An in situ hybridization study of the insulin-like growth factor system in developing condylar cartilage of the fetal mouse mandible

The objective of this study was to investigate the involvement of the insulin-like growth factor (IGF) system in the developing mandibular condylar cartilage and temporomandibular joint (TMJ). Fetal mice at embryonic day (E) 13.0-18.5 were used for in situ hybridization studies using [35S]-labeled RNA probes for IGF-I, IGF-II, IGF-I receptor (-IR), and IGF binding proteins (-BPs). At E13.0, IGF-I and IGF-II mRNA were expressed in the mesenchyme around the mandibular bone, but IGF-IR mRNA was not expressed within the bone. At E14.0, IGF-I and IGF-II mRNA were expressed in the outer layer of the condylar anlage, and IGF-IR mRNA was first detected within the condylar anlage, suggesting that the presence of IGF-IR mRNA in an IGF-rich environment triggers the initial formation of the condylar cartilage. IGFBP-4 mRNA was expressed in the anlagen of the articular disc and lower joint cavity from E15.0 to 18.5. When the upper joint cavity was formed at E18.5, IGFBP-4 mRNA expression was reduced in the fibrous mesenchymal tissue facing the upper joint cavity. Enhanced IGFBP-2 mRNA expression was first recognized in the anlagen of both the articular disc and lower joint cavity at E16.0 and continued expression in these tissues as well as in the fibrous mesenchymal tissue facing the upper joint cavity was observed at E18.5. IGFBP-5 mRNA was continuously expressed in the outer layer of the perichondrium/fibrous cell layer in the developing mandibular condyle. These findings suggest that the IGF system is involved in the formation of the condylar cartilage as well as in the TMJ.     

Response of the mandibular joint to loss of incisal function in the rat

In a study of the rat mandibular joint (MJ), Simon [Acta anat. 97: 351-360 (1977)] suggested that reduction in condylar cartilage thickness noted in animals subjected to removal or trimming of incisors resulted from the lessening of joint reaction forces produced during incision. In order to explore this question further, the microanatomy of the MJ in 47-day-old rats whose incisors had been trimmed every other day was compared to that in control animals and in a third group fed a soft diet as a control for reduced joint reaction forces. Both the incisor-clipped and soft-diet groups exhibited reduced size and density of bony trabeculae underlying the condylar cartilage and diminished staining for alcian blue. The thickness of the prechondroblastic layer of the condylar cartilage was significantly (p less than or equal to 0.01) reduced relative to controls in both experimental groups on the superior aspect of the cartilage, but was reduced in the more posterior parts of the cartilage only in the incisor-clipped group. While not denying that joint reaction forces may affect MJ response, the reduced proliferative response noted in the posterior region of the condylar cartilage in incisor-clipped animals is perhaps best explained by a decrease in the frequency and extent of protrusion of the lower jaw due to a lack of incisal preparation of food items.     

Tensile properties of the mandibular condylar cartilage

Mandibular condylar cartilage plays a crucial role in temporomandibular joint (TMJ) function, which includes facilitating articulation with the temporomandibular joint disc and reducing loads on the underlying bone. The cartilage experiences considerable tensile forces due to direct compression and shear. However, only scarce information is available about its tensile properties. The present study aims to quantify the biomechanical characteristics of the mandibular condylar cartilage to aid future three-dimensional finite element modeling and tissue engineering studies. Porcine condylar cartilage was tested under uniaxial tension in two directions, anteroposterior and mediolateral, with three regions per direction. Stress relaxation behavior was modeled using the Kelvin model and a second-order generalized Kelvin model, and collagen fiber orientation was determined by polarized light microscopy. The stress relaxation behavior of the tissue was biexponential in nature. The tissue exhibited greater stiffness in the anteroposterior direction than in the mediolateral direction as reflected by higher Young's (2.4 times), instantaneous (1.9 times), and relaxed (1.9 times) moduli. No significant differences were observed among the regional properties in either direction. The predominantly anteroposterior macroscopic fiber orientation in the fibrous zone of condylar cartilage correlated well with the biomechanical findings. The condylar cartilage appears to be less stiff and less anisotropic under tension than the anatomically and functionally related TMJ disc. The anisotropy of the condylar cartilage, as evidenced by tensile behavior and collagen fiber orientation, suggests that the shear environment of the TMJ exposes the condylar cartilage to predominantly but not exclusively anteroposterior loading.     

