic mutation in a gene that controls cell growth could not be confirmed in this study.


Asunto(s)
Asimetría Facial , Cóndilo Mandibular , Adulto , Asimetría Facial/patología , Humanos , Hiperplasia/genética , Hiperplasia/patología , Mandíbula/patología , Cóndilo Mandibular/patología , Estudios Prospectivos
8.
Int J Oral Maxillofac Surg ; 49(11): 1464-1469, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32249036

RESUMEN

Hemifacial hyperplasia (HFH) is characterized by an increase in volume of all affected tissues of half of the face. It is present at birth, subsequently grows proportionally, and stops growing before adulthood. Unilateral condylar hyperplasia (UCH) consists of progressive asymmetric growth of the mandible and develops typically in early adulthood. Both disorders have an unknown aetiology. The overgrowth limited to one body part suggests somatic mosaicism, as this has been found in other similar localized overgrowth disorders. Often this includes a variant in a gene in the (PIK3CA)/PI3K/(PTEN)/AKT1/mTOR pathway. Here we report the case of an HFH patient with asymmetry present at birth, in whom a progressive growth pattern similar to UCH subsequently occurred, causing marked mandibular asymmetry. A condylectomy was successfully performed to stop the progressive growth. Somatic mosaicism for a mutation in PIK3CA was detected in the condylar tissue. This finding might indicate that both HFH and UCH can be caused by variants in genes in the (PIK3CA)/PI3K/(PTEN)/AKT1/mTOR pathway, similar to other disorders that result in asymmetrical bodily overgrowth.


Asunto(s)
Asimetría Facial , Cóndilo Mandibular , Adulto , Cara/anomalías , Asimetría Facial/congénito , Asimetría Facial/genética , Asimetría Facial/patología , Humanos , Hiperplasia/genética , Hiperplasia/patología , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/patología
9.
BMJ Case Rep ; 13(2)2020 Feb 10.
Artículo en Inglés | MEDLINE | ID: mdl-32047087

RESUMEN

Osteomas are bone tumours arising from the cortical or medullary bones of craniofacial skeleton. Involvement of frontal bone and paranasal sinuses is more frequent than jaw bones. Jaw osteomas are slow growing benign lesions, which are usually asymptomatic or present as painless swelling. Those involving mandibular condyle are relatively rare and result in significant functional and aesthetic disturbances. This paper reports a case of solitary central compact osteoma of mandibular condyle in an adult Indian female patient. A comprehensive review of previously published reports is also presented.


Asunto(s)
Neoplasias Óseas/cirugía , Cóndilo Mandibular/patología , Cóndilo Mandibular/cirugía , Neoplasias Mandibulares/cirugía , Osteoma/cirugía , Anciano , Femenino , Humanos , Enfermedades Raras
10.
Oral Maxillofac Surg Clin North Am ; 32(1): 105-116, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31685348

RESUMEN

Idiopathic condylar resorption (ICR), alternatively called progressive condylar resorption, is an uncommon aggressive form of degenerative disease of the temporomandibular joint seen mostly in adolescent and young women. ICR occurring before the completion of growth results in a shorter mandibular condyloid process, ramus and body, compensatory growth at the gonial angle and coronoid process, as well as an increase in anterior facial vertical dimension. Management options discussed include oral appliances, orthodontics, medical management, orthognathic surgery with and without disc repositioning, and alloplastic temporomandibular joint replacement.


