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Millón Cruz A, Martin-Granizo R, Barone S, Pérez Rodríguez LM, Menéndez SM, Falahat Noushzady F, Arias Díaz J. Reliability of magnetic resonance for temporomandibular joint disc perforation: A 12 years retrospective study. J Craniomaxillofac Surg 2024; 52:548-557. [PMID: 38627190 DOI: 10.1016/j.jcms.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 03/11/2024] [Accepted: 04/08/2024] [Indexed: 05/18/2024] Open
Abstract
The aim of this study was to evaluate the reliability of magnetic resonance imaging (MRI) in detecting disc perforations in the temporomandibular joint (TMJ), and to establish diagnostic criteria for this purpose. The retrospective analysis included patients who had undergone preoperative MRI and TMJ arthroscopy at the same hospital. Direct and indirect signs of disc abnormalities on MRI were compared with arthroscopic findings of disc perforation. Out of 355 joints evaluated in 185 patients, arthroscopy confirmed disc perforations in 14.7% of cases. Several MRI findings were significantly associated with disc perforation, including anterior disc displacement without reduction (ADDwoR), signal alterations in the mid-disc area, disc deformity (SAMD), retrocondylar disc fragments, osteophytes, condylar bone marrow degeneration (CBMD), and joint effusion in both joint spaces (ESJS-EIJS). Regression analysis revealed that SAMD, osteophytes, and CBDM were strongly associated with disc perforation. The ROC curve showed that MRI had an AUC = 0.791, with a sensitivity of 88.5% and a specificity of 61.5%. Two diagnostic methods, one based on three findings (osteophytes, ADDwoR, and SAMD) and one based on two direct signs (ADDwoR and SAMD), yielded high sensitivity and specificity values of 80.4% and 69.8%, and 84.3% and 62.5%, respectively. In conclusion, MRI demonstrated acceptable accuracy in the detection of TMJ disc perforations, with specific diagnostic criteria offering high sensitivity and specificity. Significant MRI indicators of disc perforation included SAMD, osteophytes, and CBDM. This study provides valuable information on the use of MRI as a diagnostic tool for TMJ disc perforations.
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Affiliation(s)
- Alejandrina Millón Cruz
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - Rafael Martin-Granizo
- Department of Oral and Maxillofacial Surgery, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Simona Barone
- Department of Neurosciences and Reproductive and Dental Sciences, Federico II University of Naples, Naples, Italy.
| | | | | | - Farzin Falahat Noushzady
- Department of Oral and Maxillofacial Surgery, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Javier Arias Díaz
- Department of Surgery, School of Medicine, Universidad Complutense, Madrid, Spain
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Lee LM, Zhang DD, Zhu YM, Cheng HN, Yao W, Liang X, Deng QY. Outcomes of treatment with genioplasty and temporomandibular joint anchorage surgery. J Craniomaxillofac Surg 2021; 49:177-183. [PMID: 33451942 DOI: 10.1016/j.jcms.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/09/2020] [Accepted: 01/01/2021] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Anterior Disc Displacement without Reduction (ADDwoR) in adolescence can result in condylar resorption which produces mandibular retrusion/deviation (MR/D) in adulthood. This study aims to analyze the therapeutic effect of simultaneous genioplasty and temporomandibular joint (TMJ) anchorage surgery on ADDwoR with MR/D patients. METHODS During 2016-2018, ADDwoR with MR/D cases were included and underwent TMJ anchorage surgery and genioplasty guided by digital design. Pre-/Post-surgical clinical manifestations, facial photography, radiographic data, facial shape satisfaction of clinicians/patients/third-party were recorded and analyzed. RESULTS A total of 32 cases (52 joints) were included. The average age was 24.09. Ratio of male/female was 4/28. Visual analog pain scale (VAS) score pre-/post-surgical ranged from 3 to 9 and 0-3, with an average of 6.03 and 1.18 (p < 0.01). Maximal mouth opening pre-/post-surgical ranged from 16 to 33 mm and 33-40 mm, with an average of 22.43 mm and 36.46 mm (p < 0.01). MRI was completed and showed stable disc reduction without recurrence 1 year postoperatively. MR/D was corrected and a better face shape was obtained. The satisfaction rate of clinicians, patients and third-parties was 92.375%, 94.156% and 94.218%, with an average of 93.583%. CONCLUSION For ADDwoR with MR/D patients, simultaneous TMJ anchorage surgery and genioplasty can improve TMJ symptoms/functions, correct facial appearance, and enhance the degree of satisfaction. The postoperative effect is stable, safe and reliable, which is worthy of clinical promotion.