Spatio-temporal expression patterns of Wnt signaling pathway during the development of temporomandibular condylar cartilage

There is a growing body of evidence supporting the involvement of the Wnt signaling pathway in various aspects of skeletal and joint development; however, it is unclear whether it is involved in the process of temporomandibular joint development. In order to clarify this issue, we examined the spatio-temporal distribution of mRNAs and proteins of the Wnt family during the formation of the mandibular condylar cartilage at the prenatal and postnatal stages. An in situ hybridization test revealed no mRNAs of β-catenin and Axin2 during early mesenchymal condensation; the ligands surveyed in this study (including Wnt-4, 5a, and 9a) were clearly detected at various ranges of expression, mainly in the condylar blastema and later distinct cartilaginous layers. Apart from β-catenin and Axin2, the Wnt family members surveyed in this study, including Lef-1, were found to be immunopositive during early chondrogenesis in the condylar cartilage at E14.5. After distinct chondrocyte layers were identified within the cartilage at E16.5, the expression of the Wnt signaling members was different and mainly restricted to proliferating cells and mineralized hypertrophic chondrocytes. In the adult mandibular condylar cartilage, the Wnt-4 mRNA, as well as the Wnt-4 and Wnt-9a proteins, was not observed. Our findings demonstrated that the Wnt signaling pathway was associated with the development of mandibular condylar cartilage.     

髁突-翼外肌解剖复位与游离复位治疗髁状突骨折的疗效比较

目的:比较髁突-翼外肌解剖复位与游离复位治疗髁状突骨折的疗效,促进髁突形态恢复。方法:收治的80例单侧髁状突骨折患者随机分为两组,每组40例,A组行髁突-翼外肌解剖复位术,B组行髁状突游离复位术,术后3个月、6个月观察髁突形态及下颌骨运动功能变化。结果:A组治愈率为90%,高于B组的70.00%(P0.05);术后3个月A组髁状突吸收、张口受限、开口偏斜、咬合关系紊乱、关节弹响发生率分别为12.50%、15.00%、15.00%、7.50%、12.50%,均低于B组的32.50%、35.00%、37.50%、25.00%、35.00%(P0.05);术后6个月A组张口受限、关节弹响发生率为5.00%、2.50%,均低于B组的20.00%、20.00%(P0.05);两组术后并发症发生率比较差异无统计学意义(P0.05)。结论:髁突-翼外肌解剖复位术保留髁状突骨折患者骨折断端血运,髁突形态及下颌骨运动能力恢复良好,疗效优于髁状突游离复位术。     

口腔内入路行髁突高位骨折复位固定的临床效果

目的：探讨采用口腔内入路手术复位固定方法治疗下颌骨髁突颈骨折患者的临床效果。方法：将我院收治的20例下颌骨髁突颈骨折患者均使用口腔内入路手术复位固定方法治疗,将患者的骨折片与升支后缘骨块进行手术复位固定,并于原手术切口行回植,重建患者的下颌关节。结果：治疗后咬合关系异常者1例,开口范围限制者0例,关节疼痛者1例,均少于治疗前均为20例;治疗后关节间隙缩小者1例,髁突骨折块形状异常者1例,均少于治疗前均为20例。治疗后髁突稳定者19例,多于治疗前的1例。结论：髁突骨折治疗手术各有优缺点,采用口腔内入路手术复位固定方法治疗髁突高位骨折患者,虽然手术操作难度大,但能较好地克服了术后患者外部皮肤瘢痕明显的问题,有利于保护患者面部神经,提高患者治疗质量水平,值得临床上推广与进一步研究。     

