Aberrant activation of latent transforming growth factor-β initiates the onset of temporomandibular joint osteoarthritis

There is currently no effective medical treatment for temporomandibular joint osteoarthritis(TMJ-OA) due to a limited understanding of its pathogenesis. This study was undertaken to investigate the key role of transforming growth factor-β(TGF-β)signalling in the cartilage and subchondral bone of the TMJ using a temporomandibular joint disorder(TMD) rat model, an ageing mouse model and a Camurati–Engelmann disease(CED) mouse model. In the three animal models, the subchondral bone phenotypes in the mandibular condyles were evaluated by μCT, and changes in TMJ condyles were examined by TRAP staining and immunohistochemical analysis of Osterix and p-Smad2/3. Condyle degradation was confirmed by Safranin O staining, the Mankin and OARSI scoring systems and type X collagen(Col X), p-Smad2/3 a and Osterix immunohistochemical analyses. We found apparent histological phenotypes of TMJ-OA in the TMD, ageing and CED animal models, with abnormal activation of TGF-βsignalling in the condylar cartilage and subchondral bone. Moreover, inhibition of TGF-β receptor I attenuated TMJ-OA progression in the TMD models. Therefore, aberrant activation of TGF-β signalling could be a key player in TMJ-OA development.

Chronic inflammation deteriorates structure and function of collagen fibril in rat temporomandibular joint disc

Collagen is the building component of temporomandibular joint(TMJ) discs and is often affected by inflammation in temporomandibular disorders. The macromechanical properties of collagen are deteriorated by chronic inflammation. However,the mechanism by which inflammation influences disc function remains unknown. The relationship between the ultrastructure and nanomechanical properties of collagen in inflamed discs should be clarified. Seven-week-old female Sprague–Dawley rats were randomly divided into two groups. Chronic TMJ inflammation was induced by intra-articular injection of complete Freund's adjuvant, and samples were harvested after 5 weeks. Picrosirius staining revealed multiple colours under polarized light, which represented alternative collagen bundles in inflamed discs. Using atomic force microscopy scanning, the magnitude of Young's modulus was reduced significantly accompanied with disordered collagen fibril arrangement with porous architecture of inflamed discs. Transmission electron microscopy scanning revealed a non-uniform distribution of collagen fibres, and oversized collagen fibrils were observed in inflamed discs. Fourier transform infrared microspectroscopy revealed a decrease in 1 338 cm^(-1)/amide II area ratio of collagen in different regions. The peak positions of amide I and amide II bands were altered in inflamed discs,indicating collagen unfolding. Our results suggest that sustained inflammation deteriorates collagen structures, resulting in the deterioration of the ultrastructure and nanomechanical properties of rat TMJ discs.

Clinical and Therapeutic Aspects of Temporomandibular Ankylosis at the Conakry Teaching Hospital

Introduction: Temporomandibular joint ankylosis (TMJA) is a fusion of joint surfaces by fibrous or bone tissue and the resulting limitation of mouth opening. The objectives of this study were to determine the frequency of TMJA, describe the clinical aspects and assess management. Materials and Method: It was a retrospective study that was carried out in the Department of Odontostomatology and Maxillofacial Surgery of Donka National Hospital for a period of 5 years (January 2016 to December 2020). Included were all records of inpatients and managed cases of TMJA during the study period. Socio-demographic, clinical and therapeutic variables were analyzed. Results: During the study 13 TMJA cases were collected with the frequency of 0.47%. The age group 1 - 9 was the most affected (61.54%) with extremes of 4 and 28 years. Men were the most concerned (53.87%). Restriction of mouth opening was the main reason for consultation (69.23%). The etiologies of ankylosis were dominated by infection including cellulitis of dental origin (53.85%) followed by facial trauma (30.77%). Arthroplasty was the most commonly used technique (73%), two cases of recurrence were noted (15.38%). Conclusion: TMJA affects mainly children and the etiology is dominated by cellulite of dental origin hence the interest of sensitization of the population for early management of oral diseases.

