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Sang S, Ameli N, Almeida FT, Friesen R. Association between clinical symptoms and MRI image findings in symptomatic temporomandibular joint (TMJ) disease: A systematic review. J Craniomaxillofac Surg 2024; 52:835-842. [PMID: 38724287 DOI: 10.1016/j.jcms.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 01/16/2024] [Accepted: 04/11/2024] [Indexed: 07/23/2024] Open
Abstract
To evaluate the association between clinical signs and symptoms of temporomandibular joint (TMJ) and magnetic resonance image (MRI) findings in patients with temporomandibular disorders (TMD). Relevant articles on humans over 18 years of age were obtained from five databases (Ovid MEDLINE, PubMed, Scopus, Web of Science, and Google Scholar) up to August 2022. Risk of bias assessment was completed using the Joanna Briggs Institute critical appraisal tools. The GRADEpro (Grading of Recommendations, Assessment, Development, and Evaluation) instrument was applied to assess the level of evidence across studies in a GRADE Summary of Findings table. In total, 22 studies were included in this systematic review. Of these, 11 studies highlighted that joint pain was positively associated with particular MRI findings: joint effusion, bone marrow edema, disk displacement with/without reduction, and condylar erosion. Masticatory muscle pain was found to have a strong positive correlation with disk displacement in four studies. Five studies found no significant association between MRI findings and masticatory muscle pain. Range of motion and MRI findings were examined in six studies. Limited mouth opening was found to be correlated with disk displacement in five studies. Of the 11 studies evaluating the correlation between joint noise and MRI findings, eight reported a significant association between disk displacement and TMJ noise. The results suggested that patients with joint pain and limited range of motion may benefit from MRI. Patients exhibiting primarily muscle pain are unlikely to benefit clinically from MRI. Future studies with improved quality are warranted.
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Affiliation(s)
- Sara Sang
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
| | - Nazila Ameli
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
| | - Fabiana T Almeida
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
| | - Reid Friesen
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
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Saccomanno S, Saran S, Parpagliolo L, Tasquier F, Giannotta N, Kozokic J, Carganico A, Mastrapasqua RF, Raffaelli L, Levrini L. Temporomandibular disorders: the most common diagnostic approaches. Minerva Dent Oral Sci 2024; 73:142-148. [PMID: 38127420 DOI: 10.23736/s2724-6329.23.04845-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND Temporomandibular disorders (TMDs) are a heterogeneous group of conditions involving the temporomandibular joint complex, and surrounding musculature and osseous components. They are a multifactorial disease that can be determined by organic, genetic aspects, oral parafunctional habits, and psychological stress. They have an annual incidence of more than 5% of the population and about 6% to 12% of the population is affected by symptoms. The diagnostic criteria (DC), introduced by Dworkin, is considered the standard system to diagnose this disease in a specific way. Imaging can support the diagnosis of TMD when history and physical examination findings are equivocal. The aim of the study was to evaluate instrumental examinations and therapies, clinicians prefer to use in different cases of TMDs. METHODS An anonymized survey, available in two languages (Italian and English), was given to 450 patients, 398 (120 males, 274 females and 4 who did not answer) of different private dental practices were considered, using Google Form (Google LLC, Mountain View, CA, USA) and used an electronic platform, from September 2021 to February 2022. There was no reminder sent to patients to let them feel free to answer. RESULTS We performed binary regression for oral bite prescription considering common symptoms and found that the most representative is jaw block (P=0.007, exponential value [EXP]=0.509), followed by TMJ noises (P=0.01, EXP=0.503) and feeling stressed (P=0.04, EXP=1.125) while headache and tinnitus resulted not significant. CONCLUSIONS The study highlighted that magnetic resonance imaging (MRI) is the most instrumental examination adopted by the clinicians and the oral splint(bite) is the therapy most widespread nowadays, even if TMDs are a multifactorial disease that is not, probably, only linked to an alteration of dental occlusion.
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Affiliation(s)
- Sabina Saccomanno
- Department of Health, Life and Environmental Science, University of L'Aquila, L'Aquila, Italy
| | - Stefano Saran
- School of Dentistry, Postgraduate of Orthodontics, Department of Human Sciences, Innovation and Territory, University of Insubria, Varese, Italy -
| | - Luca Parpagliolo
- School of Dentistry, Postgraduate of Orthodontics, Department of Human Sciences, Innovation and Territory, University of Insubria, Varese, Italy
| | - Federico Tasquier
- School of Dentistry, Postgraduate of Orthodontics, Department of Human Sciences, Innovation and Territory, University of Insubria, Varese, Italy
| | - Nicola Giannotta
- School of Dentistry, Postgraduate of Orthodontics, Department of Human Sciences, Innovation and Territory, University of Insubria, Varese, Italy
| | - Jovana Kozokic
- School of Dentistry, Postgraduate of Orthodontics, Department of Human Sciences, Innovation and Territory, University of Insubria, Varese, Italy
| | - Andrea Carganico
- School of Dentistry, Postgraduate of Orthodontics, Department of Human Sciences, Innovation and Territory, University of Insubria, Varese, Italy
| | - Rodolfo F Mastrapasqua
- Ear, Nose, and Throat (ENT) Department, Rivoli Hospital, ASL Torino3, Rivoli, Turin, Italy
| | - Luca Raffaelli
- Dental School, Sacred Heart Catholic University, Rome, Italy
| | - Luca Levrini
- School of Dentistry, Postgraduate of Orthodontics, Department of Human Sciences, Innovation and Territory, University of Insubria, Varese, Italy
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Wahidi J, Zuniga JR. Can cone-beam CT evaluation of the temporomandibular joint (TMJ) be the standard criteria for the positional and morphological evaluation of TMJ osseous structures? Eur Radiol 2024; 34:3123-3125. [PMID: 38451325 DOI: 10.1007/s00330-024-10673-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 03/08/2024]
Affiliation(s)
- Jason Wahidi
- Division of Oral and Maxillofacial Surgery, Department of Surgery, UT Southwestern/Parkland Memorial Hospital, Dallas, TX, USA
| | - John R Zuniga
- Division of Oral and Maxillofacial Surgery, Department of Surgery and Neurology, UT Southwestern/Parkland Memorial Hospital, Dallas, TX, USA.
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Zhu H, Zhang Q, Li R, Chen Y, Zhang G, Wang R, Lu M, Yan X. A detunable wireless resonator insert for high-resolution TMJ MRI at 1.5 T. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2024; 360:107650. [PMID: 38417250 DOI: 10.1016/j.jmr.2024.107650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 02/09/2024] [Accepted: 02/21/2024] [Indexed: 03/01/2024]
Abstract
MRI is essential for evaluating and diagnosing various conditions affecting the temporomandibular joint (TMJ) and surrounding structures, as it provides highly detailed images that enable healthcare professionals to assess the joints and surroundings in great detail. While commercial MRI scanners typically come equipped with basic receive coils, such as the head receive array, RF coils tailored for specialized applications like TMJ MRI must be obtained separately. Consequently, TMJ MRI scans are often conducted using the head receive array, yet this configuration proves suboptimal due to the lack of specialized coils. In this study, we introduce a simple, low-cost, and easy-to-reproduce wireless resonator insert to enhance the quality of TMJ MRI at 1.5 T. The wireless resonator shows a significant improvement in signal-to-noise ratio (SNR) and noticeably better imaging quality than the head array alone configuration in both phantom and in vivo images.
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Affiliation(s)
- Haoqin Zhu
- Sino Canada Health Institute Inc., Winnipeg, Manitoba, Canada.
| | - Qiang Zhang
- The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010010, China
| | - Rangsong Li
- Sino Canada Health Engineering Research Institute (Hefei) Ltd., Hefei, Anhui 230088, China
| | - Yuanyuan Chen
- Sino Canada Health Engineering Research Institute (Hefei) Ltd., Hefei, Anhui 230088, China
| | - Gong Zhang
- Hubei Key Laboratory of Intelligent Conveying Technology and Device, Hubei Polytechnic University, China
| | - Ruilin Wang
- College of Nuclear Equipment and Nuclear Engineering, Yantai University, Yantai, Shandong, China
| | - Ming Lu
- College of Nuclear Equipment and Nuclear Engineering, Yantai University, Yantai, Shandong, China
| | - Xinqiang Yan
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37232, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA; Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN 37232, USA.