Size and shape of the mandibular condyle in primates

The relationships between the size of the articular surface of the mandibular condyle and masticatory muscle size, tooth size, diet, and biomechanical variables associated with mastication were studied by taking 12 measurements on skulls of 253 adult female anthropoid primates, including three to ten specimens from each of 32 species. In regressions of condylar length, width, or area against body weight, logarithmic transformations substantially improve the fit of the equations compared with untransformed data. There is a strong relationship between condylar measurements and body weight, with all correlations being .94 or higher. The slopes of the allometric regressions of length, width, and area of the condylar head indicate slight positive allometry with body size. Folivorous primates have smaller condyles than frugivorous primates, and colobines have smaller condyles than cebids, cercopithecines, or hominoids. When colobines are eliminated, the differences between frugivores and folivores are not significant. However, the two species with the relatively largest condyles are Pongo pygmaeus and Cercocebus torquatus, suggesting that there may be a relationship between unusually large condylar dimensions and the ability to crack hard nuts between the teeth. Cranial features having strong positive correlations with condylar dimensions include facial prognathism, maxillary incisor size, maxillary postcanine area, mandibular ramus breadth, and temporal fossa area. These data are interpreted as indicating that relatively large condyles are associated with relatively large masticatory muscles, relatively inefficient mandibular biomechanics, and a large dentition. These relationships support the growing evidence that the temporomandibular joint is a stress-bearing joint in normal function.     

Correlation between MRI evidence of degenerative condylar surface changes, induction of articular disc displacement and pathological joint sounds in the temporomandibular joint

Objectives: The relationship of bony changes in the condylar surfaces in articular disc displacement without reduction in temporomandibular joint (TMJ) was investigated using diagnostic imaging. The study also evaluated whether the bony changes in the condylar surfaces limit disc and condyle motion, and produce pathological joint sounds. Materials and methods: Thirty‐seven joints in 28 patients diagnosed with degenerative bony changes in the condylar surfaces radiographically and anterior disc displacement without reduction using magnetic resonance imaging (MRI) were studied. The bony changes were assessed by radiographic examination and classified into two types: pathological bone changes (PBCs) including erosion, osteophyte formation and deformity, and adaptive bone changes (ABCs) including flattening and concavity. MRI was performed on the TMJ to examine the configuration and position of the discs. Joint sounds in the TMJ were determined using electrovibratograghy with a joint vibration analysis. Results: The articular disc motion to the condyle in the PBC group was smaller than in the ABC group irrespective of the configuration of the disc, even though there were no significant differences between the two types of bony changes in the disc position during jaw closing. The joint vibration analysis of the TMJ showed that joint sounds with a higher frequency were observed in the PBC group than in the ABC group. High energy levels needed to produce the higher frequencies (over 300 Hz) were observed only in the PBC group.     

The contribution of the cruciate ligaments to the load-displacement characteristics of the human knee joint

Human knee specimens were subjected to anterior-posterior, medial-lateral, varus-valgus, and torsional displacement tests. Loads were recorded for the intact joint and for the joint with all soft tissues cut except for the cruciate ligaments. The effect of condylar interference was determined for anterior-posterior, medial-lateral, and torsional displacements. The variation in load with flexion angle was considerable for medial-lateral (0-90-deg flexion) displacements, and less for varus-valgus (0-45-deg flexion) displacements. The cruciates were found to carry almost the entire anterior-posterior load; they carried a significant percentage of the medial-lateral load which varied considerably with flexion angle. A small, but not insignificant percentage of the varus-valgus load was carried by the cruciates and the variations with flexion angle were small. In torsion, the cruciates resisted only internal rotation. In the tested displacement ranges, condylar interference had a small effect on the medial-lateral load but did not affect anterior-posterior or torsional loads.     

