颞下颌关节MR冠状影像测量与分析

目的　探讨颞下颌关节冠状面形态结构的关系。方法　将福尔马林液浸泡1年以上的,能将下颌固定在牙尖交错位的15具尸头的28侧TMJ,斜冠状位磁共振质子加权扫描,以下颌升支中线为基准,作相应测量。结果　①横径由大到小排序为:关节窝内外径、髁突内外径、关节窝内径、髁突内径、髁突外径、关节窝外径。②髁突外径与关节窝外径间,髁突内径与关节窝内径间,髁突内外径和关节窝的内外径间均存在正相关关系。③变异系数关节窝外径大于髁突外径、内径大于其他横径。④关节间隙面积与关节盘断面面积正相关。结论　颞下颌关节各结构的冠状形态及大小具有高度协调性,髁突相对于关节窝的内外位置关系具有较大的变异范围。     

颞下颌关节磁共振三维重建的实验与临床应用研究

目的：建立颞下颌关节磁共振三维重建方法：探讨三维重建影像与大体解剖结构的一致性。以证实该方法的准确性：分析该方法在颞下颌关节紊乱病临床诊断中的意义。方法：对小型猪颞下颌关节进行磁共振扫描，进行三维重建，并对小型猪进行解剖，观察其大体形态，将两者进行比较，对1名无症状志愿者及1名颞下颌关节紊乱病患者进行增强磁共振扫描，并进行三维重建。结果：小型猪磁共振三维重建影像与大体解剖形态基本一致，2名受检者的三维影像均可清晰再现颞下颌关节各结构的形态及相对位置关系。结论：磁共振三维重建方法能准确反映颞下颌关节解剖形态，并具有广泛的临床应用前景。     

145例颞下颌关节紊乱病患者的磁共振影像分析

目的 研究145例颞下颌关节紊乱病（TMD）患者的磁共振（MRI）影像学表现,为临床治疗提供依据。方法 利用MRI对145例TMD患者的290侧关节完成开闭口斜矢状位、闭口斜冠状位T1/T2加权成像,观察盘突关系,髁突骨质改变,关节腔积液,关节盘形态改变等情况,并进行分类统计。结果 MRI检查结果显示：37.2%患者双侧TMD病变,71%患者伴有不可复关节盘前移位,10.3%患者伴有可复性关节盘前移位,6.9%患者伴有髁突骨质改变,4.8%患者伴关节腔积液,52.4%患者伴关节盘明显变形。结论 TMD患者中以关节盘不可复性前移位最为常见,提示正常盘突关系的重要性。MRI可以为临床医师提供可靠的影像学诊断依据。     

下颌运动轨迹分析在颞下颌关节紊乱病诊疗中的应用及展望

近年来,颞下颌关节紊乱综合征(temporomandibular disorder,TMD)患病率越来越高,且病因复杂.下颌运动轨迹观测能够针对颞下颌关节(temporomandibular joint,TMJ)的运动能力及协调性进行诊断分析,广泛应用于口腔正畸、修复及外科治疗过程中,对TMD的诊断分析及疗效评定具有重...     

老年颞下颌关节紊乱综合征患者合夹板治疗前后CT影像的三维分析

通过对老年颞下颌关节紊乱综合征（ＴＭＪＤＳ）患者在治疗前后，戴与不戴夹板时正中位关节ＣＴ扫描的图像分析，发现老年颞下颌关节紊乱综合征患者的髁突不仅在矢状面发生了后移位，而且在水平面双侧髁突水平倾斜角亦呈不对称状态。而夹板对老年ＴＭＪＤＳ的矫治作用不仅为适当恢复垂直距离，主要在于消除了干扰，使后移位的髁突调整到关节凹的中位，并且平衡不对称的两侧髁突水平角。作者认为，本方法在颞下颌关节紊乱综合征的诊断及疗效判断方面，参考价值较大。     