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Magnetic Resonance Imaging Evaluation of Closed-Mouth TMJ Disc-Condyle Relationship in a Population of Patients Seeking for Temporomandibular Disorders Advice. Pain Res Manag 2021; 2021:5565747. [PMID: 34900071 PMCID: PMC8660213 DOI: 10.1155/2021/5565747] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 09/04/2021] [Accepted: 11/09/2021] [Indexed: 11/23/2022]
Abstract
Objective To characterize the closed-mouth temporomandibular joint (TMJ) disc-condyle relationship in a population of individuals who sought hospital services for temporomandibular disorders (TMD). Methods Two hundred and twenty-four TMJ magnetic resonance images (MRIs) of 112 patients were assessed in all spatial planes to classify disc position with respect to the condyle in a closed-mouth position. Results Disc displacement (DD) was present in 62.1% and superior disc position in 29.9% of the patients. Position could not be determined in 8% of the cases. Among DD, pure anteriorized position was the most common condition (34.4%), with different combined translational and rotational displacements in all the other joints (27.7%). Conclusion There is a wide biological variability in disc position in closed mouth among patients seeking for TMD advice. Getting deeper into the correlation with clinical symptoms is recommended to refine the potential relevance of any diagnostic and management strategies based on the imaging evaluation of TMJ disc position.
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Condylar erosion is predictive of painful closed lock of the temporomandibular joint: a magnetic resonance imaging study. Head Face Med 2021; 17:40. [PMID: 34507596 PMCID: PMC8431861 DOI: 10.1186/s13005-021-00291-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 08/24/2021] [Indexed: 12/19/2022] Open
Abstract
Background To assess whether magnetic resonance imaging (MRI) findings of condylar erosion (CE) are predictive of a specific clinical diagnosis of painful closed lock of the temporomandibular joint (TMJ), and to determine the strength of association between CE and types of internal derangement (ID). Methods Based upon sample size estimation, this retrospective paired-design study involved 62 patients, aged between 18 and 67 years. Inclusion criteria were the presence of a unilateral clinical diagnosis of arthralgia coexisting with disk displacement without reduction (‘AR and DDwoR/wLO’), assigned according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I, and the absence of signs and symptoms of TMJ pain and dysfunction on the contralateral TMJ side. Bilateral sagittal and coronal MR images were obtained to establish the prevalence of CE and TMJ ID types of disk displacement with (DDR) and without reduction (DDNR). Logistic regression analysis was used to compute odds ratios for CE and ID types. Confounding variables adjusted for were age, sex, time since pain onset, pain intensity, and type of ID. Results In the regression analysis, the MRI items of DDR (p = 0.533) and DDNR (p = 0.204) dropped out as nonsignificant in the diagnostic clinical ‘AR and DDwoR/wLO’ group. Significant increases in the risk of ‘AR and DDwoR’ occurred with CE (3.1:1 odds ratio; p = 0.026). The presence of CE was significantly related to DDNR (adjusted OR = 43.9; p < 0.001). Conclusions The data suggest CE as a dominant factor in the definition of painful closed lock of the TMJ, support the view that joint locking needs to be considered as a frequent symptom of osteoarthritis, and emphasize a strong association between the MRI items of CE and DDNR.
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Jeon KJ, Lee C, Choi YJ, Han SS. Analysis of three-dimensional imaging findings and clinical symptoms in patients with temporomandibular joint disorders. Quant Imaging Med Surg 2021; 11:1921-1931. [PMID: 33936975 DOI: 10.21037/qims-20-857] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background The purpose of this study was to analyze cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI) findings in temporomandibular joint disorder (TMD) patients and to comprehensively assess the relationships between these imaging findings and clinical symptoms. Methods A total of 754 temporomandibular joints (TMJs) in 377 patients with clinical symptoms of TMD who underwent both CBCT and MRI examinations were retrospectively reviewed. Clinical symptoms included TMJ pain, TMJ sound, and limitation of mouth opening. Oral radiologists evaluated osseous changes of the condylar head on CBCT, as well as the disc configuration, internal derangement, and joint effusion on MRI. The frequency of CBCT and MRI findings and the mean and standard deviation of age were analyzed. Logistic regression analysis was used to identify associations between these imaging findings and clinical symptoms using SPSS version 25.0 for Windows (IBM Corp., Armonk, NY, USA). The model fit was evaluated using the Hosmer and Lemeshow test. Results TMD patients consisted of 294 females and 83 males, and the age group of 20-39 accounted for 47.2% of the patients. Normal findings regarding osseous changes of the condylar head on CBCT were found in 65.1% of the patients. On MRI, a change in disc configuration was found in 54.9% of the patients, internal derangement in 62.6%, and joint effusion in 46.0%. TMJ pain was significantly associated with sclerosis [odds ratio (OR): 3.81], disc displacement without reduction (DDWOR) (OR: 3.22), grade 2 joint effusion (OR: 2.33), and grade 3 joint effusion (OR: 5.54). TMJ sound was significantly associated with disc displacement with reduction (DDWR) (OR: 3.04), DDWOR (OR: 2.50), grade 2 joint effusion (OR: 2.37), and grade 3 joint effusion (OR: 3.23). Limitation of mouth opening was significantly associated with flattened disc configuration (OR: 2.08), folded disc configuration (OR: 2.30), and grade 3 joint effusion (OR: 2.85). Conclusions CBCT findings had little to do with clinical symptoms. In contrast, MRI findings, including disc configuration, internal derangement, and joint effusion, were associated with clinical symptoms. These results suggest that MRI should be recommended over CBCT for the proper diagnosis of TMD patients.
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Affiliation(s)
- Kug Jin Jeon
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Chena Lee
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Yoon Joo Choi
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Sang-Sun Han
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Republic of Korea
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8
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Goyal P, Singh RK, Gangwar S, Mohammad S, Pal US, Singh G. Effect of duloxetine in temporomandibular joint disorders: A comparison with arthrocentesis. Natl J Maxillofac Surg 2020; 11:219-223. [PMID: 33897184 PMCID: PMC8051665 DOI: 10.4103/njms.njms_86_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/08/2020] [Accepted: 04/20/2020] [Indexed: 11/04/2022] Open
Abstract
Purpose This study was conducted to compare the efficacy of temporomandibular joint (TMJ) arthrocentesis, duloxetine therapy alone, and duloxetine in combination with TMJ arthrocentesis in the treatment of painful TMJ. Materials and Methods Thirty patients with TMJ pain were included in the study who were divided into three groups with ten patients in each group. Group A included patients having only TMJ arthrocentesis; in Group B, only duloxetine therapy (30 mg) was given twice a day orally for 3 months; and in Group C, a combination of TMJ arthrocentesis with duloxetine therapy (30 mg) was given twice a day orally for 3 months. Patients were followed at regular interval of the 1st day, 5th day, 7th day, 4th week, 6th week, and 12th week and assessed in terms of pain, maximum mouth opening (mm), clicking, Hospital Anxiety and Depression Rating Scale and estimation of interleukin-6 (IL-6). The data collected were compiled and statistically analyzed. Results The pain was found to be significantly lower in Group C than other groups at weeks 4, 6, and 12. In Group C, mouth opening increased significantly than Groups A and B on subsequent follow-ups. On biochemical analysis of IL-6 levels in lavage fluid, a significant decrease was observed in levels of IL-6 in lavage fluid in Groups A and C postoperatively. Conclusion The present study states that pain was observed to be much less after arthrocentesis along with duloxetine therapy. This combination therapy leads to much better and faster outcome, but still, long-term follow-ups with larger number of patients are required.
