Arthrography of the temporomandibular joint: a simple technique

The problem of the patient with the painful clicking temporomandibular joint is one of the most difficult to manage in oral surgical practice. Traditional methods of treatment have been largely empirical and have included the use of analgesics, muscle exercises, psychotherapy, condylar osteotomy and tooth grinding. Temporomandibular joint arthrography offers a method of accurately assessing internal derangements of the joint in order to select those patients for whom surgical reconstruction is appropriate.     

颞颌关节紊乱综合征上腔造影影像与临床症状对比分析

自1944年Norgaard首先报告颞下颌关节造影术(TMJ Arthrography)并于1947年发表专著以来[1],颞下颌关节造影术得到了较广泛推广和应用.近年来虽然CT、MR等已应用于颞下颌关节紊乱综合征(Temporomandibular joint disturbance syndrome,TMJDS)的诊断,但CT检查不能清楚地显示关节盘,MR虽能显示关节盘的形态、大小、位置,却不能明确关节盘有无穿孔及穿孔的位置和程度[2],故TM造影检查仍是TMJDS诊断的重要方法.     

Arthrography of the dislocated elbow joint

Arthrography has been suggested as a useful tool for diagnosing ligament ruptures. In 14 consecutive patients with non-fractured elbow dislocations arthrography was performed after reduction of the dislocation. One or two days following arthrography all elbows were examined under general anesthesia with regard to stability and half of them were randomized for surgery with exploration and suture of both the ulnar and the radial collateral ligaments. Arthrography, even if performed within 24 hours after the injury, was found to be unreliable in diagnosing ligament injuries after elbow dislocation. Leakage of the contrast medium was more or less limited to the site of the major injury, which in the dorsal and dorso-radial dislocation was a rupture of the volar aspect of the capsule and the ulnar side of the joint in the radial dislocation.     

Arthrography in dislocation of the acromioclavicular joint.

Arthrography was performed in 10 patients with dislocation of the acromioclavicular joint. The examination was unsuccessful in one case. In the remaining 9 patients, leakage of the contrast medium was observed around the joint and in the direction of the coracoid process. The arthrographic abnormalities were compared with the findings at operation. The distribution of the medium that had leaked out provided information on the severity of the injury to the ligaments.     

Arthrography of the ankle joint in chronic instability

Papers on arthrography of injuries of the lateral ligaments of the ankle relate mainly to recent distortion of the joint. Arthrography performed at a later stage after injury generally is considered useless. In fact, changes in chronic instability are observed; they are subtle and consist either of small recesses adjacent to the lateral malleolus or communication of the joint with the peroneal tendon sheaths. Arthrography was assessed in 61 cases of recurrent lateral sprains of the ankle more than 2 weeks after acute injury; 38 were considered as positive. Twenty-five patients had operative evaluation, with four false negative and one false positive results. Small recesses adjacent to the lateral malleolus or opacification of the peroneal tendon sheaths are sequelae of an acute sprain with tear of the anterior talofibular and/or the calcaneofibular ligaments. Although false negative results occur, arthrography is useful in the preoperative assessment of chronic ankle instability.     

Arthrography of the knee joint with amipaque.

In a double-blind investigation, 30 knee arthrographies were performed by injection of either Amipaque 290 mg I/ml or Urografin 60% (292 mg I/ml). Both contrast media are well tolerated, and give excellent initial contrast quality, which deteriorates rapidly. This occurs more slowly with Amipaque, which has lower osmolality and causes less joint effusion.     

Arthrography and the medial compartment of the patello-femoral joint

In four groups of patients with normal patellar cartilage, synovitis, patellar chondropathy, and degenerative changes of the patellar surface of the femur, the anatomical relationships within the medial compartment of the patello-femoral joint were examined. Clear differences were observed between these groups in the incidence of visualization of the medial alar plica and the mediopatellar synovial plica. As a consequence, an explanation has been sought for the occurrence of patellar chondropathy and degenerative changes of the patellar surface of the femur. It seems probable that a long-standing traumatic synovitis with effusion, attenuation of the synovial membrane, and the composition of the synovial fluid can lead to patellar chondropathy. The degenerative changes of the patellar surface of the femur are usually secondary to those of the load-bearing patellar facet. Insufficient covering of the cartilage by soft tissue may play a role in chondropathy of the nonload-bearing portion of the patella and the femoral condyle.     

