Double-contrast Arthrotomography Research Articles

顎関節内障クローズドロック症例に対するパンピング療法，上関節腔洗浄療法および鏡視下剥離授動術の臨床評価

We clinically studied 30 patients (34 joints) with closed lock who underwent arthroscopic surgery (lysis and lavage operations) of the superior joint compartment of the temporomandibular joint (TMJ). Arthroscopic surgery was studied as compared with arthrocenthesis and pumping manipulation by double-contrast arthrotomography and magnetic resonance imaging (MRI).The results were as follows:1. There was arthrographic evidence of marked narrowing of the anterior recess and lateral portion, of the upper joint compartment in patients who underwent arthrocenthesis and pumping, whereas narrowing of the posterior compartment and medial portion was found in patients who underwent arthroscopic surgery.2. In patients who underwent arthrocenthesis, MRI showed that anterior disk displacement and disk deformity were severer than after arthroscopic surgery.3. There was arthroscopic evidence of extensive synovitis, and osteoarthrosis and adhesionwere severe in the anterior recess.We found that upper joint arthroscopy of the TMJ was an important additional diagnostic method and that arthroscopy was effective in the diagnosis of synovitis and osteoarthrosis within the superior cavity and permitted the observation of adhesion.

Diagnostic performances of double-contrast arthrotomography and arthroscopic examination of the TMJ

Diagnostic performances of double-contrast arthrotomography and arthroscopic examination of the TMJ

Image diagnosis for internal derangements of the temporomandibular joint

1. Relationship of the articular disk to the condyle. This study consisted of 175 patients (181 joints) out of 203 patients reviewed. Thirty-eight joints showed anterior disk displacement with reduction, 76 joints showed anterior disk displacement without reduction and 40 joints showed anterior disk displacement with associated perforation of the posterior attachment of the disk. 2. Capsular adhesions of internal derangements of the TMJ. Fifty-five joints (70%) had capsular adhesion in joints showing anterior disk displacement without reduction. Nine joints (21%) had capsular adhesion in joints showing anterior disk displacement with reduction. Arthrotomographically 9 patients were found to have only capsular adhesion without displacement of the disk. 3. Osseous abnormalities of internal derangements of the TMJ. One hundred and one joints were studied. In the patients with anterior disk displacement without reduction, thirty-seven (67%) out of 55 joints had erosive bone changes on the condyle. Nine (17%) out of fifty-three joints with asymptomatic and clinically normal TMJ had erosive bone changes on the condyle. 4. Comparison of double-contrast arthrotomography and MR imaging at 0.2 T. Both methods of evaluation provided highly reliable information regarding the disk. Double-contrast arthrotomography was superior to MR imaging in detecting capsular adhesion and perforation of the posterior attachment. 5. Selection of routine radiographic techniques of the TMJ. The lateral tomograph produced the highest diagnostic accuracy (90%). The diagnostic accuracy of osseous changes of the TMJ is better with rotational panoramic radiography than with lateral oblique transcranial radiography.

A case of incoordination of temporomandibular joint diagnosed on double contrast arthrotomography

A case of incoordination of temporomandibular joint diagnosed on double contrast arthrotomography

顎関節の二重造影ＣＴ法に関する臨床的検討

Soft tissue pathology should be appreciated in diagnosing temporomandibular joint (TMJ) disease. For this purpose, contrast arthrography is useful and we also have introduced double-contrast arthrotomography of the TMJ.X-ray computed tomography (CT), on the other hand, is well suited to the diagnosis of TMJ disease, because it can clearly delineate both hard and soft tissues. We thus introduce direct sagittal CT of the head with the enhancement of the articular space of the TMJ using negative and positive contrast media and confirmed that this method is very useful for the diagnosis of TMJ disease.In this paper we principally investigate the suitability of this double-contrast computed tomography of the TMJ.We conclude that double-contrast CT technique is equally or more useful in some cases than single-contrast CT technique in the diagnosis of TMJ disease.

