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Costello A, Twilt M, Lerman MA. Provider assessment of the temporomandibular joint in Juvenile idiopathic arthritis: a retrospective analysis from the CARRA database. Pediatr Rheumatol Online J 2024; 22:41. [PMID: 38589909 PMCID: PMC11000332 DOI: 10.1186/s12969-024-00968-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Temporomandibular joint (TMJ) involvement is an often underrecognized complication of juvenile idiopathic arthritis (JIA) that can cause decreased mandibular growth, altered facial morphology, and orofacial pain. It is estimated that the TMJ is affected in 30-45% of children with JIA. Standardized physical examination and imaging evaluations are important in accurately assessing active TMJ arthritis and sequalae. Little is known about the rate at which providers evaluate TMJ involvement in their clinical practice. METHODS Data were obtained from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry. Data fields related to assessment for TMJ arthritis were added in 2019. Patients were included in the study if they had a diagnosis of JIA and had data recorded between January 2020 and August 2021. Standard descriptive statistics were used to describe demographic and clinical features. RESULTS A total of 17,761 visits were reviewed for a total of 7473 patients with JIA. A total of 52.7% of patients had maximal mouth opening (MMO) recorded as finger breadths or total incisal distance (TID). Only 8% had TID measured. A total of 5.0% had MRI with contrast performed. A total of 939 patients had a diagnosis of TMJ arthritis. Of these, 28.5% had an MRI documented, 83% had an MMO documented, and 40% had TID measured. Few patient-level characteristics were statistically related to having MMO assessed. MRI was more likely to be obtained in older and in female patients. MMO was recorded at a given visit > 80% of the time at 17 sites, and it was recorded < 1% of the time at 8 sites. MRIs were infrequently performed at all sites, with 27 sites having no MRIs obtained and only 7 sites having an MRI obtained at > 10% of visits. CONCLUSIONS MMO is not consistently measured in patients with JIA, and it is rarely measured quantitatively. Similarly, TMJ MRIs are rarely obtained in patients with JIA. Site of care is more associated with TMJ assessments than patient-level characteristics. These data suggest that provider education is needed to improve the assessment of the TMJ in patients with JIA to enable earlier recognition and prevent long-term complications.
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Affiliation(s)
- Anna Costello
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| | - Marinka Twilt
- Department of Pediatrics, Division of Rheumatology, Cumming School of Medicine, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Melissa A Lerman
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
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Ozsari S, Güzel MS, Yılmaz D, Kamburoğlu K. A Comprehensive Review of Artificial Intelligence Based Algorithms Regarding Temporomandibular Joint Related Diseases. Diagnostics (Basel) 2023; 13:2700. [PMID: 37627959 PMCID: PMC10453523 DOI: 10.3390/diagnostics13162700] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/13/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Today, with rapid advances in technology, computer-based studies and Artificial Intelligence (AI) approaches are finding their place in every field, especially in the medical sector, where they attract great attention. The Temporomandibular Joint (TMJ) stands as the most intricate joint within the human body, and diseases related to this joint are quite common. In this paper, we reviewed studies that utilize AI-based algorithms and computer-aided programs for investigating TMJ and TMJ-related diseases. We conducted a literature search on Google Scholar, Web of Science, and PubMed without any time constraints and exclusively selected English articles. Moreover, we examined the references to papers directly related to the topic matter. As a consequence of the survey, a total of 66 articles within the defined scope were assessed. These selected papers were distributed across various areas, with 11 focusing on segmentation, 3 on Juvenile Idiopathic Arthritis (JIA), 10 on TMJ Osteoarthritis (OA), 21 on Temporomandibular Joint Disorders (TMD), 6 on decision support systems, 10 reviews, and 5 on sound studies. The observed trend indicates a growing interest in artificial intelligence algorithms, suggesting that the number of studies in this field will likely continue to expand in the future.
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Affiliation(s)
- Sifa Ozsari
- Department of Computer Engineering, Ankara University, 06830 Ankara, Turkey;
| | - Mehmet Serdar Güzel
- Department of Computer Engineering, Ankara University, 06830 Ankara, Turkey;
| | - Dilek Yılmaz
- Faculty of Dentistry, Baskent University, 06490 Ankara, Turkey;
| | - Kıvanç Kamburoğlu
- Department of Dentomaxillofacial Radiology, Ankara University, 06560 Ankara, Turkey;
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Inarejos Clemente EJ, Tolend M, Navallas M, Doria AS, Meyers AB. MRI of the temporomandibular joint in children with juvenile idiopathic arthritis: protocol and findings. Pediatr Radiol 2023; 53:1498-1512. [PMID: 36944679 DOI: 10.1007/s00247-023-05616-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 03/23/2023]
Abstract
Contrast-enhanced magnetic resonance imaging (MRI) is the technique of choice for diagnosis and monitoring of temporomandibular joint (TMJ) disorders in patients with juvenile idiopathic arthritis (JIA), as it is able to visualize both soft tissue and osteochondral changes. Approximately 40% of children with JIA develop inflammatory and chronic osteochondral changes observable on imaging, which if left untreated can lead to significant facial growth impairment, including facial asymmetry and retrognathia. MRI of the TMJ plays a paramount role in diagnosis and treatment monitoring in JIA since early signs of TMJ involvement are difficult to detect clinically and with physical examination. Findings of TMJ arthritis may be classified into acute and chronic domains. Early or acute manifestations include joint effusion, bone marrow edema, synovial thickening, and increased joint enhancement. With disease progression, there are characteristic osteochondral changes, including deformity of the mandibular condyle with shortening of the mandibular ramus, bone erosions, and disk abnormalities. In this pictorial essay, we describe a consensus MRI protocol for the study of the TMJ and illustrate the degree of normal and pathological MRI findings using currently available MRI scoring systems of the TMJ developed for JIA.
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Affiliation(s)
- Emilio J Inarejos Clemente
- Department of Diagnostic Imaging, Hospital Sant Joan de Déu, Av. Sant Joan de Déu, 2, CP: 08950, Esplugues de Llobregat, Barcelona, Spain.
| | - Mirkamal Tolend
- Department of Diagnostic Imaging, Institute of Medical Science, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, Canada
| | - Maria Navallas
- Department of Diagnostic Imaging, Hospital Universitario, 12 de Octubre, Av. de Córdoba, s/n, Madrid, Spain
| | - Andrea S Doria
- Department of Diagnostic Imaging and Research Institute, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, 555 University Avenue, Toronto, ON, Canada
| | - Arthur B Meyers
- Department of Diagnostic Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA
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Bousquet B, Kellenberger CJ, Caprio RM, Jindal S, Resnick CM. Does MRI Distinguish Juvenile Idiopathic Arthritis from Other Causes of Progressive TMJ Destruction? J Oral Maxillofac Surg 2023:S0278-2391(23)00331-2. [PMID: 37086749 DOI: 10.1016/j.joms.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/23/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE Similarities in initial presentations of temporomandibular joint (TMJ) involvement from juvenile idiopathic arthritis (JIA), idiopathic condylar resorption, and other forms of progressive TMJ destruction in children create diagnostic confusion. Treatment pathways, however, depend on determination of etiology. The purpose of this study was to compare TMJ magnetic resonance images (MRIs) of patients with joint degeneration localized to the TMJs to those with JIA and TMJ involvement. METHODS This is a retrospective cross-sectional study including subjects younger than 18 years that presented from February 2008 to October 2019 with clinical TMJ degeneration, a gadolinium-enhanced TMJ MRI and a negative pediatric rheumatologic workup ("non-JIA" group), and a series of age and sex-matched subjects with TMJ degeneration on gadolinium-enhanced MRI and JIA ("JIA group"). MRIs were evaluated in a blinded fashion by 1 pediatric radiologist. The primary outcome variable was the radiologist's accuracy in predicting study grouping, assessed in 1 randomly-selected joint per patient. Secondary outcome variables included MRI characteristics of inflammation, osseous damage and articular disc morphology. Independent samples t-tests, sensitivity/specificity, Fisher's exact and Mann-Whitney tests were computed as applicable, and P < .05 was considered significant. RESULTS The sample included 34 subjects: 16 non-JIA (75% female, age 13.9 ± 2.8 years) and 18 JIA (77% female, age 13.6 ± 2.8 years) (P ≥ .738). The radiologist correctly classified 64.7% of subjects as non-JIA or JIA (P = .078, sensitivity = 94.4%, specificity = 31.3%). Inflammatory and osseous findings were similar between groups (P ≥ .073). The disc was anteriorly displaced in 9 non-JIA and 0 JIA joints (P < .001, sensitivity = 100%, specificity = 100%) and flattened in 3 non-JIA and 14 JIA joints (P = .006, sensitivity = 38.9%, specificity = 90.6%). CONCLUSION Inflammatory and osseous findings on gadolinium-enhanced TMJ MRIs are insufficient to determine the etiology of progressive TMJ destruction. Disc characteristics, however, significantly differ between JIA and non-JIA etiologies and may be important in differentiating these conditions.
