Degree Of Disc Displacement Research Articles

Comparison of magnetic resonance imaging findings in 880 temporomandibular disorder patients of different age groups: a retrospective study

BackgroundMagnetic resonance imaging (MRI) findings of temporomandibular joint (TMJ) in temporomandibular disorder (TMD) patients of different ages are still unclear. The aim of this study was to analyze and compare the characteristics of MRI features of TMJs in different age groups.MethodsA total of 1760 TMJs from 880 patients were included in the study and divided into three groups: ≤ 18Y (n = 195, 14.89 ± 2.35Y); 19-30Y (n = 475, 24.09 ± 3.23Y); and > 30Y (n = 210, 41.73 ± 10.45Y). T2-weighted image (T2WI) of MRI was obtained to evaluate the relationship between age and disc morphology, the degree of disc displacement, joint effusion, joint movement and changes of condylar bone morphology. Data were analyzed by Pearson Chi square test and Spearman correlation coefficient.ResultsThere was no statistical difference between left and right sides in all age groups. Except condylar morphology (χ2 = 0.943, P = 0.624), there were significant differences in the distribution of disc morphology, disc position, joint effusion and joint motion among different age groups (χ2 = 24.450, χ2 = 24.829, χ2 = 19.855, χ2 = 39.259, respectively). There were significant differences in the distribution of the degree of anterior disc displacement, condyle morphology and joint effusion in different types of disc morphology among the different age groups (except for joint effusion in > 30Y), among which the first two were significantly correlated with the disc morphology.ConclusionsThe morphology and position of the articular disc changed significantly with age, but the proportion of abnormal condylar bone remained about 50%. The greater the degree of disc folding, the more prone to bone abnormalities.Trial registration This study was retrospectively registered on 28/03/2022 and endorsed by the Ethics committee (LCYJ2022014).

Correlation between lumbar spinal canal magnetic resonance imaging grading systems and parameters in lumbar spinal canal compromise

BackgroundThere is a need to assess how commonly used classification systems of intervertebral disc degeneration reflect the compromise of neural elements. This study aims to explore the relationship between lumbar discs degenerative diseases using the Pfirrmann and the Combined Task Forces (CTF) of the North American Spine Society (NASS) grading systems as well as qualitative and quantitative grades of lumbar spinal stenosis. This retrospective cohort study included adult patients undergoing non-contrast MR imaging of lumbosacral spine. The radiological assessment included the Pfirrmann grading system, Van Rijn classification, Combined Task Force (CTF) classification, measurement of the cross-sectional area of the dural sac, mid-sagittal antero-posterior diameter of the thecal sac, the degree of dural sac compression at disc level, lateral recesses heights, and intervertebral foramina diameters. The degree of stenosis of the spinal canal and intervertebral foramina was assessed.ResultsOne hundred patients were included in the study. At all levels, Pfirrmann grades had a moderate, significant, positive correlation with the severity of stenosis of the central and lateral spinal canals as well as foraminal stenosis. The grades of lumbar spinal canal and foraminal stenosis had a significant positive correlation with degree of disc displacement as assessed by CTF classification and had a significant negative correlation with the quantitative lumbar spinal canal and foraminal measures.ConclusionsThere is a good correlation between Pfirrmann classification, CTF classification of NASS, qualitative grading and quantitative measures of lumbar spinal canal that reflects the severity of lumbar spinal canal stenosis and nerve root compression.

Long-term follow-up of patients treated with pyrocarbon disc implant for thumb carpometacarpal osteoarthritis: the effect of disc position on outcomes measures

Pyrocarbon disc interposition arthroplasty is an effective treatment for thumb base osteoarthritis. However, as with all implant techniques, the disc can (sub)luxate over time. The relationship between disc position, the experienced pain, and the necessity for revision surgery is not known. This study evaluated the effect of radiographic pyrocarbon disc position on the Michigan Hand Questionnaire (MHQ) outcome measurement. In addition, the correlation between disc position and other factors, including pain intensity, thumb strength, and occupation, was assessed. In this retrospective study, we included 136 patients (161 thumbs) with a mean follow-up of 6.7 years (range 3.3–11). Radiographs were scored on disc position and classified as ‘well aligned’ (Grade 1) up to ‘luxated’ (Grade 4). A database used for outcome measures included MHQ scores, pain intensity, satisfaction, thumb strength, range of motion, occupation, and hand dominance. In bivariate analyses, we assessed any association between disc position and outcome measurements. Eighty of the 136 implants (59%) were well-positioned (not displaced), 41% were (slightly) displaced (grade 2–3). No relationship existed between the degree of disc displacement and MHQ scores. Manual labor occupation was the only factor that correlated with more severe disc displacement. We could not detect any association between disc position and other outcome variables including pain intensity, thumb strength, or hand dominance. In conclusion, our study suggests that radiographic disc displacement has little clinical consequences. Future studies must assess if there is a causality between heavy mechanical stress to the CMC1 joint and luxation of the pyrocarbon disc over time. Level of evidence: IV Therapeutic—Retrospective case series.

