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Nutrient Arteries of the Temnoromandibular Joint: an Anatomical and a Pathological Study

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Nutrient Arteries of the Temnoromandibular Joint: an Anatomical and a Pathological Study Okajimas Folia Anat. Jpn., 78(1): 7-16, May, 2001 Nutrient Arteries of the Temnoromandibular Joint: An Anatomical and A Pathological Study By Keisuke FUNAKOSHI Department of Oral Pathology, Faculty of Dental Medicine, Kyushu Dental College, Kitakyushu, Fukuoka, Japan -Received for Publication, November 20, 2000- Key Words: Inferior alveolar artery, Artery of mandibular head, Mandibular head, Mandible, Arteriosclerosis Summary: We have identified an artery which is a sub-branch of the inferior alveolar artery, and propose to call it the temporomandibular branch. Mandibular bones of 36 autopsy cases (ages 23-85; 20 males and 16 females) were examined. Contrast media were injected into the inferior alveolar artery, decalcification was conducted, and photographs were taken using soft X-ray equipment (Softex: Nippon Softex, co. CSM type). Then, an examination was conducted concerning sclerosis of these arteries. Next, H.E., Azan, and Pap silver stains were used for microscopic specimens to examine arteriosclerosis of the temporomandibular joint. The artery that sub-branches toward the temporomandibular branch, branches out immediately after the inferior alveolar artery and enters the mandibular foramen, becoming the artery that supplies the temporomandibular joint. This temporomandibular branch travels slightly downward, forward of the inferior alveolar artery, and turns back toward the mandibular base. It advances to the mandibular joint almost directly. The route taken was classified into three types. Toward the head of the mandible, the temporomandibular branch, after passing over the neck of the mandible, divides into two sub-branches, anterior and posterior. In our pathological study of the temporomandibular branch, there were a small number of cases with slight intimal thickening and mild elastosis. As regards sderotic changes, particularly in cases more than 50 years old. There were very few cases showing intimal changes. Sclerotic changes of the artery supplying the head of the mandible increase with age. The same can be said of the about the constriction rate. These findings correlated with subject age. As regards the route of the nutrient artery in the have an accurate knowledge of the route of the temporomandibular joint, a study by Bromme13) artery supplying the head of the mandible. To date, was reported. However, Brommel provides no de- we have conducted pathological examinations of tailed descriptions concerning the type of nutrient the mandibular bone, in terms of the arterio- route taken by this artery. Furthermore, there are losclerosis of the inferior alveolar artery (Urago no accurate or detailed descriptions concerning the et al."'"); Funakoshi et al.6)). Nevertheless, these route of the artery that supplies the mandibular studies did not clarify the route of the tempor- head in earlier reports concerning the route of this omandibular joint artery or its pathological changes. artery in the temporomandibular joint, such as Herein, we have identified the starting point of the those of Blackood", Boyer2), Fukuoka5), Ikejiri9), nutrient artery for the head of the human mandible Itikawa8) and Kubota 1" ". However, the tempor- and clarified its route. Therefore, we hereby report °mandibular joint arteries constitute one of the these findings, as well as pathological findings of the non-clarified areas among organ arteries studied in artery. anatomical angiology. In view of the increase in the number of temporomandibular joint arthroses and progress in the study of bone graft in the recent years, the author considers it vitally important to Address for correspondence: Keisuke Funakoshi, Department of Oral Pathology, Kyushu Dental College, 2-6-1, Manazuru, Kokura- kita, Kitakyushu, Fukuoka, 803-8580, Japan 7 8 K. Funakoshi Materials and Methods classified into three types (Fig. 3a, 4a, 5a). There- fore, we will describe the route type of each of the 1) Materials three types, as well as report histopathological We used a total of 36 autopsy cases (20 males findings of the artery coursing toward the tempor- and 16 females) between age 23 and age 85, se- °mandibular joint. Typical photographs and tracing lected at random (Fig. 1), in which it was possible images of the three types of arteriolar route are remove the mandibular bones. All 36 cases were presented in Plate 3. autopsied within three hours of death and showed few postmortem changes. None of these cases had I-1) Examination of the Route of Type I special diseases characterized by oral lesions or Thirteen (9 males and 4 females) of 36 cases had pathological findigns affecting oral lesions. There a Type I which traveled toward the temporo- was no known antemortem history of oral lesions in mandibular joint. As indicated in Fig. 6, these