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Affiliation(s)
- Pawan Goyal
- Senior Resident, Faculty of Dental Sciences, KGMU, Lucknow, Uttar Pradesh, India
| | - R K Singh
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, KGMU, Lucknow, Uttar Pradesh, India
| | - Shilpi Gangwar
- Department of Oral and Maxillofacial Surgery, Chandra Dental College, Dharsania, Uttar Pradesh, India
| | - Shadab Mohammad
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, KGMU, Lucknow, Uttar Pradesh, India
| | - U S Pal
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, KGMU, Lucknow, Uttar Pradesh, India
| | - Geeta Singh
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, KGMU, Lucknow, Uttar Pradesh, India
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Silva MAG, Pantoja LLQ, Dutra-Horstmann KL, Valladares-Neto J, Wolff FL, Porporatti AL, Guerra ENS, De Luca Canto G. Prevalence of degenerative disease in temporomandibular disorder patients with disc displacement: A systematic review and meta-analysis. J Craniomaxillofac Surg 2020; 48:942-955. [PMID: 32896478 DOI: 10.1016/j.jcms.2020.08.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/01/2020] [Accepted: 08/16/2020] [Indexed: 12/15/2022] Open
Abstract
To assess the available literature on the prevalence of degenerative joint disease (DJD) in patients with anterior disc displacement (ADD) of the temporomandibular joint (TMJ), using a systematic review with meta-analysis. Search strategies were performed in the following databases: PubMed/MEDLINE, EMBASE, LILACS, Web of Science, Scopus, and LIVIVO. A search was also carried out in the gray literature. Two independent reviewers selected the included articles using a two-phase process based on the eligibility criteria. Three reviewers independently collected the required information from the included articles. The methodological quality of the selected studies was assessed individually. In accordance with the inclusion and exclusion criteria, 1349 studies were found and 18 articles were included. The total sample size was 3158 TMJs. The sex distribution was predominant for females (1161 females and 345 males). The average age was 46 (range 10-82) years. Among the 1762 TMJs quantitatively assessed, the prevalence of DJD involving disc displacement with reduction (DDWR) was 35%, while for disc displacement without reduction (DDWoR) the prevalence was 66%. The prevalences of different features of DJD were as follows: sclerosis 24.3%, erosion 23.5%, osteophyte 17.9%, and subcortical cyst 7.6%. The prevalence of DJD in temporomandibular disorder patients with disc displacement is around 50% and is higher in DDWoR (66%) than in DDWR (35%). Sclerosis and erosion would be the most expected radiological signs in a developing DJD. Clinicians should adequately address the frequent DJD features associated with disc displacement in terms of diagnostics and therapeutic management.
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Affiliation(s)
- Maria Alves Garcia Silva
- Department of Stomatological Sciences, Faculty of Dentistry, Federal University of Goiás, Goiânia, Goiás, Brazil.
| | | | | | - José Valladares-Neto
- Department of Orthodontics, Faculty of Dentistry, Federal University of Goiás, Goiânia, Goiás, Brazil
| | | | - André Luís Porporatti
- Brazilian Centre for Evidence-Based Research, Department of Dentistry, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Eliete Neves Silva Guerra
- Laboratory of Oral Histopathology, Health Sciences Faculty, University of Brasília, Brasília, Brazil
| | - Graziela De Luca Canto
- Department of Dentistry, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
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Matsubara R, Yanagi Y, Oki K, Hisatomi M, Santos KC, Bamgbose BO, Fujita M, Okada S, Minagi S, Asaumi J. Assessment of MRI findings and clinical symptoms in patients with temporomandibular joint disorders. Dentomaxillofac Radiol 2018; 47:20170412. [PMID: 29451403 DOI: 10.1259/dmfr.20170412] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To investigate the correlations among various temporomandibular joint (TMJ) findings on MRI and the relationships between MRI findings and symptoms. METHODS 425 patients (850 TMJs) with temporomandibular joint disorders (TMDs) who underwent MRI were enrolled. Oblique sagittal proton density-weighted and T2 weighted images in open- and closed-mouth positions were evaluated. MRI findings included disc configuration, disc position, condylar morphology, bone marrow pattern, and joint effusion. Symptoms included TMJ pain, TMJ noise, and limitation of mouth opening. For statistical analyses, Spearman's rank correlation coefficient and logistic regression analysis were applied. RESULTS Folded disc, disc displacement without reduction (DDWOR), and osteophytes had significant negative correlations with other normal MRI findings (p < 0.01). DDWOR and marrow edema were associated with TMJ pain. Conversely, osteophytes [odds ratio (OR): 0.52; 95% CI (0.30-0.90)] and combination-type condylar degeneration [OR: 0.45; 95% CI (0.24-0.83)] were associated with decreased risk of TMJ pain. Condylar flattening was positively associated with TMJ noise [OR: 5.25; 95% CI (1.44-19.07)] and negatively associated with limitation of mouth opening [OR: 0.34; 95% CI (0.11-0.99)]. High-grade joint effusion was significantly associated with TMJ pain and noise. CONCLUSIONS DDWOR and high-grade joint effusion (an indicator of inflammation in the articular cavity) were associated with TMD symptoms. This finding suggests that treatment strategy for DDWOR and decreasing inflammation might lessen clinical TMD symptoms. Condylar degeneration was not associated with indicators of inflammation or TMJ symptoms. These results suggest that patients with TMD symptoms should undergo initial MRI to allow rapid selection of appropriate therapies.
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Affiliation(s)
- Risa Matsubara
- 1 Department of Oral and Maxillofacial Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University , Okayama , Japan
| | - Yoshinobu Yanagi
- 2 Department of Dental Informatics, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University , Okayama , Japan
| | - Kazuhiro Oki
- 3 Department of Occlusal and Oral Functional Rehabilitation, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University , Okayama , Japan
| | - Miki Hisatomi
- 4 Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital , Okayama , Japan
| | - Karina Cp Santos
- 5 Department of Stomatology, School of Dentistry, University of Sao Paulo , Sao Paulo , Brazil
| | - Babatunde O Bamgbose
- 1 Department of Oral and Maxillofacial Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University , Okayama , Japan.,6 Oral Diagnostic Sciences, Faculty of Dentistry, Bayero University , kano , Nigeria
| | - Mariko Fujita
- 7 Preliminary Examination Room, Okayama University Hospital , Okayama , Japan
| | - Shunsuke Okada
- 4 Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital , Okayama , Japan
| | - Shogo Minagi
- 3 Department of Occlusal and Oral Functional Rehabilitation, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University , Okayama , Japan.,8 Department of Occlusal and Oral Funtional Rehabilitation, Okayama University Hospital , Okayama , Japan
| | - Junichi Asaumi
- 1 Department of Oral and Maxillofacial Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University , Okayama , Japan.,4 Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital , Okayama , Japan.,7 Preliminary Examination Room, Okayama University Hospital , Okayama , Japan
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Abstract
Compressive stress may be involved in temporomandibular joint (TMJ) synovitis, but its mechanism has not been fully elucidated. We hypothesized that mechanical stress to the synovial cells of the TMJ potentially causes degenerative changes in temporomandibular joint disease. We examined the effect of cyclic compressive loading on three-dimensionally engineered constructs using human TMJ synovium-derived cells in vitro. Human TMJ synovium-derived cells were cultured onto collagen scaffolds, resulting in three-dimensional constructs. Cyclic compression loading was applied to the constructs by means of a custom-designed apparatus. DNA amount, apoptotic cells, and mRNA levels for inflammatory cytokines were analyzed. The protein expression and activity of MMPs were examined. DNA amount or apoptotic cell number was unchanged by loading. MMP-2, -3, and IL-8 mRNA expression was up-regulated by the compression, and both MMP-1 and -3 protein expression and MMP-2 activity were detected. Thus, compression of human TMJ synovium-derived cells appears to modulate inflammatory cytokines.
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Affiliation(s)
- Y Muroi
- Second Department of Oral and Maxillofacial Surgery, Osaka Dental University, 1-5-17, Otemae, Chuo-ku, Osaka, 540-0008, Japan.
