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Xu B, Park JJ, Kim SH. Correlations of temporomandibular joint morphology and position using cone-beam computed tomography and dynamic functional analysis in orthodontic patients: A cross-sectional study. Korean J Orthod 2024; 54:325-341. [PMID: 39317705 PMCID: PMC11422681 DOI: 10.4041/kjod24.089] [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: 05/16/2024] [Revised: 08/16/2024] [Accepted: 09/04/2024] [Indexed: 09/26/2024] Open
Abstract
Objective To correlate temporomandibular joint (TMJ) morphology and position with cone-beam computed tomography (CBCT) images, Joint Vibration Analysis (JVA), and Jaw Tracker (JT) to develop a radiation-free, dynamic method for screening and monitoring the TMJ in orthodontic patients. Methods A total of 236 orthodontic patients without symptoms of TMJ disorders who had undergone CBCT were selected for the JVA and JT tests in this cross-sectional study. TMJ position and morphology were measured using a three-dimensional analysis software. JT measurements involved six opening-closing cycles, and JVA measurements were performed using a metronome to guide the mouth opening-closing movements of the patients. The correlations among the three measuring devices were evaluated. Results Abnormalities in condylar surface morphology affected the mandibular range of motion. The cut-off value results show that when various measurement groups are within a certain range, abnormalities may be observed in morphology (area under the curve, 0.81; P < 0.001). A 300/< 300 Hz ratio ≥ 0.09 suggested abnormal morphology (P < 0.05). Correlations were observed among the maximum opening velocity, maximum vertical opening position, and joint spaces in the JT measurements. Correlations were also observed between the > 300/< 300 Hz ratio, median frequency, total integral, integral < 300 Hz, and peak frequency with joint spaces in the JVA measurements. Conclusions JT and JVA may serve as rapid, non-invasive, and radiation-free dynamic diagnostic tools for monitoring and screening TMJ abnormalities before and during orthodontic treatment.
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Affiliation(s)
- Bin Xu
- Department of Orthodontics, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Jung-Jin Park
- Department of Orthodontics, Dental Hospital, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Seong-Hun Kim
- Department of Orthodontics, School of Dentistry, Kyung Hee University, Seoul, Korea
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Ohba S, Tominaga J, Shido R, Koga T, Yamamoto H, Zaiima H, Yoshida N, Asahina I. Influence of different treatment procedures on the temporomandibular joint after mandibular setback in skeletal class III - A retrospective study. J Craniomaxillofac Surg 2022; 50:712-718. [DOI: 10.1016/j.jcms.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 06/30/2022] [Accepted: 07/20/2022] [Indexed: 11/26/2022] Open
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Mizuhashi F, Ogura I, Watarai Y, Suzuki T, Mizuhashi R, Oohashi M, Saegusa H. Examination for the factors contribute to joint effusion in patients with internal derangement on temporomandibular joint disorder. JOURNAL OF ORAL AND MAXILLOFACIAL RADIOLOGY 2022. [DOI: 10.4103/jomr.jomr_17_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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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: 7] [Impact Index Per Article: 1.8] [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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Mohebbian M, Walia E, Habibullah M, Stapleton S, Wahid KA. Classifying MRI motion severity using a stacked ensemble approach. Magn Reson Imaging 2020; 75:107-115. [PMID: 33148512 DOI: 10.1016/j.mri.2020.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
Motion artifacts are a common occurrence in Magnetic Resonance Imaging exam. Motion during acquisition has a profound impact on workflow efficiency, often requiring a repeat of sequences. Furthermore, motion artifacts may escape notice by technologists, only to be revealed at the time of reading by the radiologists, affecting their diagnostic quality. There is a paucity of clinical tools to identify and quantitatively assess the severity of motion artifacts in MRI. An image with subtle motion may still have diagnostic value, while severe motion may be uninterpretable by radiologists and requires the exam to be repeated. Therefore, a tool for the automatic identification of motion artifacts would aid in maintaining diagnostic quality, while potentially driving workflow efficiencies. Here we aim to quantify the severity of motion artifacts from MRI images using deep learning. Impact of subject movement parameters like displacement and rotation on image quality is also studied. A state-of-the-art, stacked ensemble model was developed to classify motion artifacts into five levels (no motion, slight, mild, moderate and severe) in brain scans. The stacked ensemble model is able to robustly predict rigid-body motion severity across different acquisition parameters, including T1-weighted and T2-weighted slices acquired in different anatomical planes. The ensemble model with XGBoost metalearner achieves 91.6% accuracy, 94.8% area under the curve, 90% Cohen's Kappa, and is observed to be more accurate and robust than the individual base learners.
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Affiliation(s)
- MohammadReza Mohebbian
- Department of Electrical and Computer Engineering, University of Saskatchewan S7N 5A9, Saskatoon, Saskatchewan, Canada.
| | - Ekta Walia
- Advanced Innovation, Enterprise Operational Informatics, Philips HealthCare, 281 Hillmount Road, L6C2S3, Markham, Ontario, Canada
| | - Mohammad Habibullah
- Department of Electrical and Computer Engineering, University of Saskatchewan S7N 5A9, Saskatoon, Saskatchewan, Canada
| | - Shawn Stapleton
- Advanced Innovation, Enterprise Operational Informatics, Philips HealthCare, North America
| | - Khan A Wahid
- Department of Electrical and Computer Engineering, University of Saskatchewan S7N 5A9, Saskatoon, Saskatchewan, Canada
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Barbieri AA, Costa ALF, Perez Gomes JP, Ricardo ALF, Braz-Silva PH, Lopes SLPDC. Association of volume and voxel intensity of the articular disc and lateral pterygoid muscle in migraine patients: a study with magnetic resonance imaging. Acta Odontol Scand 2020; 78:189-195. [PMID: 31646924 DOI: 10.1080/00016357.2019.1676917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: To compare the volume and voxel intensity of articular disc and lateral pterygoid muscle (LPM) between a group of migraine patients and a control group (those without history of headache) by using magnetic resonance imaging (MRI).Patients and methods: MRI scans of 17 migraine patients and 15 healthy controls subjects were analysed and processed, using ITK-SNAP software, by a single investigator, for calculation of volumes and voxel intensity of articular disc and superior and inferior head of LPM.Results: There were statistically significant differences between migraine patients and controls regarding the volume and voxel intensity of articular disc and inferior head of LPM, increasing in migraine patients. Intra-rater was highly consistent and reproducible (intra-class correlation coefficient [ICC] = 1).Conclusions: Higher voxel intensity in disc and inferior head of LPM of MRI scans was linked to the increased volume of articular disc, inferior head of LPM and migraine.
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Affiliation(s)
- Ana Amelia Barbieri
- Department of Diagnosis and Surgery, Institute of Science and Technology, São Paulo State University, São José Dos Campos, Brazil
| | | | - João Pedro Perez Gomes
- Department of Stomatology, Division of General Pathology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | - Paulo Henrique Braz-Silva
- Department of Stomatology, Division of General Pathology, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Lim J, Yoon Y, Hwang T, Lee HC. Novel vertebral computed tomography indices in normal and spinal disorder dogs. J Vet Sci 2018; 19:296-300. [PMID: 29169229 PMCID: PMC5879078 DOI: 10.4142/jvs.2018.19.2.296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/07/2017] [Accepted: 11/16/2017] [Indexed: 11/20/2022] Open
Abstract
This study was carried out to derive and evaluate reference computed tomography (CT)-based indices for normal canine spine. CT and magnetic resonance images were acquired from 12 clinically normal Beagle dogs (normal group) and 50 dogs with 56 spinal disorders (patient group). Image acquisition regions were cervical spine (C2–T1), thoracic spine (T1–T13), and lumbar spine (L1–L7). Measured indices were: the ratios of width to height of the spinal cord including the dura matter (CR) and of the vertebral foramen (FR), and the ratio of the cross-sectional area of the spinal cord to that of the vertebral foramen (CFAR). Reliability analysis was performed to evaluate intermodality agreement. Student's t-tests and receiver operating characteristic curves were used to discriminate the normal and patient groups on CT. Intermodality agreements of the normal and patient groups were acceptable to excellent. The highest discriminating levels of CR at the vertebral body level and the intervertebral disc space level were 1.25 or more and 1.44 or more, respectively. FR and CFAR had the highest discriminating level at the cervical region. This report presents quantitative information on canine spinal morphometry; the obtained indices may be helpful for CT screening of dogs with spinal disorders.
