Temporomandibular arthropathies: A retrospective study with histopathological characteristics.

BACKGROUND: To investigate the incidence of temporomandibular arthropathies diagnosed in a university center and to describe their histopathological characteristics. MATERIAL AND METHODS: Temporomandibular arthropathy cases with corresponding slides were selected from an oral and maxillofacial surgical pathology service. Cases of exclusively articular disc disease were not included. RESULTS: The mean age was 31.3 years with a predominance of females (69.7%). Of these diagnoses, 53.6% were unilateral condylar hyperplasia, 17.8% were bony ankylosis, 14.3% were degenerative joint disease, 10.7% were osteochondroma, and 3.6% were synovial chondromatosis. Condylar hyperplasia presented as thick fibrocartilage and cartilage nests in the cancellous bone. Bony ankylosis exhibited lamellar bone and nests of chondrocytes. Degenerative joint disease presented as an irregular layer of fibrocartilage with areas of clustered chondrocytes and calcified cartilage. Osteochondroma of the condyle exhibited hyaline cartilage and areas of new bone formation. Synovial chondromatosis presented as immature cartilaginous tissue and randomly arranged chondrocytes. CONCLUSIONS: The pathological alterations verified in these arthropathies involved diseases that were predominantly proliferative, i.e., unilateral condylar hyperplasia, osteochondroma and synovial chondromatosis of the tumor or pseudotumor type and bony ankylosis associated with callus formation of the reparative type, and less frequent degenerative changes for which the disease is so named.

Fixation of mandibular fractures with plates or miniplates: prospective study.

AIM: The choice of a more adequate internal fixation system in the treatment of mandibular fractures still originates controversy in the literature. The purpose of this study was to evaluate the effectiveness of internal fixation systems in the fixation of mandibular fractures, comparing indications and postoperative results between 2.4-mm plates and 2.0-mm miniplates. METHODS: A total of 42 consecutive patients with 71 mandibular fractures that had undergone either 2.4-mm plates (N.=20) or 2.0-mm miniplates (N.=22) were prospectively analyzed. Patients had a minimum follow-up of 6 months. Statistical analyses were made in the comparison between systems. RESULTS: There was no significant difference in the choice of systems as to age and characteristics of the fractures, but in patients with systemic diseases or chronic substance abuse, as well as in exposed fractures, with more frequency of 2.4-mm plates. 2.0-mm miniplates presented better recovery of jaw opening in the postoperative period. Temporary facial nerve deficit was observed exclusively in the case of extraoral approach. Both systems presented low rate of complications which required reoperation, however 2.0-mm miniplates presented better efficacy when compared to 2.4-mm plates. CONCLUSION: In conclusion, 2.0-mm miniplates should be always used when possible in the fixation of mandibular fractures, respecting their contraindications.

Observation of covalent intermediates in an enzyme mechanism at atomic resolution.

In classical enzymology, intermediates and transition states in a catalytic mechanism are usually inferred from a series of biochemical experiments. Here, we derive an enzyme mechanism from true atomic-resolution x-ray structures of reaction intermediates. Two ultra-high resolution structures of wild-type and mutant d-2-deoxyribose-5-phosphate (DRP) aldolase complexes with DRP at 1.05 and 1.10 angstroms unambiguously identify the postulated covalent carbinolamine and Schiff base intermediates in the aldolase mechanism. In combination with site-directed mutagenesis and (1)H nuclear magnetic resonance, we can now propose how the heretofore elusive C-2 proton abstraction step and the overall stereochemical course are accomplished. A proton relay system appears to activate a conserved active-site water that functions as the critical mediator for proton transfer.

Healing of the displaced condylar process fracture: an experimental study.

