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Importance of Mobilization of the TMJ: Orthopedic Literature Review

This literature review examines the effects of immobilization and remobilization of the TMJ, the formation of adhesions, and the clinical studies supporting the use of passive motion devices for TMJ rehabilitation.

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Importance of Mobilization of the TMJ: Orthopedic Literature Review

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  1. ORTHOPEDIC LITERATURE ON THE IMPORTANCE OF MOBILIZATION OF THE TMJ(please click here)

  2. IMMOBILIZATION OF THE RABBIT TMJ FOR 10-28 DAYS PRODUCED • thinning and degradation of condylar articular cartilage as early as 10 days • progressive degenerative changes as duration of immobilization increased Lydiatt DD, Davis LF: J Oral Maxillofac Surg 43:188, 1985

  3. EFFECTS OF IMMOBILIZATION AND REMOBILIZATION OF THE TMJ ON MONKEYS: • immobilization for 8 weeks produced • articular cartilage thinning • loss of GAGs from cartilage matrix • osteoarthritic changes • remobilization from 2 weeks to 8 months produced • progressive increase in cartilage thickness • return of GAG content in cartilage Glineberg RW, Laskin DM, Blaustein DI: J Oral MaxillofacSurg 40:3, 1982

  4. Formation of Adhesions: Substances in Synovium & Synovial Fluids Contributing to Adhesions • Inflamed synovial cells release • Inflammatory mediators & cytokines that cause fibrosis of synovial membrane • IL 1 stimulates production of type I & type III collagen, & fibronectin causing fibrosis of synovial membrane Dijkgraaf, De Bont, Boering, et al. J Oral MaxillofacSurg 53:1182, 1995

  5. Formation of Adhesions: The Role of Free Radicals • Hypervascularity>Bleeding>Hemoblogin>Fe deposition • Hydrogen peroxide production + Fe = hydroxyl anion free radical • Free radicals>crosslinking of fibrinogen & fibronectin>protein aggregates>adhesion formation • Low pH increases cross linking reaction & adhesion formation • Dijkgraaf, et al. J Oral Maxillofac Surg 61:101, 2003

  6. CLINICAL STUDIES HAVE SUPPORTED THE USE OF PASSIVE MOTION DEVICES FOR THE REHABILITATION OF TMJ FUNCTION • Poremba and Moffett - 1989 • Sebastian and Moffett - 1989 • Spijkervet, DeBont and Boering - 1994 • Israel H, Syrop S: J CraniomandPract - 1997 • Vogel, Horrell, Israel – 1996 • Maloney GE et al. Cranio. 2002;20(1):55- 66. • McNeely Ml, Olivo SA, Magee DJ. Phys Ther. 2006 May;86(5):710-25. • Sebastian MH, Moffett BC. Oral Surg Oral Med Oral Pathol. 1989;67(6):644-653. • Salter RB: ClinOrthop 242:12, 1989 • Akeson WH, et al: ClinOrthop 219:28, 1987 • Ellis E, Carlson DS: Clin Plastic Surg 16(1):133, 1989 • Lo LJ, Lin CL, Chen YR: J Plastic ReconstrAesthetSurg 61(3):297, 2008

  7. MOBILIZATION REGIMENS ARE ESSENTIAL FOLLOWING TMJ TRAUMA, SURGERY AND ALL CASES OF MANDIBULAR HYPOMOBILITY • prevents formation of adhesions • transynovial nutrient movement necessary for cartilage nutrition • maintains the integrity of cartilage matrix • physical therapy should be supplemented by home passive motion regimens

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