Alteration of the horizontal mandibular condyle size associated with temporomandibular joint internal derangement in adult females

OBJECTIVES: The purpose of this retrospective study was to analyse the relationship between horizontal size of the mandibular condyle and internal derangement (ID) of the temporomandibular joint (TMJ). METHODS: One hundred and thirty-nine joints in 88 women aged over 18 years were included in this study. The horizontal condylar size was measured in the antero-posterior and medio-lateral (ML) dimensions using axial magnetic resonance (MR) images. Radiological findings of ID were also assessed from MR imaging. RESULTS: The condyles in the joints with permanent disk displacement were smaller than those in joints without displacement in both dimensions (Fisher's protected least significant difference, P<0.05). There were statistically significant correlations between horizontal condylar size in the ML dimension and both disk morphology and radiological stage of ID (Spearman's correlation coefficient by rank, P<0.05). CONCLUSIONS: The results of this study suggest a possible relationship between horizontal condylar size and disk displacement. It is also suggested that the condyle becomes smaller in the ML dimension with advancement of ID.     

Resorption of the lateral pole of the mandibular condyle in temporomandibular disc displacement

OBJECTIVES: To assess the possible relationship between resorption of the superolateral pole of the mandible condyle (RSLC) and TMJ disk displacement. METHODS: Two hundred and seventeen TMJs in 138 patients were studied. Displacement of the disc, degree of displacement and disc configuration were assessed using MRI. RSLC was assessed from a transorbital radiograph. RESULTS: Seventy-two joints (37%) were considered to have RSLC. A significantly higher prevalence of RSLC was found in joints with disc displacement (goodness test of fit for chi-square, P<0.05). A significantly higher prevalence of RSLC was found in joints with advanced disc displacement and advanced disk deformation (Mann-Whitney U-test, P<0.01). CONCLUSIONS: RSLC appears more likely to occur in joints with advanced disc displacement.     

Magnetic resonance imaging of internal derangement of the temporomandibular joint

MRI is currently capable of diagnosing anterior derangements of the temporomandibular joint. Although large prospective studies comparing MRI with conventional modalities have not yet been done, early evidence suggests that findings seen on high-resolution surface coil MR images correlate very well with CT, arthrographic, and surgical findings. Much additional work will need to be performed before MRI of the temporomandibular joint becomes a standard diagnostic tool. However, we believe strongly that it will begin to replace arthrography and CT for diagnosing internal derangements within the next few years.     

Relationship between alteration of horizontal size and bony morphological change in the mandibular condyle

OBJECTIVE: To analyse the relationship between horizontal size and morphological changes on the articular surface and the lateral part of the mandibular condyle. METHODS: The study group comprised 139 joints in 88 women aged over 18 years. Horizontal condylar size was measured in the anteroposterior (AP) and mediolateral (ML) dimensions using axial MR images. Bony morphological change on the articular surface (sagittal change) was assessed on the sagittal MR image, and resorption of the lateral part of the condyle (RLC) was assessed on a plane radiograph in the AP projection. RESULTS: There was no significant relationship between horizontal condylar size and sagittal change. However, condyles with RLC were smaller than those without RLC in the ML dimension. CONCLUSIONS: The results of this study suggest a possible relationship between decreased horizontal condylar size and RLC. It is also suggested that sagittal bone changes do not influence the horizontal size of the condyle.     

MR tomographic diagnosis of internal derangement of the temporomandibular joint]

On the basis of MR imaging studies in 150 temporomandibular joints (TMJ) a classification system for internal derangement of the TMJ was defined. Clinically, internal derangement is characterized by disc displacement and disorders of the mandibular condyle. MR imaging enables a differentiation of early stages (I,II) with disc displacement, the intermediate stage (III), and the later stages (IV,V) with osseous destruction. Optimal diagnostic results (n = 140) allowed the use of proton-density sequences in both open and closed joint positions (TR/TE = 1000/28). Dynamic imaging of the TMJ was performed using fast-gradient echo sequences and a self-developed hydraulic opening device (n = 20). MR imaging has proved to be the method of choice for the pre- and post-therapeutic evaluation of internal derangement of the TMJ.     

