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1.
ObjectivesPathological changes of the lateral pterygoid muscle (LPM) have been investigated using various modalities, including magnetic resonance (MR) imaging and electromyography. Fluid-attenuated inversion recovery (FLAIR) is an MR sequence that we hypothesized can be used to evaluate abnormalities of the LPM. The purpose of this study was to analyze the FLAIR signal intensity of the LPM in painful temporomandibular joints (TMJs) and investigate the pathological changes of the muscle.MethodsThe study was based on 149 TMJs of 77 patients who were referred for MR imaging of the TMJ. Patients rated their degree of pain during chewing and mouth opening using a visual analog scale (VAS). Regions of interest were placed over the superior and inferior heads of the LPM and gray matter on FLAIR sagittal images. Using the signal intensity of gray matter as a reference, the signal intensity ratio (SIR) of the LPM was calculated. Spearman’s rank-correlation coefficient was used to analyze the correlation between the SIR and the VAS score (p?<?0.05).ResultsA significant correlation was present between the SIR on FLAIR images and the VAS score.ConclusionsThese results suggest that the FLAIR signal intensity of the superior and inferior heads of the LPM significantly increases as TMJ pain becomes more severe. Thus, FLAIR could be useful in assessing the relationship between the MR signals of the LPM and clinical symptoms. 相似文献
2.
Objective To evaluate the cone-beam computed tomography (CBCT) findings of temporomandibular joints (TMJs) with osseous abnormalities. Methods CBCT images of 88 TMJs in 44 patients with arthrogenic TMJ disorder and 40 normal TMJs of 20 asymptomatic patients were selected for the study. All images were used for evaluation of the condyles (position and width), glenoid fossae (width and depth), and joint spaces (anterior, posterior, and maximum superior). The frequencies of the condylar positions were compared between the two groups using the Chi-square test. The mean values of the remaining CBCT findings were compared between the two groups using the Mann?CWhitney U test. Results In the 88 TMJs with osseous abnormalities, a dorsal position of the condyle was most frequently seen (62/88), whereas central and ventral positions of the condyle were seen in two and 24 joints, respectively. The TMJs with osseous abnormalities exhibited a significantly lower mean value for the condyle width and a significantly higher mean value for the anterior joint space than the TMJs without such abnormalities. Conclusions Small and dorsally positioned condyles are characteristic CBCT findings of TMJs with osseous abnormalities. 相似文献
3.
ObjectivesJoint effusion is demonstrated by high signal intensity in the upper and lower temporomandibular joint (TMJ) spaces on T2-weighted images. The fluid-attenuated inversion recovery (FLAIR) technique can be applied to analyze joint effusion in the TMJ. FLAIR signal intensity can be more sensitively influenced by the contents of joint effusion than T2-weighted signal intensity. The purpose of this study was to analyze the signal intensity of joint effusion on FLAIR images and to investigate the changes in joint effusion contents according to the status of TMJ disorders.MethodsA total of 48 joints (45 patients) with joint effusion were investigated by magnetic resonance (MR) imaging. Regions of interest were placed over the joint effusion and gray matter on FLAIR images. The joints were categorized as normal disk position (NL), disk displacement with reduction (DWR), disk displacement without reduction (DWOR), and osteoarthritis (OA). The signal intensity ratio of joint effusion was calculated using gray matter as the reference point. The Kruskal–Wallis test and Steel test were applied. A probability of less than 0.05 was considered statistically significant.ResultsThe median signal intensity ratios of joint effusion differed significantly among the four joint categories (p?=?0.02, Kruskal–Wallis test). The median signal intensity ratio of joint effusion in the OA category was significantly higher than that in the NL category (p?=?0.04, Steel test).ConclusionsThe present findings suggest that FLAIR images can demonstrate the changes in joint effusion contents according to the status of TMJ disorders. 相似文献
4.
