title: Neurosensory assessment in patients with total reconstruction of the temporomandibular joint.
abstract: Somatosensory sensitivity and postoperative endogenous pain modulation have not been investigated in temporomandibular joint (TMJ) prosthesis patients. The objectives of this study were to assess somatosensory function at the TMJ and examine possible differences in conditioned pain modulation (CPM) between patients with total TMJ prostheses (n=7) and a reference group of healthy controls (n=20). Somatosensory abnormalities were assessed using quantitative sensory testing (QST), which encompasses thermal and mechanical testing procedures. CPM was tested by comparing pressure pain thresholds (PPT) before (baseline), during, and after the application of painful and non-painful cold stimuli. PPTs were measured at the TMJ and thenar eminence (control). The effect of CPM on PPT values was tested with analysis of variance. Three patients exhibited mixed somatosensory loss (i.e., decreased thermal and mechanical detection) with mixed hyperalgesia (i.e., increased sensitivity to thermal and mechanical pain) and two patients exhibited mixed loss with only mechanical hyperalgesia. There was a significant decrease in pressure pain sensitivity at both sites during painful cold application in healthy controls (P<0.001) but not in patients (P=0.476). In conclusion, QST measures demonstrated somatosensory abnormalities in patients with total TMJ prostheses. Noxious conditioning cold stimuli evoked CPM-like effects in healthy subjects but not in patients with TMJ reconstruction.
authors.affiliation: Section of Clinical Oral Physiology, Department of Dentistry, Aarhus University, Denmark. Electronic address: simplef.kothari@odontologi.au.dk.
authors.forename: S F
authors.initials: SF
authors.lastname: Kothari
authors.affiliation: Section of Clinical Oral Physiology, Department of Dentistry, Aarhus University, Denmark.
authors.forename: L
authors.initials: L
authors.lastname: Baad-Hansen
authors.affiliation: Section of Oral and Maxillofacial Surgery, Aarhus University Hospital, Denmark; Section of Oral Pathology and Maxillofacial Surgery, Department of Dentistry, Aarhus University, Denmark.
authors.forename: K
authors.initials: K
authors.lastname: Andersen
authors.affiliation: Section of Clinical Oral Physiology, Department of Dentistry, Aarhus University, Denmark; Center for Functionally Integrative Neuroscience (CFIN), MindLab, Aarhus University Hospital, Denmark.
authors.forename: P
authors.initials: P
authors.lastname: Svensson
mesh_terms: D000328:Adult; D019643:Arthroplasty, Replacement / Q000009:adverse effects* / Q000295:instrumentation; D016022:Case-Control Studies; D003718:Denmark; D005260:Female; D006801:Humans; D007595:Joint Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D012684:Sensory Thresholds; D020886:Somatosensory Disorders / Q000209:etiology* / Q000503:physiopathology*; D013705:Temporomandibular Joint Disorders / Q000503:physiopathology* / Q000601:surgery*; D014732:Vibration
keywords: conditioned pain modulation; quantitative sensory testing; somatosensory function; total temporomandibular joint prostheses