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Heo HA, Park S, Pyo SW, Yoon HJ. Clinical outcomes of patients with unilateral internal derangement of the temporomandibular joint following arthrocentesis and stabilization splint therapy. Maxillofac Plast Reconstr Surg 2024; 46:24. [PMID: 38976106 PMCID: PMC11231121 DOI: 10.1186/s40902-024-00436-7] [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: 03/21/2024] [Accepted: 07/02/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND The management of internal derangement (ID) of the TMJ is challenging because of multiple etiologic factors and varying degrees of severity. The aim of this study was to evaluate the clinical outcomes of patients with unilateral ID treated with arthrocentesis and stabilization splint therapy during a 6-month period. METHODS A total of 105 patients (87 females, 18 males) with unilateral ID were included in this study. Patients were divided into unilateral anterior disc displacement with reduction (ADDwR) and unilateral anterior disc displacement without reduction (ADDwoR). Patients with ADDwoR were subdivided according to the erosive bone changes. Objective parameters on mandibular movement and subjective parameters on pain were obtained and assessed. Their clinical outcomes before and after arthrocentesis and stabilization splint therapy were compared with the chi-square, Fisher's exact test, paired t-test, or Wilcoxon singed-rank test. RESULTS All objective parameters of unilateral ID patients significantly increased at the 6-month follow-up. The differences in mean visual analog scale (VAS) pain scores were statistically significant in all subjective variables (p < 0.01). In joints with ADDwoR, preoperative maximal mouth opening, and maximal protrusive movement in both groups, with erosive and non-erosive changes were significantly increased after 6 months (p < 0.01). However, right and left maximal lateral movement increased after treatment in both groups but without significant differences. All VAS pain scores on jaw movement and palpation of associated muscles showed a significant decrease regardless of erosive changes. CONCLUSIONS The combination of arthrocentesis and subsequent stabilization splint therapy was shown to be highly effective in pain reduction and improvement of mandibular movements in both unilateral ADDwR and ADDwoR, as well as in cases with both erosive and non-erosive bony changes associated with unilateral ADDwoR.
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Affiliation(s)
- Hyun-A Heo
- Department of Advanced General Dentistry, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Suhyun Park
- Department of Advanced General Dentistry, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Woon Pyo
- Department of Oral and Maxillofacial Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun-Joong Yoon
- Department of Oral and Maxillofacial Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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2
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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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3
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López JP, Orjuela MP, Díaz-Baez D, González LV. Comparison of the TMJ arthroscopy discopexy techniques: A systematic review and meta-analysis. J Craniomaxillofac Surg 2024; 52:558-564. [PMID: 38631972 DOI: 10.1016/j.jcms.2024.04.004] [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: 12/24/2023] [Revised: 03/12/2024] [Accepted: 04/03/2024] [Indexed: 04/19/2024] Open
Abstract
This article aims to analyze which of the main arthroscopic discopexy techniques has the best results and if there are differences between the techniques for both pain and maxillary intercuspid opening. A systematic review and meta-analysis was performed according to the PRISMA statement. An electronic search was performed with no publication date restriction in PubMed, Ovid and Embase. The PICO criteria: (P) Patients: With temporomandibular internal disorders with discopexy indication. (I) Intervention: Temporomandibular joint arthroscopic discopexy. (C) Comparison: Arthroscopic discopexy among different techniques classified as non-rigid, semi-rigid and rigid. (O) Outcomes: Impact in clinical conditions such as pain and maximum mouth opening. The inclusion criteria were Patients with temporomandibular internal disorders with discopexy indication performed with different techniques classified as non-rigid, semi-rigid and rigid. The outcomes evaluated were pain and maximum mouth opening. Case series, cohort studies, quasi-experimental studies, and randomized clinical trials with at least 3 months of follow-up were included. The exclusion criteria considered were patients with related concomitant surgeries, patients with associated neoplastic disease or connective tissue disease. A total of 1515 joints where 1400 discopexies were performed including 849 females and 204 males. The most common diagnostic was Wilkes stage III in 257 joints. For pain and oral opening, the semi-rigid technique shows the best results median (MD) 4.84 (CI 2.52-7.16; p = 0.001, I2:100%), MD -2.78 (CI -4.34, -1.21; p = 0.001, I2:99%), respectively. The rigid technique has the greatest probability for complications MD 0.14 CI 95% (0.00, -0.28). Although the semi-rigid technique showed better results, there is no statistically significant difference. However, due to the heterogeneity of the studies, the results should be interpreted with caution.
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Affiliation(s)
- Juan Pablo López
- Oral and Maxillofacial Surgeon, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia; Universidad El Bosque, Unidad de Investigación en Epidemiología Clínica Oral UNIECLO, Bogotá DC, Colombia.
| | - María Paula Orjuela
- Oral and Maxillofacial Surgery Surgeon, Universidad El Bosque, Bogotá DC, Colombia
| | - David Díaz-Baez
- Unit of Basic Oral Investigation (UIBO), Facultad de Odontología, Universidad El Bosque, Bogotá DC, Colombia
| | - Luis Vicente González
- Oral and Maxillofacial Surgeon, Hospital Universitario La Samaritana, Bogotá DC, Colombia; Department of Oral Research, School of Dentistry, Institución Universitaria de Colegios de Colombia UNICOC, Colombia
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4
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Kakimoto N, Wongratwanich P, Shimamoto H, Kitisubkanchana J, Tsujimoto T, Shimabukuro K, Verdonschot RG, Hasegawa Y, Murakami S. Comparison of T2 values of the displaced unilateral disc and retrodiscal tissue of temporomandibular joints and their implications. Sci Rep 2024; 14:1705. [PMID: 38242921 PMCID: PMC10798969 DOI: 10.1038/s41598-024-52092-6] [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: 09/10/2023] [Accepted: 01/13/2024] [Indexed: 01/21/2024] Open
Abstract
Unilateral anterior disc displacement (uADD) has been shown to affect the contralateral joints qualitatively. This study aims to assess the quantitative T2 values of the articular disc and retrodiscal tissue of patients with uADD at 1.5 Tesla (T). The study included 65 uADD patients and 17 volunteers. The regions of interest on T2 maps were evaluated. The affected joints demonstrated significantly higher articular disc T2 values (31.5 ± 3.8 ms) than those of the unaffected joints (28.9 ± 4.5 ms) (P < 0.001). For retrodiscal tissue, T2 values of the unaffected (37.8 ± 5.8 ms) and affected joints (41.6 ± 7.1 ms) were significantly longer than those of normal volunteers (34.4 ± 3.2 ms) (P < 0.001). Furthermore, uADD without reduction (WOR) joints (43.3 ± 6.8 ms) showed statistically higher T2 values than the unaffected joints of both uADD with reduction (WR) (33.9 ± 3.8 ms) and uADDWOR (38.9 ± 5.8 ms), and the affected joints of uADDWR (35.8 ± 4.4 ms). The mean T2 value of the unaffected joints of uADDWOR was significantly longer than that of healthy volunteers (P < 0.001). These results provided quantitative evidence for the influence of the affected joints on the contralateral joints.
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Affiliation(s)
- Naoya Kakimoto
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Pongsapak Wongratwanich
- Division of Oral Diagnosis, Department of Oral Biomedical Sciences, Khon Kaen University, Khon Kaen, Thailand.
| | - Hiroaki Shimamoto
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Jira Kitisubkanchana
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Tomomi Tsujimoto
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Kiichi Shimabukuro
- Department of Oral and Maxillofacial Radiology, Hiroshima University Hospital, Hiroshima, Japan
| | | | - Yoko Hasegawa
- Division of Comprehensive Prosthodontics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shumei Murakami
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, Osaka, Japan
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5
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Xu J, Wang D, Yang C, Wang F, Wang M. Reconstructed magnetic resonance image-based effusion volume assessment for temporomandibular joint arthralgia. J Oral Rehabil 2023; 50:1202-1210. [PMID: 37391274 DOI: 10.1111/joor.13551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 03/01/2023] [Accepted: 06/27/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Joint effusion is often noticed in magnetic resonance image (MRI) and its diagnostic value for arthralgia of the temporomandibular joint (TMJ) remains obscure. OBJECTIVE To develop a method for quantitatively evaluating the joint effusion revealed in MRI and its diagnostic value for arthralgia of the TMJ. METHODS Two-hundreds and twenty-eight TMJs, 101 with arthralgia (Group P) and 105 without (Group NP) from 103 patients, and 22 TMJs (Group CON) from 11 asymptomatic volunteers were examined by using MRI. The effusion volume was measured after constructing a three-dimensional structure of the joint effusion revealed in MRI by using the ITK-SNAP software. The diagnostic capabilities of the effusion volume on arthralgia were evaluated with receiver operating characteristic (ROC) curve analysis. RESULTS Totally 146 joints showed MRI signs of joint effusion, including nine joints from Group CON. However, the medium volume was greater in Group P (66.65 mm3 ), but was much similar in Group CON (18.33 mm3 ) to Group NP (27.12 mm3 ). The effusion volume larger than 38.20 mm3 was validated to discriminate Group P from Group NP. The AUC value was 0.801 (95% CI 0.728 to 0.874), with a sensitivity of 75% and specificity of 78.9%. The median volume of the joint effusion was larger in those with than without bone marrow oedema, osteoarthritis, Type-III disc configurations, disc displacement and higher signal intensity of the retrodiscal tissue (all, p < .05). CONCLUSION The present method for evaluate joint effusion volume well discriminated painful TMJs from non-pain ones.