内窥镜手术治疗颞下颌关节紊乱综合征的初步体会

作者在应用颞下颌关节内窥镜检查颚下颌关节紊乱综合征患者的基础上，对２０例较明显关节腔内纤维素性悬浮物、盘凹之间粘连带形成及关节凹软骨面粗糙不平患者施行内窥镜直视下手术，并观察１２～３０个月。７０％患者临床症状获得改善，其中３０％患者临床症状消失，随访期内无复发。结果表明颞下颌关节内窥镜手术创伤小，无严重并发症，对某些关节内病变，是一种很有价值的治疗手段。     

颞下颌关节紊乱综合征手术治疗进展

颞下颌关节紊乱综合征是口腔科学中的一种常见病和多发病,是一组病因尚未完全清楚的疾病总称。手术仍是治疗症状严重的晚期颞下颌关节紊乱综合征的有效方法。以手术方法治疗颞下颌关节紊乱综合征已有100多年的历史不同的历史时期其主要的手术方法也有不同。本世纪初以Lanz为代表摘除关节盘为主要的手术方法;50～60年代,手术方法主要着眼于调整棵状突的位置来改变盘／髁关系;70～80年代,MdCarty等应用关节盘复位和关节重建成形术治疗领下颌关节紊乱综合征,取得良好效果,随着材料学的发展,以聚四氟已烯和硅橡胶为代表的关节盘替代物…     

287例颞下颌关节紊乱综合征患者临床及X线分析

通过287例TMD患者的临床及X线分析探讨临床症状与TMJ骨质改变间的关系。所有患者进行常规临床检查并拍摄许勒位及经咽侧位,其中59例(66侧)行关节上腔造影检查。X线片骨组织改变分为三类:正常关节、改建关节、骨关节病关节。本研究结果表明:TMD患者临床症状单侧者占多数。单侧症状患者关节骨结构改变症状与非症状侧比较有显著性差异,症状侧骨关节病改变明显高于非症状侧。本组59例(66侧)关节上腔造影病例中,可复性关节盘前移病例关节骨质多为正常,而关节盘穿孔时,多发生骨质退行性变。     

What you can and cannot see in TMJ imaging – an overview related to the RDC/TMD diagnostic system

Summary In the current version (I) of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), imaging of the temporomandibular joint (TMJ) is not required for a diagnosis. Research has shown that radiological findings of the TMJ do not always support the clinical findings of the RDC/TMD diagnosis. But imaging should only be performed when it is known that it could contribute to (i) a proper diagnosis and (ii) treatment with a better prognosis. Several techniques are used to image the TMJ: panoramic radiography, plain radiography, conventional and computed tomography (CT), digital volume tomography or cone‐beam computed tomography (CBCT), arthrography and magnetic resonance imaging (MRI). Osseous changes are best visualized in tomography, and the newly developed CBCT is a promising method but must be evaluated in a comparative analysis with other tomographic techniques. And although MRI is the method of choice for imaging the disc, a systematic review found the evidence grade for the diagnostic efficacy of MRI to be insufficient. Today, there is no clear evidence for when TMD patients should be examined with imaging methods. Future research designs should be randomized controlled trials where various radiological examination findings are analysed in relation to therapeutic outcome. In future versions of the RDC/TMD diagnostic system, recommended radiographic techniques must be evaluated and defined, diagnostic criteria well defined and observers calibrated.     

颞下颌关节紊乱病的ＭＲＩ观察

目的：应用核磁共振技术（ＭＲＩ）检查颞下颌关节紊乱病（ＴＭＤ）。方法：观察６１例颞下关节紊乱病患者的关节盘（Ｄisc)位置和形态改变,并对照出现的临床表现进行分析,以探讨在诊断中的意义,结果：显示在所有ＴＭＤ患者的关节中,８６．８％有Ｄisc前移位,８０．９％有Ｄisc形态改变,伴关节弹响,张口受限,关节破碎音或磨控音等症状的关节中,ＭＲＩ也显示Ｄisc和髁突有不同程度的改变,结论;ＭＲＩ是一种有前途的颞下颌关节紊乱病诊断方法。     

