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Lee YH, Chun YH, Bae H, Lee JW, Kim HJ. Comparison of ultrasonography-based masticatory muscle thickness between temporomandibular disorders bruxers and temporomandibular disorders non-bruxers. Sci Rep 2024; 14:6923. [PMID: 38519584 PMCID: PMC10960048 DOI: 10.1038/s41598-024-57696-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/20/2024] [Indexed: 03/25/2024] Open
Abstract
To compare masticatory muscle thickness in patients with temporomandibular disorders (TMDs) during rest and clenching, and by body position, using ultrasonography. This prospective study included 96 patients with TMD (67 females, 29 males; mean age: 40.41 ± 17.88 years): group 1, comprising 66 patients with TMD without bruxism (TMD_nonbruxer), and group 2, comprising 30 patients with concurrent TMD and bruxism (TMD_bruxer). In patients with TMD, bruxism was correlated with the presence of tinnitus, muscle stiffness, sleep problems, psychological stress, and restricted mouth opening. The masseter muscle significantly thickened during clenching (11.16 ± 3.03 mm vs 14.04 ± 3.47 mm, p < 0.001), whereas the temporalis muscle showed no significant increase in thickness from resting to clenching in an upright position (7.91 ± 1.98 vs 8.39 ± 2.08, p = 0.103). Similarly, during clenching in the supine position, the masseter muscle was significantly thicker compared with rest (11.24 ± 2.42 vs 13.49 ± 3.09, p < 0.001), but no significant difference was observed in temporal muscle thickness (8.21 ± 2.16 vs 8.43 ± 1.94, p = 0.464). In comparison between two groups, the average thickness of the masseter muscle was greater among TMD_bruxers than among TMD_nonbruxers in both the upright and supine positions (all p < 0.05). In the generalized lineal model, female sex (B = - 1.018, 95% confidence interval [CI] - 1.855 to - 0.181, p = 0.017) and bruxism (B = 0.868, 95% CI 0.567 to 1.169, p = 0.048) significantly predicted changes in masseter muscle thickness. Female sex (B = - 0.201, 95% CI - 0.299 to - 0.103, p = 0.011), increased age (B = - 0.003, 95% CI - 0.005 to 0.000, p = 0.038), and muscle stiffness (B = - 1.373, 95% CI - 2.369 to - 0.376, p = 0.007) were linked to decreased temporal muscle thickness. Comparing TMD nonbruxer and bruxer muscle thicknesses in upright and supine positions revealed significant increased thickness in the masseter muscle during clenching but not in the temporalis muscle. Masseter muscle thickness varied significantly by sex, body position, and resting/clenching, notably influenced by bruxism. These findings emphasize the relevance of these factors in clinical examinations of patients with TMD.
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Affiliation(s)
- Yeon-Hee Lee
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University, Kyung Hee University Dental Hospital, #613 Hoegi-dong, Dongdaemun-gu, Seoul, 02447, South Korea.
| | - Yang-Hyun Chun
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University, Kyung Hee University Dental Hospital, #613 Hoegi-dong, Dongdaemun-gu, Seoul, 02447, South Korea
| | - Hyungkyu Bae
- Division in Anatomy and Developmental Biology, Department of Oral Biology, BK21 FOUR Project, Human Identification Research Institute, Yonsei University College of Dentistry, Seoul, South Korea
| | - Jung-Woo Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, 02447, South Korea
| | - Hee-Jin Kim
- Division in Anatomy and Developmental Biology, Department of Oral Biology, BK21 FOUR Project, Human Identification Research Institute, Yonsei University College of Dentistry, Seoul, South Korea
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Maranini B, Ciancio G, Mandrioli S, Galiè M, Govoni M. The Role of Ultrasound in Temporomandibular Joint Disorders: An Update and Future Perspectives. Front Med (Lausanne) 2022; 9:926573. [PMID: 35795636 PMCID: PMC9251198 DOI: 10.3389/fmed.2022.926573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/24/2022] [Indexed: 12/11/2022] Open
Abstract
Temporomandibular joint (TMJ) disorder is the second most common chronic pain condition affecting the general population after back pain. It encompasses a complex set of conditions, manifesting with jaw pain and limitation in mouth opening, influencing chewing, eating, speaking, and facial expression. TMJ dysfunction could be related to mechanical abnormalities or underlying inflammatory arthropathies, such as rheumatoid arthritis (RA) or juvenile idiopathic arthritis (JIA). TMJ exhibits a complex anatomy, and thus a thorough investigation is required to detect the TMJ abnormalities. Importantly, TMJ involvement can be completely asymptomatic during the early stages of the disease, showing no clinically detectable signs, exposing patients to delayed diagnosis, and progressive irreversible condylar damage. For the prevention of JIA complications, early diagnosis is therefore essential. Currently, magnetic resonance imaging (MRI) is described in the literature as the gold standard method to evaluate TMJ. However, it is a high-cost procedure, not available in all centers, and requires a long time for image acquisition, which could represent a problem notably in the pediatric population. It also suffers restricted usage in patients with claustrophobia. Ultrasonography (US) has emerged in recent years as an alternative diagnostic method, as it is less expensive, not invasive, and does not demand special facilities. In this narrative review, we will investigate the power of US in TMJ disorders based on the most relevant literature data, from an early screening of TMJ changes to differential diagnosis and monitoring. We then propose a potential algorithm to optimize the management of TMJ pathology, questioning what would be the role of ultrasonographic study.