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Affiliation(s)
- Jiali Xu
- Department of stomatology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Dongmei Wang
- Department of stomatology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Chunhua Yang
- Department of Magnetic Resonance, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Fangfang Wang
- Department of Magnetic Resonance, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Meiqing Wang
- Department of stomatology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
- Department of TMD, Shanghai Stomatological Disease Centre, Fudan University, Shanghai, China
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Wang Q, Jia J, Zhou C, Ye W, Bi R. A Bibliometric Analysis of Research on Temporomandibular Joint Disc Displacement from 1992 to 2022. Healthcare (Basel) 2023; 11:2108. [PMID: 37510548 PMCID: PMC10379638 DOI: 10.3390/healthcare11142108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/04/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
The temporomandibular joint (TMJ) disc displacement is the most common temporomandibular disorders (TMD) condition. It causes clicking, pain, limited mandibular movements, and even masticatory difficulties in many people. The aim of this study is showcasing hotspots and frontiers in the field and providing a reference for the future research by a bibliometric analysis. Studies published from 1992 to 2022 were retrieved from Web of Science Core Collection on 23 April 2023. A total of 1882 studies (1739 articles and 143 reviews) were included in the bibliometric analysis. From 1992 to 2022, the annual number of publications and citations greatly increased. The United States of America (USA) contributed the most publications about TMJ disc displacement. Shanghai Jiao Tong University was the most productive institution; meanwhile, Yang, C. from this institution was the most prolific author. The University of Washington was the most influential institution, and Brooks, S. was the most influential author. Diagnostic criteria and management of TMJ disc displacement, as well as TMJ disc displacement-associated conditions, might be a hotspot for current global research. We provided an objective and valuable reference for future research on TMJ disc displacement.
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Affiliation(s)
- Qiuhao Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Jin Jia
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Changhan Zhou
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Wang Ye
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Ruiye Bi
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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7
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Topaloglu Yasan G, Adiloglu S, Tuz HH, Sahar D. Evaluation of clinical signs and magnetic resonance imaging findings in patients with temporomandibular disorders. J Craniomaxillofac Surg 2023; 51:441-447. [PMID: 37604767 DOI: 10.1016/j.jcms.2023.08.013] [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: 03/20/2023] [Revised: 07/24/2023] [Accepted: 08/14/2023] [Indexed: 08/23/2023] Open
Abstract
This study assessed the relationship between clinical symptoms and magnetic resonance imaging (MRI) findings in temporomandibular disorders (TMD). A total of 324 temporomandibular joints (TMJs) from 162 patients were included. The TMJs were divided into three groups based on disc positions on MRI: normal disc position, anterior disc displacement with reduction (ADDwR), and anterior disc displacement without reduction (ADDwoR). Clinical findings included TMJ pain, TMJ noise, and maximum mouth opening (MMO). The disc configuration, disc positions, condylar morphology, and joint effusion were evaluated in proton density-weighted and T2-weighted open and closed-mouth sagittal sections. Patients comprised 135 females and 27 males, with a mean age of 37.63 ± 13.86 years. The VAS score was significantly higher in ADDwoR than in ADDwR (p = 0.007). Condylar sclerosis (β coefficient: 1.449, 95% confidence interval (CI): 0.505-2.393, p = 0.003) and condylar flattening (β coefficient: 1.024, 95% CI: 0.209-1.840, p = 0.014) had higher VAS scores than the other MRI findings in multiple regression analyses. Limited mouth opening (MO) was independently associated with ADDwoR. ADDwoR had a higher risk of having limited MO than normal disc position (odds ratio: 5.268), while there were no associations between limited MO and other MRI findings. None of the MRI findings showed significant performance in predicting TMJ noise. The convex and folded disc configuration percentages, the frequencies of osteophyte formation, and grade 3 effusion were significantly higher in the ADDwoR group. More severe clinical symptoms and a higher degree of disc deformity, osteophyte formation, and high-grade effusion were shown to be associated with ADDwoR.
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Affiliation(s)
| | - Selen Adiloglu
- Hacettepe University, Department of Oral and Maxillofacial Surgery, Turkey
| | - Hakan H Tuz
- Hacettepe University, Department of Oral and Maxillofacial Surgery, Turkey
| | - Dilek Sahar
- Hacettepe University, Department of Oral and Maxillofacial Surgery, Turkey
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8
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Clinical and magnetic resonance imaging findings in patients with and without improvement after mandibular manipulation and conservative physical therapy for temporomandibular joint disorders. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 135:294-302. [PMID: 36307302 DOI: 10.1016/j.oooo.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/26/2022] [Accepted: 09/05/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study compared clinical and magnetic resonance imaging (MRI) findings in patients with anterior disk displacement without reduction (ADDWOR) who improved to anterior disk displacement with reduction (ADDWR) vs. patients who did not improve after mandibular manipulation (MM) and conservative self-administered physical therapy (CSAPT). STUDY DESIGN Of 15 patients diagnosed with ADDWOR by MRI, 7 improved to ADDWR (WOR-WR) and 8 did not improve (WOR-WOR). The clinical and MRI findings before and after therapy were compared in each group. RESULTS Significant differences between the groups included age, period of awareness of trismus, and maximum mouth opening (MMO). The MRI findings revealed significant differences in the degree of ADD and morphology of the disk and condyle. MMO significantly improved in the WOR-WR group between initial and follow-up visits. CONCLUSION Patients who were successfully treated with MM and CSAPT tended to be <30 years old, with a longer period of awareness of trismus, MMO <40 mm, a slight or moderate degree of ADD, no deformity of the disk, and no morphologic change in the condyle. Patients with ADDWOR who are treated with MM and CSAPT require an accurate clinical examination and MRI before treatment.
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Takahara N, Nakagawa S, Sumikura K, Yoda T. Comparison of magnetic resonance imaging findings in patients with intermittent closed lock and acute closed lock of the temporomandibular joint: a cross-sectional retrospective study. Oral Radiol 2022:10.1007/s11282-022-00659-2. [DOI: 10.1007/s11282-022-00659-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022]
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10
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Intra- and inter-examination reproducibility of T2 mapping for temporomandibular joint assessment at 3.0 T. Sci Rep 2022; 12:10993. [PMID: 35768628 PMCID: PMC9243045 DOI: 10.1038/s41598-022-15184-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
T2 mapping allows quantification of the temporomandibular joint (TMJ) ultrastructural degeneration. The study aimed to assess intra- and inter-examination reproducibility of T2 mapping for TMJ evaluation at 3.0 Tesla (T). Seventeen volunteers, regardless of temporomandibular disorder (TMD) diagnosis, received magnetic resonance (MR) examination at 3.0 T. T2 mapping was performed twice (> 5 min between sessions without repositioning) on 12 volunteers to ensure intra-examination reproducibility. Nine volunteers underwent two examinations (> 6 months) to ensure inter-examination reproducibility. The regions of interest (ROIs) of the articular disc and retrodiscal tissue were manually selected and calculated. The mean T2 values of the articular disc and retrodiscal tissue were 25.3 ± 3.0 and 30.0 ± 4.1 ms, respectively. T2 mapping showed excellent intra-examination intraclass correlation coefficients (ICCs) for both articular disc (0.923) and retrodiscal tissue (0.951). Very strong correlations (r) were observed in both articular disc (0.928) and retrodiscal tissue (0.953) (P < .001). Inter-examination reproducibility also demonstrated that the ICCs were excellent (0.918, 0.935) on both ROIs. T2 values between first and second examinations were strongly correlated (r = 0.921, 0.939) (P < .001). In conclusion, T2 mapping seems to be a promising tool for TMJ assessment, regardless of the TMJ condition.
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11
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Leite DDFC, Costa ALF, Appenzeller S, Campos PSF, Soares MQS, Martins JS, Prado GD, Panzarella FK. Magnetic resonance imaging assessment of juvenile idiopathic arthritis using OMERACT and EuroTMjoint classifications. Int J Oral Maxillofac Surg 2022; 51:1473-1481. [PMID: 35597667 DOI: 10.1016/j.ijom.2022.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 04/13/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
This retrospective case-control study compared inflammatory and structural damage in the temporomandibular joint of patients with juvenile idiopathic arthritis (JIA) and its subtypes and healthy patients using the Outcome Measures in Rheumatology Clinical Trials (OMERACT) and EuroTMjoint classifications. Correlations between the scores of the two classifications and time of diagnosis were evaluated. Twenty-nine JIA patients and 48 age-matched healthy participants were examined. TMJ images on each side were considered individually. Oligoarticular and polyarticular subtypes were present in 44.8% and 55.2% of patients, respectively. The JIA group presented a higher frequency and more severe signs of inflammatory and structural changes (P < 0.05), except for effusion (P = 0.83). The polyarticular subtype showed a higher change intensity. The time of JIA diagnosis was not correlated with inflammatory and structural changes. Positive correlations between inflammation and bone deformity scores were observed for the EuroTMjoint classification (r = 0.462, P < 0.001; low correlation) and OMERACT classification (r = 0.737, P < 0.001; high correlation). Positive correlations between the OMERACT and EuroTMjoint classifications were found for inflammation score (r = 0.907, P < 0.001; very high correlation) and bone deformity score (r = 0.854, P < 0.001; high correlation). Both classifications showed a higher frequency and intensity of inflammation and bone deformity in JIA patients. The results of this study suggest that the appropriate management of inflammation may reduce the potential for structural damage to the TMJ.
