MR Evidence of Characteristics in Symptomatic Osteoarthritis of the Temporomandibular Joint: Increased Signal Intensity Ratio on Proton Density-Weighted Images of Bone Marrow in the Mandibular Condyle

Abstract

The purpose of this study was to clarify the presence of pain and a correlation between pain and characteristics of signal intensity of mandibular bone marrow in temporomandibular joints (TMJ) with osteoarthritis (OA). A total of 196 joints in 98 patients with TMJ disorders were examined using magnetic resonance imaging (MRI). A pain score and signal intensity on mandibular bone marrow were analyzed in the TMJ with OA. TMJ with OA showed a higher degree of pain compared to those without (p<0.05). During opening, the joints in the higher signal intensity group showed a significantly higher degree of pain compared to the joints in the lower signal intensity group in those with OA on proton density weighted images (p<0.05). It was concluded that TMJ with osteoarthritis is related to pain and that a symptomatic osteoarthritic TMJ can accompany bone marrow changes in the condyle, showing an increased signal on proton density weighted images.     

Differences in temporomandibular joint pain and age distribution between marrow edema and osteonecrosis in the mandibular condyle

This study investigated the differences of age distribution and temporomandibular joint (TMJ) pain between marrow edema and osteonecrosis in the mandibular condyle. Subjects consisted of 35 TMJs in 35 patients with abnormal bone marrow on MR images who were selected from a consecutive series of 527 patients with TMJ disorders. Proton density and T2-weighted MR images taken in the oblique sagittal and coronal planes were used to diagnose condylar marrow abnormalities and divide them into either edema or osteonecrosis. The differences in TMJ pain and age distribution for these two abnormalities were assessed with the one-sided Wilcoxon rank sum test with 0.05 alpha level. The degree of pain was higher in joints with marrow edema than in joints with osteonecrosis (p = 0.033). The mean age was higher in joints with osteonecrosis (p < 0.001). Our results suggest that there is more severe pain in TMJs with marrow edema of the mandibular condyle than in those with osteonecrosis. Since the patients with marrow edema have lower age, it also appears that marrow edema may be a precursor condition for osteonecrosis of the TMJ.     

The relationship of bone marrow edema pattern in the mandibular condyle with joint pain in patients with temporomandibular joint disorders: longitudinal study with MR imaging

The purpose of this study was to investigate the course of bone marrow edema pattern (decreased signal intensity on T1- or proton-density-weighted images and increased signal intensity on T2-weighted fat-suppressed images) in the mandibular condyle after improvement in clinical symptoms, and to clarify its relationship with temporomandibular joint (TMJ) pain. This study was based on 14 joints of 11 patients (all female, mean age 37.5 years) with TMJ disorders showing condylar bone marrow edema pattern on initial magnetic resonance (MR) images. All joints were re-evaluated clinically and using MR images after relief of joint pain following arthrocentesis combined with non-surgical treatment. The time interval between the initial and follow-up MR images ranged from 14 to 27 months (mean 17 months). Of the 14 joints, 4 joints (28.6%) showed a normal bone marrow signal, whereas 10 joints (71.4%) showed persistent bone marrow edema pattern on follow-up MR images (P = 0.125). Therefore, the reduction in TMJ pain did not correlate with resolution of bone marrow edema pattern in most joints. The results of this study suggest that the bone marrow edema pattern in the mandibular condyle does not always contribute to the occurrence of joint pain in patients with TMJ disorders.     

Medical Managed Care for Temporomandibular Disorders and Orofacial Pain

Abstract

This study investigated the differences of age distribution and temporomandibular joint (TMJ) pain between marrow edema and osteonecrosis in the mandibular condyle. Subjects consisted of 35 TMJs in 35 patients with abnormal bone marrow on MR images who were selected from a consecutive series of 527 patients with TMJ disorders. Proton density and T2-weighted MR images taken in the oblique sagittal and coronal planes were used to diagnose condylar marrow abnormalities and divide them into either edema or osteonecrosis. The differences in TMJ pain and age distribution for these two abnormalities were assessed with the one-sided Wilcoxon rank sum test with 0.05 alpha level.The degree of pain was higher in joints with marrow edema than in joints with osteonecrosis (p=0.033). The mean age was higher in joints with osteonecrosis (p<0.001). Our results suggest that there is more severe pain in TMJs with marrow edema of the mandibular condyle than in those with osteonecrosis. Since the patients with marrow edema have lower age, it also appears that marrow edema may be a precursor condition for osteonecrosis of the TMJ.     

Signal intensity on fluid-attenuated inversion recovery images of condylar marrow changes correspond with slight pain in patients with temporomandibular joint disorders

Objectives

Edema and necrosis of the temporomandibular joint (TMJ) have been described in terms of bone marrow signal abnormalities in magnetic resonance imaging (MRI). However, painful joints often show no such signaling abnormalities, making the diagnosis of TMJ disorders difficult in the clinical setting. An association has been suggested between TMJ bone marrow change and TMJ pain, but even when such change results in slight pain, it may be too slight to be visually apparent on MR images. We hypothesized that fluid-attenuated inversion recovery (FLAIR) can be used to detect such minimal changes. The purpose of this study was to determine whether there is an association between signal intensity on FLAIR images and pain in the TMJ.

