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Temporomandibular Joint (TMJ) Dysfunction and Disorders

Stem Cell and Platelet Rich Plasma Treatment Options


TMJ (temporomandibular joint) disorders or derangements are common and often result in disabling symptoms including the following:           

  • Pain (joint pain, facial pain and headache)
  • TMJ clicking, locking, joint noises and mechanical dysfunction
  • Changes in the way the upper and lower teeth fit (unstable or changing dental occlusion)

 

TMJ
MR image of an abnormal TMJ

Depending on the status of TMJ derangement and specific joint pathology, bio cellular therapy with stem cell or platelet rich plasma (PRP) injections are a treatment option to alleviate TMJ symptoms in some patients. Diagnosis of the degree (stages)1,2 of pathology is crucial and is established with a combination of history, physical examination and medical imaging with high resolution magnetic resonance imaging (MRI) performed by skilled and experienced experts. An MRI is critically important to assess the status (health and healing potential) of joint cartilage to determine whether stem cell or PRP therapy is a realistic treatment option. 

 

Kurt P. Schellhas, MD is an interventional neuroradiologist with CDI who has been diagnosing and treating TMJ derangements for more than 35 years. He has performed thousands of diagnostic and therapeutic TMJ arthrograms (joint injections) 3, and has published extensively regarding TMJ derangements in peer reviewed medical and dental journals4-35. Dr. Schellhas has also published peer reviewed articles regarding diagnostic and therapeutic spine injections and spine imaging36-57, and has performed thousands of interventional spine procedures. His clinical practice has been devoted to spine and maxillofacial/head and neck imaging (including TMJs) and spinal injections since 1986.

 

Image-guided stem cell and platelet rich plasma therapy can help heal many deranged joints, including TMJs, depending upon the specific pathology. Dr. Schellhas and his colleagues routinely perform stem cell treatments (injections) of knees, hips, shoulders, spinal structures, tendons and small joints, including TMJs. Diagnosis with high field MR imaging is central prior to the planning of any bio cellular therapy with stem cells or PRP. As subspecialized medical radiologists (neuroradiology and musculoskeletal imaging), they are uniquely qualified to evaluate MRI studies to determine if stem cell therapy is a realistic option. 

 

In 1988, Dr. Schellhas described the two-compartment TMJ arthrography technique in the American Journal of Neuroradiology and the American Journal of Radiology, detailing the specific technique employed to this day for injecting diagnostic and/or therapeutic substances into both compartments of the TMJ3.


Dr. Schellhas

To schedule an evaluation for TMJ treatment with Dr. Schellhas and his colleagues, call 952-204-9901. If you have had a recent MRI study of the TMJs (or other joints, including the spine), we offer MRI review to evaluate your potential eligibility for bio cellular therapy. 

  

About Stem Cells

Stem cells reside in highest concentration in the bone marrow of large bones, where it can be retrieved with a skilled bone marrow aspiration procedure, performed with conscious (awake) sedation and image guidance. Bone marrow is by far the richest source of stem cells and is the only source we use.

 

The combination of sedation and local anesthetic makes the procedure for obtaining the bone marrow easily tolerated. The bone marrow aspirate is then processed to isolate stem cells and other components that are naturally present in our bodies to maintain and restore cellular health and viability. Clinical and scientific research in regenerative medicine continues to expand, providing improved techniques that harness natural biologic processes for the treatment of disease and repair of damaged tissue. 


To schedule an evaluation for TMJ treatment, call 952-204-9901.