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Affiliation(s)
- D de F C Leite
- Oral Radiology Division, São Leopoldo Mandic Research Institute, Campinas, São Paulo, Brazil
| | - A L F Costa
- Postgraduate Program in Dentistry, Cruzeiro do Sul University (UNICSUL), São Paulo, São Paulo, Brazil
| | - S Appenzeller
- Rheumatology Unit, Department of Orthopedics, Rheumatology and Traumatology, School of Medical Science, University of Campinas, São Paulo, Brazil
| | - P S F Campos
- Department of Oral Radiology, Federal University of Bahia, Salvador, Bahia, Brazil
| | - M Q S Soares
- Oral Radiology Division, São Leopoldo Mandic Research Institute, Campinas, São Paulo, Brazil
| | - J S Martins
- Medical Pathophysiology, School of Medical Science, University of Campinas, São Paulo, Brazil
| | - G D Prado
- Department of Oral Radiology, Federal University of Bahia, Salvador, Bahia, Brazil
| | - F K Panzarella
- Oral Radiology Division, São Leopoldo Mandic Research Institute, Campinas, São Paulo, Brazil.
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12
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Akkemik Ö, Kugel H, Fischbach R. Acute soft tissue injury to the temporomandibular joint and posttraumatic assessment after mandibular condyle fractures: a longitudinal prospective MRI study. Dentomaxillofac Radiol 2022; 51:20210148. [PMID: 34762508 PMCID: PMC8925873 DOI: 10.1259/dmfr.20210148] [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] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Evaluation of acute soft tissue injury of the temporomandibular joint (TMJ) with type I-VI fractures immediately after trauma and investigation of the longitudinal evolution including response to conservative treatment using MRI. METHODS The joints of 24 patients with 33 condylar fractures (15 unilateral, nine bilateral) were imaged on a 1 Tesla MR system within the first 24 h post-trauma. 12 of these patients with 16 condylar fractures (eight unilateral, four bilateral) were clinically re-evaluated using MRI after 3 months of closed treatment. The position, morphology, and signal intensities of the disc, capsule, retrodiscal tissue, and osseous structures were documented. RESULTS In the acute phase, disc displacements (DDs) were diagnosed in 8 out of 33 joints with fracture, including posterior DDs in two joints and tears of the inferior retrodiscal lamina in 11 joints. The follow-up MRI in 12 patients revealed new DD in four joints on the fractured side (FS) including a posterior DD and an increased degree of displacement, and new DDs in two joints in the non-fractured side (NFS). CONCLUSION Preexisting and traumatic DD and soft tissue injuries are frequent findings in patients with condylar fracture. Independent of the degree of trauma, condylar fractures may determine the subsequent development of DD on both FS and NFS. Early MR imaging may help initiate well-directed specific measures for better outcomes in the acutely injured TMJ.
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Affiliation(s)
| | - Harald Kugel
- University Clinic for Radiology, University of Münster, Münster, Germany
| | - Roman Fischbach
- Department of Radiology, Asklepios Hospital Hamburg-Altona, Hamburg, Germany
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13
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González LV, López JP, Díaz-Báez D, Gómez-Delgado A. Correlation between MRI-diagnosed joint effusion and demographic, clinical, imaging, and arthroscopic findings of the temporomandibular joint. J Craniomaxillofac Surg 2021; 49:1169-1174. [PMID: 34246539 DOI: 10.1016/j.jcms.2021.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 06/04/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022] Open
Abstract
Our study aimed to evaluate the diagnostic accuracy of MRI in cases of joint effusion and documented its relationship with clinical and arthroscopic findings. A cross-sectional study was carried out, using the following selection criteria: clinical, radiological, and MRI-based diagnosis of joint pathology; joint pain; and indication for minimally invasive management with arthroscopy. Arthroscopic analysis, included synovitis, adhesions, chondromalacia, and disc perforations. These variables were recorded and compared with MRI findings of effusion. Data were analyzed using chi-square and Fisher's exact tests. In total, 44 temporomandibular joints were studied, of which 38 corresponded to women; 21 cases were diagnosed as Wilkes IV-V, with effusion found in all of them. The presence of effusion was significantly related to synovitis (p = 0.031) and adherences (p = 0.042). Pain was significantly related to the presence of effusion (p = 0.002), Wilkes advanced stages (p = 0.006), synovitis (p = 0.031), and adherences (p = 0.004). Regarding maximum mouth opening, there was no significant correlation with the variables studied, aside from gender and Wilkes classification. There was a significant correlation between the presence of joint effusion detected by MRI and clinical and arthroscopic findings. This suggests that effusion diagnosed by magnetic resonance has a significant value. Therefore, an adequate presurgical examination should be considered before submitting the patient to an invasive diagnostic procedure.
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Affiliation(s)
- Luis Vicente González
- Oral and Maxillofacial Surgeon, Hospital Universitario La Samaritana, Bogotá, Colombia
| | - Juan Pablo López
- Oral and Maxillofacial Service, Hospital Universitario Fundación Santa Fe de Bogotá, Colombia; Oral and Maxillofacial Surgery Resident, Universidad El Bosque, Bogotá, Colombia.
| | - David Díaz-Báez
- Unit of Basic Oral Investigation (UIBO), Facultad de Odontología, Universidad El Bosque, Bogotá, Colombia
| | - Andrés Gómez-Delgado
- Oral and Maxillofacial Surgeon, Hospital San Juan de Dios and Hospital UNIBE, San José, Costa Rica; Oral and Maxillofacial Surgery Residency Program, Universidad El Bosque, Bogotá, Colombia
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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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Jeon KJ, Lee C, Choi YJ, Han SS. Assessment of bone marrow fat fractions in the mandibular condyle head using the iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL-IQ) method. PLoS One 2021; 16:e0246596. [PMID: 33635882 PMCID: PMC7909693 DOI: 10.1371/journal.pone.0246596] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/22/2021] [Indexed: 12/25/2022] Open
Abstract
The prevalence of temporomandibular joint disorder (TMD) is gradually increasing, and magnetic resonance imaging (MRI) is becoming increasingly common as a modality used to diagnose TMD. Edema and osteonecrosis in the bone marrow of the mandibular condyle have been considered to be precursors of osteoarthritis, but these changes are not evaluated accurately and quantitatively on routine MRI. The iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL-IQ) method, as a cutting-edge MRI technique, can separate fat and water using three asymmetric echo times and the three-point Dixon method. The purpose of this study was to analyze the quantitative fat fraction (FF) in the mandibular condyle head using the IDEAL-IQ method. Seventy-nine people who underwent MRI using IDEAL-IQ were investigated and divided into 1) the control group, without TMD symptoms, and 2) the TMD group, with unilateral temporomandibular joint (TMJ) pain. In both groups, the FF of the condyle head in the TMJ was analyzed by two oral and maxillofacial radiologists. In the TMD group, 29 people underwent cone-beam computed tomography (CBCT) and the presence or absence of bony changes in the condylar head was evaluated. The FF measurements of the condyle head using IDEAL-IQ showed excellent inter-observer and intra-observer agreement. The average FF of the TMD group was significantly lower than that of the control group (p < 0.05). In the TMD group, the average FF values of joints with pain and joints with bony changes were significantly lower than those of joints without pain or bony changes, respectively (p < 0.05). The FF using IDEAL-IQ in the TMJ can be helpful for the quantitative diagnosis of TMD.
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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
- * E-mail:
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Castro VA, Pereira RMA, Mascarenhas GM, Neto AIT, Perez DE, Rodrigues D, Prado CJ, Zanetta-Barbosa D. Magnetic resonance imaging evaluation of articular disk position after orthognathic surgery with or without concomitant disk repositioning: a retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:276-285. [PMID: 33229287 DOI: 10.1016/j.oooo.2020.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/12/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to compare the outcomes of 2 surgical treatment options: one for correction of class II malocclusion skeletal deformity and one for pre-existing temporomandibular joint (TMJ) disorders requiring orthognathic surgery (OS) for correction of dentofacial deformity. STUDY DESIGN This retrospective study evaluated patients who underwent OS with maxillomandibular advancement (MMA) with or without concomitant TMJ surgery for articular disk repositioning (ADR). Patients were divided into 2 groups: group I (MMA) was treated with OS only (18 patients); and group II (MMA-ADR) was treated with OS and concomitant ADR (19 patients). The sample consisted of 74 TMJs (mean patient age 29.86 years). RESULTS In group I, 38.5% of the disks that were originally in normal position became displaced after OS, and 33.3% of displaced disks with reduction became nonreducing after OS. In group II, 78.9% of disks exhibited normal position in the final evaluation, and 97.3% of patients showed improved disk position after surgery. There was significant symptom improvement in all patients in group II, but no significant improvement in group I. CONCLUSIONS OS with ADR appears to produce stable and beneficial results in improving symptoms in patients with displaced disk and TMJ pain.