Age-related osteo-arthrotic degeneration of the temporomandibular joint in the mouse

The light-microscopic and ultrastructural characteristics of the temporomandibular joints (TMJs) of female STR/IN mice, aged from 3 to 12 months, were studied. Every TMJ of an adult mouse starts to degenerate in early adulthood and subsequently suffers from osteo-arthrosis. Ageing of the TMJ is characterized by thinning out of its cartilaginous components. The chondrocytes are no longer distributed regularly in the ground substance but form clusters. Cracks and fissures invade the condylar cartilage and lead to the formation of cartilage islands, which finally become loose as free bodies in the lower joint chamber and joint capsule. The lower joint chamber diminishes, but no ankylosis is observed. Ultrastructurally, the number of vesicles around the degenerated chondrocytes increases. Aged chondrocytes contain more lysosomes. The condylar surface becomes irregular and reveals microscars. Its surface is covered by an electron-dense fine granular material, considered to be built up by proteoglycans. Compared to the male ICR mouse, the osteo-arthrotic destruction of the cartilage, the subchondral sclerosis and the deformation of the underlying bone exhibit only minor states in the female STR/IN mouse. Concerning the aetiology and pathogenesis, the very early degeneration of the mostly unloaded TMJ seems to be based on a genetically altered composition of the articular cartilage, possibly due to failing articular chondrocyte responses to stimuli connected with degeneration and repair.     

Biomechanical properties of the mandibular condylar cartilage and their relevance to the TMJ disc

Mandibular condylar cartilage plays a crucial role in temporomandibular joint (TMJ) function, which includes facilitating articulation with the TMJ disc, reducing loads on the underlying bone, and contributing to bone remodeling. To improve our understanding of the TMJ function in normal and pathological situations, accurate and validated three-dimensional (3-D) finite element models (FEMs) of the human TMJ may serve as valuable diagnostic tools as well as predictors of thresholds for tissue damage resulting from parafunctional activities and trauma. In this context, development of reliable biomechanical standards for condylar cartilage is crucial. Moreover, biomechanical characteristics of the native tissue are important design parameters for creating functional tissue-engineered replacements. Towards these goals, biomechanical characteristics of the condylar cartilage have been reviewed here, highlighting the structure–function correlations. Structurally, condylar cartilage, like the TMJ disc, exhibits zonal and topographical heterogeneity. Early structural investigations of the condylar cartilage have suggested that the tissue possesses a somewhat transversely isotropic orientation of collagen fibers in the fibrous zone. However, recent tensile and shear evaluations have reported a higher stiffness of the tissue in the anteroposterior direction than in the mediolateral direction, corresponding to an anisotropic fiber orientation comparable to the TMJ disc. In a few investigations, condylar cartilage under compression was found to be stiffer anteriorly than posteriorly. As with the TMJ disc, further compressive characterization is warranted. To draw inferences for human tissue using animal models, establishing stiffness–thickness correlations and regional evaluation of proteoglycan/glycosaminoglycan content may be essential. Efforts directed from the biomechanics community for the characterization of TMJ tissues will facilitate the development of reliable and accurate 3-D FEMs of the human TMJ.     

Variations of femoral condyle shape

The aim of this study is to mathematically approximate the shape of the femoral articulating line and compare radiuses of condylar curves within and between males and females. Ten male and ten female participants were included in the study. Radiuses of medial and lateral condylar curves were calculated from the side view knee X-ray by original mathematical equation. Average radiuses of condylar curves were between 4.5 and 1.7 cm medially, and between 3.2 and 1.8 cm laterally, for 0 degrees and 90 degrees flexion contact point respectively. Males had longer curve radiuses of both condyles (p < 0.05). Differences turned out to be statistically insignificant after adjusting to body height. Even small changes in the joint geometry during lifetime could make a joint susceptible to osteoarthritis or injuries. Approximation of the radiuses of femoral condyle curves is a useful method in anthropometric, radiological and virtual calculations of the knee geometry, and other ellipsoidal structures in human body, like wrist, scull segments, dental arches, etc.     

