颞下颌关节盘前移位患者关节骨形态与矢状向关节盘位置的关系

目的　利用磁共振成像（MRI）技术和锥形束CT（CBCT）分析颞下颌关节盘前移位患者矢状向关节盘位置与关节骨形态的关系。方法　对97例患者的178个颞下颌关节（TMJ）进行回顾性分析，根据矢状向MRI上关节盘的位置分成4组，即对照组（关节盘无移位）、轻度组（关节盘轻度前移位）、中度组（关节盘中度前移位）和重度组（关节盘重度前移位）。然后利用Mimics 20软件基于CBCT数据进行TMJ的相关形态学参数测量，包括髁突线性尺寸（宽度、长度和高度）、髁突体积和表面积，关节窝的深度和长度，关节结节倾斜角，关节前、上、后间隙等，并对各组矢状髁突位置进行评估。使用方差分析、非参数检验和卡方检验等比较关节形态及位置参数的组间差异，采用相关性分析探索矢状关节盘位置与关节测量参数之间的相关性。结果　髁突的线性尺寸、关节窝深度、关节倾斜角、关节间隙和矢状髁突位置分布在4组间差异有统计学意义，而关节窝长度在4组间差异没有统计学意义；相关性分析显示：髁突的线性尺寸、髁突的体积及表面积、关节窝的深度、关节结节倾斜角和关节上间隙与关节盘矢状位置之间存在显著负相关，而关节后间隙与矢状关节盘位置之间存在显著正相关。结论　TMJ骨形态与不同矢状关节盘位置之间存在相关性，应警惕临床看到的关节骨形态的退行性改变可能是患者存在关节盘前移位的标志。     

3T磁共振成像显示颞下颌关节盘的技术研究

目的探索3T磁共振成像（MRI）显示颞下颌关节盘的序列、参数及电影成像方式的技术特点,并为临床研究颞下颌关节盘病变提供形态与功能影像学参照。方法选择15例正常志愿者和7例颞下颌关节损伤患者为研究对象,采用GE Signa HD 3T MRI和颞下颌关节专用表面线圈对颞下颌关节进行扫描,获得斜矢状、斜冠状闭口位FSE-XL/T1WI、FLAIR/T1WI、FSE-XL/PDWI、FSE/PDWI+FS、FRFSE-XL/T2WI、FRFSE/T2WI+FS扫描及斜矢状张口位FSE-XL/T1WI、FSE-XL/PDWI图像。由口腔颌面外科医师和MRI医师共同对各序列进行打分,分析各序列不同加权像对颞下颌关节盘的显示效果。结果PDWI对关节盘的显示效果得分最高,能清楚显示关节盘的解剖结构与形态。T2WI对关节盘损伤、撕裂、穿孔和关节囊积液显示良好,对关节盘移位情况则以PDWI序列显示效果为好。结论3T MRI可以清楚地显示关节盘在关节运动中的动态改变与病变受累情况,对颞下颌关节软组织损伤的诊治有重要价值。T1WI、PDWI及T2WI应作为常规的扫描方法。     

无症状颞下颌关节关节盘位置磁共振成像观察

为了解国人无症状人群中是否存在颞下颌关节关节盘移位，并探讨其对临床工作的参考意义，应用颞下颌关节斜矢状位和斜冠状位磁共振成像，对５０侧（３９例）无症状志愿受试者关节盘位置进行观察，发现盘移位率达３２％。对关节盘前移位和旋转移位的诊断及无症状关节存在盘移位在临床工作中的参考意义进行了讨论     

颞下颌关节侧向咬合位与对刃位薄层塑化断面对照研究

目的:对比分析下颌对刃位、侧向咬合位颞下颌关节的运动解剖形态,为颞下颌关节病变提供解剖依据。方法:将8例新鲜尸头摆置成对刃位5例、下颌侧向咬合位3例,以颞下颌关节为中心,切割成8cm×8cm×10cm的标本块,利用生物塑化技术,制成斜矢状位、斜冠状位、轴位塑化断层标本共16套。下颌侧向咬合位工作侧、非工作侧关节形态改变与对刃位相对照。结果:下颌侧向咬合位工作侧,髁突在关节窝内向后、向上、向外移位,关节盘位置无变化,关节盘双板及后带受压;非工作侧,髁突向下、向前、向内侧移位,关节盘后带位置向下移位,无前移位,关节盘中带外侧位居上下关节面之间,明显受压变薄。结论:关节盘并非随髁突作同步同向运动。关节盘在髁突作滑动运动时发生移位;当转动运动、滑动运动复合出现时,关节盘发生移位;而在关节窝内发生的转动运动,关节盘不发生移位。     