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Affiliation(s)
- Beatrice Maranini
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- *Correspondence: Beatrice Maranini
| | - Giovanni Ciancio
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Stefano Mandrioli
- Department of Cranio-Maxillofacial Surgery, Unit of Cranio-Maxillofacial Surgery, University of Ferrara, Ferrara, Italy
| | - Manlio Galiè
- Department of Cranio-Maxillofacial Surgery, Unit of Cranio-Maxillofacial Surgery, University of Ferrara, Ferrara, Italy
| | - Marcello Govoni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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Stimmer H, Grill F, Waschulzik B, Nieberler M, Wolff KD, Kolk A. Temporal Tendinitis in Craniomandibular Dysfunction (CMD) - Does it Really Exist? A Temporomandibular MRI Investigation. ROFO-FORTSCHR RONTG 2022; 194:1242-1249. [PMID: 35613906 DOI: 10.1055/a-1829-6134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aim of the study was to analyze the role of temporal muscle and particularly tendon pathology in patients suffering from craniomandibular dysfunction (CMD) using magnetic resonance imaging. MATERIALS AND METHODS Retrospective analysis of MRI examinations was carried out with regard to temporal muscle fibrosis and fatty degeneration and particularly temporal tendon rupture, thickening, and degenerative signal alterations. Descriptive statistics and the Mann-Whitney U-test were used for statistical evaluation. RESULTS Structural lesions of temporal muscle parenchyma were the absolute exception. PD hyperintensity, pronounced contrast enhancement, or peritendinous fluid collections along the temporal tendon were found only to a small extent, and a (partial) rupture occurred in only one case. The tendon diameter showed only slight variability. The Mann-Whitney U-test provided no results indicating a causal connection between degenerative joint or disc disease and temporal tendon pathology. CONCLUSION A large sample of 128 magnetic resonance imaging examinations provided no evidence of a major role of temporal tendinitis in clinical CMD syndrome. KEY POINTS · Retrospective analysis of temporal tendon in CMD patients.. · Abnormal structural findings along the tendon seen only rarely.. · Obviously no crucial role of temporal tendon lesions in CMD syndrome.. CITATION FORMAT · Stimmer H, Grill F, Waschulzik B et al. Temporal Tendinitis in Craniomandibular Dysfunction (CMD) - Does it Really Exist? A Temporomandibular MRI Investigation. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1829-6134.
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Affiliation(s)
- Herbert Stimmer
- Department of Radiology, Klinikum rechts der Isar der Technischen Universität München, D-81675 München, Germany
| | - Florian Grill
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar der Technischen Universität München, D-81675 München, Germany
| | - Birgit Waschulzik
- Department of Medical Statistics and Epidemiology, Klinikum rechts der Isar der Technischen Universität München, D-81675 München, Germany
| | - Markus Nieberler
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar der Technischen Universität München, D-81675 München, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar der Technischen Universität München, D-81675 München, Germany
| | - Andreas Kolk
- Department of Oral and Maxillofacial Surgery, Medizinische Universität Innsbruck, A-6020 Innsbruck, Austria
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MRI-Based Assessment of Masticatory Muscle Changes in TMD Patients after Whiplash Injury. J Clin Med 2021; 10:jcm10071404. [PMID: 33915742 PMCID: PMC8036470 DOI: 10.3390/jcm10071404] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/20/2021] [Accepted: 03/29/2021] [Indexed: 12/15/2022] Open
Abstract
Objective: to investigate the change in volume and signal in the masticatory muscles and temporomandibular joint (TMJ) of patients with temporomandibular disorder (TMD) after whiplash injury, based on magnetic resonance imaging (MRI), and to correlate them with other clinical parameters. Methods: ninety patients (64 women, 26 men; mean age: 39.36 ± 15.40 years), including 45 patients with symptoms of TMD after whiplash injury (wTMD), and 45 age- and sex-matched controls with TMD due to idiopathic causes (iTMD) were included. TMD was diagnosed using the study diagnostic criteria for TMD Axis I, and MRI findings of the TMJ and masticatory muscles were investigated. To evaluate the severity of TMD pain and muscle tenderness, we used a visual analog scale (VAS), palpation index (PI), and neck PI. Results: TMD indexes, including VAS, PI, and neck PI were significantly higher in the wTMD group. In the wTMD group, muscle tenderness was highest in the masseter muscle (71.1%), and muscle tenderness in the temporalis (60.0%), lateral pterygoid muscle (LPM) (22.2%), and medial pterygoid muscle (15.6%) was significantly more frequent than that in the iTMD group (all p < 0.05). The most noticeable structural changes in the masticatory muscles occurred in the LPM with whiplash injury. Volume (57.8% vs. 