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Affiliation(s)
- Lee Mui Lee
- Department of Stomatology,Shenzhen University General Hospital and Shenzhen University Clinical Medical Academy,Shenzhen University, 1098# XueYuan Road, NanShan District, Shenzhen City, 518055, GuangDong Province, China.
| | - Dan Di Zhang
- Department of Stomatology,Shenzhen University General Hospital and Shenzhen University Clinical Medical Academy,Shenzhen University, 1098# XueYuan Road, NanShan District, Shenzhen City, 518055, GuangDong Province, China.
| | - Yao Min Zhu
- Department of Oral&Maxillofacial Surgery, Shenzhen Stomatology Hospital Affiliated to Shenzhen University,Shenzhen University, 70# GuiYuan North Road, LuoHu District, Shenzhen City, GuangDong Province, China.
| | - Hui Na Cheng
- Department of Stomatology,Shenzhen University General Hospital and Shenzhen University Clinical Medical Academy,Shenzhen University, 1098# XueYuan Road, NanShan District, Shenzhen City, 518055, GuangDong Province, China.
| | - Wei Yao
- Department of Stomatology,Shenzhen University General Hospital and Shenzhen University Clinical Medical Academy,Shenzhen University, 1098# XueYuan Road, NanShan District, Shenzhen City, 518055, GuangDong Province, China.
| | - Xiao Liang
- Department of Anesthesiology, Shenzhen Stomatology Hospital Affiliated to Shenzhen University, Shenzhen University, China.
| | - Qiang Yong Deng
- Department of Stomatology,Shenzhen University General Hospital and Shenzhen University Clinical Medical Academy,Shenzhen University, 1098# XueYuan Road, NanShan District, Shenzhen City, 518055, GuangDong Province, China.
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Liu X, Zhou Z, Mao Y, Chen X, Zheng J, Yang C, Zhang S, Huo L. Temporomandibular joint anchorage surgery: a 5-year follow-up study. Sci Rep 2019; 9:19106. [PMID: 31836752 PMCID: PMC6911021 DOI: 10.1038/s41598-019-54592-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 11/01/2019] [Indexed: 11/24/2022] Open
Abstract
The purpose of this study was to confirm the 5-year efficiency of temporomandibular joint (TMJ) anchorage, using clinical evaluation and magnetic resonance imaging (MRI). We also studied the influence of disc length and position on efficiency and postoperative condylar height. Sixty-one patients (76 joints) undergoing TMJ disc anchorage were followed up for >5 years. Visual analogue scale (VAS) score and maximum mouth-opening pre-and postsurgery were analysed and patient satisfaction recorded. Disc length, condyle height and disc position pre- and postsurgery were measured using MRI. Patients were ranked as A, B or C degree according to postoperative disc condyle position. Mean follow-up time was 71.34 months. Maximum mouth-opening improved by 14.34 ± 5.87 mm, and VAS score decreased by 33.44 ± 20.56 (P < 0.05). Clinical evaluation efficiency was 84.21%; patient satisfaction rate was 85.53%. On follow-up MRI, 68 joints were judged A or B degree (89.67%). Disc length was 7.96 ± 1.38 mm, 7.10 ± 1.41 mm and 5.75 ± 1.16 mm in A, B and C groups, respectively. In patients evaluated as C, condylar height decreased by 0.43 ± 1.36 mm, while increasing by 0.67 ± 1.88 mm and 0.51 ± 1.09 mm in A and B groups, respectively (all P < 0.05). We concluded that anchorage surgery improves mouth-opening and eliminates pain, longer disc length is related to better postoperative disc position, and significant condylar reconstruction occurs after disc repositioning. MRI confirmed that TMJ disc anchorage is reliable 5 years postsurgery.