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Affiliation(s)
- Vanessa A Castro
- Postgraduate PhD student, School of Dentistry, Federal University of Uberlândia, Uberlândia, MG, Brazil; Private Practitioner, Salvador, BA, Brazil
| | - Rafael M A Pereira
- Assistant Professor, School of Dentistry, University Center of Patos de Minas, Patos de Minas, Minas Gerais, Brazil.
| | - Gustavo M Mascarenhas
- Private Practitioner, Salvador, BA, Brazil; Postgraduate PhD student, School of Dentistry, São Leopoldo Mandic, Campinas, SP, Brazil
| | | | - Daniel E Perez
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Texas, San Antonio, TX, USA
| | - Daniel Rodrigues
- Private Practitioner, Salvador, BA, Brazil; Assistant Professor, Residency of Oral and Maxillofacial Surgery, Federal University of Bahia, Salvador, BA, Brazil
| | - Célio J Prado
- Adjunct Professor, School of Dentistry, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - Darceny Zanetta-Barbosa
- Adjunct Professor, School of Dentistry, Federal University of Uberlândia, Uberlândia, MG, Brazil
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Díaz Reverand S, Muñoz Guerra M, Rodríguez Campo J, Escorial V, Cordero J. Correlation between joint effusion and clinical symptoms, magnetic resonance imaging and arthroscopic findings in patients with temporomandibular joint disease. J Craniomaxillofac Surg 2020; 48:1146-1151. [PMID: 33199210 DOI: 10.1016/j.jcms.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 08/02/2020] [Accepted: 10/25/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the relationship between temporomandibular joint (TMJ) effusions and clinical, magnetic resonance imaging and arthroscopic variables. METHODS We designed a retrospective cohort study of patients attending our Department who presented temporomandibular joint disease according to the Research Diagnostic Criteria for Temporomandibular Disorders. According to the presence of effusion in magnetic resonance imaging, the sample was divided into 2 groups: patients with or without joint effusion. RESULTS A total of 203 patients fulfilled the inclusion criteria, of which 99 (48.8%) showed no joint effusion and 104 (51.2%) presented effusion. We found no significant differences between clinical variables and joint effusion. However, patients without effusion showed significantly longer duration of symptoms that patients with effusion (mean = 34.8 months, standard deviation = 43.41 vs 20.25, 23.76; p = 0.005). We found no significant differences in magnetic resonance imaging and arthroscopic variables associated with the presence of effusions. For both groups, there were statistically significant differences in values of mean pain scores and mean maximum interincisal distance between the different times of examination (before surgery and 3, 6 and 12 months after surgery). CONCLUSION Joint effusion is not associated with clinical, imaging or arthroscopic variables, but may be a clinical characteristic of early stages of temporomandibular joint disease.
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Affiliation(s)
- S Díaz Reverand
- Department of Oral and Maxillofacial Surgery and Aesthetic Medicine, Diagonal Clinic, Barcelona, Spain; Temporomandibular Joint Subdivision, Department of Oral and Maxillofacial Surgery, University Hospital La Princesa, Madrid, Spain.
| | - M Muñoz Guerra
- Temporomandibular Joint Subdivision, Department of Oral and Maxillofacial Surgery, University Hospital La Princesa, Madrid, Spain
| | - J Rodríguez Campo
- Temporomandibular Joint Subdivision, Department of Oral and Maxillofacial Surgery, University Hospital La Princesa, Madrid, Spain
| | - V Escorial
- Temporomandibular Joint Subdivision, Department of Oral and Maxillofacial Surgery, University Hospital La Princesa, Madrid, Spain
| | - J Cordero
- Department of Traumatology, University Hospital La Princesa, Madrid, Spain
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Eriksen ES, Hellem S, Skartveit L, Brun JG, Bøe OE, Moen K, Geitung JT. Temporomandibular joint pain and associated magnetic resonance findings: a retrospective study with a control group. Acta Radiol Open 2020; 9:2058460120938738. [PMID: 33088591 PMCID: PMC7545518 DOI: 10.1177/2058460120938738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 06/07/2020] [Indexed: 01/01/2023] Open
Abstract
Background To better understand and evaluate clinical usefulness of magnetic resonance imaging (MRI) in diagnosis and treatment of temporomandibular disorders (TMD), parameters for the evaluation are useful. Purpose To assess a clinically suitable staging system for evaluation of MRI of the temporomandibular joint (TMJ) and correlate the findings with age and some clinical symptoms of the TMJ. Material and Methods Retrospective analysis of 79 consecutive patients with clinical temporomandibular disorder or diagnosed inflammatory arthritis. Twenty-six healthy volunteers were included as controls. Existing data included TMJ pain, limited mouth opening (<30 mm) and corresponding MRI evaluations of the TMJs. Results The patients with clinical TMD complaints had statistically significantly more anterior disc displacement (ADD), disc deformation, caput flattening, surface destructions, osteophytes, and caput edema diagnosed by MRI compared to the controls. Among the arthritis patients, ADD, effusion, caput flattening, surface destructions, osteophytes, and caput edema were significantly more prevalent compared to the healthy volunteers. In the control group, disc deformation and presence of osteophytes significantly increased with age, and a borderline significance was found for ADD and surface destructions on the condylar head. No statistically significant associations were found between investigated clinical and MRI parameters. Conclusion This study presents a clinically suitable staging system for comparable MRI findings in the TMJs. Our results indicate that some findings are due to age-related degenerative changes rather than pathological changes. Results also show that clinical findings such as pain and limited mouth opening may not be related to changes diagnosed by MRI.
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Affiliation(s)
| | - Sølve Hellem
- Center for Clinical Dental Research, Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Liv Skartveit
- Section for Oral and Maxillofacial Radiology, Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Johan G Brun
- Section for Rheumatology, University of Bergen and Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Olav E Bøe
- Center for Clinical Dental Research, Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Ketil Moen
- Section for Oral and Maxillofacial Surgery, Arendal Hospital (HFS), Arendal, Norway
| | - Jonn Terje Geitung
- Department of Radiology, University of Oslo and Akershus University Hospital, Oslo, Norway
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Koca CG, Gümrükçü Z, Bilgir E. Does clinical findings correlate with magnetic resonance imaging (MRI) findings in patients with temporomandibular joint (TMJ) pain? A cross sectional study. Med Oral Patol Oral Cir Bucal 2020; 25:e495-e501. [PMID: 32134894 PMCID: PMC7338075 DOI: 10.4317/medoral.23501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/20/2020] [Indexed: 11/19/2022] Open
Abstract
Background Although magnetic resonance imaging (MRI) helps to clearly visualize the disorders in temporomandibular joint (TMJ), the relationship between cross-sectional and clinical findings has not been precisely established. The aim of this study was to evaluate the relationship between clinical symptoms and MRI findings in individuals with TMJ pain.
Material and Methods This cross-sectional study, conducted on the clinical and MRI findings of the patients, who applied to Uşak University, Oral and Maxillofacial Surgery Clinic with TMJ pain between the years 2016-2019. The primary predictor variables were MRI findings; disc position (normal, disc displacement with reduction (DDWR), disc displacement without reduction (DDWOR)), disc structural distortion (normal, folded, lengthened, round, biconvex, thick), condyle degeneration type (normal, moderate, severe) and joint effusion (JE) (absent, present). The primary outcome variable was pain, recorded on a visual analog scale (VAS) (numbered between 0-10). The other variables were demographic variables (age/gender). The relationship between clinical and MRI findings were statistically evaluated. The data were analysed by Kruskal Wallis and Mann Whitney U test. Chi-square (x2) test was used for categorical variable comparisons. P values < .05 were considered to indicate statistical significance.
Results Clinical and MRI records of 700 TMJ, from 350 patients with the mean age of the 31 (12-65) were evaluated in this study. Statistically significant differences were found between; disc position and pain, disc position and JE; JE and pain; disc structural distortion and pain; and disc structural distortion and disc position. JE was seen more common in DDWOR group. The most common disc distortion, seen in patients with JE, is the folded type.
Conclusions The present study can infer that pain is associated with disc position, JE, disc structural distortion, and DDWOR is associated with JE. Folded type disc is the most common disc type in TMJ with JE. Key words:Internal derangement, TMJ, MRI evaluation, disc morphology, disc position, condyle degeneration, joint effusion.
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Affiliation(s)
- C-G Koca
- Department of Oral and Maxillofacial Surgery Faculty of Dentistry, Recep Tayyip Erdoğan University Rize, Turkey
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Toshima H, Ogura I. Characteristics of patients with temporomandibular joint osteoarthrosis on magnetic resonance imaging. J Med Imaging Radiat Oncol 2020; 64:615-619. [PMID: 32478461 DOI: 10.1111/1754-9485.13054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/20/2020] [Accepted: 05/06/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Temporomandibular joint (TMJ) dysfunction is a common condition that is best evaluated with magnetic resonance (MR) imaging. The aim of this study was to investigate the characteristics of the patients with TMJ osteoarthrosis on MR imaging. METHODS The MR images of 206 TMJs of 103 patients with temporomandibular disorders (TMD) were evaluated retrospectively in this study. The relationship between osteoarthrosis and age, gender, TMJ pain and MR imaging findings, such as disc displacement with or without reduction and TMJ effusion, was analysed. RESULTS The patients with TMJ osteoarthrosis (mean: 51.6 years) were significantly older than those without osteoarthrosis (mean: 44.8 years, P = 0.027). The incidence of the patients with TMJ osteoarthrosis was significantly different between with (10.0 %) and without reduction (57.0 %, P < 0.001). Logistic multivariate regression analysis demonstrated that disc displacement without reduction was significant in patients with TMJ osteoarthrosis (odds ratio = 12.285, P < 0.001). CONCLUSIONS This study suggests that characteristics of the patients with TMJ osteoarthrosis on MR imaging include older and disc displacement without reduction.
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Affiliation(s)
- Hiroo Toshima
- Quantitative Diagnostic Imaging, Field of Oral and Maxillofacial Imaging and Histopathological Diagnostics, Course of Applied Science, The Nippon Dental University Graduate School of Life Dentistry at Niigata, Niigata, Japan
| | - Ichiro Ogura
- Quantitative Diagnostic Imaging, Field of Oral and Maxillofacial Imaging and Histopathological Diagnostics, Course of Applied Science, The Nippon Dental University Graduate School of Life Dentistry at Niigata, Niigata, Japan.,Department of Oral and Maxillofacial Radiology, The Nippon Dental University School of Life Dentistry at Niigata, Niigata, Japan
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Painful clicking jaw: a pictorial review of internal derangement of the temporomandibular joint. Pol J Radiol 2020; 84:e598-e615. [PMID: 32082459 PMCID: PMC7016362 DOI: 10.5114/pjr.2019.92287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 11/26/2019] [Indexed: 11/17/2022] Open
Abstract
Temporomandibular joint disorders are a common cause of chronic musculoskeletal pain worldwide. Among these, internal disc derangement is the most frequent type of disorder. Internal derangement is defined as an abnormal positional and functional relationship between the disc and articulating surfaces. Common clinical symptoms include pain and clicking. Imaging plays a key role in diagnosing temporomandibular joint disorders. It is important for the radiologist to detect early imaging signs of internal derangement, thereby avoiding the evolution of this condition to degenerative joint disease. The aim of this article is to familiarise the reader with the spectrum of imaging findings that are encountered at different stages of the disease.