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Panoramic imaging may detect morphologically abnormal temporomandibular joints in children with juvenile idiopathic arthritis. PEDIATRIC DENTAL JOURNAL 2023. [DOI: 10.1016/j.pdj.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Augdal TA, Angenete OW, Shi XQ, Säll M, Fischer JM, Nordal E, Rosendahl K. Cone beam computed tomography in the assessment of TMJ deformity in children with JIA: repeatability of a novel scoring system. BMC Oral Health 2023; 23:12. [PMID: 36627622 PMCID: PMC9830735 DOI: 10.1186/s12903-022-02701-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/28/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The temporomandibular joint (TMJ) is frequently involved in juvenile idiopathic arthritis (JIA). Diagnostic imaging is necessary to correctly diagnose and evaluate TMJ involvement, however, hitherto little has been published on the accuracy of the applied scoring systems and measurements. The present study aims to investigate the precision of 20 imaging features and five measurements based on cone beam computed tomography (CBCT). METHODS Imaging and clinical data from 84 participants in the Norwegian study on juvenile idiopathic arthritis, the NorJIA study, were collected. Altogether 20 imaging features and five measurements were evaluated independently by three experienced radiologists for intra- and interobserver agreement. Agreement of categorical variables was assessed by Fleiss', Cohen's simple or weighted Kappa as appropriate. Agreement of continuous variables was assessed with 95% limits of agreement as advised by Bland and Altman. RESULTS "Overall impression of TMJ deformity" showed almost perfect intraobserver agreement with a kappa coefficient of 0.81 (95% CI 0.69-0.92), and substantial interobserver agreement (Fleiss' kappa 0.70 (0.61-0.78)). Moreover, both "flattening" and "irregularities" of the eminence/fossa and condyle performed well, with intra- and interobserver agreements of 0.66-0.82 and 0.55-0.76, respectively. "Reduced condylar volume" and "continuity" of the fossa/eminence had moderate intra- and interobserver Kappa values, whereas continuity of the condyle had Kappa values above 0.55. Measurements of distances and angles had limits of agreement of more than 15% of the sample mean. CONCLUSIONS We propose a CBCT-based scoring system of nine precise imaging features suggestive of TMJ deformity in JIA. Their clinical validity must be tested.
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Affiliation(s)
- Thomas A. Augdal
- grid.412244.50000 0004 4689 5540Section of Paediatric Radiology, University Hospital of North Norway, Postboks 100, 9038 Tromsø, Norway ,grid.10919.300000000122595234Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Oskar W. Angenete
- grid.52522.320000 0004 0627 3560Department of Radiology and Nuclear Medicine, St. Olav University Hospital, Trondheim, Norway ,grid.5947.f0000 0001 1516 2393Faculty of Medicine and Health Sciences, Institute for Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Xie-Qi Shi
- grid.7914.b0000 0004 1936 7443Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway ,grid.32995.340000 0000 9961 9487Department of Oral and Maxillofacial Radiology, Faculty of Odontology, University of Malmö, Malmö, Sweden
| | - Mats Säll
- grid.52522.320000 0004 0627 3560Department of Radiology and Nuclear Medicine, St. Olav University Hospital, Trondheim, Norway
| | - Johannes M. Fischer
- grid.7914.b0000 0004 1936 7443Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Ellen Nordal
- grid.10919.300000000122595234Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway ,grid.412244.50000 0004 4689 5540Department of Paediatrics, University Hospital of North Norway, Tromsø, Norway
| | - Karen Rosendahl
- grid.412244.50000 0004 4689 5540Section of Paediatric Radiology, University Hospital of North Norway, Postboks 100, 9038 Tromsø, Norway ,grid.10919.300000000122595234Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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7
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Stoustrup P, Resnick CM, Abramowicz S, Pedersen TK, Michelotti A, Küseler A, Koos B, Verna C, Nordal EB, Granquist EJ, Halbig JM, Kristensen KD, Kaban LB, Arvidsson LZ, Spiegel L, Stoll ML, Lerman MA, Glerup M, Defabianis P, Frid P, Alstergren P, Cron RQ, Ringold S, Nørholt SE, Peltomaki T, Larheim TA, Herlin T, Peacock ZS, Kellenberger CJ, Twilt M. Management of Orofacial Manifestations of Juvenile Idiopathic Arthritis: Interdisciplinary Consensus-Based Recommendations. Arthritis Rheumatol 2023; 75:4-14. [PMID: 36041065 PMCID: PMC10100353 DOI: 10.1002/art.42338] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 08/08/2022] [Accepted: 08/19/2022] [Indexed: 02/04/2023]
Abstract
Involvement of the temporomandibular joint (TMJ) is common in juvenile idiopathic arthritis (JIA). TMJ arthritis can lead to orofacial symptoms, orofacial dysfunction, and dentofacial deformity with negative impact on quality of life. Management involves interdisciplinary collaboration. No current recommendations exist to guide clinical management. We undertook this study to develop consensus-based interdisciplinary recommendations for management of orofacial manifestations of JIA, and to create a future research agenda related to management of TMJ arthritis in children with JIA. Recommendations were developed using online surveying of relevant stakeholders, systematic literature review, evidence-informed generation of recommendations during 2 consensus meetings, and Delphi study iterations involving external experts. The process included disciplines involved in the care of orofacial manifestations of JIA: pediatric rheumatology, radiology, orthodontics, oral and maxillofacial surgery, orofacial pain specialists, and pediatric dentistry. Recommendations were accepted if agreement was >80% during a final Delphi study. Three overarching management principles and 12 recommendations for interdisciplinary management of orofacial manifestations of JIA were outlined. The 12 recommendations pertained to diagnosis (n = 4), treatment of TMJ arthritis (active TMJ inflammation) (n = 2), treatment of TMJ dysfunction and symptoms (n = 3), treatment of arthritis-related dentofacial deformity (n = 2), and other aspects related to JIA (n = 1). Additionally, a future interdisciplinary research agenda was developed. These are the first interdisciplinary recommendations to guide clinical management of TMJ JIA. The 3 overarching principles and 12 recommendations fill an important gap in current clinical practice. They emphasize the importance of an interdisciplinary approach to diagnosis and management of orofacial manifestations of JIA.