The evaluation of lateral pterygoid signal intensity changes related to temporomandibular joint anterior disc displacement.

The aim of this study was to evaluate lateral pterygoid muscle (LPM) signal intensity changes related to different degrees of disc status groups using magnetic resonance imaging (MRI). Four groups were established according to disc displacement of examined temporomandibular joint (TMJ) and opposing TMJ. MRI scans were obtained with a 1.5T device. The signal intensity was measured from the sagittal slice where midportion of the muscle belly was observed. The regions of interest were placed over the superior and inferior heads of LPM. To normalize differences in signal intensity, signal intensity of the grey matter and white matter of the brain was also measured. Signal intensity ratio (SIR) was calculated. Measurements were performed in both T1- and T2-weighted images. In the intergroup comparisons, a statistically significant difference was found for SIR1 sup., SIR1 inf., SIR2 sup. and SIR2 inf. variables (p < 0.01). According to multiple comparison test (Tukey), no significant difference was found between group 0 and group 1 for SIR1 sup., SIR1 inf., SIR2 sup. and SIR2 inf. variables (p > 0.05). For SIR1 sup., SIR1 inf., SIR2 sup. and SIR2 inf. variables, significant differences were found between five binary comparison groups (1-2, 1-3, 2-3, 0-2, 0-3) (p < 0.05). In conclusion, SIR is correlated with the degree of disc displacement. The internal derangement of the opposite joint did not affect SIR of superior and inferior heads of examined LPM in both T1- and T2-weighted images. The inferior head of LPM was also found affected by disc displacement.

Condylar long axis and articular eminence in MRI in patients with temporomandibular disorders

ABSTRACT Objective To compare morphologic findings in MRI and skeletal divergence of a group of patients with temporomandibular joint disorders (TMD) subdivided into condylar symmetric and asymmetric. Methods Fifty-nine adults (26.7 years old) with TMD were retrospectively recruited. Condylar height symmetry was evaluated by orthopantomography (Habets’s method) and used to divide patients into Symmetric and Asymmetric groups; skeletal divergence was assessed on lateral cephalograms. MRI was used to evaluate the condylar long axis’ angle, the glenoid fossa morphology, and the degree of disc displacement. Results Asymmetric subjects showed a hyperdivergent skeletal pattern (p = 0.036), asymmetric condylar long axis (p = 0.018), and deeper (p = 0.025) and asymmetric (p = 0.001) glenoid fossa compared to symmetric subjects. Conclusion Patients with TMD and condylar asymmetry diagnosed with orthopantomography are more likely to show hyperdivergent skull in cephalometry, condylar asymmetry of both height and major axis, and a steeper glenoid fossa in MRI.

Characteristics of Temporomandibular Joint Vibrations in Anterior Disk Displacement With Reduction in Adults

The objective to the present study was to compare temporomandibular joint (TMJ) vibration in anterior disk displacement with reduction (ADDWR) in adults and to explore the diagnostic value of frequency spectrography of TMJ vibrations. Twenty-one patients with ADDWR formed the case group and were further divided into three subgroups according to the degree of disk displacement, and 26 symptomless adults formed the control group. The joint vibration was recorded during rhythmic maximal open-close jaw movement using JVA/JT, BioPAK (Bioresearch, Inc., Brown Deer, WI)). The sensitivity and specificity of the total integral for diagnosis of ADDWR was calculated. All TMJ vibration parameters, including total integral, integral>300Hz, integral<300Hz, >300/<300 ratio, peak amplitude, peak and median frequencies of the case group were significantly higher than that of the control group. Along with the degree of disk displacement, the amplitude and frequency of TMJ vibrations increased, and the total integral significantly increased. The total integral demonstrated high sensitivity and specificity for diagnosis of ADDWR (85.7% and 84.6%, respectively). TMJ vibration was significantly higher in adults with ADDWR than that in the symptomless control group. Different pathological stages of disk displacement have different TMJ vibrations.

