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Stimmer H, Grill F, Waschulzik B, Nieberler M, Wolff KD, Kolk A. Temporal Tendinitis in Craniomandibular Dysfunction (CMD) - Does it Really Exist? A Temporomandibular MRI Investigation. ROFO-FORTSCHR RONTG 2022; 194:1242-1249. [PMID: 35613906 DOI: 10.1055/a-1829-6134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aim of the study was to analyze the role of temporal muscle and particularly tendon pathology in patients suffering from craniomandibular dysfunction (CMD) using magnetic resonance imaging. MATERIALS AND METHODS Retrospective analysis of MRI examinations was carried out with regard to temporal muscle fibrosis and fatty degeneration and particularly temporal tendon rupture, thickening, and degenerative signal alterations. Descriptive statistics and the Mann-Whitney U-test were used for statistical evaluation. RESULTS Structural lesions of temporal muscle parenchyma were the absolute exception. PD hyperintensity, pronounced contrast enhancement, or peritendinous fluid collections along the temporal tendon were found only to a small extent, and a (partial) rupture occurred in only one case. The tendon diameter showed only slight variability. The Mann-Whitney U-test provided no results indicating a causal connection between degenerative joint or disc disease and temporal tendon pathology. CONCLUSION A large sample of 128 magnetic resonance imaging examinations provided no evidence of a major role of temporal tendinitis in clinical CMD syndrome. KEY POINTS · Retrospective analysis of temporal tendon in CMD patients.. · Abnormal structural findings along the tendon seen only rarely.. · Obviously no crucial role of temporal tendon lesions in CMD syndrome.. CITATION FORMAT · Stimmer H, Grill F, Waschulzik B et al. Temporal Tendinitis in Craniomandibular Dysfunction (CMD) - Does it Really Exist? A Temporomandibular MRI Investigation. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1829-6134.
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Affiliation(s)
- Herbert Stimmer
- Department of Radiology, Klinikum rechts der Isar der Technischen Universität München, D-81675 München, Germany
| | - Florian Grill
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar der Technischen Universität München, D-81675 München, Germany
| | - Birgit Waschulzik
- Department of Medical Statistics and Epidemiology, Klinikum rechts der Isar der Technischen Universität München, D-81675 München, Germany
| | - Markus Nieberler
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar der Technischen Universität München, D-81675 München, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar der Technischen Universität München, D-81675 München, Germany
| | - Andreas Kolk
- Department of Oral and Maxillofacial Surgery, Medizinische Universität Innsbruck, A-6020 Innsbruck, Austria
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Meng H, Dai J, Li Y. Quantitative sensory testing in patients with the muscle pain subtype of temporomandibular disorder: a systemic review and meta-analysis. Clin Oral Investig 2021; 25:6547-6559. [PMID: 34487241 DOI: 10.1007/s00784-021-04171-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/28/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVES This meta-analysis aimed to evaluate quantitative sensory testing (QST) evidence for pain processing in patients with the muscle pain subtype of temporomandibular disorders (mTMD). MATERIALS AND METHODS A comprehensive systematic electronic search strategy was performed in online literature databases. All full-text observational studies published up to July 2021 with the aim of investigating pain sensitization in humans with mTMD using QST measures were eligible for inclusion. Meta-analysis of QST data was performed using a random effects model, which included results comparing patients with mTMD to healthy controls, and standard mean difference (SMD) results were analyzed. RESULTS Twelve studies with 732 participants (371 patients with mTMD and 361 healthy controls) were analyzed following screening and quality appraisal. Compared with healthy controls, patients with mTMD had significantly lower pressure pain threshold (SMD - 1.10, 95% confidence interval [CI] - 1.52 to - 0.68) with high heterogeneity (Tau2 = 0.61, I2 = 86%), and significantly lower mechanical pain threshold (SMD - 0.64, 95% CI - 0.95 to - 0.32) with no heterogeneity (Tau2 = 0.00, I2 = 0%). No difference was observed in the cold pain threshold (SMD 0.16, 95% CI - 0.13 to 0.45), heat pain threshold (SMD - 0.13, 95% CI - 0.40 to 0.15), and wind-up ratio (SMD 0.63, 95% CI - 0.11 to 1.38) between patients with mTMD and healthy controls. Other QST parameters were also discussed. CONCLUSIONS The study results suggest that the pain processing of deep tissues is likely sensitized in mTMD and calls for more QST studies with standard procedures to reduce inter-study heterogeneity. CLINICAL RELEVANCE The major findings of this meta-analysis support using PPT to examine the pain processing in patients with mTMD in clinical scenario.
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Affiliation(s)
- He Meng
- Department of Stomatology, Shenzhen University General Hospital and Shenzhen University Clinical Medical Academy, Shenzhen, Guangdong, China
| | - Juan Dai
- Department of Stomatology, Shenzhen University General Hospital and Shenzhen University Clinical Medical Academy, Shenzhen, Guangdong, China
| | - Yuzhou Li
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Stomatological Hospital of Chongqing Medical University, Chongqing, Chongqing, China.
