Is There an Association Between Temporomandibular Joint Effusion and Arthralgia?

Relationship Between Temporomandibular Joint Effusion, Pain, and Jaw Function Limitation: A 2D and 3D Comparative Study

Purpose

This study aimed to investigate the relationship between temporomandibular joint (TMJ) effusion and TMJ pain, as well as jaw function limitation in patients via two-dimensional (2D) and three-dimensional (3D) magnetic resonance imaging (MRI) evaluation.

Patients and Methods

121 patients diagnosed with temporomandibular disorder (TMD) were included. TMJ effusion was assessed qualitatively using MRI and quantified with 3D Slicer software, then graded accordingly. In addition, a visual analogue scale (VAS) was employed for pain reporting and an 8-item Jaw Functional Limitations Scale (JFLS-8) was utilized to evaluate jaw function limitation. Statistical analyses were performed appropriately for group comparisons and association determination. A probability of p<0.05 was considered statistically significant.

Results

2D qualitative and 3D quantitative strategies were in high agreement for TMJ effusion grades (κ = 0.766). No significant associations were found between joint effusion and TMJ pain, nor with disc displacement and JLFS-8 scores. Moreover, the binary logistic regression analysis showed significant association between sex and the presence of TMJ effusion, exhibiting an Odds Ratio of 5.168 for females (p = 0.008).

Conclusion

2D qualitative evaluation was as effective as 3D quantitative assessment for TMJ effusion diagnosis. No significant associations were found between TMJ effusion and TMJ pain, disc displacement or jaw function limitation. However, it was suggested that female patients suffering from TMD may be at a risk for TMJ effusion. Further prospective research is needed for validation.

Reconstructed magnetic resonance image-based effusion volume assessment for temporomandibular joint arthralgia

BACKGROUND

Joint effusion is often noticed in magnetic resonance image (MRI) and its diagnostic value for arthralgia of the temporomandibular joint (TMJ) remains obscure.

OBJECTIVE

To develop a method for quantitatively evaluating the joint effusion revealed in MRI and its diagnostic value for arthralgia of the TMJ.

METHODS

Two-hundreds and twenty-eight TMJs, 101 with arthralgia (Group P) and 105 without (Group NP) from 103 patients, and 22 TMJs (Group CON) from 11 asymptomatic volunteers were examined by using MRI. The effusion volume was measured after constructing a three-dimensional structure of the joint effusion revealed in MRI by using the ITK-SNAP software. The diagnostic capabilities of the effusion volume on arthralgia were evaluated with receiver operating characteristic (ROC) curve analysis.

RESULTS

Totally 146 joints showed MRI signs of joint effusion, including nine joints from Group CON. However, the medium volume was greater in Group P (66.65 mm3 ), but was much similar in Group CON (18.33 mm3 ) to Group NP (27.12 mm3 ). The effusion volume larger than 38.20 mm3 was validated to discriminate Group P from Group NP. The AUC value was 0.801 (95% CI 0.728 to 0.874), with a sensitivity of 75% and specificity of 78.9%. The median volume of the joint effusion was larger in those with than without bone marrow oedema, osteoarthritis, Type-III disc configurations, disc displacement and higher signal intensity of the retrodiscal tissue (all, p < .05).

CONCLUSION

The present method for evaluate joint effusion volume well discriminated painful TMJs from non-pain ones.

Examination for the Factors Involving to Joint Effusion in Patients with Temporomandibular Disorders Using Magnetic Resonance Imaging

BACKGROUND

This study investigated the factors involving joint effusion in patients with temporomandibular disorders.

METHODS

The magnetic resonance images of 131 temporomandibular joints (TMJs) of patients with temporomandibular disorders were evaluated. Gender, age, disease classification, duration of manifestation, muscle pain, TMJ pain, jaw opening disturbance, disc displacement with and without reduction, deformation of the articular disc, deformation of bone, and joint effusion were investigated. Differences in the appearance of symptoms and observations were evaluated using cross-tabulation. The differences in the amounts of synovial fluid in joint effusion vs. duration of manifestation were analyzed using the Kruskal-Wallis test. Multiple logistic regression analysis was performed to analyze the factors contributing to joint effusion.