Kindlin-2 loss in condylar chondrocytes causes spontaneous osteoarthritic lesions in the temporomandibular joint in mice

The progressive destruction of condylar cartilage is a hallmark of the temporomandibular joint(TMJ) osteoarthritis(OA);however, its mechanism is incompletely understood. Here, we show that Kindlin-2, a key focal adhesion protein, is strongly detected in cells of mandibular condylar cartilage in mice. We find that genetic ablation of Kindlin-2 in aggrecan-expressing condylar chondrocytes induces multiple spontaneous osteoarthritic lesions, including progressive cartilage loss and deformation, surface fissures, and ectopic cartilage and bone formation in TMJ. Kindlin-2 loss significantly downregulates the expression of aggrecan, Col2a1 and Proteoglycan 4(Prg4), all anabolic extracellular matrix proteins, and promotes catabolic metabolism in TMJ cartilage by inducing expression of Runx2and Mmp13 in condylar chondrocytes. Kindlin-2 loss decreases TMJ chondrocyte proliferation in condylar cartilages. Furthermore,Kindlin-2 loss promotes the release of cytochrome c as well as caspase 3 activation, and accelerates chondrocyte apoptosis in vitro and TMJ. Collectively, these findings reveal a crucial role of Kindlin-2 in condylar chondrocytes to maintain TMJ homeostasis.

叶黄素对兔创伤性颞下颌关节强直的预防作用研究

目的:探讨叶黄素对兔创伤性颞下颌关节强直的作用。方法:将16只新西兰大白兔随机分为空白对照组及叶黄素干预组(实验组),所有实验动物均在保护关节囊的前提下建立创伤性颞下颌关节强直模型。术后实验组口服叶黄素10 mg·kg^(-1)·d^(-1),连续给药4周。比较2组动物的最大开口度、体重、组织学、影像学、骨代谢指标等方面的差异。采用GraphPad Prism 9.4.0软件包对数据进行统计学分析。结果:术后实验组动物体重、开口度、血清骨钙素浓度、CT测量的髁突表面积及体积显著高于对照组(P<0.05)。组织形态学观察显示,2组实验动物髁突残端可见编织骨和新生骨,纤维中有时可见软骨化生灶,偶可见肉芽组织和陈旧性出血。实验组髁突纤维层增厚,细胞增殖活跃,细胞层次更加明显。结论:叶黄素对创伤性颞下颌关节强直的发生有一定预防作用,其作用机制可能与叶黄素促进骨形成、提高血清骨钙素浓度等有关。

改良式尾侧下颌骨节段性切除术治疗猫颞下颌关节强直效果的回顾性分析

为了探讨猫颞下颌关节强直的临床发病特点、手术方法、并发症和手术效果,本文回顾性分析了在中国农业大学教学动物医院就诊的8只颞下颌关节强直患猫的病历,结合电话回访评估手术并发症和手术效果。结果显示,8只患猫均进行了电子计算机断层扫描(CT)检查,其中4只(3只单侧和1只双侧)诊断为假性强直,另外4只(2只单侧和2只双侧)诊断为真性强直;5只(3只单侧和2只双侧)进行了改良式尾侧下颌骨节段性切除术,3只(2只单侧和1只双侧)放弃治疗;进行手术的5只患猫术后口腔打开角度均良好,其中1只(单侧)因苏醒质量较差选择了安乐死。长期随访(随访时间7个月~5年,平均约25个月)结果显示,单侧强直的2只患猫手术效果良好,双侧强直的2只患猫手术效果较差,未手术的3只患猫因无法进食而安乐死。结果表明,颞下颌关节强直患猫应该进行手术治疗。改良式尾侧下颌骨节段性切除术可以替代关节成形术、关节外骨切除术和尾侧下颌骨节段性切除术,达到相似的手术效果,并可以降低关节周围医源性神经和血管损伤或牙齿损伤的风险;改良式尾侧下颌骨节段性切除术对于单侧颞下颌关节强直的患猫治疗效果较好,而对于双侧颞下颌关节强直的患猫治疗效果不理想。