Background Ankylosing spondylitis (AS) is a chronic inflammatory disease with multiple articular and para-articular involvement that has a predilection for the axial skeleton. In spite of its high prevalence, ankylosis secondary to AS is a rare condition. Case report A 31-year-old male diagnosed with AS was referred for computed tomography (CT) of the temporomandibular joint (TMJ) due to severe mouth opening limitation. The patient had a 16-year medical history of AS and sought assistance due to TMJ pain and incapacity to open his mouth. Results Previous bony scintigraphy revealed involvement of the spine, sacroiliac joints, right knee, and left TMJ. Magnetic resonance imaging revealed erosion of the left condyle and posterior slope of the articular eminence, and a mass of heterogeneous signal intensity between these structures. The left condyle also presented sclerosis/edema of the bone marrow and the disk could not be identified. Sagittal and coronal CT images showed moderate alterations of the TMJ on the right side. On the left side, the images displayed markedly eroded condyle and mandibular fossa, and a bony mass resulting in ankylosis of the osseous components of the joint. Conclusion TMJ ankylosis in AS patients is rare and very few reports have presented imaging features of the condition through advanced diagnostic techniques. 相似文献
5.
The purpose of the present study is to analyze the fluid-attenuated inversion recovery (FLAIR) signal intensity of the retrodiscal tissue in a painful temporomandibular joint (TMJ), and to develop a diagnostic system based on FLAIR data. Methodology:The study was based on 33 joints of 17 patients referred for MR imaging of the TMJ. Regions of interest were placed over retrodiscal tissue and gray matter (GM) on FLAIR images. Using signal intensities of GM as reference points, signal intensity ratios (SIR) of retrodiscal tissue were calculated. SIRs in painful TMJ were compared with those in painless TMJ. Wilcoxon’s Rank Sum Test was used to analyze the difference in SIRs between the painful and painless groups (P<0·05). Results:The SIRs of retrodiscal tissue were significantly higher in painful joints than in painless joints. Conclusion:FLAIR sequences provide a high signal in patients having painful TMJ, and it suggests that retrodiscal tissue in painful TMJ contains elements such as protein. 相似文献
6.
Objectives The objective of this study was to investigate whether a relationship exists between total antioxidant capacity (TAC) and total oxidant status (TOS) of synovial fluids (SFs) of temporomandibular joint (TMJ) pain patients with pain and dysfunction. Materials and methods Forty-two patients with TMJ pain were included in this study. TAC and TOS values of SFs were measured with a novel colorimetric method. Independent t test and correlations were used to analyze the data. Results TAC of SFs in patients with TMJ pain and limited mouth opening (LMO; n?=?21) were significantly lower ( P?=?0.03) than patients without LMO ( n?=?21). TOS of SF was negatively correlated with duration of the disease. There was no correlation between TAC, TOS, and VAS scores of the patients as well as age and maximum mouth opening values. Conclusions Antioxidant response to oxidative changes (TAC and TOS) in SF decreased as the stage of dysfunction increased. Clinical relevance Local administration of antioxidant agents might be considered in management of TMJ pain and dysfunction to prevent possible increased oxidative stress. 相似文献
7.
Aim of the study The aim of this study was to establish a reliable educational model for and a further refinement of arthroscopic surgery in the temporomandibular joint (TMJ). Material and methods As a first step, the lateral-medial (length) and anterior-posterior distances (width) of the mandibular head of nine pig cadavers (country breed) of about 30 ( n=3), 60 ( n=3) and 90 kg ( n=3) body weight were measured and compared with findings in 12 adult human cadavers. The best points of access for the arthroscopic and lavage channels using the triangulation technique were determined. As determined by these findings, 15 arthroscopies were performed on eight pig TMJs under general anaesthetic. A control arthroscopy was performed after 2 weeks followed by another clinical follow-up at 4 weeks before the pigs were sacrificed. Results The TMJ of the pigs between 30 and 60 kg body weight was found to be highly comparable to the human TMJ. The best locations for puncturing the upper joint compartment of the TMJ in pigs were 5.0 cm and 6.1 cm anterior to the tragus on a line drawn along the lower margin of the zygoma. The only complication encountered was a subcutaneous infection treated successfully by antibiotics and incision. Conclusions In our opinion, a standard and easily reproducible model is necessary for further studies in arthroscopic TMJ-surgery. The country bred pig represents a good model for educational purposes and for studying further refinements of arthroscopic technique. 相似文献
8.