Asunto(s)
Resorción Ósea , Cóndilo Mandibular/cirugía , Ortodoncia Correctiva , Procedimientos Quirúrgicos Ortognáticos/métodos , Trastornos de la Articulación Temporomandibular/cirugía , Adolescente , Resorción Ósea/etiología , Femenino , Humanos , Cóndilo Mandibular/patología , Aparatos Ortopédicos , Articulación Temporomandibular
11.
Orphanet J Rare Dis ; 14(1): 293, 2019 12 16.
Artículo en Inglés | MEDLINE | ID: mdl-31842965

RESUMEN

BACKGROUND: Both mandibular condylar hyperplasia and condylar osteochondroma can lead to maxillofacial skeletal asymmetry and malocclusion, although they exhibit different biological behavior. This study attempted to compare the histological features of mandibular condylar hyperplasia and condylar osteochondroma using hematoxylin-and-eosin (H&E) staining, and immunohistochemistry staining of PCNA and EXT1 with quantitative analysis method. RESULTS: The H&E staining showed that condylar hyperplasia and condylar osteochondroma could be divided into four histological types and exhibited features of different endochondral ossification stages. There was evidence of a thicker cartilage cap in condylar osteochondroma as compared condylar hyperplasia (P = 0.018). The percentage of bone formation in condylar osteochondroma was larger than was found in condylar hyperplasia (P = 0.04). Immunohistochemical staining showed that PCNA was mainly located in the undifferentiated mesenchymal layer and the hypertrophic cartilage layer, and there were more PCNA positive cells in the condylar osteochondroma (P = 0.007). EXT1 was mainly expressed in the cartilage layer, and there was also a higher positive rate of EXT1 in condylar osteochondroma (P = 0.0366). The thicker cartilage cap, higher bone formation rate and higher PCNA positive rate indicated a higher rate of proliferative activity in condylar osteochondroma. The more significant positive rate of EXT1 in condylar osteochondroma implied differential biological characteristic as compared to condylar hyperplasia. CONCLUSIONS: These features might be useful in histopathologically distinguishing condylar hyperplasia and osteochondroma.


Asunto(s)
Hiperplasia/patología , Cóndilo Mandibular/patología , Osteocondroma/patología , Femenino , Humanos , Hiperplasia/metabolismo , Inmunohistoquímica , Cóndilo Mandibular/metabolismo , N-Acetilglucosaminiltransferasas/metabolismo , Osteocondroma/metabolismo , Antígeno Nuclear de Célula en Proliferación/metabolismo
12.
Int J Mol Sci ; 20(24)2019 Dec 13.
Artículo en Inglés | MEDLINE | ID: mdl-31847127

RESUMEN

The temporomandibular joint (TMJ) is an intricate structure composed of the mandibular condyle, articular disc, and glenoid fossa in the temporal bone. Apical condylar cartilage is classified as a secondary cartilage, is fibrocartilaginous in nature, and is structurally distinct from growth plate and articular cartilage in long bones. Condylar cartilage is organized in distinct cellular layers that include a superficial layer that produces lubricants, a polymorphic/progenitor layer that contains stem/progenitor cells, and underlying layers of flattened and hypertrophic chondrocytes. Uniquely, progenitor cells reside near the articular surface, proliferate, undergo chondrogenesis, and mature into hypertrophic chondrocytes. During the past decades, there has been a growing interest in the molecular mechanisms by which the TMJ develops and acquires its unique structural and functional features. Indian hedgehog (Ihh), which regulates skeletal development including synovial joint formation, also plays pivotal roles in TMJ development and postnatal maintenance. This review provides a description of the many important recent advances in Hedgehog (Hh) signaling in TMJ biology. These include studies that used conventional approaches and those that analyzed the phenotype of tissue-specific mouse mutants lacking Ihh or associated molecules. The recent advances in understanding the molecular mechanism regulating TMJ development are impressive and these findings will have major implications for future translational medicine tools to repair and regenerate TMJ congenital anomalies and acquired diseases, such as degenerative damage in TMJ osteoarthritic conditions.