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Affiliation(s)
| | - Cory M. Resnick
- Department of Plastic and Oral SurgeryBoston Children's HospitalBostonMassachusetts
| | - Shelly Abramowicz
- Division of Oral and Maxillofacial Surgery, Departments of Surgery and PediatricsEmory University School of MedicineAtlantaGeorgia
| | - Thomas K. Pedersen
- Section of Orthodontics and Department of Oral and Maxillofacial SurgeryAarhus University HospitalAarhusDenmark
| | | | - Annelise Küseler
- Section of Orthodontics and Department of Oral and Maxillofacial SurgeryAarhus University HospitalAarhusDenmark
| | - Bernd Koos
- Department of OrthodonticsUniversity Hospital TübingenTübingenGermany
| | - Carlalberta Verna
- Department of Pediatric Oral Health and OrthodonticsUZB University Center for Dentistry Basel, University of BaselBaselSwitzerland
| | - Ellen B. Nordal
- Department of Pediatrics, University Hospital of North Norway and the Pediatric Research Group, Department of Clinical MedicineUiT The Arctic University of NorwayTromsøNorway
| | - Eric J. Granquist
- Department of Oral and Maxillofacial Surgery, School of Dental MedicineUniversity of PennsylvaniaPhiladelphia
| | - Josefine Mareile Halbig
- The Public Dental Health Competence Centre of North Norway, and the Department of Clinical Medicine, Faculty of Health SciencesUiT The Arctic University of NorwayTromsøNorway
| | | | - Leonard B. Kaban
- Massachusetts General Hospital, Harvard School of Dental MedicineBostonMassachusetts
| | - Linda Z. Arvidsson
- Department of Maxillofacial RadiologyInstitute of Clinical Dentistry, University of OsloOsloNorway
| | - Lynn Spiegel
- The Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | | | - Melissa A. Lerman
- Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvania
| | - Mia Glerup
- Department of Pediatrics and Adolescent MedicineAarhus University HospitalAarhusDenmark
| | | | - Paula Frid
- Department of Otorhinolaryngology, Division of Oral and Maxillofacial Surgery, University Hospital of North Norway, Public Dental Service Competence Centre of North Norway, and Department of Clinical DentistryUiT The Arctic University of NorwayTromsøNorway
| | - Per Alstergren
- Faculty of Odontology, Orofacial Pain UnitMalmö UniversityMalmöSweden
| | | | | | - Sven Erik Nørholt
- Section of Orthodontics and Department of Oral and Maxillofacial SurgeryAarhus University HospitalAarhusDenmark
| | - Timo Peltomaki
- Faculty of Medicine and Health Technology, and Department of Ear and Oral Diseases, Tampere University, Tampere, Finland, and Institute of Dentistry, Faculty of Health Sciences, University of Eastern Finland and Department of Oral and Maxillofacial Diseases, Kuopio University HospitalKuopioFinland
| | - Tore A. Larheim
- Department of Maxillofacial RadiologyInstitute of Clinical Dentistry, University of OsloOsloNorway
| | - Troels Herlin
- Department of Pediatrics and Adolescent MedicineAarhus University HospitalAarhusDenmark
| | - Zachary S. Peacock
- Massachusetts General Hospital, Harvard School of Dental MedicineBostonMassachusetts
| | | | - Marinka Twilt
- Alberta Children's Hospital and University of CalgaryCalgaryAlbertaCanada
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Whittingslow DC, Gergely T, Prahalad S, Inan OT, Abramowicz S. TEMPOROMANDIBULAR JOINT ACOUSTIC EMISSIONS IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS DIFFER FROM HEALTHY CHILDREN. J Oral Maxillofac Surg 2022; 80:1466-1473. [DOI: 10.1016/j.joms.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/09/2022] [Accepted: 05/19/2022] [Indexed: 10/18/2022]
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9
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Preliminary experience with black bone magnetic resonance imaging for morphometry of the mandible and visualisation of the facial skeleton. Pediatr Radiol 2022; 52:951-958. [PMID: 35076727 DOI: 10.1007/s00247-021-05257-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/21/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Children with orofacial deformity may require repeated imaging of the facial skeleton. OBJECTIVE To test the feasibility and accuracy of "black bone" magnetic resonance imaging (MRI) for assessing facial deformity in children. MATERIALS AND METHODS Three-dimensional (3-D) black bone gradient echo sequences (flip angle 5°, submillimetre spatial resolution) from 10 children (median age: 13 years, range: 2-16 years), who underwent MRI of the temporomandibular joints, were evaluated with multiplanar reconstruction and 3-D rendering tools. Intra- and inter-reader agreement was investigated for measuring the height of the mandibular ramus and condyle, basal length of the mandible, gonion angle and mandibular inclination angle by intraclass correlation coefficient (ICC) and Bland-Altman analysis. Absolute percentage error was calculated with the average of all measurements serving as reference. RESULTS Sixty linear and 40 angle measurements were obtained on reformatted multiplanar black bone images with excellent inter-reader agreement (ICC > 0.99, agreement bias < 1.4 mm/ < 1.5°) and small error (median absolute error < 3%). The black bone images required inversion of the signal intensity and removal of air before they could be processed with standard volume rendering tools. The diagnostic utility of 3-D views for assessing the facial skeleton was sufficient except for assessing dental relationship. CONCLUSION Morphometric measurements of the mandible can be obtained from black bone MRI with comparable inter-rater agreement to that reported for cone beam computed tomography (CT). With improvements of 3-D rendering techniques and software, black bone MRI may become a radiation-free alternative to CT in children with facial deformities.
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10
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Collin M, Hagelberg S, Ernberg M, Hedenberg-Magnusson B, Christidis N. Temporomandibular joint involvement in children with juvenile idiopathic arthritis-Symptoms, clinical signs and radiographic findings. J Oral Rehabil 2022; 49:37-46. [PMID: 34665893 DOI: 10.1111/joor.13269] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 09/13/2021] [Accepted: 10/12/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Although many children with juvenile idiopathic arthritis (JIA) develop arthritis and deformity of the temporomandibular joint (TMJ), many go undetected. OBJECTIVE This study investigates whether findings from patient history and clinical examination using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) can be used to diagnose TMJ involvement. METHODS As a part of the screening program, 59 consecutive JIA patients age 7-14 years underwent a clinical examination according to RDC/TMD including self-reported orofacial pain and pain related to jaw function, and cone beam computer tomography (CBCT). Data were obtained from the patient's medical charts. Patients were divided into two groups based on the presence or absence of TMJ deformities on CBCT. RESULTS Self-reported TMJ symptoms before inclusion were reported by 52% of children with and 18% of children without TMJ deformities on CBCT (p = .020). On a group level, the maximum unassisted (mouth) opening (MUO) with and without pain was within the normal range, but children with TMJ deformities showed a significantly smaller MUO with pain (p = .035). A diagnosis of osteoarthritis and osteoarthrosis was more prevalent in children with TMJ deformities. CONCLUSION Although there were few differences between children with and without radiographic TMJ deformities, self-reported previous TMJ symptoms and reduced MUO with pain could indicate the presence of TMJ involvement. However, radiographic examinations are needed to confirm TMJ involvement. Thus, this study indicates that the RDC/TMD protocol is a blunt tool when targeting TMJ involvement in JIA.
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Affiliation(s)
- Malin Collin
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Scandinavian Center for Orofacial Neurosciences, Huddinge, Sweden.,Folktandvården Sörmland AB, Nyköping, Sweden
| | - Stefan Hagelberg
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Malin Ernberg
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Scandinavian Center for Orofacial Neurosciences, Huddinge, Sweden
| | - Britt Hedenberg-Magnusson
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Scandinavian Center for Orofacial Neurosciences, Huddinge, Sweden.,Folktandvården Stockholms län AB, Stockholm, Sweden
| | - Nikolaos Christidis
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Scandinavian Center for Orofacial Neurosciences, Huddinge, Sweden
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11
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Fischer J, Augdal TA, Angenete O, Gil EG, Skeie MS, Åstrøm AN, Tylleskär K, Rosendahl K, Shi XQ, Rosén A. In children and adolescents with temporomandibular disorder assembled with juvenile idiopathic arthritis - no association were found between pain and TMJ deformities using CBCT. BMC Oral Health 2021; 21:518. [PMID: 34641860 PMCID: PMC8513178 DOI: 10.1186/s12903-021-01870-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background Children and adolescents with juvenile idiopathic arthritis (JIA) may suffer from temporomandibular disorder (TMD). Due to this, imaging diagnosis is crucial in JIA with non-symptomatic TM joint (TMJ) involvement. The aim of the study was to examine the association between clinical TMD signs/symptoms and cone-beam computed tomography (CBCT) findings of TMJ structural deformities in children and adolescents with JIA. Methods This cross-sectional study is part of a longitudinal prospective multi-centre study performed from 2015–2020, including 228 children and adolescents aged 4–16 years diagnosed with JIA, according to the International League of Associations for Rheumatology (ILAR). For this sub-study, we included the Bergen cohort of 72 patients (32 female, median age 13.1 years, median duration of JIA 4.5 years). Clinical TMD signs/symptoms were registered as pain on palpation, pain on jaw movement, and combined pain of those two. The severity of TMJ deformity was classified as sound (no deformity), mild, or moderate/severe according to the radiographic findings of CBCT. Results Of 72 patients, 21 (29.2%) had pain on palpation at and around the lateral pole, while 41 (56.9%) had TMJ pain upon jaw movement and 26 (36.1%) had pain from both. Of 141 TMJs, 18.4% had mild and 14.2% had moderate/severe structural deformities visible on CBCT. CBCT findings were not significantly associated with either the pain on palpation or the pain on jaw movement. A significant difference was found between structural deformities in CBCT and the combined pain outcome (pain at both palpation and movement) for both TMJs for the persistent oligoarticular subtype (p = 0.031). Conclusions There was no association between painful TMD and CBCT imaging features of the TMJ in patients with JIA, but the oligoarticular subtype of JIA, there was a significant difference associated with TMJ pain and structural CBCT deformities. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01870-z.