Correlation of pathology observed in double contrast arthrotomography and arthroscopy of the shoulder

Correlation of double contrast arthrotomography (DCAT) of the shoulder and arthroscopic surgery diagnostic results have been undertaken in 55 patients with persistent shoulder pain or involuntary shoulder instability. During the period March 1984 to December 1986, 55 patients underwent DCAT followed by videotaped diagnostic shoulder arthroscopy. The primary indication for DCAT was persistent pain in 36 patients and instability in 17 patients. DCAT was performed according to the method of El-Khoury and Albright, and all arthroscopies were performed in a similar fashion by the senior author (HJS). Both tests were reviewed separately, retrospectively, and their results were correlated. For combined (anterior and posterior) labral pathology, the sensitivity/specificity for the instability group was 0.91/0.91, respectively; sensitivity/specificity for the pain group was 0.63/0.94. DCAT accurately depicted the status of 76% of anterior labrums and 96% of posterior labrums. For complete rotator cuff tears, sensitivity/specificity was 1.0/0.94. The status of a complete rotator cuff tear was accurately depicted in 91% of patients. Partial rotator cuff tears were missed in 83% of patients by DCAT. The presence or absence of loose bodies was accurately represented by 96% of DCAT. Arthroscopy showed that 71% of the instability patients had a labral tear, compared with 44% of the pain patients. Rotator cuff pathology was present in 12% of instability patients and 42% of pain patients. These findings indicate that DCAT may be a conditionally reliable test in the diagnosis of shoulder instability. DCAT must be considered inconclusive, however, in the painful shoulder without instability. Its usefulness as a preoperative screening test is discussed, and a diagnostic algorithm is presented. DCAT does not equal the diagnostic accuracy of shoulder arthroscopy.

肩関節臼唇前方部分の撮影法 : 半軸位 double-contrast arthrotomography

In recurrent dislocation of the shoulder joint, the semi-axial view of double-contrast arthrotomography that we had tried provided superior visualization of anterior glenoid labrum, articular cartilage and of the capsule on the radiographs. In our method ; 1-1.5 ml of 76% Urografin and 10-12 ml room air are injected anteriorly into the glenohumeral joint space of the patient under fluoroscopic control. After that procedure, put the patient in about a 45°angle sitting position. And maintaining it, turn the patient oblique to a 60° angle to the table, with the injured shoulder closest to it. In this position, the glenoid cavity is positioned semi-axial and the joint is perpendicular to the film anatomically. At that time, the humerus of the damaged side need to be slightly abducted and rotated internally. Following to the aforementioned positioning, arthrotomography is carried out using the spiral locus program. In sectioning, we go down from the coracoid process at 3 millimeter intervals. In this tomography, we use high-contrast single-screen system. To maintain the positioning for tomographic sectioning, we made a special devide. This method is now routine X-ray studies for recurrent dislocation of the shoulder and for the loose shoulder in our hospital.

Arthrotomography of the unstable shoulder.

Thirty-seven patients suffering from clinically verified subluxation of the shoulder joint underwent double-contrast arthrotomography. Sixteen of these patients were operated on, 4 of whom after arthroscopy, and 1 patient had only arthroscopy. Arthrotomography readily revealed lesions of the glenoid labrum, most of them small, and also redundancy of the anterior joint capsule. The method can be recommended in the examination of the glenoid labrum in patients suffering from anterior subluxation of the shoulder.

関節鏡を診断，治療に適応した急性化膿性顎関節炎の１症例

Recently, there have been few patients with suppurative arthritis of the temporomandibular joint, following the improvement of in antibiotics therapy in recent years.A case of acute suppurative arthritis of the temporomandibular joint in a 47 year-old man is presented. He first visited our hospital in February 1984 with the chief complaint of pain in the left mandible. Regarding his general status, he had anorexia, and a general feeling of dullness and locally he had rotation of occlusion, difficulty in opening his mouth, diffuse swelling of the mandibular joint and pain and tenderness.We examined him by conventional radiographic computed tomography, Ga-cintigraphy, single contrast and double contrast arthrotomography, bacteriological tests and arthroscopy. We aspirated pus and concluded that the cause of his ailment was bacterial, and after antiinflammatory therapy, discharge of pus and irrigation the patient is progressing favorably.After healing of the inflammation, clinical and radiographic observations indicated ankylosis of the temporomandibular joint. Therefore we performed an examination and arthroscopic surgery.It is suggested that in this case, arthritis of the temporomandibular joint had an important secondary effect on the form and function of the temporomandibular joint after the respite of the inflammation.

Correlation of pathology observed in double contrast arthrotomography and arthroscopy of the shoulder

Correlation of pathology observed in double contrast arthrotomography and arthroscopy of the shoulder

Internal derangement of the temporomandibular joint: Radiographic and histologic changes associated with severe pain