17.8%) and signal changes (42.2% vs. 15.6%) of LPM were significantly more frequent in the wTMD group than in the iTMD group. The presence of signal changes in the LPM was positively correlated with the increased VAS scores only in the wTMD group (r = 0.346, p = 0.020). The prevalence of anterior disc displacement without reduction (ADDWoR) (53.3% vs. 28.9%) and disc deformity (57.8% vs. 40.0%) were significantly higher in the wTMD group (p < 0.05). The presence of headache, sleep problems, and psychological distress was significantly higher in the wTMD group than in the iTMD group. Conclusion: abnormal MRI findings and their correlations with clinical characteristics of the wTMD group were different from those of the iTMD group. The underlying pathophysiology may differ depending on the cause of TMD, raising the need for a treatment strategy accordingly.
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Whyte A, Boeddinghaus R, Bartley A, Vijeyaendra R. Imaging of the temporomandibular joint. Clin Radiol 2020; 76:76.e21-76.e35. [PMID: 32709388 DOI: 10.1016/j.crad.2020.06.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/29/2020] [Indexed: 12/11/2022]
Abstract
Temporomandibular disorders are common, especially in young to middle-aged women, and most settle with supportive treatment. Imaging is indicated for the small percentage of cases that do not respond to conservative management and when the diagnosis is no doubt. The temporomandibular joint (TMJ) is a bilateral synovial articulation between the mandible and skull base. It has an intra-articular disc dividing the joint into superior and inferior compartments and the articular surfaces are lined with fibrocartilage. The normal imaging anatomy of the TMJ is described and illustrated. Different movements occur in each joint compartments: a hinge movement in the inferior joint space and translation or gliding in the superior joint space. Internal derangement is the commonest disorder affecting the TMJ and is most commonly due to disc displacement, followed by osteoarthritis and inflammatory arthritides. The imaging findings, primarily on magnetic resonance imaging (MRI) and computed tomography (CT), of internal derangement and less common disorders of the joint, are reviewed and illustrated. Optimal imaging protocols are discussed with detailed reporting guidelines.
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Affiliation(s)
- A Whyte
- Perth Radiological Clinic, 127 Hamersley Rd, Subiaco WA 6008, Australia; Department of Dentistry, University of Western Australia, Nedlands, WA 6009, Australia; Department of Medicine and Radiology, University of Melbourne, Carlton, Victoria 3000, Australia.
| | - R Boeddinghaus
- Perth Radiological Clinic, 127 Hamersley Rd, Subiaco WA 6008, Australia; Department of Surgery, University of Western Australia, Nedlands WA 6009, Australia
| | - A Bartley
- Perth Radiological Clinic, 127 Hamersley Rd, Subiaco WA 6008, Australia; Medical Imaging, Perth Children's Hospital, 15 Hospital Avenue, Nedlands WA 6009, Australia
| | - R Vijeyaendra
- Irwin Dental Clinic - Army Barracks, Samichon Road, Karrakatta WA 6010, Australia
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Whyte A, Matias MATJ. Imaging of orofacial pain. J Oral Pathol Med 2020; 49:490-498. [PMID: 32531821 DOI: 10.1111/jop.13063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Orofacial pain is a common complaint, with an estimated 75% of cases caused by dental disease, specifically a diseased pulp. A small percentage of orofacial pain cases will require specialist referral most commonly to oral medicine specialists or oral and maxillofacial surgeons from a dental perspective, or otolaryngologists or neurologists from a medical perspective. IMAGING MODALITIES Following a thorough history and clinical examination, imaging is often required to narrow the differential diagnosis or answer a specific query related to the final diagnosis. A range of imaging modalities can be used to evaluate orofacial pain including dental panoramic tomography (DPT), intraoral radiographs, cone beam computed tomography (CBCT), multidetector computed tomography (MDCT), ultrasonography (US), magnetic resonance imaging (MRI) and nuclear medicine. IMAGING PROTOCOLS This paper provides a guideline outlining imaging protocols for categories of facial pain divided into: (a) unilateral odontalgia; (b) unilateral facial pain; (c) combined unilateral odontalgia and facial pain; (d) trigeminal neuralgia; (e) trigeminal neuropathic pain with or without other sensory, autonomic or motor features; (f) temporomandibular joint disorders and associated pain; (g) referred pain and (h) non-specific orofacial pain. CONCLUSION Imaging for orofacial pain should be tailored to answer a specific query related to the aetiology of the reported pain. This should result in a specific diagnosis or narrowing of the differential diagnosis as possible causes of orofacial pain are eliminated. Choosing the correct imaging modality and protocol based on the pain category is important for efficient and effective pain diagnosis and management.
