The role of facial trauma as a possible etiologic factor in temporomandibular joint disorder.
OBJECTIVE
Facial trauma has been suggested as a possible etiologic factor of temporomandibular joint disorder. However, there is little information on the role of macrotrauma. The main purpose of this study was to validate facial trauma as a potential etiologic factor for temporomandibular joint (TMJ) disorder. Multidirectional approaches were applied for the evaluation of the changes of TMJ after TMJ macrotrauma.


METHODS
Analysis of TMJ status including arthroscopic examination, histomorphologic examination, and synovial fluid biochemical analysis were performed on the patients with mandibular fractures. Additionally, the efficacy of arthrocentesis for the patients of mandibular fracture was evaluated from the functional point of view.


RESULTS
In arthroscopic examinations, evidence of synovitis with variable degrees was found. The representative findings are fibrillation and ecchymosis. On histomorphologic examination, bloody smear, degenerated cells and cartilage, inflammatory cells, and crystal were observed. In biochemical analysis, considerable amounts of prostaglandin E(2) and leukotriene B(4) were detected in the synovial fluid of the patients.


CONCLUSIONS
The inflammatory and degenerative changes of TMJ can develop after facial trauma. Trauma can be a possible etiologic factor in cartilage degeneration, and biochemical and intra-articular pathology. Clinicians should recognize the etiologic importance of macrotrauma, and long-term evaluation of the TMJ as well as adequate treatment is required for patients with facial trauma.
Yun
Pil-Young
PY
Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Gyeonggi-do 463-707, Korea.
Kim
Young-Kyun
YK
D015232:Dinoprostone / Q000378:metabolism; D005151:Facial Injuries / Q000150:complications* / Q000601:surgery; D006801:Humans; D007975:Leukotriene B4 / Q000378:metabolism; D008337:Mandibular Fractures / Q000150:complications* / Q000601:surgery; D019152:Paracentesis / Q000379:methods; D013582:Synovial Fluid / Q000166:cytology / Q000378:metabolism; D013585:Synovitis / Q000209:etiology* / Q000601:surgery; D013704:Temporomandibular Joint / Q000473:pathology* / Q000601:surgery; D013705:Temporomandibular Joint Disorders / Q000209:etiology* / Q000378:metabolism / Q000601:surgery
D007975:Leukotriene B4; D015232:Dinoprostone