Temporomandibular joint internal derangement type III: relationship to magnetic resonance imaging findings of internal derangement and osteoarthrosis. An intraindividual approach.

The purpose of this study was to investigate whether in patients with a clinical unilateral temporomandibular joint (TMJ)-related finding of internal derangement type (ID)-III (disk displacement without reduction) in combination with TMJ-related pain, the intraindividual variable of 'unilateral TMJ ID-III pain' may be linked to subject-related magnetic resonance (MR) imaging findings of TMJ ID, and TMJ osteoarthrosis (OA). The study comprised 48 consecutive TMJ pain patients, who were assigned a clinical unilateral TMJ pain side-related diagnosis of ID-III. Bilateral sagittal and coronal MR images were obtained to establish the presence or absence of TMJ ID and/or OA. Comparison of the TMJ side-related data showed a significant relationship between the clinical finding of TMJ ID-III pain and the MR imaging diagnoses of TMJ ID (P=0.000) and TMJ ID type (P=0.000). There was no correlation between the clinical finding of TMJ ID-III pain and the MR imaging diagnosis of TMJ OA (P=0.217), nor between the MR imaging diagnosis of TMJ OA and that of TMJ ID (P=0.350). Regarding the diagnostic subgroups of TMJ ID, a significant relationship was found between the presence of TMJ OA and the MR imaging diagnoses of TMJ ID type(P=0.002). Use of the Kappa statistical test indicated a fair diagnostic agreement between the presence of TMJ ID-III pain and the MR imaging diagnosis of disk displacement without reduction (DDNR) (K=0.42). The results suggest that TMJ ID-III pain is related to TMJ-related MR imaging diagnoses of ID. Further, the data confirm the biological concept of 'DDNR and OA' as an underlying mechanism in the etiology of TMJ-related pain and dysfunction.     

Magnetic resonance imaging findings of internal derangement in temporomandibular joints without a clinical diagnosis of temporomandibular disorder

The purpose of this study was to assess the prevalences of magnetic resonance (MR) imaging findings of internal derangement (ID) in temporomandibular joints (TMJs) without a specific clinical diagnosis of temporomandibular disorder (TMD), and to investigate whether in this TMJ group the variable of pain may be linked to MR imaging findings of ID. The study comprised 109 patients, who were assigned a clinical uni- or bilateral TMJ-related diagnosis of 'absence of TMD'. Bilateral sagittal and coronal MR images were obtained subsequently to establish the prevalence of TMJ ID. An MR imaging diagnosis of ID was found in 99 (55.9%) of the 177 TMJs investigated. About 30.3% of the closed mouth-related TMJ positions characterized by disc displacement presented with anterior disc displacement, while 27.3% had anterolateral and 25.3% anteromedial disc displacement. Analysis of the data revealed the presence of TMJ pain to be associated with significantly more MR imaging diagnoses of disc displacement without reduction than disc displacement with reduction (P < 0.05), while there was no significant difference in the prevalences of ID and those of absence of ID (P > 0.05). Using chi-square analysis, no significant relationship was found between the presence of TMJ pain and the MR imaging diagnosis of TMJ ID (P=0.93). Use of the kappa statistical test indicated poor diagnostic agreement between the presence of TMJ pain and the MR imaging diagnosis of ID (kappa=0.01). The results suggest TMJs with a clinical diagnosis of 'absence of TMD' to be associated with a high rate of IDs, while in these instances the clinical variable of TMJ pain may have no effect on prevalences of MR imaging diagnoses TMJ ID. The data confirm the aspect of clinical diagnostic criteria as an unreliable instrument in predicting MR imaging diagnoses of TMJ ID.     

Magnetic resonance imaging findings of internal derangement and effusion in patients with unilateral temporomandibular joint pain.

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.     