偏突颌患者颞下颌关节盘冠状向位置的MRI评估

目的研究偏突颌畸形患者双侧颞下颌关节盘-髁突位置在冠状位磁共振图像(magnetic resonance imaging,MRI)上的差异,并分析其关节盘移位程度与偏斜严重程度的相关性。方法对54例骨性Ⅲ类错患者进行标准化临床影像学检查得到闭口斜冠状位MRI,通过计算机软件测量分析其冠状位关节盘内外侧移位情况,应用wilcoxon秩和检验分析各组间颞下颌关节盘-髁位置在冠状位磁共振图像上的差异。结果40例偏突颌畸形患者中,偏斜侧7侧(17.5%)关节盘外侧移位,16侧(40.0%)内侧移位;而40侧偏斜对侧关节盘中,27侧(67.5%)关节盘内侧移位,仅2侧(5.0%)关节盘向外侧移位。14例(28侧)无偏斜骨性Ⅲ类患者中,18侧(64.3%)存在关节盘内侧移位,未发现外侧移位的关节盘。本研究证实了偏斜侧关节盘内外侧位置与偏斜对侧及无偏斜组存在显著性差异(P<0.05),中等到重度偏突颌患者偏斜侧关节盘位置与轻度及无偏斜者之间的差异具有统计学意义(P<0.05)。结论在冠状位磁共振图像中显示,中等到重度偏突颌患者偏斜侧关节盘倾向于向外侧移位,偏斜对侧关节盘倾向于向内侧移位。     

青少年颞下颌关节盘移位关节镜盘复位后的髁突改建

目的：通过磁共振评价青少年颞下颌关节盘移位患者关节镜盘复位后的髁突改建情况。方法：回顾分析2006年1月—2008年12月间因颞下颌关节盘移位而接受关节镜关节盘复位术且随访期超过6个月的26例青少年患者（38侧关节）,在术前和随访磁共振图像上对斜矢状位和冠状位的髁突高度、前后径和内外径分别进行定量测量,应用SPSS13.0软件包中的t检验进行统计学分析。结果：患者手术时的平均年龄为17.7岁,术后平均随访间隔期为15个月。根据Wilkes分类,术前7侧关节为IDⅡ期,26侧为Ⅲ期,2侧为Ⅳ期,3侧为Ⅴ期。随访磁共振显示,所有患者关节盘位于正常位置。与术前相比,在斜矢状位上,髁突前后径和高度分别平均增加了0.45mm（P〈0.05）和0.92mm（P〈0.05）;而在冠状位上,髁突内外径和高度的变化无显著差异（P〉0.05）。结论：青少年颞下颌关节盘前移位患者在关节镜关节盘复位术后,髁突可出现以增生为主的明显改建,这种改建可能对改善面形有所帮助。     

颞下颌关节病变的CT检查

随着影像技术的飞速发展 ,对颞下颌关节疾病诊断提到了一个新的高度。本文介绍了ＣＴ检查 ,尤其三维ＣＴ成像在颞下颌关节中的应用。一、ＴＭＪＣＴ检查及用途[1～ 6]80年代初ＣＴ开始用于ＴＭＪ病变的检查。常用位置有横断位、直接矢状位和冠状位扫描。主要观察 :①ＴＭＪ关节结节和关节窝形态、位置及骨质结构改变。②关节间隙周围的关系并进行关节间隙测量。③髁状突骨质形态、边缘、解剖结构和活动范围并进行髁状突水平角、垂直倾斜角及内外前后径测量。④ＴＭＪ关节盘改变 (闪烁法显示 )。另外 ,横断位扫描还易于进行矢状、冠状和任意…     

磨牙症患者颞下颌关节结构的锥形束CT测量分析研究

目的:了解磨牙症患者的颞下颌关节三维位置并分析变化特征。方法:对45例口腔门诊磨牙症患者的病例资料、其颞下颌关节锥形束CT图像中关节间隙及位置进行定量测量研究,并进行统计分析和评价。结果:获得了不同三维层面关节间隙及位置的测量值。矢状方向分析:90侧关节,30.5%处于后位,27.8%处于前位;冠状方向:双侧关节近中、冠中、远中间隙测量结果对应比较,差异均无统计学意义(P>0.05);水平方向:左右侧髁突角度比较无统计学差异(P>0.05)。结论:磨牙症患者对TMJ结构位置产生影响,在矢状位方向存在髁突非中性移位。     