Longitudinal MRI follow-up of temporomandibular joint internal derangement with closed lock after successful disk reduction with mandibular manipulation

We present a case of bilateral temporomandibular joint (TMJ) internal derangement with closed lock, which was followed over 11 years using serial MRI after successful disk reduction with mandibular manipulation. MRI of the bilateral TMJs before and after mandibular manipulation followed by anterior repositioning splint showed that the disk improved from non-reducible to reducible, and that the reducing disk persisted for 11 years, although minor changes in configuration and position of the disk occurred. These MRI findings suggest that non-surgical treatment with successful mandibular manipulation prevents progressive changes in the TMJ. This case report complements observations regarding the longitudinal course of TMJ internal derangement with closed lock after non-surgical treatment.     

颞颌关节内错乱的直接矢状面CT检查

This paper reported the preliminary experience of direct sagittal CT of temporomandibular joint (TMJ) and its modalities of TMJ was made. By using a specially devised table, the bony structure and disc of TMJ can be well demonstrated. The major advantage of this technique is direct demonstration of the articular disc and a diagnosis of anteriorly displaced meniscus which is reducible or irreducible can thus be made. The application of CT in internal derangement of TMJ will open up new insight into the diagnosis and management of these patients.     

Flattening of the articular eminence correlates with progressive internal derangement of the temporomandibular joint

OBJECTIVES: To test the hypothesis that flattening of the slope of the articular eminence occurs with progressive internal derangement (ID) of the TMJ. METHODS: MR images of 170 TMJs in 130 patients with proven disk displacement were studied. The correlation between the prevalence of a flattened articular eminence and radiological stage of ID was analysed. RESULTS: The prevalence of a flattened articular eminence was significantly higher in the joints with advanced ID (Mann-Whitney's U-test, P < 0.05). CONCLUSIONS: It appears that a flattening of the slope of the articular eminence occurs as a result of remodeling or degenerative changes secondary to ID.     

Relationship between temporomandibular joint (TMJ)-related pain and morphological changes of the TMJ condyle in patients with temporomandibular disorders

OBJECTIVES: The purpose of this study was to analyse the relationship between temporomandibular joint (TMJ)-related pain and morphological change of the TMJ condyle in patients with temporomandibular disorders. METHODS: Data were obtained from 178 joints in 89 patients. The joints were clinically assessed for pain on mandibular function and on lateral palpation of the TMJ. They were also assessed for radiographic evidence of bone change at the articular surface (OAAS) and resorption of the lateral part of the condyle (RLC). RESULTS: A higher prevalence of joint pain on function was observed in joints with OAAS than in those without OAAS (Chi-square test of independence, P < 0.05). Significant relationships were found between palpation pain and OAAS and between palpation pain and RLC (Chi-square test of independence, P < 0.05). In addition, patients with RLC showed a significantly lower pain threshold for external mechanical stimuli than those without RLC (Welch's t-test, P < 0.05). CONCLUSIONS: These results suggest a possible relationship between pain on function and OAAS as well as a relationship between palpation pain and RLC. Pain on lateral palpation may be related to the pathological conditions that induce RLC.     

Bilateral bifid mandibular condyle associated with ankylosis of the temporomandibular joint in a 6-year-old child

Bifid mandibular condyle with ankylosis is an extremely rare condition and may arise as a developmental or traumatic defect. We report here a case of bilateral bifid mandibular condyle with ankylosis in a 6-year-old child. The patient had severe limitation of mouth opening and history of trauma 2 years ago.     

Bifid mandibular condyle with temporomandibular joint ankylosis: report of two cases and review of literature

Bifid mandibular condyle is an uncommon entity with a controversial etiology. It can be developmental or acquired and rarely may be associated with temporomandibular joint (TMJ) ankylosis. Although the patient may be asymptomatic, the radiologist should be aware of this entity and its clinical implications. We report two cases of BMC, one developmental and the other secondary to trauma. Both were diagnosed using computed tomography, which additionally revealed the associated ankylosis of TMJ in both the patients.     

Recent developments in understanding temporomandibular joint disorders. Part 1: Bone marrow abnormalities of the mandibular condyle

Improvements in diagnostic imaging of the temporomandibular joint in the past 20 years have shown that disk displacement is the most frequent abnormality in patients with joint pain and dysfunction. The aetiology of the pain is poorly understood. Recent studies with magnetic resonance imaging have demonstrated a number of other changes in the TMJ. In this paper I review the possible significance of alterations in the condylar bone marrow and its relationship to osteonecrosis.     

