Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5184_Библиотеки_им_академика_М_И_Перельмана.pdf
xxxvi
Stack BC. My journey from orthodontics to craniofacial pain and TMJ to
movement disorders. Cranio. 2012;30(3):156–8. https://doi.org/10.1179/
crn.2012.023.
Brown JL. Brendan C. Stack, The father of TMJ treatment. Cranio.
2020;38(6):357. https://doi.org/10.1080/08869634.2020.1823792.
BrendanC.Stack Jr.
Acknowledgments
Contents
Part I Fundamentals
The Temporomandibular Joint: Form and Function . . . . . . . . . . . . . 3
Anita R. Joy-Thomas and Robert D. Spears
The Etiology of Temporomandibular Disorders . . . . . . . . . . . . . . . . . 21
Feras Al Khatib and Achint Utreja
Orthodontics and Temporomandibular Disorders . . . . . . . . . . . . . . . 43
Achint Utreja and Feras Al Khatib
An Overview of Chronic Neuropathic Orofacial Pain . . . . . . . . . . . . . 55
Revathi Shekar
Imaging of the Common Conditions of the
Temporomandibular Joint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Husniye Demirturk and Anitha Potluri
Temporomandibular Joint: Review of the Anatomy,
Pathology, and Magnetic Resonance Imaging Techniques . . . . . . . . . 91
Francisco Abaete Chagas-Neto, José Luiz de Sá Neto,
and Paulo Moraes Agnollitto
Basic Clinical Management of Temporomandibular
Disorders (TMDs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Cyril Pandarakalam
Review of TMJ Surgery for Non-surgeons . . . . . . . . . . . . . . . . . . . . . . 135
Ioannis Gkikas
Arthrocentecis and Arthroscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Anis Tebyanian
Part II Advanced Topics
The Neurological Aspects of the Trigeminal Cranial Complex
and Its Role in the TMJ Dysfunction and Multiple
Movement Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Anthony B. Sims
xxxvii
xxxviii
A Journey to Understanding and Treating TMD/Craniofacial
Pain: Rediscovering the Structure Often Overlooked
in Orthodontics and Facial Orthopedics: The TMJ . . . . . . . . . . . . . . 185
Lidia Yavich
Structural Misalignment: Postural Changes Related
to Temporomandibular Joint Pathology . . . . . . . . . . . . . . . . . . . . . . . . 205
Lidia Yavich
TMJ Pathology Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Lidia Yavich
Transformation of Trigeminal Nerve Stimuli into Movement
Disorders: A Series of Cases
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Anthony B. Sims
Contents
Part I
Fundamentals
The Temporomandibular Joint:
Form andFunction
AnitaR.Joy-Thomas andRobertD.Spears
1 Introduction
The temporomandibular joint (TMJ) is a specialized synovial joint that is essential for the full
range of function of the mammalian jaw. It is a
complex joint made up of various tissue types,
including bone, cartilage, connective tissues, as
well as associated muscles and tendons. The TMJ
is described as a bilateral, diarthrodial, synovial
joint that is located between the mandibular condyles and the temporal bones. Each TMJ is made
up of the condylar head of the mandible, the glenoid fossa and articular eminence of the temporal
bone, an articular disc, and a synovial membranelined brous capsule that encloses the entire joint
(Fig.1). The articulating surfaces of the joint are
lined by brocartilage, rather than hyaline cartilage, in adults. The articular disc is another
unique feature of the TMJ, which by its location
divides the joint space into two chambers—superior and inferior (Fig.2). This particular anatomical feature of the TMJ allows the joint to function
as a unit in both hinge/axial/rotational (ginglymus) and gliding/translational (arthrodial) movements, thus also being described as a
ginglymoarthrodial joint [1, 2].
As with any joint in the human body, the TMJ
not only allows for a full range of motion associated with mastication, but it also reduces forces
acting on the associated bones by dissipation or
distribution of load-bearing from the associated
bones to the surrounding soft tissues. TMJ dysfunction therefore affects not only the bony components of the joint, but also the soft tissue
components. Therefore, from a functional standpoint and to better manage TMJ dysfunction, a
thorough understanding of TMJ anatomy, both of
the hard and soft tissue components, is essential.