IL-1、IL-6、TNF对人TMJ滑膜细胞蛋白合成的影响

目的：研究人ＴＭＪ滑膜细胞（ＳＭＣ）蛋白质合成能力，与其它组织细胞的差异，及细胞因子对这方面的影响。方法：采用体外培养的ＳＭＣ、ＴＧＣ、ＮＭＣ３种细胞及无血清培养液，应用紫外分光光度仪在２８０ｎｍ波长处，对培养上清中的蛋白含量进行测定，并与加用ＩＬ－１、ＩＬ－６、ＴＮＦ后蛋白质合成的量进行对比观察。结果：正常状态下，ＴＧＣ蛋白合成量最高，ＯＤ值达０．１４，而ＳＭＣ最低，为０．０７９。在加用细胞因子作用４８ｈ后，ＳＭＣ蛋白含量达到０．１１７，提高３０％，而ＴＧＣ、ＮＭＣ却下降１０％～３０％。结论：正常状态下ＳＭＣ合成蛋白质成份较其它细胞少，而细胞因子可刺激ＳＭＣ蛋白质合成增加，这些蛋白成份中可能具有影响关节炎症的物质。

IL-1、IL-6、TNF对TMJ滑膜细胞培养上清粘度影响的研究

目的：了解体外培养滑膜细胞培养上清粘度情况，及与其它细胞的区别，细胞因子对其功能的影响。方法：采用体外培养滑膜细胞，牙乳头细胞、粘膜纤维细胞，用椎板式粘度仪对细胞因子作用前后的培养上清进行粘度测定，将粘度测定值绘制成图。结果：正常状态，ＳＭＣ粘度值达２．８，其它细胞仅为２，细胞因子作用后，ＳＭＣ粘度明显减少，降为２以下，其它细胞无明显变化。结论：体外培养ＳＭＣ能保持体内功能特点，细胞因子所引起ＳＭＣ的培养上清粘度下降，这可能是影响关节炎病情的因素之一。

人TMJ滑膜细胞的生长特性观察

目的：研究体外培养人ＴＭＪ滑膜细胞生长特性和遗传稳定性。方法：采用ＭＴＴ法、ＨＥ染色及培养细胞染色体制备法，测定３种细胞（ＳＭＣ、ＴＧＣ、ＮＭＣ）的生长曲线、分裂指数、和贴壁率，观察不同代数的染色体数量和形态。结果：３种细胞体外生长都较为稳定，滑膜细胞生长速率略低于其它两种细胞，分裂指数最多为１５‰，贴壁率８ｈ为６０％，１２ｈ达９５％，不同代数的滑膜细胞染色体形态正常，数量均在２３对，遗传性状稳定。结论：体外培养人ＴＭＪ滑膜细胞生长稳定，在一定培养代数以内，生长较为规律，保持二倍体正常细胞特性，可以应用该细胞进行ＴＭＪ相关问题的研究。

Evaluation of Mandibular Deprogramming Using TENS (Transcutaneous Electrical Nerve Stimulation) in Patients at the Specialty Clinic of the Juarez Autonomous University of Tabasco from 2022 to 2024

Temporomandibular disorders (TMD) negatively affect quality of life, causing pain and restricted jaw movements. This study evaluates the effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) on TMD patients before orthodontic treatment at the Juarez Autonomous University of Tabasco. A quantitative, quasi-experimental study was conducted with 30 patients who met the inclusion criteria: aged 18 to 65 years, with TMJ pain symptoms, diagnosed with temporomandibular disorders using the Helkimo index, and who had provided informed consent for the study. The range of mandibular movement and the Visual Analog Scale (VAS) were measured to record values before therapy. The electrodes of the TENS therapy were positioned on both sides of the jaw in the preauricular area and the masseter muscle, the therapy was administered for 40 minutes, utilizing a frequency of 2 - 4 Hz and a pulse duration of 300 microseconds. Following this, the range of mandibular movement and the VAS were reassessed to evaluate the outcomes., significantly improved maximum mouth opening (37.7 ± 6.4 mm to 44.6 ± 5.88 mm), right laterality (3.86 ± 1.57 mm to 5.43 ± 1.21 mm), left laterality (3.13 ± 1.63 mm to 4.53 ± 1.61 mm), protrusion (4.01 ± 1.7 mm to 5.36 ± 1.32 mm), and pain perception (4.56 ± 2.045 to 2.03 ± 1.5) (P < 0.01). TENS therapy enhances mandibular movement and reduces pain, making it a well-tolerated, non-invasive complementary treatment for TMD.