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Affiliation(s)
- Xiuming Liu
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Zhihang Zhou
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Yi Mao
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Xuzhuo Chen
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Jisi Zheng
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Chi Yang
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China.
| | - Shanyong Zhang
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Liang Huo
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
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Can anterior repositioning splint effectively treat temporomandibular joint disc displacement? Sci Rep 2019; 9:534. [PMID: 30679602 PMCID: PMC6346049 DOI: 10.1038/s41598-018-36988-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 11/28/2018] [Indexed: 12/18/2022] Open
Abstract
The aim of this study was to determine whether anterior repositioning splint (ARS) can effectively treat temporomandibular joint (TMJ) anterior disc displacement with reduction (DDwR) in juvenile Class II patients. This study investigated disc repositioning clinically and through use of MRI with 12-month follow up. Patients with skeletal Class II malocclusions and DDwR diagnosed by magnetic resonance imaging (MRI) were treated with ARS. The efficacy of ARS was assessed clinically and by means of MRI before treatment (T0), immediately after bite registration (T1), at the end of treatment (T2), and at 12 months after functional appliance treatment (T3). Improvement in TMJ pain, TMJ noises, and range of mandibular movement were assessed. MRI evaluation was based on disc-condylar relationship in parasagittal images. Seventy-two juvenile patients with 91 joints were included in this study. The average age was 15.7 years old (range, 10–20 years) at first visit. There were statistically significant reductions in TMJ pain, disability in daily life and TMJ clicking (P < 0.01). MRI at T2 indicated that the success rate was 92.31% (84/91), but decreased to 72.53% (66/91) at T3. The unsuccessful splint disc capture was mainly observed in late adolescence, especially over 18 years old. Using MRI results as the gold standard, we found that clinical assessment had an accuracy rate of 75.82% at 12-month follow-up. In conclusion, although success rate for ARS treatment decreased over time, both clinical findings and MRI examination indicate that the ARS is relatively effective in repositioning the DDwR, especially for patients in early puberty. However, further and larger studies are needed to evaluate the outcome with ARS.
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Miao Z, Wang XD, Mao LX, Xia YH, Yuan LJ, Cai M, Liu JQ, Wang B, Yang X, Zhu L, Yu HB, Fang B. Influence of temporomandibular joint disc displacement on mandibular advancement in patients without pre-treatment condylar resorption. Int J Oral Maxillofac Surg 2017; 46:328-336. [DOI: 10.1016/j.ijom.2016.08.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 08/06/2016] [Accepted: 08/17/2016] [Indexed: 12/19/2022]
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Prevention of adhesions in the temporomandibular joint by the use of chitosan membrane in goats. Br J Oral Maxillofac Surg 2017; 55:26-30. [DOI: 10.1016/j.bjoms.2016.08.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 08/22/2016] [Indexed: 11/20/2022]
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Hu YK, Yang C, Xie QY. Changes in disc status in the reducing and nonreducing anterior disc displacement of temporomandibular joint: a longitudinal retrospective study. Sci Rep 2016; 6:34253. [PMID: 27671371 PMCID: PMC5037465 DOI: 10.1038/srep34253] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 09/08/2016] [Indexed: 11/21/2022] Open
Abstract
Treatment procedures for anterior disc displacement (ADD) of temporomandibular joint (TMJ) are far from reaching a consensus. The aim of the study was to evaluate disc status changes of anterior disc displacement with reduction (ADDWR) and without reduction (ADDWoR) comparatively, to get a better understanding of the disease progress without intervention. This longitudinal retrospective study included 217 joints in 165 patients, which were divided into ADDWR group and ADDWoR group based on magnetic resonance imaging (MRI) examination. The joints were assessed quantitatively for disc length and displacement distance at initial and follow-up visits. Disc morphology, which was classified in 5 types, was also evaluated. Paired t-test and Wilcoxon signed rank test were used to assess intra-group differences and independent t-test for inter-group differences. Moreover, analysis of covariance was applied to analyze influential factors for changes in disc length and displacement distance. According to our results, discs tended to become shorter, move further forward and distort more seriously in ADDWoR group than in ADDWR group after follow-up. Moreover, discs were prone to become shorter and more anteriorly displaced in teenagers, type I and III morphologies, advanced Wilkes stages, or those with joint effusion. Follow-up period seemed to be not critical.
