Witte, T H

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  RVC OPEN ACCESS REPOSITORY – COPYRIGHT NOTICE  This is the peer reviewed version of the following article: Witte, T. H. (2016), TMJ pathology: is it real?. Equine Veterinary Education, 28: 173–174. doi: 10.1111/eve.12340 which has been published in final form at http://dx.doi.org/10.1111/eve.12340.     This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. The full details of the published version of the article are as follows:  TITLE: TMJ pathology: is it real? AUTHORS: T.H. Witte  JOURNAL TITLE: Equine Veterinary Education VOLUME/EDITION: 28 PUBLISHER: Wiley PUBLICATION DATE: January 2016 DOI: 10.1111/eve.12340  1 TMJ pathology: is it real? 2 T. H. Witte* 3  4  5 * Clinical Science and Services, Royal Veterinary College, London, UK 6 Email: twitte@rvc.ac.uk  7   8 Clinical scenario: can poor athletic performance or behavioural problems, such as 9 quidding, headshaking or dysphagia, be attributed to temporomandibular joint disorder 10 (TMJ)? 11 P (population) = adult horses with poor-/under-performance or behavioural problems and no other localising signs 12 I (intervention/indicator) = clinical history and diagnostic testing (diagnostic imaging, arthrocentesis or intrasynovial 13 anaesthesia, surgery) 14 C (comparator/control) = N/A 15 O (outcome) = diagnosis of poor performance attributable to the TMJ 16 Search Strategy 17 PubMed, search date 1 May 2014: (‘temporomandibular joint’ [MeSH Terms] OR (‘temporomandibular’ [All 18 Fields] AND ‘joint’ [All Fields]) OR ‘temporomandibular joint’ [All Fields]) AND (‘horse’ [All Fields] OR 19 ‘equine’ [All Fields]). 20 Quantity of Evidence 21 PubMed result: 32 papers, including 12 single case reports or case series, 11 experimental studies of imaging 22 (radiography, computed tomography, ultrasonography, magnetic resonance imaging), diagnostic (arthrocentesis) 23 or surgical (arthroscopic) techniques (8 such studies used only cadaveric material, 7 used healthy live horses and 24 4 studies used both cadavers and live horses), 4 editorials or invited reviews, 2 experimental kinematic studies 25 (1 technique validation and 1 measuring impact of dietary change), 2 studies of molecular biology (1 study of 26 the correlation of TMJ cytokine profiles with dental pathology scores, and 1 of the cytokine response of TMJ 27 compared to metarcarpophalangeal joints). 28 Quality of Evidence 29 An absence of systemic reviews, controlled clinical trials, case–control studies or large case series means that 30 definitive evidence of TMJ disorder in horses is limited. This search used broad search terms, and only found 31 mention of TMJ disorder amongst editorials and review articles. The experimental studies of diagnostic 32 approaches are robust and provide good evidence for the benefits of advanced imaging modalities for this 33 complex structure. 34 Can this evidence be applied in my case population/clinical scenario? 35 Anatomical studies have provided robust data for the application of a variety of diagnostic and surgical 36 techniques, including radiography (Townsend et al. 2009), delayed phase nuclear scintigraphy (Weller et al. 37 1999a), computed tomography (CT: Rosenstein et al. 2001; Devine et al. 2005; Nagy and Simhofer 2006) and 38 ultrasonography (Weller et al. 1999b; Rodríguez et al. 2007), but these have primarily been applied to the 39 management of fractures (Devine et al. 2005), luxations (Hurtig et al. 1984; Hardy and Shiroma 1991), and 40 septic and nonseptic arthritis (Carmalt and Wilson 2005; Nagy and Simhofer 2006), rather than the more vague 41 TMJ disorder. 42  43 Experimental evidence regarding the cytokine response in the TMJ indicates that this joint may show different 44 cytokine dynamics to other diarthrodial joints (Carmalt et al. 2011), and does not definitively support the 45 possibility of putative TMJ disorder contributing to the cluster of vague clinical signs listed. Dental pathology 46 has been postulated as one cause of TMJ disorder; however, TMJ articular pro-inflammatory cytokine 47 concentrations did not correlate with age and dental pathology score in one study (Carmalt et al. 2006). 48 Clinical message 49 Confirmed reports of TMJ disorder in horses are absent, but this may be due to the diagnostic challenge that 50 results from nonspecific signs. It is clear from this search that diagnostic techniques have progressed and should 51 allow more specific diagnoses to be made. It is hoped that robust (multi-centre) case series will follow. 52 Author's declaration of interests 53 References 54 Carmalt, J.L. and Wilson, D.G. (2005) Arthroscopic treatment of temporomandibular joint sepsis in a horse. 55 Vet. Surg. 34, 55-58. 56  57 Carmalt, J.L., Gordon, J.R. and Allen, A.L. (2006) Temporomandibular joint cytokine profiles in the horse. J. 58 Vet. Dent. 23, 83-88. 59  60 Carmalt, J.L., Bell, C.D., Tatarniuk, D.M., Suri, S.S., Singh, B. and Waldner, C. (2011) Comparison of the 61 response to experimentally induced short-term inflammation in the temporomandibular and 62 metacarpophalangeal joints of horses. Am. J. Vet. Res. 72, 1586-1591. 63  64 Devine, D.V., Moll, H.D. and Bahr, R.J. (2005) Fracture, luxation, and chronic septic arthritis of the 65 temporomandibular joint in a juvenile horse. J. Vet. Dent. 22, 96-99. 66  67 Hardy, J. and Shiroma, J.T. (1991) What is your diagnosis? Rostral luxation of the right temporomandibular 68 joint. J. Am. Vet. Med. Ass. 198, 1663-1664. 69  70 Hurtig, M.B., Barber, S.M. and Farrow, C.S. (1984) Temporomandibular joint luxation in a horse. J. Am. Vet. 71 Med. Ass. 185, 78-80. 72  73 Nagy, A.D. and Simhofer, H. (2006) Mandibular condylectomy and meniscectomy for the treatment of septic 74 temporomandibular joint arthritis in a horse. Vet. Surg. 35, 663-668. 75  76 Rodríguez, M.J., Soler, M., Latorre, R., Gil, F. and Agut, A. (2007) Ultrasonographic anatomy of the 77 temporomandibular joint in healthy pure-bred Spanish horses. Vet. Radiol. Ultrasound 48, 149-154. 78  79 Rosenstein, D.S., Bullock, M.F., Ocello, P.J. and Clayton, H.M. (2001) Arthrocentesis of the 80 temporomandibular joint in adult horses. Am. J. Vet. Res. 62, 729-733. 81  82 Townsend, N.B., Cotton, J.C. and Barakzai, S.Z. (2009) A tangential radiographic projection for investigation of 83 the equine temporomandibular joint. Vet. Surg. 38, 601-606. 84  85 Weller, R., Cauvin, E.R., Bowen, I.M. and May, S.A. (1999a) Comparison of radiography, scintigraphy and 86 ultrasonography in the diagnosis of a case of temporomandibular joint arthropathy in a horse. Vet. Rec. 144, 87 377-379. 88  89 Weller, R., Taylor, S., Maierl, J., Cauvin, E.R. and May, S.A. (1999b) Ultrasonographic anatomy of the equine 90 temporomandibular joint. Equine Vet. 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TMJ pathology: is it real?

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TMJ pathology: is it real?

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