Analysis of Criteria for MRI Diagnosis of TMJ Disc Displacement and Arthralgia

DC/TMD Axis I diagnostic subtypes in TMD patients from Confucian heritage cultures: a stratified reporting framework

OBJECTIVES

This study proposed a conceptual framework for reporting Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I conditions and investigated the prevalence of TMD subtypes/categories in patients from Confucian heritage cultures. Variances in gender, age, and TMD chronicity between Chinese (CN) and Korean (KR) patients were also explored.

MATERIALS AND METHODS

Subjects were recruited from consecutive patients seeking care at two University-based centers in Beijing and Seoul. Eligible patients completed a demographic survey as well as the DC/TMD Symptom Questionnaire and were clinically examined according to the DC/TMD methodology. Axis I diagnoses were subsequently rendered with the DC/TMD algorithms and documented using the stratified reporting framework. Statistical evaluations were performed with chi-square, Mann-Whitney U tests, and logistic regression analysis (α = 0.05).

RESULTS

Data of 2008 TMD patients (mean age 34.8 ± 16.2 years) were appraised. Substantial differences in female-to-male ratio (CN > KR), age (KR > CN), and TMD duration (KR > CN) were observed. Ranked frequencies of the most common Axis I diagnoses were: CN - disc displacements (69.7%) > arthralgia (39.9%) > degenerative joint disease (36.7%); KR - disc displacements (81.0%) > myalgia (60.2%) > arthralgia (56.1%). Concerning TMD categories, notable differences in the prevalence of intra-articular (CN 55.1% > KR 15.4%) and combined (KR 71.8% > CN 33.4%) TMDs were discerned.

CONCLUSIONS

Though culturally similar, the two countries require disparate TMD care planning/prioritization. While TMJ disorders in children/adolescents and young adults should be emphasized in China, the focus in Korea would be on TMD pain in young and middle-aged adults.

CLINICAL RELEVANCE

Besides culture, other variables including socioeconomic, environmental, and psychosocial factors can influence the clinical presentation of TMDs. Chinese and Korean TMD patients exhibited significantly more intra-articular and combined TMDs respectively.

A Bibliometric Analysis of Research on Temporomandibular Joint Disc Displacement from 1992 to 2022

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.

Evaluation of clinical signs and magnetic resonance imaging findings in patients with temporomandibular disorders

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.

Nonsurgical Management of Temporomandibular Joint Arthropathy

Arthropathy is a broad diagnostic term for any pathologic condition afflicting one or more joints of the body. Temporomandibular joint (TMJ) arthropathy is an umbrella term that may be applied to mechanical dysfunction or disease of one or both TMJs. This article provides evidence-based recommendations for conducting a patient evaluation, initiating a diagnostic workup, formulating an assessment, and instituting various nonsurgical modalities for the treatment of TMJ arthropathies.

COL12A1 Single Nucleotide Polymorphisms rs240736 and rs970547 Are Not Associated with Temporomandibular Joint Disc Displacement without Reduction

Temporomandibular disorders (TMDs) may affect up to 25% of the population, with almost 70% of these TMD cases developing malpositioning of the disc over time in what is known as internal derangement (ID). Despite significant efforts, the molecular mechanism underlying disease progression is not yet very well known. In this study, the role of COL12A1 rs970547 and rs240736 polymorphisms as potential genetic factors regulating ID was investigated. The study included 124 Caucasian patients of both sexes after disc displacement without reduction (DDwoR) in either one or two temporomandibular joints (TMJs), either of which meet the criteria for this condition. All patients underwent clinical examination and 3D digital imaging. The COL12A1 rs970547 and rs240736 polymorphisms were evaluated. There were no statistically significant differences in the chi-square test between the study group and healthy controls. The examined COL12A1 rs240736 and rs970547 polymorphisms do not contribute to DDwoR in Polish Caucasians.

The importance of multisection sagittal and coronal magnetic resonance imaging evaluation in the assessment of temporomandibular joint disc position

OBJECTIVES

The aim of this study was to evaluate diagnoses of temporomandibular (TMJ) disc displacement by comparing evaluations done on the basis of central sagittal scans only, the most often used in temporomandibular disorder (TMD) patients, with a multisection evaluation done with both sagittal and coronal scans.

MATERIALS AND METHODS

Multisection MRI analysis of 382 TMJs was conducted in 191 patients with disc displacement according to RDC/TMD criteria. Disc position in the intercuspal position (IP) was assessed two times using two different methods. The first method involved a TMJ disc position evaluation on the central slide in the oblique sagittal plane only. In the second method, the TMJ disc position was assessed on all oblique sagittal and coronal images. McNemar's χ² test was used to evaluate the differences between the sensitivities of two methods.

RESULTS

The first method (central oblique sagittal scans assessment) identified 148 TMJs (38.7%) with normal disc position compared with 89 TMJs (23.3%) with normal disc position found by the second method (all oblique sagittal and coronal scans assessment). The sensitivity of analysis in both planes was significantly higher than in the sagittal plane only (p < 0.001).

CONCLUSIONS

The multisection analysis in the sagittal and coronal plane allows to distinguish the correct disc position from disc displacement and thus improve evaluation of TMJ internal derangement.

CLINICAL RELEVANCE

The multisection sagittal and coronal images should be recommended as a standard in MRI of the TMJ disc displacement in patients with TMD to avoid false-negative diagnoses.

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

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.