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Affiliation(s)
- Ying Kai Hu
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, Shanghai Key Laboratory of Stomatology, People's Republic of China
| | - Chi Yang
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, Shanghai Key Laboratory of Stomatology, People's Republic of China
| | - Qian Yang Xie
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, Shanghai Key Laboratory of Stomatology, People's Republic of China
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Zayed O, Khedr M, Sadakah A, El-deeb A. Evaluation of using botulinum toxin (A) in the treatment of myofacial pain syndrome. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.tdj.2015.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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9
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Millon-Cruz A, Martín-Granizo R, Encinas A, Berguer A. Relationship between intra-articular adhesions and disc position in temporomandibular joints: Magnetic resonance and arthroscopic findings and clinical results. J Craniomaxillofac Surg 2015; 43:497-502. [DOI: 10.1016/j.jcms.2015.02.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 01/08/2015] [Accepted: 02/13/2015] [Indexed: 11/27/2022] Open
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10
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Changes in the Temporomandibular Joint Space After Functional Treatment of Disk Displacement With Reduction. J Craniofac Surg 2015; 26:e78-81. [DOI: 10.1097/scs.0000000000001392] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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11
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Shen P, Huo L, Zhang SY, Yang C, Cai XY, Liu XM. Magnetic resonance imaging applied to the diagnosis of perforation of the temporomandibular joint. J Craniomaxillofac Surg 2014; 42:874-8. [DOI: 10.1016/j.jcms.2014.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 10/06/2013] [Accepted: 01/03/2014] [Indexed: 10/25/2022] Open
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Peck CC, Goulet JP, Lobbezoo F, Schiffman EL, Alstergren P, Anderson GC, de Leeuw R, Jensen R, Michelotti A, Ohrbach R, Petersson A, List T. Expanding the taxonomy of the diagnostic criteria for temporomandibular disorders. J Oral Rehabil 2014; 41:2-23. [PMID: 24443898 PMCID: PMC4520529 DOI: 10.1111/joor.12132] [Citation(s) in RCA: 193] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2013] [Indexed: 12/21/2022]
Abstract
There is a need to expand the current temporomandibular disorders' (TMDs) classification to include less common but clinically important disorders. The immediate aim was to develop a consensus-based classification system and associated diagnostic criteria that have clinical and research utility for less common TMDs. The long-term aim was to establish a foundation, vis-à-vis this classification system, that will stimulate data collection, validity testing and further criteria refinement. A working group [members of the International RDC/TMD Consortium Network of the International Association for Dental Research (IADR), members of the Orofacial Pain Special Interest Group (SIG) of the International Association for the Study of Pain (IASP), and members from other professional societies] reviewed disorders for inclusion based on clinical significance, the availability of plausible diagnostic criteria and the ability to operationalise and study the criteria. The disorders were derived from the literature when possible and based on expert opinion as necessary. The expanded TMDs taxonomy was presented for feedback at international meetings. Of 56 disorders considered, 37 were included in the expanded taxonomy and were placed into the following four categories: temporomandibular joint disorders, masticatory muscle disorders, headache disorders and disorders affecting associated structures. Those excluded were extremely uncommon, lacking operationalised diagnostic criteria, not clearly related to TMDs, or not sufficiently distinct from disorders already included within the taxonomy. The expanded TMDs taxonomy offers an integrated approach to clinical diagnosis and provides a framework for further research to operationalise and test the proposed taxonomy and diagnostic criteria.