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Affiliation(s)
- J Fischer
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway.
| | - T A Augdal
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - O Angenete
- Department of Radiology and Nuclear Medicine, St. Olav Hospital HF, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - E G Gil
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway
| | - M S Skeie
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway.,Center for Oral Health Services and Research, Mid-Norway (TkMidt), Trondheim, Norway
| | - A N Åstrøm
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway.,Public Dental Service Competence Centre of Western-Norway (TkVest), Bergen, Norway
| | - K Tylleskär
- Paediatric Clinic at Haukeland University Hospital, Bergen, Norway
| | - K Rosendahl
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway.,UiT Arctic University of North Norway, Tromsø, Norway
| | - X-Q Shi
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway.,Department of Oral and Maxillofacial Radiology, Faculty of Odontology, University of Malmö, Malmö, Sweden
| | - A Rosén
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway.,Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
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12
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Tolend M, Doria AS, Meyers AB, Larheim TA, Abramowicz S, Aguet J, Appenzeller S, Arvidsson LZ, Averill LW, Feldman BM, Guleria S, Inarejos Clemente EJ, Jaremko JL, Junhasavasdikul T, von Kalle T, Kirkhus E, Koos B, Miller E, Moineddin R, Panwar J, Peacock ZS, Resnick CM, van Rossum MA, Stimec J, Tomlinson G, Tzaribachev N, Kellenberger CJ. Assessing the Reliability of the OMERACT Juvenile Idiopathic Arthritis Magnetic Resonance Scoring System for Temporomandibular Joints (JAMRIS-TMJ). J Clin Med 2021; 10:jcm10184047. [PMID: 34575158 PMCID: PMC8467699 DOI: 10.3390/jcm10184047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/22/2021] [Accepted: 08/27/2021] [Indexed: 12/24/2022] Open
Abstract
Contrast-enhanced magnetic resonance imaging (MRI) remains the most comprehensive modality to assess juvenile idiopathic arthritis (JIA)-related inflammation and osteochondral damage in the temporomandibular joints (TMJ). This study tested the reliability of a new JIA MRI scoring system for TMJ (JAMRIS-TMJ) and the impact of variations in calibration and reader specialty. Thirty-one MRI exams of bilateral TMJs were scored independently using the JAMRIS-TMJ by 20 readers consisting of radiologists and non-radiologist clinicians in three reading groups, with or without a calibrating atlas and/or tutorial. The inter-reader reliability in the multidisciplinary cohort assessed by the generalizability coefficient was 0.61–0.67 for the inflammatory and 0.66–0.74 for the damage domain. The atlas and tutorial did not improve agreement within radiologists, but improved the agreement between radiologist and non-radiologist groups. Agreements between different calibration levels were 0.02 to 0.08 lower by the generalizability coefficient compared to agreement within calibration levels; agreement between specialty groups was 0.04 to 0.10 lower than within specialty groups. Averaging two radiologists raised the reliability above 0.8 for both domains. Therefore, the reliability of JAMRIS-TMJ was moderate-to-good depending on the presence of specialty and calibration differences. The atlas and tutorial are necessary to improve reliability when the reader cohort consists of multiple specialties.
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Affiliation(s)
- Mirkamal Tolend
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada; (M.T.); (B.M.F.)
| | - Andrea S. Doria
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada; (M.T.); (B.M.F.)
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (J.A.); (J.S.)
- Correspondence: ; Tel.: +1-416-813-6079
| | - Arthur B. Meyers
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
| | - Tore A. Larheim
- Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, 0317 Oslo, Norway; (T.A.L.); (L.Z.A.)
| | - Shelly Abramowicz
- Division of Oral and Maxillofacial Surgery, Departments of Surgery and Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA;
- Oral and Maxillofacial Surgery, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Julien Aguet
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (J.A.); (J.S.)
| | - Simone Appenzeller
- Department of Orthopedics, Rheumatology and Traumatology, School of Medical Science, University of Campinas, Campinas 13083-970, Brazil;
| | - Linda Z. Arvidsson
- Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, 0317 Oslo, Norway; (T.A.L.); (L.Z.A.)
| | - Lauren W. Averill
- Department of Medical Imaging, Nemours Children’s Health System, Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA;
| | - Brian M. Feldman
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada; (M.T.); (B.M.F.)
- Division of Rheumatology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | | | | | - Jacob L. Jaremko
- Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, AB T6G 2B7, Canada;
| | | | - Thekla von Kalle
- Department of Pediatric Radiology, Radiologisches Institut, Olgahospital Klinikum Stuttgart, 70174 Stuttgart, Germany;
| | - Eva Kirkhus
- Department of Radiology, Oslo University Hospital, 0424 Oslo, Norway;
| | - Bernd Koos
- Department of Orthodontics, University Hospital Tübingen, 72076 Tübingen, Germany;
| | - Elka Miller
- Department of Medical Imaging, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON K1H 8L1, Canada;
| | - Rahim Moineddin
- Department of Family & Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada;
| | - Jyoti Panwar
- Department of Radiology, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India;
| | - Zachary S. Peacock
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Cory M. Resnick
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, MA 02115, USA;
| | - Marion A. van Rossum
- Department of Pediatrics, Emma Children’s Hospital, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands;
- Amsterdam Rheumatology and Immunology Center, Reade, 1007 MB Amsterdam, The Netherlands
| | - Jennifer Stimec
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (J.A.); (J.S.)
| | - George Tomlinson
- Department of Medicine, University Health Network, Toronto, ON M5G 2C4, Canada;
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13
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Juvenile idiopathic arthritis of the temporomandibular joint - no longer the forgotten joint. Br J Oral Maxillofac Surg 2021; 60:247-256. [PMID: 35249742 DOI: 10.1016/j.bjoms.2021.03.013] [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: 10/21/2020] [Accepted: 03/25/2021] [Indexed: 11/22/2022]
Abstract
Juvenile idiopathic arthritis (JIA) of the temporomandibular joint (TMJ) is common in children, with an increasing awareness of the condition in all healthcare professionals. TMJ involvement presents a challenge in both diagnosis and treatment, as late presentation can still occur as the disease often develops asymptomatically. This can result in facial deformity and/or functional difficulties including obstructive sleep apnoea. Early diagnosis is therefore essential, requiring a high index of clinical suspicion coupled with the judicious use of gadolinium contrast magnetic resonance imaging (MRI). Long-term management is best provided by a multidisciplinary team as patients often need a combination of pharmacological management, surgical interventions, orthodontics, and psychological support. End stage deformity can be treated by different surgical options, each with their own risks and benefits, however recently there is increasing recognition for the role of total alloplastic TMJ replacement. This review focuses on the diagnosis and management of TMJ arthritis and aims to highlight the important role of maxillofacial surgeons in JIA treatment.