颞下颌关节磁共振影像形态与解剖形态相关性研究

目的：探讨颞下颌关节（TMJ）的磁共振成像（MRI）和相应解剖形态的相关关系。方法：4具尸体，①双侧TMJMRI（头部线圈、SE序列T1加权）检查和解剖学测量，并作相应的相关性分析；②翼外肌正矢状位与髁状突翼颌斜位（CPMOP）图像及相关性分析。结果：TMJ骨质结构MRI影像检查结果与解剖测量结果具有高度一致性，关节盘内1／3两种测量结果有相关性；翼外肌正矢状位MRI和髁状突翼颌斜位MRI图像具有高度相关关系。结论：MRI（头部线圈、SE序列T1加权）可用以TMJ硬组织形态的观察和测量，翼刈肌正矢状位片可用以对翼外肌上下头形态测量。     

健康成年人颞下颌关节上腔造影螺旋CT扫描图像分析

目的 探讨健康成年人开闭口位颞下颌关节(TMJ)上腔造影螺旋CT扫描图像的三维断面形态.方法 选择5名健康成年男性志愿者,左侧TMJ上腔行76%泛影葡胺造影,在开闭口位行螺旋CT扫描,分别截取经关节窝顶点的矢状面和冠状面图像以及关节窝高度中点的横断面图像,并与3具TMJ局部解剖标本进行对照,分析关节上腔形态与下颌运动的关系.结果 健康成年人闭口位关节上腔造影的矢状面、冠状面及横断面图像分别为"S形"、"半圆弧形"和"圆环形";开口位关节上腔造影的矢状面、冠状面及横断面图像分别为"月牙形"、中间部分扩张的"S形"和"半圆形";关节上腔形态能反映关节盘在开闭口运动中的位置变化和颞骨关节面的形态.结论 健康TMJ上腔造影经螺旋CT扫描的图像能综合反映关节上腔及其毗邻组织在开闭口位的形态和结构,为颞下颌关节疾病的影像学检查提供正常对照资料,为TMJ的生理运动和临床诊断研究提供依据.     

Disk position and the bilaminar zone of the temporomandibular joint in asymptomatic young individuals by magnetic resonance imaging

OBJECTIVE: The purpose was to study the disk position of the temporomandibular joint (TMJ) in young individuals without any clinical signs or symptoms or history of internal derangement or degenerative joint disease and to study the features of the bilaminar zone of the TMJ in sagittal magnetic resonance (MR) images and the behavior of the bilaminar zone during jaw opening. STUDY DESIGN: MR imaging examinations of 80 TMJs of 40 symptom-free healthy subjects (20 women and 20 men) with a mean age of 26.9 years formed the basis of this study. RESULTS: In 33 of the 40 symptom-free subjects (82.5%), there was a normal relationship between disk and condyle at occlusion, whereas 5 individuals had unilateral disk displacement and 2 had bilateral disk displacement. The superior part of the bilaminar zone could be identified in all of the 40 symptom-free subjects. The inferior band of the bilaminar zone was identified bilaterally in 57.5% of individuals and unilaterally in 20%. In 9 subjects, the inferior band of the bilaminar zone could not be identified in any of the TMJs. CONCLUSIONS: Disk displacement of the TMJ occurred in approximately 20% of the young individuals in this sample. The use of both sagittal and oblique coronal MR images is of importance for classification of the position of the disk in that the oblique coronal imaging plane rendered significant complementary information to that of the sagittal images. The identification of both the superior and the posterior band of the bilaminar zone must be considered new information. The superior band remained consistently in contact with the fossa at the open-mouth position.     

颞下颌关节增强磁共振成像研究

目的：探讨磁共振对比增强剂Gd—DTPA对颞下额关节紊乱病的临床诊断意义。方法：对12名临床诊断为颞下颌关节紊乱病患进行磁共振增强前后扫描，观察影像增强效果。结果：Gd—DTPA对关节盘位置正常的关节闭口斜矢状位前伸部及张口位双板区具有显的增强效果；对可复性及不可复性关节盘前移位张闭口位前伸部及双板区均有明显的增强效果；对冠状位也有明显增强效果。结论：磁共振对比增强剂的增强效果明确，为提高临床诊断准确性及作为磁共振常规扫描的辅助手段提供理论依据。     

Disk and joint morphology variations on coronal and sagittal MRI in temporomandibular joint disorders

Objectives

This study aims to assess the disk morphology and the condyle position in subjects with temporomandibular (TMJ) disk displacements on sagittal and coronal magnetic resonance imaging (MRI).