Healing of the displaced condylar process fracture was analysed by means of an experimental model using adults rats. Displaced fractures of the right condylar process were achieved under general anaesthesia. Histological data initially demonstrated neutrophilic exudation along the articular capsule and adjacent muscle fibres. One week later, devitalized bone areas at the fracture site, as well as proliferation of cartilaginous and osseous tissue were observed. Subsequently, exuberant callus formation and a decrease in the inflammatory process occurred. After 3 months, the condylar process presented characteristics of normality and was centralized into the temporal fossa, with interposition of the articular disc. These results indicate that experimentally induced, displaced condylar process fractures heal by callus formation with simultaneous repositioning of the condyle.

Rotated subcondylar process fracture in the growing animal: an experimental study in rats.

Unilateral, rotated subcondylar fractures were surgically induced in young rats under general anaesthesia. A decrease in body weight was observed in the fractured animals, with recovery at the end of the experimental period. A tendency of deviation of the mandible to the fracture side was noticed on axial radiographs, but without significant difference between experimental and sham-operated animals. Histological data initially demonstrated acute inflammation along the articular capsule and adjacent muscle fibres. Within 2 weeks, exuberant callus formation occurred. Neither devitalized bone ends nor intra-articular granulation tissue were seen. After 1 month, the temporomandibular joint presented characteristics of normality, with the condylar process centralized into the temporal fossa, interposed by the articular disc. These results were preserved after 3 months. We concluded that rotational subcondylar fractures in young rats heal by callus formation, with simultaneous and prompt repositioning of the condyle.

The effect of indirect trauma on the rat temporomandibular joint.

The effect of indirect trauma to the rat temporomandibular joint (TMJ) is analysed by means of an experimental model. The trauma, applied from an angle-glenoid fossa direction, produced injury of the TMJ. The histological data demonstrated that the impact could produce fractures of the glenoid fossa, but no hemarthrosis was observed. Trauma, both with or without fracture, caused proliferative changes in the TMJ. The glenoid fossa, the articular disk and the articular surface of the condyle were injured. Thickening of the articular surfaces had resulted in reduced joint space. Subsequently, remodelling changes in the condyle were found.

Effect of freeze-dried bone and a dextran agglutinant on the healing of defects in the rat mandible.

The effects of inorganic, freeze-dried bone, alone or mixed with a dextran agglutinant, on the repair of experimentally created critical-size bone defects were evaluated in the rat mandible. Histological data demonstrated a progressive resorption of the freeze-dried bone particles, without osseous proliferation into the defect, and a posterior foreign-body reaction. These results indicate that the freeze-dried bone did not induce bony healing in the critical-size defect and that the addition of dextran agglutinant did not change the tissue response. Dextran may have other applications as a biocompatible, resorbable agglutinant.

Active unilateral condylar hyperplasia.

Two cases of active unilateral condylar hyperplasia which were treated with condylectomy alone are presented. The first case was an adult form and the other a juvenile form. Both were classified as active by using 99Tc bone scintigraphy. Clinical and radiographic features of both cases conformed to the hemimandibular hypertrophy type. Satisfactory facial symmetry and dental occlusion were achieved. Histopathological data confirmed the activity of the articular cartilage layers.

Passive mandibular border positions in craniomandibular disorder patients and asymptomatic individuals: a comparative study.

Measurements of passive mandibular border positions were recorded in a group of patients with craniomandibular disorders and compared with those of a control group of asymptomatic individuals. The mean values of triplicate measurements did not show significant difference. This finding indicates that a passive measurement is sufficient for surveying mandibular border positions. The mean values of mandibular border positions revealed no significant difference between patients with craniomandibular disorders and asymptomatic individuals. Results indicate that measurement of mandibular border positions is not a specific factor for diagnosis of craniomandibular disorders, but it seems a valuable method to evaluate the treatment of individual cases.

Remodelling of bilateral fractures of the mandibular condyle.

