Evaluation of the effects of temporomandibular joint disc displacement and its progression on dentocraniofacial morphology in symptomatic patients using posteroanterior cephalometric analysis

Feasibility of simultaneous TMJ arthroscopy in ADDwoR patients undergoing orthognathic surgery for jaw deformity

This study evaluated the feasibility of simultaneous temporomandibular joint (TMJ) arthroscopy and orthognathic surgery as a new treatment strategy for anterior disc displacement without reduction (ADDwoR) patients with severe jaw deformities. Twelve ADDwoR patients with facial deformities who underwent arthroscopy and orthognathic surgery between September 2015 and December 2019 were retrospectively evaluated. Pre- and postoperative maximum incisal opening (MIO) and joint pain were recorded. Computed tomography (CT) and three-dimensional cephalometric analysis were performed at 3 (T1) and ≥6 (T2) months postoperatively. Magnetic resonance imaging (MRI) of the TMJ was performed before, ≤7 days after and ≥6 months after surgery. The lateral profile radiological findings, the symmetry of the maxilla and mandible, and the MRI measurements were compared. Anterior disc displacement did not recur, and the maximum incisal opening (MIO) increased from 27.4 mm to 32.7 mm after surgery (p < 0.05). No significant differences were found in the lateral profile, symmetry indices or condylar height via MRI between T1 and T2. Joint morphology and the position of both the maxilla and mandible remained stable during postoperative follow-up, while joint symptoms were markedly relieved and facial appearance was noticeably improved. Combined arthroscopy and orthognathic surgery is effective and recommended for ADDwoR patients with jaw deformities.

Disc Displacement of the Temporomandibular Joint and Facial Asymmetry in Children and Adolescents: A Systematic Review and Meta-Analysis

Subjects with facial skeletal asymmetries have a higher incidence of anterior temporomandibular joint disc displacement. The objective of the study was to consolidate existing evidence on the connection between temporomandibular joint disc displacement and mandibular asymmetry in youngsters and adolescents. A thorough examination was undertaken in the following databases: PubMed, Scopus, EMBASE, Web of Science, and Cochrane. To judge the publications’ methodological quality Newcastle Ottawa Scale was used. From the 1011 identified records, eight were selected for the qualitative synthesis and five for the quantitative synthesis, amounting to 692 subjects. Fifteen cephalometric variables were meta-analyzed. The distance from menton (Me) to midline (lateral mandibular asymmetry) was significantly shorter [−1.75 (95% CI −2.43–−1.07), p ≤ 0.001] in subjects with disc displacement compared to those without disc displacement. The distance from articulare (Ar) to gonion (Go) was significantly longer [3.74 (95% CI 1.04–6.44), p = 0.007] in subjects with disc displacement compared to those without disc displacement. The relationship between distance from articulare (Ar) to gonion (Go) or sella (S) to gonion (Go) and disc displacement was shown to be close to statistical significance level, but not for other cephalometric data. Disc displacement was associated with several cephalometric measurement variations in children and adolescents.

MRI characteristics of the asymptomatic temporomandibular joint in patients with unilateral temporomandibular joint disorder

OBJECTIVE

To determine the association between unilateral temporomandibular joint disorder (TMD) and the presence of imaging abnormalities in the contralateral, asymptomatic joint.

METHODS

MRI studies of 219 subjects with symptoms of unilateral TMD were examined for signs of disc displacement, osteoarthritis, disc deformation, and effusion in both temporomandibular joints (TMJ). The Chi-Square test and stepwise logistic regression analysis were performed.

RESULTS

Disc displacement, osteoarthritis, disc deformation, and effusion were more common on the symptomatic side. However, in the category of disc displacement with a reduction in open mouth position (DDWR), the difference was not significant between the symptomatic and the asymptomatic TMJs. Stepwise logistic regression showed that the presence of any imaging abnormality other than DDWR was related to osteoarthritis and disc deformity on the symptomatic side. On the other hand, the presence of any MRI abnormality (including DDWR) on the asymptomatic side was related only to the presence of osteoarthritis on the symptomatic side.