The Relationship between Temporomandibular joint Pain and the Relative Signal Intensity of Retrodiscal Tissue on T1-, and T2-Weighted MRI Images

Aims: The purpose of this study was to evaluate the relationship between temporomandibular joint pain and the relative signal intensity (RSI) of retrodiscal tissue on T1-, and T2-weighted MRI images. Materials and Methods: This study was based on 122 TMJs of 61 patients who complain of TMJ pain in only one side but were revealed to have disc displacement in both TMJs according to MRI findings. The signal intensities of regions of interest (ROIs) in retrodiscal tissues were measured using T1-, and T2-weighted MRI images. The RSIs of retrodiscal tissues were referenced to the signal intensities of the ROIs of brain gray matter. The relationships between the RSI of retrodiscal tissue and joint pain, joint effusion, condylar degenerative change, and degree of disc displacement were examined. In addition, the relationships between joint pain and joint effusion, condylar degenerative change, and degree of disc displacement were examined. Results: On T1-weighted MR images, the painful TMJs showed significantly higher retrodiscal tissue RSI than non-painful TMJs. In addition, there is an association between joint pain and the degree of disc displacement. However, on T2-weighted MR images, the RSIs of retrodiscal tissues didn't show any significant differences with regard to joint pain, joint effusion, condylar degenerative change, and degree of disc displacement. Conclusions: The signal intensity of retrodiscal tissue can be used as a diagnostic marker for painful TMJ. However, the overall results suggest the signal intensity of retrodiscal tissue has a limited diagnostic significance in determining the pathologic status of TMJ.

Influence of mouthguard on temporomandibular joint

The aim of this study is to examine whether wearing a mouthguard (MG) has an influence on temporomandibular joint (TMJ) components (i.e., the condyle and the articular disk) and whether clenching with a resilient MG has an effect on the same components. Twenty-six healthy volunteers (15 females, 11 males) with an age range of 26-42 years old (median 28 years) participated in this study. Among all 52 joints in the 26 subjects, anterior disk displacement (AntDD) was recognized in 15. Thus, we classified the 52 joints into two groups, the AntDD group and the Normal group. Resilient thermoplastic materials were used to fabricate two types of MG, one that raised the vertical dimension height by 3 mm and another that raised it by 6 mm. Subjects were scanned with/without two types of MG with/without clenching by magnetic resonance imaging (MRI). The movement of the condylar head and articular disk was measured in the magnetic resonance images using the special subtraction technique. Wearing the MG without clenching did not have a negative influence on the TMJ and clenching in the Normal group. In the AntDD group, however, the relationship between the disk and condyle was affected by clenching and the degree of disk displacement was worsened by clenching with the thicker MG. From our results, we recommend that athletes with an internal derangement of the TMJ not wear the thicker MG and attention should be paid to its setting. And the subtraction technique using MRI was thought as a good tool for detecting a slight change in the TMJ.

相反性クリックを有する無歯顎顎関節症患者に対し全部床義歯製作により治療した１症例

This case report describes a treatment method for a 68-year-old female with reciprocal clicking on her left temporomandibular joint. Wearing complete dentures for a long time and her unilateral habitual mastication caused this condition. As a countermeasure, an interocclusal record was taken at a position without clicking and a new complete denture set was fabricated. In such a case, we usually expect to adopt a new jaw position by adjusting the old dentures. If the degree of disc displacement or transformation of the disc is severe, mandibular repositioning may be difficult. Furthermore, many aged patients have limitated ability to adapt to a new mandibular position. In this case, the degree of disc displacement was slight, so the patient could accept a new position. After wearing the new dentures, her clicking disappeared and MRI showed reduction of the disc. She was able to accept the new position.

Clinical correlation of MRI findings of internal derangements of the temporomandibular joints

We studied 131 temporomandibular joints (TMJs) in 73 patients (56 women, 17 men) with internal derangement using magnetic resonance imaging (MRI) in addition to clinical examinations. The type of TMJ sounds correlated significantly with the degree of disc displacement. Rounded and folded disc deformities caused crepitus, which was a sign of the advanced stage of anterior disc displacement without reduction. Tenderness on palpation of the lateral pterygoid muscle was found in anterior disc displacements with or without reduction. The more deformed the TMJ disc that was shown on MRI the more substantial the clinical signs and symptoms. As the MRI results correlated well with the clinical findings we concluded that expensive diagnostic methods such as MRI should be used for surgical planning and in difficult cases to diagnose pathological conditions of the TMJ.