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Affiliation(s)
- Andy Whyte
- Perth Radiological Clinic, Subiaco, WA, Australia
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Evaluation of Biofeedback Usefulness in Masticatory Muscle Activity Management-A Systematic Review. J Clin Med 2019; 8:jcm8060766. [PMID: 31151198 PMCID: PMC6616888 DOI: 10.3390/jcm8060766] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 05/22/2019] [Accepted: 05/25/2019] [Indexed: 12/14/2022] Open
Abstract
Temporomandibular disorders (TMD) have multifactorial and complex etiology. Regardless of their etiology, all those conditions may result in centrally mediated chronic muscle pain, myalgia, myofascial pain, myofibrotic contracture, myosistis, myospasm, headache and a variety of neck, shoulder, upper back and lower back pain. Biofeedback (BF) is one of methods that has been used for more than 50 years in rehabilitation to facilitate normal movement patterns after injuries. Some studies suggest that biofeedback may be an effective treatment option for patients with different muscle disorders. The aim of this study was to evaluate the efficiency of biofeedback in masticatory muscle activity management in the light of current medical literature. The authors followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines for this systematic review. The authors searched the MEDLINE, Scopus, Web of Science, CINAHL databases to identify relevant publications. Finally 10 papers were included. Most of the selected studies showed a significant correlation between biofeedback usage and reduction of masticatory muscle activity. By analyzing qualified studies, it can be concluded that biofeedback can be an effective tool in masticatory muscle activity management.
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Costa YM, Ariji Y, Ferreira DMAO, Bonjardim LR, Conti PCR, Ariji E, Svensson P. Muscle hardness and masticatory myofascial pain: Assessment and clinical relevance. J Oral Rehabil 2018; 45:640-646. [PMID: 29745983 DOI: 10.1111/joor.12644] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2018] [Indexed: 11/29/2022]
Abstract
The impression of increased muscle hardness in painful muscles is commonly reported in the clinical practice but may be difficult to assess. Therefore, the aim of this review was to present and discuss relevant aspects regarding the assessment of muscle hardness and its association with myofascial temporomandibular disorder (TMD) pain. A non-systematic search for studies of muscle hardness assessment in patients with pain-related TMDs was carried out in PubMed, Cochrane Library, Embase and Google Scholar. Mechanical devices and ultrasound imaging (strain and shear wave elastography) have been consistently used to measure masticatory muscle hardness, although an undisputable reference standard is yet to be determined. Strain elastography has identified greater masseter hardness of the symptomatic side in patients with unilateral myofascial TMD pain when compared to the contralateral side and healthy controls (HC). Likewise, shear wave elastography has shown greater masseter elasticity modulus in patients with myofascial TMD pain when compared to HC, which may be an indication of muscle hardness. Although assessment bias could partly explain these preliminary findings, future randomised controlled trials are encouraged to investigate this relationship. This qualitative review indicates that the muscle hardness of masticatory muscles is still a rather unexplored field of investigation with a good potential to improve the assessment and potentially also the management of myofascial TMD pain. Nonetheless, the current evidence in favour of increased hardness in masticatory muscles in patients with myofascial TMD pain is weak, and the pathophysiological importance and clinical usefulness of such information remain unclear.
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Affiliation(s)
- Y M Costa
- Section of Head and Face Physiology, Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.,Bauru Orofacial Pain Group, University of São Paulo, Bauru, Brazil
| | - Y Ariji
- Department of Oral and Maxillofacial Radiology, Aichi-Gakuin University School of Dentistry, Nagoya, Japan
| | - D M A O Ferreira
- Bauru Orofacial Pain Group, University of São Paulo, Bauru, Brazil.,Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - L R Bonjardim
- Section of Head and Face Physiology, Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.,Bauru Orofacial Pain Group, University of São Paulo, Bauru, Brazil
| | - P C R Conti
- Bauru Orofacial Pain Group, University of São Paulo, Bauru, Brazil.,Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - E Ariji
- Department of Oral and Maxillofacial Radiology, Aichi-Gakuin University School of Dentistry, Nagoya, Japan
| | - P Svensson
- Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.,Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
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