The role of salivary function in modulating chemotherapy-induced oropharyngeal mucositis: a review of the literature

OBJECTIVES: We sought to investigate whether the finding of temporomandibular joint (TMJ)-related pain may be linked to magnetic resonance (MR) imaging findings of TMJ internal derangement and TMJ osteoarthrosis. STUDY DESIGN: The study consisted of 194 consecutive TMJ patients. Criteria for including a patient with a painful TMJ were as follow: report of orofacial pain in the TMJ, with the presence of unilateral or bilateral TMJ pain during palpation, function, and unassisted or assisted mandibular opening. Criteria for including a patient with a nonpainful TMJ were as follow: absence of a TMJ with pain during palpation, function, and unassisted or assisted mandibular opening. Application of the criteria resulted in a study group of 150 patients with unilateral TMJ pain, 10 with bilateral TMJ pain, and 34 without TMJ pain. Bilateral sagittal and coronal MR images were obtained to establish the presence or absence of TMJ internal derangement or osteoarthrosis, or both. RESULTS: A comparison of the TMJ-related data showed a significant relationship between the clinical finding of TMJ pain and the MR imaging diagnoses of TMJ internal derangement (P =.002) and TMJ osteoarthrosis (P =.004). Significant increases in risk of pain occurred with "disk displacement without reduction and osteoarthrosis" (P =.000), "disk displacement without reduction and absence of osteoarthrosis" (P =.000), and "disk displacement with reduction and osteoarthrosis" (P =.036). CONCLUSIONS: The results suggest that TMJ-related pain is correlated with TMJ-related MR imaging diagnoses of internal derangement and osteoarthrosis. The data confirm the biological concept of "internal derangement and osteoarthrosis," yet re-emphasize that internal derangement and osteoarthrosis may not be regarded as the unique and dominant factors in the definition of TMJ pain.     

Diagnosing TMJ internal derangement and osteoarthritis with magnetic resonance imaging.

BACKGROUND: The authors conducted a study to investigate the relationship between the presence of temporomandibular joint, or TMJ, pain and magnetic resonance imaging, or MRI, findings of internal derangement, or ID, and arthritis, or OA. METHODS: The authors studied 131 consecutively seen TMJ pain patients. Their criteria for including a patient in the study were report of unilateral orofacial pain referred to TMJ and the presence of unilateral TMJ pain during palpation, function, and unassisted or assisted mandibular opening. The authors took bilateral sagittal and coronal MRIs to establish the presence or absence of TMJ ID, OA or both. RESULTS: When the authors compared TMJ side-related data from all subjects, they found a significant relationship between the clinical findings of TMJ pain and the MRI diagnoses of TMJ ID (P = .000) and TMJ OA (P = .013). They also found a significant relationship between the MRI diagnosis of TMJ ID type and that of TMJ OA (P = .000). The authors used the kappa statistical test and found poor diagnostic agreement between the presence of TMJ pain and the MRI diagnosis of TMJ ID (kappa = 0.21), TMJ OA (kappa = 0.15), and TMJ ID and OA combined (kappa = 0.18). CONCLUSIONS: The study's findings suggest that while clinical pain is related to TMJ-related MRI findings, the presence of clinical pain is not a reliable predictor of TMJ ID, OA or both. CLINICAL IMPLICATIONS: Using MRI to supplement clinical findings of TMJ pain appears warranted and necessary to establish the presence or absence of TMJ ID.     

Are internal derangement and osteoarthrosis linked to changes in clinical outcome measures of arthrocentesis of the temporomandibular joint?