cases any of these cases. covered almost all ages, including those from a 23 year old male case to a 69 year old male case. No 2) Methods relationships were seen between the presence (or In all cases, examinations were done on the right absence) of teeth or dentures, and no differences side. First, the mandibular bone was taken out as a were found between males and females (Student's whole, after which a tube was inserted from the t-test). However, there were correlation between origin of the inferior alveolar artery. the sizes of mandibular bones. In each case, a mixed water solution (to which As regards the route type, an artery that KI had been added) of barium sulfate (BaSO4) and branches out in the bone marrow of the mandible gelatin was injected, synchronized with a pressure within about 15 mm from the mandibular foramen midway between the highest antemortem systolic of the inferior alveolar artery advances down and blood pressure and the lowest diastolic blood pres- forward into the bone marrow, turns back and sure. This water solution of BaSO4 and gelatin of upward at an angle of about 30 degrees near the was adjusted to approximately the viscosity blood, outer periphery of the mandibular ramus and using the viscid measuring device. After the in- travels toward the temporomandibular joint at the jection, fixation and decalcification were carried posterior of the mandibular ramus (Type I in Fig. out following the conventional methods. Then, the 3a, 3b). In two male cases (among 9 male cases) right side was photographed by soft X-ray (Softex: and 2 female cases (among 4 female cases), had Nippon Softex, co. CSM type) to examine the arte- arteries producing the temporomandibular artery riole's distribution and route to the temporo- gave off several branches to the mandible head mandibular joint. right or the left, while going upward at the ramus of For histopathological examination, staining was mandible (See Fig. 3a, 3b). carried out, in all cases, on the origin of the branch from the inferior alveolar artery, using H.E., Azan, 1-2) Examination of Type II Pap silver and PAS stains. We also measured the Eleven cases (7 males and 4 females) with Type constriction rate by examining pathological findings II were confirmed among total of 36 cases (Fig. 6). of arteriosclerosis in the head of the mandible, In Type II, the length of the artery's path down in accordance with Satoh's method") (Fig. 2). The and forward is slightly shorter than that of Type I. results are expressed as the mean + SD. Data In all Type II cases, the branch toward the tem- were examined by one-factor analysis of variance poromandibular joint advances slightly downward (ANOVA). When differences were detected, the and forward after branching out from the inferior significance of the differences was determined by alveolar artery and, after passing a point about the Scheffe'F procedure. 10 mm from the line (wavy line of Type II in Fig. 4a, 4b) linking the angle of the mandible with the ret- romolar triangle, turns back gently upward toward Results the temporomandibular joint (Fig. 4a, 4b). As in- dicated in the table, there were 9 cases older than 1. Examination of the Route to the Tempor- 40 years (including both genders) among 11 cases, omandibular Joint thereby showing a large percentage of the elderly By examining Softex images in all cases, the au- to have Type II. However, no differences were thor confirmed an artery that branches out within found between males and females (Student's t-test). 5 mm from the mandibular foramen of the inferior However, there were relationships between the alveolar artery and route toward the temporo- sizes of mandibular bones. mandibular joint. This branching of the artery was Nutrient Arteries of the Temporomandibular Joint 9 1-3) Examination of Type III ing 4 cases showed intimal thickening of mild de- Out of the total of 36 cases, there were 12 grees. Of 5 cases in their thirties, 3 showed mild (4 males and 8 females) with Type III (Fig. 6). elastosis and 2 had intimal thickening. Of 7 cases in Contrary to Types I and II, there were twice as their forties, 3 showed intimal thickening and elas- many female as male cases (no differences were tosis was seen in 3 (Fig. 9). In the forties, intimal found between males and females, Student's t-test). thickening was slightly more marked than in the Seven of the 12 cases were over age 50, i.e. in their thirties. Of 6 cases in their fifties, 3 had elastosis, sixties and eighties. In Type III, in 7 cases, the which was rather strong in one case, accompanied artery branched out from the inferior alveolar by moderate intimal thickening (Fig. 10). Fibrosis artery and traveled directly to the head of the was recognized in all 6 cases. mandible (Fig. 5a, 5b), while in the remaining In the fifties, arteriolosclerosis was somewhat 4 cases, the artery traveled down and forward by more severe, overall, than in the thirties and the 3-4 mm, immediately turning back and upward forties.
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