Diagnosis Of Internal Derangement Research Articles

Effect of dextrose prolotherapy on internal derangement of the temporomandibular joint.

This study aimed to evaluate the effect of dextrose prolotherapy in treating internal derangement of the temporomandibular joint. A total of 20 patients with temporomandibular joint internal derangement were enrolled in the study. The diagnosis of internal derangement was confirmed by magnetic resonance imaging (MRI). The posterior and anterior disc attachment, as well as the most tender part of the masseter muscle, were injected with 12.5% dextrose. Pain, maximum mouth opening, clicking, and deviation were assessed immediately before treatment, as well as at 2-, 4-, and 12- weeks post-treatment. There was a significant improvement in the four clinical variables at the three-time intervals. Pain at two weeks was reduced by 60% (6 vs. 3.75) and by 200% (6 vs. 1.9) at 4 weeks. The maximum mouth opening was increased by 6.4 mm at 2 weeks and 7.85 mm at 4 weeks. The percentage of patients with clicking decreased from 70%, preoperatively- to 50% at 2 weeks, 15% at 4 weeks, and 5% at 12 weeks. The ratio of patients with deviation was decreased from 80% preoperatively to 35% at 2 weeks, 15% at 4 weeks, and 5% at 12 weeks. Prolotherapy is a safe and effective treatment for alleviating the symptoms of internal derangement of the temporomandibular joint.

Hand-Carried Ultrasonography Instrumentation in the Diagnosis of Temporomandibular Joint Dysfunction.

Internal derangement (ID) in the temporomandibular joint (TMJ) is defined as a mechanical problem of the joint that interferes with its function. It is attributed to an abnormal interaction among the articular disc, condyle, and joint eminence. The aim of this study is to evaluate diagnostic efficacy of non-invasive hand-carried ultrasonography instrumentation (US) to provide high-level images for a correct diagnosis of ID. Twenty-eight ID patients, 15 female and 13 males, were examined both clinically and by MRI images in order to achieve a diagnosis of ID (using Helkimo index). Then, they were submitted to US examination with a 12 MHz transducer by using hand-carried instrumentation by a clinician that was blind to their diagnosis and clinical data. TMJ US examination was performed with the mouth closed and mouth open, with proper technique. Each position was then evaluated with two different orientations of the transducer. US showed acceptable results in identifying bone structures. Lower values of diagnostic efficacy were obtained for disc position during joint movements with respect to MRI images. MRI still represents the gold standard for the identification of joint structures. If not corroborated by clinical and anamnestic data, the diagnostic efficacy of US in identifying the position of the disc during opening and closing jaw movements appears limited than compared to MRI.

Arthroscopic outcomes in TMJ internal derangement and surgical progression in a single centre in New Zealand

This study aims to examine outcomes for temporomandibular joint (TMJ) arthroscopy in different Wilkes stages of internal derangement (ID) and factors relevant in relapse in those requiring further surgical management. A review was undertaken of patients who underwent TMJ arthroscopy from June 2017 until August 2019 at St George's Medical Centre, Christchurch, New Zealand. Those with a primary diagnosis of ID with adequate follow up were reviewed. Gender, pre-and post-operative visual analogue scale (VAS) pain scores and maximum incisal opening (MIO) according to Wilkes stages were statistically analysed. Parameters of those who underwent further surgery were assessed. Ninety-nine patients were reviewed with follow up time between 3 and 27 months. No difference in pre- and post-operative VAS pain scores occurred between Wilkes stages (p = 0.9527). Wilkes II patients had the lowest re-operation rates (6.7%). Twenty-one percent of patients underwent further surgery with either re-arthroscopy, arthrotomy or total joint replacement. Gender did not influence the risk of further surgery (p = 0.3451). Four Wilkes IV and 5 Wilkes V patients underwent TJR, with none from Wilkes II or III. This study shows TMJ arthroscopy should be considered a first line intervention in treating symptomatic ID regardless of initial Wilkes stage. A significant improvement in pain and functional levels occurred across all stages. No specific factors were identified for those undergoing further surgery. However, a trend towards open surgery and total joint replacement was seen in Wilkes IV and V patients.

