Internal derangement as a predictor of provoked pain on mouth opening: A magnetic resonance imaging study

Correlation of arthroscopic findings with clinical-radiological signs and symptoms of temporomandibular joint dysfunction: retrospective study of 829 joints

Temporomandibular joint (TMJ) arthroscopic findings are difficult to predict based on clinical criteria. Few studies have attempted to correlate signs, symptoms, and characteristics of patients with the final arthroscopic findings. The aim of this study was to assess the correlation between clinical-radiological signs and symptoms and arthroscopic findings in patients with TMJ dysfunction undergoing arthroscopy. A retrospective study was performed involving 487 patients (829 joints) with TMJ dysfunction who underwent TMJ arthroscopy between 2000 and 2019. The clinical-radiological variables recorded were pain, maximum mouth opening, joint noises, Wilkes classification, and disc displacement. The arthroscopic findings evaluated were synovitis, chondromalacia, adhesions, disc perforation, disc displacement, and roofing. Pain symptoms were significantly associated with the intensity of synovitis (P = 0.005) and disc displacement evaluated arthroscopically (P < 0.001). A statistically significant relationship was observed between Wilkes stage and the level of synovitis (P < 0.001) and chondromalacia (P < 0.001). Mouth opening was negatively correlated with adhesions (P < 0.001). Based on this study, pain symptomatology was associated with the intensity of synovitis and disc displacement evaluated arthroscopically, the Wilkes stage was a good predictor of the severity of synovitis and chondromalacia, and mouth opening was negatively correlated with adhesions.

Diagnostic correlation between clinical protocols and magnetic resonance findings in temporomandibular disorders: A systematic review and meta-analysis

BACKGROUND

Our aim was to assess the diagnostic correlation between clinical protocols and magnetic resonance (MRI) findings in temporomandibular disorders (TMDs), including disc displacement with and without reduction (DDwR; DDwoR) and arthralgia.

METHODS

A systematic review performed in two phases according to the PRISMA checklist. Specific indexing terms were used for search of studies assessing TMDs through clinical diagnostic protocols with the aid of Research Diagnostic Criteria for TMDs or Diagnostic Criteria for TMDs. Quality assessment performed using QUADAS-2. Heterogeneity was assessed using I² . Publication bias was assessed using funnel plots. For meta-analysis, we used random effect model or fixed effect. The main outcomes were sensitivity and specificity of clinical protocols.

RESULTS

Fourteen studies included in the qualitative analysis and 11 studies in the meta-analysis. None of the studies fulfilled all criteria of QUADAS-2. High heterogeneity and high publication bias were found among the studies. Clinical protocols for assessing DDwR compared with MRI showed pooled sensitivity of 66% and specificity of 72%. For DDwoR, sensitivity was 61% and specificity 98%. For arthralgia, sensitivity was 43% and specificity 68% for the presence of effusion.

CONCLUSIONS

This review reveals the need for studies with improved quality. Clinical protocols show poor to moderate validity in diagnosis of DDwR and DDwoR compared with MRI. No correlation was found between a clinical diagnosis of arthralgia and MRI effusion. Clinical diagnostic protocols can be used as screening tools, reserving the use of MRI for a more accurate diagnosis in patients with symptoms or dysfunction.

Temporomandibular joint morphology does not influence the presence of arthralgia in patients with disk displacement with reduction: a magnetic resonance imaging-based study

OBJECTIVE

The aim of this study was to compare, by using magnetic resonance imaging (MRI), temporomandibular joint (TMJ) morphology between patients with disk displacement with reduction (DDWR) with or without arthralgia and a control group and to identify which factors are associated with the concomitant presence of arthralgia in DDWR patients.

STUDY DESIGN

In this investigation, 36 TMJ MRIs were divided into 3 groups. Group 1 (n = 12) comprised patients with DDWR and arthralgia; group 2 (n = 12) comprised patients with DDWR without arthralgia; and group 3 (n = 12) was the control group. Disk and mandibular condyle morphologies; articular eminence morphology and inclination; size of the mandibular fossa; joint space size; joint effusion; bone marrow of the mandibular condyle; and the relative signal intensity of retrodiscal tissue were evaluated.

RESULTS

Fisher's exact test and 1-way analysis of variance (ANOVA) revealed no significant differences (P > .05) between groups for any variable. Logistic regression analysis showed that no anatomic variables were related to the concomitant presence of arthralgia in patients with DDWR (P > .05).

CONCLUSIONS

As evaluated on MRI scans, no significant differences in the anatomic characteristics of the TMJ were detected between DDWR patients with or without concomitant arthralgia and the control group. There were no factors associated with the concomitant presence of arthralgia in patients with DDWR.

Temporomandibular joint disc displacement with reduction: a review of mechanisms and clinical presentation

Disc displacement with reduction (DDWR) is one of the most common intra-articular disorders of the temporomandibular joint (TMJ). Factors related to the etiology, progression and treatment of such condition is still a subject of discussion. This literature review aimed to address etiology, development, related factors, diagnosis, natural course, and treatment of DDWR. A non-systematic search was conducted within PubMed, Scopus, SciELO, Medline, LILACS and Science Direct using the Medical Subjective Headings (MeSH) terms “temporomandibular disorders”, “temporomandibular joint”, “disc displacement” and “disc displacement with reduction”. No time restriction was applied. Literature reviews, systematic reviews, meta-analysis and clinical trials were included. DDWR is usually asymptomatic and requires no treatment, since the TMJ structures adapt very well and painlessly to different disc positions. Yet, long-term studies have shown the favorable progression of this condition, with no pain and/or jaw locking occurring in most of the patients.