正颌外科技术治疗TMJ后OSAS(英文)

目的 评估正颌外科技术矫治14例颞颌关节强直所致OSAS的效果。方法 手术采用患侧关节成形,下颌升支、体部的“L”形半层截骨及健侧矢状截骨术,将患侧下颌升支加高固定,下颌前部整体前移。结果14例颞颌关节强直伴OSAS患者术后张口度达2.5～3.5cm,术后2年随访张口度仍维持在2.5～3.2cm之间。所有患者的AHI指数下降了20以上,12例患者的打鼾症状消失,持续血氧饱和度平均提高了18.45％（P<0.01）,达到了正常人的范围,持续血氧饱和度最低值由术前的58％提高至术后的95％以上,OSAS得以治愈。结论 颞颌关节强直伴OSAS患者通过正颌外科手术可以在关节成形的同时,解决患者下颌后缩的缺陷,解除上气道狭窄,从而缓解或纠正患者的低氧血症。

应用带蒂颊脂垫治疗颞下颌关节强直的解剖学研究

目的通过测量颊脂垫及穿经血管、神经及颞下颌关节的相关解剖结构径线,从解剖学角度探讨应用带蒂颊脂垫移位治疗颞下颌关节强直(TMJA)的可行性。方法成人头颈部标本40例,随机分为A、B组,每组20例。观察A组颊脂垫的形态,测量其大小及穿经血管、神经压扁径;观测B组颞下颌关节相关解剖结构数据。结果A组颊脂垫体积:左侧(10.10±1.10)mL,右侧(9.70±1.50)mL;颊脂垫纵轴线长度:左侧(28.18±1.35)mm,右侧(29.47±1.12)mm;颊脂垫横轴线长度:左侧(18.56±1.67)mm,右侧(18.97±1.73)mm;有面动脉、面静脉、上颌动脉分支、面神经颊支等穿行于颊脂垫。B组颞下颌关节盘矢状切面呈S型15例(75.0%),L型3例(15.0%),二者间的过渡型2例(10.0%);关节盘前后径:左侧(14.42±1.94)mm,右侧(15.34±1.37)mm;关节盘内外径:左侧(20.18±1.77)mm,右侧(19.57±1.32)mm;关节内、外侧分别有上颌动脉、颞浅动脉的分支分布。结论带蒂颊脂垫解剖位置恒定,血供丰富,具有很强的组织修复、抗感染能力和“缓冲垫”作用,可减少TMJA术后瘢痕的形成,降低术后复发率,有助于术后恢复正常的关节功能。

地塞米松在创伤性颞下颌关节强直中的作用机制研究

目的 通过建立小型猪髁突囊内骨折(ICF)动物模型,探讨地塞米松在预防颞下颌关节强直中的作用。方法 对15只3个月龄健康小型猪行ICF,随机将猪分为3组:自然愈合组、生理盐水组、地塞米松组。通过定量实时聚合酶链反应(RT-PCR)和蛋白质印迹技术检测血管内皮生长因子(VEGF)、骨钙素(OCN)、骨桥蛋白(OPN)、骨形态发生蛋白(BMP2)的mRNA和蛋白表达水平。结果 与自然愈合组和生理盐水组相比,地塞米松组发生关节强直的风险较小(P<0.05)。术后6个月地塞米松组最大颌骨张开度明显高于自然愈合组和生理盐水组(P<0.05)。在大体标本观察、影像学、组织学检查中,自然愈合组比生理盐水组和地塞米松组有更多的病理变化。自然愈合组VEGF、OCN、OPN蛋白及mRNA表达明显高于生理盐水组和地塞米松组(P<0.05)。结论 VEGF、OCN、OPN和BMP2是参与外伤性颞下颌关节强直的重要蛋白。地塞米松通过抑制VEGF、OCN、OPN的表达,从而降低颞下颌关节强直的发生风险。