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Affiliation(s)
- Christopher C. Peck
- Jaw Function and Orofacial Pain Research Unit, Faculty of Dentistry, The University of Sydney, Sydney, Australia
| | | | - Frank Lobbezoo
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
| | - Eric L. Schiffman
- Department of Diagnostic and Biological Sciences, Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, USA
| | - Per Alstergren
- Department of Orofacial Pain and Jaw Function, Malmö University, Sweden
| | | | - Reny de Leeuw
- Orofacial Pain Center, Department of Oral Health Science, University of Kentucky, USA
| | - Rigmor Jensen
- Danish Headache Center, University of Copenhagen, Denmark
| | - Ambra Michelotti
- Department of Orthodontics and Gnathology, University of Naples Federico II, Italy
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo, USA
| | - Arne Petersson
- Department of Maxillofacial Radiology, Malmö University, Sweden
| | - Thomas List
- Department of Orofacial Pain and Jaw Function, Malmö University, Sweden
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Vieira-Queiroz I, Gomes Torres MG, de Oliveira-Santos C, Flores Campos PS, Crusoé-Rebello IM. Biometric parameters of the temporomandibular joint and association with disc displacement and pain: a magnetic resonance imaging study. Int J Oral Maxillofac Surg 2013; 42:765-70. [PMID: 23490476 DOI: 10.1016/j.ijom.2013.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 09/28/2012] [Accepted: 01/09/2013] [Indexed: 11/28/2022]
Abstract
The aim of this study was to evaluate the relationship between biometric parameters of the components of the temporomandibular joint (TMJ), articular disc displacement, and TMJ pain. Magnetic resonance imaging (MRI) examinations of 185 patients were assessed (39 males and 146 females (370 TMJs), mean age 41.3 years, range 18-79 years). The antero-posterior length of the condyle was measured in its medial and lateral regions, as well as the transverse length of the condyle. Possible associations between linear measurements of the condyle, presence of disc displacement, and joint pain were tested. Although pain was more commonly reported among patients with disc displacements, this association was not statistically significant. We found statistically significant associations showing that the antero-posterior length of the condyle at the lateral pole (D1L), the antero-posterior length of the condyle at the medial pole (D1M), and the transverse length of the condyle (D2) were higher among patients without disc displacements when compared to those with unilateral or bilateral displacements. This study showed that disc displacement was associated with smaller condyles in the antero-posterior and transverse dimensions when compared to condyles in subjects with normal disc position.
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Affiliation(s)
- I Vieira-Queiroz
- Federal University of Bahia, School of Dentistry, Salvador, Brazil.
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Zhang S, Cao W, Wei K, Liu X, Xu Y, Yang C, Undt G, Haddad MS, Chen W. Expression of VEGF-receptors in TMJ synovium of rabbits with experimentally induced internal derangement. Br J Oral Maxillofac Surg 2013; 51:69-73. [PMID: 22342115 DOI: 10.1016/j.bjoms.2012.01.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 01/23/2012] [Indexed: 02/05/2023]
Abstract
Our aim was to evaluate the expression of vascular endothelial growth factor receptors (VEGFRs) in the synovium of the temporomandibular joints (TMJ) of rabbits with experimentally induced internal derangement. Internal derangement was experimentally induced in 52 rabbit TMJ, and established on the right side of TMJ while the left side was used as the control. Each joint and its control was evaluated by magnetic resonance imaging (MRI) and endoscopy. The synovial tissues on both sides were harvested after one, two, three, and four weeks. The expression of VEGFRs mRNA was investigated in the experimental joint and its control using real-time polymerase chain reaction (PCR). Internal derangement was successfully confirmed in 45 of the 52 of the experimental joints (87%) on the right side by MRI and endoscopy. In the first and fourth week, the VEGFR-2 mRNA expression was higher in the experimental joints than in the controls (P=0.008 and P=0.02). Meanwhile, the VEGFR-1 mRNA expression was up-regulated in the experimental group compared with the controls during the fourth week (P=0.02). However, we found no significant differences in VEGFR-3 mRNA expression in the two groups during the first and fourth weeks. During the second and third weeks, the mRNA expression of the three receptors did not differ significantly among the groups. Our data have shown increased expression of VEGFR-1 and VEGFR-2 mRNA in the synovium of rabbit TMJ with internal derangement, which indicates that VEGFR-1 and VEGFR-2 may have important roles in the processes of internal derangement and formation of adhesions.