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14
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Tolend M, Junhasavasdikul T, Cron RQ, Inarejos Clemente EJ, von Kalle T, Kellenberger CJ, Koos B, Miller E, van Rossum MA, Saurenmann RK, Spiegel L, Stimec J, Twilt M, Tzaribachev N, Abramowicz S, Appenzeller S, Arvidsson LZ, Guleria S, Jaremko JL, Kirkhus E, Larheim TA, Meyers AB, Panwar J, Resnick CM, Shelmerdine SC, Feldman BM, Doria AS. Discrete Choice Experiment on a Magnetic Resonance Imaging Scoring System for Temporomandibular Joints in Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2021; 74:308-316. [PMID: 33555146 DOI: 10.1002/acr.24577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 11/20/2020] [Accepted: 02/04/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the relative importance weights of items and grades of a newly developed additive outcome measure called the juvenile idiopathic arthritis (JIA) magnetic resonance imaging (MRI) scoring system for temporomandibular joints (TMJ, JAMRIS-TMJ). METHODS An adaptive partial-profile discrete choice experiment (DCE) survey using the 1000Minds platform was independently completed by members of an expert group consisting of radiologists and non-radiologist clinicians to determine the group-averaged relative weights for JAMRIS-TMJ. Subsequently, an image-based vignette ranking exercise was done, during which experts individually rank-ordered 14 patient vignettes for disease severity while blinded to the weights and unrestricted to JAMRIS-TMJ assessment criteria. Validity of the weighted JAMRIS-TMJ was tested by comparing the consensus-graded, DCE-weighted JAMRIS-TMJ score of the vignettes with their unrestricted image-based ranks provided by the experts. RESULTS Nineteen experts completed the DCE survey and 21 completed the vignette ranking exercise. Synovial thickening and joint enhancement showed higher weights per raw score compared to bone marrow items and effusion in the inflammatory domain, while erosions and condylar flattening showed non-linear and higher weights compared to disk abnormalities in the damage domain. The weighted JAMRIS-TMJ score of the vignettes correlated highly with the ranks from the unrestricted comparison method, with median Spearman's rho of 0.92 (intra-quartile range: 0.87-0.95) for the inflammation and 0.93 (0.90-0.94) for the damage domain. CONCLUSIONS A DCE survey was used to quantify the importance weights of the items and grades of the JAMRIS-TMJ. The weighted score showed high convergent validity with an unrestricted, holistic vignette ranking method.
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Affiliation(s)
- Mirkamal Tolend
- The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | | | - Randy Q Cron
- Children's of Alabama, Birmingham, AL, United States
| | | | | | | | - Bernd Koos
- University Hospital Tübingen, Tübingen, Germany
| | | | - Marion A van Rossum
- Emma Children's Hospital, Academic Medical Centre, and Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
| | | | - Lynn Spiegel
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Marinka Twilt
- Alberta Children's Hospital, and University of Calgary, Calgary, Alberta, Canada
| | | | - Shelly Abramowicz
- Emory University School of Medicine, and Children's Healthcare of Atlanta, Atlanta, GA, United States
| | | | | | | | | | | | | | - Arthur B Meyers
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Jyoti Panwar
- Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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15
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Malattia C, Tolend M, Mazzoni M, Panwar J, Zlotnik M, Otobo T, Vidarsson L, Doria AS. Current status of MR imaging of juvenile idiopathic arthritis. Best Pract Res Clin Rheumatol 2020; 34:101629. [PMID: 33281052 DOI: 10.1016/j.berh.2020.101629] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is the most common chronic arthropathy in the pediatric population. Although the diagnosis is essentially clinical for many affected joints, MR imaging has become an important tool for the assessment of joints that are difficult to evaluate clinically, such as temporomandibular and sacroiliac joints, and for screening of inflammatory changes in the entire body by whole body MRI (WBMRI) assessment. The utilization of MR imaging is challenging in the pediatric population given the need for discrimination between pathological and physiological changes in the growing skeleton. Several multicentric multidisciplinary organizations have made major efforts over the past decades to standardize, quantify, and validate scoring systems to measure joint changes both cross-sectionally and longitudinally according to rigorous methodological standards. In this paper, we (1) discuss current trends for the diagnosis and management of JIA, (2) review challenges for detecting real pathological changes in growing joints, (3) summarize the current status of standardization of MRI protocols for data acquisition and the quantification of joint pathology in JIA by means of scoring systems, and (4) outline novel MR imaging techniques for the evaluation of anatomy and function of joints in JIA. Optimizing the role of MRI as a robust biomarker and outcome measure remains a priority of future research in this field.
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Affiliation(s)
- Clara Malattia
- Clinica Pediatrica e Reumatologia, Istituto Giannina Gaslini, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genoa, Italy
| | - Mirkamal Tolend
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Marta Mazzoni
- Clinica Pediatrica e Reumatologia, Istituto Giannina Gaslini, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genoa, Italy
| | - Jyoti Panwar
- Department of Radiology, Christian Medical College, Vellore, India
| | - Margalit Zlotnik
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Tarimobo Otobo
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Logi Vidarsson
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Andrea S Doria
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada; Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
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16
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Frid P, Augdal TA, Larheim TA, Halbig J, Rypdal V, Songstad NT, Rosén A, Tylleskär KB, Berstad JR, Flatø B, Stoustrup P, Rosendahl K, Kirkhus E, Nordal E. Efficacy and safety of intraarticular corticosteroid injections in adolescents with juvenile idiopathic arthritis in the temporomandibular joint: a Norwegian 2-year prospective multicenter pilot study. Pediatr Rheumatol Online J 2020; 18:75. [PMID: 32998740 PMCID: PMC7528594 DOI: 10.1186/s12969-020-00464-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/03/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Intraarticular corticosteroids (IACs) have been used to treat temporomandibular joint (TMJ) arthritis. However, prospective clinical studies with magnetic resonance imaging (MRI) scoring are lacking. The aim of this study was to examine efficacy and safety of a single IAC in the TMJ in adolescents with juvenile idiopathic arthritis (JIA) in a clinical setting. METHODS In this Norwegian prospective multicenter pilot study 15 patients with JIA (mostly persistent oligoarthritis or RF negative polyarthritis categories) and a clinically and MRI-verified diagnosis of TMJ arthritis were treated with IACs and followed for 2 years. Demographics, systemic medication, general disease activity and outcome measures were recorded including a pain-index score and maximal incisal opening (MIO). Inflammation and bone damage scores were assessed, using two recently published MRI scoring systems with masked radiological evaluation. RESULTS Among the 15 patients, 13 received a single IAC (5 bilateral), and 2 repeated IACs once unilaterally. Thus, the total number of IACs was 22. Median age was 15 years and the majority had an age not thought of as critical regarding mandibular growth retardation due to steroid injection. During the 2-year observation period systemic medication with disease modifying antirheumatic drugs (DMARDs) including biologics was initiated or adjusted in 10/15 (67%) patients. At the 2-months study visit after injection we observed a minimal improvement in MIO from median 44 (1st, 3rd quartiles; 36, 48) mm to 45 (43, 47) mm, p = 0.045 and decreased MRI mean additive inflammatory score from 4.4 ± 1.8 standard deviations (SD) to 3.4 ± 2.0, p = 0.040. From baseline to the 2-months follow-up pain improved in 6/11 patients but pain scores were not significantly improved. MRI-assessed damage increased in two patients with repeated IACs, and decreased in 3 patients but most of the patients were stable over the 2-year follow-up. Intra-rater repeatability of the MRI scoring system domains varied from poor to excellent. CONCLUSIONS In this pilot study of predominately single IACs to the TMJ in combination with systemic treatment we observed improvement in MRI-assessed inflammation, mostly stable condylar bone conditions and minimal clinical improvement in adolescents with JIA and TMJ arthritis. No severe side effects were seen.
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Affiliation(s)
- Paula Frid
- Department of Otorhinolaryngology, Division of Oral and Maxillofacial Surgery, University Hospital North Norway, Tromsø, Norway.
- Public Dental Service Competence Centre of North Norway, Tromsø, Norway.