Asunto(s)
Cartílago Articular/embriología , Condrogénesis , Proteínas Hedgehog/metabolismo , Osteoartritis/embriología , Transducción de Señal , Disco de la Articulación Temporomandibular/embriología , Animales , Cartílago Articular/patología , Diferenciación Celular , Humanos , Cóndilo Mandibular/embriología , Cóndilo Mandibular/patología , Ratones , Osteoartritis/patología , Disco de la Articulación Temporomandibular/patología
13.
PLoS One ; 14(10): e0223244, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31603905

RESUMEN

The temporomandibular joint (TMJ) is a fibrocartilaginous tissue critical for chewing and speaking. In patients with temporomandibular disorders (TMDs), permanent tissue loss can occur. Recapitulating the complexity of TMDs in animal models is difficult, yet critical for the advent of new therapies. Synovial fluid from diseased human samples revealed elevated levels of tumor necrosis factor alpha (TNF-alpha). Here, we propose to recapitulate these findings in mice by subjecting murine TMJs with TNF-alpha or CFA (Complete Freund's Adjuvant) in mandibular condyle explant cultures and by local delivery in vivo using TMJ intra-articular injections. Both TNF-alpha and CFA delivery to whole mandibular explants and in vivo increased extracellular matrix deposition and increased cartilage thickness, while TNF-alpha treated explants had increased expression of inflammatory cytokines and degradative enzymes. Moreover, the application of TNF-alpha or CFA in both models reduced cell number. CFA delivery in vivo caused soft tissue inflammation, including pannus formation. Our work provides two methods of chemically induced TMJ inflammatory arthritis through a condyle explant model and intra-articular injection model that replicate findings seen in synovial fluid of human patients, which can be used for further studies delineating the mechanisms underlying TMJ pathology.


Asunto(s)
Artritis Experimental/inmunología , Cartílago Articular/inmunología , Matriz Extracelular/inmunología , Trastornos de la Articulación Temporomandibular/inmunología , Articulación Temporomandibular/inmunología , Proteína ADAMTS5/genética , Proteína ADAMTS5/inmunología , Adolescente , Adulto , Anciano , Animales , Artritis Experimental/inducido químicamente , Artritis Experimental/genética , Cartílago Articular/efectos de los fármacos , Cartílago Articular/patología , Colágeno Tipo II/genética , Colágeno Tipo II/inmunología , Colágeno Tipo X/genética , Colágeno Tipo X/inmunología , Modelos Animales de Enfermedad , Matriz Extracelular/efectos de los fármacos , Matriz Extracelular/patología , Femenino , Adyuvante de Freund/administración & dosificación , Expresión Génica/efectos de los fármacos , Expresión Génica/inmunología , Humanos , Interleucinas/genética , Interleucinas/inmunología , Masculino , Cóndilo Mandibular/efectos de los fármacos , Cóndilo Mandibular/inmunología , Cóndilo Mandibular/patología , Ratones , Ratones Endogámicos C57BL , Persona de Mediana Edad , Líquido Sinovial/inmunología , Articulación Temporomandibular/efectos de los fármacos , Articulación Temporomandibular/patología , Trastornos de la Articulación Temporomandibular/genética , Trastornos de la Articulación Temporomandibular/patología , Técnicas de Cultivo de Tejidos , Factor de Necrosis Tumoral alfa/administración & dosificación
14.
Am J Orthod Dentofacial Orthop ; 156(4): 531-544, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31582125

RESUMEN

Progressive condylar resorption, also known as idiopathic condylar resorption, is an uncommon, aggressive, degenerative disease of the temporomandibular joint (TMJ) seen mostly in adolescent girls and young women. This condition leads to loss of condylar bone mass, decrease of mandibular ramal height, steep mandibular and occlusal plane angles, and an anterior open bite. In 3 case reports, we review the pathogenesis of TMJ degenerative disease and the clinical management of TMJ arthrosis. We emphasize that TMJ arthritic disease should be discussed in dental circles as a pathologic entity in the same way that orthodontists discuss arthritic disease in orthopedic circles. Regarding the degenerative pathology of the TMJ, treatment goals include restored function and pain reduction. The treatment methods used to achieve these goals can range from noninvasive therapy to minimally invasive and invasive surgery. Most patients can be treated noninvasively, and the importance of disease prevention and conservative management in the overall treatment of TMJ disease must be acknowledged. The decision to manage TMJ osteoarthrosis surgically must be based on evaluation of the patient's response to noninvasive treatments, mandibular form and function, and effect of the condition on his or her quality of life.