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The value of MRI in patients with temporomandibular joint dysfunction: Correlation of MRI and clinical findings. Eur J Radiol 2016; 85:714-9. [PMID: 26971413 DOI: 10.1016/j.ejrad.2016.02.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 01/17/2016] [Accepted: 02/01/2016] [Indexed: 11/21/2022]
Abstract
AIM To estimate the correlation between the MRI findings and clinical outcomes in patients with temporomandibular joint dysfunction (TMD). METHODS AND MATERIALS We included 546 female and 248 male patients who were clinically diagnosed with TMD (mean age 38.7 years) and examined by MRI (T1 and T2 weighted images, parasagittal and paracoronal slices). A questionnaire, radiological, and clinical findings were analysed for statistically significant correlations. The analysed parameters included gender, age, disk position, joint degeneration, arthralgia, mouth opening, condyle position and clinical progress. RESULTS Of all TMJ's 62% showed physiological disc position, 35% anterior and 3% posterior disc position. Modification of therapy occurred in 20% and alteration of diagnosis was found in 32% of all cases. Anterior disc displacement with reduction showed a specificity of 88% and a sensitivity of 78%, whereas anterior disc displacement without reduction showed a specificity of 84% and a sensitivity of 73%. A significant correlation between disc length, condyle morphology and disc displacement was found. With the increase of intra-articular liquid as seen on MRI the level of arthralgia significantly rose as opposed to mouth opening. CONCLUSION Specificity and sensitivity, for anterior disc displacement and osseous changes in TMJ were highly acceptable. Results had confirmed the diagnostic capability of MRI in diagnostic imaging of TMJ. Additionally MRI should be used primarily in severe, therapy-resistant cases and for surgical planning purposes.
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Suenaga S, Nagayama K, Nagasawa T, Kawabata Y, Indo H, Majima HJ. Evaluation of the relationships between contrast-enhanced magnetic resonance characteristics and joint pain in patients with temporomandibular disorders. Oral Radiol 2015. [DOI: 10.1007/s11282-015-0213-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jeon DM, Jung WS, Mah SJ, Kim TW, Ahn SJ. The effects of TMJ symptoms on skeletal morphology in orthodontic patients with TMJ disc displacement. Acta Odontol Scand 2014; 72:776-82. [PMID: 24702009 DOI: 10.3109/00016357.2014.906650] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of temporomandibular joint (TMJ) symptoms on skeletal morphologies of orthodontic patients with TMJ disc displacement (DD). MATERIALS AND METHODS The sample consisted of 197 women seeking orthodontic treatment. The subjects were divided into two groups according to the presence of TMJ symptoms: the presence and absence of TMJ symptoms. Each group was sub-divided into three groups based on magnetic resonance images of bilateral TMJs: bilateral normal disc position (BN), bilateral disc displacement with reduction (DDR) and bilateral disc displacement without reduction (DDNR). Seventeen variables from lateral cephalograms were analyzed by two-way analysis of variance to identify differences in skeletal morphologies with respect to TMJ symptoms and TMJ DD status. RESULTS Patients with TMJ DD were more likely to have short ramus height, short mandibular body length and backward positioning of the ramus and mandible. These skeletal morphologies became more severe as TMJ DD progressed to DDNR. However, the skeletal morphologies associated with TMJ DD were not significantly different between symptomatic and asymptomatic patients. As a result, patients with TMJ DD had backward positioning and clockwise rotation compared to those with bilateral normal TMJs, irrespective of the presence of TMJ symptom. CONCLUSIONS This study suggests that TMJ DD is associated with altered skeletal morphology, but TMJ symptoms do not significantly influence the relationships between TMJ DD and skeletal morphology.
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Affiliation(s)
- Da-Mi Jeon
- Dental Research Institute and Department of Orthodontics, School of Dentistry, Seoul National University , Seoul , Korea (ROK)
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16
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17
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Cooper BC, Kleinberg I. Examination of a Large Patient Population for the Presence of Symptoms and Signs of Temporomandibular Disorders. Cranio 2014; 25:114-26. [PMID: 17508632 DOI: 10.1179/crn.2007.018] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Temporomandibular Disorder (TMD) is a term generally applied to a condition or conditions characterized by pain and/or dysfunction of the masticatory apparatus. Its characterization has been difficult because of the large number of symptoms and signs attributed to this disorder and to variation in the number and types manifested in any particular patient. For this study, data on 4,528 patients, presenting over a period of 25 years to a single examiner for TMD treatment, was made available for retrospective analysis and determination of whether the TMD care-seeking patient can be profiled, particularly pain difficulties. All patients in this database filled out a questionnaire and were examined for the prevalence of a range of symptoms and clinical examination findings (signs) commonly attributed to TMD. There was no attempt in this study to assign patients to TMD diagnostic subcategories. The data collected were analyzed to determine which of these symptoms and signs were sufficiently "characteristic of the TMD condition" that they might be used in diagnosis, research and treatment, especially in patients needing relief from pain and discomfort. All 4,528 patients reported symptoms and all but 190 of them also showed signs upon examination. Symptoms most commonly reported on the questionnaire included (i) pain (96.1%), (ii) headache (79.3%), (iii) temporomandibular joint discomfort or dysfunction (75.0%) and (iv) ear discomfort or dysfunction (82.4%). In the 4,338 patients who showed signs, the most prevalent was tenderness to palpation of the pterygoid muscles (85.1%), followed by tenderness to palpation of the temporomandibular joints (62.4%). Pain symptoms and signs were often accompanied by compromised mandibular movements, TMJ sounds and dental changes, such as incisal edge wear and excessive overbite. Clearly prevalence of pain disclosed by the symptoms and signs examinations was high. Patients showed variable prevalence and nonprevalence of eight categories of painful symptoms and seven categories of painful signs. Despite the variability, these might be developed in the future into TMD scores or indices for studying and unraveling the TMD conundrum.
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Sicurezza E, Loreto C, Musumeci G, Almeida LE, Rusu M, Grasso C, Leonardi R. Expression of β-defensin 4 on temporomandibular joint discs with anterior displacement without reduction. J Craniomaxillofac Surg 2013; 41:821-5. [PMID: 23453269 DOI: 10.1016/j.jcms.2013.01.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 01/09/2013] [Accepted: 01/10/2013] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES β-defensin-4 is a member of antimicrobial peptides (APs) of the immunity system. This molecule has antimicrobial activity but it seems to be involved in articular inflammatory processes too, as it happens during osteoarthritic disease (OA). Considering the possible relation existing between (OA) and temporomandibular disorders (TMD), the aim of our study was to evaluate immunohistochemically the presence of β- defensin-4 in pathological temporomandibular joint (TMJ) discs affected by internal derangement without reduction (ADDwoR). DESIGN Eighteen TMJ-displaced disc specimens were considered in this study and were analysed by immunohistochemical evaluation. They were compared with a control sample of sixteen healthy discs and two scores, intensity of staining (IS) and extent score (ES) were estimated. RESULTS Findings of our analysis showed a significant difference between control and study sample (P < 0.001). IS and ES of control sample and pathological sample were 1 and 4 respectively. CONCLUSION Our results confirmed the presence of β-defensin-4 in human TMJ discs affected by ADDwoR, hypothesing a possible role of this molecule in articular bone disruption.
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Affiliation(s)
- Edoardo Sicurezza
- Department of Dentistry, Faculty of Dentistry-University of Catania, Policlinico Universitario, Italy.