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Affiliation(s)
- Jongsu Lim
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju 30488, Korea
| | - Youngmin Yoon
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju 30488, Korea
| | - Taesung Hwang
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju 30488, Korea
| | - Hee Chun Lee
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju 30488, Korea
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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: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Bag AK, Gaddikeri S, Singhal A, Hardin S, Tran BD, Medina JA, Curé JK. Imaging of the temporomandibular joint: An update. World J Radiol 2014; 6:567-582. [PMID: 25170394 PMCID: PMC4147437 DOI: 10.4329/wjr.v6.i8.567] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 02/27/2014] [Accepted: 06/20/2014] [Indexed: 02/06/2023] Open
Abstract
Imaging of the temporomandibular joint (TMJ) is continuously evolving with advancement of imaging technologies. Many different imaging modalities are currently used to evaluate the TMJ. Magnetic resonance imaging is commonly used for evaluation of the TMJ due to its superior contrast resolution and its ability to acquire dynamic imaging for demonstration of the functionality of the joint. Computed tomography and ultrasound imaging have specific indication in imaging of the TMJ. This article focuses on state of the art imaging of the temporomandibular joint. Relevant normal anatomy and biomechanics of movement of the TMJ are discussed for better understanding of many TMJ pathologies. Imaging of internal derangements is discussed in detail. Different arthropathies and common tumors are also discussed in this article.
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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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Sano T, Westesson PL, Yamamoto M, Okano T. Differences in Temporomandibular Joint Pain and Age Distribution Between Marrow Edema and Osteonecrosis in the Mandibular Condyle. Cranio 2014; 22:283-8. [PMID: 15532312 DOI: 10.1179/crn.2004.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This study investigated the differences of age distribution and temporomandibular joint (TMJ) pain between marrow edema and osteonecrosis in the mandibular condyle. Subjects consisted of 35 TMJs in 35 patients with abnormal bone marrow on MR images who were selected from a consecutive series of 527 patients with TMJ disorders. Proton density and T2-weighted MR images taken in the oblique sagittal and coronal planes were used to diagnose condylar marrow abnormalities and divide them into either edema or osteonecrosis. The differences in TMJ pain and age distribution for these two abnormalities were assessed with the one-sided Wilcoxon rank sum test with 0.05 alpha level. The degree of pain was higher in joints with marrow edema than in joints with osteonecrosis (p = 0.033). The mean age was higher in joints with osteonecrosis (p < 0.001). Our results suggest that there is more severe pain in TMJs with marrow edema of the mandibular condyle than in those with osteonecrosis. Since the patients with marrow edema have lower age, it also appears that marrow edema may be a precursor condition for osteonecrosis of the TMJ.
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Affiliation(s)
- Tsukasa Sano
- Department of Radiology, Showa University School of Dentistry 2-1-1, Kitasenzoku, Ohta-ku, 145 Tokyo, Japan.
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Yano K, Sano T, Okano T. A Longitudinal Study of Magnetic Resonance (MR) Evidence of Temporomandibular Joint (TMJ) Fluid in Patients with TMJ Disorders. Cranio 2014; 22:64-71. [PMID: 14964339 DOI: 10.1179/crn.2004.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
It has been reported that joint effusion, the excessive accumulation of joint fluid in and around the joint, is related to temporomandibular joint (TMJ) disorders such as pain and disk displacement. However, there have been no longitudinal studies of this phenomenon. We performed a longitudinal study on the relationship between joint fluid and various pathological disk conditions. The subjects were 17 patients who visited our facility for orthodontic treatment and were diagnosed using MRI as having internal derangement of one or both TMJs (three males and 14 females; age 12-31 years; mean age 20.5 years). MRI was performed before, during, or after treatment for their disorders. We evaluated the relationship between changes in joint fluid in the joint space and the state of the disk, as well as the presence or absence of pain. Joint fluid was evaluated by classifying the extent of high-signal areas in the upper and lower articular cavities on T2-weighted images. The extent of high-signal areas was classified into five levels. Disk displacement and the extent of displacement were evaluated using proton density-weighted images. Statistical analysis was performed using the chi-square test, and differences in the distribution among the groups were examined. Effusion was noted on the first MRI in nine of the eleven joints (81.8%) in which joint fluid decreased on the second MRI (p<0.01). Displacement remained unchanged or worsened in 18 of the 21 joints (85.7%) that showed joint fluid on the first MRI (p<0.01). Pain was alleviated or absent in all joints in which the fluid decreased. These results suggest that joint fluid may be a factor in the outcome of disk recapture treatment as well as in the evaluation of pain.
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Affiliation(s)
- Keisuke Yano
- Department of Radiology, Showa University School of Dentistry, Tokyo, Japan
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Koh KJ, Park HN, Kim KA. Relationship between anterior disc displacement with/without reduction and effusion in temporomandibular disorder patients using magnetic resonance imaging. Imaging Sci Dent 2013; 43:245-51. [PMID: 24380063 PMCID: PMC3873312 DOI: 10.5624/isd.2013.43.4.245] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 05/02/2013] [Accepted: 05/09/2013] [Indexed: 01/24/2023] Open
Abstract
PURPOSE This study was performed to evaluate the relationship between anterior disc displacement and effusion in temporomandibular disorder (TMD) patients using magnetic resonance imaging (MRI). MATERIALS AND METHODS The study subjects included 253 TMD patients. MRI examinations were performed using a 1.5 T MRI scanner. T1- and T2-weighted images with para-sagittal and para-coronal images were obtained. According to the MRI findings, temporomandibular joint (TMJ) disc positions were divided into 3 subgroups: normal, anterior disc displacement with reduction (DWR), and anterior disc displacement without reduction (DWOR). The cases of effusion were divided into 4 groups: normal, mild (E1), moderate (E2), and marked effusion (E3). Statistical analysis was made by the Fisher's exact test using SPSS (version 12.0, SPSS Inc., Chicago, IL, USA). RESULTS The subjects consisted of 62 males and 191 females with a mean age of 28.5 years. Of the 253 patients, T1- and T2-weighted images revealed 34 (13.4%) normal, DWR in 103 (40.7%), and DWOR in 116 (45.9%) on the right side and 37 (14.6%) normal, DWR in 94 (37.2%), and DWOR in 122 (48.2%) joints on the left side. Also, T2-images revealed 82 (32.4%) normal, 78 (30.8%) E1, 51 (20.2%) E2, and 42 (16.6%) E3 joints on the right side and 79 (31.2%) normal, 85 (33.6%) E1, 57 (22.5%) E2, and 32 (12.7%) E3 on the left side. There was no difference between the right and left side. CONCLUSION Anterior disc displacement was not related to the MRI findings of effusion in TMD patients (P>0.05).
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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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Ikeda K, Kawamura A. Disc displacement and changes in condylar position. Dentomaxillofac Radiol 2012; 42:84227642. [PMID: 22933537 DOI: 10.1259/dmfr/84227642] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To determine whether disc displacement (DD) can be a factor causing changes in condylar position in the glenoid fossa, using limited cone beam CT (LCBCT) images taken in the same time period as MRI that verified DD. METHODS The study included 60 joints in 57 male and female subjects aged 12-20 years (mean age 14.8 years). Subjects fulfilling the inclusion criteria were enrolled from a pool of post-orthodontic patients, and divided into four groups according to their disc status confirmed by MRI: partial DD (PDD), total DD with reduction (TDDWR), lateral DD (LDD) and medial DD (MDD). Changes in joint space from previously reported norms were measured on LCBCT images. RESULTS In PDD, the condyles were displaced posteriorly in the fossae with a mean anterior space of 2.7 ± 0.5 mm (normal 1.3 ± 0.2 mm) and a posterior space of 1.8 ± 0.4 mm (normal 2.1 ± 0.3 mm). In TDDWR, the condyles were displaced not only posteriorly as observed in PDD, but also vertically with a reduced superior space of 1.9 ± 0.4 mm (normal 2.5 ± 0.5 mm). In LDD, the lateral space was significantly increased to 2.5 ± 0.3 mm (normal 1.8 ± 0.4 mm), while central and medial spaces were significantly decreased to 2.2 ± 0.5 mm (normal 2.7 ± 0.5 mm) and 1.7 ± 0.4 mm (normal 2.4 ± 0.5 mm), respectively. In MDD, the medial space was increased and the lateral and central spaces were significantly decreased. CONCLUSIONS These results indicate that DD in adolescents and young adults can cause the condyle to change its position in the fossa with alterations in joint space which depend on the direction and extent of DD.
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Affiliation(s)
- K Ikeda
- Hillside View Orthodontic Office, Daikanyama Plaza 3F, 24-7, Sarugakucho, Shibuya-ku, Tokyo 150-0033, Japan.