Effect of altered masticatory function on [3H]-thymidine and [35S]-sulfate incorporation in the condylar cartilage of the rat

The response of the condylar cartilage to alterations in compressive joint reaction forces in vivo has been little studied. In an attempt to reduce or eliminate the occlusal forces resulting from mastication or incision, male weanling rats were fed a soft diet requiring little chewing and/or had their incisors clipped every other day. Incorporation (dpm/micrograms DNA) of [3H]-thymidine and [35S]-sulfate was significantly decreased relative to controls in the incisor-clipped group, but not in the soft-diet group. Animals having both treatments also exhibited significantly lower incorporation values than controls, suggesting the importance of incision for loading at the mandibular joint. These data corroborate in vitro studies which suggest that compressive forces can affect mitotic activity and synthesis of proteoglycans in the condylar cartilage. However, additional factors, both hormonal and biomechanical in nature, may be important in the in vivo environment.     

Trps1 is necessary for normal temporomandibular joint development

Mutation of the human TRPS1 gene leads to trichorhinophalangeal syndrome (TRPS), which is characterized by an abnormal development of various organs including the craniofacial skeleton. Trps1 has recently been shown to be expressed in the jaw joints of zebrafish; however, whether Trps1 is expressed in the mammalian temporomandibular joint (TMJ), or whether it is necessary for TMJ development is unknown. We have analyzed (1) the expression pattern of Trps1 during TMJ development in mice and (2) TMJ development in Trps1 knockout animals. Trps1 is expressed in the maxillo-mandibular junction at embryonic day (E) 11.5. At E15.5, expression is restricted to the developing condylar cartilage and to the surrounding joint disc progenitor cells. In Trps1 knockout mice, the glenoid fossa of the temporal bone forms relatively normally but the condylar process is extremely small and the joint disc and cavities do not develop. The initiation of condyle formation is slightly delayed in the mutants at E14.5; however, at E18.5, the flattened chondrocyte layer is narrowed and most of the condylar chondrocytes exhibit precocious chondrocyte maturation. Expression of Runx2 and its target genes is expanded toward the condylar apex in the mutants. These observations underscore the indispensable role played by Trps1 in normal TMJ development in supporting the differentiation of disc and synoviocyte progenitor cells and in coordinating condylar chondrocyte differentiation.     

Immunohistochemical study of the upper surface layer in rat mandibular condylar cartilage

Both hyaluronic acid and fibronectin localizations were examined in the upper surface layer of rat mandibular condylar cartilages by immunohistochemical techniques. Their delicate structure was successfully preserved by preparation procedures of joint condyles with disks. Paraformaldehyde-fixed cartilaginous tissues were cut in a cryostat, and cryosections were analyzed using streptavidin-peroxidase and indirect immunofluorescence methods. Another immunogold method with conventional preparation procedures and a quick-freezing method was performed for their ultrastructural analyses. Both hyaluronic acid-binding protein and anti-fibronectin antibody were used to localize hyaluronic acid and fibronectin in the mandibular condylar cartilage, respectively. Some cryosections were pre-treated with hyaluronidase and chondroitinase before such labeling. The upper surface layer was composed of double laminar structures. One bordered with the cartilage matriceal surface, which was positive for fibronectin. The hyaluronic acid was localized over the fibronectin layer. Therefore, the hyaluronic acid in vivo was bound with fibronectin in the cartilaginous matrix, performing lubrication for the mandibular joint movement.     