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Affiliation(s)
- ShanYong Zhang
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Collage of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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Zhang S, Huang D, Liu X, Yang C, Undt G, Haddad SM, Chen Z. Arthroscopic Treatment for Intra-Articular Adhesions of the Temporomandibular Joint. J Oral Maxillofac Surg 2011; 69:2120-7. [DOI: 10.1016/j.joms.2010.12.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 11/18/2010] [Accepted: 12/28/2010] [Indexed: 10/18/2022]
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Venetis G, Pilavaki M, Triantafyllidou K, Papachristodoulou A, Lazaridis N, Palladas P. The value of magnetic resonance arthrography of the temporomandibular joint in imaging disc adhesions and perforations. Dentomaxillofac Radiol 2011; 40:84-90. [PMID: 21239570 DOI: 10.1259/dmfr/13255885] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study attempted to validate MR arthrography (MRAr) of the temporomandibular joint (TMJ) in detecting the position, integrity and relations of the articular disc and retrodiscal tissue. METHODS A total of 20 TMJs from 10 patients with severe TMJ dysfunction underwent MRI and MRAr. A paramagnetic contrast medium was injected into the upper joint compartment to observe possible adhesions and/or leakage into the lower compartment. 15 TMJs were surgically or arthroscopically explored and restored. RESULTS MRAr was approximately in the same diagnostic value as MRI when locating position, but superior in detecting disc perforations (eight TMJs) and adhesions (seven TMJs) appearing together in four cases. Surgery confirmed radiological findings in all but one case, where arthroscopy and surgery failed to confirm a disc perforation indicated by MRAr. CONCLUSIONS TMJ MRAr may simultaneously reveal adhesions and perforations. Sensitivity and the probability of false-positive results require further study.
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Affiliation(s)
- G Venetis
- University Clinic of Oral and Maxillofacial Surgery, Thessaloniki, Greece.
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Zhang S, Liu X, Xu Y, Yang C, Undt G, Chen M, Haddad MS, Yun B. Application of Rapid Prototyping for Temporomandibular Joint Reconstruction. J Oral Maxillofac Surg 2011; 69:432-8. [DOI: 10.1016/j.joms.2010.05.081] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Revised: 03/14/2010] [Accepted: 05/19/2010] [Indexed: 11/26/2022]
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Zhang S, Liu X, Yang X, Yang C, Chen M, Haddad MS, Chen Z. Temporomandibular joint disc repositioning using bone anchors: an immediate post surgical evaluation by magnetic resonance imaging. BMC Musculoskelet Disord 2010; 11:262. [PMID: 21073724 PMCID: PMC2992481 DOI: 10.1186/1471-2474-11-262] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 11/12/2010] [Indexed: 11/18/2022] Open
Abstract
Background Open joint procedures using bone anchors have shown clinical and radiograph good success, but post surgical disc position has not been documented with MRI imaging. We have designed a modified technique of using two bone anchors and 2 sutures to reposition the articular discs. This MRI study evaluates the post surgical success of this technique to reposition and stabilize the TMJ articular discs. Methods Consecutive 81 patients with unilateral TMJ internal derangement (ID) (81 TMJs) were treated between December 1, 2003, and December 1, 2006, at the Department of Oral and Maxillofacial Surgery, Ninth Peoples Hospital, Shanghai, Jiao Tong University School of Medicine. All patients were subjected to magnetic resonance imaging before and one to seven days post surgery to determine disc position using the modified bone anchor technique. Results Postoperative MRIs (one to seven days) confirm that 77 of 81 joints were identified as excellent results and one joint was considered good for an overall effective rate of 96.3% (78 of 81 joints). Only 3.7% (3 of 81) of the joints were designated as poor results requiring a second open surgery. Conclusions This procedure has provided successful repositioning of the articular discs in unilateral TMJ ID at one to seven days post surgery.