- Pediatric Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
| | - Thomas A Augdal
- Pediatric Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
- Section for Pediatric Radiology, Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Tore A Larheim
- Department of Clinical Dentistry, UiT The Arctic University of Norway, Tromsø, Norway
| | - Josefine Halbig
- Public Dental Service Competence Centre of North Norway, Tromsø, Norway
- Pediatric Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Veronika Rypdal
- Pediatric Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
- Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Nils Thomas Songstad
- Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Annika Rosén
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
- Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
| | - Karin B Tylleskär
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Johanna Rykke Berstad
- Department of ENT and Oral and Maxillofacial Surgery, Oslo University Hospital, Oslo, Norway
| | - Berit Flatø
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Peter Stoustrup
- Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Karen Rosendahl
- Pediatric Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
- Section for Pediatric Radiology, Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Eva Kirkhus
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Ellen Nordal
- Pediatric Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
- Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
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17
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Bollhalder A, Patcas R, Eichenberger M, Müller L, Schroeder-Kohler S, Saurenmann RK, Kellenberger CJ. Magnetic Resonance Imaging Followup of Temporomandibular Joint Inflammation, Deformation, and Mandibular Growth in Juvenile Idiopathic Arthritis Patients Receiving Systemic Treatment. J Rheumatol 2019; 47:909-916. [PMID: 31523042 DOI: 10.3899/jrheum.190168] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate the course of temporomandibular joint (TMJ) inflammation, osseous deformation, and mandibular ramus growth in children with juvenile idiopathic arthritis (JIA) during systemic therapy. METHODS Longitudinal study of 38 consecutive patients with JIA (29 female, median age 9.0 yrs, interquartile range 6.2-10.7 yrs) receiving systemic therapy with TMJ involvement, with 2 TMJ magnetic resonance imaging (MRI) examinations ≥ 2 years apart and no TMJ corticosteroid injection. Clinical and MRI findings were compared between initial and followup examinations and between TMJ with and without active inflammation at baseline. RESULTS Over a median period of 3.6 years (range, 2.0-8.7 yrs), MRI grade of TMJ inflammation improved (p = 0.009) and overall osseous deformity tended to become less severe (p = 0.114). In TMJ with arthritis at baseline (46 TMJ), both the grades of inflammation (p < 0.001) and deformity (p = 0.011) improved. In TMJ with no arthritis at baseline (30 TMJ), the frequency and grade of condylar deformation remained stable. Mandibular ramus growth rates were not significantly different between TMJ with and without arthritis at baseline (1.3 mm/yr vs 1.5 mm/yr, p = 0.273), and were not correlated with the degree of inflammation at baseline or followup. The frequency of facial asymmetry tended to be lower at followup than at initial examination (24% vs 45%, p = 0.056). CONCLUSION Our results suggest that systemic treatment of TMJ arthritis in children with JIA decreases the degree of inflammation seen on MRI, preserves osseous TMJ morphology, and maintains normal mandibular ramus growth.
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Affiliation(s)
- Andrea Bollhalder
- From the Department of Diagnostic Imaging, the Division of Paediatric Rheumatology, and the Children's Research Center, University Children's Hospital Zürich; Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich, Zürich; Department of Child and Adolescent Medicine, Kantonsspital Winterthur, Winterthur, Switzerland.,A. Bollhalder, DDS, Orthodonist, Department of Diagnostic Imaging, University Children's Hospital Zürich, and Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich; R. Patcas, DDS, PhD, PD, Orthodonist, Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich; M. Eichenberger, DDS, Orthodontist, Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich; L. Müller, DDS, Orthodontist, Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich; S. Schroeder-Kohler, MD, Pediatric Rheumatologist, Division of Paediatric Rheumatology, University Children's Hospital Zürich, and Children's Research Center, University Children's Hospital Zürich; R.K. Saurenmann, MD, Professor, Pediatric Rheumatologist, Director, Department of Child and Adolescent Medicine, Kantonsspital Winterthur, and Division of Paediatric Rheumatology, University Children's Hospital Zürich, and Children's Research Center, University Children's Hospital Zürich; C.J. Kellenberger, MD, Professor, Pediatric Radiologist, Radiologist-in-Chief, Department of Diagnostic Imaging, and Children's Research Center, University Children's Hospital Zürich
| | - Raphael Patcas
- From the Department of Diagnostic Imaging, the Division of Paediatric Rheumatology, and the Children's Research Center, University Children's Hospital Zürich; Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich, Zürich; Department of Child and Adolescent Medicine, Kantonsspital Winterthur, Winterthur, Switzerland.,A. Bollhalder, DDS, Orthodonist, Department of Diagnostic Imaging, University Children's Hospital Zürich, and Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich; R. Patcas, DDS, PhD, PD, Orthodonist, Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich; M. Eichenberger, DDS, Orthodontist, Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich; L. Müller, DDS, Orthodontist, Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich; S. Schroeder-Kohler, MD, Pediatric Rheumatologist, Division of Paediatric Rheumatology, University Children's Hospital Zürich, and Children's Research Center, University Children's Hospital Zürich; R.K. Saurenmann, MD, Professor, Pediatric Rheumatologist, Director, Department of Child and Adolescent Medicine, Kantonsspital Winterthur, and Division of Paediatric Rheumatology, University Children's Hospital Zürich, and Children's Research Center, University Children's Hospital Zürich; C.J. Kellenberger, MD, Professor, Pediatric Radiologist, Radiologist-in-Chief, Department of Diagnostic Imaging, and Children's Research Center, University Children's Hospital Zürich
| | - Martina Eichenberger
- From the Department of Diagnostic Imaging, the Division of Paediatric Rheumatology, and the Children's Research Center, University Children's Hospital Zürich; Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich, Zürich; Department of Child and Adolescent Medicine, Kantonsspital Winterthur, Winterthur, Switzerland.,A. Bollhalder, DDS, Orthodonist, Department of Diagnostic Imaging, University Children's Hospital Zürich, and Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich; R. Patcas, DDS, PhD, PD, Orthodonist, Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich; M. Eichenberger, DDS, Orthodontist, Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich; L. Müller, DDS, Orthodontist, Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich; S. Schroeder-Kohler, MD, Pediatric Rheumatologist, Division of Paediatric Rheumatology, University Children's Hospital Zürich, and Children's Research Center, University Children's Hospital Zürich; R.K. Saurenmann, MD, Professor, Pediatric Rheumatologist, Director, Department of Child and Adolescent Medicine, Kantonsspital Winterthur, and Division of Paediatric Rheumatology, University Children's Hospital Zürich, and Children's Research Center, University Children's Hospital Zürich; C.J. Kellenberger, MD, Professor, Pediatric Radiologist, Radiologist-in-Chief, Department of Diagnostic Imaging, and Children's Research Center, University Children's Hospital Zürich
| | - Lukas Müller
- From the Department of Diagnostic Imaging, the Division of Paediatric Rheumatology, and the Children's Research Center, University Children's Hospital Zürich; Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich, Zürich; Department of Child and Adolescent Medicine, Kantonsspital Winterthur, Winterthur, Switzerland.,A. Bollhalder, DDS, Orthodonist, Department of Diagnostic Imaging, University Children's Hospital Zürich, and Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich; R. Patcas, DDS, PhD, PD, Orthodonist, Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich; M. Eichenberger, DDS, Orthodontist, Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich; L. Müller, DDS, Orthodontist, Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich; S. Schroeder-Kohler, MD, Pediatric Rheumatologist, Division of Paediatric Rheumatology, University Children's Hospital Zürich, and Children's Research Center, University Children's Hospital Zürich; R.K. Saurenmann, MD, Professor, Pediatric Rheumatologist, Director, Department of Child and Adolescent Medicine, Kantonsspital Winterthur, and Division of Paediatric Rheumatology, University Children's Hospital Zürich, and Children's Research Center, University Children's Hospital Zürich; C.J. Kellenberger, MD, Professor, Pediatric Radiologist, Radiologist-in-Chief, Department of Diagnostic Imaging, and Children's Research Center, University Children's Hospital Zürich
| | - Silke Schroeder-Kohler
- From the Department of Diagnostic Imaging, the Division of Paediatric Rheumatology, and the Children's Research Center, University Children's Hospital Zürich; Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich, Zürich; Department of Child and Adolescent Medicine, Kantonsspital Winterthur, Winterthur, Switzerland.,A. Bollhalder, DDS, Orthodonist, Department of Diagnostic Imaging, University Children's Hospital Zürich, and Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich; R. Patcas, DDS, PhD, PD, Orthodonist, Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich; M. Eichenberger, DDS, Orthodontist, Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich; L. Müller, DDS, Orthodontist, Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich; S. Schroeder-Kohler, MD, Pediatric Rheumatologist, Division of Paediatric Rheumatology, University Children's Hospital Zürich, and Children's Research Center, University Children's Hospital Zürich; R.K. Saurenmann, MD, Professor, Pediatric Rheumatologist, Director, Department of Child and Adolescent Medicine, Kantonsspital Winterthur, and Division of Paediatric Rheumatology, University Children's Hospital Zürich, and Children's Research Center, University Children's Hospital Zürich; C.J. Kellenberger, MD, Professor, Pediatric Radiologist, Radiologist-in-Chief, Department of Diagnostic Imaging, and Children's Research Center, University Children's Hospital Zürich
| | - Rotraud Katharina Saurenmann
- From the Department of Diagnostic Imaging, the Division of Paediatric Rheumatology, and the Children's Research Center, University Children's Hospital Zürich; Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich, Zürich; Department of Child and Adolescent Medicine, Kantonsspital Winterthur, Winterthur, Switzerland.,A. Bollhalder, DDS, Orthodonist, Department of Diagnostic Imaging, University Children's Hospital Zürich, and Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich; R. Patcas, DDS, PhD, PD, Orthodonist, Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich; M. Eichenberger, DDS, Orthodontist, Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich; L. Müller, DDS, Orthodontist, Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich; S. Schroeder-Kohler, MD, Pediatric Rheumatologist, Division of Paediatric Rheumatology, University Children's Hospital Zürich, and Children's Research Center, University Children's Hospital Zürich; R.K. Saurenmann, MD, Professor, Pediatric Rheumatologist, Director, Department of Child and Adolescent Medicine, Kantonsspital Winterthur, and Division of Paediatric Rheumatology, University Children's Hospital Zürich, and Children's Research Center, University Children's Hospital Zürich; C.J. Kellenberger, MD, Professor, Pediatric Radiologist, Radiologist-in-Chief, Department of Diagnostic Imaging, and Children's Research Center, University Children's Hospital Zürich
| | - Christian Johannes Kellenberger
- From the Department of Diagnostic Imaging, the Division of Paediatric Rheumatology, and the Children's Research Center, University Children's Hospital Zürich; Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich, Zürich; Department of Child and Adolescent Medicine, Kantonsspital Winterthur, Winterthur, Switzerland. .,A. Bollhalder, DDS, Orthodonist, Department of Diagnostic Imaging, University Children's Hospital Zürich, and Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich; R. Patcas, DDS, PhD, PD, Orthodonist, Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich; M. Eichenberger, DDS, Orthodontist, Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich; L. Müller, DDS, Orthodontist, Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich; S. Schroeder-Kohler, MD, Pediatric Rheumatologist, Division of Paediatric Rheumatology, University Children's Hospital Zürich, and Children's Research Center, University Children's Hospital Zürich; R.K. Saurenmann, MD, Professor, Pediatric Rheumatologist, Director, Department of Child and Adolescent Medicine, Kantonsspital Winterthur, and Division of Paediatric Rheumatology, University Children's Hospital Zürich, and Children's Research Center, University Children's Hospital Zürich; C.J. Kellenberger, MD, Professor, Pediatric Radiologist, Radiologist-in-Chief, Department of Diagnostic Imaging, and Children's Research Center, University Children's Hospital Zürich.
