Interpretation of images and discrepancy between osteoarthritic findings and symptomatology in temporomandibular joint

MRI characteristics of the asymptomatic temporomandibular joint in patients with unilateral temporomandibular joint disorder

OBJECTIVE

To determine the association between unilateral temporomandibular joint disorder (TMD) and the presence of imaging abnormalities in the contralateral, asymptomatic joint.

METHODS

MRI studies of 219 subjects with symptoms of unilateral TMD were examined for signs of disc displacement, osteoarthritis, disc deformation, and effusion in both temporomandibular joints (TMJ). The Chi-Square test and stepwise logistic regression analysis were performed.

RESULTS

Disc displacement, osteoarthritis, disc deformation, and effusion were more common on the symptomatic side. However, in the category of disc displacement with a reduction in open mouth position (DDWR), the difference was not significant between the symptomatic and the asymptomatic TMJs. Stepwise logistic regression showed that the presence of any imaging abnormality other than DDWR was related to osteoarthritis and disc deformity on the symptomatic side. On the other hand, the presence of any MRI abnormality (including DDWR) on the asymptomatic side was related only to the presence of osteoarthritis on the symptomatic side.

CONCLUSIONS

Unilateral symptomatic TMD is related to the presence of imaging abnormalities on the contralateral, asymptomatic side, suggesting that the development and progression of joint changes in symptomatic and contralateral asymptomatic TMJs are interrelated.

Microbiological investigation of the mandibular condyle in patients with advanced osteoarthritis of the temporomandibular joint

PURPOSE

The aim of this study was to investigate the presence of bacteria in samples of the temporomandibular joint taken from patients suffering from advanced osteoarthritis of the temporomandibular joint (TMJ).

MATERIALS AND METHODS

25 fresh mandibular condyle samples were taken from 17 consecutive patients undergoing mandibular condylectomy (8 bilateral) for advanced TMJ osteoarthritis (Dimitroulis Category 5 joints). The joint samples were stained and cultured for the presence of microorganisms following a standardised joint culture protocol.

RESULTS

No evidence of bacteria was found on staining or solid culture mediums. Late growth (day 12) of commensal skin organisms (P. Acnes, S. Epidermitis, S. Capitis) were identified in enriched broth samples in 5 joint samples. No statistically significant associations were noted between positive broth samples and age or previous joint intervention (p > 0.05) CONCLUSIONS: Within the limitations of this study, we have failed to identify meaningful bacterial growth in tissues (i.e. condylar head) of the TMJ that would suggest a contributory bacterial pathogenesis for arthritis of the TMJ.