Arthrography following sport injuries to the knee joint

The arthrography is one of the most important diagnostic methods of sport injuries of the knee joint. The examination must give an exact information to the surgeon; a good technique and standard X-rays are an absolute postulate. The submitted examinations are based on 6687 arthrographies during a period of 5 years. The arthrography should not be carried out before the acute symptomatology has ceased, usually after an interval of 2-3 weeks. Most frequently are the meniscus injuries by rotary traumas of the knee-joint. Football as the most popular sport is responsible for more than 50% of the injuries, followed by skiing, handball and jogging.     

Imaging of the temporomandibular joint

The recent advances in imaging of the temporomandibular joint (TMJ), especially the introduction of MR imaging and surface colls allowing precise visualization of superficial structures led us to reconsider the different techniques used in this very complex anatomical region, due to both its morphology and function. We also tried to determine their respective role, especially in the study of TMJ dysfunction syndromes, that represent the most frequent pathology of this region. Conventional radiography allows us to appreciate the overall amplitude of the joint movements, and to study bone abnormalities, but CT is much more precise in the study of cortical bone. In TMJ dysfunction, the joint itself is studied by either arthrography or MRI, but both techniques have their limitations and remain complementary in some aspects, which are detailed here, so that the choice between them depends on availability and therapeutic indications.     

Arthrography in evaluation of birth injuries of the shoulder

Birth injuries of the shoulder and proximal humerus of infants can be difficult to evaluate on plain radiographs because of lack of ossification in the proximal humeral epiphysis. We here describe arthrography of the infant shoulder and advocate it as a useful diagnostic procedure in the evaluation of humeral fractures and brachial palsies. Two infants with birth injuries of the shoulder are described. The value of dynamic fluoroscopic evaluation of the injured joint in conjunction with arthrography is illustrated in evaluation of a brachial plexus palsy.     

Imaging of the temporomandibular joint

Both arthrography and MR imaging are of proven value in the evaluation of internal derangements of the TMJ. Arthrography provides the advantages of a dynamic display of joint mechanics and the easy detection of disc perforation. Its disadvantages include its technical difficulty and its poor visualization of the disc in the medial-lateral plane. MR imaging of the TMJ provides excellent soft-tissue detail and more readily demonstrates medial and lateral displacements of the disc. Unfortunately, perforations of the disc or ligaments are not usually visualized, and bony detail is not seen as well as on plain radiographs or computed tomography. In addition, real-time dynamic imaging of joint mechanics is not readily available. Currently, the choice of imaging modality is based on the specific diagnostic question, and availability of arthrography and MR imaging.     

The temporomandibular joint

MRI is the procedure of choice for diagnosing most internal derangements. MRI provides images that not only demonstrate bony detail but show excellent representation of soft tissues in both anatomic and semifunctional relationships. MRI does not use ionizing radiation and has no known adverse effects. Multiplanar imaging allows a three-dimensional analysis of the TMJ, providing a more complete assessment of the condyle, articular disc, fossa relationships. Whenever capsular adhesions or disc perforations are suspected and are not demonstrated with MRI, then arthrography should be performed.     

超声引导关节腔内注射富血小板血浆治疗颞下颌关节紊乱的疗效分析

【摘要】　目的?评估超声引导下关节腔中注射富小板血浆（PRP）治疗颞下颌关节紊乱病的有效性。方法?2016年4月至2018年4月,门诊诊治45例确诊为颞下颌关节紊乱患者,超声引导将采集于患者自身的PRP注射于患者病变的颞下颌关节腔内。观察患者在治疗前和治疗后1、3和6个月的最大张口度,及颞下颌关节在静息、运动和咀嚼时VAS评分。结果?关节腔内注射PRP可有效改善最大口腔开放程度,颞下颌关节在静息,运动和咀嚼时VAS评分与治疗前相比显著降低。结论?超声引导下关节腔内注射PRP可显著改善颞下颌关节紊乱患者的体征和症状。