A case of complete remodelling of bilateral fractures of the mandibular condyle in an 11-year-old boy is presented. Initial radiographic examination revealed fractures of the right and left condylar neck with medial and anterior dislocation of the proximal fragment. The fractures were treated conservatively, with a short-time intermaxillary fixation and early jaw function, and thirty-five months later the patient was asymptomatic. Radiographic changes observed following treatment have revealed a gradual return to normal shape and position of the condyles.

Incidence of temporomandibular joint disorders in patients seen at a hospital emergency room.

A retrospective survey of a hospital emergency room population seen at an oral and maxillofacial surgery clinic during a 6-month period found 62 patients (2.7% of the total population) with temporomandibular joint disorders. The diagnoses were myofascial pain-dysfunction/temporomandibular joint dysfunction (MPD/TMJ) syndrome (70.9% of the cases) and dislocation (luxation) (22.5% of the cases). The chief complaint was well defined in relation to the diagnoses: facial pain in the MPD/TMJ syndrome cases, and displacement of the mandible in the dislocation cases.

Incidence of dentoalveolar injuries in hospital emergency room patients.

A retrospective survey over one year of a hospital emergency room population, seen at an oral and maxillofacial surgery clinic, found 271 patients (4.6% of the total population) with dentoalveolar injuries. A very large number of injuries occurred to children between the ages of 0 and 5 years (42.1%), and there was a significant number of injured patients in the adult population (19.1%). The ratio of male to female was 1.9:1. The leading cause of injury was falls (59.8%). The largest number of injuries was seen during summer. The diagnoses were lateral luxation (27.3%), concussion (17.3%), exarticulation (14.3%), tooth fracture (12.5%), intrusive luxation (11.1%), fracture of alveolar process (7.4%), extrusive luxation (3.7%), and cases with more than one diagnosis (6.3%). Most of the involved teeth were maxillary central incisors, in both dentitions.

Changes in hemoglobin and hematocrit levels following orthognathic surgery of the mandible.

Red blood cell mass has been shown to recover rapidly with great decreases, as occurs in orthognathic surgery. However, blood loss during bilateral sagittal split osteotomy is considered minimal. The purpose of this study was to verify changes in hemoglobin (Hb) and hematocrit (Ht) levels following orthognathic surgery of the mandible. Data from 12 patients with a mean age of 27.5 years, from both genders, that were submitted to bilateral sagittal split osteotomy in the prognathism reduction were evaluated. No patient received blood transfusion during the procedure nor postoperatively. Procedures were performed by the same surgeon, with the use of reciprocating and sagittal saws. Levels of Hb and Ht were obtained in preoperative, one day postsurgery, and one, three and six weeks postoperatively. Statistical analyses were used to verify the difference in each group, and between periods. Patients lost a mean decrease in Hb of 2.0 g/dl, and in Ht of 5.2%. There was significant difference as to the levels of Hb (p=0.002) and Ht (p=0.010). These levels presented significant changes from immediate postoperative to six weeks for Hb, and to three weeks for Ht. It was concluded that a slow recovery of hemoglobin and hematocrit levels occurred following orthognathic surgery of the mandible.

Effects of unilateral upper incisor extraction on facial growth of young rats.

The effects of unilateral extraction of the upper incisor (one tooth) on facial growth of young rats were studied. The remaining upper incisor showed deviation towards the opposite side, and there was regular dental wear of all the incisors. The effects were evident only in the mid-facial area. Cephalometric measurements showed significant shortening with deviation of the incisor bone on the extraction side. There was no significant disturbance of the growth of the rest of the maxilla and mandible. These results indicate that upper incisor extractions have a localized influence, leading to impairment of incisor bone growth.

Characteristics of chief complaints of patients with temporomandibular disorders in a Brazilian population.