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Arakawa M, Kitahara T, Inadomi D, Iikubo M, Hyakutake H, Yuasa K, Takahashi I. Molecular imaging in masseter muscle observed by muscle function magnetic resonance imaging and 31 P-magnetic resonance spectroscopy in patients with a jaw deformity. Clin Exp Dent Res 2021; 8:231-238. [PMID: 34623750 PMCID: PMC8874048 DOI: 10.1002/cre2.494] [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: 07/05/2021] [Accepted: 09/03/2021] [Indexed: 11/12/2022] Open
Abstract
Background Skeletal mandibular protrusion would influence to the muscle fatigue of the masticatory muscles. Establishing a diagnostic procedures combining physiological and biochemical information is necessary for quantitative evaluation of masticatory muscle fatigue. Objective The transverse relaxation time (T2 time) of muscle functional magnetic resonance imaging (mfMRI), and 31P‐magnetic resonance spectroscopy (MRS) were used to investigate the reliability as parameters for measuring the masseter muscle in patients with skeletal mandibular prognathism. Method The subjects were 19 patients diagnosed as skeletal mandibular protrusions and 19 healthy subjects as a control group. Transverse relaxation time (T2 value) determined by mfMRI along with creatine phosphate (PCr) and inorganic phosphorus (Pi) determined by 31P‐MRS before, during, and after clenching were used for molecular imaging of muscle fatigue. Results The average T2 value of the patient group was significantly higher than that of the healthy control group at rest. Furthermore, the average T2 value transiently increased in both groups during experimental clenching. The PCr and Pi showed a tendency toward a transient decrease and increases, respectively. The pH in the masseter muscle showed a transient decrease in both groups prior to and following experimental clenching. The pH in the masseter muscle of the patient group was significantly lower than that in the healthy control group at rest and recovery. Conclusion We showed mfMRI and 31P‐MRS are useful for evaluating masseter fatigue during clenching, and the masseter muscle in the prognathic patients showed more severe fatigue than the healthy controls.
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Affiliation(s)
- Masahiro Arakawa
- Section of Orthodontics and Dentofacial Orthopedics, Graduate School of Dentistry, Kyushu University, Fukuoka, Japan
| | - Toru Kitahara
- Section of Orthodontics and Dentofacial Orthopedics, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Daisuke Inadomi
- Radiology Center, Fukuoka Dental College Hospital, Fukuoka, Japan
| | - Masahiro Iikubo
- Department of Oral Diagnosis, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Hiroto Hyakutake
- Graduate School of Information Sciences, Hiroshima City University, Hiroshima, Japan
| | - Kenji Yuasa
- Section of Image Diagnosis, Department of Diagnostics and General Care, Fukuoka Dental College, Fukuoka, Japan
| | - Ichiro Takahashi
- Section of Orthodontics and Dentofacial Orthopedics, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
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Cioffi I, Farella M, Chiodini P, Ammendola L, Capuozzo R, Klain C, Vollaro S, Michelotti A. Effect of weather on temporal pain patterns in patients with temporomandibular disorders and migraine. J Oral Rehabil 2017; 44:333-339. [DOI: 10.1111/joor.12498] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2017] [Indexed: 11/29/2022]
Affiliation(s)
- I. Cioffi
- Discipline of Orthodontics; Faculty of Dentistry; University of Toronto - University of Toronto Center for the Study of Pain; Toronto ON Canada
- Section of Orthodontics; Department of Neuroscience, Reproductive Sciences and Oral Sciences; University of Naples Federico II; Naples Italy
| | - M. Farella
- Sir John Walsh Research Institute; University of Otago; Dunedin New Zealand
| | - P. Chiodini
- Medical Statistics Unit; University of Campania Luigi Vanvitelli; Naples Italy
| | - L. Ammendola
- Section of Orthodontics; Department of Neuroscience, Reproductive Sciences and Oral Sciences; University of Naples Federico II; Naples Italy
| | - R. Capuozzo
- Section of Orthodontics; Department of Neuroscience, Reproductive Sciences and Oral Sciences; University of Naples Federico II; Naples Italy
| | - C. Klain
- Section of Orthodontics; Department of Neuroscience, Reproductive Sciences and Oral Sciences; University of Naples Federico II; Naples Italy
| | - S. Vollaro
- Section of Orthodontics; Department of Neuroscience, Reproductive Sciences and Oral Sciences; University of Naples Federico II; Naples Italy
| | - A. Michelotti
- Section of Orthodontics; Department of Neuroscience, Reproductive Sciences and Oral Sciences; University of Naples Federico II; Naples Italy
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Ariji Y, Ariji E. Magnetic resonance and sonographic imagings of masticatory muscle myalgia in temporomandibular disorder patients. JAPANESE DENTAL SCIENCE REVIEW 2017; 53:11-17. [PMID: 28408964 PMCID: PMC5390334 DOI: 10.1016/j.jdsr.2016.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 04/30/2016] [Accepted: 05/13/2016] [Indexed: 12/20/2022] Open
Abstract
This article reviews recently published studies investigating the MRI and sonographic diagnosis of masticatory muscle myalgia in temporomandibular disorder patients. The MRI and sonographic features of muscle after treatment are also discussed. Literature published within the last 15 years was obtained from the PubMed database using the following Mesh terms: magnetic resonance imaging (MRI) or sonography, masticatory muscle pain, and treatment. MRI and sonography enable accurate visualization and evaluation of the masticatory muscles, thereby increasing our understanding of pathology and cause of pain associated with these muscles. Although therapeutic efficacy is often evaluated based on clinical findings, MR and sonographic imaging studies may also be valuable.