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Higuchi K, Chiba M, Sai Y, Yamaguchi Y, Nogami S, Yamauchi K, Takahashi T. Relationship between temporomandibular joint pain and magnetic resonance imaging findings in patients with temporomandibular joint disorders. Int J Oral Maxillofac Surg 2020; 49:230-236. [DOI: 10.1016/j.ijom.2019.06.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/23/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
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Ertem SY, Konarılı FN, Ercan K. Does Incidence of Temporomandibular Disc Displacement With and Without Reduction Show Similarity According to MRI Results? J Maxillofac Oral Surg 2019; 19:603-608. [PMID: 33071510 DOI: 10.1007/s12663-019-01322-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/17/2019] [Indexed: 10/25/2022] Open
Abstract
Purpose The aim of this study is to assess MRI reports of the patients and to provide retrospective analysis by conducting detailed evaluation of temporomandibular disc position. Patients and Methods MRI images of 259 patients from 2008 to 2017 were reviewed retrospectively. Existence of disc displacement in joint with and without reduction, existence of effusion in joint gap, arthritis, degenerative changes in joints and limitation of movement of joint and anatomic characteristics were evaluated. Results One hundred and seventeen (45.2%) of the patients had healthy joint connection bilaterally. Anterior disc displacement was observed in 101 (38.9%) of the patients. The number of the patients having disc displacement with reduction was 50 (19.3%) and without reduction was 51 (19.6%) similarly. Conclusion The incidence of anterior disc displacement with or without reduction was similar; besides this, the majority of the patients diagnosed with anterior disc displacement were unilateral.
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Affiliation(s)
- Sinan Yasin Ertem
- Oral and Maxillofacial Surgery Department, Dentistry Faculty, Ankara Yildirim Beyazit University, Guclukaya Mah., Fatih Cad. Cagla Sok. No:2, 06280 Kecioren, Ankara Turkey
| | - Fatma Nur Konarılı
- Oral and Maxillofacial Surgery Department, Dentistry Faculty, Ankara Yildirim Beyazit University, Guclukaya Mah., Fatih Cad. Cagla Sok. No:2, 06280 Kecioren, Ankara Turkey
| | - Karabekir Ercan
- Department of Radiology, Ankara Ataturk Training and Research Hospital, Universiteler Mh., Bilkent Cad. No:1, Çankaya, Ankara Turkey
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Heo HA, Yoon HJ. Clinical outcomes of patients with bilateral anterior disc displacement without reduction and erosive change of the temporomandibular joint after performance of unilateral arthrocentesis and stabilisation splint therapy. J Oral Rehabil 2019; 47:307-312. [PMID: 31557342 DOI: 10.1111/joor.12897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 08/21/2019] [Accepted: 09/24/2019] [Indexed: 11/27/2022]
Abstract
The efficacy of a combination treatment of arthrocentesis and stabilisation splint for patients with bilateral anterior disc displacement without reduction (ADDWoR) and erosive change of the TMJ remains controversial. To evaluate clinical outcomes of patients with ADDWoR and erosive change of the TMJ after performance of unilateral arthrocentesis and stabilisation splint therapy. A retrospective study of 44 patients (37 females, 7 males, mean age of 34 years) with bilateral ADDWoR and erosive change of the TMJ were included in this study. Their clinical outcomes before and after arthrocentesis and stabilisation splint therapy were compared. Evaluation criteria were as follows: (a) Maximal mouth opening (MMO); (b) Right and left maximal lateral movement (RLM, LLM) and maximal protrusive movement (PM); (c) Visual analog scale (VAS) pain score during MMO, RLM, LLM and PM; and (d) VAS pain score during palpation of masticatory muscles. Wilcoxon signed-rank test, Mc Nemar test and paired t test were used for statistical analysis. Differences in VAS pain score between arthrocentesis and non-arthrocentesis sites were not statistically significant except MMO and LLM (P < .05) after 6 months. Differences in mean VAS pain scores for all variables between before arthrocentesis and 6 months follow-up in the arthrocentesis site were statistically significant. (P < .01). Unilateral arthrocentesis on more symptomatic TMJ and subsequent stabilisation splint therapy was highly successful for pain and achievement of normal range of mandibular movements in patients with both ADDWoR and bony change.
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Affiliation(s)
- Hyun-A Heo
- Department of Advanced General Dentistry, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun-Joong Yoon
- Department of Oral and Maxillofacial Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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T2 relaxation times of the retrodiscal tissue in patients with temporomandibular joint disorders and in healthy volunteers: a comparative study. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:311-318. [DOI: 10.1016/j.oooo.2019.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/31/2019] [Accepted: 02/09/2019] [Indexed: 11/20/2022]
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Pinto GNDS, Grossmann E, Iwaki Filho L, Groppo FC, Poluha RL, Muntean SA, Iwaki LCV. Correlation between joint effusion and morphology of the articular disc within the temporomandibular joint as viewed in the sagittal plane in patients with chronic disc displacement with reduction: A retrospective analytical study from magnetic resonance imaging. Cranio 2019; 39:119-124. [DOI: 10.1080/08869634.2019.1582166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Eduardo Grossmann
- Craniofacial Pain Applied to Dentistry, Dentistry Faculty, Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Liogi Iwaki Filho
- Oral and Maxillofacial Surgery, Department of Dentistry, State University of Maringá, Paraná, Brazil
| | - Francisco Carlos Groppo
- Department of Physiological Sciences, Pharmacology, Anesthesiology and Therapeutics, Piracicaba Dental School, University of Campinas, São Paulo, Brazil
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Kowalchuk RM, Kowalchuk RO, Kaplan-List K, Caplash JM, Block P. Temporomandibular Joint Internal Derangement Score (TIDS): novel magnetic resonance imaging assessment score and its relation to invasive treatment in patients with clinical temporomandibular joint pathology. Heliyon 2018; 4:e00916. [PMID: 30456324 PMCID: PMC6232617 DOI: 10.1016/j.heliyon.2018.e00916] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/04/2018] [Accepted: 11/01/2018] [Indexed: 11/28/2022] Open
Abstract
Purpose A new magnetic resonance imaging (MRI) based scoring system for temporomandibular joint (TMJ) internal derangement was developed to predict disease severity and the likelihood of invasive treatment. Patients and methods Reports and images from bilateral TMJ MRI studies of 100 consecutive patients with TMJ pain were retrospectively reviewed. A Temporomandibular Joint Internal Derangement Score (TIDS) score was composed of 6 MRI characteristics: joint effusion, disc displacement, disc nonrecapture, disc degenerative changes, abnormal condyle translation, and condyle arthritis. The primary endpoint was whether disease severity merited invasive treatment (arthrocentesis, arthroscopy, arthroplasty, or discectomy). Primary analyses were conducted as univariate regression, with the level of significance set at p < .05. Multivariate regression was also used to assess the impacts of each variable upon the need for invasive treatment. Results Invasive treatment was performed in 29 patients and planned in an additional 9 patients. Patients with clinical bilateral pathology were no more likely to undergo invasive treatment than those with unilateral clinical pathology. Statistically significant correlations were found between bilateral invasive treatment and the presence of bilateral joint effusions (p = 0.0037) and disc displacement (p = 0.014), as well as with increasing values of right TIDS (p = 0.0015) and bilateral TIDS (p = 0.0090). Bilateral TIDS of greater than 6 was correlated with both bilateral invasive treatment (p = 0.0033) and with invasive treatment of any kind (p = 0.041). In each instance of TIDS > 6, the patient demonstrated multiple signs of bilateral TMJ pathology. On multivariate regression, only disc recapture failed to trend towards statistical significance in both the six and twelve component regressions, which trended towards significance only in the twelve component analysis. Conclusion A TIDS score was developed to serve as an adjunct to the clinical assessment of TMJ pathology. Bilateral TIDS score greater than 6 was statistically significantly correlated with the severity of TMJ pathology.
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Affiliation(s)
- Roman M Kowalchuk
- Musculoskeletal Imaging, Department of Diagnostic Imaging, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY 14621, USA.,Department of Imaging Sciences, University of Rochester School of Medicine, 601 Elmwood Avenue, Box 706, Rochester, NY 14642, USA
| | - Roman O Kowalchuk
- University of Virginia School of Medicine, 1215 Lee St, Charlottesville, VA 22903, USA
| | - Katia Kaplan-List
- Department of Diagnostic Imaging, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY 14621, USA
| | - Jolly M Caplash
- Department of Oral & Maxillofacial Surgery, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY 14621, USA.,Department of Oro-maxillofacial Surgery, University of Rochester School of Medicine, 601 Elmwood Avenue, Rochester, NY 1464, USA
| | - Penelope Block
- Department of Diagnostic Imaging, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY 14621, USA
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Pasqual PGV, Poluha RL, Setogutti ÊT, Grossmann E. Evaluation of effusion and articular disc positioning after two different arthrocentesis techniques in patients with temporomandibular joint disc displacement without reduction. Cranio 2018; 38:256-263. [PMID: 30165804 DOI: 10.1080/08869634.2018.1511266] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate joint effusion and positioning of the articular disc through magnetic resonance imaging (MRI) before and after two different arthrocentesis techniques. METHODS Twenty-six patients with dislocation of the articular disc without reduction (ADDwoR) were included and randomly divided into two groups: single needle arthrocentesis with distention of the upper compartment of the TMJ (A1) and conventional arthrocentesis with 2 needles (A2). RESULTS A statistically significant difference was observed between the different effusion categories (p = 0.009). No differences were found comparing both treatment modalities concerning the position of the mandibular condyle and the articular disc. CONCLUSION Conventional arthrocentesis was able to change the effusion variable, whereas the single needle arthrocentesis was not. Both techniques were responsible for altering the position of the mandibular head or the disc-head complex, projecting them to a more anterior position related to the increase in the final maximum interincisal distance.