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Larheim TA, Sano T, Yotsui Y. Clinical Significance of Changes in the Bone Marrow and Intra-Articular Soft Tissues of the Temporomandibular Joint. Semin Orthod 2012. [DOI: 10.1053/j.sodo.2011.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Imoto K, Otonari-Yamamoto M, Nishikawa K, Sano T, Yamamoto A. Potential of fluid-attenuated inversion recovery (FLAIR) in identification of temporomandibular joint effusion compared with T2-weighted images. ACTA ACUST UNITED AC 2011; 112:243-8. [DOI: 10.1016/j.tripleo.2011.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 03/02/2011] [Accepted: 03/04/2011] [Indexed: 12/24/2022]
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Orhan K, Delilbasi C, Paksoy C. Magnetic resonance imaging evaluation of mandibular condyle bone marrow and temporomandibular joint disc signal intensity in anaemia patients. Dentomaxillofac Radiol 2009; 38:247-54. [PMID: 19474251 DOI: 10.1259/dmfr/61024383] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To compare the signal intensity (SI) of mandibular condyle bone marrow (MCBM) and the temporomandibular joint (TMJ) disc in patients with chronic anaemia and healthy subjects, and to investigate the relationships between bone marrow changes, age, types of anaemia and severity of anaemia. METHODS MRIs of 18 patients with chronic anaemia were compared with those of 12 healthy subjects. The SI of MCBM and the TMJ disc were quantitatively evaluated. The SI of the grey matter (GM), white matter (WM) and the lateral pterygoid muscle were also investigated. Relationships between age, MCBM and TMJ disc signal-intensities and anaemia severity, and correlations between the groups, were analysed. RESULTS The mean MCBM SI was lower in anaemia patients (including both subgroups and also separately) than in healthy subjects (P < 0.05). No statistical significance was found for GM, WM and the muscle SI between the anaemia patients and healthy patient group (P > 0.05). No statistical significance was found between the groups with respect to the anterior band, whereas the mean SI value of the posterior band in the study group was significantly lower than in healthy subjects (P < 0.05). There were no correlations between age and MCBM SI, or between anaemia severity and MCBM SI. CONCLUSIONS Anaemia may cause bone marrow alterations without any internal derangement. Patients with chronic anaemia exhibit lower mandibular condyle bone marrow and posterior band SI than healthy subjects.
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Affiliation(s)
- K Orhan
- Department of Oral Diagnosis and Radiology, Ankara University, Ankara, Turkey
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Nakaoka K, Hamada Y, Holmlund AB, Saito T, Arai G, Horiuchi T, Mishima A, Seto K. The changes of joint effusion on MRI and arthroscopic findings after visually guided TMJ irrigation correlated to the clinical outcome. ACTA ACUST UNITED AC 2009; 108:99-104. [DOI: 10.1016/j.tripleo.2008.11.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 10/16/2008] [Accepted: 11/18/2008] [Indexed: 10/21/2022]
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Yajima A, Sano T, Otonari-Yamamoto M, Otonari T, Ohkubo M, Harada T, Wakoh M. MR evidence of characteristics in symptomatic osteoarthritis of the temporomandibular joint: increased signal intensity ratio on proton density-weighted images of bone marrow in the mandibular condyle. Cranio 2007; 25:250-6. [PMID: 17983124 DOI: 10.1179/crn.2007.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The purpose of this study was to clarify the presence of pain and a correlation between pain and characteristics of signal intensity of mandibular bone marrow in temporomandibular joints (TMJ) with osteoarthritis (OA). A total of 196 joints in 98 patients with TMJ disorders were examined using magnetic resonance imaging (MRI). A pain score and signal intensity on mandibular bone marrow were analyzed in the TMJ with OA. TMJ with OA showed a higher degree of pain compared to those without (p < 0.05). During opening, the joints in the higher signal intensity group showed a significantly higher degree of pain compared to the joints in the lower signal intensity group in those with OA on proton density weighted images (p < 0.05). It was concluded that TMJ with osteoarthritis is related to pain and that a symptomatic osteoarthritic TMJ can accompany bone marrow changes in the condyle, showing an increased signal on proton density weighted images.
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Affiliation(s)
- Aya Yajima
- Dept. of Oral and Maxillofacial Radiology, Tokyo Dental College 1-2-2 Masago, Mihama-ku Chiba 261-8502, Japan.
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Sano T, Otonari-Yamamoto M, Otonari T, Yajima A. Osseous abnormalities related to the temporomandibular joint. Semin Ultrasound CT MR 2007; 28:213-21. [PMID: 17571704 DOI: 10.1053/j.sult.2007.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
With the arrival of arthrography, computed tomography, and magnetic resonance imaging, diagnostic imaging of the temporomandibular joint has improved tremendously over the last 20 years. In patients with temporomandibular joint pain and dysfunction, the main focus was on meniscal pathology. The purpose of this article is to discuss several osseous abnormalities and demonstrate their association with temporomandibular joint pain and dysfunction.
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Affiliation(s)
- Tsukasa Sano
- Department of Oral and Maxillofacial Radiology, Tokyo Dental College, Chiba, Japan.
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22
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Emshoff R, Rudisch A. Temporomandibular Joint Internal Derangement and Osteoarthrosis: Are Effusion and Bone Marrow Edema Prognostic Indicators for Arthrocentesis and Hydraulic Distention? J Oral Maxillofac Surg 2007; 65:66-73. [PMID: 17174766 DOI: 10.1016/j.joms.2005.11.113] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Revised: 07/27/2005] [Accepted: 11/23/2005] [Indexed: 11/24/2022]
Abstract
PURPOSE Arthrocentesis and hydraulic distention of the temporomandibular joint (TMJ) has proven to be an effective modality in treating patients exhibiting clinical findings consistent with the diagnosis of disc displacement without reduction. The purpose of this study was to investigate whether the magnetic resonance imaging (MRI) variables of effusion and/or bone marrow edema may predict treatment outcomes of arthrocentesis and hydraulic distention of the TMJ. PATIENTS AND METHODS The study group comprised 37 consecutive patients with TMJ pain, who were assigned a unilateral clinical TMJ disorder of TMJ pain associated with an internal derangement (ID) type III (disc displacement without reduction) and a TMJ pain side-related MRI diagnosis of disc displacement without reduction associated with osteoarthrosis (OA). Bilateral sagittal and coronal MRI images were obtained immediately before the operation to establish the presence or absence of ID, OA, TMJ effusion, and bone marrow edema. Pain level and mandibular range of motion (ROM) were assessed preoperatively and compared with the respective 2-month follow-up findings. Outcome criteria for success were a ROM >or=35 mm and pain reduction >50%. A logistic regression analysis was used to compute the odds ratio for TMJ effusion and bone marrow edema for successful outcomes (n = 21) versus unsuccessful (n = 16) outcomes. RESULTS At the 2-month follow-up, clinical evaluation showed a significant reduction in TMJ pain during function (P = .000), a significant reduction in clinical diagnoses of TMJ disorders (P = .016), and a significant increase in ROM (P = .000). A significant increase in the risk of an unsuccessful outcome of ROM <35 mm and/or pain reduction >or=50% occurred with MRI findings of effusion (odds ratio 1:10.8 = 0.09; P = .007). CONCLUSIONS TMJ effusion may prove to be an important prognostic determinant of successful arthrocentesis. However, the data re-emphasize the concept that the prediction of a specific outcome is not a matter of simple linearity, in which the presence of 1 factor may equate with predictive ability, but rather is a function of a complex interaction among different biological variables.
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Affiliation(s)
- Rüdiger Emshoff
- Department of Oral and Maxillofacial Surgery, University Clinic Innsbruck, Innsbruck, Austria.
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Güler N, Uçkan S, Imirzalioğlu P, Açikgözoğlu S. Temporomandibular joint internal derangement: relationship between joint pain and MR grading of effusion and total protein concentration in the joint fluid. Dentomaxillofac Radiol 2005; 34:175-81. [PMID: 15897289 DOI: 10.1259/dmfr/49181266] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The objective of this study was to determine whether there is any association between the protein concentration in the synovial fluid and (i) the amount of articular hydrops, as graded in magnetic resonance (MR) images, and (ii) joint pain in temporomandibular joints (TMJs) with and without displacement of the disc. PATIENTS AND METHODS This study involved 16 joints in 16 patients referred to our clinic with the complaint of pain and limited mouth opening. The control group consisted of 15 joints in 15 patients with unilaterally normal disc and condyle relationship and no pain while the opposite side had a non-painful joint with disc displacement without reduction (DDwoR). The subjects and controls were different individuals and only a single joint was used for each. Pain and dysfunction were evaluated by visual analogue scale. Bilateral proton density and T2 weighted images of the TMJs of the 31 subjects were analysed for fluid and condyle bony changes as well as disc position. The amount of fluid, identified as an area of high signal intensity in the region of the upper and lower joint spaces, was characterized as none, minimal, moderate or marked. Arthrocentesis was performed both for synovial fluid analysis of total protein concentration and the treatment of the joints with DDwoR. Total protein concentration was measured by using protein dye binding on spectrophotometry. RESULTS All patients experienced a significant (P<0.01) increase in maximal mouth opening immediately post-arthrocentesis. In the study group, the disc was displaced most frequently in an anteriormedial direction (75%) and deformation of disc form was seen in 13 joints. Condylar bony changes were seen in 27% of joints in the control group and in 81% of joints in the study group. A statistically significant association was found between joints with disc displacement, disc form and condylar bony changes (P<0.05). In the control group, only one joint, which had an osteophyte, showed joint effusion (JE) with moderate fluid. In the study group, only four joints had no fluid (25%). JE was found in 10 (63%) joints with disc displacement on anteromedial direction, in 10 (63%) joints with disc deformation and in 10 (63%) joints with osteophytes and erosion. Mean total protein concentration was 16.87+/-7.9 (range 7.4-34.1 mg dl-1) in control joints, 55.08+/-35.16 (range 21.5-153.9 mg dl-1) in study joints. There were significant differences in the mean total protein concentration between the control and study groups (P<0.01). Significant positive correlation was found between the total protein concentration and JE (r=0.65, P<0.01). No significant correlation was found between the level of pain and dysfunction and JE and total protein concentration in either control or study groups (P>0.05). CONCLUSION Pain in the TMJ was not related to MR findings of effusion in internal derangement and synovial fluid aspirate findings of total protein concentration. However, total protein concentration was related to the amount of JE in DDwoR joints and painful joints were more likely to demonstrate the JE.