RESULTS

Manifestation duration was significantly longer when joint effusion was not recognized (p < 0.05). Arthralgia and deformation of the articular disc were related to a high risk of joint effusion (p < 0.05).

CONCLUSIONS

The results of this study suggest that joint effusion recognized in magnetic resonance imaging was easily observed when the manifestation duration was short, and arthralgia and deformation of the articular disc were related to a higher risk of joint effusion.

Neuroendocrine Influencers and Associated Factors That Shape Jaw Movement and Growth in Temporomandibular Joint Disorder Management: A Systematic Review of Clinical and Radiographic Evidence

OBJECTIVE

To investigate the influence of endogenous and exogenous neuroendocrine analogues on the range and motion of jaw movement, mandibular growth, and factors affecting condylar guidance in patients with temporomandibular joint disorders using clinical assessment and radiographic imaging.

MATERIAL AND METHODS

Eligible articles were extracted from eleven databases in early 2023 and screened following PRISMA protocols. Certainty of evidence and potential biases were assessed using the GRADE approach.

RESULTS

Nineteen articles were screened, with four deemed to be of high quality, eight of moderate quality, and the remaining seven of low to very low quality. Corticosteroids improve maximal incisal opening but not TMJ disorder symptoms. Higher doses worsen jaw movement and cause osseous deformity. Growth hormone affects occlusal development, and delayed treatment affects arch width. Sex hormone correlation with TMJ disorder is complex, with some studies showing a correlation between menstrual cycle phases and pain/limited mobility.

CONCLUSIONS

The evaluation of neuroendocrine influencers in relation to jaw movement in patients with temporomandibular joint disorders involves the complex interplay of potentially confounding factors that each require careful consideration to ensure accurate diagnoses and evaluations.

A Comparative Study of Temporomandibular Joints in Adults with Definite Sleep Bruxism on Magnetic Resonance Imaging and Cone-Beam Computer Tomography Images

Objective: The aim was to study the imaging characteristics of the temporomandibular joint (TMJ) of definite sleep bruxers through magnetic resonance imaging (MRI) and cone-beam computer tomography (CBCT). Methods: Nineteen definite sleep bruxers diagnosed by polysomnography and twenty asymptomatic non-bruxers matched by age, gender, and education level participated in this study. After obtaining MRI and CBCT images of all TMJs of the subjects, evaluation and measurement were conducted, respectively. The analyzed parameters included disc position, disc configuration, joint effusion (JE), joint space or condyle position, and condylar bony changes. Results: Of the 38 joints in the study group, disc deformity and disc displacement of TMJs were both 57.9% when the mouth was closed, and 76.3% showed condylar bony changes, while when the mouth was open, 82% of all TMJs showed physiological biconcave discs. Comparison of joint space revealed that the anterior space was larger in the study group. There was no significant difference between the mild and the moderate to severe sleep bruxism subgroups in the changes of TMJ. Conclusion: The results demonstrated that a higher prevalence of disc deformity, disc displacement, JE, and condylar bony changes occurred in temporomandibular joints of sleep bruxers. These changes were not related to the severity of sleep bruxism.

Comparison of imaging findings of 714 symptomatic and asymptomatic temporomandibular joints: a retrospective study

BACKGROUND

The correlation between temporomandibular disorders (TMD) and imaging features remains unclear. This study compared the cone beam computed tomography (CBCT) and magnetic resonance imaging (MRI) features in the temporomandibular joints (TMJs) with and without TMD symptoms.

METHODS

The participants were recruited from the TMJ Diagnosis and Treatment Center from March 2022 to September 2022. Condylar morphology and condylar position were evaluated by CBCT. Disc morphology, disc position, and joint effusion were evaluated by T2-weighted image of MRI. The Chi-Square test and binary logistic regression analysis were carried out.