Internal derangement of the temporomandibular joint

Purpose: To evaluate the role of magnetic resonance imaging (MRI) in the diagnosis of internal derangement and to assess the complimentary role of MRI and clinical assessment in prognostication. To assess the role of MRI in demonstrating disc displacement and reduction. Methods: A total of 34 patients (28 cases and 6 controls) with clinical features of temporomandibular joint (TMJ) internal derangement underwent a dedicated MRI at our institution. MRI was assessed for disc displacement, morphology, and reduction on open-mouth imaging. For analysis, the patients were divided into those with disc displacement with reduction (WR) and those without reduction (WOR). Clinical and MRI grading of internal derangement were done in all patients and correlated with each other. Prognostication was attempted using the clinical and MRI features, and patients were followed up over a mean period of 6 months. Results: Most of the patients were females (n = 20 71%) in the child-bearing age group (third decade). MRI demonstrated disc displacement in all but two patients in whom disc was not visible. Fourteen (54%) patients were placed in WR group, whereas 10 (38%) were in WOR group. In two (8%) patients, stuck disc was diagnosed. Patients in WR group responded to conservative treatment alone while those in WOR group needed conservative management in some (n = 8 57%) and surgical intervention in others (n = 6 43%). Both patients with stuck disc failed conservative management. Conclusion: MRI is an essential component of TMJ evaluation and helps in diagnosing and staging internal derangement together with disc assessment. Patients with disc displacement WOR and those with higher grades of derangement on MRI including stuck disc require surgical intervention if conservative management fails.

Cone Beam Computed Tomography-A Third Eye in Interpreting TMJ Disorders-A Case Report

Imaging is an important diagnostic adjunct for clinical assessment of Dental Patients. Rapid advances in diagnostic imaging and computer technology have major impact in dental radiology. Cone Beam Computed Tomography Technique presents an innovation of tomographic imaging system and subsequent volumetric image reconstruction for dentistry. Here we present a case of 28 year old female patient with chief complaint of pain in the right & left preauricular region since 6months. Pain was intense, dull in nature. Pain was aggravated while chewing food. Patient gave history of clicking sound while opening & closing the mouth from the past 5months & now from past 2months no clicking sound present but pain still persists with limited mouth opening. With the above clinical findings provisional diagnosis of Internal Derangement was given. CBCT scan was performed which revealed Early to mild right TMJ Degenerative changes & Chronic mild Left TMJ degenerative changes.

ARTHROSCOPIC DETERMINATION OF ACCURACY OF CLINICAL EXAMINATION IN INJURIES WITH INTERNAL DERANGEMENT OF KNEE

Abstract Background: For the diagnosis of knee injuries some investigations along with detailed history and clinical examination such as arthrography and arthroscopy are required, which increase the authenticity of diagnosis. Objective: To determine diagnostic accuracy of pre-operative clinical diagnosis with arthroscopic diagno-sis in internal derangement of knee. Methods: This was a Comparative cross sectional study. Conducted at Department of Orthopaedic Sur-gery and Traumatology (DOST) Unit - 1, King Edward Medical University, Mayo Hospital Lahore. Total 45 patients having symptomatic knee injuries, were inclu-ded in this study. After taking informed consent from these patients, a clinical diagnosis of medial meniscus tear (MMT), lateral meniscus tear (LMT), anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament(MCL) and lateral collateral ligament (LCL) injury of knee was made, confirmation with magnetic resonance imaging (MRI) was done and those patients having positive clinical and MRI findings of above mentioned injuries arthro-scopy was carried out and then findings of both clini-cal examination and arthroscopy were compared to find out the diagnostic accuracy of clinical examinat-ion. Data was analyzed with the help of SPSS version 20. Results: Mean age of all 45 patients was 29.51 ± 8.72 years. Minimum and maximum age of patients was 18 and 48 years respectively. Clinical examination is 70.83% sensitive and 19.05% specific for medial meniscus tear. Clinical examination has 50% Positive predictive value and 36.36% Negative predictive value. For the diagnosis of Lateral Meniscal tear, clini-cal examination is 16.67% sensitive and 89.47% speci-fic. While clinical examination has 20% positive pre-dictive value and 87.5% negative predictive value. For ACL rupture diagnosis clinical examination is 72.73% sensitive and 66.67% specific. While clinical examina-tion has 85.71% positive predictive value and 47.06% negative predictive value. Conclusion: Results of this study clearly revealed that diagnostic accuracy of clinical examination for the diagnosis of internal derangement of knee shows vari-ability. Clinical examination findings have high sensi-tivity for diagnosis of MMT and ACL injuries while it shows very low sensitivity for LMT. While specificity of clinical examination for diagnosing LMT and ACL was high but for MMT was low. Key Words: Arthroscopy, Clinical Examination, Internal derangement, Knee.