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Affiliation(s)
- N Güler
- Yeditepe Universitesi, Dis Hekimligi Fakultesi, Bagdat cad. No: 238 Goztepe Istanbul, Turkiye.
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Abolmaali ND, Schmitt J, Schwarz W, Toll DE, Hinterwimmer S, Vogl TJ. Visualization of the articular disk of the temporomandibular joint in near-real-time MRI: feasibility study. Eur Radiol 2004; 14:1889-94. [PMID: 15378254 DOI: 10.1007/s00330-004-2418-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2004] [Revised: 06/05/2004] [Accepted: 06/17/2004] [Indexed: 10/26/2022]
Abstract
While static MRI of the TMJ is the method of choice to evaluate the articular disk (AD), dynamic MRI so far has failed to display the AD. The capability of a modified True-FISP sequence to visualize the AD in dynamic near-real-time imaging (NRTI) was evaluated. Twelve healthy subjects and 17 patients were investigated. Besides static routine imaging, sagittal NRTI of both TMJs was performed with a True-FISP sequence at 1.5 T with TE/TR=1.84/3.68 ms. Two temporal resolutions (250/500 ms) were tested. The quality of the visualization of the AD was rated on a four-point scale (1= very good to 4= poor visualization) by two observers in consensus. ADs of the volunteers were visualized with high quality in all stages of movement (score: 1.69). In patients with internal derangement, disk-motion was clearly depicted, including fast reposition movements. Due to degenerative changes of the AD, the quality of the depiction in patients was slightly lower (score: 2.4). According to the preliminary results of this feasibility study, the suggested NRTI True-FISP sequence is capable of visualizing the entire motion of the AD of the TMJ in normal and pathologic stages with high quality. Further studies are needed to prove the clinical usefulness of this new technique.
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Affiliation(s)
- Nasreddin D Abolmaali
- Department of Diagnostic and Interventional Radiology, J.W. Goethe University, Theodor Stern Kai 7, Frankfurt/Main, Germany.
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Mori S, Kaneda T, Lee K, Kato M, Motohashi J, Ogura I. T2-weighted MRI for the assessment of joint effusion: comparative study of conventional spin-echo and fast spin-echo sequences. ACTA ACUST UNITED AC 2004; 97:768-74. [PMID: 15184862 DOI: 10.1016/j.tripleo.2004.02.074] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study aimed to evaluate the usefulness of suitable conventional spin-echo (CSE) and fast spin-echo (FSE) T2-weighted imaging parameters for the assessment of joint effusion in a phantom study and in a comparative study of CSE and FSE using clinical cases. STUDY DESIGN In the phantom study, the signal ratios of water and oil signal fields were determined and studied comparatively. The shape and size of signals were evaluated separately. In the study of joint effusion images, 318 joints were evaluated. CSE T2-weighted imaging and FSE T2-weighted imaging were carried out, and a comparative assessment was performed. RESULTS In both CSE and FSE imaging, the ratios of mean MRI signal values showed divergence as TR/TE values increased. The evaluation of joint effusion with FSE TR/TE 8000/120 msec was significantly better than that in all other groups (P <.01). CONCLUSION The use of FSE requires investigation of TR/TE values. When a 0.5 T static field strength MRI apparatus is employed, TR/TE 8000/120 msec is recommended.
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Affiliation(s)
- Shintaro Mori
- Department of Radiology, Nihon University School of Dentistry at Matsudo, Chiba, Japan.
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Sano T, Yamamoto M, Okano T, Gokan T, Westesson PL. Common abnormalities in temporomandibular joint imaging. Curr Probl Diagn Radiol 2004; 33:16-24. [PMID: 14712198 DOI: 10.1016/j.cpradiol.2003.09.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Magnetic resonance imaging has evolved as a prime diagnostic method for soft-tissue abnormalities of the temporomandibular joint. The most common temporomandibular joint abnormalities are internal derangement and osteoarthritis, but there are many other reasons for pain and dysfunction that are often overlooked. The purpose of this paper is to illustrate several of these more unusual and less well-recognized causes for temporomandibular joint pain and dysfunction. For example, internal derangement is often seen in asymptomatic individuals. Another purpose is to illustrate the difference in magnetic resonance imaging of asymptomatic and symptomatic internal derangement.
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Affiliation(s)
- Tsukasa Sano
- Department of Radiology, Showa University School of Dentistry, Tokyo, Japan.
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Matsumura Y, Nomura J, Murata T, Inui M, Nagai K, Yanase S, Nomura Y, Tagawa T. Magnetic Resonance Imaging of Synovial Proliferation in Temporomandibular Disorders with Pain. J Comput Assist Tomogr 2004; 28:73-9. [PMID: 14716236 DOI: 10.1097/00004728-200401000-00012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to assess the clinical significance of synovial proliferation in patients with painful temporomandibular disorders based on magnetic resonance imaging findings. METHODS The current study was conducted in 100 joints of 100 patients with unilateral painful temporomandibular disorders. One hundred joints on the contralateral side of patients with unilateral disease were used as nonpain group. Areas in the articular space that showed a low signal intensity on T1-weighted imaging, a high signal intensity on T2-weighted imaging, and high signal intensity on gadolinium-enhanced fat-suppressed T1-weighted imaging were judged to be regions of synovial proliferation. RESULTS Synovial proliferation alone was observed in 8.0% of the pain group, but in none of the nonpain group. Synovial proliferation + effusion was observed in 33.0% of the pain group and in 7.0% of the nonpain group. Effusion alone was observed in 7.0% of the pain group and in 3.0% of the nonpain group. The mean visual analog scale value of pain was in the order of synovial proliferation alone > synovial proliferation + effusion > effusion alone. The incidence rates of anterior displacement of the disk were 100% for synovial proliferation alone, 93.9% for synovial proliferation + effusion, 57.1% for effusion alone, and 57.7% for "without synovial proliferation/effusion." CONCLUSIONS Strong correlations were observed between synovial proliferation, pain, and disk displacement. It is considered that evaluating effusion alone provides only limited information on the disease state in painful temporomandibular disorders. Thus, it is essential to include enhanced T1-weighted imaging as a means to judge the disease state as well as to assess disease progression.
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Affiliation(s)
- Yoshihiko Matsumura
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
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Manfredini D, Tognini F, Melchiorre D, Zampa V, Bosco M. Ultrasound assessment of increased capsular width as a predictor of temporomandibular joint effusion. Dentomaxillofac Radiol 2003; 32:359-64. [PMID: 15070837 DOI: 10.1259/dmfr/25091144] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate whether an increased capsular width evidenced by ultrasound (US) could be an indirect marker of temporomandibular joint (TMJ) effusion. METHODS 138 TMJs were evaluated by US and magnetic resonance imaging (MRI) by two blinded calibrated investigators. US measures of capsular width (in mm) and MRI diagnosis of TMJ effusion (presence/absence) were used to perform a receiver operating characteristic (ROC) curve analysis in order to assess the most accurate cut-off value of capsular width that was able to discriminate between joints with and without MRI effusion. RESULTS Diagnostic accuracy of US to detect MRI-depicted TMJ effusion was good (area under the ROC curve=0.817). US sensitivity was high for values below the cut-off value of 1.950 mm (true positive rate (TPR)=83.9%; false positive rate (FPR)=26.3%), while specificity was high for values above the cut-off value of 2.150 mm (TPR=71.0%; FPR=11.8%). CONCLUSIONS Analysis of ROC curve appears to reveal that the critical area is around the 2 mm value for TMJ capsular width. These findings need to be refined by further studies assessing the smallest detectable difference in capsular width, with attention to reliability of interobserver observations.
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Affiliation(s)
- D Manfredini
- Section of Prosthetic Dentistry, Department of Neuroscience, University of Pisa, Italy.
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29
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Defabianis P. Post-traumatic TMJ internal derangement: impact on facial growth (findings in a pediatric age group). J Clin Pediatr Dent 2003; 27:297-303. [PMID: 12924728 DOI: 10.17796/jcpd.27.4.2782236161p3p467] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Many clinical studies have shown how jaw injuries sustained during impact trauma to the face or mandible are the single most important cause of TMJ subsequent internal derangement. Proper function of the masticatory system is certainly the most influential variable in the TMJ remodelling; once a TMJ is internally deranged, adaptative or degenerative osteocartilagineous processes take place in the mandible, temporal bones and muscles. To evaluate relationships between consequences of post-traumatic TMJ internal derangement and disturbed facial skeleton growth in children, 25 patients (16 boys 9 girls), 14 year of age or younger, were selected out of a group of 74 and analysed. They all had been treated by physiotherapy and had undergone combined clinical and radiographic examination for five years. Symptoms included either individually or in various combination, pain, mechanical TMJ dysfunction and facial skeletal abnormalities, such as mandibular retrognathia and lower facial asymmetry manifested by chin deviation from the midline. Seventeen patients were found to have at least one abnormal and internally deranged TMJ on imaging studies; in twelve of them a mandibular asymmetry with chin deviation from the midline to the smaller or more degenerated TMJ was evident. Of the eight retrognathic patients, five were found to have bilateral TMJ derangement. In three patients both TMJ(s) were normal with normal facial structure. These data suggest that TMJ derangement in children may potentially have an impact on facial growth and lead to the development of retrognathia, with or without asymmetry, in many cases.