A. R. Joy-Thomas (*) · R. D. Spears
Department of Diagnostic and Biomedical Sciences,
UTHealth Houston School of Dentistry, Houston,
TX, USA
e-mail: Anita.JoyThomas@uth.tmc.edu;
Robert.D.Spears@uth.tmc.edu
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2024
B. C. Stack Jr. et al. (eds.), Craniofacial Pain, https://doi.org/10.1007/978-3-031-57563-1_1
3
4
ab
A. R. Joy-Thomas and R. D. Spears
Fig. 1 Anatomy of the normal human temporomandibular joint. Photographs of human skulls from a young adolescent (a) and an adult (b) show the difference in size of
the bony components of the temporomandibular joint. The
circled area in both panels shows the condylar head of the
a
b
mandible located posterior to the articular tubercle of the
temporal bone. Note the difference in size of the articular
tubercle between the adolescent skull and the adult skull.
(Anatomical specimen courtesy of Dr. Anita Joy-Thomas,
UTHealth Houston School of Dentistry)
Fig. 2 Coronal section through the temporomandibular
joint showing the articular disc and the two joint compartments. Image shows a coronal section through a plastinated anatomical specimen. The outlined area in panel a is
enlarged in panel b and shows the articular disc situated in
the joint space. The position of the articular disc divides
the joint space into a superior and inferior chamber.
Coronal sections through the condylar head of the mandible, and three muscles of mastication (masseter, inferior
and superior heads of the lateral pterygoid, and supercial
and deep heads of the medial pterygoid) are also visible.
(Plastinated anatomical specimen courtesy of the
Anatomy Collection at the UTHealth Houston School of
Dentistry)
The Temporomandibular Joint: Form andFunction
5
2 Embryology
The embryonic development of the human TMJ
follows a similar process that is shared across
various mammalian species. However, TMJ
development is signicantly different compared
to other synovial joints in the body. In long
bones, synovial joint formation occurs by cartilaginous differentiation at the locations of the
joints, which then undergo cleavage or segmentation secondary to cartilage formation. This
process occurs through the development of a
noncartilaginous region known as the interzone, which serves as a critical signaling center, expressing bone morphogenetic proteins
(BMPs), Wnt-14/beta- catenin, as well as BMP
antagonists. The interplay between these signaling molecules allows for the interzone to
maintain its nonchondrogenic nature. Interzone
formation is followed by joint cavitation, which
is regulated by the nonchondrogenic interzone
cells secreting hyaluronan. The articular cartilage then continues to develop by appositional
growth in the long bone [3–5]. In contrast, during TMJ development, there are two distinct
and unconnected mesenchymal condensations
or blastemas that grow toward each other while
undergoing different ossication processes that
ultimately result in the formation of the mandibular condyle and the glenoid fossa of the
temporal bone. The condylar blastema arises
from the secondary condyle cartilage of the
mandible and forms bone through endochondral ossication. The glenoid fossa blastema
arises from the otic capsule and undergoes
intramembranous ossication [5–7]. The glenoid fossa blastema forms posterior and lateral
to the developing condylar blastema. The condylar blastema then grows rapidly toward the
glenoid fossa blastema, and during this growth,
the intervening mesenchyme between the glenoid fossa and condylar blastemas is trapped,
condenses, and differentiates into the lateral
pterygoid muscle and the articular disc. This
developmental sequence results in the superior
belly of the lateral pterygoid muscle having an
attachment on the medial aspect of the articular
disc in the adult.