PURPOSE: Arthrocentesis and hydraulic distention of the temporomandibular joint (TMJ) have been described as an effective modality in the treatment of patients with clinical findings consistent with the diagnosis of disc displacement without reduction. The purpose of this study was to investigate whether the magnetic resonance (MR) imaging variables of internal derangement (ID) and osteoarthrosis (OA) and the presence of capsulitis/synovitis (C/S) may be linked to changes in TMJ signs and symptoms associated with the performance of arthrocentesis and hydraulic distention. PATIENTS AND METHODS: The study consisted of 27 TMJ pain patients, who were assigned a clinical unilateral TMJ diagnosis of ID type III (disc displacement without reduction). Bilateral sagittal and coronal MR images were obtained immediately preoperatively and at a 2-month follow-up to establish the presence or absence of ID and OA. TMJ pain level of function and mandibular range of motion were assessed preoperatively and compared with the respective 2-month follow-up findings. RESULTS: The pretreatment data revealed a significant relationship between the clinical finding of TMJ pain and the MR imaging findings of ID (P <.001), ID type (P <.001), and OA (P <.05). At 2-month follow-up, clinical evaluation showed a significant reduction in TMJ pain during function (P <.001), a significant reduction in the clinical diagnoses of ID type III (P <.05), and a significant increase in mandibular range of motion (P <.05). There was no change in the prevalence rates of associated MR imaging diagnoses of TMJ ID and/or OA. CONCLUSION: The study findings suggest that clinical pain is related to TMJ-related MR imaging findings of ID and OA. These diagnoses proved not to be linked to changes in therapeutic outcome measures of TMJ pain and mandibular range of motion.     

Magnetic resonance imaging findings of osteoarthrosis and effusion in patients with unilateral temporomandibular joint pain

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.     

Risk factors for temporomandibular joint pain in patients with disc displacement without reduction - a magnetic resonance imaging study

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.     

Prognostic indicators of the outcome of arthrocentesis: a short-term follow-up study

OBJECTIVES: Arthrocentesis of the temporomandibular joint (TMJ) is purported to be an effective modality in the treatment of patients with closed-lock symptoms. The purpose of this study was to determine whether the clinical findings of disk displacement without reduction associated with pain in the TMJ are related to the discovery of TMJ osteoarthrosis (OA) through the use of magnetic resonance (MR) imaging and whether the presence of OA affects the treatment outcome of patients who undergo arthrocentesis of the TMJ. STUDY DESIGN: The study population consisted of 38 patients with TMJ pain who were assigned a clinical diagnosis of unilateral internal derangement (ID) of the TMJ, type III (disk displacement without reduction), in combination with capsulitis/synovitis (C/S) and an MR imaging diagnosis of disk displacement without reduction in the painful TMJ only. Before the patients underwent arthrocentesis, bilateral sagittal and coronal MR images were obtained to confirm the presence or absence of ID and OA. The preoperative and postoperative levels of TMJ function with respect to pain and mandibular range of motion were evaluated and compared. Multiple logistic regression analysis was used to compute the odds ratios for successful outcomes for OA (n = 24) versus unsuccessful outcomes for TMJs (n = 14). RESULTS: The preoperative data revealed a significant relationship between the clinical diagnosis of TMJ ID type III with C/S and the discovery of OA on MR images (P =.048). At the 2-month follow-up, a clinical evaluation revealed a significant reduction in TMJ pain during function (P =.000); a significant reduction in the clinical diagnoses of ID type III (P =.000), and C/S (P =.000); and a significant increase in the mandibular range of motion (P =.000). The patients with successful outcomes were more likely to be associated with an MR imaging finding of OA than were the patients with unsuccessful outcomes. (10.4 odds ratio; P =.016). CONCLUSIONS: Our preliminary findings suggest that the presence of OA revealed on MR images is related to clinical pain; furthermore, OA proved to be an important prognostic determinant of successful arthrocentesis.     

Clinical versus magnetic resonance imaging findings with internal derangement of the temporomandibular joint: an evaluation of anterior disc displacement without reduction.

PURPOSE: The purpose of this study was to investigate whether the clinical finding of anterior disc displacement without reduction (ADWOR) and pain in the temporomandibular joint (TMJ) is correlated to the magnetic resonance imaging (MRI) findings of TMJ internal derangement (ID). PATIENTS AND METHODS: The TMJ group was composed of 55 TMJ pain patients who were assigned a clinical diagnosis of unilateral ADWOR. The control group consisted of 58 nonpainful TMJ patients. Sagittal and coronal MR images were obtained to establish the incidence and type of ID. RESULTS: Using chi-square analysis, the results showed a significant relationship between the presence of pain and the MRI diagnosis of ID (P =.000) and its type (P =.000). Use of the kappa statistical test indicated poor diagnostic agreement between the presence of pain and the MRI diagnosis of ID (kappa = 0.37) and disc displacement with reduction (kappa = 0.20). The diagnostic agreement for disc displacement without reduction was 78.8%, with a corresponding kappa-value of 0.58, indicating fair agreement between the clinical and the MRI diagnosis. CONCLUSION: The results suggest that TMJ pain associated with ADWOR is correlated with MRI diagnoses of ID and the ID type. These data confirm the use of the clinical diagnostic criteria for disc displacement without reduction as a reliable method of predicting similar MRI diagnoses.     