Cytokine profile in synovial fluid from patients with internal derangement of the temporomandibular joint: a preliminary study

OBJECTIVES: Temporomandibular joint disorders (TMD) comprise a group of chronic painful conditions of mastication in the temporomandibular joint (TMJ). Although the association between TMD and internal derangement of the TMJ is well documented, the functional relevance is still unclear. Increased concentrations of inflammatory mediators have been identified in the synovial fluid of affected patients with TMD, suggesting an underlying degenerative or inflammatory process. The aim of this study was to generate a comprehensive cytokine expression profile in TMD. METHODS: 15 samples from patients with internal derangement of TMJ were analysed using a novel cytokine array that enables the analysis of 79 different cytokines simultaneously. RESULTS: Cytokine levels were correlated with the presence of joint effusion (JE) determined by MRI. In the majority of synovial fluid samples, angiogenin (Ang), fibroblast growth factor (FGF)-9, insulin-like growth factor-binding protein (IGFBP)-3, interleukin (IL)-1alpha, IL-1beta, IL-8, inducible protein (IP)-10, macrophage inflammatory protein (MIP)-1beta, osteoprotegerin (OPG), transforming growth factor (TGF)-beta2, tissue inhibitor of metalloproteinase (TIMP)-1, TIMP-2, tumour necrosis factor (TNF)-beta and vascular endothelial growth factor (VEGF) were detectable. Furthermore, the expression levels of Ang, brain-derived neurotrophic factor (BDNF), FGF-4, FGF-9, IGFBP-2, IL-8, MIP-1beta, OPG, pulmonary and activation-regulated protein (PARC), TGF-beta2, TIMP-2 and VEGF were significantly associated with the presence of JE; among these, nine cytokines (Ang, BDNF, FGF-4, FGF-9, IGFBP-2, MIP-1beta, PARC, TGF-beta2 and TIMP-2) were hitherto not described in TMD. CONCLUSIONS: This study confirmed previous reports of elevated cytokine levels in TMD. Additionally, we identified previously undescribed cytokines that were upregulated and correlated significantly with the presence of JE. We were able to identify novel cytokines that have hitherto not been described in TMD. Strategies targeting the identified cytokines may represent a novel therapy option in TMD.     

Radiographic changes in the condyle of the temporomandibular joint in psoriatic arthritis

One hundred and ten patients with psoriatic arthritis (PA) and 100 matched control patients were examined by using orthopantomography to discover radiographic changes in the condyle of the temporomandibular joint (TMJ). Thirty-one per cent of the PA patients and 13 per cent of the control patients had radiographic changes in the condyle of the TMJ. The most common radiographic finding in PA patients was unilateral erosion of the condyle. Of the radiographic changes in the PA group, cortical erosions correlated negatively with age, whereas osteophytes correlated positively with the duration of PA.     

Temporomandibular joint internal derangement: relationship between joint pain and MR grading of effusion and total protein concentration in the joint fluid

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.     

Pathologic changes of the lateral pterygoid muscle in patients with derangement of the temporomandibular joint disk: objective measures at MR imaging

BACKGROUND AND PURPOSE: The superior head of the lateral pterygoid muscle (SHLP), which inserts on the anterior disk of the temporomandibular joint (TMJ), can spasm, contracting and exerting forward traction on the disk. This mechanism can lead to anterior displacement. In TMJ dysfunction, it is hypothesized that the SHLP will demonstrate morphologic changes with measurable changes in signal intensity related to atrophy or muscular edema, or both. The goal of this study was to evaluate the lateral pterygoid muscle (LPM) in patients with TMJ dysfunction. MATERIALS AND METHODS: Patients with displacement of the TMJ disk with and without reduction were identified through a review of radiology reports. Absolute measurements of thickness as well as region-of-interest measurements were placed over the 2 heads of the LPM bilaterally on sagittal T1- and T2-weighted images. Statistically significant differences between the superior and inferior heads of the LPM were calculated with use of a 1-tailed Student t test and were correlated with the degree of disk derangement. RESULTS: In patients with disk derangement, significantly increased region-of-interest values on T2- and T1-weighted images were demonstrated within the SHLP. No patients with anatomically normal disks demonstrated a statistically significant difference in region-of-interest values between the superior and inferior heads of the LPMs. CONCLUSION: Correlation between increased region-of-interest values and pathologic alteration of the relationship between the condylar head and disk was identified. In patients with displacement of the anterior disk with and without reduction, region-of-interest values were significantly increased, which indicates abnormal signal intensity involving the superior head of the LPM.     