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18
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Kellenberger CJ, Bucheli J, Schroeder-Kohler S, Saurenmann RK, Colombo V, Ettlin DA. Temporomandibular joint magnetic resonance imaging findings in adolescents with anterior disk displacement compared to those with juvenile idiopathic arthritis. J Oral Rehabil 2018; 46:14-22. [PMID: 30252949 DOI: 10.1111/joor.12720] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 09/04/2018] [Accepted: 09/19/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Deformation of the mandibular condyle can be associated with anterior disk displacement (ADD) or involvement of the temporomandibular joint (TMJ) by juvenile idiopathic arthritis (JIA). Diagnostic differentiation is critical for proper management. OBJECTIVES To compare morphology and inflammation between TMJs with ADD and JIA. METHODS Retrospective assessment of contrast-enhanced TMJ MRI in 18 adolescents (15 female, mean age 15.1 ± 1.9 years) with ADD and age- and gender-matched patients with JIA. Articular disk findings, inflammatory signs and osseous morphology were compared. RESULTS In the ADD group, 31 of 36 disks were displaced. In total, 28 of 31 displaced disks showed thickening of the bilaminar zone. In JIA patients, the disks were mainly flattened (19/36), centrally perforated (12/36) and/or anteriorly displaced (2/36). In total, 19 of 31 TMJs with ADD showed various degrees of inflammation, with joint effusion, synovial thickening and joint enhancement not significantly different from JIA patients. Osseous deformity was present in 27 of 31 TMJs with ADD, with frequent erosions in both groups (ADD 25/31; JIA 32/36, P = 0.55) but lower grades of condylar and temporal bone flattening than in JIA (P ≤ 0.001). Glenoid fossa depth was preserved in 28 of 31 joints with ADD and decreased in 26 of 36 joints with JIA (P < 0.0001). Mandibular ramus height was decreased in both groups. CONCLUSION In adolescents, inflammatory signs are common MRI findings in symptomatic TMJs with ADD and thus should not be considered diagnostic for JIA involvement. In this cohort, both entities had high rates of condylar deformity, while TMJs with ADD showed a better-preserved and often normal shape of the glenoid fossa.
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Affiliation(s)
- Christian J Kellenberger
- Department of Diagnostic Imaging, University Children's Hospital Zürich, Zürich, Switzerland.,Children's Research Centre, University Children's Hospital Zürich, Zürich, Switzerland
| | - Jeannine Bucheli
- Department of Diagnostic Imaging, University Children's Hospital Zürich, Zürich, Switzerland.,Center of Dental Medicine, University of Zürich, Zürich, Switzerland
| | - Silke Schroeder-Kohler
- Children's Research Centre, University Children's Hospital Zürich, Zürich, Switzerland.,Division of Rheumatology, University Children's Hospital, Zürich, Switzerland
| | - Rotraud K Saurenmann
- Division of Rheumatology, University Children's Hospital, Zürich, Switzerland.,Department of Paediatrics, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Vera Colombo
- Center of Dental Medicine, University of Zürich, Zürich, Switzerland
| | - Dominik A Ettlin
- Center of Dental Medicine, University of Zürich, Zürich, Switzerland
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19
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Junhasavasdikul T, Abadeh A, Tolend M, Doria AS. Developing a reference MRI database for temporomandibular joints in healthy children and adolescents. Pediatr Radiol 2018; 48:1113-1122. [PMID: 29789889 DOI: 10.1007/s00247-018-4142-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/16/2018] [Accepted: 04/16/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Recognition of normal temporomandibular joints (TMJs) is essential to assess arthropathic changes. Few, if any, prior studies have evaluated the morphological appearance of growing TMJs by magnetic resonance (MR) examinations in the pediatric population. OBJECTIVE This study aimed to determine normative osseous appearance of growing TMJs according to age and gender, both qualitatively and quantitatively, concerning structural and bone marrow changes. MATERIALS AND METHODS From 1,036 MR scans screened, one joint was included from each of 157 patients (76% female; 2-18 years) presenting with at least one normal-appearing TMJ was included. Quantitatively, mandibular condyle was characterized by measuring the following: (i) head-neck angle, (ii) anteversion angle, (iii) condylar dimensions (mediolateral, craniocaudal and anteroposterior [AP]) and (iv) condylar volume. Furthermore, qualitative categorization of condylar shape, into one of three types, and condylar bone marrow type was performed. RESULTS The head-neck angle significantly correlated with age (bivariable regression β =0.60, P<0.001), indicating an increase of 1.6 degrees per year. Except for AP diameter of condyles, all other mandibular dimensions and condylar volume increased with age (β =0.20-0.59, P≤0.001-0.004). Significant age difference was observed among the different condylar shapes (P<0.001), indicating a change from rounded head without anterior tilt to rectangular head with anterior tilt. Lastly, mandibular condylar size, measured by volume and by AP and mediolateral dimensions, appeared larger in males. CONCLUSION The morphology of the mandibular condyles changes with age. During development, the shape of the condyles changes from round to rectangular in contour with the development of the anterior condylar tilt, as measured by the head-neck angle.
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Affiliation(s)
- Thitiporn Junhasavasdikul
- Department of Medical Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave., 2nd floor, Toronto, ON, M5G1X8, Canada.,Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Aryan Abadeh
- Department of Medical Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave., 2nd floor, Toronto, ON, M5G1X8, Canada
| | - Mirkamal Tolend
- Department of Medical Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave., 2nd floor, Toronto, ON, M5G1X8, Canada
| | - Andrea S Doria
- Department of Medical Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave., 2nd floor, Toronto, ON, M5G1X8, Canada. .,Research Institute, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada.