A retrospective survey of 894 patients with temporomandibular disorders was conducted in order to analyse the characteristics of chief complaints. The patients presented complaints of pain (82.1%), functional disturbance (12.3%), articular sounds (5.0%) and swelling (0.6%). Unilateral occurrence (66.5%) was more frequent than bilateral. The most frequent location of pain was the temporomandibular joint (TMJ) (82.1%) followed by ear (10.8%), face (2.3%), head (2.3%), mandible (1.0%), neck (0.9%), temporal (0.4%) and frontal (0.1%) areas. Pain in the TMJ occurred in isolation (87.9%) or associated to other locations. The most frequent functional disturbance was limitation of jaw opening (32.1%).

Verification of the symmetry of the mandibular ramus in patients with temporomandibular disorders and asymptomatic individuals: a comparative study.

Some studies have reported that mandibular ramus asymmetries are more pronounced in patients with temporomandibular disorders. The symmetry of the mandibular ramus was verified in a group of patients with temporomandibular disorders and compared with that of a control group of asymptomatic individuals. Heights of the mandibular ramus and of the condyle and gonial angles were measured from panoramic radiographs. In the comparison of numerical values between dysfunction and asymptomatic groups there was no significant difference; when comparing sides within each group, there was a significant difference in gonial angle in the asymptomatic group. Using the formula: (R-L)/(R+L) x 100%, in the comparison between groups, there was a significant difference as to condylar height. With a subdivision in each group, having the value of 3% to calculated symmetry as a reference, there was no significant difference between groups. Comparing gender or age intervals in both groups, there was no significant difference. It was concluded that there was significant difference in calculated symmetry only as to condylar height between disorder patients and asymptomatic individuals.

Substrate specificity and kinetic mechanism of the insect sulfotransferase, retinol dehydratase.

Spodoptera frugiperda retinol dehydratase catalyzes the conversion of retinol to the retro-retinoid anhydroretinol. It shares sequence homology with the family of mammalian cytosolic sulfotransferases and provides the first link between sulfotransferases and retinol metabolism. In this study the enzymatic properties of retinol dehydratase were examined using bacterially expressed protein. We show that retinol dehydratase can catalyze the transfer of the sulfonate moiety to small phenolic compounds and exhibits many functional similarities to the mammalian cytosolic sulfotransferases. The bisubstrate reaction that it catalyzes between retinol and the universal sulfonate donor 3'-phosphoadenosine 5'-phosphosulfate seems to involve ternary complex formation and to proceed via a Random Bi Bi mechanism. In addition to the low nanomolar Km value for free retinol, retinol dehydratase is strongly inhibited by retinol metabolites, suggesting a preference for retinoids. Conversely, a number of tested mammalian cytosolic sulfotransferases do not utilize retinol, indicating that retinol is not a general substrate for sulfotransferases.

Passive mandibular border positions and their relationships with signs and symptoms of craniomandibular disorder. A study of linear and angular measurements.

Linear measurements of passive mandibular border positions and angular measurements of passive opening were recorded in a group of patients with craniomandibular disorders. The relationships between signs and symptoms of craniomandibular disorders and abnormal capacity of movement were studied. There was significant association of some signs and symptoms related to the temporomandibular joint and abnormal vertical and horizontal excursions. On the other hand, there was only one relationship between occlusal factors and abnormal passive mandibular border positions.

[Temporomandibular injury: a cause of limited mouth opening]. / Ferimento na região temporomandibular: uma causa de limitação da abertura de boca.

A case of limitation of jaw opening caused by an intentional knife wound to the temporomandibular region is presented. The chief complaint was pain and restricted jaw movement. Treatment consisted of the administration of antiinflammatory agent. Recovery was complete and without complications, normal jaw opening being obtained. The possibility that the inflammatory process stimulates muscular spasm is emphasized.

Microanatomic features of unilateral condylar hyperplasia.

Microanatomic features of unilateral condylar hyperplasia (UCH) are described. The articular surface exhibited clefts with surrounding elevations, and globules varying 0.5-2 microns in diameter. The articular zone presented giant coiled fibers, and the proliferative zone was composed of small round cells. The findings suggest that degenerative changes occur in UCH, both in adult and juvenile forms.