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Naeije M, te Veldhuis AH, te Veldhuis EC, Visscher CM, Lobbezoo F. Disc displacement within the human temporomandibular joint: a systematic review of a ‘noisy annoyance’. J Oral Rehabil 2012. [DOI: 10.1111/joor.12016] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- M. Naeije
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), Research Institute MOVE; University of Amsterdam and VU University Amsterdam; Amsterdam The Netherlands
| | - A. H. te Veldhuis
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), Research Institute MOVE; University of Amsterdam and VU University Amsterdam; Amsterdam The Netherlands
| | - E. C. te Veldhuis
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), Research Institute MOVE; University of Amsterdam and VU University Amsterdam; Amsterdam The Netherlands
| | - C. M. Visscher
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), Research Institute MOVE; University of Amsterdam and VU University Amsterdam; Amsterdam The Netherlands
| | - F. Lobbezoo
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), Research Institute MOVE; University of Amsterdam and VU University Amsterdam; Amsterdam The Netherlands
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Dias IM, Coelho PR, Picorelli Assis NMS, Pereira Leite FP, Devito KL. Evaluation of the correlation between disc displacements and degenerative bone changes of the temporomandibular joint by means of magnetic resonance images. Int J Oral Maxillofac Surg 2012; 41:1051-7. [PMID: 22464851 DOI: 10.1016/j.ijom.2012.03.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 02/03/2012] [Accepted: 03/02/2012] [Indexed: 10/28/2022]
Abstract
The aim was to evaluate the correlation between disc displacements and degenerative bone changes in magnetic resonance images (MRI) of 112 patients of both genders, with signs and symptoms of temporomandibular disorder. For this purpose, a calibrated examiner evaluated 224 MRI by assigning scores for the displacement of the disc and degenerative bone changes. Disc displacement was found in 58.42% of the temporomandibular joints (TMJs) evaluated. Anterior displacement of the disc with reduction was the most common, occurring in 67.18% cases of joints with disc displacement. Degenerative bone changes were observed in 53.94% of the TMJs analysed. There was significant correlation between disc displacement with reduction and condylar flattening, disc displacement without reduction and condylar flattening, disc displacement without reduction, and associated degenerative bone changes (flattening and erosion, flattening, osteophyte and erosion; flattening and osteophytes, erosion and sclerosis, flattening and sclerosis, flattening, osteophytes and sclerosis). The correlation between advanced cases of disc displacement and the occurrence of degenerative bone changes emphasises the importance of MRI for an accurate diagnosis and development of an appropriate treatment plan and in cases in which clinical examination is not sufficient for these purposes.
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Ogura I, Kaneda T, Mori S, Sakayanagi M, Kato M. Magnetic resonance characteristics of temporomandibular joint disc displacement in elderly patients. Dentomaxillofac Radiol 2011; 41:122-5. [PMID: 22116131 DOI: 10.1259/dmfr/1286942] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate the MR characteristics of temporomandibular joint (TMJ) disc displacement in elderly patients. METHODS Of the MR images of 1660 TMJs in 847 patients with disc displacement who underwent MRI for suspected temporomandibular disorders, 301 TMJs in 154 patients aged over 50 years were studied as an elderly group. These MR images of the elderly group were compared with those of a control group (1359 TMJs in 693 patients aged under 51 years) concerning disc displacement with or without reduction, joint effusion and osteoarthrosis. RESULTS The incidence of disc displacement with osteoarthrosis was significantly different between the elderly (41.9%) and the control (19.8%) groups (p = 0.000). Logistic multivariate regression analysis demonstrated that the osteoarthrosis was a significant variable (odds ratio = 2.94, p = 0.000). CONCLUSIONS This study suggests that MR characteristics of TMJ disc displacement in elderly patients includes osteoarthrosis.
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Affiliation(s)
- I Ogura
- Department of Radiology, Nihon University School of Dentistry at Matsudo, Chiba, Japan.
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Emshoff R, Moriggl A, Rudisch A, Brunold S, Neunteufel N, Crismani A. Cephalometric variables discriminate among magnetic resonance imaging-based structural characteristic groups of the temporomandibular joint. ACTA ACUST UNITED AC 2011; 112:118-25. [PMID: 21546280 DOI: 10.1016/j.tripleo.2011.02.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 02/04/2011] [Accepted: 02/08/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to assess retrospectively whether, in patients with temporomandibular joint (TMJ) arthralgia, commonly used cephalometric variables of dentofacial morphology can discriminate among magnetic resonanace imaging (MRI)-based TMJ structural characteristic groups of "uni- or bilateral disc displacement without reduction (DDwoR) associated with bilateral osteoarthrosis (OA)" and "uni- or bilateral disc displacement with reduction (DDwR) without OA." STUDY DESIGN Bilateral MRI of the TMJ was performed in 56 consecutive TMJ arthralgia patients to identify individuals with specific structural characteristic of uni- or bilateral TMJ DDwoR, DDwR, and OA. Application of the criteria resulted in a study group of 31 patients with "uni- or bilateral DDwoR with bilateral OA" and 25 with "uni- or bilateral DDwR without OA." Linear and angular cephalometric measurements were taken from lateral cephalograms to apply selected criteria of dentofacial morphology. One-way analysis of variance was used to assess differences in cephalometric variables by MRI-based TMJ group. Then, discriminant function analysis predicted TMJ group membership. RESULTS A-B plane to facial plane angle, palatal plane to occlual plane, and interincisal angle produced a significantly discriminant function that predicted TMJ group membership (P < .001). This function correctly classified 85.7% of original grouped cases. CONCLUSIONS Cephalometric variables may discriminate among MRI-based TMJ structural characteristic groups. Additional diagnostic information related to MRI-based classification groups was generated.
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Affiliation(s)
- Rüdiger Emshoff
- Orofacial Pain Unit, Department of Oral and Maxillofacial Surgery, Center of Dentistry and Oral Surgery, Innsbruck, Austria.
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Are temporomandibular joint disk displacements without reduction and osteoarthrosis important determinants of mandibular backward positioning and clockwise rotation? ACTA ACUST UNITED AC 2011; 111:435-41. [PMID: 20869274 DOI: 10.1016/j.tripleo.2010.05.064] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 05/22/2010] [Accepted: 05/25/2010] [Indexed: 11/22/2022]
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Kimos P, Nebbe B, Heo G, Packota G, Major PW. Changes in temporomandibular joint sagittal disc position over time in adolescents: a longitudinal retrospective study. Am J Orthod Dentofacial Orthop 2009; 136:185-91. [PMID: 19651347 DOI: 10.1016/j.ajodo.2008.12.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 12/23/2008] [Accepted: 12/23/2008] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Temporomandibular joint (TMJ) disc displacement (DD) is a common finding in preorthodontic adolescents. The natural progression of this disorder has not been described with magnetic resonance imaging. METHODS The TMJs of a longitudinal sample of 94 preorthodontic adolescents were evaluated with magnetic resonance imaging to quantify sagittal disc position (SDP). The average time between imaging visits (V1 and V2) was 3.7 years (range, 1-6 years). Boys and girls had significantly different SDP values at V1, and therefore changes in SDP from V1 to V2 were analyzed separately for each sex. RESULTS The highest standard deviation was 0.58 mm for intraobserver measurement error. Regression analysis identified no significant association between change in disc status and time between imaging. There was no significant difference in mean change in SDP in girls or the right TMJ in boys. The boys' left TMJ showed a significant mean increase (0.87 mm of anterior displacement). Approximately 10% of right TMJs and 15% of left TMJs had more than 2 mm of anterior DD during the study. In the girls, approximately 8% of the right TMJs and 3% of the left TMJs showed more than 2 mm of posterior disc position changes from V1 to V2. CONCLUSIONS A natural progression in severity of DD in adolescents was not identified. Some subjects had large increases in anterior DD.
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Affiliation(s)
- Pablo Kimos
- Department of Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Currie P, Lobo-Lobo S, Stark P, Mehta N. Effect of maxillary molar distalization on mandibular condylar pathways. INTERNATIONAL JOURNAL OF STOMATOLOGY & OCCLUSION MEDICINE 2009. [DOI: 10.1007/s12548-008-0008-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hirata FH, Guimarães AS, Oliveira JXD, Moreira CR, Ferreira ETT, Cavalcanti MGP. Evaluation of TMJ articular eminence morphology and disc patterns in patients with disc displacement in MRI. Braz Oral Res 2008; 21:265-71. [PMID: 17710294 DOI: 10.1590/s1806-83242007000300013] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2006] [Accepted: 02/11/2007] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to assess the shape of the temporomandibular joint (TMJ) articular eminence and the articular disc configuration and position in patients with disc displacement. TMJ magnetic resonance images (MRI) of 14 patients with bilateral disc displacement without unilateral reduction were analyzed. Articular eminence morphology was characterized as box, sigmoid, flattened, or deformed. Articular disc configuration was divided into biconcave, biplanar, biconvex, hemiconvex or folded, and its position, as "a" (superior), "b" (anterosuperior), "c" (anterior) or "d" (anteroinferior). The images were divided and the sides with disc displacement with reduction (DDWR) and without reduction (DDWOR) were compared. Regarding articular eminence shape, the sigmoid form presented the greatest incidence, followed by the box form, in the DDWR side, although this was not statistically significant. In the DDWOR side, the flattened shape was the most frequent (p = 0.041). As to disc configuration, the biconcave shape was found in 79% of the DDWR cases (p = 0.001) and the folded type predominated in 43% of the DDWOR cases (p = 0.008). As to disc position, in the DDWR side, "b" (anterosuperior position) was the most frequent (p = 0.001), whereas in the DDWOR side, "d" (anteroinferior position) was the most often observed (p = 0.001). The side of the patient with altered disc configuration and smaller shape of TMJ articular eminence seems to be more likely to develop non-reducing disc displacement as compared to the contralateral side.