Asunto(s)
Resorción Ósea/diagnóstico por imagen , Resorción Ósea/cirugía , Ortodoncia Correctiva/métodos , Procedimientos Quirúrgicos Ortognáticos/métodos , Osteoartritis/diagnóstico por imagen , Osteoartritis/cirugía , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/terapia , Adulto , Resorción Ósea/patología , Niño , Terapia Combinada , Progresión de la Enfermedad , Femenino , Humanos , Cóndilo Mandibular/patología , Cóndilo Mandibular/cirugía , Osteoartritis/patología , Calidad de Vida , Trastornos de la Articulación Temporomandibular/patología , Resultado del Tratamiento
15.
Am J Orthod Dentofacial Orthop ; 156(4): 555-565, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31582127

RESUMEN

A common dilemma when treating anterior open bite is understanding its etiology. Idiopathic condylar resorption (ICR) can cause open bite in affected individuals. Although it is prudent to not treat patients with ICR until active resorption has ceased, orthodontists may begin treating them because anterior open bite from ICR may not appear before or during their orthodontic treatment. This article reports a 12-year-old female who was diagnosed with ICR 10 months after completion of her orthodontic treatment for a Class II Division 1 malocclusion. When a young patient with a high mandibular angle and previous skeletal or dental Class II malocclusion returns with an open bite during the retention phase, the patient's condyles must be carefully examined to determine whether any temporomandibular joint disorder, such as ICR, is present. Currently, the controversy over the cause and the cure for ICR is continuing to challenge orthodontists in diagnoses and treatments. Orthodontists should closely monitor and offer informed treatment options to patients with risk factors for ICR or signs of its pathology that might develop at any stage of orthodontic treatment, including the retention period.


Asunto(s)
Resorción Ósea/complicaciones , Resorción Ósea/terapia , Maloclusión de Angle Clase II/terapia , Cóndilo Mandibular/patología , Enfermedades Mandibulares/patología , Enfermedades Mandibulares/terapia , Mordida Abierta/etiología , Mordida Abierta/terapia , Ortodoncia Correctiva/métodos , Trastornos de la Articulación Temporomandibular/terapia , Resorción Ósea/diagnóstico por imagen , Cefalometría , Niño , Terapia Combinada , Estética Dental , Femenino , Humanos , Maloclusión de Angle Clase II/diagnóstico por imagen , Enfermedades Mandibulares/diagnóstico por imagen , Mordida Abierta/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Resultado del Tratamiento
16.
J Craniomaxillofac Surg ; 47(11): 1665-1675, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31473057

RESUMEN

PURPOSE: To investigate the morphological features of hemimandibular hyperplasia (HH) in comparison to other condylar hyperplasia-associated asymmetries, including hemimandibular elongation (HE), solitary condylar hyperplasia (SCH), simple mandibular asymmetry (SMA) and condylar osteoma or osteochondroma (COS). MATERIALS AND METHODS: A total of 31 HH, 9 HE, 6 SCH, 10 SMA and 10 COS patients were included in this study. Clinical documentation, panoramic radiography and computed tomography data were retrospectively reviewed. The three-dimensional measurements were performed on multi-planar reformation images and volume rendering images. The accuracy of the subjective radiological signs was evaluated using sensitivity, specificity and receiver operating curve analysis. Discriminant analysis was performed to generate predictive formulas using quantitative data. RESULTS: The condyles in HH were regularly or irregularly enlarged, with significantly enlarged anterior-posterior length [16.2/5.29 (mean/SD, mm) P < 0.001] and volume [5.3/2.9(mean/SD, cm3) P < 0.001] compared to the normal values. The condyles in HE and SMA were normally shaped, and the quantitative measurements were within the normal range. The ramus heights in the HH patients [55.7/5.4(mean/SD, mm)] were enlarged in comparison to the contralateral side (P < 0.001) and normal values (P < 0.001). The ramus heights in the HE [52.4/7.1 (mean/SD, mm), P < 0.001] and SMA [50.3/5.0(mean/SD, mm), P = 0.002] patients were enlarged in the contralateral side comparison but were within the normal range. The mandibular body heights in HH were enlarged in the premolar [16.6/1.3 (mean/SD, mm), P < 0.001] and molar [24.8/1.4 (mean/SD, mm), P < 0.001] regions. The inferior convexity of the lower mandibular border and inferiorly displaced mandibular canal produced high specificity, sensitivity and area under the curve for the diagnosis of HH. Discriminant analysis could predict the diagnoses with a cross-validation accuracy rate of 85.7%. CONCLUSIONS: HH is a distinct clinical entity characterized by enlargement of the condyle, ramus and mandibular body. The inferior convexity of the lower mandibular border and inferiorly displaced mandibular canal is accurate and specific for the diagnosis of HH. The condyles in HE are not hyperplastic. The term "condylar hyperplasia" alone cannot be used to refer to HH or HE.