  1. INTERNAL DERANGMENT OF THE TEMPOROMANDIBULAR JOINT: PATHOLOGIC VARIATIONS.   Wilkes CH.  Arch Otolaryngol Head Neck Surg 115(4):469-477, 1989.
  2. INTERNAL DERANGEMENT OF THE TEMPOROMANDIBULAR JOINT: RADIOLOGIC STAGING WITH CLINICAL, SURGICAL AND PATHOLOGIC CORRELATION.  Schellhas KP.  Magnetic Resonance Imaging 1989; 7(5):495-515.
  3. THE DIAGNOSIS OF TEMPOROMANDIBULAR JOINT DISEASE: TWO COMPARTMENT ARTHROGRAPHY AND MR.  Schellhas KP, Wilkes CH, Omlie MR, et al.  AJNR 1988; 9:579-588 and AJR 1988; 151:341-350.
  4. TEMPOROMANDIBULAR JOINT: DIAGNOSIS OF INTERNAL DERANGEMENTS USING MAGNETIC RESONANCE IMAGING.  Schellhas KP, Wilkes CH, Heithoff KB.  Minnesota Medicine 1986; 69:516-519.
  5. TEMPOROMANDIBULAR JOINT IMAGING: PRACTICAL APPLICATIONS OF AVAILABLE TECHNOLOGY.  Schellhas KP, Wilkes CH, Omlie M, et al.  Archives of Otolaryngology Head and Neck Surgery 1987; 133:744-748.
  6. TEMPOROMANDIBULAR JOINT: MR IMAGING OF INTERNAL DERANGEMENTS AND POSTOPERATIVE CHANGES.  Schellhas KP, Wilkes CH, Omlie MR, et al.  AJNR 1987; 8:1093-1101 and AJR 1988; 150(2):381-389.
  7. TEMPOROMANDIBULAR JOINT: MR FAST SCANNING.  Schellhas KP, Fritts HM, Heithoff KB, Jahn JA, Wilkes CH, Omlie MR.  J Craniomand Pract 1988; 6:209-216.
  8. THREE-DIMENSIONAL COMPUTED TOMOGRAPHY IN MAXILLOFACIAL SURGICAL PLANNING.  Schellhas KP, El Deeb M, Wilkes CH, et al.  Archives of Otolaryngology Head and Neck Surgery 1988; 114:438-442.
  9. PERMANENT PROPLAST TEMPOROMANDIUBLAR JOINT IMPLANTS: MR IMAGING OF DESTRUCTIVE COMPLICATIONS.  Schellhas KP, El Deeb M, Wilkes CH, et al.  AJR 1988; 151:731-735.
  10. MAXILLOFACIAL IMAGING: DIAGNOSIS BEFORE TREATMENT.  Schellhas KP, El Deeb M.  Northwest Dentistry 1988; 64(4):13-18.
  11. MR OF OSTEOCHONDRITIS DISSECANS AND AVASCULAR NECROSIS OF THE MANDIBULAR CONDYLE.  Schellhas KP, Wilkes CH, Fritts HM, et al.  AJNR 1989; 10:3-12 and AJR 1989; 152:551-560.
  12. MEDICAL IMAGING IN THE EVALUATION OF FACIAL PAIN.  Schellhas KP.  Seminars in Neurology 1988; 8(4):265-271.
  13. TEMPOROMANDIBULAR JOINT ARTHROGRAPHY: ANALYSIS OF PROCEDURE-RELATED DISCOMFORT IN ABNORMAL JOINTS.  Schellhas KP, Wilkes CH.  The Journal of Craniomandibular Practice 1988; 6(4):308-311.
  14. FACIAL PAIN, HEADACHE, AND TEMPOROMANDIBULAR JOINT INFLAMMATION.  Schellhas KP, Wilkes CH, Baker CC.  Headache 1989; 29(4):229-232.
  15. TEMPOROMANDIBULAR JOINT INFLAMMATION: COMPARISON OF MR FAST SCANNING TO T1 AND T2-WEIGHTED IMAGING TECHNIQUES.  Schellhas KP, Wilkes CH.  AJNR 1989; 10(3):589-594 and AJR 1989; 152:93-98.