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Affiliation(s)
- Yoshiko Ariji
- Department of Oral and Maxillofacial Radiology, Aichi-Gakuin University School of Dentistry, Nagoya, Japan
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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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Edefonti V, Bravi F, Cioffi I, Capuozzo R, Ammendola L, Abate G, Decarli A, Ferraroni M, Farella M, Michelotti A. Chronic pain and weather conditions in patients suffering from temporomandibular disorders: a pilot study. Community Dent Oral Epidemiol 2012; 40 Suppl 1:56-64. [PMID: 22369710 DOI: 10.1111/j.1600-0528.2011.00667.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Patients with temporomandibular disorders (TMDs) often report increased pain in response to changes in weather conditions. Nevertheless, scientific evidence supporting this relationship is scarce. The aim of this study was to assess a potential relationship between pain intensity and meteorological factors, through a newly developed, portable device, in patients affected by chronic masticatory muscle pain. METHODS Seven female subjects were diagnosed with myofascial pain of the masticatory muscles, according to RDC/TMD criteria, were recruited, and participated in the study. Each patient was provided with a portable data logger that recorded and stored weather variables (atmospheric pressure, air humidity, temperature) every 15 min. Patients were asked to record the level of perceived pain on an electronic visual analogue scale (VAS) every hour. The relationship between meteorological variables and pain scores was investigated using separate generalized least squares regression models with a correlation structure estimated via autoregressive integrated moving average models. RESULTS Individual VAS trajectories in the study period were different. The effect of meteorological factors on VAS scores was statistically significant in five subjects, with at least one main effect and/or one two-way interaction between meteorological variables being significant. CONCLUSIONS The analyses suggest the existence of different interindividual responses to climatic changes. However, the identified putative role of meteorological variables and of their two-way interactions suggests that further investigations on larger samples may be useful to assess the research question under examination.
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Affiliation(s)
- Valeria Edefonti
- Sezione di Statistica Medica e Biometria Giulio A. Maccacaro, Dipartimento di Medicina del Lavoro Clinica del Lavoro L. Devoto, Università degli Studi di Milano, Milan, Italy.
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Yoshida T, Ishikawa H, Yoshida N, Hisanaga Y. Analysis of masseter muscle oxygenation and mandibular movement during experimental gum chewing with different hardness. Acta Odontol Scand 2009; 67:113-21. [PMID: 19153844 DOI: 10.1080/00016350802715806] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze masseter muscle oxygenation changes and mandibular movements in the experimental chewing of gums with different hardness. MATERIAL AND METHODS Subjects for this experiment comprised 23 male volunteers with normal occlusion. Mean age (SD) was 28.3 (2.2) years. Three kinds of gum with mean fracture stresses of 3.52 x 10(4) N/m(2) (Gum 1), 5.35 x 10(4) N/m(2) (Gum 2), and 14.0 x 10(4) N/m(2) (Gum 3) were used. The subjects were instructed to chew gum for 80 s (100 strokes) on the voluntary chewing side at a pace of 1.25 strokes/s. Oxygen saturation in the masseter muscle and mandibular movement during gum chewing were recorded simultaneously using near-infrared spectroscopy tissue oximetry and mandibular kinesiography. RESULTS For Gum 1, no subjects showed any significant changes in oxygen saturation during gum chewing. For Gum 2, 10 subjects showed no significant changes, whereas the other 13 showed significant decreases in oxygen saturation. For Gum 3, significant decreases were seen in all subjects. Chewing motions were larger and velocity was higher in gum chewing with decreases in masseter muscle oxygen saturation compared to chewing showing no significant changes. CONCLUSIONS The results suggest that the harder texture of gum enlarges chewing motion and increases chewing velocity, with an increase in the contribution of anaerobic metabolism to energy yield in masseter muscle. Differences in the responses to gum hardness may indicate individual differences in muscle fatigue tendencies when chewing harder foods.
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