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

IMMOBILIZATION OF THE RABBIT TMJ FOR 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

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 Maxillofac Surg 40:3, 1982

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 Maxillofac Surg 53:1182, 1995

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

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

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