In this study of the temporomandibular joint, two instruments were employed to aid in understanding the effect of alteration of the mandible upon temporomandibular joint functions The two instruments employed were the S, S, White Panorex Radiograph and the Denar Pantograph tracing device. The question was considered, does alteration of the mandible result in a modification of the functional path of the mandibular condyle? Should one expect normal function to return to the temporomandibular joint of a mandibular condyle fracture patient?
A group of 12 patients were studied with the Pantograph to determine a set of standard values for the unaltered temporomandibular joint pathway. The reproducibility of the instrument was studied by recording half of the control group a second time. The method was demonstrated to be statistically reproducible at a 95% statistical level.
When a range of normal values was established, three groups of patients were studied. The first group were patients who had sustained condylar fractures. This group was further divided into those in which the fracture was intracapsular and those in which the fracture was extracapsular. The second group was patients who had had surgical alteration of the mandible. The third group was patients presenting with symptomatic temporomandibular joints.
A. Condylar fracture patients
1. Patients sustaining intracapsular fractures
Altered condyle versus normal value of control group There is a definite statistical indication of limitation of mandibular movement after intracapsular fracture.
Unaltered condyle versus normal condyle of control group There was no statistically significant difference between the unaltered condyle and the normal value of the control group. It should be pointed out that the value of the unaltered versus normal of control group was in the low range of normal.
Fractured condyle versus unaltered within the same patient There was found to be a significant difference between fractured and non-fractured condyles within the same patient.
2. Patients sustaining extracapsular fractures
The three comparisons carried out as in the intracapsular fracture cases above, resulted in no significant alteration of function in these patients from normal values of the control group,
B. Mandibular surgery patients
Surgeries not involving the condyle or its capsule demonstrated no limitation of function. Surgeries consisting of replacement of the condyle showed extreme modification of temporomandibular joint function.
C. Symptomatic temporomandibular joint patients
The type of complaint was not necessarily an indication of altered or limited movement of the temporomandibular joint. Two patients who complained of dysfunction, upon exam were found to have a normal pat tern and range of motion. One patient who was experiencing no functional discomfort but felt he had limited motion of one temporomandibular joint was found to have a fibrotic limitation of the affected condyle, not directly located in the joint, but between the ramus and the posterior antral wall.
In the section of the paper marked results, each of these categories is expanded and detailed descriptions of groups are given. Photographs and photoradiographs are shown to illustrate each type of condition.
Four conclusions were reached in this research project.
1. Intracapsular condylar fractures of the mandible in this study were shown to have a statistically significant limitation of range of motion when compared to the control group.
2. Surgery of the mandible does not significantly alter temporomandibular joint function unless the surgery is intracapsular.
3. Symptomatology in the temporomandibular joint region does not necessarily reflect an alteration of function within the temporomandibular joint.
4. This method of studying the temporomandibular joint, employing the panorex radiograph and pantographic tracing device, provides more clinical information than the employment of either instrument independently.
Bernard C. Byrd
Master of Science (MS)
Year Degree Awarded
Date (Title Page)
Library of Congress/MESH Subject Headings
Temporomandibular; Joint Mandible
Loma Linda University Libraries
This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.
Cram, Donald L., "A Study of Temporomandibular Joint Movement After Mandibular Alteration" (1970). Loma Linda University Electronic Theses, Dissertations & Projects. 1261.
Loma Linda University Electronic Theses and Dissertations
Loma Linda University. Del E. Webb Memorial Library. University Archives