  16. MR IMAGING OF MUSCLES OF MASTICATION.  Schellhas KP.  AJNR 1989; 10:829-837 and AJR 1989; 153(4):847-855.
  17. UNSTABLE OCCLUSION AND TEMPOROMANDIBULAR JOINT DISEASE.  Schellhas KP.  Journal of Clinical Orthodontics 1989; 23(5):332-337.
  18. DISORDERS OF SKELETAL OCCLUSION AND TEMPOROMANDIBULAR JOINT DISEASE.  Schellhas KP, Keck RJ.  Northwest Dentistry 1989; 68(1):35-42.
  19. TEMPOROMANDIBULAR JOINT INJURIES.  Schellhas KP.  Radiology 1989; 173(1):211-216.
  20. TEMPOROMANDIBULAR JOINT IMAGING: WHY?  “Opinion” in AJNR 1990; 11:843-844.
  21. FACIAL SKELETON REMODELING DUE TO TEMPOROMANDIBULAR JOINT DEGENERATION: AN IMAGING STUDY OF 100 PATIENTS.  Schellhas KP, Piper MA, Omlie MR.  AJNR 1990; 11(3):541-551 and AJR 1990; 155(2):373-383.
  22. DENTISTRY, THE TEMPOROMANDIBULAR JOINT, IMAGING AND PRACTICE STANDARDS.  Schellhas KP.  Northwest Dentistry 1990; 69:49-50.
  23. MAGNETIC RESONANCE IMAGING OF THE TEMPOROMANDIBULAR JOINT.  Pollei SR, Schellhas KP.  Seminars in Ultrasound, CT, and MR 1990; 11(4):346-361.
  24. MAGNETIC RESONANCE IMAGING OF THE TEMPOROMANDIBULAR JOINT: PRELIMINARY EVALUATION OF PARTIAL FLIP ANGLE THREE-DIMENSIONAL VOLUME ACQUISITIONS AGAINST CONVENTIONAL SINGLE AND MULTIECHO PULSE SEQUENCES.  Jahn JA, Schellhas KP.  J Craniomand Pract 1991; 9(2):145-151.
  25. MANDIBULAR RETRUSION, TEMPOROMANDIBULAR JOINT DERANGEMENT, AND ORTHOGNATHIC SURGERY PLANNING.  Schellhas KP, Piper MA, Bessette RW, Wilkes CH. Plastic and Reconstructive Surgery 1992; 90(2):218-229.
  26. GUIDELINES TO THE DIAGNOSIS AND MANAGEMENT OF TEMPOROMANDIBULAR JOINT AND RELATED MUSCULOSKELETAL DISORDERS.  Co-authored with Roger Meyer, DMD, MD, David Hall, DMD, MD, Clyde H. Wilkes, DDS, MD, PhD, and Thomas Indresano, DMD, on behalf of the American Society of Temporomandibular Joint Surgeons and the American Society of Maxillofacial Surgeons 1992.  Published in Northwest Dentistry 1992; 71(5):21-27.
  27. FACIAL SKELETON REMODELING DUE TO TEMPOROMANDIBULAR JOINT DEGENERATION: AN IMAGING STUDY OF 100 PATIENTS.  Schellhas KP, Piper MA, Omlie MR.  Reprinted in Cranio (The Journal of Craniomandibular Practice) 1992; 10:248-259.
  28. PEDIATRIC INTERNAL DERANGEMENTS OF THE TEMPOROMANDIBULAR JOINT: EFFECT UPON FACIAL DEVELOPMENT.  Schellhas KP, Pollei SR, Wilkes CH.  American Journal of Orthodontics and Dentofacial Orthopedics 1993; 104:51-59.
  29. TEMPOROMANDIBULAR JOINT IMAGING.  Chapter in “Craniofacial Pain: Diagnosis and Management”.   James R. Fricton, D.D.S., Editor, Ishiyaku Press International, 1988.