Purpose The aim of the study was the development and proof testing of an arthroscopic dorsal ligament plasty using a hydrojet knife in the pig TMJ before using in man. Material and methods The dorsal TMJ ligament of ten pigs (country breed) was irradiated with a hydrojet (diameter 120 µm, working pressure 90 bar) under arthroscopic visualization. Postoperatively the pigs were controlled for 10 weeks before sacrifice. The isolated TMJs were examined by light microscope and the results compared with untreated pig TMJs. The flows over our arthroscopic instruments were measured to exclude the possibility of damaging surrounding structures by pressure. Results Clinically we found no complications after arthroscopic surgery. Food intake was normal and development of body weight according to the food offered. Histology revealed tissue reorganization connected with increased collagen fibre production. Our calculations showed no pressure higher than 1000 mm water column in the TMJ under our working conditions. Conclusions The idea of arthroscopic dorsal ligament plasty using a hydrojet works in pig TMJs. Experience in TMJ arthroscopy is necessary. We found no danger of barotrauma under arthroscopy with the hydrojet. The results indicate dorsal ligament shortening by development of scar formations. In our opinion the method can be used for the therapy of dorsal ligament elongation and disk displacements in the TMJ of man. 相似文献
9.
Introduction Juvenile idiopathic arthritis is the most common disease in pediatric rheumatology. It is characterized by chronically progressive joint destruction. The temporomandibular joints (TMJs) are involved in up to 87% of patients and may take an asymptomatic course in 69% of cases. Other than contrast-enhanced magnetic resonance imaging (MRI), there are no reliable screening symptoms or non-invasive procedures available to diagnose the inflammation in its acute form. The goal of this study was to establish an imaging-based classification system for TMJ erosion via MRI and cone-beam computed tomography (CBCT) in an effort to improve indication-specific treatment approaches and to facilitate the comparison of findings. Materials and methods A total of 46 patients were included. Contrast-enhanced MRI and CBCT images obtained during treatment by pediatric rheumatologists and orthodontists were available from 23 patients with juvenile idiopathic arthritis. We devised a classification system combining the findings of both imaging techniques based on this patient sample in comparison with CBCT findings from an age- and gender-matched group of 23 non-arthritis patients, taking into consideration the available literature and administration of contrast medium. Results Our cohort of 46 patients comprised 60% female and 40% male patients with a mean age of 14 years, providing a total of 92 TMJs for evaluation. We were able to apply the findings efficiently and conveniently to this classification system with no relevant interobserver differences. Mild structural abnormalities were noted in 21% of TMJs in the control group, whereas 83% of TMJs in the arthritis group exhibited severe anomalies, including cases of extreme destruction. Age and gender did not affect the degree of destruction significantly. Conclusion This is the first classification system to link CBCT and MRI with the use of contrast medium. Contrast-enhanced MRI is an internationally recognized technique that permits acute inflammation to be unequivocally diagnosed. Although structural erosion of the TMJs in our arthritis group was generally severe and significant, we were surprised to observe some cases that were clinically asymptomatic. 相似文献
10.
Objectives To clarify the magnetic resonance (MR) imaging features of bisphosphonate-related osteonecrosis of the jaw (BRONJ), particularly those in the early stage, through a literature review and case analysis. Methods Literature on MR imaging of BRONJ was collected, and the MR imaging features were summarized. On MR images of patients with BRONJ, the signal intensity of the bone marrow was evaluated quantitatively by means of the contrast-to-noise ratio (CNR). The relationships of the imaging features with the presence of exposed bone, types and administration routes of bisphosphonates (BP), and duration of symptoms were investigated. Results Fifteen articles were identified. In the early stages, the region of osteonecrosis displayed decreased signal intensity on T1-weighted images and normal signal intensity on T2-weighted images. In the late stages, the signal intensity of the bone marrow on T2-weighted images was variable: the exposed diseased bone displayed decreased signal intensity, and the unexposed diseased bone displayed increased signal intensity. These changes were also seen in BRONJ cases. There was a significant difference in the CNR between the exposed and unexposed diseased bones on STIR images. There were no significant differences in the CNR among the three groups by types and administration routes of BP, both on T1-weighted and STIR images. Changes in the signal intensity of bone marrow were seen at the early duration of symptoms. In the early stage, the CNR on T1-weighted images had a significant correlation with duration of symptoms. Conclusion MR imaging may provide visualization of useful features in the early stage of BRONJ. 相似文献
11.