Methods

The study included 85 TMJs in 45 patients referred to our department for MRI. The signal intensity on FLAIR images was measured. Pain was evaluated based on the visual analog scale. An unpaired t test and Pearson’s product-moment correlation coefficient were used for the statistical analysis. A p value of <0.05 was considered statistically significant.

Results

Signal intensity on the FLAIR images was significantly higher in painful than in nonpainful TMJs, although a significant correlation was not observed between the signal intensity and the pain score.

Conclusions

The results of this study suggest an association between abnormalities in the marrow of the mandibular condyle and pain. They also indicate that FLAIR imaging is a useful tool in the clinical diagnosis of painful TMJs.     

Relationship between temporomandibular joint pain and magnetic resonance imaging findings in patients with temporomandibular joint disorders

The purpose of this study was to evaluate abnormal magnetic resonance imaging (MRI) findings related to temporomandibular joint (TMJ) pain. This study included 245 joints of 152 patients with temporomandibular disorders with anterior disc displacement; of these, 129 joints had joint pain whereas 116 joints had no joint pain. MRI was used to evaluate the reduction of anterior disc displacement, joint effusion, mandible condylar morphology, bone marrow oedema of the mandibular condyle, and signal intensity of the posterior disc attachment (PDA) on fat-suppressed T2-weighted images. The odds ratio (OR) for each MRI variable for the pain group versus the no pain group was computed using logistic regression analysis. Univariate logistic regression analysis showed significant correlations between TMJ pain and all MRI findings. Multivariate logistic regression analysis showed significant correlations with joint effusion (P = 0.03, OR 2.21), bone marrow oedema (P < 0.001, OR 11.75), and signal intensity of the PDA (P < 0.001, OR 6.21). These results suggest that bone marrow oedema, high signal intensity of the PDA on fat-suppressed T2-weighted images, and joint effusion, in descending order of influence, are factors related to TMJ pain.     

Osteoarthritis and abnormal bone marrow of the mandibular condyle

OBJECTIVE: The purpose of this study was to analyze the relationship between abnormal bone marrow of the mandibular condyle and osteoarthritis. STUDY DESIGN: The relationship between abnormal bone marrow and osteoarthritis of the mandibular condyle was analyzed in magnetic resonance images of the temporomandibular joints of 74 patients. Thirty-seven patients had magnetic resonance evidence of abnormal bone marrow, and 37 control patients had magnetic resonance images with normal bone marrow. RESULTS: Fifteen of 37 patients with magnetic resonance evidence of abnormal bone marrow had no magnetic resonance evidence of osteoarthritis; the other 22 patients had both abnormal bone marrow and osteoarthritis. CONCLUSIONS: Abnormal bone marrow of the mandibular condyle can occur separately from osteoarthritis; nearly one half of the joints with magnetic resonance evidence of abnormal bone marrow did not have any evident osteoarthritis. Abnormal bone marrow may therefore initially represent a separate disease entity. Over time, secondary osteoarthritis probably develops in joints with initial bone marrow abnormalities.     

髁突骨髓腔MRI信号异常与颞下颌关节疼痛的关系

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。     

Differences in signal intensities of temporomandibular joint (TMJ) effusion on fluid-attenuated inversion recovery (FLAIR) images

Objectives

Joint 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.

Methods

A 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.

Results

The 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).

Conclusions

The present findings suggest that FLAIR images can demonstrate the changes in joint effusion contents according to the status of TMJ disorders.

     

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.     

MR evidence of temporomandibular joint fluid and condyle marrow alterations: occurrence in asymptomatic volunteers and symptomatic patients

The purpose of this study was to estimate the frequency and amount of temporomandibular joint (TMJ) fluid, as well as the frequency and type of condyle marrow alterations in asymptomatic volunteers and compare to patients with TMJ pain and dysfunction. Proton-density and T2 weighted magnetic resonance (MR) images of the TMJs of 62 asymptomatic volunteers and 58 symptomatic patients were analysed for fluid and condyle marrow alterations as well as disk position. The amount of fluid (increased T2 signal) was characterized as none, minimal, moderate or marked and related to the disk position. The differentiation between moderate and marked fluid was based on the maximum amount of fluid seen in the volunteers; more than this amount was categorized as marked fluid. The marrow of the mandibular condyle was categorized as normal, edema (increased T2 signal) or sclerosis (decreased proton-density and T2 signal) and related to fluid and disk position. In the 62 asymptomatic volunteers, 50 (81%) had none or minimal and 12 (19%) had moderate TMJ fluid. In the 58 symptomatic patients, 40 (69%) had none or minimal and 18 (31%) had moderate or marked fluid. Both in volunteers and patients, moderate fluid could be seen in joints with normal disk position, but was significantly associated with disk displacement. In the 62 volunteers, no signal abnormalities in the condyle marrow were found. In the 58 patients, six (10%) had abnormal bone marrow. These six patients had disk displacement and two had moderate or marked fluid. Marked fluid and condyle marrow abnormalities were therefore not encountered in any of the asymptomatic volunteers but in about 10% of the patients.     