Effect of temporomandibular joint arthrocentesis on synovial fluid mediator level of tumor necrosis factor-alpha: implications for treatment outcome

Temporomandibular joint (TMJ) pain is a predominant sign and symptom in patients with temporomandibular disorder, and a common cause of chronic orofacial pain. Arthrocentesis of the upper joint space proved to be effective in reducing TMJ-related pain and reestablishing normal mandibular range of movement in patients diagnosed for a 'closed lock'. Using the therapeutic approach of arthrocentesis in TMJ-related instances of capsulitis/ synovitis (C/S) with a recency of first pain onset of < or =6 months, the purpose of the present study was to evaluate whether the TMJ-related variable synovial fluid (SF) level of TNF-alpha may be linked to the cessation of related signs and symptoms associated with the performance of arthrocentesis and hydraulic distension. In 23 patients with a specific temporomandibular disorder diagnosis of unilateral C/S with a recency of first pain onset of < or =6 months, TMJ SF aspirates were obtained from the pain and contralateral non-pain sides immediately before and after arthrocentesis. Visual analog scales were used for pre- and postoperative self-assessment of TMJ-related pain during function, while enzyme-linked immunosorbent assays were applied for measurement of the tumor necrosis factor-alpha (TNF-alpha) concentration. With a mean SF TNF-alpha level of 13.91 ng/ml associated with the pain side, and a mean SF TNF-alpha level of 7.73 ng/ml associated with the non-pain side, a statistically significant difference was found between the sample groups (P=0.001). Arthrocentesis led to a significant intraoperative decrease of the respective preoperative SF TNF-alpha levels, namely 61.64% (P=0.000) on the pain side and 89.50% (P=0.000) on the non-pain side, while reduction of TMJ-related pain during function was 73.17%, (P=0.000). Clinical evaluation showed a significant reduction in the prevalence of TMJ-related diagnoses of C/S (P<0.001). There was no change in the prevalence of associated TMJ-related diagnoses of internal derangement. In view of the fact that the described technique of TMJ SF analysis may be suggested as a valuable diagnostic method for the detection of biochemical SF events, the results of this study should encourage research in its potential uses so that it can become established as a reliable diagnostic approach. Further, the findings may support the concept of bilateral arthrocentesis to be effective in the treatment of patients with a unilateral specific TMD diagnosis of non-chronic C/S.     

Relative odds of temporomandibular joint pain as a function of magnetic resonance imaging findings of internal derangement,osteoarthrosis, effusion,and bone marrow edema

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.     

Temporomandibular joint pain: relationship to internal derangement type, osteoarthrosis, and synovial fluid mediator level of tumor necrosis factor-alpha