Purpose We aimed to investigate factors related to the prevalence of anterior disc displacement without reduction (ADDwoR) and bony changes of the condylar head (bony changes) in the temporomandibular joints (TMJs) of patients with anterior open bite. Methods Subjects are comprised of 36 preoperative patients (72 joints) with skeletal anterior open bite without facial asymmetry who had undergone orthognathic surgery at the Hokkaido University Hospital; magnetic resonance imaging of the TMJ and cephalometric analysis were performed before treatment. Logistic regression analysis was performed to clarify relationships among age, overbite, overjet, ANB angle, sella to nasion (SN) to mandibular plane angle (SN–MP angle), SN to ramus plane angle (GZN angle), gonial angle, and incidence of ADDwoR or bony changes in patients with anterior open bite. Results Fifteen patients had bilateral ADDwoR, and five patients had unilateral ADDwoR; 17 patients had bilateral bony changes, and five patients had unilateral bony changes. SN–MP angle was greater in 20 patients with ADDwoR than that in 16 patients without ADDwoR ( p?0.05). GZN angle was greater in the 20 patients showing bony changes than that in the 16 patients without bony changes ( p?0.05). Conclusion In terms of dentofacial morphology, SN–MP angle appears to be associated with the incidence of ADDwoR, and GZN angle appears to be associated with bony changes in the TMJ. 相似文献
12.
Objectives The aim of this study was to assess the efficacy in pain reduction of topical 2 % lidocaine compared to a placebo cream in children with oral mucosal lesions due to trauma or aphthous ulcers or in the prevention of clamp placement pain. Materials and methods The design was a double-blind, randomized, placebo-controlled, four-center trial on 64 patients. Pain intensity and relief were measured using a 100-mm visual analog scale (VAS). One-tailed Student’s t test and ANOVA were used for statistical analyses. Results Independent of the pain origin, application of 2 % lidocaine cream led to a mean reduction in VAS pain intensity of 19.7 mm?±?18.3, which was significantly greater than that obtained with the placebo cream ( p?=?.025). Analyses showed a statistically significant efficacy of the 2 % lidocaine cream ( p?<?.0001). Its efficacy was not associated to any local or systemic adverse drug reaction, as reported by the patients. As the most important population represented in our patients was children whom a rubber dam clamp was placed, we also specifically analysed this population, and we were able to demonstrate a significantly greater efficacy of the 2 % lidocaine cream on the pain caused by the rubber dam clamp placement in comparison to the placebo cream ( p?<?.005). Conclusions A significant reduction in pain intensity occurred after application of 2 % lidocaine cream, and the effect was significantly greater than that obtained with the placebo cream. Considering the study’s limitations, this product appears safe for use in children. Clinical relevance For painful benign lesions of the oral mucosa (trauma or aphthous ulcers) or for preventing painful iatrogenic procedures such as rubber dam clamp placement, it is essential to treat or prevent pain onset, especially in the pediatric population for whom a painful experience could end in refusal of dental care. Application of a topical anesthetic in this specific situation is of particular interest, as is defining its efficacy and safety. 相似文献
13.
Purpose This study was designed to investigate the efficacy of arthrocentesis on mouth opening and pain in the treatment of temporomandibular joint (TMJ) internal derangement patients. Materials and Methods Fifteen males and 25 females aged between 18 and 37 years comprised the study material in the department of oral and maxillofacial surgery at Govt Dental College Srinagar (India). The patients’ complaints were limited mouth opening and TMJ pain. Arthrocentesis was performed under aseptic conditions. Clinical evaluation of the patients was done before the procedure, and 1 week and 4 months post-operatively. Intensity of TMJ pain and maximal mouth opening were recorded at each follow-up visit. Results There was significant improvement in mouth opening and reduction in pain scores in the post-operative period. Conclusions Arthrocentesis is a simple and safe procedure for patients of internal derangement with closed lock for improving mouth opening and decreasing pain. 相似文献
14.