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Affiliation(s)
| | | | | | - Eduardo Grossmann
- Department of Dentistry, Craniofacial Pain Applied to Dentistry, Dentistry Faculty, Federal University of Rio Grande do Sul , Porto Alegre, RS, Brazil
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Larheim TA, Hol C, Ottersen MK, Mork-Knutsen BB, Arvidsson LZ. The Role of Imaging in the Diagnosis of Temporomandibular Joint Pathology. Oral Maxillofac Surg Clin North Am 2018; 30:239-249. [DOI: 10.1016/j.coms.2018.04.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Yapici-Yavuz G, Şimşek-Kaya G, Oğul H. A comparison of the effects of Methylprednisolone Acetate, Sodium Hyaluronate and Tenoxicam in the treatment of non-reducing disc displacement of the temporomandibular joint. Med Oral Patol Oral Cir Bucal 2018; 23:e351-e358. [PMID: 29680845 PMCID: PMC5945235 DOI: 10.4317/medoral.22237] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/18/2018] [Indexed: 12/03/2022] Open
Abstract
Background This clinical study aimed to radiologically and clinically compare the effect of intra-articular injection of methylprednisolone, sodium hyaluronate or tenoxicam following arthrocentesis with that of arthrocentesis alone in patients with non-reducing disc displacement. Material and Methods A total of 44 patients radiographically diagnosed with non-reducing disc displacement of the temporomandibular joint (TMJ) were randomly divided into four treatment groups, as follows: Group 1, arthrocentesis alone; Group 2, arthrocentesis plus methylprednisolone acetate; Group 3, arthrocentesis plus sodium hyaluronate; Group 4, arthrocentesis plus tenoxicam. Maximum mouth opening (MMO), lateral movement, pain severity and tenderness of TMJ and muscles of mastication on palpation were measured before treatment and at 1 week and 1, 3 and 6 months after treatment. Disc position, presence or absence of disc reduction, level of effusion, joint movement and joint space were also evaluated using magnetic resonance imaging (MRI) before treatment and 6 months after treatment. Results No significant differences in treatment success were found among the four groups. MRI findings did not vary significantly among the groups, but pre- and post-operative MRI findings varied significantly within all four groups (p<0.001). Conclusions According to the data from this study, it may be concluded that either arthrocentesis alone or arthrocentesis with methylprednisolone acetate or sodium hyaluronate or tenoxicam intra-articular injections are similarly effective and promising methods in the treatment of TMJ with non-reducing disc displacement. Key words:Non-reduction disc displacement, arthrocentesis, methylprednisolone, sodium hyaluronate, tenoxicam.
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Affiliation(s)
- G Yapici-Yavuz
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Adiyaman University, Adiyaman, Turkey,
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31
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Giozet AF, Iwaki LCV, Grossmann E, Previdelli ITS, Pinto GNDS, Iwaki Filho L. Correlation between clinical variables and magnetic resonance imaging findings in symptomatic patients with chronic temporomandibular articular disc displacement with reduction: A retrospective analytical study. Cranio 2018; 37:374-382. [PMID: 29570042 DOI: 10.1080/08869634.2018.1449360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objective: To correlate the clinical aspects of symptomatic patients with chronic articular disc displacement with reduction with alterations in the articular disc (AD) morphology and sagittal position. Methods: Records from 109 patients were selected that included data on AD morphology and sagittal position as determined by MRI. According to the MRI results, the sagittal position and AD morphology with opened and closed mouth were correlated with many clinical variables. Results: More than half of the patients studied were female, and the biconcave and hemiconvex morphologies were most common. Thirty-four patients (31.3%) presented with restricted maximum interincisal distance (MID). The biplanar morphology was associated with eccentric bruxism and MID (p < 0.05). Visual analog scale (VAS) scores between 2 and 7 were shown to be risk factors (p < 0.05). Conclusion: The mouth position can influence AD morphology and eccentric bruxism. VAS scores and unknown etiology were risk factors.
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Affiliation(s)
| | | | - Eduardo Grossmann
- Craniofacial Pain Applied to Dentistry, Dentistry Faculty, Federal University of Rio Grande do Sul , Porto Alegre , Brazil
| | | | | | - Liogi Iwaki Filho
- Dental Radiology and Stomatology, Department of Dentistry, State University of Maringá , Maringá , Brazil
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Kim JY, Jeon KJ, Kim MG, Park KH, Huh JK. A nomogram for classification of temporomandibular joint disk perforation based on magnetic resonance imaging. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:682-692. [PMID: 29574057 DOI: 10.1016/j.oooo.2018.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 02/08/2018] [Accepted: 02/15/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The aim of this study was to analyze risk factors and establish a prediction model for temporomandibular joint (TMJ) disk perforation by constructing a nomogram. STUDY DESIGN The study included a total of 282 joints in 274 patients. All patients underwent open TMJ surgery after obtaining magnetic resonance imaging (MRI), from 2005 to 2015. The presence or absence of disk perforation was confirmed during the operation. Patients were classified into 2 groups: perforation and nonperforation groups. We investigated demographic data and the characteristics of the disk, joint space, and bone on MRI. A logistic regression analysis was performed to analyze risk factors. A nomogram was constructed and validated internally and externally. RESULTS Risk factors for disk perforation were increased age, disk shape (eyeglass or amorphous), low bone marrow signal, abnormal joint space, and 2 or more bony changes in the condyle and fossa. The area under the receiver operating characteristic curve of the nomogram was 0.908 (95% confidence interval [CI] 0.869-0.946) in the internal validation and 0.889 (95% CI 0.804-0.973) in the external validation with good suitability. CONCLUSIONS We were able to predict the probability of disk perforation with analyzed risk factors and constructed a nomogram, which may be helpful in proper diagnosis and treatment.
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Affiliation(s)
- Jae-Young Kim
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Kug-Jin Jeon
- Department of Oral and Maxillofacial Radiology, Yongin Severance Hospital, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Myeong-Gyun Kim
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Kwang-Ho Park
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Jong-Ki Huh
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Republic of Korea.
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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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Otonari-Yamamoto M, Imoto K. Differences in signal intensities of temporomandibular joint (TMJ) effusion on fluid-attenuated inversion recovery (FLAIR) images. Oral Radiol 2018; 34:245-250. [DOI: 10.1007/s11282-018-0317-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 12/13/2017] [Indexed: 11/28/2022]
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Koh KJ, Park HN, Kim KA. Internal derangement as a predictor of provoked pain on mouth opening: A magnetic resonance imaging study. Imaging Sci Dent 2017; 47:219-226. [PMID: 29279820 PMCID: PMC5738503 DOI: 10.5624/isd.2017.47.4.219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/16/2017] [Accepted: 09/23/2017] [Indexed: 12/30/2022] Open
Abstract
Purpose This study investigated the relationship between pain and internal derangement in temporomandibular disorder (TMD) patients using magnetic resonance imaging (MRI). Materials and Methods This study analyzed 356 TMD patients (712 temporomandibular joints [TMJs]). The inclusion criteria were the presence of spontaneous or provoked pain on one or both TMJs and having undergone MRI. The patients with provoked pain were divided into 3 groups: pain on palpation, pain on mouth opening, and pain on mastication. MRI was performed using a 1.5-T scanner. T1- and T2-weighted parasagittal and paracoronal images were obtained. According to the findings on the T1-weighted images, another 3 groups were created based on internal derangement: normal, disc displacement with reduction, and disc displacement without reduction. The MRI findings were independently interpreted by 2 experienced oral and maxillofacial radiologists at 2 different times. Statistical analysis was performed by the chi-square test using SPSS (version 12.0; SPSS Inc., Chicago, IL, USA). Results Provoked pain on mouth opening was found to be correlated with internal derangement in TMD patients (P<.05). However, spontaneous pain and provoked pain on palpation or mastication were not associated with internal derangement (P>.05). Conclusion These results suggest that internal derangement was a significant predictor of provoked pain on mouth opening.