TEMPOROMANDIBULAR PAIN DYSFUNCTION SYNDROME IN PATIENTS ATTENDING LAGOS UNIVERSITY TEACHING HOSPITAL, LAGOS, NIGERIA

BACKGROUND

Temporomandibular joint pain dysfunction syndrome (TMJPDS) is the most common temporomandibular disorder. This condition presents with symptoms of pain, restricted jaw movement and joint noise. Other symptoms include otalgia, headache, neck pain and trismus.

AIM

To determine the pattern of Temporomandibular joint pain dysfunction syndrome patients managed at the Lagos University Teaching Hospital, Lagos, Nigeria.

METHODOLOGY

A descriptive study of patients with signs and symptoms of Temporomandibular joint pain dysfunction syndrome attending the Oral Medicine Clinic of Lagos University Teaching Hospital.

RESULTS

Twenty-one patients with Temporomandibular joint pain dysfunction syndrome were enrolled into the study, out of which 10(48%) were females and 11(52%) were males. The age range was 23-81years with a mean of 45.2 ± 18.9 years. Majority of the patients 20(95.2%) complained of pain around the joint, in the pre-auricular region, in the muscles of mastication and the ear. While 7(35%) complained of clicking sounds, 10(47.6%) complained of pain on mouth opening and during mastication only. In all 5(23.8%) had impaired movement of the jaws, mouth opening was normal in 18(85.7%) but reduced in 3(14.3%) patients. Over half of patients 12(57%) experienced clicking sounds, there was tenderness around the temporomandibular joint in 16(76.2%) cases, pain in the ear of 7(33.3%) patients and 13(61.9%) people presented with tenderness of the muscles of mastication. Conservative management of all the cases resulted in resolution of the symptoms.

CONCLUSION

Temporomandibular joint pain dysfunction syndrome has diverse clinical presentation and though distressing, it responds to prompt and effective conservative management.

Correlation Between Clinical Findings of Temporomandibular Disorders and MRI Characteristics of Disc Displacement

Objectives : Temporomandibular joint (TMJ) dysfunction is a common condition that is best evaluated with magnetic resonance (MR) imaging. The first step in MR imaging of the TMJ is to evaluate the articular disk, or meniscus, in terms of its morphologic features and its location relative to the condyle in both closed- and open-mouth positions. Disk location is of prime importance because the presence of a displaced disk is a critical sign of TMJ dysfunction. However, disk displacement is also frequently seen in asymptomatic volunteers. It is important for the maxillofacial radiologist to detect early MR imaging signs of dysfunction, thereby avoiding the evolution of this condition to its advanced and irreversible phase which is characterized by osteoarthritic changes such as condylar flattening or osteophytes. Further the MR imaging techniques will allow a better understanding of the sources of TMJ pain and of any discrepancy between imaging findings and patient symptoms. Henceforth, the aim of the study was to evaluate whether MRI findings of various degrees of disk displacement could be correlated with the presence or absence of clinical signs and symptoms of temporomandibular disorders in symptomatic and asymptomatic subjects. Materials and Methods : In this clinical study, 44 patients (88 TMJs) were examined clinically and divided into two groups. Group 1 consisted of 22 patients with clinical signs and symptoms of TMDs either unilaterally or bilaterally and considered as study group. Group 2 consisted of 22 patients with no signs and symptoms of TMDs and considered as control group. MRI was done for both the TMJs of each patient. Displacement of the posterior band of articular disc in relation to the condyle was quantified as anterior disc displacement with reduction (ADDR), anterior disc displacement without reduction (ADDWR), posterior disc displacement (PDD). Results : Disk displacement was found in 18 (81.8%) patients of 22 symptomatic subjects in Group 1 on MRI and 4 (18.1%) were diagnosed normal with no disc displacement. In Group 2, 2 (9.1%) of 22 asymptomatic patients were diagnosed with disc displacement while 20 (90.1%) were normal. Sensitivity and Specificity tests were applied in both the groups to correlate clinical findings of TMD and MRI characterstics of disc displacement and results showed Sensitivity of 90% and Specificity of 83.3%. Conclusion : Disk displacement on MRI correlated well with presence or absence of clinical signs and symptoms of temporomandibular disorders with high Sensitivity and Specificity of 90% and 83.3% respectively.

Temporomandibular disorders: evaluation and management

Temporomandibular disorders remain a common cause of visits to primary care physicians, internists, pediatricians, and emergency departments. Advances in the clinical diagnosis, radiographic imaging, and classification of these disorders have improved long-term management. There are several types of disorders of the masticatory muscles and the temporomandibular joint as well as associated structures and each may have a complex cause, clinical course, and response to therapy. Host susceptibility plays a role at several stages of these disorders. Future research offers greater possibility in defining this heterogeneous group of disorders and providing more focused and effective treatment strategies.

Epidemiology, diagnosis, and treatment of temporomandibular disorders

Temporomandibular disorder (TMD) is a multifactorial disease process caused by muscle hyperfunction or parafunction, traumatic injuries, hormonal influences, and articular changes. Symptoms of TMD include decreased mandibular range of motion, muscle and joint pain, joint crepitus, and functional limitation or deviation of jaw opening. Only after failure of noninvasive options should more invasive and nonreversible treatments be initiated. Treatment can be divided into noninvasive, minimally invasive, and invasive options. Temporomandibular joint replacement is reserved for severely damaged joints with end-stage disease that has failed all other more conservative treatment modalities.