Objectives Symptoms of temporomandibular joint (TMJ) dysfunction can seriously compromise patients' quality of life. The aim of our study was to use magnetic resonance imaging (MRI) T2 mapping of the articular disc to determine whether T2 mapping of the TMJ disc is feasible in routine clinical imaging and to assess the normal T2 relaxation time distribution within the TMJ. Methods Included were ten asymptomatic volunteers without pain, any mouth-opening limitations, or any clicking phenomena. MR imaging was performed on a 3-T MR scanner using a flexible, dedicated, eight-channel multielement coil. T2 mapping was performed in the oblique sagittal plane. The regions of interest (ROIs) for the T2 relaxation time maps of the disc were selected manually. Results The mean values for ROIs ranged between 22.4 and 28.8 ms, and the mean for all ROIs was 26.0?±?5.0 ms. Intraclass correlation (ICC) for interobserver variability was 0.698, and ICC for intraobserver variability was 0.861. There was no statistically significant difference between raters ( p?=?0.091) or sides ( p?=?0.810). Conclusion The T2 mapping technique enables ultrastructural analysis of the composition of TMJ disc. This biochemical technique is feasible in vivo, as shown in our study, when a high-field (3 T) MR and a dedicated TMJ coil are used. Clinical relevance T2 mapping as a biochemical technique, together with morphological MRI, may help to gain more insights into the physiology and into the pathophysiology of the articular disc in the TMJ noninvasively and in vivo. 相似文献
15.
ObjectivesTo evaluate the correlations between temporomandibular joint (TMJ) pain and both conventional and gadolinium-enhanced magnetic resonance (MR) imaging characteristics in patients with temporomandibular disorders (TMDs).MethodsT1-weighted, T2-weighted, and fat-suppressed contrast-enhanced T1-weighted MR imaging were performed in 80 TMD patients with the main complaint of TMJ pain. A kappa statistical analysis was performed to calculate the interobserver agreement between two of three radiologists. The relationships between TMJ pain and various MR findings were analyzed by multiple comparison test, Spearman’s rank correlation test, Chi-square test, Student’s t test, and multivariate logistic regression analysis.ResultsSignificant correlations were observed between anterior disk displacement without reduction, joint effusion, and TMJ pain (p < 0.01). The degree of contrast enhancement of the posterior disk attachment was correlated with the severity of TMJ pain, especially spontaneous pain (r = 0.725, p < 0.01), while no correlation was observed in the masticatory muscle pain group. The correlation tended to be higher in the latero-central portions than in the medial portion of the mandibular condyle, although no significant difference was seen.ConclusionsIt has been suggested that fat-suppressed contrast-enhanced MR imaging techniques facilitate better understanding of the sources of TMJ pain, but not masticatory muscle pain, and could reflect TMJ synovial inflammation. The severity of TMJ pain was closely correlated with the degree of contrast enhancement. The above-mentioned correlation had a tendency to be higher in the latero-central portions of the mandibular condyle. 相似文献
16.
目的:探讨髁突骨髓腔信号异常与关节疼痛的关系。方法:利用MRI金标准,对44例单侧关节疼痛TMD患者88侧关节进行闭口斜矢状位T1W和T2W扫描,以非疼痛侧作为自身对照;利用可视疼痛模拟标尺(VAS)进行疼痛程度的判定,观察髁突髓腔信号异常与疼痛的关系。结果:44个疼痛关节中,11个关节(25%)出现髓腔信号异常,均为水肿型;而44个非疼痛关节中,仅2个关节(4.5%)出现髓腔信号异常,分别表现为硬化型和混合型,经统计学分析,TMJ疼痛与髓腔信号异常有显著相关性(P<0.01)。44个疼痛关节中,骨髓腔信号异常及正常患者VAS平均值分别为39.5±27.5和42.6±21.9。经t检验,两组问差别无统计学意义(P=0.696)。结论:髁突髓腔信号异常与关节疼痛密切相关,而与TMJ疼痛程度无关。 相似文献
17.
Objectives Masticatory muscle pain is one of the typical symptoms of temporomandibular joint disorders (TMD). T2 mapping (distribution of T2 values) is a notable MRI technique for evaluating water contents in tissues. We investigated the clinical significance of T2 mapping for the evaluation of masticator muscle conditions by comparing the difference in the T2 values between the painful and pain-free sides of the masseter muscle in patients with TMD. Methods Seventy-three patients clinically diagnosed with TMD were enrolled in this study. We divided the patients into two groups: a unilateral pain group (patients with unilateral masseter muscle pain) and a painless group (patients without muscle pain). There were 29 patients in the unilateral pain group and 44 patients in the painless group. We compared the difference in the mean T2 values between the painful and pain-free sides of the masseter muscle in the unilateral pain group and between the right and left sides in the painless group. Results The mean T2 values of the masseter muscle on the painful side were significantly higher than those on the pain-free side in the unilateral muscle pain group ( p < 0.01). In the painless group, there was no significant difference in the mean T2 values between the right and left sides. Conclusions It is suggested that T2 mapping is a promising method for evaluating masseter muscle pain caused by edematous change related to TMD through monitoring of the T2 values. 相似文献
18.