Characteristics related to TMJ arthralgia,visualized by magnetic resonance imaging (3.0 Tesla)

PatientsSix women, with ages ranging from 52 to 64 years old, clinically evaluated (Research Diagnostic Criteria for Temporomandibular Disorders) by a single examiner were submitted to MRI (3.0 T). They had only arthralgia diagnosis. The images were evaluated by two radiologists who were not informed about the patients’ clinical conditions, in which discs displacements, osteophytes and morphological irregularities, as well as completely normal images, i.e., without any characteristics were identified.DiscussionTMJ arthralgia can be caused by various conditions, few of which are objectively observed when investigating its causes or diagnose temporomandibular disorders (TMD). In some cases, imaging exams can detect some conditions and magnetic resonance imaging (MRI) is commonly used for this purpose. Here, the MRI (3.0 T) enabled a detailed visualization of the structures of the TMJ, allowing the characterization of the symptomology in some cases. Despite, some images were completely normal.ConclusionThis case report detected some features seen on the MRI that justified a clinical diagnosis arthralgia, not associated with other clinical diagnosis. However, the detailed clinical examination should be sovereign even in the face of equipment with advanced technology.     

The evaluation of temporomandibular joint disc position in TMJ disorders using MRI

The purpose of this study was to correlate disc position and the type of disc displacement, intra-capsular effusion and degenerative changes of the condyle as demonstrated in MRI studies. In this study, 126 temporomandibular joints (TMJs) of 63 patients with TMJ disorders were investigated using clinical examination and MRI. One hundred and twelve TMJs were found to have internal derangement as disc displacement. The angle between the posterior margin of the disc and the vertical line drawn through the centre of the condyle was measured on MRI for each TMJ. The positions of the discs were normal, 0 degrees-10 degrees, in 11.11%; slightly displaced, 11 degrees-30 degrees, in 37.30%; mildly displaced 31 degrees-50 degrees, in 15.08%; moderately displaced, 51 degrees-80 degrees, in 7.14% of the TMJs with anterior displacement with reduction (ADDR). The disc position was severely displaced anteriorly, as over 80 degrees, in all TMJs with anterior disc displacement without reduction (ADD), constituting 27.78% of all cases. We found that the smaller the degree of disc displacement the milder the internal derangement and that the intra-capsular effusion was more frequently associated with TMJ with ADDR. The degenerative condylar changes were more severe with an increased degree of anterior disc displacement.     

A magnetic resonance imaging study on the temporomandibular joint disc–condyle relationship in young asymptomatic adults

The aim of this study was to assess the temporomandibular joint (TMJ) disc–condyle relationship in asymptomatic young adults. Ninety-three volunteers aged 19–23 years without temporomandibular disorder (TMD) symptoms underwent TMJ magnetic resonance imaging (MRI). The condylar centre and apex methods were used to measure and analyse the position of the disc in the oblique sagittal plane, and the reliability of the two methods was compared by calculating the intra-class correlation coefficient (ICC). Furthermore, 18 of the volunteers were randomly selected for three-dimensional (3D) reconstruction of the TMJ structure and the disc–condyle relationship. The 3D TMJ structure was established by semi-automatic segmentation of the condyle and articular disc in ITK-SNAP software; the condylar apex method was then performed. It was found that only 33.3% of the posterior edge of the articular discs were located in the normal 12 o’clock position with respect to the condyle. Moreover, this study suggests that the condylar centre method lacks accuracy when compared to the condylar apex method in regard to the measurement of the TMJ disc–condyle relationship (0 < ICC_cen < ICC_apex < 1). The position of the articular disc (left and right) was more forward in young women when compared to young men. However, there was no significant difference in the TMJ disc–condyle position between the left and right sides in the same individual, although the two joint discs in the same individual were not completely symmetrical.     