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Affiliation(s)
- Shanyong Zhang
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, No 639, Zhi Zao Ju Rd, 200011 Shanghai, People's Republic of China
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Zhang SY, Liu XM, Yang C, Cai XY, Chen MJ, Haddad MS, Yun B, Chen ZZ. New Arthroscopic Disc Repositioning and Suturing Technique for Treating Internal Derangement of the Temporomandibular Joint: Part II—Magnetic Resonance Imaging Evaluation. J Oral Maxillofac Surg 2010; 68:1813-7. [DOI: 10.1016/j.joms.2009.08.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Accepted: 08/18/2009] [Indexed: 10/20/2022]
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Liu XM, Zhang SY, Yang C, Chen MJ, Y Cai X, Haddad MS, Yun B, Chen ZZ. Correlation between disc displacements and locations of disc perforation in the temporomandibular joint. Dentomaxillofac Radiol 2010; 39:149-56. [PMID: 20203276 DOI: 10.1259/dmfr/72395946] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the correlation between disc displacement types and locations of disc perforation in the temporomandibular joint (TMJ). METHODS 157 patients (162 joints) with disc perforation observed through arthroscopy were included in this study. The types of disc displacement were analysed by TMJ MRI before operation. The locations of disc perforation under arthroscopy were recorded. The correlation between types of disc displacement and locations of disc perforation was analysed by Fisher's exact test. RESULTS Medial disc perforation was observed in 55.6% of patients with anterolateral displacement without reduction, but was observed in only 3.7% of patients with pure anterior displacement, and was not observed in patients with anteromedial displacement without reduction. There was a statistically significant difference between these groups in the incidence of medial disc perforation. CONCLUSIONS There is a correlation between different disc displacements and locations of disc perforation. The incidence of medial disc perforation in patients with anterolateral displacement was significantly higher. The types of disc displacement may have direct influence over the locations of disc perforation.
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Affiliation(s)
- X M Liu
- Department of Oral & Maxillofacial Surgery, Ninth People's Hospital, School of Stomatology, Shanghai JiaoTong University, No. 639, Zhi Zao Ju Rd, 200011, Shanghai, People's Republic of China
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Robinson de Senna B, Marques LS, França JP, Ramos-Jorge ML, Pereira LJ. Condyle-disk-fossa position and relationship to clinical signs and symptoms of temporomandibular disorders in women. ACTA ACUST UNITED AC 2009; 108:e117-24. [PMID: 19716481 DOI: 10.1016/j.tripleo.2009.04.034] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2008] [Revised: 04/07/2009] [Accepted: 04/29/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of the present study was to assess the disk-condyle-fossa relationship through magnetic resonance imaging and determine its association with clinical signs and symptoms of temporomandibular disorder in patients with myofascial pain and disk displacement (with and without reduction). STUDY DESIGN Sixty-two female patients with complaints of pain were clinically examined using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and divided into the following groups: Group I, myofascial pain (n = 19); Group IIa, disk displacement with reduction (n = 32); and Groups IIb and IIc, disk displacement without reduction (n = 11). Classification of disk position was based on the positioning on a clock face (> or < than 11 o'clock) and condylar excursion was determined as (1) the proximal side of the apex of the articular eminence; (2) at the level of the articular eminence; and (3) beyond the apex of the articular eminence. Condylar position was determined in the sagittal images based on Gelb's template (normal, posteriorly displaced). Pain was assessed using a visual analogue scale (VAS). The univariate logistic regression, Mann-Whitney, Kruskall-Wallis and Pearson's correlation tests were used in the statistical analysis (P < or = .05). RESULTS No significant association was found between the independent variables (condylar position, disk position, and condylar excursion) and the dependent variables (pain, maximal opening of the mouth, maximal lateral movement). However, there was a significant association between increased condyle excursion and pain (P = .035) and also maximum mouth opening movement was associated with lateral movement (P = .01; r = 0.31). CONCLUSIONS Increase in condyle excursion may significantly influence pain perception in TMD patients. The type of dysfunction and severity of alterations on the imaging exams were not related to the severity of pain or range of motion of the mandible.