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Affiliation(s)
- Kwang-Joon Koh
- Department of Oral and Maxillofacial Radiology, School of Dentistry and Institute of Oral Bioscience, Chonbuk National University, Jeonju, Korea
| | - Ha-Na Park
- Department of Oral and Maxillofacial Radiology, School of Dentistry and Institute of Oral Bioscience, Chonbuk National University, Jeonju, Korea
| | - Kyoung-A Kim
- Department of Oral and Maxillofacial Radiology, School of Dentistry and Institute of Oral Bioscience, Chonbuk National University, Jeonju, Korea
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Clinical study of splint therapeutic efficacy for the relief of temporomandibular joint discomfort. J Craniomaxillofac Surg 2017; 45:1772-1777. [PMID: 28943181 DOI: 10.1016/j.jcms.2017.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/17/2017] [Accepted: 08/15/2017] [Indexed: 11/21/2022] Open
Abstract
PURPOSE This study aimed to evaluate the relationship between displacement of the mandibular condyle/disc due to occlusal splint insertion with splint therapy and changes in discomfort of the temporomandibular joint (TMJ), and to clarify the relationships between the outcomes over time of temporomandibular discomfort and TMJ magnetic resonance imaging (MRI) findings at the initiation of splint therapy. MATERIALS AND METHODS A total of 75 patients admitted to hospital with discomfort around the TMJ were evaluated. A visual analogue scale for TMJ discomfort was administered during visits for approximately 3 months following the initiation of splint therapy. At the start of splint therapy, magnetic resonance imaging (MRI) was performed with and without splint insertion, and condyle and disc movements were evaluated. Disc balance, disc position and function, disc configuration, joint effusion, osteoarthritis, and bone marrow were evaluated. Linear regression and multiple regression analyses were used to clarify relationships between changes in discomfort and the factors evaluated. RESULTS There was no significant correlation between TMJ discomfort and condyle/disc movement with splint insertion. TMJ discomfort was significantly relieved by splint therapy regardless of temporomandibular MRI findings. Unilateral anterior disc displacement and marked or extensive joint effusion fluid were significantly improved with splint therapy. CONCLUSION Discomfort tended to remit with splint therapy regardless of temporomandibular MRI findings. Improvement of TMJ discomfort appears more likely to occur in patients with unilateral anterior disc displacement and with an apparent organic disorder, such as a joint effusion.
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Takahara N, Nakagawa S, Sumikura K, Kabasawa Y, Sakamoto I, Harada H. Association of Temporomandibular Joint Pain According to Magnetic Resonance Imaging Findings in Temporomandibular Disorder Patients. J Oral Maxillofac Surg 2017; 75:1848-1855. [DOI: 10.1016/j.joms.2017.03.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 03/16/2017] [Accepted: 03/16/2017] [Indexed: 01/23/2023]
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Hasegawa Y, Kakimoto N, Tomita S, Fujiwara M, Ishikura R, Kishimoto H, Honda K. Evaluation of the role of splint therapy in the treatment of temporomandibular joint pain on the basis of MRI evidence of altered disc position. J Craniomaxillofac Surg 2017; 45:455-460. [DOI: 10.1016/j.jcms.2017.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 11/29/2016] [Accepted: 01/16/2017] [Indexed: 02/06/2023] Open
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Krohn S, Gersdorff N, Wassmann T, Merboldt KD, Joseph AA, Buergers R, Frahm J. Real-time MRI of the temporomandibular joint at 15 frames per second—A feasibility study. Eur J Radiol 2016; 85:2225-2230. [DOI: 10.1016/j.ejrad.2016.10.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 09/05/2016] [Accepted: 10/18/2016] [Indexed: 10/20/2022]
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Suenaga S, Nagayama K, Nagasawa T, Indo H, Majima HJ. The usefulness of diagnostic imaging for the assessment of pain symptoms in temporomandibular disorders. JAPANESE DENTAL SCIENCE REVIEW 2016; 52:93-106. [PMID: 28408961 PMCID: PMC5390340 DOI: 10.1016/j.jdsr.2016.04.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 04/14/2016] [Accepted: 04/26/2016] [Indexed: 12/30/2022] Open
Abstract
The causes of pain symptoms in the temporomandibular joint (TMJ) and masticatory muscle (MM) regions may not be determined by clinical examination alone. In this review, we document that pain symptoms of the TMJ and MM regions in patients with temporomandibular disorders (TMDs) are associated with computed tomography and magnetic resonance (MR) findings of internal derangement, joint effusion, osteoarthritis, and bone marrow edema. However, it is emphasized that these imaging findings must not be regarded as the unique and dominant factors in defining TMJ pain. High signal intensity and prominent enhancement of the posterior disk attachment on fat saturation T2-weighted imaging and dynamic MR imaging with contrast material are closely correlated with the severity of TMJ pain. Magnetic transfer contrast, MR spectroscopy, diffusion tensor imaging, and ultrasonography findings have helped identify intramuscular edema and contracture as one of the causes of MM pain and fatigue. Recently, changes in brain as detected by functional MR neuroimaging have been associated with changes in the TMJ and MM regions. The thalamus, the primary somatosensory cortex, the insula, and the anterior and mid-cinglate cortices are most frequently associated with TMD pain.
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Affiliation(s)
- Shigeaki Suenaga
- Department of Maxillofacial Radiology, Division of Oncology, Kagoshima University Graduate School of Medical and Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
| | - Kunihiro Nagayama
- Department of Orthodontics and Dentofacial Orthopedics, Kagoshima University Graduate School of Medical and Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
| | - Taisuke Nagasawa
- Department of Maxillofacial Radiology, Division of Oncology, Kagoshima University Graduate School of Medical and Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
| | - Hiroko Indo
- Department of Maxillofacial Radiology, Division of Oncology, Kagoshima University Graduate School of Medical and Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
| | - Hideyuki J. Majima
- Department of Maxillofacial Radiology, Division of Oncology, Kagoshima University Graduate School of Medical and Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
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Muraoka H, Kaneda T, Kawashima Y, Hirahara N, Fukuda T, Muramatsu T, Ito K. Parotid Lymphadenopathy Is Associated With Joint Effusion in Non-Neoplastic Temporomandibular Disorders. J Oral Maxillofac Surg 2016; 75:491-497. [PMID: 27741415 DOI: 10.1016/j.joms.2016.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 09/08/2016] [Accepted: 09/08/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE Lymphadenopathy often occurs in the setting of inflammation, with or without infection. We sought to elucidate any association of parotid lymphadenopathy with joint effusion in temporomandibular joint (TMJ) disorders. MATERIALS AND METHODS We performed a retrospective cohort study. We analyzed the magnetic resonance imaging studies of patients with suspected TMJ disorders performed from April 2006 to March 2007. The degree of joint effusion was graded on sagittal T2-weighted spin echo images according to a commonly used system. On axial short T1-weighted short inversion recovery images, the number and short-axis diameter of the parotid lymph nodes were recorded. We performed analyses of the cluster-correlated data using the Mann-Whitney U test and Spearman's correlation coefficients. P < .05 was considered to indicate significance. To assess the possible predictive value of certain variables, a generalized linear model (generalized estimation equation) was constructed, considering the multiple measurements. RESULTS A total of 402 TMJ disorders were analyzed from 201 patients during the study period. The number and size of the parotid lymph nodes identified was significantly greater in the patients with TMJ effusion (P < .01) than in those without effusion. CONCLUSION In the present study, we found an association between parotid lymphadenopathy and joint effusion in TMJ disorders. These findings indicate that lymphadenopathy should be considered as an inflammation condition commonly associated with joint effusion in TMJ disorders.
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Affiliation(s)
- Hirotaka Muraoka
- Graduate Student, Department of Radiology, Nihon University School of Dentistry, Matsudo, Japan.
| | - Takashi Kaneda
- Professor, Department of Radiology, Nihon University School of Dentistry, Matsudo, Japan
| | - Yusuke Kawashima
- Research Associate, Department of Radiology, Nihon University School of Dentistry, Matsudo, Japan
| | - Naohisa Hirahara
- Graduate Student, Department of Radiology, Nihon University School of Dentistry, Matsudo, Japan
| | - Taiga Fukuda
- Graduate Student, Department of Radiology, Nihon University School of Dentistry, Matsudo, Japan
| | - Teruaki Muramatsu
- Research Associate, Department of Radiology, Nihon University School of Dentistry, Matsudo, Japan
| | - Kotaro Ito
- Research Associate, Department of Radiology, Nihon University School of Dentistry, Matsudo, Japan
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Value of additional axial imaging in magnetic resonance imaging of the temporomandibular joint to identify extra-articular diseases. Oral Radiol 2016. [DOI: 10.1007/s11282-016-0259-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Khawaja SN, Crow H, Mahmoud RFG, Kartha K, Gonzalez Y. Is There an Association Between Temporomandibular Joint Effusion and Arthralgia? J Oral Maxillofac Surg 2016; 75:268-275. [PMID: 27663534 DOI: 10.1016/j.joms.2016.08.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 08/17/2016] [Accepted: 08/19/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE The literature on joint effusion (JE) and its association with clinical and radiologic variables in patients with temporomandibular disorders (TMDs) is inconsistent and is characterized by multiple methodologic limitations. The primary aim of this investigation was to evaluate the association between magnetic resonance imaging (MRI) identified JE and temporomandibular joint (TMJ) arthralgia. The secondary aim of this investigation was to determine the association between JE and other clinical and MRI-identified soft tissue characteristics. MATERIALS AND METHODS A retrospective cohort study was conducted. Clinical and soft tissue imaging assessments were carried out according to the Diagnostic Criteria for Temporomandibular Disorders guidelines. The dependent variable was JE and the primary independent variable was arthralgia. The secondary independent variables were TMJ pain-associated characteristics and MRI-identified variables. When applicable, Pearson χ2 or t test was used to determine the statistical associations between JE and clinical characteristics and between JE and MRI-identified variables. Furthermore, generalized estimating equation (GEE) modeling was conducted to determine which of the independent clinical and MRI-identified variables were associated with JE. RESULTS Data for 158 participants, representing 312 joints, were extracted. The mean age of the female sample (59.4%) was 31 ± 11.1 years and that of the male sample (40.6%) was 29.8 ± 9.7 years. No association was found between JE and arthralgia. However, statistically significant associations were found between JE and lateral disc rotation (P = .001) and between JE and disc position in the coronal and sagittal planes (P = .001). The GEE model suggested that disc displacement with reduction (odds ratio = 2.5) was a statistically relevant contributing factor for JE in the absence of degenerative joint disease. CONCLUSION Results associated JE with the position of the disc in the sagittal plane. No association was found between JE and arthralgia or TMJ pain-associated clinical characteristics in patients with TMDs.
