КОМПЛЕКСНАЯ ЛУЧЕВАЯ ДИАГНОСТИКА У ПАЦИЕНТОВ С ДИСФУНКЦИЕЙ ВИСОЧНО-НИЖНЕЧЕЛЮСТНОГО СУСТАВА (ВНЧС)

Abstract

Purpose. Сonducting a comprehensive analysis of clinical and radiological data in patients with temporomandibular joint (TMJ) dysfunction at the stages before and after conservative and dental types of treatment using multislice computed tomography (MSCT) and magnetic resonance imaging (MRI). Materials and methods. The present study included the results of clinical and radiological examinations at the stages before and after conservative and dental types of treatment of 36 patients (31 women and 5 men) in the age range of 18-52 years. All patients were divided into four groups depending on the clinical manifestations of temporomandibular joint dysfunction. Group I (n = 11; 30.3%) - patients with pain syndrome with TMJ dysfunction; Group II (n = 14; 39.2%) - patients with manifestation of acoustic effects in TMJ dysfunction and group III (n = 5; 13.7%) - patients with degenerative changes in bone tissue. Group IV (n = 6; 16.8%) - was a control group – volunteers without clinical manifestations of TMJ dysfunction. Patients of all groups underwent radiological diagnostic methods at various stages of treatment: MSCT examination at treatment and 12 months after the initial examination; MRI - at treatment, at 6 and 12 months. Results. According to the study, it was revealed that the asymmetric arrangement of the heads of the condylar processes of the lower jaw (n = 14; 42.4%) was noted in view of the violation of the biomechanics of the act of chewing. The presence of pronounced dystrophic processes on the part of the lesion in groups I, II, III was regarded by us as changes as a result of functional overload, which was indirectly confirmed by the regression of the process after the complex treatment. The posterior position of the head of the condylar process of the lower jaw was found much more often than any other localization, especially in the destructive process of the cartilaginous component in 20 patients (60.6%). According to MSCT data, the size of the joint space before and after the treatment was modernized: in the anterior section from 1.761.8 to 3.08.51.5 mm; in the middle section from 1.181.7 to 1.862.5mm after treatment and in the back section from 0.802.5 to 3.421.3mm after treatment In the absence of violations of the integrity of the dentition and trauma in the anamnesis in 25 patients (75.7%), a predominance of the active function of the masticatory muscles on the leading side was noted. According to MRI data, the volumetric characteristics of the lateral pterygoid muscles before and after treatment ranged from 17.81.9 to 15.12.5 mm; medial pterygoid muscles from 13.351.5 to 11.211.5 mm and the masticatory muscles proper from 18.531.5 to 14.221.6 mm. A statistically significant increase in the volumetric parameters (thickness) of the masticatory muscles in 25 patients (75.7%) indicates a functional overload of the masticatory apparatus, since the volumetric characteristics of the studied muscles became comparable with the data of the control group (n=6; 16,8%) after the treatment. Changes in the parameters of the articular disc, MRI studies revealed the following changes before and after the treatment: in the anterior region from 2.32.6 to 2.72.7 mm, in the central region from P 1 - I.M. Sechenov First Moscow State Medical University (Sechenov University). Moscow, Russia. 2 - Tver State Medical University. Tver, Russia. RUSSIAN ELECTRONIC JOURNAL OF RADIOLOGY | www.rejr.ru | REJR. 2021; 11 (1):88-102 DOI: 10.21569/2222-7415-2021-11-1-88-102 Страница 90 0.52,9 to 1.91.7 mm, in the posterior section from 3.22.7 to 4.32.1 mm. Bone density indicators of patients (n = 31; 100.0%) varied from +234.55.8 HU (in group III) to +565.55.9 HU (in group I) during the primary study, which made it possible to differentiate the severity of osteoporotic changes in bone tissue to correct the treatment. Conclusion. The use of highly informative methods of radiological diagnostics (MSCT, MRI) in patients with TMJ dysfunction is an integral part both at the stage of initial consultation and after treatment.