Larry M. Wolford D.M.D.

Wolford, L. M. (2017). “Understanding tmj reactive arthritis.” Cranio 35(5): 274-275.

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There are many different joint pathologies that can affect the TMJ patient. One of the most common of these conditions, but least understood, is reactive arthritis (ReA). ReA, or seronegative spondyloarthropathy, is an inflammatory disease in joints usually caused by venereal and respiratory bacteria. ReA commonly develops in the mid teens through the 4th decade, predominately in females, and can cause TMJ pain, arthritis, and condylar resorption. Systemic symptoms of ReA may include joint pain, fever, fatigue, back pain, degenerative joint disease, polyarthritis, and dysfunction of the immune system. The most common bacteria that cause ReA are from 2 genera: Chlamydia and Mycoplasma. The specific species include C. trachomatis, C. pneumoniae, C. psittaci, M. genitalium, M. pneumoniae, and M. fermentans [1–5].

Angelieri, F., L. Franchi, L. H. S. Cevidanes, J. R. Goncalves, M. Nieri, L. M. Wolford and J. A. McNamara, Jr. (2017). “Cone beam computed tomography evaluation of midpalatal suture maturation in adults.” Int J Oral Maxillofac Surg: 2017 Jul [Epub ahead of print].

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The aim of this study was to evaluate midpalatal suture maturation in adults, as observed in cone beam computed tomography (CBCT) images. CBCT scans from 78 subjects (64 female and 14 male, age range from 18 to 66 years) were evaluated. Midpalatal suture maturation was verified on the central cross-sectional axial slice in the superior-inferior dimension of the palate, using methods validated previously. Intra-examiner agreement was analyzed by weighted kappa test. Multinomial logistic regression was used to test whether sex and chronological age (adults <30 years or >/=30 years) could be used as a predictor for the maturational stages of the midpalatal suture. The majority of the adults presented a fused midpalatal suture in the palatine (stage D) and/or maxillary bones (stage E). However, the midpalatal suture was not fused in 12% of the subjects. Sex and chronological age were not significant predictors of the maturational stages of the midpalatal suture. The individual assessment of midpalatal suture maturation by way of CBCT images may provide reliable information critical to making the clinical decision between rapid maxillary expansion and surgically assisted rapid maxillary expansion for the treatment of maxillary atresia in adults.

Gomes, L. R., L. H. Cevidanes, M. R. Gomes, A. C. Ruellas, D. P. Ryan, B. Paniagua, L. M. Wolford and J. R. Goncalves (2017). “Counterclockwise maxillomandibular advancement surgery and disc repositioning: Can condylar remodeling in the long-term follow-up be predicted?” Int J Oral Maxillofac Surg: 2017 Jul [Epub ahead of print].

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This study investigated predictive risk factors of condylar remodeling changes after counterclockwise maxillomandibular advancement (CCW-MMA) and disc repositioning surgery. Forty-one female patients (75 condyles) treated with CCW-MMA and disc repositioning had cone beam computed tomography (CBCT) scans taken pre-surgery, immediately after surgery, and at an average 16 months post-surgery. Pre- and post-surgical three-dimensional models were superimposed using automated voxel-based registration on the cranial base to evaluate condylar displacements after surgery. Regional registration was performed to assess condylar remodeling in the follow-up period. Three-dimensional cephalometrics, shape correspondence (SPHARM-PDM), and volume measurements were applied to quantify changes. Pearson product-moment correlations and multiple regression analysis were performed. Highly statistically significant correlation showed that older patients were more susceptible to overall condylar volume reduction following CCW-MMA and disc repositioning (P

Wolford, L. M. (2017). “Understanding tmj reactive arthritis.” Cranio: 2017 Aug [Epub ahead of print].

Full text of this article.

There are many different joint pathologies that can affect the TMJ patient. One of the most common of these conditions, but least understood, is reactive arthritis (ReA). ReA, or seronegative spondyloarthropathy, is an inflammatory disease in joints usually caused by venereal and respiratory bacteria. ReA commonly develops in the mid teens through the 4th decade, predominately in females, and can cause TMJ pain, arthritis, and condylar resorption. Systemic symptoms of ReA may include joint pain, fever, fatigue, back pain, degenerative joint disease, polyarthritis, and dysfunction of the immune system. The most common bacteria that cause ReA are from 2 genera: Chlamydia and Mycoplasma. The specific species include C. trachomatis, C. pneumoniae, C. psittaci, M. genitalium, M. pneumoniae, and M. fermentans [1–5].

Al-Moraissi, E. A. and L. M. Wolford (2017). “Does temporomandibular joint pathology with or without surgical management affect the stability of counterclockwise rotation of the maxillomandibular complex in orthognathic surgery? A systematic review and meta-analysis.” J Oral Maxillofac Surg 75(4): 805-821.

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PURPOSE: This study was designed to determine the stability of counterclockwise rotation (CCWR) of the maxillomandibular complex (MMC) in orthognathic surgery with or without surgical correction of coexisting temporomandibular joint (TMJ) pathology. MATERIALS AND METHODS: The authors implemented a systematic review and meta-analysis. A search of major databases through PubMed, EMBASE, and Cochrane CENTRAL was performed. Inclusion criteria were studies that analyzed CCWR of the MMC in regard to skeletal stability after orthognathic surgery in patients with or without pre-existing TMJ pathology that was or was not surgically corrected concomitantly. The predictor variables were patients who underwent CCWR of the MMC in the following subgroups: 1) healthy TMJs (presumed healthy based on history, clinical evaluation, and radiographic analysis but without magnetic resonance imaging [MRI] confirmation), 2) no TMJ assessment, 3) untreated TMJ disc displacement (confirmed by MRI), 4) TMJ disc displacement (confirmed by MRI) repositioned using Mitek anchors, and 5) reconstruction with TMJ total joint prosthesis. Outcome variables were surgical relapse for angular and linear measurements. Postsurgical mean changes for the occlusal plane (OP) and linear measurements using a fixed-effects model with a 95% confidence interval were analyzed. RESULTS: A total of 345 patients enrolled in 12 studies were included in this study. There was significant OP relapse and horizontal relapse at the B point and menton for studies with untreated TMJ disc displacement and studies without TMJ assessment (P < .005). There was significant horizontal relapse at the A point for studies with healthy TMJs, without assessment of the TMJs, and with TMJ reconstruction with total joint prostheses (P < .005). There was no significant vertical relapse at the B and A points for all subgroup analyses (P < .005). CONCLUSION: The result of the meta-analysis suggests that CCWR of the MMC is a stable procedure for patients with healthy TMJs, patients undergoing concomitant TMJ disc repositioning with Mitek anchors, and patients with TMJ patient-fitted total joint prostheses but unstable in the presence of untreated TMJ disc displacements and when TMJ status is not assessed.