Correlation Among the Changes Observed in Temporomandibular Joint Internal Derangements Assessed by Magnetic Resonance in Symptomatic Patients

The objective was to assess possible correlations among the anatomy and position of the articular disc, the morphology of the articular eminence and of the condyle, and the presence of joint effusion. Magnetic resonance images of 142 joints of symptomatic patients were assessed. The articular disc was classified as normal, elongated, or folded; displacement was classified as normal, anterior with reduction, anterior without reduction, or posterior, lateral, or medial; the condyle was classified as rounded, convex, flattened, or angulated; and the articular eminence was classified as box, sigmoid, flattened, or deformed. The most frequent forms of the articular disc, articular eminence, and condyle were normal, box, and flattened, respectively. Associations were confirmed between the form of the articular disc and its anterior and lateral positions; between the form of the condyle and an anterior position of the disc; and between the form of the articular eminence and the form of the disc. The form of the articular eminence was the only variant that was not associated to the presence of joint effusion. Magnetic resonance imaging allowed the clear observation of articular structures, without attributing a cause-and-effect relation. The prevalence of changes observed was associated with the diagnosis of internal derangement and was statistically proved.

The value of early MRI in acute knee injury: A randomised controlled trial

Purpose: To determine if early MRI diagnosis in the acutely injured knee affects management, use of resources and patient satisfaction compared to conventional management with physiotherapy. Methods: Patients referred to fracture clinic with acute knee injury in whom a specific clinical diagnosis could not be made were randomised to one of two groups. The MRI group had a scan within 2 weeks and were then reassessed in clinic with management according to the results. The control group received physiotherapy and then reassessed. Patients were assessed in clinic on presentation, at 2 weeks and then by a telephone questionnaire at 3 months. Electronic medical records were also reviewed. Results: 48 patients were recruited in total: 23 in the MRI group (78.2% male, 21.8% female) and 25 in the control group (68% male, 32% female). The mean age was similar in the two groups (29 years (range 18–61) vs. 30 years (18–50)). The MRI group had significantly less physiotherapy appointments (5 ± 3.42 vs. 2.52 ±1.93, p=0.003) on average until definitive treatment but not outpatient appointments (2.72 ± 1.1 vs. 2.43 ±0.66, p=0.27). Median time to surgery was less in the MRI group (138 (31–199) vs.180 days (33–826) vs.) but not statistically significant (p=0.19). A similar number of patients returned to work in both groups (82.6% vs. 76%) but the MRI group had less time off work (15.82 ±22.26 vs. 20.56 ±25.38 days, p=0.48) and statistically better satisfaction scores (2 ±2.68 vs. 3.5 ±2.75, p=0.048) than the control group. Conclusion: We have shown that early MRI in acute knee injury can provide early diagnosis of internal derangement and therefore allow targeted treatment. These patients had significantly less physiotherapy appointments and less time off work which may offset the cost of the MRI. Moreover these patients were significantly more satisfied with the service.