RESULTS

Eighty-two patients with bilateral symptoms, 196 patients with unilateral symptoms, and 79 asymptomatic participants received MRI and CBCT examination. There were significant differences in the distribution of sex, age, condylar morphology, condylar position, disc morphology, disc position, and joint effusion in symptomatic and asymptomatic TMJs (P < 0.05), which showed a positive correlation with symptoms (P < 0.05). In multiple logistic regression, 19-30-year-age group, > 30-year-age group, abnormal condylar morphology, posterior condylar position, disc displacement with reduction (DDWR), and disc displacement without reduction (DDWoR) were found to be statistically significant (P < 0.05). The odds of having symptomatic TMJ were 1.952 higher in the 19-30-year-age group and 1.814 higher in the > 30-year-age group when compared to those aged ≤ 18-year-age group. The odds of having symptomatic TMJ were 2.360 higher in persons with abnormal condylar morphology when compared to those with normal condylar morphology. The odds of having symptomatic TMJ were 2.591 higher in persons with posterior condylar position when compared to those with the normal condylar position. The odds of having symptomatic TMJ were 2.764 higher in persons with DDWR and 4.189 higher in persons with DDWoR when compared to those with normal disc position. The area under the curve of the model was 0.736 ± 0.019 (95% CI 0.700-0.773, P = 0.000), which indicated that the model has a good fitting effect.

CONCLUSIONS

The imaging findings of TMJs were significantly different between symptomatic and asymptomatic TMJs. TMD is affected by multiple factors including > 19-year-age, abnormal condylar morphology, posterior condylar position, DDWR, and DDWoR, which could be risk factors for the development of TMD symptoms. Trial registration This study was retrospectively registered on 28/03/2022 and endorsed by the Ethics Committee of Affiliated Stomatology Hospital of Guangzhou Medical University (LCYJ2022014).

Widespread bodily pain is not associated with the presence of painful TMJ osteoarthritis: a case control study

Purpose: Temporomandibular Joint Arthralgia (TMJA) in the absence of osteoarthritis has not been thoroughly studied. We aimed to investigate the presence of comorbid bodily pain conditions (CBPC) in patients with TMJA with and without TMJOA and hypothesized that TMJOA is not associated with a higher presence of CBPC. Methods: This is a retrospective study involving patients at the University of North Carolina Orofacial Pain Clinic between 2010 and 2014 with TMJA according to the RDC/TMD criteria [1]. Cases fulfilled the Ahmad classification for TMJOA [2], and had TMJA (TMJA+OA), while controls had TMJA only (TMJA-OA). Data was collected from reports of Cone-Beam Computerized Tomography (CBCT). CBPC were self-reported. Results: Twenty-eight cases (TMJA+OA) and 25 controls (TMJA-OA) were included. The mean age of cases and controls (P = 0.027) and mean pain duration differed (P = 0.031). However, the gender distribution (P = 0.552), mean pain intensity (P = 0.381), mean number of painful muscles upon palpation (P = 0.759) and mean number of CBPC (P = 0.575) were not different. At least one CBPC was reported by 68% cases and 72% control subjects (P = 0.743). Conclusions: In this group of patients with TMJA, the presence of CBPC was high and not associated with the presence of TMJOA. This finding suggests that CBPC and TMJOA occur independently.

Diagnostic correlation between clinical protocols and magnetic resonance findings in temporomandibular disorders: A systematic review and meta-analysis

BACKGROUND

Our aim was to assess the diagnostic correlation between clinical protocols and magnetic resonance (MRI) findings in temporomandibular disorders (TMDs), including disc displacement with and without reduction (DDwR; DDwoR) and arthralgia.

METHODS

A systematic review performed in two phases according to the PRISMA checklist. Specific indexing terms were used for search of studies assessing TMDs through clinical diagnostic protocols with the aid of Research Diagnostic Criteria for TMDs or Diagnostic Criteria for TMDs. Quality assessment performed using QUADAS-2. Heterogeneity was assessed using I² . Publication bias was assessed using funnel plots. For meta-analysis, we used random effect model or fixed effect. The main outcomes were sensitivity and specificity of clinical protocols.