儿童颞下颌关节强直的治疗进展

颞下颌关节强直(TMJA)好发于儿童,不仅影响发音和咀嚼功能,还会导致儿童颌面部发育畸形。儿童TMJA的手术技术难度较大,复发率也较高。但随着现代麻醉以及手术技术的进一步发展,儿童TMJA可以进行早期治疗。儿童TMJA的治疗原则为解除强直并初步纠正颌面部畸形,手术方法主要包括关节成形术和关节重建术,手术方法的选择应考虑TMJA的类型及有无颌面部畸形。目前儿童TMJA的治疗以病例报道为主,尚缺乏统一标准,未来的研究应该规范病例报道的标准,从而提供更高等级的研究报告。

多学科协作模式在颞下颌关节强直肋骨肋软骨重建术患者护理中的应用

目的:探讨多学科协作模式(multi-disciplinary team,MDT)在颞下颌关节强直肋骨肋软骨重建术患者护理中的应用效果。方法:选择2022年1月—2023年2月在上海交通大学医学院附属第九人民医院口腔外科因颞下颌关节强直行肋骨肋软骨重建术的66例患者为研究对象,以随机数列分为对照组(31例)与实验组(35例)。对照组给予常规护理,实验组实施MDT协作模式,比较2组患者术后恢复情况、术后口腔健康状态、术后生活质量及出院患者护理满意度的差异。采用SPSS 25.0软件包对数据进行统计学分析。结果:实验组患者住院时间显著少于对照组(P<0.05),术后口腔健康状态、生活质量及出院护理满意度显著高于对照组(P<0.05)。结论:MDT协作模式优于传统常规护理模式,有利于促进颞下颌关节强直行肋骨肋软骨重建术患者的术后康复,提高患者术后生活质量和护理满意度。

创伤性颞下颌关节强直与异位骨化发病机制相似性的实验研究

目的:研究异位骨化与创伤性颞下颌关节强直发病机制是否具有相似性,为拓展后者的防治提供新思路。方法:选取确诊为肘、髋、膝关节区异位骨化和创伤性颞下颌关节强直的病例各30例,对术中截取的关节区及周边区骨质标本收集保存,分别作为实验组A(A组)和实验组B(B组);另取5个正常完整喙突作为对照组(C组)。H-E染色观察3组标本的组织学结构形态,免疫组织化学法观察标本中BMP-2、BMP-4、CD34阳性表达差异,利用影像资料比较A、B 2组的影像学特征。采用SPSS 17.0软件包对数据进行统计学分析。结果:A组和B组的组织学结构及影像学特点基本一致。免疫组织化学显示,A组和B组的BMP-2、BMP-4、CD34阳性表达均显著强于C组(P<0.05)。结论:创伤性颞下颌关节强直与异位骨化发病机制具有相似性。

1例双侧颞下颌关节强直患者伴张口受限30年的护理体会

总结双侧颞下颌关节强直患者的护理经验体会。选取2021年11月南京医科大学附属口腔医院收治的1例双侧颞下颌关节强直患者作为研究对象,该患者因双侧颞下颌关节强直收入院,既往有右侧关节骨折病史。入院后在全麻下行“导航下右侧颞下颌关节成形术+右侧颞肌筋膜瓣转移术+肌筋膜悬吊术+面神经松解解压术+颞下颌关节病骨关节刨削术+右侧颞下颌关节盘手术+深部肿物切除术+双侧下颌骨C型截骨术+颌间结扎术”,术后予以抗炎补液等治疗。本病例患者有营养不良、张口受限等健康问题,患者体质量指数值为16.77 kg/m^(2),体重偏低,可能会出现营养不良、免疫力下降等情况。在过去的30年中,患者有张口有限的情况,张口度为0 cm。患者入院后接受营养专家和康复锻炼组的特殊指导和治疗。