Asunto(s)
Asimetría Facial/diagnóstico , Hiperplasia , Procesamiento de Imagen Asistido por Computador/métodos , Imagenología Tridimensional/métodos , Mandíbula/anomalías , Osteocondroma , Osteoma , Humanos , Mandíbula/patología , Cóndilo Mandibular/patología , Estudios Retrospectivos
17.
Am J Orthod Dentofacial Orthop ; 156(2): 193-202, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31375229

RESUMEN

OBJECTIVES: To evaluate whether the effects on the mandibular condylar cartilage (MCC) and subchondral bone are transient of botulinum neurotoxin (Botox) injection into the masseter muscle. METHODS: Botox (0.3 U) was injected into the right masseter of 6-week-old female mice (C57BL/6; n = 16). In addition, 16 mice were used as control and received no injections. Experimental and matching control mice were killed 4 or 8 weeks after the single Botox injection. Mandibles and mandibular condyles were analyzed by means of microscopic computed tomography (microCT) and histology. Sagittal sections of condyles were stained for tartrate-resistant acid phosphatase (TRAP), toluidine blue, 5-ethynyl-2'-deoxyuridine (EdU), and terminal deoxynucleotide transferase-mediated dUTP nick-end labeling. RESULTS: Bone volume fraction was significantly decreased on the subchondral bone of the Botox-injected side, compared with the control side and control mice, 4 and 8 weeks after injection. Furthermore, histologic analysis revealed decrease in mineralization, cartilage thickness, TRAP activity, and EdU-positive cells in the MCC of the Botox-injected side 4 and 8 weeks after injection. CONCLUSIONS: The effects on the MCC and subchondral bone of Botox injection into the masseter muscle persisted for 8 weeks after injection and were not considered to be transient.


Asunto(s)
Toxinas Botulínicas Tipo A/farmacología , Cóndilo Mandibular/efectos de los fármacos , Músculo Masetero/efectos de los fármacos , Animales , Apoptosis/efectos de los fármacos , Proliferación Celular/efectos de los fármacos , Femenino , Inyecciones , Masculino , Mandíbula , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/patología , Músculo Masetero/diagnóstico por imagen , Músculo Masetero/patología , Ratones , Ratones Endogámicos C57BL , Modelos Animales , Articulación Temporomandibular
18.
Artículo en Inglés | MEDLINE | ID: mdl-31447325

RESUMEN

OBJECTIVE: The aim of this study was to correlate the morphometric measurements of the temporomandibular joint, including condylar size, joint space, and articular eminence size, with gender, disk position, and condylar position by using magnetic resonance imaging. STUDY DESIGN: Overall, 93 patients were evaluated (31.2% males and 68.8% females; age 18-81 years; mean age 41 years). Condylar size (D1), joint space (D2), and eminence size (D3) were measured. Correlations with gender, disk position, and condylar position were calculated. RESULTS: A statistically significant correlation was found between D2 and gender, with the joint space being significantly larger in the male group (P = .05). There were correlations between D2 and the position of the disk and the position of the condyle (P ≤ .05). CONCLUSIONS: The results indicate a correlation between male gender and larger joint space. In addition, we found that the joint space size influences the articular disk and condyle position, which can cause disk displacement.