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Affiliation(s)
- Fabio Henrique Hirata
- Department of Morphology, College of Medicine, Federal University of São Paulo, Brazil
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Cozzolino FA, Rapoport A, Franzi SA, Souza RPD, Pereira CADB, Dedivitis RA. Correlação entre os achados clínicos e imaginológicos nas disfunções temporomandibulares. Radiol Bras 2008. [DOI: 10.1590/s0100-39842008000100006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Verificar a relação entre sinais e sintomas observados no exame clínico de pacientes com diagnóstico de disfunção temporomandibular, conforme os resultados fornecidos pelo exame de ressonância magnética. MATERIAIS E MÉTODOS: Trinta pacientes que apresentavam sinais e sintomas de disfunção temporomandibular foram submetidos a exame clínico e de ressonância magnética. Cada exame de ressonância magnética de articulação temporomandibular foi interpretado, independentemente, por dois radiologistas experientes. Os exames de ressonância magnética foram realizados com 12 cortes de 3 mm de espessura, em orientação coronal (T1) em posição de boca fechada, cortes sagitais em posição de boca aberta e fechada (T1 e T2) e em abertura e fechamento progressivos, com intervalo de 5 mm, para reproduzir toda a extensão do movimento mandibular. A significância estatística entre a análise clínica dos pacientes com disfunção temporomandibular e os resultados obtidos no exame de ressonância magnética foi avaliada pelo teste kappa. RESULTADOS: Obteve-se, na análise interobservadores de imagens, concordância bruta do lado esquerdo e direito, respectivamente, de 56,7% (kappa = 0,1) e 56,7 (kappa = 0). CONCLUSÃO: Não foi encontrada correlação entre o diagnóstico clínico da luxação discal e imagens de ressonância magnética.
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Bernhardt O, Biffar R, Kocher T, Meyer G. Prevalence and clinical signs of degenerative temporomandibular joint changes validated by magnetic resonance imaging in a non-patient group. Ann Anat 2007; 189:342-6. [PMID: 17695989 DOI: 10.1016/j.aanat.2007.02.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study is to investigate associations between degenerative bony changes of the temporomandibular joint (TMJ) evaluated by magnetic resonance imaging (MRI) and signs and symptoms of temporomandibular disorders (TMD) in a non-patient group. A total of 307 subjects (140 males and 167 females) were selected from the cross-sectional epidemiological study "Study of Health in Pomerania" (SHIP) for this evaluation. A clinical functional examination of the masticatory muscles and the TMJs was performed as well as an MRI examination of the TMJs. Another 77 subjects (25%) exhibited degenerative changes of one or both TMJs in the MRI. Clinical analysis revealed pain on palpation of the masticatory muscles in 113 subjects. Some 39 subjects had pain during palpation of the TMJs. There were significant associations between the MRI confirmed diagnosis of osteoarthrosis and some clinical signs (joint noises, joint palpation pain, reduced mouth opening) and symptoms (reported pain in the jaw and masticatory muscles) of TMD as well as further MRI diagnoses (disc displacement with and without reduction, fibrosis of the posterior ligament). Although there were some associations, clinical examination alone is not sufficient for diagnosing degenerative joint diseases. MRI is a necessary diagnostic adjunct for estimating the prevalence of TMD subgroups in non-patient populations.
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Affiliation(s)
- Olaf Bernhardt
- Department of Restorative Dentistry, Periodontology and Endodontology, School of Dentistry, University of Greifswald, Rotgerberstrasse 8, D-17475 Greifswald, Germany.
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Limchaichana N, Nilsson H, Ekberg EC, Nilner M, Petersson A. Clinical diagnoses and MRI findings in patients with TMD pain. J Oral Rehabil 2007; 34:237-45. [PMID: 17371560 DOI: 10.1111/j.1365-2842.2006.01719.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The aim of this study was to compare the findings on magnetic resonance imaging (MRI) in temporomandibular disorders (TMD) pain patients with clinical diagnoses of myofascial pain or arthralgia/osteoarthritis in combination with myofascial pain according to the Research Diagnostic Criteria for TMD. The temporomandibular joints of 60 consecutive patients, 19 with myofascial pain and 41 patients with arthralgia/osteoarthritis in combination with myofascial pain were examined clinically and with MRI. Overall the most common MRI findings were different kinds of disc displacements and structural bone changes, which were found in both pain groups. However, disc displacements were found significantly (P=0.002) more often in the group arthralgia/osteoarthritis in combination with myofascial pain. One hundred and four joints were found to have no clinical diagnosis of disc displacements, but 64 of these joints had findings of disc displacements on MRI. Joint fluid was found in both pain groups. Patients having a combination of disc displacement and joint fluid were significantly (P=0.047) more common in the pain group arthralgia/osteoarthritis in combination with myofascial pain. In conclusion, the MRI findings of different kinds of disc displacement and structural bone changes were common in TMD patients. The clinical diagnoses for subdivision into myogenous only or combined arthrogenous and myogenous pain groups were not confirmed by MRI.
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Affiliation(s)
- N Limchaichana
- Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
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Emshoff R, Rudisch A. Temporomandibular Joint Internal Derangement and Osteoarthrosis: Are Effusion and Bone Marrow Edema Prognostic Indicators for Arthrocentesis and Hydraulic Distention? J Oral Maxillofac Surg 2007; 65:66-73. [PMID: 17174766 DOI: 10.1016/j.joms.2005.11.113] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Revised: 07/27/2005] [Accepted: 11/23/2005] [Indexed: 11/24/2022]
Abstract
PURPOSE Arthrocentesis and hydraulic distention of the temporomandibular joint (TMJ) has proven to be an effective modality in treating patients exhibiting clinical findings consistent with the diagnosis of disc displacement without reduction. The purpose of this study was to investigate whether the magnetic resonance imaging (MRI) variables of effusion and/or bone marrow edema may predict treatment outcomes of arthrocentesis and hydraulic distention of the TMJ. PATIENTS AND METHODS The study group comprised 37 consecutive patients with TMJ pain, who were assigned a unilateral clinical TMJ disorder of TMJ pain associated with an internal derangement (ID) type III (disc displacement without reduction) and a TMJ pain side-related MRI diagnosis of disc displacement without reduction associated with osteoarthrosis (OA). Bilateral sagittal and coronal MRI images were obtained immediately before the operation to establish the presence or absence of ID, OA, TMJ effusion, and bone marrow edema. Pain level and mandibular range of motion (ROM) were assessed preoperatively and compared with the respective 2-month follow-up findings. Outcome criteria for success were a ROM >or=35 mm and pain reduction >50%. A logistic regression analysis was used to compute the odds ratio for TMJ effusion and bone marrow edema for successful outcomes (n = 21) versus unsuccessful (n = 16) outcomes. RESULTS At the 2-month follow-up, clinical evaluation showed a significant reduction in TMJ pain during function (P = .000), a significant reduction in clinical diagnoses of TMJ disorders (P = .016), and a significant increase in ROM (P = .000). A significant increase in the risk of an unsuccessful outcome of ROM <35 mm and/or pain reduction >or=50% occurred with MRI findings of effusion (odds ratio 1:10.8 = 0.09; P = .007). CONCLUSIONS TMJ effusion may prove to be an important prognostic determinant of successful arthrocentesis. However, the data re-emphasize the concept that the prediction of a specific outcome is not a matter of simple linearity, in which the presence of 1 factor may equate with predictive ability, but rather is a function of a complex interaction among different biological variables.