New aspects of the histology of the mandibular condyle in the rat

The function of the multipotential mesenchymal cells in the mandibular condyle was studied histochemically and histologically in 27 Long Evans/Turku rats. Sagittal sections from the temporomandibular joint were stained with haematoxylin and eosin, toluidine blue, or van Gieson's stain. A weakly orthochromatically stained fibrous layer was followed in the upper region by a weakly metachromatically stained mesenchymal cell layer. Deep within this was a strongly metachromatically stained layer of immature chondroblasts. The metachromasia of the matrix of these layers disappeared abruptly in an anterior direction and gradually in a posterior direction. The changes in the staining reactions are explained by the fact that mesenchymal cells can differentiate into chondrogenic or osteogenic cells depending on the environmental conditions. A new hypothesis is presented according to which regulation of the direction of condylar growth is achieved by choosing the cells for chondrogenesis more posteriorly or anteriorly from among the mesenchymal cells covering the whole condylar cartilage.     

Assessment of Condyle and Glenoid Fossa Morphology Using CBCT in South-East Asians

Introduction

Proper imaging allows practitioners to evaluate an asymptomatic tempormandibular joint (TMJ) for potential degenerative changes prior to surgical and orthodontic treatment. The recently developed cone-beam computed tomography (CBCT) allows measurement of TMJ bony structures with high accuracy. A study was undertaken to determine the morphology, and its variations, of the mandibular condyle and glenoid fossa among Malay and Chinese Malaysians.

Methods

CBCT was used to assess 200 joints in 100 subjects (mean age, 30.5 years). i-CAT CBCT software and The Mimics 16.0 software were employed to measure the volume, metrical size, position of each condyle sample and the thickness of the roof of the glenoid fossa (RGF).

Results

No significant gender differences were noted in thickness of the RGF and condylar length; however condylar volume, width, height and the joint spaces were significantly greater among males. With regards to comparison of both TMJs, the means of condylar volume, width and length of the right TMJ were significantly higher, while the means of the left condylar height and thickness of RGF were higher. When comparing the condylar measurements and the thickness of RGF between the two ethnic groups, we found no significant difference for all measurements with exception of condylar height, which is higher among Chinese.

Conclusion

The similarity in measurements for Malays and Chinese may be due to their common origin. This information can be clinically useful in establishing the diagnostic criteria for condylar volume, metrical size, and position in the Malaysian East Asians population.     

Cephalometric Analysis of the Facial Skeletal Morphology of Female Patients Exhibiting Skeletal Class II Deformity with and without Temporomandibular Joint Osteoarthrosis

Purpose

This study evaluated the differences in the facial morphological characteristics of female patients exhibiting skeletal class II deformity with and without temporomandibular joint osteoarthrosis.

Methods

Eighty-three female patients with skeletal class II deformity were included in this study; these patients were classified into three groups on the basis of the condylar features shown in cone-beam computed tomography scans: normal group, indeterminate for osteoarthrosis group, and osteoarthrosis group. The cephalometric differences among the three groups were evaluated through one-way ANOVA.

Results

Of the 83 patients, 52.4% were diagnosed with osteoarthrosis, as indicated by the changes in the condylar osseous component. The cephalometric measurements that represented skeletal characteristics, including mandibular position relative to the cranial base, mandibular plane angle (MP-SN), posterior facial height (S-Go), and facial height ratio, were significantly different among the three groups (p < 0.05). The patients in the osteoarthrosis group yielded the smallest S-Go, the highest MP-SN, and the most retruded mandible.

Conclusions

Temporomandibular joint osteoarthrosis is commonly observed in female patients with skeletal class II deformity. The morphological characteristics of the facial skeleton in patients with bilateral condylar osteoarthrosis may be altered.     

The load-bearing area in the knee joint

Measurements were made of the location and size of the contact areas in cadaver knee joints, for a load of 150 Kgf applied for 5 sec down the long axis of the tibia. Results were obtained from a total of 4 knees, considering flexion angles from 0 to 120°. The methods used were to measure directly from castings of the joint cavity; and to calculate from measurements of radii of curvature and joint deflection. Average contact areas for lateral and medial condyles were 1·4 and 1·8 cm² respectively. Areas for the medial condyle were greater than for the lateral condyle and also the areas diminished as flexion angle increased. The implications of the results to contact stresses, joint lubrication and ‘condylar replacement’ knee prosthesis design were discussed.