Asunto(s)
Luxaciones Articulares , Cóndilo Mandibular , Trastornos de la Articulación Temporomandibular , Adulto , Algoritmos , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/patología , Factores de Riesgo , Factores Sexuales , Articulación Temporomandibular , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen
19.
Ann Anat ; 226: 3-9, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31336151

RESUMEN

The purpose of this study was to evaluate the skeletal units of a normal mandible (class I) and a prognathic mandible (class III), to compare the groups, and to investigate the key functional unit responsible for mandibular prognathism. Hemi-mandibles of 101 cases were evaluated by cone-beam computed tomography. Of these, 50 cases had Class I and 51 had Class III mandibles. The length, volume, and volume/length ratio of each skeletal unit were measured. The ratios of the condyle, body unit, and sum of the hemi-mandible between Class I and Class III showed statistically significant results (P<0.05). However, the ratios of angle, coronoid, and symphysis units did not show any statistical significance on comparison. Dependent on gender, in males the ratio of the condyle of the hemi-mandible showed statistically significant results (P<0.05). Meanwhile in females the ratio of the body and sum of the hemi-mandible showed statistically significant results (P<0.05). Accordingly, the mandibular body and condylar units are thinner in mandibular prognathism. On the basis of the functional matrix theory to determine the aetiology of mandibular prognathism, the key skeletal units are the body and condylar units.


Asunto(s)
Mandíbula/patología , Prognatismo/patología , Esqueleto , Adulto , Tomografía Computarizada de Haz Cónico , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Imagenología Tridimensional , Masculino , Mandíbula/diagnóstico por imagen , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/patología , Prognatismo/diagnóstico por imagen , Reproducibilidad de los Resultados , Caracteres Sexuales , Adulto Joven
20.
Arch Oral Biol ; 106: 104473, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31302469

RESUMEN

OBJECTIVE: This study aimed to evaluate the effects of nasal obstruction on mandibular growth, especially condyle, in adolescent rats and explore the possible mechanism with a focus on mesenchymal stem cells (MSCs) from condylar tissues. DESIGN: 4-week-old male Sprague-Dawley rats were randomly divided into bilateral intermittent nasal obstruction (i.e. mouth-breathing, MB) and nasal-breathing (NB) groups. Self-made plugs were used to obstruct the nasal cavity in the MB group for 4 weeks, from 8:00 a.m. to 4:00 p.m. every day. The body weights were recorded. Three-dimensional computed tomography (3D-CT) scanning of the craniomaxillary region was performed after 2 and 4 weeks of nasal obstruction. Other rats were sacrificed, and MSCs were isolated from condylar tissues and cultured in vitro for examining the cell proliferation and expression of chondrogenic marker genes. RESULTS: Significant decreases in body weight were observed in the MB group compared with the NB group during 4 weeks of nasal obstruction. All mandibular parameters in the sagittal, vertical, and transverse dimensions (except bi-condylar width) measured via 3D-CT were significantly smaller in the MB group. No significant difference was found in the proliferative ability of cultured MSCs derived from condylar tissues between the two groups. However, the expression of chondrogenic marker genes Acan, Col2a1 and Sox9 was significantly lower in the MB group-derived MSCs, using Cell Counting Kit-8 and quantitative polymerase chain reaction. CONCLUSION: The findings suggested that mouth breathing forced by nasal obstruction lead to developmental defects in the mandibular condyle, which might be related to the reduced cartilage differentiation of condylar MSCs.


Asunto(s)
Cóndilo Mandibular/patología , Células Madre Mesenquimatosas/citología , Obstrucción Nasal/complicaciones , Animales , Células Cultivadas , Condrogénesis , Masculino , Cóndilo Mandibular/citología , Distribución Aleatoria , Ratas , Ratas Sprague-Dawley
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