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Affiliation(s)
- Patrizia Defabianis
- Department of Odontostomatology, St. John the Baptiste Hospital, University of Torino, Italy.
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30
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Abstract
Diagnostic imaging of TMJ has improved remarkably in the last 20 years. Various abnormalities related patient symptoms. Further studies using the latest imaging techniques will allow a better understanding of the sources of joint pain and the discrepancy between imaging findings and patient symptoms. For clinical practice, appropriate clinical examinations are needed to determine exactly which imaging findings are significant.
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Affiliation(s)
- Tsukasa Sano
- Department of Radiology, Showa University School of Dentistry, 2-1-1, Kitasenzoku, Ohta-ku, 145-8515 Tokyo, Japan.
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31
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Segami N, Suzuki T, Sato J, Miyamaru M, Nishimura M, Yoshimura H. Does joint effusion on T2 magnetic resonance images reflect synovitis? Part 3. Comparison of histologic findings of arthroscopically obtained synovium in internal derangements of the temporomandibular joint. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2003; 95:761-6. [PMID: 12789161 DOI: 10.1067/moe.2003.243] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To evaluate the relationship between the volume of joint effusion (JE), determined by T2-weighted magnetic resonance imaging (MRI), and microscopic findings of synovial inflammation in internal derangement of the temporomandibular joint (TMJ). STUDY DESIGN Magnetic resonance images of 53 symptomatic TMJs (53 patients) associated with painful hypomobility were taken to evaluate the degree of JE on a scale of 0 to 3. Within 2 months after MRI, biopsy specimens obtained by arthroscopy were quantitatively assessed, on the basis of Gynther's grading system, for severity of hyperplasia of synovial lining cell layers, vascularity, and the presence of inflammatory cells. Each synovitis score was compared among the 4 JE grades, as well as between 2 groups-effusion present (grades 2 and 3) and effusion absent (grades 0 and 1)-by using the Spearman correlation coefficiency and the Mann-Whitney U test. RESULTS The distribution of JE was as follows: 14 joints had grade 0, 9 joints had grade 1, 19 joints had grade 2, and 11 joints had grade 3. Significant relationships were found between the grades of JE and scores of synovial lining cell layers (P =.0012) as well as between the grades of JE and scores of presence of inflammatory cells (P =.0064). The joints with effusion had significantly higher scores for synovial lining cell layers (2.0 +/- 0.2) than the joints without effusion (1.3 +/- 0.2) (P =.029). There was no statistically significant correlation between the scores of vascularity and JE (P =.394). CONCLUSIONS The evidence of JE on MRI might correlate with synovial inflammatory activity. It confirms the common consensus that JE probably reflects synovitis, especially when synovial hyperplasia has a key role in the pathogenesis of JE.
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Emshoff R, Brandlmaier I, Gerhard S, Strobl H, Bertram S, Rudisch A. Magnetic resonance imaging predictors of temporomandibular joint pain. J Am Dent Assoc 2003; 134:705-14. [PMID: 12839406 DOI: 10.14219/jada.archive.2003.0256] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The authors conducted a study to evaluate whether temporomandibular joint, or TMJ, disorder subgroups are related to magnetic resonance imaging, or MRI, diagnoses of TMJ internal derangement, or ID; osteoarthrosis, or OA; effusion; and bone marrow edema. METHODS The TMJ disorder group was composed of 118 subjects with TMJ pain who were assigned a clinical unilateral single diagnosis of a specific TMJ disorder. The control group consisted of 46 subjects who did not have TMJ pain. Sagittal and coronal magnetic resonance images were obtained to establish the prevalence of ID, OA, effusion and bone marrow edema. The authors used a multiple logistic regression analysis to compute the odds ratios, or OR, for MRI features for control subjects versus four groups of subjects who had TMJ pain: ID type I (n = 35), ID type III (n = 39), capsulitis/synovitis (n = 26) and degenerative joint disease, or DJD, (n = 18). RESULTS MRI diagnoses that did not contribute to the risk of TMJ pain included disk displacement, or DD, with reduction and effusion. Significant increases in the risk of experiencing TMJ pain occurred selectively with DD without reduction (OR = 10.2:1; P = .007) and bone marrow edema (OR = 15.6:1, P = .003) for the ID type III group and with DD without reduction (OR = 11.7:1, P = .054) for the DJD group. Subjects in the group with ID type I were less likely to be associated with an MRI finding of OA than were control subjects (OR = 1:5.6). CONCLUSIONS While the contribution of MRI variables to the TMJ pain subgroups was not zero, most of the variation in each TMJ pain population was not explained by MRI parameters. Thus, MRI diagnoses may not be considered the unique or dominant factor in defining TMJ disorder populations. CLINICAL IMPLICATIONS Therapy for subjects with TMJ based on the evaluation of concomitant morphological abnormalities, whether prophylactically or as treatment for TMJ disorders, may be unwarranted.
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Affiliation(s)
- Rüdiger Emshoff
- Department of Oral and Maxillofacial Surgery, University of Innsbruck, Austria.
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Emshoff R, Brandlmaier I, Bertram S, Rudisch A. Risk factors for temporomandibular joint pain in patients with disc displacement without reduction - a magnetic resonance imaging study. J Oral Rehabil 2003; 30:537-43. [PMID: 12752937 DOI: 10.1046/j.1365-2842.2003.01111.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to evaluate whether the magnetic resonance (MR) imaging variables of temporomandibular joint (TMJ) internal derangement, osteoarthrosis and/or effusion may predict the presence of pain in patients with a clinical disorder of an internal derangement type (ID)-III. The relationship between TMJ ID-III pain and TMJ internal derangement, osteoarthrosis and effusion was analysed in MR images of 84 TMJs in 42 patients with a clinical unilateral diagnosis of TMJ ID-III pain. Criteria for including a TMJ ID-III pain patient were report of orofacial pain referred to the TMJ, with the presence of unilateral TMJ pain during palpation, function and/or unassisted or assisted mandibular opening. Bilateral sagittal and coronal MR images were obtained to establish the presence or absence of TMJ internal derangement, osteoarthrosis and effusion. Using chi-square analysis for pair-wise comparison, the data showed a significant relationship between the MR imaging findings of TMJ ID-III pain and those of internal derangement (P=0.01) and effusion (P=0.00). Of the MR imaging variables considered simultaneously in the multiple logistic regression analysis, osteoarthrosis (P=0.82) and effusion (P=0.08) dropped out as non-significant in the diagnostic TMJ pain group when compared with the TMJ non-pain group. The odds ratio that a TMJ with an internal derangement type of disk displacement without reduction might belong to the pain group was strong (2.7:1) and highly significant (P=0.00). Significant increases in risk of TMJ pain occurred with 'disk displacement without reduction in combination with osteoarthrosis' (5.2:1) (P=0.00) and/or 'disk displacement without reduction in combination with osteoarthrosis and effusion' (6.6:1) (P=0.00). The results suggest that TMJ pain is related to internal derangement, osteoarthrosis and effusion. However, the data re-emphasize the aspect that these MR imaging variables may not be regarded as the unique and dominant factors in defining TMJ pain instances.
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Affiliation(s)
- R Emshoff
- Department of Oral and Maxillo-Facial Surgery, University of Innsbruck, A-6020 Innsbruck, Austria.