Early TMJ development includes the following stages—(1) blastematic stage (7–9weeks in
utero), (2) cavitation stage (9–11weeks in utero),
and (3) maturational stage (after 11 weeks in
utero). During the blastematic stage is when mesenchymal condensation of cells occurs at the site
of the future condylar cartilage. During this stage,
intramembranous ossication of the squamous
part of the temporal bone has also begun. During
the cavitation stage, chondrocytes are clearly evident in the condylar blastema, and clefting occurs
in the area that will form the future joint chambers, with the inferior cleft (future inferior joint
chamber) forming rst. Development of the TMJ
occurs relatively later in utero (about 7–8weeks)
unlike most other synovial joints that have completed their initial cavity development by the seventh week in utero. In contrast, the TMJ has
scarcely begun its development at this time and
does not exhibit cavitation until approximately
9–11weeks in utero. By week 13in utero of the
maturational stage, the area of the glenoid fossa
acquires a clearly concave morphology. After
week 14in utero, a clear reduction in the size of
Meckel’s cartilage is also evident. It is only after
about 18–20weeks in utero that the TMJ is truly
functional (i.e., with lateral pterygoid muscle
attached to the condyle and the articular disc).
After 18–20weeks in utero, the TMJ takes over
as the primary joint between the cranium and
mandible. Later in the prenatal period, the condylar cartilage, which was originally carrot-shaped,
gradually thins as birth approaches, and this is
accompanied by the presence of vascular
ingrowths into the condylar cartilage, a feature
that is not seen in other cartilages.
2.1 Role ofMeckel’s Cartilage
In addition to these two mesenchymal condensations that contribute to TMJ development, the
Meckel’s cartilage, a primary cartilage derived
from the rst branchial arch, is critical in mandibular formation and growth. However, this cartilage has no part to play in the formation of the
mandibular condyle. The cartilage that forms the
condyles develops adjacent to the intramembra-
6
ab
A. R. Joy-Thomas and R. D. Spears
Fig. 3 Fate of Meckel’s cartilage. Diagrammatic representation of the development of the mandible and the role
of Meckel’s cartilage. Panel a shows the Meckel’s cartilage located lateral to the developing mandibular bone.
Meckel’s cartilage is continuous on its proximal end with
the cartilage that will develop into the malleus and incus,
two of the bones found in the middle ear. Panel b shows
the mandible at birth. Remnants from the proximal/poste-
nous bone of the mandible; however, it is physically separate from and its development is
chronologically later than Meckel’s cartilage.
Like other primary cartilages in the human,
Meckel’s cartilage is a rod of fetal cartilaginous
skeleton in the mandible that begins with condensation of the cells to form a precartilaginous blastema very early in development (4–5weeks of
development) and forms the fetal template or
anlagen of the developing mandible. Similar to
primary limb cartilage, Meckel’s cartilage arises
rior part of Meckel’s cartilage persist as the malleus and
incus, the intermediate/central part of Meckel’s cartilage
persists as the anterior ligament of the malleus and the
sphenomandibular ligament, while the distal/anterior part
of Meckel’s cartilage persists in the mandibular symphyseal area. (Adapted and redrawn from Fawcett (1924). The
Growth of the Jaws, Normal and Abnormal in Health and
Disease)
bones of the middle ear. During the rst
16–18weeks of prenatal life, the synovial joint
between the malleus and incus is thought to function as the (primary) jaw joint. Subsequently,
portions of Meckel’s cartilage differentiate into
various tissues [8]. After it loses its function at
18–20 weeks (as the TMJ begins to function),
Meckel’s cartilage is gradually resorbed; in the
adult, remnants of Meckel’s cartilage exist as two
ear ossicles, malleus and incus, and the sphenomandibular ligament (Fig.3).