The accuracy of dynamic Magnetic Resonance Imaging in evaluation of internal derangement of the temporomandibular joint; comparison with arthroscopic findings

Purpose

To determine the correlation between dynamic Magnetic Resonance Imaging (MRI) and arthroscopy findings in internal derangement of the temporo-mandibular joint (TMJ).

Material and methods

This study was conducted on 25 patients (of 28 TMJs), 18 females and 7 males their age ranging from 20 to 42 years (mean 31 years). All patients were submitted to MRI examination of the TMJ. All of these patients underwent arthroscopy for diagnosis and treatment and results were compared with dynamic MRI findings.

Results

Concerning disc position, MR examination revealed 24 TMJs out of 28 (85.7%) with anteriorly displaced discs, while 4 TMJs (15.3%) showed normal disc position. When type of displacement was considered, MRI revealed 8 TMJs (28.7%) with anterior disc displacement with reduction (ADDWR), while 16 TMJs (57.1%) with anterior disc displacement without reduction (ADDWOR). While arthroscopy revealed 6 TMJs out of 28 (21.4%) with ADDWR, 14 TMJs (50%) showed ADDWOR and 8 TMJs (28.6%) with normal disc position.MRI assessment of disc mobility revealed 12 out of 28 TMJs (42.8%) with limited asynchronous movements, while 3 TMJs (10.7%) with stuck disc, and 13 TMJs (46.4%) with normal mobility. While arthroscopy revealed 11 out of 28 TMJs (39.2%) with limited disc mobility, 1 TMJs (3.5%) with stuck disc, and 16 TMJs (57.1%) with normal mobility.The results of this study showed no significant statistical difference between arthroscopy and MRI in diagnosing disc position and disc mobility.

Conclusions

Both arthroscopy and dynamic MRI are statistically correlated with each other in detecting TMJ internal derangement. Nevertheless, reviewing the results highlighted the advantages of MRI augmented by dynamic protocol over arthroscopy in diagnosing disc position and mobility and hence, we recommend using MRI as a first line diagnostic modality when internal derangement is suspected.     

The accuracy of sonography for evaluation of internal derangement of the temporomandibular joint in asymptomatic elementary school children: comparison with MR and CT

BACKGROUND AND PURPOSE: In order to clarify the incidence and evolution of disk displacement in the temporomandibular joint (TMJ) in children, we performed a longitudinal analysis in 18 subjects. Some investigators have suggested that sonography can provide information about the articular disk position of the TMJ. The purpose of this study was to determine the diagnostic accuracy of sonography for revealing internal derangement of the TMJ in elementary school children compared with our standard of reference, MR imaging and helical CT. METHODS: Eighteen children were examined using both sonography and MR imaging or helical CT or both. The sonographically revealed distance between the articular capsule and the lateral surface of the mandibular condyle was measured and compared with that obtained by MR or helical CT scanning. RESULTS: Compared with our MR/CT standard of reference, sonography revealed a sensitivity of 83%, a specificity of 96%, and an accuracy of 92% for identifying disk displacement (defined as a distance of 4 mm or more between the articular capsule and the lateral surface of the mandibular condyle). CONCLUSION: Although sonography's sensitivity, specificity, and accuracy for the diagnosis of disk displacement were slightly inferior to those of MR or helical CT, we assert it is a useful imaging method for longitudinal investigations of a large group of elementary school children. Internal derangement of the TMJ should be suspected if sonography reveals a distance between the articular capsule and the lateral surface of the mandibular condyle of 4 mm or more.     

A study of the relationship between the position of the condylar head and displacement of the temporomandibular joint disk.

OBJECTIVES: To examine the possible relationship between condylar position and disk displacement in the TMJ. METHODS: Forty-eight joints with no disk displacement (NDD), 84 joints with a reducible displaced disk (RDD) and 99 joints with a permanently displaced disk (PDD) were selected. The positions of the condyle and TMJ disk were calculated from lateral MR images. RESULTS: There were significant differences in condylar position between the joints with NDD and RDD, while there was no difference between those with NDD and PDD (Kruskal-Wallis and post-hoc test, P<0.05). There was also a significant correlation between the position of the condylar and the displaced disk (Spearman's rank correlation, P<0.05). The condyle was located more anteriorly with advancing disk displacement. CONCLUSIONS: We suggest that if the disk displacement is slight, the condyle is displaced posteriorly: as the disk displacement becomes more severe (i.e. more anteriorly displaced), the condyle returns to the concentric position.