Adhesions in the Temporomandibular Joint: Formation and Significance

Abstract

Background: Adhesions are frequently seen in the deranged temporomandibular joint (TMJ). In the early stage of the degenerative process the adhesion does not seem to be a significant factor in reduced mandibular movement. This is reversed in advanced degenerative joint disease where the adhesion requires release to achieve a satisfactory clinical result. Correlation of clinical history and findings within the joint should increase understanding of limited jaw movement. Methods: Arthroscopic examination of deranged TMJs was performed on 75 patients with limited jaw opening and correlated with the history of the derangement. Results: A progressive maturation of adhesion formation was observed with longer standing symptoms. A different adhesion pattern was noted with derangement caused by direct trauma on the joint. Conclusions: Internal derangement of the TMJ is associated with formation of intra-articular adhesions. These are unlikely to be associated with reduced condyle movement in the early phase of the derangement. Later stage adhesions are more substantial and require release to achieve a satisfactory clinical outcome.

Zygapophyseal Joint Adhesions After Induced Hypomobility

“…He was convinced that the ADH were the result of a "deposition of fibrinoid material" secondary to "degeneration of type-A cells of the synovial membrane." 14 Although the TMJs are modified fibrous joints and the Z joints are planar synovial joints, the same mechanism is reasonable for the Z joints, because the Z joints have an ample synovium found not only along the inner joint capsule but also surrounding the Z joint synovial folds. 20,21 Further research is required to verify the source of Z joint intra-articular ADH.…”

“…Hase 14 addressed the issue of the source of intra-articular ADH in his study of the TMJ. He was convinced that the ADH were the result of a "deposition of fibrinoid material" secondary to "degeneration of type-A cells of the synovial membrane."…”

“…3 However, a description of ADH development within the Z joints (Fig 1, Step 2) has not been reported in the peer-reviewed literature, even though ADH have been demonstrated in hypomobile knee, 11,12 shoulder, 13 and temporomandibular joints (TMJ). 14 In fact, Hase 14 concluded that "A progressive maturation of ADH [thicker, more abundant] was observed which was directly related to the length of time of clinical symptoms of internal (TMJ) derangement." The TMJ is a modified fibrous joint that differs somewhat from the purely synovial, planar Z joints, and TMJ derangement is different than pure hypomobility (although hypomobility is frequently associated with TMJ derangement); however, Hase's findings and the findings of the other groups suggest that ADH develop in a time dependent manner in hypomobile joints.…”

Influence of arthroscopically observed fibrous adhesions before and after joint irrigation on clinical outcome in patients with chronic closed lock of the temporomandibular joint

“…FA of the TMJ is more frequently observed in patients with longer duration of chronic closed-lock 4,10 , usually in conjunction with the development of osteoarthitis and associated repeated synovitis episodes 4,10,15 . In this study, newly developed FA or progression of preexisting FA was observed in 25% of the joints at the second VGIR.…”

Adhesión discal de la articulación temporomandibular: revisión de la literatura

“…La cirugía artroscópica es una técnica mínimamente invasiva donde es posible observar los tejidos directamente y producir la lisis de las fibras adhesivas presentes (17,18). Para poder llevarse a cabo es necesario contar con un artroscopio, una cánula de irrigación y cánulas accesorias para guiar los instrumentos quirúrgicos necesarios (5, 16,17,19).…”