Abstract
The aim of this study was to assess the shape of the temporomandibular joint (TMJ) articular eminence and the articular disc configuration and position in patients with disc displacement. TMJ magnetic resonance images (MRI) of 14 patients with bilateral disc displacement without unilateral reduction were analyzed. Articular eminence morphology was characterized as box, sigmoid, flattened, or deformed. Articular disc configuration was divided into biconcave, biplanar, biconvex, hemiconvex or folded, and its position, as "a" (superior), "b" (anterosuperior), "c" (anterior) or "d" (anteroinferior). The images were divided and the sides with disc displacement with reduction (DDWR) and without reduction (DDWOR) were compared. Regarding articular eminence shape, the sigmoid form presented the greatest incidence, followed by the box form, in the DDWR side, although this was not statistically significant. In the DDWOR side, the flattened shape was the most frequent (p = 0.041). As to disc configuration, the biconcave shape was found in 79% of the DDWR cases (p = 0.001) and the folded type predominated in 43% of the DDWOR cases (p = 0.008). As to disc position, in the DDWR side, "b" (anterosuperior position) was the most frequent (p = 0.001), whereas in the DDWOR side, "d" (anteroinferior position) was the most often observed (p = 0.001). The side of the patient with altered disc configuration and smaller shape of TMJ articular eminence seems to be more likely to develop non-reducing disc displacement as compared to the contralateral side.
Highlights
Magnetic resonance imaging (MRI) provides an excellent representation of soft tissues in anatomical and semi-functional relationships
The multisection images allow a tridimensional analysis of the temporomandibular joint (TMJ), providing the most complete assessment of the relationship of the mandibular head, articular disc, mandibular fossa and articular eminence.[10]
Gation was based on a retrospective study of 14 selected patients (11 females, 3 males), with signs and/ or symptoms of temporomandibular disorders, who were submitted to TMJ MRI in a Philips Gyroscan ACS - II 1.5 Tesla (Philips Medical Systems, Best, Netherlands) in the closed-mouth, maximum opening and pseudodynamic positions, which presented unilateral disc displacement without reduction (DDWOR)
Summary
Magnetic resonance imaging (MRI) provides an excellent representation of soft tissues in anatomical and semi-functional relationships. The multisection images allow a tridimensional analysis of the temporomandibular joint (TMJ), providing the most complete assessment of the relationship of the mandibular head, articular disc, mandibular fossa and articular eminence.[10] The TMJ is a bilateral articulation, connected to the mandible and interdependent, with its own movements in each side yet simultaneous, and could be considered as one sole joint.[15] Several studies have assessed the TMJ as an individual or unilateral structure,[2,3,12,18,20,22,23,24] not taking into account the contralateral side. It has been argued that the articular eminence morphology may be a factor in the etiology of internal TMJ disorders.[8,9,11,12,13,14,19,20,21,25] Some authors have suggested that greater articular eminence inclination would be a predisposing factor for internal disorders,[9,20,21] even though other studies did not support these results.[8,11,13,14,19] Articular eminence flattening can be a result of internal disorders.[5,12] The association of articular disc position and configuration in the TMJ with internal derangements,[2,3,12,18,20,22,24] as well as temporomandibular disorders,[1,4,5,6,7,16,17,23] has been reported by many authors
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