PurposeThis study was designed to investigate the efficacy of the temporomandibular joint arthrocentesis with and without injection of sodium hyaluronate (SH) in the treatment of temporomandibular joint disorders.Patients and MethodsA total of sixty two TMJs in 34 males and 28 females aged 20–65 years comprised the study material. The patients’ complaints were limited mouth opening, TMJ pain, and joint noises during function. Patients were randomly divided into 2 groups in which arthrocentesis plus intra-articular injection of sodium hyaluronate was performed in 1 group and only arthrocentesis was performed in the other group. Both groups contained patients with disc displacement with reduction and without reduction. Clinical evaluation of the patients was done before the procedure, immediately after the procedure, at 1 week and 1, 3 and 6 months postoperatively. Intensity of TMJ pain was assessed using visual analog scales. Maximal mouth opening and lateral jaw movements also were recorded at each follow-up visit.ResultsBoth techniques increased maximal mouth opening, lateral movements, and function, while reducing TMJ pain and noise.ConclusionsAlthough patients benefitted from both techniques, arthrocentesis with injection of SH seemed to be superior to arthrocentesis alone. 相似文献
19.
ObjectivesThe conventional magnetic resonance (MR) imaging protocol for the temporomandibular joint (TMJ) is typically performed with focused oblique, sagittal, and coronal imaging of each joint and can miss extra-articular diseases and conditions that may present with similar symptoms. The purpose of this study was to investigate the value of an additional axial short tau inversion recovery (STIR) sequence to identify conditions other than ordinal TMJ disorders.MethodsFrom September 2000 to April 2006, 601 patients with clinically diagnosed TMJ disorders underwent MR imaging at 0.5 T with a dedicated TMJ coil. In addition to the standard TMJ MR imaging protocol with oblique, sagittal, and coronal proton-density and T2-weighted images of each TMJ in the closed- and open-mouth positions, axial STIR images from the superior orbit to the thoracic inlet level were obtained.ResultsOf 601 patients, 580 (96.5 %) had TMJ disorders without other imaging abnormalities. Extra-articular diseases outside the TMJ were found in 21 patients (3.5 %), with all abnormalities seen only on axial STIR images. These conditions comprised 13 infectious/inflammatory processes and 8 neoplasms including 7 malignancies. Six of these patients had coexistent TMJ disorders, and 15 had no TMJ abnormality.ConclusionsThe addition of axial STIR images to the standard TMJ MR imaging protocol detected unexpected pathology in 3.5 % of patients, including malignancies (1.0 %). The addition of these images could potentially be used as an adjunct to the typical TMJ MR imaging protocol to improve detection of unexpected extra-articular disease. 相似文献
20.
Objectives The purpose of the present study was to determine the inclination and height of the articular eminence with respect to the condylar bone changes, condyle shape, fossa shape and condylar movements in patients with and without temporomandibular joint (TMJ) dysfunction using cone-beam computed tomography (CBCT). Methods The associations between the eminence inclination and the condylar bone changes, condylar movements, condylar shape and fossa shape were evaluated in patients with TMJ disorders and control patients without TMJ disorders. The measurements of the articular eminence inclination were established on central sagittal slices of the TMJ. The central coronal slices were used to determine the condyle and fossa shapes. The types of movements of the condyles were determined on open-mouth images, and mandibular hypermobility or hypomobility was noted for each joint. Results There were no significant differences in the eminence inclination and height with respect to the condylar bone changes and condylar movements in the TMJ disorder group. However, there was a significant association between the eminence inclination and the fossa shape in the TMJ disorder group and significant associations between the eminence inclination and both the condyle and fossa shapes in the control group. The articular eminence inclination was steeper in the control group than in the TMJ disorder group. Conclusions The eminence inclination was steeper in the control patients than in the patients with TMJ disorders, and was not correlated with the condylar bone changes or condylar movements. 相似文献
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