OBJECTIVES: The purpose of this study was to investigate whether patients with temporomandibular joint (TMJ)-related pain classified as capsulitis/synovitis may be linked to magnetic resonance imaging (MRI) findings of internal derangement, osteoarthrosis, or the synovial fluid aspirate findings of tumor necrosis factor-alpha (TNF-alpha) level. STUDY DESIGN: The study comprised 23 patients with temporomandibular disorders (TMD), who had nonchronic pain (pain onset < or =6 months) and a unilateral TMJ-related diagnosis of capsulitis/synovitis. Bilateral sagittal and coronal magnetic resonance images were obtained to establish the presence or absence of internal derangement, osteoarthrosis, or both. TMJ synovial fluid aspirates were obtained from the pain and contralateral nonpain sides to determine the TNF-alpha level. RESULTS: Comparison of the TMJ side-related data showed a significant relationship between the clinical TMD diagnosis of capsulitis/synovitis and the MRI diagnoses of TMJ internal derangement (P =.002) and of TMJ internal derangement type (P =.04). The mean TNF-alpha level in synovial fluid aspirates from TMJs assigned a clinical TMD diagnosis of capsulitis/synovitis was significantly higher than in those obtained from contralateral nonpain sides (P =.001). There was no correlation between the clinical diagnosis of capsulitis/synovitis and the MRI diagnosis of TMJ osteoarthrosis (P =.13) or between the MRI diagnosis of TMJ osteoarthrosis and that of TMJ internal derangement (P =.70) or TMJ internal derangement type (P =.33). CONCLUSIONS: The results suggest that the TMJ pain condition of capsulitis/synovitis is related to TMJ-side specific MRI diagnoses of internal derangement and internal derangement type, and synovial fluid aspirate findings of TNF-alpha level. The data confirm the concept of elevated mediator level as a diagnostic approach for patients presenting with TMJ-related pain. MRI and synovial fluid aspirates may be used as diagnostic methods for evaluating TMJ-related pain conditions.     

Determining predictor variables for treatment outcomes of arthrocentesis and hydraulic distention of the temporomandibular joint.

PURPOSE: Arthrocentesis and hydraulic distention of the temporomandibular joint (TMJ) has been described as an effective modality in the treatment of patients demonstrating clinical findings consistent with the diagnosis of disc displacement without reduction. The purpose of this study was to investigate whether the clinical variable of TMJ pain chronicity and the magnetic resonance (MR) imaging variable of osteoarthrosis (OA) may predict treatment outcomes of arthrocentesis and hydraulic distention of the TMJ. PATIENTS AND METHODS: The study consisted of 29 TMJ pain patients, who were assigned a unilateral clinical temporomandibular disorder (TMD) of "TMJ pain associated with an internal derangement (ID) type III (disc displacement without reduction)," and a TMJ pain side-related MR imaging diagnosis of disc displacement without reduction. Bilateral sagittal and coronal MR images were obtained immediately preoperatively to establish the presence or absence of ID and OA. TMJ pain level of function and mandibular range of motion were assessed preoperatively and compared with the respective 2-month follow-up findings. Outcome criteria of success were 1). an absence of signs and symptoms characteristic of a diagnosis of ID type III and/or 2). a reduction in pain level of 85% or greater. A multiple logistic regression analysis was used to compute the odds ratio for TMJ pain chronicity (duration >6 months and <2 years) and OA for successful outcomes versus nonsuccessful outcomes. RESULTS: The pretreatment data revealed no significant relationship between the clinical disorder "TMJ pain associated with ID type III" and the MR imaging finding of OA (P =.103). At 2-month follow-up, clinical evaluation showed a significant reduction in TMJ pain during function (P =.000), a significant reduction in clinical diagnoses of TMDs (P =.000), and a significant increase in mandibular range of motion (P =.000). Significant increase in risk of a nonsuccessful outcome (pain reduction <85%) occurred with TMJ pain chronicity (odds ratio of 41.0) (P =.018). Significant increase in benefit of a successful outcome (absence of ID type III) occurred with TMJ OA (odds ratio 1:16.7, P =.06) (P =.044). CONCLUSIONS: Arthrocentesis in chronic TMJ pain patients was less successful than in nonchronic patients with regard to treatment outcome of pain reduction. Arthrocentesis in patients with TMJ OA was more beneficial with regard to the disappearance of ID type III than in non-OA patients. Predictive modeling may provide clinicians with the opportunity to identify "at-benefit" patients early and initiate specific treatments.     