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34
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Emshoff R, Brandlmaier I, Bertram S, Rudisch A. Relative odds of temporomandibular joint pain as a function of magnetic resonance imaging findings of internal derangement, osteoarthrosis, effusion, and bone marrow edema. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2003; 95:437-45. [PMID: 12686927 DOI: 10.1067/moe.2003.95] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate whether common magnetic resonance (MR) imaging variables such as temporomandibular joint (TMJ) internal derangement, osteoarthrosis, effusion, and bone marrow edema are predictive of the presence of TMJ pain. STUDY DESIGN The relationship between TMJ pain and TMJ internal derangement, osteoarthrosis, effusion, and bone marrow edema was analyzed in MR images of 338 TMJs in 169 patients with a clinical diagnosis of TMJ pain and dysfunction. Criteria for including a patient with TMJ pain were a report of orofacial pain referred to the TMJ, with the presence of unilateral or bilateral TMJ pain during palpation, function, or unassisted or assisted mandibular opening. The criteria for including a patient with no pain were the absence of TMJ pain during palpation, function, and unassisted or assisted mandibular opening. Application of the criteria resulted in a study group of 129 patients with unilateral TMJ pain, 18 with bilateral TMJ pain, and 22 without TMJ pain. Bilateral sagittal and coronal MR images were obtained to establish the presence or absence of TMJ internal derangement, osteoarthrosis, effusion, and bone marrow edema. Logistic regression analysis was used to compute the odds ratios for internal derangement, osteoarthrosis, effusion, and bone marrow edema for nonpainful TMJs (n = 173) versus painful TMJs (n = 165). RESULTS For pairwise comparison, the chi(2) test was used; the resultant data showed a significant relationship between the clinical findings of TMJ pain and the MR imaging diagnoses of internal derangement (P =.000), osteoarthrosis (P =.015), effusion (P =.002), and bone marrow edema (P =.016). Of the MR imaging variables considered simultaneously in multiple logistic regression analysis, osteoarthrosis (P =.405), effusion (P =.131), and bone marrow edema (P =.231) dropped out as nonsignificant in the diagnostic TMJ pain group in comparison with the TMJ no-pain group. Significant increases in risk of TMJ pain occurred with disk displacement without reduction in combination with osteoarthrosis and bone marrow edema (3.7:1 odds ratio; P =.000) and with disk displacement without reduction in combination with osteoarthrosis and effusion (2.8:1 odds ratio; P =.000). CONCLUSIONS The results suggest that TMJ pain is related to internal derangement, osteoarthrosis, effusion, and bone marrow edema. However, the data reemphasize that these MR imaging variables may not be regarded as the unique and dominant factors in defining TMJ pain occurrence.
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Affiliation(s)
- Rüdiger Emshoff
- University of Innsbruck, Höhenstrae 5, A-6020 Innsbruck, Austria.
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35
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Hamada Y, Kondoh T, Sekiya H, Seto K. Morphologic changes in the unloaded temporomandibular joint after mandibulectomy. J Oral Maxillofac Surg 2003; 61:437-41. [PMID: 12684960 DOI: 10.1053/joms.2003.50084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The aim of this study was to examine intra-articular conditions in unloaded temporomandibular joints (TMJs) after mandibulectomy including the condyle or segmental mandibulectomy. PATIENTS AND METHODS Seventeen joints were defined as unloaded TMJs. Eleven of the 17 joints were classified into the "without condyle" (WOC) group in which TMJs had the condyle removed but the disc and superior joint compartment were preserved, and remaining 6 joints were classified into the "with condyle" (WC) group in which TMJs were connected to the condylar process. Disc configuration, bony changes, and joint effusion were examined by magnetic resonance imaging. In 8 of the 17 joints, arthroscopic examination of the superior joint compartment was performed. Correlation between data of the WOC and WC groups was evaluated. The relationship between arthroscopic findings and joint effusion was also analyzed. RESULTS Deformed discs were observed in 7 of the 11 joints (63.6%) of the WOC group but were not observed in the WC group, in which there was a normal relationship between the disc and condyle. Bony changes were not detected in any joints. Joint effusion and arthroscopically diagnosed fibrous adhesion were observed in nearly all joints of both groups. CONCLUSIONS We conclude that alteration of the relationship between the disc and condyle is more important for the initiation of disc deformation than loading conditions on the disc. The present findings suggest that, in the unloaded TMJs, articular degeneration is induced by disturbance of synovial fluid metabolism but that bony conditions are not affected.
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Affiliation(s)
- Yoshiki Hamada
- First Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Tsurumi University, Yokohama, Japan.
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Emshoff R, Brandlmaier I, Schmid C, Bertram S, Rudisch A. Bone marrow edema of the mandibular condyle related to internal derangement, osteoarthrosis, and joint effusion. J Oral Maxillofac Surg 2003; 61:35-40. [PMID: 12524605 DOI: 10.1053/joms.2003.50006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The purpose of this prospective study was to evaluate whether common magnetic resonance imaging (MRI) variables such as temporomandibular joint (TMJ) internal derangement, osteoarthrosis, and effusion may predict the diagnostic group of bone marrow edema of the mandibular condyle. MATERIALS AND METHODS The relationship between bone marrow edema and TMJ disc displacement, osteoarthrosis, and effusion was analyzed in MRIs of 120 TMJs in 73 consecutive patients with TMJ pain and/or a clinical diagnosis of TMJ internal derangement type III (disc displacement without reduction). The diagnostic bone marrow edema group was comprised of 54 TMJs in 40 patients with a unilateral or bilateral MRI diagnosis of bone marrow edema. The control group consisted of 66 non-bone marrow edema TMJs in 33 patients with a bilateral MRI finding of an absence of bone marrow edema. A logistic regression analysis was used to compute the odds ratios for internal derangement, osteoarthrosis, and effusion for non-bone marrow edema TMJs (n = 66) versus TMJs with bone marrow edema (n = 54). RESULTS Using Chi;(2) analysis for pair-wise comparison, the TMJ-related data showed a significant relationship between the MR imaging findings of TMJ bone marrow edema and those of internal derangement (P = .000), osteoarthrosis (P = .000), and effusion (P = .010). Of the MRI variables considered simultaneously in the multiple logistic regression analysis, osteoarthrosis (P = .107) and effusion (P = .102) dropped out as nonsignificant in the diagnostic bone marrow edema group when compared with the control group. The odds ratio for individuals with an internal derangement showing bone marrow edema was strong (3.6:1) and highly significant (P = .000). Significant increases in risk of bone marrow edema occurred with disc displacement without reduction and osteoarthrosis (9.2:1) (P = .000) and disc displacement without reduction and effusion (6.4:1) (P = .002). CONCLUSIONS The results suggest that the MR imaging findings for TMJ bone marrow edema are related to those of internal derangement, osteoarthrosis, and effusion. However, the data re-emphasize the aspect that internal derangement, osteoarthrosis, and effusion may not be regarded as the unique and dominant factors in defining TMJ bone marrow edema instances.
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Affiliation(s)
- Rüdiger Emshoff
- Department of Oral and Maxillofacial Surgery, University of Innsbruck, Innsbruck, Austria.
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Emshoff R, Brandimaier I, Bertram S, Rudisch A. Magnetic resonance imaging findings of osteoarthrosis and effusion in patients with unilateral temporomandibular joint pain. Int J Oral Maxillofac Surg 2002; 31:598-602. [PMID: 12521314 DOI: 10.1054/ijom.2002.0314] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to investigate the relationship between the presence of temporomandibular joint (TMJ) pain and the magnetic resonance (MR) imaging findings of osteoarthrosis (OA), and effusion. The study comprised 112 consecutive TMJ pain patients. Criteria for including a patient were report of unilateral pain near the TMJ, with the presence of unilateral TMJ pain during palpation, function, and/or unassisted or assisted mandibular opening. Bilateral sagittal and coronal MR images were obtained to establish the presence or absence of TMJ OA, and/or effusion. Comparison of the TMJ side-related data showed a significant relationship between the clinical finding of TMJ pain and the MR imaging diagnoses of TMJ OA (P=0.000), and TMJ effusion (P=0.000). Further, there was a significant relationship between the MR imaging diagnosis of TMJ OA and TMJ effusion (P=0.000). Use of the Kappa statistical test indicated poor diagnostic agreement between the presence of TMJ pain and the MR imaging diagnosis of TMJ OA (K=0.22), TMJ effusion (K=0.29), and TMJ 'OA and effusion' (K=0.30). The study's findings suggest that while clinical pain is correlated to TMJ-related MR imaging findings, clinical pain in and of itself, is not reliable for predicting the presence of TMJ OA and/or effusion. Validation of MR imaging diagnoses would involve the investigation of cross-sectional and longitudinal evidence to assess decisive differences in terms of prognosis and/or treatment outcome.
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Affiliation(s)
- R Emshoff
- Department of Oral and Maxillo-Facial Surgery, University of Innsbruck, A-6020 Innsbruck, Austria.
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Brooks SL. Basic Principles of MR Imaging. Oral Maxillofac Surg Clin North Am 2001. [DOI: 10.1016/s1042-3699(20)30110-2] [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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Rudisch A, Innerhofer K, Bertram S, Emshoff R. Magnetic resonance imaging findings of internal derangement and effusion in patients with unilateral temporomandibular joint pain. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2001; 92:566-71. [PMID: 11709695 DOI: 10.1067/moe.2001.116817] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the relationship between the presence of temporomandibular joint (TMJ) pain and the magnetic resonance (MR) imaging findings of internal derangement (ID) and effusion. STUDY DESIGN The study was comprised of 41 consecutive patients with TMJ pain. Criteria for including a patient were report of unilateral pain near the TMJ, with the presence of unilateral TMJ pain during palpation, function, and/or unassisted or assisted mandibular opening, and the absence of a specific clinical TMJ-related diagnosis of disk displacement with or without reduction. Bilateral sagittal and coronal MR images were obtained to establish the presence or absence of TMJ ID or effusion, or both. RESULTS Comparison of the TMJ side-related data showed a significant relationship between the clinical finding of TMJ pain and the MR imaging diagnoses of TMJ ID (P =.001), and TMJ effusion (P =.004). Furthermore, there was a significant relationship between the MR imaging diagnosis of TMJ ID and TMJ effusion (P =.000). Use of the kappa statistic test indicated poor diagnostic agreement between the presence of TMJ pain and the MR imaging diagnosis of TMJ ID (kappa = 0.34), TMJ effusion (kappa = 0.32), and TMJ ID and effusion (kappa = 0.27). CONCLUSIONS The study's findings suggest that although clinical pain is correlated with TMJ-related MR imaging findings, clinical pain in and of itself is not reliable for predicting the presence of TMJ ID or effusion, or both. Therefore, MR imaging appears to be a warranted and necessary supplement to the clinical findings.