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de Senna BR, dos Santos Silva VK, França JP, Marques LS, Pereira LJ. Imaging diagnosis of the temporomandibular joint: critical review of indications and new perspectives. Oral Radiol 2009. [DOI: 10.1007/s11282-009-0025-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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MRI-Guided Injection Procedures of the Temporomandibular Joints in Children and Adults: Technique, Accuracy, and Safety. AJR Am J Roentgenol 2009; 193:1148-54. [PMID: 19770341 DOI: 10.2214/ajr.09.2473] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Zhang S, Liu X, Yang C, Cai X, Chen M, Haddad MS, Yun B, Chen Z. Intra-articular adhesions of the temporomandibular joint: Relation between arthroscopic findings and clinical symptoms. BMC Musculoskelet Disord 2009; 10:70. [PMID: 19534789 PMCID: PMC2702314 DOI: 10.1186/1471-2474-10-70] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 06/17/2009] [Indexed: 11/30/2022] Open
Abstract
Background Intra-articular adhesion (IA) is one of the important pathologic signs of intracapsular temporomandibular joint (TMJ) diseases, but this factor has been rarely described with respect to its arthroscopic characteristics and histology. The purpose of this study was to describe the incidence and distribution of IA in patients with internal derangement (ID) and to investigate the correlation between adhesions and the clinical symptoms of patients with ID of TMJ with closed-lock. Methods A retrospective analysis was conducted of 1822 TMJs with ID that were refractory to nonsurgical treatments and underwent arthroscopic surgery between May 2001 and June 2008 in our department. Clinical findings were assessed on the basis of mandibular range of motion, patients' age and locking duration at the initial visit. ID stages were judged according to the Wilkes and Bronstein classification based on clinical symptoms and pre-operative magnetic resonance imaging. 1506 patients (1822 joints) with ID were divided into an adhesion group (486 patients) and a non-adhesion group (1020 patients). The associations between the two groups with respect to interincisal opening, clicking duration, locking duration and patients' age were statistically analyzed using a t-test. Results Arthroscopy confirmed occurrences of adhesion in 28.76% of the joints (524 joints out of a total of 1822). Grade 1 adhesion was found in 68.89% of those cases; grade 2 in 20.61%; grade 3 in 4.58%; and grade 4 in 5.92%. The percentages of instances of adhesion in different stages were as follows: 13.89% of the joints in Stage II had adhesion, 25.47% in Stage III, 37.99% in Stage IV, and 40.37% in Stage V. There were statistically significant differences for patients' age (t = 10.41, P < 0.001), interincisal opening (t = 9.54, P < 0.001), paining duration (t = 3.66, P < 0.001) and locking duration (t = 3.89, P < 0.001) between the two groups, while no statistically significant difference was found for clicking duration (t = 1.08, P > 0.05). Conclusion The arthroscopic findings confirmed that the incidence ratio of adhesion was high and occurred predominantly with older patients with longer locking duration and less interincisal opening. As the stage of ID increased, the adhesion grade rose.
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Affiliation(s)
- ShanYong Zhang
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, No 639, Zhi Zao Ju Rd, 200011 Shanghai, PR China.
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Histologic study of adhesions in the upper joint compartment of the temporomandibular joint. J Oral Maxillofac Surg 2009; 67:1184-90. [PMID: 19446202 DOI: 10.1016/j.joms.2008.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2007] [Revised: 09/14/2008] [Accepted: 12/05/2008] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study was to observe the histologic characteristics of adhesions in the upper joint compartment of the temporomandibular joint and investigate the mechanism of genesis. PATIENTS AND METHODS During arthroscopic surgery, we obtained 42 biopsy specimens of different grades of adhesions, ranging from grade I to grade IV, from 21 joints in 21 patients with internal derangement. Two biopsy specimens from each temporomandibular joint were obtained in this study; one was immediately fixed in 4% formalin and examined under a light microscope, and the other was fixed in 2% glutaraldehyde solution and examined under a transmission electron microscope. RESULTS Different grades of adhesions had uniform dense connective tissue under the light microscope, and a number of fibrocytic cells were scattered within the extracellular matrix. However, in grade II adhesions, synovial membrane and some elastic fibers were shown. Under the transmission electron microscope, orderly arranged collagen bundles were prominent in grade I and grade III adhesions. Elastic fibers were abundant in grade II adhesions with orderly arranged collagen bundles; a small number of inactive fibroblasts were scattered about these adhesions. Randomly arranged collagen bundles and elastic fibers were also observed in grade IV adhesions, in which synovial membrane cells and cartilaginoid cells were detected. In addition, fibroblasts with active secretion were observed, and a considerable amount of rough endoplasmic reticulum was noted. CONCLUSIONS Different arrangements of collagen fibers with or without elastic fibers were observed in the 4 types of adhesions. These findings could enable further exploration into the mechanism of adhesion formation.
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