O.655 Surgical treatment protocol for disfunctional painful TMJ

This study aims to examine outcomes for temporomandibular joint (TMJ) arthroscopy in different Wilkes stages of internal derangement (ID) and factors relevant in relapse in those requiring further surgical management. A review was undertaken of patients who underwent TMJ arthroscopy from June 2017 until August 2019 at St George's Medical Centre, Christchurch, New Zealand. Those with a primary diagnosis of ID with adequate follow up were reviewed. Gender, pre-and post-operative visual analogue scale (VAS) pain scores and maximum incisal opening (MIO) according to Wilkes stages were statistically analysed. Parameters of those who underwent further surgery were assessed. Ninety-nine patients were reviewed with follow up time between 3 and 27 months. No difference in pre- and post-operative VAS pain scores occurred between Wilkes stages (p = 0.9527). Wilkes II patients had the lowest re-operation rates (6.7%). Twenty-one percent of patients underwent further surgery with either re-arthroscopy, arthrotomy or total joint replacement. Gender did not influence the risk of further surgery (p = 0.3451). Four Wilkes IV and 5 Wilkes V patients underwent TJR, with none from Wilkes II or III. This study shows TMJ arthroscopy should be considered a first line intervention in treating symptomatic ID regardless of initial Wilkes stage. A significant improvement in pain and functional levels occurred across all stages. No specific factors were identified for those undergoing further surgery. However, a trend towards open surgery and total joint replacement was seen in Wilkes IV and V patients.

Expression of matrix metalloproteinases and aggrecanase in the synovial fluids of patients with symptomatic temporomandibular disorders

To investigate whether matrix metalloproteinases (MMPs) and/or aggrecanase in synovial fluid can be used as biochemical markers in the diagnosis of internal derangement (ID) of the temporomandibular joint (TMJ). Forty-four samples of synovial fluid were obtained from 35 patients with ID and osteoarthritis (OA) and 15 normal samples from 10 asymptomatic volunteers. MMP-2, -9, and aggrecanase in the synovial fluid were examined by immunoblotting. The incidences of MMP-2, -9, and aggrecanase expression in the ID and OA group were significantly higher than those in the normal group (P < .05). Those with anterior disc displacement without reduction and severe OA showed significantly high expression of MMP-9 compared with other disease subgroups (P < .05). Conversely, comparatively high expression of MMP-2 and aggrecanase was shown in the early-stage OA group. However, there was no significant difference in expression of MMP-2 and aggrecanase among disease subgroups. These findings suggested that expression of aggrecanase could be a potential biochemical marker for articular cartilage degradation in ID of the TMJ.

Magnetic resonance imaging findings of internal derangement in temporomandibular joints without a clinical diagnosis of temporomandibular disorder.

The purpose of this study was to assess the prevalences of magnetic resonance (MR) imaging findings of internal derangement (ID) in temporomandibular joints (TMJs) without a specific clinical diagnosis of temporomandibular disorder (TMD), and to investigate whether in this TMJ group the variable of pain may be linked to MR imaging findings of ID. The study comprised 109 patients, who were assigned a clinical uni- or bilateral TMJ-related diagnosis of 'absence of TMD'. Bilateral sagittal and coronal MR images were obtained subsequently to establish the prevalence of TMJ ID. An MR imaging diagnosis of ID was found in 99 (55.9%) of the 177 TMJs investigated. About 30.3% of the closed mouth-related TMJ positions characterized by disc displacement presented with anterior disc displacement, while 27.3% had anterolateral and 25.3% anteromedial disc displacement. Analysis of the data revealed the presence of TMJ pain to be associated with significantly more MR imaging diagnoses of disc displacement without reduction than disc displacement with reduction (P < 0.05), while there was no significant difference in the prevalences of ID and those of absence of ID (P > 0.05). Using chi-square analysis, no significant relationship was found between the presence of TMJ pain and the MR imaging diagnosis of TMJ ID (P=0.93). Use of the kappa statistical test indicated poor diagnostic agreement between the presence of TMJ pain and the MR imaging diagnosis of ID (kappa=0.01). The results suggest TMJs with a clinical diagnosis of 'absence of TMD' to be associated with a high rate of IDs, while in these instances the clinical variable of TMJ pain may have no effect on prevalences of MR imaging diagnoses TMJ ID. The data confirm the aspect of clinical diagnostic criteria as an unreliable instrument in predicting MR imaging diagnoses of TMJ ID.