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Affiliation(s)
- Rüdiger Emshoff
- Department of Oral and Maxillofacial Surgery, University Clinic Innsbruck, Innsbruck, Austria.
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Magnetic resonance imaging characteristics of temporomandibular joint pain during opening and biting in patients with disc displacement. ACTA ACUST UNITED AC 2006; 102:669-72. [PMID: 17052645 DOI: 10.1016/j.tripleo.2005.11.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2005] [Revised: 11/25/2005] [Accepted: 11/29/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the magnetic resonance (MR) imaging characteristic of temporomandibular joint (TMJ) pain during opening and biting in patients with disk displacement. STUDY DESIGN MR images of 1252 TMJs in 640 patients with disk displacement were studied retrospectively. The relationship between TMJ pain and age, sex, and MR imaging findings, such as disk displacement with or without reduction, TMJ fluid, and osteoarthrosis, was analyzed using logistic regression analysis. RESULTS The resultant data showed a significant relationship between TMJ pain during maximum jaw opening and disk displacement without reduction (OR = 2.36). The resultant data also showed a significant relationship between TMJ pain during maximum biting and TMJ fluid (OR = 1.85). CONCLUSION The results suggest that TMJ pain during opening and biting is related to disk displacement without reduction and TMJ fluid on MR images.
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Emshoff R, Gerhard S, Ennemoser T, Rudisch A. Magnetic resonance imaging findings of internal derangement, osteoarthrosis, effusion, and bone marrow edema before and after performance of arthrocentesis and hydraulic distension of the temporomandibular joint. ACTA ACUST UNITED AC 2006; 101:784-90. [PMID: 16731401 DOI: 10.1016/j.tripleo.2005.09.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Revised: 08/18/2005] [Accepted: 09/09/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To investigate whether temporomandibular joint (TMJ) internal derangement type III and capsulitis/synovitis are related to magnetic resonance imaging (MRI) diagnoses of internal derangement, osteoarthrosis (OA), effusion, and/or bone marrow edema (BME), and whether arthrocentesis is associated with changes in diagnoses of internal derangement, OA, effusion, and/or BME. STUDY DESIGN The study comprised 28 patients with a clinical unilateral TMJ disorder of internal derangement type III and capsulitis/synovitis. Bilateral MRI was immediately performed preoperatively and at a 2-month follow-up. RESULTS There was a significant relationship between TMJ internal derangement type III and capsulitis/synovitis and TMJ internal derangement (P = .000), effusion (P = .036), and BME (P = .002). MRI showed a significant decrease in diagnoses of TMJ BME ((P = .018). CONCLUSIONS MRI variables of internal derangement, effusion, and BME were related to TMJ internal derangement type III and capsulitis/synovitis; however, arthrocentesis was only associated with a significant change in diagnoses of TMJ BME.
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Affiliation(s)
- Rüdiger Emshoff
- Department of Oral and Maxillo-Facial Surgery, University Clinic of Innsbruck, Innsbruck, Austria.
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Takatsuka S, Yoshida K, Ueki K, Marukawa K, Nakagawa K, Yamamoto E. Disc and condyle translation in patients with temporomandibular disorder. ACTA ACUST UNITED AC 2005; 99:614-21. [PMID: 15829887 DOI: 10.1016/j.tripleo.2004.08.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The purpose of this study was to elucidate causal relationship between disc and condyle range of movement and clinical signs and symptoms in patients with temporomandibular disorders (TMD), using magnetic resonance imaging (MRI). STUDY DESIGN The subjects comprised of a study group of 191 patients with TMD and a control group of 43 asymptomatic patients. The clinical assessment consisted of range of maximum mouth opening (MMO) and preauricular pain during mandibular function. After clinical and radiographic findings assessment, disc and condyle condition were examined by MRI and the range of movement was accordingly classified. RESULTS Disc displacement was observed in 156/191 (81.7%) of the study group and 9/43 (20.9%) of the control group. When disc and condyle mobility was presented around the eminence, wider MMO range was maintained, P < .05. Presence of osteoarthrosis (OA) was not correlated with preauricular pain, because OA variables were mild in the study group. CONCLUSION Maintenance of disc/condyle translation is an important factor in TMJ function, irrespective of disc displacement or arthritis.
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Affiliation(s)
- Shigeyuki Takatsuka
- Oral and Maxillofacial Surgery, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
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Emshoff R, Rudisch A. Determining predictor variables for treatment outcomes of arthrocentesis and hydraulic distention of the temporomandibular joint. J Oral Maxillofac Surg 2004; 62:816-23. [PMID: 15218559 DOI: 10.1016/j.joms.2003.12.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Arthrocentesis and hydraulic distention of the temporomandibular joint (TMJ) has been described as an effective modality in the treatment of patients demonstrating clinical findings consistent with the diagnosis of disc displacement without reduction. The purpose of this study was to investigate whether the clinical variable of TMJ pain chronicity and the magnetic resonance (MR) imaging variable of osteoarthrosis (OA) may predict treatment outcomes of arthrocentesis and hydraulic distention of the TMJ. PATIENTS AND METHODS The study consisted of 29 TMJ pain patients, who were assigned a unilateral clinical temporomandibular disorder (TMD) of "TMJ pain associated with an internal derangement (ID) type III (disc displacement without reduction)," and a TMJ pain side-related MR imaging diagnosis of disc displacement without reduction. Bilateral sagittal and coronal MR images were obtained immediately preoperatively to establish the presence or absence of ID and OA. TMJ pain level of function and mandibular range of motion were assessed preoperatively and compared with the respective 2-month follow-up findings. Outcome criteria of success were 1). an absence of signs and symptoms characteristic of a diagnosis of ID type III and/or 2). a reduction in pain level of 85% or greater. A multiple logistic regression analysis was used to compute the odds ratio for TMJ pain chronicity (duration >6 months and <2 years) and OA for successful outcomes versus nonsuccessful outcomes. RESULTS The pretreatment data revealed no significant relationship between the clinical disorder "TMJ pain associated with ID type III" and the MR imaging finding of OA (P =.103). At 2-month follow-up, clinical evaluation showed a significant reduction in TMJ pain during function (P =.000), a significant reduction in clinical diagnoses of TMDs (P =.000), and a significant increase in mandibular range of motion (P =.000). Significant increase in risk of a nonsuccessful outcome (pain reduction <85%) occurred with TMJ pain chronicity (odds ratio of 41.0) (P =.018). Significant increase in benefit of a successful outcome (absence of ID type III) occurred with TMJ OA (odds ratio 1:16.7, P =.06) (P =.044). CONCLUSIONS Arthrocentesis in chronic TMJ pain patients was less successful than in nonchronic patients with regard to treatment outcome of pain reduction. Arthrocentesis in patients with TMJ OA was more beneficial with regard to the disappearance of ID type III than in non-OA patients. Predictive modeling may provide clinicians with the opportunity to identify "at-benefit" patients early and initiate specific treatments.
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Schmitter M, Kress B, Rammelsberg P. Temporomandibular joint pathosis in patients with myofascial pain: a comparative analysis of magnetic resonance imaging and a clinical examination based on a specific set of criteria. ACTA ACUST UNITED AC 2004; 97:318-24. [PMID: 15024353 DOI: 10.1016/j.tripleo.2003.10.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE We sought to determine the prevalence of joint diseases in patients with either of 2 forms of myofascial pain (with and without limited mouth opening) and to verify the accuracy of temporomandibular joint-related clinical diagnoses through the use of magnetic resonance imaging (MRI). STUDY DESIGN On the basis of the results of a clinical examination carried out according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), 61 patients were divided into 2 subgroups. The first group consisted of 36 patients who had myofascial pain with limited mouth opening (MPLO), whereas the other 25 patients were diagnosed with myofascial pain without limited mouth opening. MRI was carried out on all patients. The clinical joint-related diagnoses from RDC/TMD were compared with MRI results. RESULTS Patients with MPLO often had joint diseases that were not detected by means of a clinical examination alone. The kappa statistic was used to compare MRI and clinical diagnoses, confirming poor agreement in patients with MPLO (kappa=0.13) and acceptable agreement in patients with myofascial pain without limited mouth opening (kappa=0.72). CONCLUSION Restricted mandibular mobility is frequently associated with temporomandibular joint diseases that were not identified during a clinical examination. Therefore, an adaptation of the classification scheme used for the RDC/TMDs may result in the improvement of the sensitivity of clinical joint-related diagnoses, especially in patients with MPLO.