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Affiliation(s)
- A Rudisch
- Department of Magnetic Resonance Imaging and Radiology, University of Innsbruck, Austria
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Shaefer JR, Jackson DL, Schiffman EL, Anderson QN. Pressure-pain thresholds and MRI effusions in TMJ arthralgia. J Dent Res 2001; 80:1935-9. [PMID: 11706955 DOI: 10.1177/00220345010800101401] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
It has been suggested that MRI-depicted effusions identify patients with TMJ arthralgia. The Research Diagnostic Criteria (RDC) propose a pressure-pain threshold (PPT) of 1 pound for the identification of TMJ arthralgia. The hypotheses in this study were that: (1) there is no association between MRI-depicted effusions and TMJ arthralgia, and (2) a PPT of 1 pound does not discriminate between subjects with and those without arthralgia. Thirty females with TMJ disc displacement with reduction were divided into two groups based on the presence or absence of the self-report of TMJ pain. Bilateral TMJ PPTs and MRIs were obtained. Increasing palpation pressure from 1 to 3 pounds increased the sensitivity for identifying arthralgia from 22% to 100%, with a corresponding decrease in the specificity from 100% to 81%. The sensitivity and specificity of effusions for identifying arthralgia were 85% and 28%, respectively. These results suggest that the use of palpation pressures greater than 1 pound is a valid test for TMJ arthralgia. However, TMJ effusions lack adequate specificity for identifying TMJ arthralgia and were not associated with pain.
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Affiliation(s)
- J R Shaefer
- Department of Diagnostic and Surgical Sciences, University of Minnesota, School of Dentistry, Minneapolis, USA.
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Segami N, Nishimura M, Kaneyama K, Miyamaru M, Sato J, Murakami KI. Does joint effusion on T2 magnetic resonance images reflect synovitis? Comparison of arthroscopic findings in internal derangements of the temporomandibular joint. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2001; 92:341-5. [PMID: 11552156 DOI: 10.1067/moe.2001.117808] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to clarify the characteristics of joint effusion (JE) in the temporomandibular joint by comparing T2-weighted magnetic resonance (MR) images with arthroscopic findings. STUDY DESIGN MR images of 47 symptomatic temporomandibular joints (47 patients) with internal derangement associated with painful hypomobility were taken to evaluate the degree of JE on a scale of 0 to 3. Within 2 months after MR images, arthroscopic findings with respect to the severity of synovitis, adhesion, and degenerative change in the superior compartment were each quantitatively assessed on a scale of 0 to 10. The arthroscopic scores were compared among the 4 JE grades, as well as between 2 groups, effusion-present (grades 2 and 3) and effusion-absent (grades 0 and 1), by using the Spearman correlation coefficient and the Mann-Whitney U test. RESULTS The distribution of JE was as follows: 10 joints had grade 0, 5 joints had grade 1, 19 joints had grade 2, and 13 joints had grade 3. The synovitis score had a significant relationship to the degree of effusion (P =.0012) and was higher in the effusion-present group (6.4 +/- 2.0) than in the effusion-absent group (4.2 +/- 1.6) (P =.0005) On the other hand, there was no statistically significant correlation between either adhesion or degenerative change and effusion. CONCLUSIONS JE may reflect synovitis; however, the nature of JE itself needs to be further elucidated by additional studies.
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Affiliation(s)
- N Segami
- Department of Oral and Maxillofacial Surgery, Kanazawa Medical University, Uchinada, Ishikawa Prefecture, Japan.
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Larheim TA, Katzberg RW, Westesson PL, Tallents RH, Moss ME. MR evidence of temporomandibular joint fluid and condyle marrow alterations: occurrence in asymptomatic volunteers and symptomatic patients. Int J Oral Maxillofac Surg 2001; 30:113-7. [PMID: 11405445 DOI: 10.1054/ijom.2000.0018] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The purpose of this study was to estimate the frequency and amount of temporomandibular joint (TMJ) fluid, as well as the frequency and type of condyle marrow alterations in asymptomatic volunteers and compare to patients with TMJ pain and dysfunction. Proton-density and T2 weighted magnetic resonance (MR) images of the TMJs of 62 asymptomatic volunteers and 58 symptomatic patients were analysed for fluid and condyle marrow alterations as well as disk position. The amount of fluid (increased T2 signal) was characterized as none, minimal, moderate or marked and related to the disk position. The differentiation between moderate and marked fluid was based on the maximum amount of fluid seen in the volunteers; more than this amount was categorized as marked fluid. The marrow of the mandibular condyle was categorized as normal, edema (increased T2 signal) or sclerosis (decreased proton-density and T2 signal) and related to fluid and disk position. In the 62 asymptomatic volunteers, 50 (81%) had none or minimal and 12 (19%) had moderate TMJ fluid. In the 58 symptomatic patients, 40 (69%) had none or minimal and 18 (31%) had moderate or marked fluid. Both in volunteers and patients, moderate fluid could be seen in joints with normal disk position, but was significantly associated with disk displacement. In the 62 volunteers, no signal abnormalities in the condyle marrow were found. In the 58 patients, six (10%) had abnormal bone marrow. These six patients had disk displacement and two had moderate or marked fluid. Marked fluid and condyle marrow abnormalities were therefore not encountered in any of the asymptomatic volunteers but in about 10% of the patients.
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Affiliation(s)
- T A Larheim
- Department of Maxillofacial Radiology, Faculty of Dentistry, University of Oslo, Norway.
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Chu SA, Suvinen TI, Clement JG, Reade PC. The effect of interocclusal appliances on temporomandibular joints as assessed by 3D reconstruction of MRI scans. Aust Dent J 2001; 46:18-23. [PMID: 11355235 DOI: 10.1111/j.1834-7819.2001.tb00269.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Magnetic resonance imaging (MRI) enables simultaneous visualization of hard and soft tissues. The aims of the present study were to computer generate three-dimensional (3D) images, reconstructed from MRI scans of normal temporomandibular joints (TMJ), to assess the relative positions of the disc, condyle and articular surface of the temporal bone and to study the effect of two mandibular group function interocclusal appliances (IOAs). Bilateral MRI scans of 2 mm slice thickness were generated for the TMJs of 12 asymptomatic subjects with the image acquisition coils orientated in a corrected oblique sagittal plane. MRI scans were generated for all subjects with 3 mm interincisal distance IOAs, while a subgroup (n = 4) was also scanned with a 5 mm interincisal IOA in situ. An average of 10 slices through each TMJ were generated for the closed mouth and IOA positions. Three-dimensional reconstruction was performed on a 486 IBM compatible computer using a suite of nine programs not commercially available. Three-dimensional images allowed visualization of composite images of joint relationships. Subjective assessment indicated that joint relations in 3D were more informative than multiple separate 2D MRI scans. With the 3 mm IOA in situ, the disc was positioned posteriorly and superiorly to the condyle in three of 12 cases. In four of 12 cases the condyle, and in two of 12 cases both the disc and condyle, were positioned anteriorly and inferiorly. With the 5 mm IOA changes in condyle/disc and condyle/fossa relationships were more variable. It was concluded that 3D images of TMJs enabled the assessment of the positional changes of the condyle/disc and condyle/fossa relationships as altered by IOAs. However, the role of IOAs on the internal arrangements within the TMJ remains variable and is deserving of further study.
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Affiliation(s)
- S A Chu
- School of Dental Science, University of Melbourne
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Hamada Y, Kondoh T, Takada N, Seto K. MRI and arthroscopic findings in the temporomandibular joint after mandibulectomy including the unilateral condyle. Int J Oral Maxillofac Surg 2000. [DOI: 10.1016/s0901-5027(00)80048-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hamada Y, Kondoh T, Nakaoka K, Seto K. Magnetic resonance imaging findings and clinical symptoms in the temporomandibular joint in patients with mandibular continuity defects. J Oral Maxillofac Surg 2000; 58:487-93; discussion 493-4. [PMID: 10800903 DOI: 10.1016/s0278-2391(00)90007-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study explored the morphologic changes and clinical symptoms related to the temporomandibular joint (TMJ) associated with long-term lack of mandibular continuity. PATIENTS AND METHODS The subjects were 20 patients (40 TMJs) who underwent mandibulectomy including the condyle or segmental mandibulectomy without mandibular reconstruction more than 6 months previous to the study. The 40 TMJs were classified into the following 3 groups: group I: TMJs with a major mandibular fragment including the mandibular body (n = 21), group II: TMJs with a minor mandibular fragment including only the condylar process or the mandibular ramus (n = 10), and group III: TMJs without a condyle (n = 9). All TMJs were examined with respect to disc position, condylar position, bony changes, and appearance of joint effusion on magnetic resonance imaging, as well as for the presence of joint or muscle pain and joint noise. RESULTS The rate of anterior disc displacement was 28.6% in group I, 10.0% in group II, and 100% in group III. All condyles in group I were located in the glenoid fossa. Seven of 10 condyles in group II were dislocated anteriorly out of the glenoid fossa. However, these condyles were situated in the intermediate zone of the disc. Osteoarthritic changes was found in 1 joint in group II. Joint effusion was not observed in group I. However, joint effusion was detected in the posterior region of the upper joint compartment in 7 of 10 TMJs in group H and in 8 of 9 TMJs in group III. In group II, the 7 TMJs with joint effusion were the same joints with anteriorly dislocated condyles. Clinical symptoms of TMJ pain, TMJ noise, or muscular pain were not found in any patients. CONCLUSIONS Partial mandibulectomy does not affect the relationship between the disc and the condyle or the bony condition of the TMJ. The disc without a condyle will become anteriorly displaced with time. The condyle not connected to the mandibular body often dislocates anteriorly out of the glenoid fossa, while retaining a normal relationship with the disc. Joint effusion, which is detected in nonfunctional TMJs, is not associated with an inflammatory reaction in the joint compartment.
