Journal of Craniomandibular Function, 02/2016

The temporomandibular joints are the most moved joints in the human body and the third most frequent location of orofacial pain. Good anatomical knowledge about these structures is therefore essential. Phylogenetically, this squamosal- dentary joint is the most important characteristic of the mammalian skeleton. The articulating surfaces are formed by the mandibular condyle and the dorsal and crestal parts of the articular eminence. Avascular articular cartilage covered with a connective tissue layer covers the bone. The articular disc, which is suspended like a hammock from the base of the skull, shows a wide variety of shapes that can differ from the typical biconcave-biconvex textbook illustrations. The disc is a mobile and shape-changing socket for the condyloid process. It serves as a shock absorber and distributor of forces under compressive, tensile, and shearing loads. The articular disc and the loose articular capsule form a functional unit: the discocapsular system. The double-layered synovial membrane that covers the articular capsule towards the articular cavity produces, secretes, and absorbs the synovial fluid. It is responsible for supplying nutrients and for the metabolism of the articular cartilage and the disc. Keywords: articular disc, phylogeny, synovial membrane, temporomandibular joints (TMJs), TMJ capsule

In children with juvenile idiopathic arthritis (JIA) - also known as juvenile chronic arthritis (JCA), and juvenile rheumatoid arthritis (JRA) - temporomandibular joint (TMJ) involvement may lead to disturbances in mandibular function. The authors present two cases: The first is a 12-year-old male patient with JIA, including mandibular retrognathia, limitation of movements, and ankylosis, which was corrected with a combined orthodontic-surgical treatment. The second is an 81-year-old female patient with JRA, including myofascial pain, limitation of movements, and ankylosis, which was corrected surgically. The occurrence of JIA, the impact of dentofacial disturbances in JIA, and the literature are discussed in this article. Keywords: ankylosis, case report, juvenile idiopathic arthritis, orthognathic surgery, temporomandibular joint

The specialist clinical practice that treats craniomandibular dysfunctions (CMDs) is often the first port of call for patients with oral and maxillofacial pain of various origins. Odontalgia and temporomandibular joint (TMJ) and/or muscular pain are the most frequent causes of orofacial pain. Atypical forms of odontalgia, which can occur as a result of conservative or endodontic treatment or periradicular surgery and tooth extractions, hold a special position among the different types of odontalgia. According to the current state of knowledge, atypical odontalgia is classed as neuropathic pain with peripheral and central sensitization of the trigeminal system. The case described here involved atypical odontalgia in combination with myogenic CMD and previously inadequately treated residual dentition, and called for a multi-axis treatment concept. With the aid of targeted differential diagnostics, it was possible to contribute to the desired pain relief and improve the patient's functional situation using a combination of medication, occlusal splint therapy, and prosthetic treatment. In this article, the diagnostics and treatment models are presented and discussed with reference to the current literature. Keywords: CMD, chronic pain, neuropathic pain, palmitoylethanolamide (PEA)