RESULTS

Fourteen studies included in the qualitative analysis and 11 studies in the meta-analysis. None of the studies fulfilled all criteria of QUADAS-2. High heterogeneity and high publication bias were found among the studies. Clinical protocols for assessing DDwR compared with MRI showed pooled sensitivity of 66% and specificity of 72%. For DDwoR, sensitivity was 61% and specificity 98%. For arthralgia, sensitivity was 43% and specificity 68% for the presence of effusion.

CONCLUSIONS

This review reveals the need for studies with improved quality. Clinical protocols show poor to moderate validity in diagnosis of DDwR and DDwoR compared with MRI. No correlation was found between a clinical diagnosis of arthralgia and MRI effusion. Clinical diagnostic protocols can be used as screening tools, reserving the use of MRI for a more accurate diagnosis in patients with symptoms or dysfunction.

Radiographic Interpretation in Oral Medicine and Hospital Dental Practice

Oral medicine practice includes the diagnosis and nonsurgical treatment of oral and orofacial diseases and oral manifestations of systemic conditions. Oral medicine specialists in medical and dental settings often require imaging in assessment and treatment of these conditions. This article reviews imaging that may be used in practice, particularly as relevant for facial pain, bone conditions, and salivary gland disease. It reviews imaging that may be considered in a hospital setting for assessment of admitted patients, patient evaluation before surgical procedures, and provision of dentistry in a hospital setting for patients who cannot submit to treatment in an outpatient setting.

Correlation between joint effusion and clinical symptoms, magnetic resonance imaging and arthroscopic findings in patients with temporomandibular joint disease

OBJECTIVES

The aim of this study was to evaluate the relationship between temporomandibular joint (TMJ) effusions and clinical, magnetic resonance imaging and arthroscopic variables.

METHODS

We designed a retrospective cohort study of patients attending our Department who presented temporomandibular joint disease according to the Research Diagnostic Criteria for Temporomandibular Disorders. According to the presence of effusion in magnetic resonance imaging, the sample was divided into 2 groups: patients with or without joint effusion.

RESULTS

A total of 203 patients fulfilled the inclusion criteria, of which 99 (48.8%) showed no joint effusion and 104 (51.2%) presented effusion. We found no significant differences between clinical variables and joint effusion. However, patients without effusion showed significantly longer duration of symptoms that patients with effusion (mean = 34.8 months, standard deviation = 43.41 vs 20.25, 23.76; p = 0.005). We found no significant differences in magnetic resonance imaging and arthroscopic variables associated with the presence of effusions. For both groups, there were statistically significant differences in values of mean pain scores and mean maximum interincisal distance between the different times of examination (before surgery and 3, 6 and 12 months after surgery).

CONCLUSION

Joint effusion is not associated with clinical, imaging or arthroscopic variables, but may be a clinical characteristic of early stages of temporomandibular joint disease.

Characteristics of patients with temporomandibular joint osteoarthrosis on magnetic resonance imaging

INTRODUCTION

Temporomandibular joint (TMJ) dysfunction is a common condition that is best evaluated with magnetic resonance (MR) imaging. The aim of this study was to investigate the characteristics of the patients with TMJ osteoarthrosis on MR imaging.

METHODS

The MR images of 206 TMJs of 103 patients with temporomandibular disorders (TMD) were evaluated retrospectively in this study. The relationship between osteoarthrosis and age, gender, TMJ pain and MR imaging findings, such as disc displacement with or without reduction and TMJ effusion, was analysed.

RESULTS

The patients with TMJ osteoarthrosis (mean: 51.6 years) were significantly older than those without osteoarthrosis (mean: 44.8 years, P = 0.027). The incidence of the patients with TMJ osteoarthrosis was significantly different between with (10.0 %) and without reduction (57.0 %, P < 0.001). Logistic multivariate regression analysis demonstrated that disc displacement without reduction was significant in patients with TMJ osteoarthrosis (odds ratio = 12.285, P < 0.001).

CONCLUSIONS

This study suggests that characteristics of the patients with TMJ osteoarthrosis on MR imaging include older and disc displacement without reduction.