Gadolinium Diethylenetriaminepentaacetic Acid Enhancement in Magnetic Resonance Imaging in Relation to Symptoms and Signs among Sciatic Patients

A cross-sectional descriptive study. Gadolinium enhancement in lumbar magnetic resonance imaging is not used routinely. The current study explored the possible intercorrelations of enhancement patterns with clinical symptoms and signs. Rim enhancement has been reported to occur in the periphery of disc herniations, and it is thought to represent neovascularization. To the authors' knowledge, the significance of the enhancement in relation to clinical symptoms has not been studied. Magnetic resonance imaging of the lumbar spine with intravenous gadolinium diethylenetriaminepentaacetic acid was performed in each patient. Various contrast enhancement parameters and volume of herniation were evaluated, and their correlations with clinical signs and symptoms (straight leg raising, motor defect, Achilles reflex, leg and back pain, disability) were analyzed. The extent of rim enhancement correlated highly significantly with the degree of disc displacement, being most pronounced in the case of sequesters. The duration of sciatic symptoms correlated negatively with enhancement. The clinical symptoms did not correlate significantly with the different enhancement parameters or disc herniation volume. Straight leg raising correlated only slightly with the extent of rim enhancement (P = 0.04) when bulges were excluded. Achilles reflex abnormality correlated significantly with all enhancement parameters for lesions at L5-S1. In the final stepwise logistic regression model, contrast enhancement extent correlated most significantly with abnormal Achilles reflex (P = 0.0002). Although rim enhancement of disc herniation is thought to represent a beneficial phagocytotic phenomenon, it may also have a harmful effect on the adjacent nerve root.

Ｓｔｕｃｋ ｄｉｓｃを示したクローズドロック患者における治療奏効例のＭＲＩによる評価

The purpose of this study was to evaluate morphological changes in temporomandibular joint components by magnetic resonance imaging (MRI, 1.5 Tesla) before and after treatment for closed lock with a stuck disc.A total of 25 joints (25 patients) that were successfully treated and showed marked improvement in range of motion and articular pain after treatment were studied. Each joint was evaluated on the basis of pretreatment and posttreatment MRI findings, including disc mobility, condylar translation, disc reduction, disc shape, degree of disc displacement, bone changes of the condyle, and signal intensity of the posterior disc attachment.Posttreatment MRI revealed that all joints had mobile discs, and the range of the condylar translation had increased. Deformity of the disc and condyle had progressed remarkably. The posterior disc attachment showed low signal intensity.These results suggest that improved disc mobility is indispensable for successful treatment. The results also reveal that the disc, condyle, and posterior attachment showed various changes caused by remodeling.

Severity of symptoms and signs in relation to magnetic resonance imaging findings among sciatic patients.

A cross-sectional study in sciatic population. To evaluate the separate roles of nerve root entrapment-based on magnetic resonance imaging-and other discogenic pain mechanisms on disability and physical signs among symptomatic sciatic patients. Data symptoms of sciatica are generally understood to be generated by nerve root compression, but other pain mechanisms of sciatica have been suggested. The authors obtained magnetic resonance scans from 160 patients with unilateral sciatic pain. The patients reported the intensity of their back and leg pain and their back-specific disability. Clinical examination and magnetic resonance imaging (1.5 T) was performed on every patient. The degree of disc displacement, neural enhancement, and nerve root compression was evaluated from magnetic resonance scans. The correlations of symptoms and signs with magnetic resonance imaging findings were calculated. The degree of disc displacement in magnetic resonance imaging did not correlate with any subjective symptoms, nor did nerve root enhancement or nerve compression. Magnetic resonance imaging classification was associated, however, with straight leg raising restriction. In regression analysis, straight leg raising restriction was best explained with a simple classification of nonherniations versus herniations. The results suggest that a discogenic pain mechanism other than the nerve root entrapment generates the subjective symptoms among sciatic patients. The findings of this study thus indicate that magnetic resonance imaging is unable to distinguish sciatic patients in terms of the severity of their symptoms.

The relationship between the degree of disk displacement and ability to perform disk reduction

Objective: To evaluate the difference in temporomandibular joint (TMJ) disk position between reducible and permanently displaced disks. Study Design: We found 182 joints with disk displacement (83 with reduction and 99 without reduction) that were available for the study. The disk position was estimated by using magnetic resonance imaging. Results: There was a statistically significant difference between them with the permanently displaced disks being located more anteriorly. When a comparison was made in the disks as to which degree of displacement was moderate, a difference of disk position at either the medial or lateral depth of the TMJ was observed. Conclusion: It was suggested that the permanently displaced disks are located more anteriorly than the reducible displaced disks. When the disk displacement was moderate, disk reduction was influenced by less disk displacement at either the medial or lateral part of the TMJ. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:16-20)