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Affiliation(s)
- Marc Schmitter
- Department of Prosthodontics, University of Heidelberg, Germany.
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Emshoff R, Rudisch A. Are internal derangement and osteoarthrosis linked to changes in clinical outcome measures of arthrocentesis of the temporomandibular joint? J Oral Maxillofac Surg 2003; 61:1162-7; discussion 1167-70. [PMID: 14586851 DOI: 10.1016/s0278-2391(03)00676-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Arthrocentesis and hydraulic distention of the temporomandibular joint (TMJ) have been described as an effective modality in the treatment of patients with clinical findings consistent with the diagnosis of disc displacement without reduction. The purpose of this study was to investigate whether the magnetic resonance (MR) imaging variables of internal derangement (ID) and osteoarthrosis (OA) and the presence of capsulitis/synovitis (C/S) may be linked to changes in TMJ signs and symptoms associated with the performance of arthrocentesis and hydraulic distention. PATIENTS AND METHODS The study consisted of 27 TMJ pain patients, who were assigned a clinical unilateral TMJ diagnosis of ID type III (disc displacement without reduction). Bilateral sagittal and coronal MR images were obtained immediately preoperatively and at a 2-month follow-up to establish the presence or absence of ID and OA. TMJ pain level of function and mandibular range of motion were assessed preoperatively and compared with the respective 2-month follow-up findings. RESULTS The pretreatment data revealed a significant relationship between the clinical finding of TMJ pain and the MR imaging findings of ID (P <.001), ID type (P <.001), and OA (P <.05). At 2-month follow-up, clinical evaluation showed a significant reduction in TMJ pain during function (P <.001), a significant reduction in the clinical diagnoses of ID type III (P <.05), and a significant increase in mandibular range of motion (P <.05). There was no change in the prevalence rates of associated MR imaging diagnoses of TMJ ID and/or OA. CONCLUSION The study findings suggest that clinical pain is related to TMJ-related MR imaging findings of ID and OA. These diagnoses proved not to be linked to changes in therapeutic outcome measures of TMJ pain and mandibular range of motion.
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Affiliation(s)
- Rüdiger Emshoff
- Department of Oral and Maxillo-Facial Surgery, Innsbruck, Austria.
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Emshoff R, Rudisch A, Bösch R, Strobl H. Prognostic indicators of the outcome of arthrocentesis: a short-term follow-up study. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2003; 96:12-8. [PMID: 12847438 DOI: 10.1016/s1079-2104(03)00219-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Arthrocentesis of the temporomandibular joint (TMJ) is purported to be an effective modality in the treatment of patients with closed-lock symptoms. The purpose of this study was to determine whether the clinical findings of disk displacement without reduction associated with pain in the TMJ are related to the discovery of TMJ osteoarthrosis (OA) through the use of magnetic resonance (MR) imaging and whether the presence of OA affects the treatment outcome of patients who undergo arthrocentesis of the TMJ. STUDY DESIGN The study population consisted of 38 patients with TMJ pain who were assigned a clinical diagnosis of unilateral internal derangement (ID) of the TMJ, type III (disk displacement without reduction), in combination with capsulitis/synovitis (C/S) and an MR imaging diagnosis of disk displacement without reduction in the painful TMJ only. Before the patients underwent arthrocentesis, bilateral sagittal and coronal MR images were obtained to confirm the presence or absence of ID and OA. The preoperative and postoperative levels of TMJ function with respect to pain and mandibular range of motion were evaluated and compared. Multiple logistic regression analysis was used to compute the odds ratios for successful outcomes for OA (n = 24) versus unsuccessful outcomes for TMJs (n = 14). RESULTS The preoperative data revealed a significant relationship between the clinical diagnosis of TMJ ID type III with C/S and the discovery of OA on MR images (P =.048). At the 2-month follow-up, a clinical evaluation revealed a significant reduction in TMJ pain during function (P =.000); a significant reduction in the clinical diagnoses of ID type III (P =.000), and C/S (P =.000); and a significant increase in the mandibular range of motion (P =.000). The patients with successful outcomes were more likely to be associated with an MR imaging finding of OA than were the patients with unsuccessful outcomes. (10.4 odds ratio; P =.016). CONCLUSIONS Our preliminary findings suggest that the presence of OA revealed on MR images is related to clinical pain; furthermore, OA proved to be an important prognostic determinant of successful arthrocentesis.
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Affiliation(s)
- Rüdiger Emshoff
- Department of Oral and Maxillo-Facial Surgery, University of Innsbruck, Austria.
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Emshoff R, Brandlmaier I, Bertram S, Rudisch A. Relative odds of temporomandibular joint pain as a function of magnetic resonance imaging findings of internal derangement, osteoarthrosis, effusion, and bone marrow edema. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2003; 95:437-45. [PMID: 12686927 DOI: 10.1067/moe.2003.95] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate whether common magnetic resonance (MR) imaging variables such as temporomandibular joint (TMJ) internal derangement, osteoarthrosis, effusion, and bone marrow edema are predictive of the presence of TMJ pain. STUDY DESIGN The relationship between TMJ pain and TMJ internal derangement, osteoarthrosis, effusion, and bone marrow edema was analyzed in MR images of 338 TMJs in 169 patients with a clinical diagnosis of TMJ pain and dysfunction. Criteria for including a patient with TMJ pain were a report of orofacial pain referred to the TMJ, with the presence of unilateral or bilateral TMJ pain during palpation, function, or unassisted or assisted mandibular opening. The criteria for including a patient with no pain were the absence of TMJ pain during palpation, function, and unassisted or assisted mandibular opening. Application of the criteria resulted in a study group of 129 patients with unilateral TMJ pain, 18 with bilateral TMJ pain, and 22 without TMJ pain. Bilateral sagittal and coronal MR images were obtained to establish the presence or absence of TMJ internal derangement, osteoarthrosis, effusion, and bone marrow edema. Logistic regression analysis was used to compute the odds ratios for internal derangement, osteoarthrosis, effusion, and bone marrow edema for nonpainful TMJs (n = 173) versus painful TMJs (n = 165). RESULTS For pairwise comparison, the chi(2) test was used; the resultant data showed a significant relationship between the clinical findings of TMJ pain and the MR imaging diagnoses of internal derangement (P =.000), osteoarthrosis (P =.015), effusion (P =.002), and bone marrow edema (P =.016). Of the MR imaging variables considered simultaneously in multiple logistic regression analysis, osteoarthrosis (P =.405), effusion (P =.131), and bone marrow edema (P =.231) dropped out as nonsignificant in the diagnostic TMJ pain group in comparison with the TMJ no-pain group. Significant increases in risk of TMJ pain occurred with disk displacement without reduction in combination with osteoarthrosis and bone marrow edema (3.7:1 odds ratio; P =.000) and with disk displacement without reduction in combination with osteoarthrosis and effusion (2.8:1 odds ratio; P =.000). CONCLUSIONS The results suggest that TMJ pain is related to internal derangement, osteoarthrosis, effusion, and bone marrow edema. However, the data reemphasize that these MR imaging variables may not be regarded as the unique and dominant factors in defining TMJ pain occurrence.
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Affiliation(s)
- Rüdiger Emshoff
- University of Innsbruck, Höhenstrae 5, A-6020 Innsbruck, Austria.
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Katzberg R. Discussion. J Oral Maxillofac Surg 2002. [DOI: 10.1053/joms.2002.29783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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