Materials and methods

Seventy-four TMJs (from 37 patients) with positive clinical TMD symptoms according to the RDC/TMD axis I protocol were evaluated by 1.5 T MRI. Disk position, disk morphology, sagittal and coronal condyle position, joint effusion, joint space, and coronal condyle angulation were evaluated. Multivariate logistic regression was used to explore the relationship between disk displacement and MRI variables.

Results

Disk displacement with reduction (DDR) was found in 36.48 % and without reduction (DDwR), in 21.62 % of the joints. Disk displacement was anterior in 35.1 %, anterior-medial in 13.5 %, and anterior-lateral in 9.45 % of cases. The thickened posterior band (94.48 OR, p?=?0.001) and the posterior condyle position (4.57 OR, p?=?0.03) were more likely found on sagittal MRI in disk displacements. On coronal slices, the disk displacement was significantly associated with the distance from the most medial condyle point to the midplane (p?<?0.05).

Conclusions

Disk displacement is associated with changes of disk shape, disk dimension, and condyle position on sagittal MRI. A significant variation of the distance from the most medial condyle point to the midplane in disk displacement was found on coronal MRI.

Clinical relevance

Our study highlights the existence of changes on coronal MRI in TMD patients which should be assessed for better understanding of the clinical evolution of temporomandibular disorders.     

Magnetic resonance imaging of the temporomandibular joint: Value of axial images

The purpose of this study was to determine the value of axial images for diagnosis of disk displacement and osseous changes of the temporomandibular joint. Sagittal, coronal, and axial magnetic resonance images were obtained of 35 fresh temporomandibular joint autopsy specimens. The sagittal and coronal images were interpreted for position of the disk and osseous changes. The value of the axial images for diagnosis of the disk and osseous components was classified into one of four categories: 1) did not add diagnostic information, 2) confirmed findings of sagittal and coronal images, 3) added diagnostic information but did not change the diagnosis, 4) changed the diagnosis. The results showed that the axial images did not add diagnostic information concerning position of the disk in 5 joints, confirmed the diagnosis in 29 joints, and added information but did not change the diagnosis in 1 joint. Concerning osseous abnormalities, the axial images did not add any diagnostic information in 5 joints, confirmed findings of the sagittal and coronal images in 26 joints, added information but did not change the diagnosis in 3 joints and changed the diagnosis in 1 joint. On the basis of these results, it is concluded that the axial plane of imaging of the temporomandibular joint is of relatively little value for assessment of disk displacement and osseous changes. Axial imaging is therefore not recommended for diagnosis of disk position and osseous abnormalities.     

Association between temporomandibular joint disc position evaluated by magnetic resonance imaging and mandibular condyle inclination evaluated by computed tomography

Temporomandibular joint disc displacement is common in the world's population and could be associated with bone and functional characteristics of the temporomandibular joint. The aim of these study was to analyse the association between temporomandibular joint disc position evaluated by magnetic resonance imaging (MRI) and the inclination of the mandibular condyle evaluated by computed tomography (CT). One hundred and seventy temporomandibular joints (TMJ) were retrospectively analysed. The temporomandibular disc position was evaluated by MRI and classified into three types: normal (N), disc displacement with reduction (DDWR) and disc displacement without reduction (DDWoR). The mandibular condyle measurements evaluated by CT included horizontal, sagittal and coronal inclination. ANOVA followed by post hoc Tukey's test was used to evaluate the interaction between condylar inclination and disc position. There was an association between disc position and the horizontal and sagittal condylar inclination (P < .05). There are statistically significant differences in the mean of horizontal and sagittal inclination of the mandibular condyle between the DDWoR and the other disc positions (P = .002 and P = .004). Disc position was not statistical associated with coronal inclination of condyle (P > .05). These results indicate that the inclination of the mandibular condyle may be different in TMJ with various disc position. A more medial horizontal inclination and a more posterior sagittal inclination of the mandibular condyle are associated with DDWoR.     