有限元分析在正颌手术对颞下颌关节的影响的应用研究进展

随着医学的不断发展与进步,越来越多的患者因牙颌面畸形导致的功能、外貌不佳而选择接受正颌外科手术。正颌外科手术的日益增多,研究其对颞下颌关节的影响变得愈发重要。正颌外科手术可能会通过改变了上下颌骨的位置关系直接影响颞下颌关节,从而改善或加重颞下颌关节紊乱病的症状。因此,正颌外科手术与颞下颌关节之间存在密切的关联。颞下颌关节紊乱病(TMD)是一组以颞下颌关节及其周围组织出现疼痛、弹响和功能障碍为特征的疾病。目前,由于研究方法的限制,许多学者借助有限元分析来研究正颌外科手术对颞下颌关节的影响。这种分析有助于医生在手术前选择合适的治疗方案、预测手术效果,并为颞下颌关节紊乱病的治疗提供参考。本文旨在综述三维有限元法在研究正颌外科手术对颞下颌关节影响方面的应用,并探讨其在临床实践中的潜在价值。

筋针疗法对颞下颌关节紊乱患者软组织张力、颞下颌运动情况的影响

目的:观察筋针疗法对颞下颌关节紊乱患者软组织张力、颞下颌运动情况的影响。方法:选取2021年6月至2022年6月期间本院医治颞下颌关节紊乱患者66例作为此次研究对象,根据随机数字表法分为常规组和试验组,每组各33例。常规组给予普通针刺联合热敷治疗,试验组给予筋针联合热敷治疗。观察两组患者治疗前后软组织张力、颞下颌运动情况、颞下颌关节紊乱指数、炎性细胞因子水平、OHIP-14量表评分及临床疗效。结果:常规组有效率为69.70%,试验组有效率为90.91%,试验组有效率高于常规组,差异有统计学意义(P<0.05);两组治疗后软组织张力、颞下颌运动情况优于治疗前,且试验组优于常规组,差异有统计学意义(P<0.05);两组治疗后颞下颌关节紊乱指数低于治疗前,且试验组低于常规组,差异有统计学意义(P<0.05);两组治疗后炎性细胞因子水平低于治疗前,且试验组低于常规组,差异有统计学意义(P<0.05);两组治疗后OHIP-14量表评分低于治疗前,且试验组低于常规组,差异有统计学意义(P<0.05)。结论:筋针热敷治疗颞下颌关节紊乱能改善患者软组织张力、颞下颌运动情况,降低炎性细胞因子水平。

USE OF A BLIND INTUBATION DEVICE FOR NASOTRA-CHEAL INTUBATION IN TEMPOROMANDIBULAR JOINT ANKYLOSIS

Objective To evaluate light-guided tracheal intubation using blind intubation device (BID) in adult patients with temporomandibular joint ankylosis. Methods Twenty adult patients, American Society of Anesthesiologists (ASA) physical status Ⅰ or Ⅱ, with temporomandibular joint ankylosis were selected for awake blind nasal intubation. The patients were prepared with nasal decongestants and inhaled 100% oxygen for 3min, then fentanyl (2μg/kg) and midazolam (1-5 mg) were intravenously injected for sedation. Topical anaesthesia for the glottis was performed by using cricothyroid injection of local anaesthesia. A blind intubation device was used to help blind nasal intubation. Three attempts of blind nasal intubation were permitted, otherwise, fiberoptic bronchoscope (FOB) intubation was utilized considering the failure of blind intubation. During the procedure, heart rate, mean arterial pressure, and pulse oxygen saturation (SpO2) were measured. Results Nineteen patients successfully underwent blind nasal intubation by BID. The success ratio for first attempt was only 65.0%, while it reached 95.0% for three attempts. Light-guided catheter failed to be inserted for three attempts in only one patient. However, FOB was successfully used for the first attempt by the same anaesthetist. Conclusion Light-guided tracheal intubation by using blind intubation device is a safe and effective method for blind nasal intubation in the patients with temporomandibular joint ankylosis.