  30. ADVANCES IN TEMPOROMANDIBULAR JOINT IMAGING.  Schellhas KP, Wilkes CH.  Chapter in “Radiology: Diagnosis and Intervention”.  Taveras J and Ferrucci JT, Editors,  JP Lippincott, Philadelphia, PA 1989.
  31. HIGH RESOLUTION TEMPORAL BONE IMAGING: CT AND MR.  Chapter in “Atlas of Surgical Otology”.  Goycoolea M, Paparella M and Nissen R, Editors, WB Saunders, Philadelphia, PA  1989.
  32. UNSTABLE OCCLUSION AND TEMPOROMANDIBULAR JOINT DEGENERATION.  Chapter in “Textbook of Craniomandibular Disorders”.  L.A. Assael and K.S. Kaplan, Editors, W.B. Saunders Company, Philadelphia, 1989.
  33. IMAGING OF THE TEMPOROMANDIBULAR JOINT.  Chapter in “Oral and Maxillofacial Surgery Clinics of North America”.  Ralph G. Merrill, Editor, W.B. Saunders Company, Philadelphia, September, 1989.
  34. IMAGING AND TEMPOROMANDIBULAR JOINT SURGERY.  Chapter in “Oral and Maxillofacial Surgery Clinics of North America”.  Ralph G. Merrill, Editor, W.B. Saunders Company, Philadelphia, December, 1989.
  35. TEMPOROMANDIBULAR JOINT TRAUMA AND SEQUELAE.  Schellhas KP.  Chapter in “Neuroimaging Clinics of North America”.  Lindell R. Gentry, M.D., Editor, W.B. Saunders Company, Philadelphia, December, 1991, pp. 305-318.
  36. THE ROLE OF DISCOGRAPHY IN THE EVALUATION OF PATIENTS WITH SPINAL DEFORMITY.  Schellhas KP and Pollei SR.  Orthopedic Clinics of North America 1994; 25(2):265-273.
  37. THORACIC DISCOGRAPHY: A SAFE AND RELIABLE TECHNIQUE.  Schellhas KP, Pollei SR, Dorwart RH.  Spine 1994; 19(18):2103-2109.
  38. LUMBAR DISC HIGH INTENSITY ZONE: CORRELATION OF MR AND DISCOGRAPHY.  Schellhas KP, Pollei SR, Gundry CR, Heithoff KB.  Spine 1996; 21(1):79-86.
  39. CERVICAL DISCOGENIC PAIN: PROSPECTIVE CORRELATION OF MR IMAGING AND DISCOGRAPHY IN ASYMPTOMATIC SUBJECTS AND PAIN SUFFERERS.  Schellhas KP, Smith MD, Gundry CR, Pollei SR. Spine 1996; 21(3):300-311.
  40. PAINFUL ADULT THORACIC SCHEUERMANN’S DISEASE: DIAGNOSIS BY DISCOGRAPHY AND TREATMENT BY COMBINED ARTHRODESIS.  Winter RB, Schellhas KP.  The American Journal of Orthopedics 1996; 25(11):783-786.
  41. EPIDUROGRAPHY AND THERAPEUTIC EPIDURAL INJECTIONS: TECHNICAL CONSIDERATIONS AND EXPERIENCE WITH 5334 CASES.  Johnson BA, Schellhas KP, Pollei SR.  American Journal of Neuroradiology 1999; 20:697-705.
  42. THORACIC DISCOGRAPHY IN HEALTHY INDIVIDUALS: A CONTROLLED PROSPECTIVE STUDY OF MAGNETIC RESONANCE IMAGING AND DISCOGRAPHY IN ASYMPTOMATIC AND SYMPTOMATIC INDIVIDUALS.  Wood KB, Schellhas KP, Garvey TA, Aeppli D.  Spine 1999; 24:1548-1555.
  43. CERVICAL DISKOGRAPHY: ANALYSIS OF PROVOKED RESPONSES AT C2-3, C3-4 and C4-5.  Schellhas KP, Garvey TA, Johnson BA, Rothbart PJ, Pollei SR.  AJNR 2000; 21(2):269-275.