Effect of arthrocentesis and hydraulic distension on the temporomandibular joint disk position

OBJECTIVE: Recent studies have suggested arthrocentesis and hydraulic distension as an effective treatment modality in patients demonstrating clinical findings consistent with the diagnosis of disk displacement without reduction, normal range of motion thereby being restored and pain of the temporomandibular joint reduced. In view of the fact that only a few studies have been performed to verify the biologic concept of disk displacement without reduction as a diagnostic and therapeutic approach in patients with "closed-lock" symptoms, the purpose of this study was to investigate whether temporomandibular joint-related variable disk position might be linked to cessation of related signs and symptoms associated with the performance of arthrocentesis and hydraulic distension. STUDY DESIGN: The study compared 15 patients, each of whom was assigned a clinical unilateral temporomandibular joint-related diagnosis of internal derangement (ID) type III (disk displacement without reduction) in combination with capsulitis/synovitis. Clinical diagnoses were made according to the Clinical Diagnostic Criteria for Temporomandibular Disorders. Bilateral sagittal and coronal magnetic resonance images were obtained immediately preoperatively and at 2-month follow-up to establish the presence or absence of associated types of ID. Temporomandibular joint-related pain, level of function, and mandibular range of motion were assessed preoperatively and the data were compared with the respective 2-month follow-up findings. RESULTS: Comparison of the pretreatment temporomandibular joint side-related data revealed the temporomandibular joint side with an ID-III in combination with capsulitis/synovitis to be associated with significantly more magnetic resonance imaging diagnoses of ID than of an absence of ID (P <.001) and with significantly more disk displacement without reduction than disk displacement with reduction (P <.001). At the 2-month follow-up, clinical evaluation showed a significant reduction in temporomandibular joint-related pain during function (P <.001), a significant reduction in the prevalence of temporomandibular joint-related diagnoses of capsulitis/synovitis (P <.001) and ID-III (P <.01), and a significant increase in mandibular range of motion (P <.01). There was no change in the prevalence rates of associated temporomandibular joint side-related IDs. CONCLUSIONS: The results confirm the concept of disk displacement as a diagnostic approach but not as a therapeutic approach for patients presenting with signs and symptoms of unilateral ID-III in combination with capsulitis/synovitis. In terms of clinical decision-making in temporomandibular disorder-related instances of ID, magnetic resonance imaging may be used as a diagnostic method for identifying the diagnostic validity of the variable "disk-condyle relationship."     

Validation of the clinical diagnostic criteria for temporomandibular disorders for the diagnostic subgroup - disc derangement with reduction

Research is needed to assess the validity of the clinical diagnostic criteria for temporomandibular disorders (CDC/TMD). The purpose of this study was to test the reliability of the clinical diagnosis of temporomandibular joint (TMJ) internal derangement type (ID)-I as compared with the magnetic resonance imaging (MRI) 'gold standard'. The study comprised 168 TMJs in 84 patients, who were assigned a clinical TMJ-related diagnosis of ID-I (disc displacement with reduction) in at least one TMJ. Bilateral sagittal and coronal MR images were obtained subsequently to establish the corresponding diagnosis of the disc-condyle relationship. For the CDC/TMD interpretations, the positive predictive value (PPV) of ID-I for disc displacement with reduction (DDR) was 44%, and for the presence of an ID 69%. The overall diagnostic agreement for ID-I was 47.6% with a corresponding K-value of 0.05. Most of the disagreement was the result of the false-positive interpretations of ID-I, and false-negative interpretations of an 'absence of ID'. The results suggest CDC/TMD for ID-I to be insufficient reliable for determination of ID and/or DDR. Patients assigned a clinical TMJ-related diagnosis of ID-I may need to be supplemented by evidence from MRI to determine the functional 'disc-condyle relationship'.     