Multifactorial comparison of disk displacement with and without reduction to normals according to temporomandibular joint hard tissue anatomic relationships

Statement of Problem. There is disagreement about the predictive value of temporomandibular joint tomographic anatomy in the diagnosis of internal derangements. Purpose. This study aimed to identify multifactorial temporomandibular hard tissue relationships that differentiate disk displacement with reduction and disk displacement without reduction from normals. Material and Methods. Temporomandibular joint tomograms from females diagnosed with unilateral disk displacement with (n=84) or without (n=78) reduction were compared to 42 asymptomatic normal joints with the use of 14 linear and angular measurements and 8 ratios. A validated classification tree model was tested for accuracy with sensitivity, specificity, goodness of fit, and the amount of log likelihood accounted for. The tree model was compared with a multiple logistic regression model and univariate testing. Results. The disk displacement with reduction tree model consisted of 3 disease and 2 normal pathways with interactions between fossa width to depth ratio, condyle position, and linear posterior joint space. This class was characterized by either a much wider- and shallower-than-average fossa shape and/or by a moderately posterior condyle position when the fossa shape was average to deeper and/or narrower. The logistic regression and univariate models also suggested wider and/or shallower fossae, as well as longer eminence length. The disk displacement without reduction tree model consisted of 2 disease pathways and 1 normal pathway. Interactions characterized this class by either a posterior to very posterior condyle position or by a much deeper than average fossa depth when the condyle position was concentric to anterior. The logistic regression model emphasized greater fossa depth and width versus normals. The tree models conservatively predicted the disease classes: Rescaled Cox and Snell R2 37.0%, sensitivity 70.2%, and specificity 90.5% for disk displacement with reduction; R2 28.8%, sensitivity 66.7%, and specificity 85.7% for disk displacement without reduction. Conclusion. Within the limitations of this study, hard tissue relationships revealed by central tomogram sections were able to model notable differences between disk displacement with reduction and disk displacement without reduction versus asymptomatic normals when temporomandibular joints were examined as a multifactorial system typified by interactions of fossa width to depth proportions and condyle position. While substantial, the hard tissue predicted only part of the biology. The model could be broadened by additional factors and interactions. (J Prosthet Dent 2002;87:298-310.)

Clinical versus magnetic resonance imaging findings with internal derangement of the temporomandibular joint: An evaluation of anterior disc displacement without reduction

Purpose: The purpose of this study was to investigate whether the clinical finding of anterior disc displacement without reduction (ADWOR) and pain in the temporomandibular joint (TMJ) is correlated to the magnetic resonance imaging (MRI) findings of TMJ internal derangement (ID). Patients and methods: The TMJ group was composed of 55 TMJ pain patients who were assigned a clinical diagnosis of unilateral ADWOR. The control group consisted of 58 nonpainful TMJ patients. Sagittal and coronal MR images were obtained to establish the incidence and type of ID. Results: Using chi-square analysis, the results showed a significant relationship between the presence of pain and the MRI diagnosis of ID (P =.000) and its type (P =.000). Use of the kappa statistical test indicated poor diagnostic agreement between the presence of pain and the MRI diagnosis of ID (κ = 0.37) and disc displacement with reduction (κ = 0.20). The diagnostic agreement for disc displacement without reduction was 78.8%, with a corresponding κ-value of 0.58, indicating fair agreement between the clinical and the MRI diagnosis. Conclusion: The results suggest that TMJ pain associated with ADWOR is correlated with MRI diagnoses of ID and the ID type. These data confirm the use of the clinical diagnostic criteria for disc displacement without reduction as a reliable method of predicting similar MRI diagnoses. © 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:36-41, 2002

Relationship between temporomandibular joint pain and magnetic resonance imaging findings of internal derangement

Abstract.In terms of clinical decision-making in instances of temporomandibular disorders (TMD) and orofacial pain, there is controversy in the literature over the diagnostic significance of the temporomandibular joint (TMJ)-related variable disk-condyle relationship (DCR). The purpose of this study was to investigate whether in patients with TMJ-related pain, the variable of TMJ pain may be linked to magnetic resonance (MR) imaging findings of internal derangement (ID). The study comprised 163 consecutive TMJ pain patients. Criteria for including a patient were report of orofacial pain referred to the TMJ, and the presence of uni- or bilateral TMJ pain during palpation, during function, and/or during unassisted or assisted mandibular opening. Bilateral sagittal and coronal MR images were obtained to establish the prevalence of TMJ ID types. Analysis of the data revealed the presence of TMJ pain to be associated with significantly more MR imaging diagnoses of ID than an absence of ID (P< 0.001), and disk displacement without reduction than disk displacement with reduction (P< 0.001). Using chi-square analysis, the results showed a significant relationship between the presence of TMJ-related pain and the MR imaging diagnosis of TMJ ID (P=0.001), and TMJ ID type (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 ID (K=0.16). The results suggest that the clinical variable of TMJ pain may have a significant effect on the prevalences of MR imaging diagnoses of TMJ ID. The data confirm the biological concept of DCR as a diagnostic approach in patients with signs and symptoms of TMJ-related pain.