Effects of splint therapy in TMJ dysfunction: A study using magnetic resonance imaging

This pilot study was undertaken to correlate clinical and MRI diagnoses in seven symptomatic TMJ dysfunction patients and to account, if possible, for the clinical improvement in the signs and symptoms after the use of a maxillary stabilizing splint. The symptomatic TMJs were evaluated by means of MRI prior to splint insertion. Sagittal open/closed, and coronal closed images were obtained with a 0.3 T Fonar MR Scanner. A follow-up MRI was taken after three months of splint therapy for the purposes of a comparative study.
All subjects responded positively even at the early phase of splint treatment. By the end of the three month period, six subjects experienced full remission of pain in the TMJ and associated masticatory muscles with one subject experiencing only partial remission following therapy. Baseline MRI study revealed that only three subjects had anterior disc displacement while the other four subjects had normal disc/condyle relationships and morphology. In the follow-up MRI study, there were no signs of recapture of the three anteriorly displaced discs despite there being evidence of improved jaw movement and remission of pain symptoms.
The use of MRI in this preliminary study indicates that some but not all TMJ pain dysfunction syndromes are caused by internal derangements of the joint. A larger MRI study using the same clinical parameters is indicated for future research.     

单纯透明质酸注射治疗对颞下颌关节功能和结构的影响

目的：利用MRI评价颞下颌关节功能和结构在透明质酸治疗前后的变化。方法：选取经过颞下颌关节门诊治疗的TMJ结构紊乱患者23例行单纯关节上腔透明质酸钠注射治疗。23例患者中,男性3例,女性20例,年龄16~58岁,平均年龄27.8岁。利用MMO及VAS评价患者颞下颌关节功能治疗前后的变化;并对所有患者进行治疗后颞下颌关节MRI检查,评价颞下颌关节结构变化。结果：23例经HA治疗的患者,治疗前MMO 25.90、VAS5.78。治疗后MMO 35.12、VAS1.42,经统计学处理,有统计学意义（P〈0.05）。MRI检查显示治疗后23例患者中均未发现颞下颌关节盘复位。结论：单纯经关节上腔注射HA治疗颞下颌关节结构紊乱可有效改善患者功能,但对颞下颌关节结构无明显影响。     

MR angiography of the TMJ in asymptomatic volunteers

To evaluate the vascular anatomy of the temporomandibular joint (TMJ) and surrounding soft tissue non-invasively, we applied magnetic resonance (MR) angiography for delineating the arterial architecture around the TMJ. MR angiograms of the left and right TMJs in asymptomatic volunteers were obtained using 3D/Time-of-flight (TOF) (First Field Echo, TR/TE/FLIP=46ms/6.8ms/17^o) with intravenous contrast. These MR angiograms were compared with experimental angiograms of human TMJ autopsy specimens in order to identify each of the branches of the arteries on the MR angiograms. This study enabled the depiction by MR angiography of arterial vessels around the TMJ region to some degree. In conclusion, MR angiography appears promising as a non-invasive tool to evaluate the vascular anatomy of the TMJ.     

儿童单侧后牙反患者下颌及颞颌关节的对称性研究

目的研究儿童单侧后牙反牙合患者下颌及颞颌关节的对称性。方法以26例替牙期单侧后牙反牙合患儿为试验组,28名正常牙合替牙期儿童为对照组,分别摄定位颏顶位片及双侧颞颌关节中位断层片进行比较。结果替牙期单侧后牙反牙合患儿在下颌骨坐标系中DMP点更靠颊侧。在颅底坐标系中,反牙合侧DMP点更靠远中,DMP、MM、DM点更靠颊侧。双侧髁突位置不对称、非反牙合侧关节前间隙减小,上后间隙均增大。结论相对于下颌坐标系,反牙合侧第一磨牙位置与对侧相比更靠远中及颊侧。在骨性结构上,未见下颌的不对称。试验组双侧髁突位置及关节间隙有差异,说明下颌发生功能性侧方移动。