Ｒｏｔａｔｉｏｎａｌ ｄｉｓｃ ｄｉｓｐｌａｃｅｍｅｎｔが認められた顎関節の臨床所見とＭＲＩ所見の検討

The most common direction of temporomandibular joint (TMJ) disc displacement is anterior. Anterior disc displacement is associated with lateral or medial disc displacement, termed rotational disc displacement (RDD). There have been few systematic studies of the clinical and magnetic resorarce imaging (MRI) findings of TMJs with RDD.The aim of this study was to assess the prevalence of RDD and to evaluate the relations between the direction of disc displacement (anteromedial RDD, anterolateral RDD, and pure anterior disc displacement) and clinical findings, including joint pain, joint sound, and range of motion, as well as MRI findings, including disc shape, disc reduction, disc mobility, degree of disc displacement, bone changes of the condyle, and degree of condylar translation. The study was based on MRI of 529 TMJs in 409 patients with symptoms and signs of TMJ. Sagittal and coronal T 1-weighted SE images (1.5 Tesla) were used.MRI showed anteromedial RDD in 96 joints (18.1%), anterolateral RDD in 64 joints (12.1%), and anterior disc displacement in 207 joints (39.1%). There were no statistical differences between anterolateral RDD, anteromedial RDD, and anterior disc displacement with regard to clinical findings. The incidence of reducible disc was higher in anterolateral RDD than in anteromedial RDD or anterior disc displacement. The incidence of bone changes was lower in anterolateral RDD than in anterior disc displacement. There were no significant differences between anteromedial RDD and anterior disc displacement with regard to MRI findings.In conclusion, anteromedial RDD may represent the same clinical entity as anterior disc displacement, but it remains unclear whether or not anterolateral RDD differs from anteromedial RDD or anterior disc displacement.

Risk factors of chronicity in lumbar disc patients. A prospective investigation of biologic, psychologic, and social predictors of therapy outcome.

The current prospective longitudinal study examined the predictive value of psychological, somatic and social variables for the prediction of the short- and long-term follow-up in 111 consecutively selected patients with acute radicular pain and a lumbar disc prolapse or protrusion. The criteria for the therapy outcome were the intensity of persistent pain at the time of the discharge from the hospital and 6 months later and the application for early retirement at the 6 month follow-up. As for the psychological predictors, we examined depression (Beck Depression Inventory BDI), daily hassles (Kiel Interview of the Subjective Situation KISS), pain coping strategies (Kiel Pain Inventory KSI), and Health locus of control (GKU). As somatic predictors, we assessed the duration of pain before treatment, previous operations, paresis, disc displacement, scoliosis, adipositas, treatment, and age. As social predictors, we assessed the social status, occupational characteristics, and the duration of inability to work. The results indicated that persistent pain was best predicted by a combination of somatic (degree of disc displacement), psychological (depression and the pain coping strategies avoidance behavior, endurance strategies, nonverbal pain behavior and search for social support), and social parameters (social status and sitting position) with a correct prediction in 86%. The application for early retirement at the 6 month follow-up was best predicted by depression and stress at work. The results lead to several hypotheses about biopsychosocial interrelations within the chronification of radicular pain and provide the clinician with a short screening instrument for early diagnosis of chronification.

Creation of disc displacement in human temporomandibular joint autopsy specimens

The purpose of this study was to investigate the possibility of iatrogenically creating disc displacement in the human temporomandibular joint (TMJ). Fourteen fresh TMJ autopsy specimens with superior disc position were selected for the study. The upper and lower joint spaces were exposed via a preauricular incision and two to three superficial mediolateral incisions were made in the inferior surface of the posterior disc attachment (ie, retrodiscal tissue). After these incisions were made it was possible to manually displace the disc anteriorly. To maintain the disc in the anterior position the condyle was positioned against the posterior disc attachment in a manner corresponding to the closed mouth position. The joints were then fixed in this relationship and magnetic resonance imaging (MRI) was repeated using the same scanning plane and scanning parameters as before intervention. After imaging, the joints were cryosectioned to show the degree of disc displacement. Histologic analysis was made of the posterior disc attachment. Postoperative MR images and cryosections showed the disc to be displaced anteriorly in 12 of the 14 joints. Displacement of the disc was complete in eight joints (the entire mediolateral dimension of the joint) and partial (only in the lateral part of the joint) in four joints. The disc remained in a superior position in two joints. Cryosections and histologic analysis showed the incisions in the inferior aspect of the posterior disc attachment to be superficial. The results of this study suggest that the integrity of the inferior aspect of the posterior attachment of the disc to the condyle is essential for keeping the disc in its position superior to the condyle.(ABSTRACT TRUNCATED AT 250 WORDS)