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20
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Kellenberger CJ, Abramowicz S, Arvidsson LZ, Kirkhus E, Tzaribachev N, Larheim TA. Recommendations for a Standard Magnetic Resonance Imaging Protocol of Temporomandibular Joints in Juvenile Idiopathic Arthritis. J Oral Maxillofac Surg 2018; 76:2463-2465. [PMID: 30028954 DOI: 10.1016/j.joms.2018.06.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 06/11/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Christian J Kellenberger
- Professor and Department Head, Department of Diagnostic Imaging, Children's Research Center, University Children's Hospital Zürich, Zurich, Switzerland.
| | - Shelly Abramowicz
- Associate Professor, Emory University School of Medicine, Atlanta, GA; and Oral and Maxillofacial Surgeon, Departments of Surgery and Pediatrics, Division of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA
| | - Linda Z Arvidsson
- Associate Professor and Department Head, Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - Eva Kirkhus
- Musculoskeletal Radiologist, Department of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Nikolay Tzaribachev
- Pediatric Rheumatologist, Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany
| | - Tore A Larheim
- Professor, Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
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21
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Miller E, Inarejos Clemente EJ, Tzaribachev N, Guleria S, Tolend M, Meyers AB, von Kalle T, Stimec J, Koos B, Appenzeller S, Arvidsson LZ, Kirkhus E, Doria AS, Kellenberger CJ, Larheim TA. Imaging of temporomandibular joint abnormalities in juvenile idiopathic arthritis with a focus on developing a magnetic resonance imaging protocol. Pediatr Radiol 2018; 48:792-800. [PMID: 29766249 DOI: 10.1007/s00247-017-4005-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 09/27/2017] [Indexed: 11/26/2022]
Abstract
Inflammation and damage in the temporomandibular joint (TMJ) often develop without clinical symptoms but can lead to severe facial growth abnormalities and impaired health-related quality of life, making early diagnosis of TMJ changes crucial to identify. Inflammatory and osteochondral changes detectable through magnetic resonance imaging (MRI) occur in TMJs of approximately 40% of children with juvenile idiopathic arthritis (JIA), and no other imaging modality or physical method of examination can reliably detect these changes. Therefore contrast-enhanced MRI is the diagnostic standard for diagnosis and interval monitoring of JIA. However the specific usage of MRI for TMJ arthritis is not standardized at present. There is a recognized need for a consensus effort toward standardization of an imaging protocol with required and optional sequences to improve detection of pathological changes and shorten study time. Such a consensus imaging protocol is important for providing maximum information with minimally necessary sequences in a way that allows inter-site comparison of results of clinical trials and improved clinical management. In this paper we describe the challenges of TMJ imaging and present expert-panel consensus suggestions for a standardized TMJ MRI protocol.
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Affiliation(s)
- Elka Miller
- Department of Medical Imaging, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | | | | | - Mirkamal Tolend
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.
- Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, 08.9840-L4, Toronto, ON, M5G 1A4, Canada.
| | - Arthur B Meyers
- Department of Radiology, Nemours Children's Health System, Orlando, FL, USA
| | - Thekla von Kalle
- Department of Pediatric Radiology, Radiologisches Institut, Olgahospital Klinikum Stuttgart, Stuttgart, Germany
| | - Jennifer Stimec
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - Bernd Koos
- Department of Orthodontics, University Hospital Tübingen, Tübingen, Germany
| | | | - Linda Z Arvidsson
- Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - Eva Kirkhus
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Andrea S Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Tore A Larheim
- Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
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22
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Tolend MA, Twilt M, Cron RQ, Tzaribachev N, Guleria S, von Kalle T, Koos B, Miller E, Stimec J, Vaid Y, Larheim TA, Herlin T, Spiegel L, Inarejos Clemente EJ, Moineddin R, van Rossum MA, Saurenmann RK, Doria AS, Kellenberger CJ. Toward Establishing a Standardized Magnetic Resonance Imaging Scoring System for Temporomandibular Joints in Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2018; 70:758-767. [PMID: 28805021 DOI: 10.1002/acr.23340] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 08/08/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The temporomandibular joints (TMJs) are frequently affected in children with juvenile idiopathic arthritis (JIA). Early detection is challenging, as major variation is present in scoring TMJ pathology on magnetic resonance imaging (MRI). Consensus-driven development and validation of an MRI scoring system for TMJs has important clinical utility in timely improvement of diagnosis and serving as an outcome measure. We report on a multi-institutional collaboration toward developing a TMJ MRI scoring system for JIA. METHODS Seven readers independently assessed MRI scans from 21 patients (42 TMJs, from patients ages 6-16 years) using 3 existing MRI scoring systems from American, German, and Swiss institutions. Reliability scores, scoring system definitions, and items were discussed among 10 JIA experts through 2 rounds of Delphi surveys, nominal group voting, and subsequent consensus meetings to create a novel TMJ MRI scoring system. RESULTS Average-measure absolute agreement intraclass correlation coefficients (avICCs) for the total scores of all 3 scoring systems were highly reliable at 0.96 each. Osteochondral items showed higher reliability than inflammatory items. An additive system was deemed preferable for assessing minor joint changes over time. Eight items were considered sufficiently reliable and/or important for integration into the consensus scoring system: bone marrow edema and enhancement (avICC 0.57-0.61, smallest detectable difference [SDD] ± 45-63% prior to redefining), condylar flattening (avICC 0.95-0.96, SDD ± 23-28%), effusions (avICC 0.85-0.88, SDD ± 25-26%), erosions (avICC 0.94, SDD ± 20%), synovial enhancement and thickening (previously combined, avICC 0.90-0.91, SDD ± 33%), and disk abnormalities (avICC 0.90, SDD ± 19%). CONCLUSION A novel TMJ MRI scoring system was developed by consensus. Further iterative refinements and reliability testing are warranted in upcoming studies.
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Affiliation(s)
| | - Marinka Twilt
- Alberta Children's Hospital, Calgary, Alberta, Canada
| | | | | | | | | | - Bernd Koos
- University Hospital Tübingen, Tübingen, Germany
| | - Elka Miller
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | | | | | | | - Lynn Spiegel
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Marion A van Rossum
- Emma Children's Hospital, Academic Medical Centre, and Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
| | | | - Andrea S Doria
- The Hospital for Sick Children, Toronto, Ontario, Canada
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23
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Kellenberger CJ, Junhasavasdikul T, Tolend M, Doria AS. Temporomandibular joint atlas for detection and grading of juvenile idiopathic arthritis involvement by magnetic resonance imaging. Pediatr Radiol 2018; 48:411-426. [PMID: 29134239 PMCID: PMC5823950 DOI: 10.1007/s00247-017-4000-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/05/2017] [Accepted: 09/26/2017] [Indexed: 11/17/2022]
Abstract
Contrast-enhanced magnetic resonance imaging (MRI) is considered the diagnostic standard for identifying involvement of the temporomandibular joint by juvenile idiopathic arthritis. Early or active arthritis is shown as bone marrow oedema, joint effusion, synovial thickening and increased joint enhancement. Subsequent joint damage includes characteristic deformity of the mandibular condyle, bone erosion, disk abnormalities and short mandibular ramus due to impaired growth. In this pictorial essay, we illustrate normal MRI findings and growth-related changes of the temporomandibular joint in children. The rationale and practical application of semiquantitative MRI assessment of joint inflammation and damage are discussed and presented. This atlas can serve as a reference for grading temporomandibular joint arthritis according to the scoring systems proposed by working groups of OMERACT (Outcome Measures in Rheumatology and Clinical Trials) and the EuroTMjoint research network. Systematic assessment of the level of inflammation, degree of osteochondral deformation, and growth of the mandibular ramus by MRI may aid in monitoring the course of temporomandibular joint arthritis and evaluating treatment options.
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Affiliation(s)
- Christian J Kellenberger
- Department of Diagnostic Imaging, University Children's Hospital Zürich, Zürich, Switzerland.
- Children's Research Centre, University Children's Hospital Zürich, Zürich, Switzerland.
| | - Thitiporn Junhasavasdikul
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada
| | - Mirkamal Tolend
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Andrea S Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Canada
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No association between types of unilateral mandibular condylar abnormalities and facial asymmetry in orthopedic-treated patients with juvenile idiopathic arthritis. Am J Orthod Dentofacial Orthop 2018; 153:214-223. [DOI: 10.1016/j.ajodo.2017.05.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 05/01/2017] [Accepted: 05/01/2017] [Indexed: 11/20/2022]
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25
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Kellenberger CJ, Arvidsson LZ, Larheim TA. Magnetic resonance imaging of temporomandibular joints in juvenile idiopathic arthritis. Semin Orthod 2015. [DOI: 10.1053/j.sodo.2015.02.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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