Temporomandibular joint internal derangement: detection with 12.5 MHz ultrasonography

The purpose of this study was to determine whether 12.5 MHz ultrasonography (US) could be used to assess the presence or absence of temporomandibular joint (TMJ) internal derangement (ID). In 48 consecutive patients with TMJ disorders 192 TMJ positions were investigated by US to analyse the functional disc-condyle relationship (DCR). In order to compare the respective findings with those of a diagnostic method offering a high accuracy, coronal and sagittal magnetic resonance imaging was carried out immediately afterwards. With US showing a sensitivity of 0.58 and 0.75, and a specificity of 0.92 and 0.84 for disc displacement with and without reduction, the data revealed US to be marginal in detecting the presence, but sensitive in detecting the absence of the respective types of a TMJ ID. In addition, with a positive predictive value of 0.83 and 0.71, and a negative predictive value of 0.81 and 0.87 for disc displacement with and without reduction, the results indicate that US may be insufficient in establishing a correct diagnosis for the presence or absence of the respective types of TMJ ID. Regarding the diagnosis of absence or presence of TMJ ID, the results demonstrate high-resolution (HR)-US to be sensitive in detecting the absence, and reliable in predicting the presence of TMJ ID. In view of the fact that the 12.5 MHz US technique proved to be a reliable diagnostic aid for the detection of normal, and the prediction of abnormal DCR, the results of this study should be of further interest and encourage research in its potential uses and diagnostic capabilities.     

MR grading of temporomandibular joint fluid: association with disk displacement categories, condyle marrow abnormalities and pain

The purpose of this study was to investigate temporomandibular joint (TMJ) effusion on magnetic resonance (MR) images, and its association with specific categories of disk displacement, bone marrow abnormalities and pain. From a series of 523 consecutive TMJ MR imaging studies of patients referred to imaging because of pain and dysfunction, those with TMJ effusion, defined as an amount of fluid that exceeded the maximum amount seen in a control group of asymptomatic volunteers, were analysed. The selected patients were reassessed and the amount of TMJ fluid was graded bilaterally according to a set of reference films. Other parameters recorded included disk displacement categories and condyle marrow abnormalities. Pain self-records were obtained from the patients immediately before MR imaging. The association between the recorded parameters and TMJ pain was analysed with t-tests and regression analysis. Of the 523 patients, 70 (13%) had TMJ effusion, which was unilateral in 61%. Only 9% of the 70 patients had effusion bilaterally, whereas bilateral disk displacement was found in 80%. In the 76 joints with effusion, 83% showed two specific categories of disk displacement at closed mouth. Condyle marrow abnormalities were found in 31% of the 70 patients, mostly on one side, and in 24% of the 76 joints. An in-patient regression analysis of the side difference in TMJ pain showed that effusion and condyle marrow abnormalities were significant pain-increasing factors. In conclusion, patients with TMJ effusion represent a subgroup with pain and dysfunction with more severe intra-articular pathology than those with disk displacement but no other joint abnormalities.     

Magnetic resonance imaging predictors of temporomandibular joint pain

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.     

Temporomandibular joint related painless symptoms, orofacial pain, neck pain, headache, and psychosocial factors among non-patients

The aims of this study were to assess the prevalence of temporomandibular joint related (TMJ) painless symptoms, orofacial pain, neck pain, and headache in a Finnish working population and to evaluate the association of the symptoms with psychosocial factors. A self-administered postal questionnaire concerning items on demographic background, employment details, perceived general state of health, medication, psychosocial status, and use of health-care services, was mailed to all employees with at least 5 years at their current job. The questionnaire was completed by 1339 subjects (75%). Frequent (often or continual) TMJ-related painless symptoms were found in 10%, orofacial pain in 7%, neck pain in 39%, and headache in 15% of subjects. Females reported all pain symptoms significantly more often than men (P < 0.001). Frequent pain and TMJ-related symptoms were significantly associated with self-reported stress, depression, and somatization (P < 0.001). Perceived poor general state of health (P < 0.001), health care visits (P < 0.001), overload at work (P < 0.001), life satisfaction (P < 0.05), and work satisfaction (P < 0.05) were also significantly associated with pain symptoms, but the work duty was not (P > 0.05). Our findings are in accordance with earlier studies and confirm the strong relationship between neck pain, headache, orofacial pain. TMJ-related painless symptoms, and psychosocial factors. Furthermore, TMJ-related symptoms and painful conditions seem to be more associated with work-related psychosocial factors than with type of work itself.