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Affiliation(s)
- Shehryar N Khawaja
- Resident, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA; Postgraduate Fellow, Harvard School of Dental Medicine, Harvard University, Boston, MA; Former Teaching and Research Fellow, Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, Buffalo, NY.
| | - Heidi Crow
- Associate Professor and Chair, Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, Buffalo, NY
| | - Ruba F G Mahmoud
- Resident, Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, Buffalo, NY
| | - Krishnan Kartha
- Adjunct Assistant Professor, Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, NY
| | - Yoly Gonzalez
- Associate Professor, Department of Oral Diagnostic Sciences; Director, TMD and Orofacial Pain Program, University at Buffalo, Buffalo, NY
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Wahaj A, Hafeez K, Zafar MS. Association of bone marrow edema with temporomandibular joint (TMJ) osteoarthritis and internal derangements. Cranio 2016; 35:4-9. [PMID: 27077262 DOI: 10.1080/08869634.2016.1156282] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE This study reviewed the dental literature in order to determine the association of bone marrow edema with osteoarthritis and temporomandibular joint (TMJ) internal derangement disorders. METHODS A literature search was performed using electronic databases PubMed/Medline (National Library of Medicine, Bethesda, Maryland) and Cochrane for articles published during the last 15 years (January 2000-December 2014). A predetermined inclusion and exclusion criteria were used for filtering the scientific papers. Research articles fulfilling the basic inclusion criteria were included in the review. RESULTS The reviewed studies showed that bone marrow edema is found in painful joints with osteoarthritis in a majority of cases. A few cases with no pain or significant degenerative changes are reported to have a bone marrow edema pattern as well. CONCLUSIONS Bone marrow edema, increased fluid level, and pain are associated with osteoarthritis in the majority of patients reporting TMJ arthritis. Degenerative and disc displacement conditions are multifactorial and require further investigations. Magnetic resonance imaging can be employed to detect bone marrow edema even in the absence of pain and clinical symptoms in the patients of internal derangements.
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Affiliation(s)
- Aiyesha Wahaj
- a Department of Orthodontics , Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University , Karachi , Pakistan
| | - Kashif Hafeez
- b Oxford Deanery, Broadshires Dental Practice , Carterton , Oxon, OX18 1JA , UK
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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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Yamazaki F, Satoh K, Seo Y. Structure and Size-selective Permeability of the Synovial Membrane of the Temporomandibular Joint of the Mouse Measured by MR Imaging at 7T. Magn Reson Med Sci 2014; 14:115-22. [PMID: 25500776 DOI: 10.2463/mrms.2014-0058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We analyzed the anatomical structure of the temporomandibular joint (TMJ) and molecular weight dependency of synovial membrane permeability in mice using 7-tesla magnetic resonance (MR) imaging. METHODS We obtained 3-dimensional (3D) T1-weighted gradient echo (3D-T1W) and 3D T2-weighted rapid acquisition with relaxation enhancement (3D-T2W RARE) MR images of the TMJ of male C57BL6 mice with voxel resolution of 65 µm. Two-dimensional (2D) T1w images were measured every 45 s before and after bolus intravenous (IV) injection of contrast reagents: gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA; 0.5 kDa); oligomer-based contrast agent (CH3-DTPA-Gd; 2.1 kDa); gadolinium-labeled polylysine (Gd-polylysine; 10 kDa); and gadolinium-labeled albumin (Gd-albumin; 74 kDa). RESULTS T1W images depicted the temporal bone and mandibular condyle as regions with lower signal intensity and the disc as a region of intermediate intensity. In the Gd-DTPA-enhanced T1W and T2W images, the articular disc could be identified as a region with lower signal intensity than that of the upper and lower joint cavities. After IV injection of Gd-DTPA or CH3-DTPA-Gd, the signal intensity of the joint cavities increased within 10 min, but this increase was not shown with Gd-polylysine and Gd-albumin. CONCLUSION The structural findings obtained by MR imaging agreed with those obtained by hematoxylin-eosin staining under light microscopy. Contrast-enhanced MR imaging suggested that smaller (<2.1 kDa) but not larger (>10 kDa) molecules can permeate the synovial membrane. Our results suggest the utility of MR imaging for analyzing the structure of the TMJ as well as permeability of the synovial membrane.
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Affiliation(s)
- Fumie Yamazaki
- Department of Maxillofacial Surgery, Nihon University School of Dentistry at Matsudo
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Hasan NMA, Abdelrahman TEF. MRI evaluation of TMJ internal derangement: Degree of anterior disc displacement correlated with other TMJ soft tissue and osseous abnormalities. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.03.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Evaluation of the TMJ by means of clinical TMD examination and MRI diagnostics in patients with rheumatoid arthritis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:328560. [PMID: 25243130 PMCID: PMC4160621 DOI: 10.1155/2014/328560] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 07/02/2014] [Accepted: 07/13/2014] [Indexed: 11/17/2022]
Abstract
This study included 30 patients with diagnosed rheumatoid arthritis (RA) and 30 test subjects without RA (control group). The objective of the study was to examine both groups for the presence of temporomandibular disorders (TMD) and morphological changes of the temporomandibular joint (TMJ). All individuals were examined using a systematic detailed clinical TMD examination as well as magnetic resonance imaging (MRI). The clinical TMD examination yielded significant differences between the RA patients and the control group concerning crepitus of the TMJ, and palpation tenderness of the masticatory muscles as well as the unassisted mandibular opening. The evaluation of the MRI images for the RA group showed significantly more frequent deformations of the condyle, osteophyte formations and erosions in the condylar compacta, and degenerative changes in the spongiosa. Increased intra-articular accumulation of synovial liquid and signs of inflammatory changes of the spongiosa were only found in the RA group. Statistical analysis showed a significant correlation between crepitus and specific osteoarthrotic changes (MRI), respectively, and between crepitus and a complete anterior disk displacement without reduction (MRI). The duration of the RA disease correlated neither with the anamnestic and clinical dysfunction index by Helkimo nor with RA-specific MRI findings.
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Otonari-Yamamoto M, Sano T, Okano T, Wakoh M. Association between osseous changes of the condyle and temporomandibular joint (TMJ) fluid in osteoarthritis. Oral Radiol 2014. [DOI: 10.1007/s11282-014-0185-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kakimoto N, Shimamoto H, Chindasombatjaroen J, Tsujimoto T, Tomita S, Hasegawa Y, Murakami S, Furukawa S. Comparison of the T2 relaxation time of the temporomandibular joint articular disk between patients with temporomandibular disorders and asymptomatic volunteers. AJNR Am J Neuroradiol 2014; 35:1412-7. [PMID: 24742804 DOI: 10.3174/ajnr.a3880] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE T2 relaxation time is a quantitative MR imaging parameter used to detect degenerated cartilage in the knee and lumbar intervertebral disks. We measured the T2 relaxation time of the articular disk of the temporomandibular joint in patients with temporomandibular disorders and asymptomatic volunteers to demonstrate an association between T2 relaxation time and temporomandibular disorder MR imaging findings. MATERIALS AND METHODS One hundred forty-four patients with temporomandibular disorders and 17 volunteers were enrolled in this study. An 8-echo spin-echo sequence for measuring the T2 relaxation times was performed in the closed mouth position, and the T2 relaxation time of the entire articular disk was measured. Patients were classified according to the articular disk location and function, articular disk configuration, presence of joint effusion, osteoarthritis, and bone marrow abnormalities. RESULTS The T2 relaxation time of the entire articular disk was 29.3 ± 3.8 ms in the volunteer group and 30.7 ± 5.1 ms in the patient group (P = .177). When subgroups were analyzed, however, the T2 relaxation times of the entire articular disk in the anterior disk displacement without reduction group, the marked or extensive joint effusion group, the osteoarthritis-positive group, and the bone marrow abnormality-positive group were significantly longer than those in the volunteer group (P < .05). CONCLUSIONS The T2 relaxation times of the articular disk of the temporomandibular joint in patients with progressive temporomandibular disorders were longer than those of healthy volunteers.
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Affiliation(s)
- N Kakimoto
- From the Department of Oral and Maxillofacial Radiology (N.K., H.S., T.T., S.T., S.M., S.F.), Osaka University Graduate School of Dentistry, Osaka, Japan
| | - H Shimamoto
- From the Department of Oral and Maxillofacial Radiology (N.K., H.S., T.T., S.T., S.M., S.F.), Osaka University Graduate School of Dentistry, Osaka, Japan
| | - J Chindasombatjaroen
- Department of Oral and Maxillofacial Radiology (J.C.), Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - T Tsujimoto
- From the Department of Oral and Maxillofacial Radiology (N.K., H.S., T.T., S.T., S.M., S.F.), Osaka University Graduate School of Dentistry, Osaka, Japan
| | - S Tomita
- From the Department of Oral and Maxillofacial Radiology (N.K., H.S., T.T., S.T., S.M., S.F.), Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Y Hasegawa
- Department of Dentistry and Oral Surgery (Y.H.), Hyogo College of Medicine, Hyogo, Japan
| | - S Murakami
- From the Department of Oral and Maxillofacial Radiology (N.K., H.S., T.T., S.T., S.M., S.F.), Osaka University Graduate School of Dentistry, Osaka, Japan
| | - S Furukawa
- From the Department of Oral and Maxillofacial Radiology (N.K., H.S., T.T., S.T., S.M., S.F.), Osaka University Graduate School of Dentistry, Osaka, Japan
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