الفهرس يوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
Internal derangement (ID) of temporomandibular joint (TMJ) have always presented a therapeutic challenge to the oral and maxillofacial surgeon. It was recognized as a potential clinical problem over 100 years ago. It was defined as a localized mechanical fault that interferes with the smooth action of the joint. Symptomatic ID of the TMJ is found to be in about 20% of the population. (1,2) Nevertheless, there is lack of complete understanding of the process that contributes to the dysfunction of TMJ leading to the greatest debate in the field of oral and maxillofacial surgery. Therefore, investigations of the biochemical aspect of the synovial fluid was the topic of the vast majority of recent researches dealing with ID of TMJ, and this provided a new insight into its pathogenesis.(3-5)
Synovial fluid (SF) of TMJ have been increasingly analyzed for the presence of various pain and inflammatory mediators which are produced or released in the synovial fluid at the site of tissue injury such as bradykinin, prostaglandin E2, interleukin, and tumor necrosis factor (TNF). (6, 7,8) It was found that there is positive correlation between preoperative pain and TNF-α values suggesting a biochemical basis for the origin of pain associated with TMJ. Therefore, it has been suggested that TNF-alpha could be used as a marker of pain and to follow response to therapy. (6, 8-13) TNF-α is a cytokine secreted by monocyte and macrophage. It has been shown not only to be an inflammatory mediator but also a modulator of bone resorption by inducing the secretion of collagenases by fibroblasts. (9,132)
Treatment of ID of TMJ is still empirical. So a wide variety of treatment modalities have been used with varying degrees of success. Painful joints were treated by medication, manipulation of the mandible with or without splint therapy.(14)
Those who did not respond to conservative treatment were generally treated with surgical intervention. The mainstay of these surgical options was based on changing the morphology and/or position of the disc, removal of the disc with or without replacement. (15-19) These procedures although fairly successful were associated with surgical risks and potential long term sequelae.