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Affiliation(s)
- Y Hamada
- First Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Tsurumi University, Yokohama, Japan
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46
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Sano T, Westesson PL, Larheim TA, Takagi R. The association of temporomandibular joint pain with abnormal bone marrow in the mandibular condyle. J Oral Maxillofac Surg 2000; 58:254-7; discussion 258-9. [PMID: 10716105 DOI: 10.1016/s0278-2391(00)90141-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE This study investigated the association between temporomandibular joint pain and bone marrow alterations in the mandibular condyle seen on magnetic resonance (MR) images. PATIENTS AND METHODS The study was based on 112 temporomandibular joints in 112 patients with disc displacement without reduction. Thirty-four patients with abnormal bone marrow on MR images were compared with a control group of 78 patients with normal bone marrow. The analysis was based on proton density and T2-weighted MR images in the oblique sagittal and coronal planes. The degree of pain was correlated to the status of the bone marrow using statistical methods. RESULTS The degree of pain in joints with abnormal bone marrow was higher than in joints with normal bone marrow signal on MR images (P = .0045). CONCLUSION Because the stage of internal derangement was similar in both groups, more intensive pain appears to be associated with bone marrow alterations.
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Affiliation(s)
- T Sano
- Department of Oral Radiology, Showa University School of Dentistry, Tokyo, Japan.
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Yoshida H, Hirohata H, Onizawa K, Niitsu M, Itai Y. Flexure deformation of the temporomandibular joint disk in pseudodynamic magnetic resonance images. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2000; 89:104-11. [PMID: 10630951 DOI: 10.1016/s1079-2104(00)80024-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to determine correlation of flexure disk deformation during jaw movement with other findings on magnetic resonance images and with clinical signs and symptoms in patients with anterior displacement of the temporomandibular joint disk. STUDY DESIGN T(1)-weighted magnetic resonance images and gradient recalled acquisition in steady state magnetic resonance images were obtained in 62 subjects with flexure deformed disk in the jaw opening phase. Each disk deformation observed on a pseudodynamic image during jaw opening was classified as an upward or downward flexure deformation. The relationships between type of disk deformation, clinical signs and symptoms, and other findings on the magnetic resonance images were statistically analyzed by chi(2) test.Results. Of 80 delineated joints, 30 showed upward deformation and 50 showed downward deformation. There were significant differences between the upward and downward deformations in TMJ sound, TMJ pain, restricted jaw opening, extent of anterior displacement, and presence of disk reduction. CONCLUSIONS The type of disk deformation appeared to correlate with the clinical signs and symptoms and with the progress of internal derangement.
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Affiliation(s)
- H Yoshida
- Department of Oral and Maxillofacial Surgery, Institute of Clinical Medicine, University of Tsukuba, Ibaraki-ken, Japan
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Cooper B, Oberdorfer M, Rumpf D, Malakhova O, Rudman R, Mariotti A. Trauma modifies strength and composition of retrodiscal tissues of the goat temporomandibular joint. Oral Dis 1999; 5:329-36. [PMID: 10561723 DOI: 10.1111/j.1601-0825.1999.tb00099.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Temporomandibular pain is often accompanied by pathologic changes to joint retrodiscal tissues. The substantial representation of females in this condition has encouraged hypotheses which link genetic or hormonally induced abnormalities in tissue composition (type III collagen, type I collagen, type III/type I ratio) to the development of temporomandibular disorders. As this condition is often associated with a history of orofacial trauma, we investigated the functional impact of retrodiscal trauma on the composition and biomechanics of retrodiscal tissues. DESIGN AND METHODS Retrodiscal tissue of female goats received trauma or sham trauma. Following a healing period of 30 days, the tissues were pulled to failure on an extensometer. OUTCOME MEASURES Assessments were made of tissue biomechanical properties (failure force, elastic stiffness, strain distribution). Tissue fragments were assayed for collagens I and III. RESULTS Thirty days after surgical section of retrodiscal tissues, the tissue had reformed, but the composition and biomechanics were substantially changed. Healed tissue manifested less than half the strength of normal tissue (P = 0.02). In addition, the development of tissue strain shifted from a relatively even distribution to a confined region near the retrodiscal-discal attachment zone. It appeared that a large increase in the expression of type III collagen (179.6%; P = 0.038) and the ratio of type III/type I collagen (180.9%; P = 0.011) accounted for these functional changes. CONCLUSIONS We suggest that shifts in collagen expression following injury create shifts in strain development which focus tissue stresses near the interface of the disc and retrodiscal tissue, and that this shift dramatically weakens the tissue and increases the probability of re-injury, inflammation and pain.
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Affiliation(s)
- B Cooper
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, University of Florida, Gainesville FL 32610, USA
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Takahashi T, Nagai H, Seki H, Fukuda M. Relationship between joint effusion, joint pain, and protein levels in joint lavage fluid of patients with internal derangement and osteoarthritis of the temporomandibular joint. J Oral Maxillofac Surg 1999; 57:1187-93; discussion 1193-4. [PMID: 10513864 DOI: 10.1016/s0278-2391(99)90483-4] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to investigate the relationship between the presence of joint effusion, joint pain, and protein levels in joint lavage fluid (JL) of patients with internal derangement (ID) and osteoarthritis (OA) of the temporomandibular joint (TMJ). PATIENTS AND METHODS Thirty-eight joints in 26 patients with ID and OA of the TMJ were studied. Magnetic resonance imaging (MRI) evidence of joint effusion was evaluated in T2-weighted images. Samples of JL were collected from the superior joint space during pumping manipulation, and the protein concentration was measured. The presence of pain was based on joint tenderness or a complaint of pain in the preauricular region during mouth opening or closing. RESULTS Joint effusion was demonstrated in 20 of 25 (80%) painful joints; a significantly higher incidence than in pain-free joints (5 of 13, 38.5%). The mean protein concentration (2.15 mg/mL) in JL from painful joints was significantly higher than in pain-free joints (1.22 mg/mL) (P < .05). Furthermore, the mean protein concentration (2.12 mg/mL) in JL from joints with effusion was significantly higher than in joints without joint effusion (1.27 mg/mL) (P < .05). CONCLUSIONS These data demonstrate that painful joints are more likely to show joint effusion on MRI, and the protein levels in JL recovered from these joints is higher than in pain-free joints. These data also suggested that joint effusion may be related to the inflammatory changes seen in patients with ID and OA.
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Affiliation(s)
- T Takahashi
- Division of Dentistry and Oral Surgery, Akita University School of Medicine, Akita City, Japan.
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Sano T, Westesson PL, Larheim TA, Rubin SJ, Tallents RH. Osteoarthritis and abnormal bone marrow of the mandibular condyle. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1999; 87:243-52. [PMID: 10052383 DOI: 10.1016/s1079-2104(99)70280-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze the relationship between abnormal bone marrow of the mandibular condyle and osteoarthritis. STUDY DESIGN The relationship between abnormal bone marrow and osteoarthritis of the mandibular condyle was analyzed in magnetic resonance images of the temporomandibular joints of 74 patients. Thirty-seven patients had magnetic resonance evidence of abnormal bone marrow, and 37 control patients had magnetic resonance images with normal bone marrow. RESULTS Fifteen of 37 patients with magnetic resonance evidence of abnormal bone marrow had no magnetic resonance evidence of osteoarthritis; the other 22 patients had both abnormal bone marrow and osteoarthritis. CONCLUSIONS Abnormal bone marrow of the mandibular condyle can occur separately from osteoarthritis; nearly one half of the joints with magnetic resonance evidence of abnormal bone marrow did not have any evident osteoarthritis. Abnormal bone marrow may therefore initially represent a separate disease entity. Over time, secondary osteoarthritis probably develops in joints with initial bone marrow abnormalities.
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Affiliation(s)
- T Sano
- Department of Oral Radiology, Showa University School of Dentistry, Tokyo, Japan
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