from the mesenchyme of mesodermal origin via
interaction with epithelial mesenchyme. This cartilage is located bilaterally and is positioned lateral to the developing mandibular bone but
contributes little to mandibular bone formation
2.2 Development oftheCondylar
Cartilage andMandibular
Condyle
[8]. This blastema extends as a solid hyaline cartilaginous rod surrounded by a brocellular capsule and extends from the developing ear region
to the midline of the fused mandibular processes
that forms the tip of the future chin. Along most
of its length, Meckel’s cartilage acts as a scaffold,
lateral to which the mandible develops via intramembranous ossication. At its proximal end,
Meckel’s cartilage is continuous with the cartilage, which will form the malleus and incus
Once the mandibular ramus is formed using
Meckel’s cartilage as a scaffold, the condylar
cartilage begins to develop from the periosteum
of the mandibular ramus. A typical periosteum in
the adult has two layers—an outer brous layer
(protective in function) and an inner osteogenic
layer (responsible for differentiation of cells during intramembranous bone formation). The perichondrium of the mandibular condylar cartilage
The Temporomandibular Joint: Form andFunction
7
is continuous with the periosteum of the mandibular ramus. During development of the condylar cartilage, the outer brous layer of the
periosteum of the mandibular ramus continues to
develop superiorly as the articular layer of the
mandibular condylar cartilage (protective in
function, and is in contact with the articular disc
and the articular eminence of the temporal bone),
while the inner osteogenic layer of the periosteum of the mandibular ramus develops superiorly to form the pre-chondroblastic layer of the
developing mandibular condylar cartilage
(responsible for differentiation and source of
chondroprogenitor cells during intramembranous bone formation) (Fig. 4
). Since the pre-
chondroblastic layer originally develops from
the osteogenic layer of the periosteum, it still
retains the ability to differentiate not only into
chondroblasts but also into bone-forming cells
under the right stimulus, and they are therefore
appropriately referred to as “skeletoblast” cells.
These two most supercial layers of the condylar cartilage (articular and pre-chondroblastic
layers) constitute the perichondrial articular
envelope (Fig.5). The articular layer is primarily
made up of broblasts in a type I collagen matrix
with some elastic bers. This layer exhibits very
low cell turnover. The pre-chondroblastic layer
of the developing condylar cartilage is made up
of multipotent mesenchymal cells in a sparse
matrix containing type I collagen and proteoglycans. Immediately below the perichondrial artic-
Fig. 4 Development of condylar cartilage. Alcian blue
staining showing the layers in a developing mandibular
condylar cartilage (MCC) of a rat. The outer brous layer
of the periosteum of the developing mandibular ramus is
continuous with and develops into the outer articular layer
of the MCC (indicated by the orange arrowheads). The
osteogenic layer of the periosteum develops into the pre-
chondroblastic layer of the MCC (indicated by the green
arrowheads). The histological image also shows the developing layer of chondroblasts (indicated by the pink arrowheads). (Image adapted from Hinton, R.J. (2014), Genes
that regulate morphogenesis and growth of the temporomandibular joint: A review. Dev. Dyn., 243: 864-874.
https://doi.org/10.1002/dvdy.24130)
8
A. R. Joy-Thomas and R. D. Spears
Fig. 5 Histological layers of condylar cartilage.
Histological section with Attwood’s staining showing the
layers in a developing mandibular condylar cartilage
(MCC) of a rat mandible. The layers from superior to inferior include an outer articular layer, a pre-chondroblastic
ular envelope (articular layer and
pre-chondroblastic layer) is the chondroblastic
layer, which is made up of multiple layers of
cells. Unlike the layers of chondroblasts seen in
the growth plates of long bones or in the cranial
base (anisotropic growth), these chondroblasts
are not oriented in palisades or rows, but rather
have no obvious directional orientation (isotropic growth). The chondroblastic layer begins
with a zone of attened cells and progresses to
more rounded chondroblasts. These cells have
considerably more matrix than seen in the prechondroblastic layer. The matrix is rich in type II
collagen and aggrecan. The next layer of cells in
layer, a chondroblastic layer, a hypertrophic layer, and a
zone of mineralization or bone formation. (Image adapted
from Hinton RJ, Jing J, Feng JQ.Genetic Inuences on
Temporomandibular Joint Development and Growth.
2015. Curr. Tops. Dev. Biol., Vol. 115, p.85-109)
the developing condylar cartilage is the hypertrophic layer wherein the cells enlarge greatly
and eventually hypertrophy. The matrix contains
both type I and type II collagen, with type I collagen more prevalent closer to the cartilage- bone
interface. Type X collagen, a synthetic product
specic to hypertrophic chondrocytes, is also
present. The deeper layers show signs of mineralization as the next layer, i.e., the cartilage-bone
interface, is approached (Fig. 5). At the cartilage-bone interface, blood vessels invade the
developing tissue, bringing with them cells that
help destroy the cartilage matrix. The hypertrophic chondrocytes undergo apoptosis or meta-