  44. MEASUREMENT OF IN VIVO INTRADISCAL PRESSURES IN HEALTHY THORACIC INTERVERTEBRAL DISCS.  Polga DJ, Beaubien BP, Kallemeier PM, Schellhas KP, Lew WD, Buttermann GR, Wood KB.  Spine 2004; 29(12):1320-1324.
  45. DISKOGRAPHY: INFECTIOUS COMPLICATIONS FROM A SERIES OF 12,634 CASES.  Pobiel RS, Schellhas KP, Pollei SR, Johnson BA, Golden MJ, Eklund JA.  AJNR 2006, 27:1930-1932.
  46. SELECTIVE CERVICAL NERVE ROOT BLOCKADE: EXPERIENCE WITH A SAFE AND RELIABLE TECHNIQUE EMPLOYING AN ANTEROLATERAL APPROACH FOR NEEDLE PLACEMENT.  Schellhas KP, Pollei SR, Johnson BA, Golden MJ, Eklund JA, Pobiel RS.  AJNR 2008; 28:1909-1914.
  47. SELECTIVE CERVICAL NERVE ROOT BLOCKADE: PROSPECTIVE STUDY OF IMMEDIATE AND LONGER TERM COMPLICATIONS.  Pobiel RS, Schellhas KP, Eklund JA, Golden MJ, Johnson BA, Chopra S, Broadbent P, Myers ME, Shrack K.  AJNR 2009; 30:507-511.
  48. THE INCIDENCE OF DISCOGRAPHY RESULTING IN RECOMMENDATIONS AGAINST LUMBAR SPINAL FUSION.  Ledonio C, Polly D, Johnson B, Schellhas K, Schwender J, Peltier C, Perra J.  The Spine Journal 2009; 9(10):8S-9S.
  49. DISCOGRAPHY.  Schellhas KP.  Chapter in “Spine: State of the Arts Reviews”.  Lee RR, M.D., Editor, Hanley & Belfus, Inc., Philadelphia, January 1995, pp 27-44.
  50. FACET NERVE BLOCKADE AND RADIOFREQUENCY NEUROTOMY.  Chapter in “Neuroimaging Clinics of North America”.  Jensen ME, M.D., Editor, W.B. Saunders Company, Philadelphia, August 2000, pp 493-501.
  51. DISCOGRAPHY.  Chapter in “Neuroimaging Clinics of North America”.  Jensen ME, M.D., Editor, W.B. Saunders Company, Philadelphia, August 2000, pp 579-596.
  52. PAIN IMAGING: DISCOGRAPHY.  Chapter in “Orthopaedic Knowledge Update for Spine, Ed. 2”, Claxton Moore, L, Editor, American Academy of Orthopaedic Surgeons & American Association of Orthopaedic Surgeons, Rosemont, Illinois, (In Press).
  53. DISCOGRAPHY.  Chapter in Mathis JM (Editor), Johnson BA, Staats PS, Wetzel FT (Associate Editors):  “Image-Guided Spine Interventions”.  Springer-Verlag.  New York, Inc.  pp 94-120, 2004.
  54. DISCOGRAPHY.  Chapter in Latchaw RE, Kucharczyk J, Moseley ME: “Imaging of the Nervous System: Diagnostic and Therapeutic Applications”.  Elsevier Mosby, Philadelphia. Volume II: 1537-1553, 2005.
  55. CT AND MRI OF LATERAL ENTRAPMENT SYNDROMES.  Heithoff KB, Ray CD, Schellhas KP, et al.  Spine Update 1987; Harry K. Genant, M.D., Editor.
  56. COMPUTED TOMOGRAPHY AND MAGNETIC RESONANCE IMAGING IN EVALUATION OF THE FAILED BACK SURGERY SYNDROME.  Heithoff KB, Burton CV, Schellhas KP, et al.  Spine Update 1987; Harry K. Genant, M.D., Editor.