Magnetic Resonance Imaging of the Temporomandibular Joint: Preliminary Evaluation of Partial Flip Angle Three-Dimensional Volume Acquisitions Against Conventional Single and Multiecho Pulse Sequences

The authors imaged 20 temporomandibular joints (TMJs) in 20 patients with high field surface coil magnetic resonance imaging, to compare the accuracy and the clinical utility of thin section partial flip angle (PFA) three dimensional (3D) volume acquisitions with T1-weighted images (T1WI), spin echo, multiecho, long TR/short and long TE images, PFA gradient recalled acquisition in the steady state (GRASS) images in the diagnosis of internal derangement of the TMJ. Pathological conditions demonstrated on imaging studies included disk derangement, joint effusion, and osteocartilaginous lesions, such as degenerative arthritis, osteoporosis, osteochondritis dissecans and early avascular necrosis of the mandibular condyle.

Temporomandibular joint direct sagittal computed tomography: Evaluation of image-processing modalities

Computed tomography (CT) is a useful method for examination of the temporomandibular joint because it allows visualization of the articular disk. In computed tomography many factors play an important role in image reconstruction and image processing. The use of image-processing modalities (such as window variation and level detection) has far-reaching consequences on the display and interpretation of the direct sagittal CT image of the temporomandibular joint (TMJ). In this study, the most important image reconstruction and processing factors were studied for use in the diagnosis of internal derangements and other disorders of the TMJ. Optimal values for the setting of the CT system for the different techniques are discussed.

Computerized axial tomography in the diagnosis of internal derangements of the temporomandibular joint

Fourteen patients with a history of pain, clicking and locking of the temporomandibular joint were assessed clinically and by using computerized axial tomography (CAT). The findings of the clinical and CAT scan assessment were correlated and compared with surgical observations. Computerized axial tomography scanning proved to be a highly accurate method of assessing meniscal position. With the advent of more sophisticated methods of CAT scanning, it provides an accurate, non-invasive method of assessing the temporomandibular joint and providing a basis for more effective treatment planning of problems related to internal derangements.

Diagnosis of internal derangements of thetemporonondibular joints volume 1: Double-contrast, arthrography and clinical correlation

Diagnosis of internal derangements of thetemporonondibular joints volume 1: Double-contrast, arthrography and clinical correlation

Diagnosis of Internal Derangements of the Temporomandibular Joint.Vol. 1.Double-Contrast Arthrography and Clinical Correlation

<b>Diagnosis of Internal Derangements of the Temporomandibular Joint.</b>Vol. 1.<b>Double-Contrast Arthrography and Clinical Correlation</b>

The Arthroscope in the Diagnosis of Disorders of the Patellofemoral Joint

Despite our current knowledge and accumulated information, orthopedic surgeons often experience difficulties in the diagnosis of internal derangement of the knee. Too often, the admission diagnosis I.D.K. means "I don't know." Disorders of the patellofemoral joint contribute to this difficulty and may simulate torn menisci and loose bodies, as well as the instability which results from rotary displacement. Patients often have difficulty describing and locating their symptoms, and 2 or more pathologic lesions may be present in the same joint. Early lesions involving the articular cartilage are especially difficult to diagnose. Even the most astute clinician cannot rely entirely on his clinical judgement, and, at times, needs the assistance of other diagnostic measures. Arthroscopy is an invaluable aid in the diagnosis of all intra-articular pathology, permitting the proper incision in the proper area, often eliminating the necessity of opening the joint and always avoiding unnecessary meniscectomy.