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.     

Significance of frequency-selective fat saturation T2-weighted MR images for the detection of bone marrow edema in the mandibular condyle

The objective of this study was to evaluate the utility of frequency-selective fat saturation (FS) T2-weighted images (T2WI) for the detection of bone marrow edema in the mandibular condyle. MR evidence of bone marrow abnormalities was examined on the set of FS T2WI and conventional T1WI or of conventional T2WI and T1WI in 200 patients with temporomandibular joint (TMJ) related pain. Other parameters studied were TMJ effusion, disk displacement categories, and cortical bone abnormalities. The detection rate and area of bone marrow edema by FS T2WI and T1WI were significantly greater than those assessed by conventional T2WI and T1WI. The correlation between bone marrow abnormalities on FS T2WI and T1WI and pain was significantly stronger than with conventional T2WI and T1WI. This study confirms that FS T2WI is useful for the detection of the "edema pattern" in the mandibular condylar associated with TMJ-related pain.     

Quantitative bone imaging biomarkers to diagnose temporomandibular joint osteoarthritis

Bone degradation of the condylar surface is seen in temporomandibular joint osteoarthritis (TMJ OA); however, the initial changes occur in the subchondral bone. This cross-sectional study was performed to evaluate 23 subchondral bone imaging biomarkers for TMJ OA. The sample consisted of high-resolution cone beam computed tomography scans of 84 subjects, divided into two groups: TMJ OA (45 patients with TMJ OA) and control (39 asymptomatic subjects). Six regions of each mandibular condyle scan were extracted for computation of five bone morphometric and 18 grey-level texture-based variables. The groups were compared using the Mann–Whitney U-test, and the receiver operating characteristics (ROC) curve was determined for each variable that showed a statically significance difference. The results showed statistically significant differences in the subchondral bone microstructure in the lateral and central condylar regions between the control and TMJ OA groups (P <  0.05). The area under the ROC curve (AUC) for these variables was between 0.620 and 0.710. In conclusion, 13 imaging bone biomarkers presented an acceptable diagnostic performance for the diagnosis of TMJ OA, indicating that the texture and geometry of the subchondral bone microarchitecture may be useful for quantitative grading of the disease.     

Unilateral bony ankylosis of the temporomandibular joint in a case of ankylosing spondylitis

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.     

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 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.     

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.     

Significance of Frequency-Selective Fat Saturation T2-Weighted MR Images for the Detection of Bone Marrow Edema in the Mandibular Condyle

Abstract

The objective of this study was to evaluate the utility of frequency-selective fat saturation (FS) T2-weighted images (T2WI) for the detection of bone marrow edema in the mandibular condyle. MR evidence of bone marrow abnormalities was examined on the set of FS T2WI and conventional T1WI or of conventional T2WI and T1WI in 200 patients with temporomandibular joint (TMJ) related pain. Other parameters studied were TMJ effusion, disk displacement categories, and cortical bone abnormalities. The detection rate and area of bone marrow edema by FS T2WI and T1WI were significantly greater than those assessed by conventional T2WI and T1WI. The correlation between bone marrow abnormalities on FS T2WI and T1WI and pain was significantly stronger than with conventional T2WI and T1WI. This study confirms that FS T2WI is useful for the detection of the “edema pattern” in the mandibular condylar associated with TMJ-related pain.     

Osteoarthritis of the temporomandibular joint: an evaluation of the effects and complications of corticosteroid injection compared with injection with sodium hyaluronate

The purpose of this study was to compare the efficacy and the complications of intra-articular temporomandibular joint (TMJ) injections in 40 patients with osteoarthritis of the TMJ. The subjects were randomly divided into two groups, and the patients received either two intra-articular injections with sodium hyaluronate or two intra-articular injections with corticosteroids, 14 days apart. The effect of the treatment was evaluated 14 days, 1 and 6 months after the initial injection and was based on the following measurements: pain intensity, pain localization, joint sounds, mandibular function and complications. Both groups of patients had less pain intensity at the 6-month follow-up, and there was significantly less pain intensity in the group of patients receiving sodium hyaluronate compared with corticosteroids (P = 0.001). A decrease in crepitation was seen in both groups. In the 20 subjects receiving sodium hyaluronate both the mandibular vertical opening and protrusion increased significantly (P < 0.000). Lateral movement from the affected side increased both in subjects injected with sodium hyaluronate (P = 0.024), and those injected with corticosteroids (P = 0.042). In conclusion, this study confirms that injections in the TMJ with sodium hyaluronate or corticosteroids may reduce pain and improve function in patients with osteoarthritis. The injections were more effective in patients with only TMJ pain compared with patients suffering from both TMJ and myofascial pain. Injection with sodium hyaluronate was significantly more effective in decreasing pain intensity than corticosteroids. Temporary pain after injections may be observed.