Cinematic study of temporomandibular joint motion using ultra-fast magnetic resonance imaging

Magnetic Resonance Images (MRI) of the temporomandibular joint (TMJ) are usually performed to study the opening/closing movements of the mandible and have up to now been pseudodynamic step-by-step images simulating condylar motion by post-processing reconstruction. The aim of this study was: 1. to optimize a TMJ cine-imaging method to give a better clinical result than the step-by-step methods; 2. to develop an ultra-fast MRI Gradient Echo (GE) sequence for this purpose; and 3. to analyze condylar movements in the sagittal, coronal and para-axial planes during border mandibular displacements and chewing. Both TM joints were studied in six asymptomatic volunteers. The method involved a compromise between in-plane resolution, slice thickness, signal-to-noise ratio and time resolution. Routine clinical use was found to be a GE pulse sequence providing three images per second with an isometric voxel resolution of approximately two millimeters in ridge. This did not allow visualization of the disk. Using this sequence enabled real and simultaneous condylar displacement observation in the three planes of space and therefore contributed to a better functional diagnosis of pathologic TMJ motions.     

Correlation between direction and severity of temporomandibular joint disc displacement and reduction ability during mouth opening

The most common temporomandibular joint (TMJ) internal derangement is an abnormal relationship of the disc with respect to the mandibular condyle, articular eminence and glenoid fossa‐disc displacement. The aim of our study was to analyse the correlation between partial/complete disc displacement in the intercuspal position (IP) and its reduction in the open‐mouth position (OMP) in both oblique sagittal and coronal planes on magnetic resonance imaging (MRI) in patients with temporomandibular disorders. Multisection MRI analysis of 382 TMJs was conducted in 191 patients with disc displacement according to the RDC/TMD criteria (148 women, 43 men; aged 14‐60 years). The disc position was evaluated on all oblique sagittal and coronal images in the IP and the OMP. Univariate logistic regression analysis showed that the severity of disc displacement in the sagittal plane is a statistically significant predictor of reduction ability during mouth opening (B = 3.118; P < .001). Moreover, the severity of disc displacement in both planes is also a significant predictor of disc reduction in OMP (B = 2.200; P < .05). In conclusion, reduction ability during mouth opening is associated with the severity of disc displacement in IP, in both sagittal and coronal planes. Multisection analysis of all MR images allows distinguishing the correct disc position from disc displacement and can improve the ability to distinguish between various stages of TMJ internal derangement.     

Magnetic resonance imaging of the temporomandibular joint: a study of inter- and intraobserver agreement

Objective The purpose of this study was to estimate the inter- and intraobserver agreement for interpreting magnetic resonance (MR) images of the temporomandibular joint (TMJ).Methods The study was based on MR images of 30 TMJs. The images were interpreted by seven observers for disk configuration, disk position, joint fluid, bone marrow changes, and diagnosis. The observers were not calibrated. Kappa statistics were used.Results The kappa values were, for interobserver agreement of disk configuration, 0.10; for disk position in the sagittal plane with closed mouth, 0.35; for a combination of closed mouth and open mouth, 0.44; for disk position in the coronal plane, 0.17; for joint fluid, 0.36; for bone marrow changes, 0.01; and for diagnosis, 0.39. Intraobserver agreement was generally higher than interobserver agreement.Conclusion Agreement on disk position in the sagittal plane, on presence and amount of joint fluid, and on diagnosis was fair to moderate. Agreement on disk configuration, on disk position in the coronal plane, and on bone marrow changes was poor.     

The use of pseudo-dynamic magnetic resonance imaging for evaluating the relationship between temporomandibular joint anterior disc displacement and joint pain

The relationship between temporomandibular joint (TMJ) pain and the magnetic resonance imaging (MRI) finding of articular disc displacement is debated. The purpose of this study is to investigate the correlation between TMJ pain and anterior disc displacement (ADD) using pseudo-dynamic MRI. A retrospective review of MRI studies was carried out on 130 TMJs in 65 patients presenting unilateral TMJ pain. The contralateral asymptomatic joints served as the control group. Bilateral oblique sagittal and coronal MRIs as well as pseudo-dynamic studies in the oblique sagittal plane were obtained. The disc–condyle relationship was divided into three subtypes (normal disc position, ADD with reduction, and ADD without reduction), based on the pseudo-dynamic MRI findings. Fisher's exact test was used to determine whether the TMJ pain was linked to ADD. The results showed that TMJ pain was significantly related to ADD (with and without reduction) compared to the group with a normal disc position (P = .0001). A significant correlation was found between TMJ pain and the ADD subtype without reduction, as compared to the ADD subtype with reduction (P = .0156). These data suggest that a displaced disc, particularly in the subtype without reduction, is an important source of pain.