CONCLUSIONS

Unilateral symptomatic TMD is related to the presence of imaging abnormalities on the contralateral, asymptomatic side, suggesting that the development and progression of joint changes in symptomatic and contralateral asymptomatic TMJs are interrelated.

Changes in disc status in the reducing and nonreducing anterior disc displacement of temporomandibular joint: a longitudinal retrospective study

Treatment procedures for anterior disc displacement (ADD) of temporomandibular joint (TMJ) are far from reaching a consensus. The aim of the study was to evaluate disc status changes of anterior disc displacement with reduction (ADDWR) and without reduction (ADDWoR) comparatively, to get a better understanding of the disease progress without intervention. This longitudinal retrospective study included 217 joints in 165 patients, which were divided into ADDWR group and ADDWoR group based on magnetic resonance imaging (MRI) examination. The joints were assessed quantitatively for disc length and displacement distance at initial and follow-up visits. Disc morphology, which was classified in 5 types, was also evaluated. Paired t-test and Wilcoxon signed rank test were used to assess intra-group differences and independent t-test for inter-group differences. Moreover, analysis of covariance was applied to analyze influential factors for changes in disc length and displacement distance. According to our results, discs tended to become shorter, move further forward and distort more seriously in ADDWoR group than in ADDWR group after follow-up. Moreover, discs were prone to become shorter and more anteriorly displaced in teenagers, type I and III morphologies, advanced Wilkes stages, or those with joint effusion. Follow-up period seemed to be not critical.

Does condylar height decrease more in temporomandibular joint nonreducing disc displacement than reducing disc displacement?: A magnetic resonance imaging retrospective study

The aim of the study was to compare condylar height changes of anterior disc displacement with reduction (ADDwR) and anterior disc displacement without reduction (ADDwoR) in temporomandibular joint (TMJ) quantitatively, to get a better understanding of the changes in condylar height of patients with anterior disc displacement who had received no treatment, and to provide useful information for treatment protocol. This longitudinal retrospective study enrolled 206 joints in 156 patients, which were divided into ADDWR group and ADDwoR group based on magnetic resonance imaging examination. The joints were assessed quantitatively for condylar height at initial and follow-up visits. Also, both groups were further divided into 3 subgroups according to age: <15 years group, 15 to 21 years group, and 22 to 35 years group. Paired t test and independent t test were used to assess intra- and intergroup differences. The average age of the ADDwR group was 19.65 years with a mean of 9.47 months' follow-up. The follow-up interval of the patients with ADDwoR was 7.96 months, with a mean age of 18.51 years. Condylar height in ADDwoR tended to decrease more than those in ADDwR, especially during the pubertal growth spurt and with the presence of osteoarthrosis, meaning ADDwoR could cause a severe disturbance in mandibular development. Thus, an early disc repositioning was suggested to avoid decrease in condylar height.

Vertical Craniofacial Morphology and its Relation to Temporomandibular Disorders

Objectives

This study investigated the association between craniofacial morphology and temporomandibular disorders in adults. The influence of different craniofacial morphologies on painful temporomandibular disorders was also evaluated.

Material and Methods

A total of 200 subjects were selected, including 100 with temporomandibular disorders (TMD) and 100 without TMD (control), diagnosed by research diagnostic criteria for temporomandibular disorders. All subjects were submitted to lateral cephalometric radiographs, and classified as brachyfacial, mesofacial, or dolichofacial by Ricketts’ analysis. Data were analysed by Tukey-Kramer and Chi-square tests.

Results

No association between craniofacial morphology and TMD was found (P = 0.6622). However, brachyfacial morphology influences the presence of painful TMD (P = 0.0077).

Conclusions

Craniofacial morphology is not related to temporomandibular disorders in general.