In 20 temporomandibular joints (TMJs) (15 patients) with internal derangement associated with severe pain, the presurgical radiographic findings were compared with the morphologic and histologic alterations. Disc extirpation was performed in 17 joints, and in three joints the disc was surgically repositioned. Deformation of the disc observed by double-contrast arthrotomography was verified histologically. Perforation of the posterior disc attachment was seen in two joints; both were associated with osteophyte formation and flattening of the articular eminence. The white disclike structure in 11 cases was composed of an anterior, stiff, bulgy, biconvex structure combined with a posterior flattened portion that grossly was incorrectly determined to be part of the disc, but that was identified histologically as a posterior disc attachment that had undergone adaptive change characterized by connective tissue hyalinization. In the arthrotomogram the disc position could easily be determined. However, the disclike clinical appearance of the posterior disc attachment in these cases made determination of disc position at surgery uncertain or impossible. The nonhyalinized posterior disc attachment was intensely red and showed advanced histologic alterations of the vessels, deposits of extravasated erythrocytes and fibrin, and altered composition of the connective tissue. Thus, signs of inflammation were present but without activation of the local immune system since no major inflammatory cell infiltrates were seen. Small accumulations of lymphocytes were seen in only two cases. The surgically extirpated posterior attachments were innervated by silver-positive nerve fibers ranging in diameter from 1 to 15 μm. The severe pain in the TMJs is likely to have originated from this innervated posterior disc attachment or capsule and to have been triggered by the vascular reaction.

Hyperplastic soft-tissue formation in the temporomandibular joint associated with internal derangement: A radiographic and histologic study

Hyperplastic connective tissue formation in the posterior part of the temporomandibular joint glenoid fossa has previously been described in autopsy specimens. The frequency of such hyperplastic tissue formation in patients with long-standing temporomandibular joint pain was studied in 103 joints from 80 patients by means of double-contrast arthrotomography. Five joints in four patients (5%) demonstrated hyperplastic tissue formation; in four cases this was associated with permanently displaced and deformed disks. All five joints were refractory to nonsurgical treatment. Surgically extirpated hyperplastic tissue and disk attachments contained nerve fibers and thickened adventitia of vessels, resulting in narrowed or obliterated lumina, extravasated erythrocytes, and fibrinlike deposits. The synovial membrane showed fibrinoid necrosis or was lost. The pain reaction in temporomandibular joints with hyperplastic soft-tissue formation may be released by compression or tension of nerves, breaking down products from blood or tissue ischemia. Contrast filling of both joint spaces, combined with tomography, was required for detection of the hyperplastic tissue formation.

Diagnostic Accuracy of Double-Contrast Arthrotomography of the Temporomandibular Joint: Correlation with Postmortem Morphology

Diagnostic Accuracy of Double-Contrast Arthrotomography of the Temporomandibular Joint: Correlation with Postmortem Morphology

Diskectomy of the temporomandibular joint: A double-contrast arthrotomographic follow-up study

The manner in which temporomandibular joint soft-tissue structures remodel following diskectomy has been assessed by double-contrast arthrotomography. Pre- and postoperative arthrograms were compared in ten joints. The intra-articular soft-tissue cover of the bony components was frequently thicker 1 to 3 years after the operation. The most pronounced thickening was observed in the mandibular fossa, whereas a thinner cover was found on the condyle and the tubercle. Development of a thick soft-tissue cover on the articulating surfaces indicates that the temporomandibular joint has a capacity for functional adaptation following diskectomy. This may be an essential factor for a favorable postoperative result.

Diagnostic accuracy of double-contrast arthrotomography of the temporomandibular joint: correlation with postmortem morphology

The diagnostic accuracy of double-contrast arthrotomography in the evaluation of internal derangement of the temporomandibular joint is unknown. Therefore, findings from double-contrast arthrotomograms of 48 temporomandibular joint autopsy specimens were correlated with postmortem morphology seen from dissections or cryosections. Arthrotomographic diagnosis was confirmed in 41 joints, signifying a diagnostic accuracy of 85%. Misinterpretations were made in seven joints (three concerning the configuration, three concerning the position, and one concerning the configuration and position of the disk). False-positive reports due to observation errors can be avoided with improved knowledge of the joint anatomy as well as with increased experience in the technique. False-negative examinations were due to limitation of the tomographic reproduction of the lateral part of the joint.

Double-contrast arthrotomography of the temporomandibular joint: Introduction of an arthrographic technique for visualization of the disc and articular surfaces

A technique for double-contrast arthrotomography of the temporomandibular joint was developed. Iodine contrast medium and air were injected into both joint compartments of 105 patients. Lateral tomography using a multi-film cassette was performed. The double-contrast arthrotomography depicted, with good definition, the configuration and position of the disc, its attachments, and the articular surfaces. Postarthrographically, the patients experienced transient discomfort, but there were no serious complications. Double-contrast arthrotomography facilitates the diagnosis of internal derangements by improving the radiographic image of the intra-articular anatomy.

Double-contrast arthrotomography of the shoulder.

We have used double-contrast arthrotomography to assess the glenoid labrum, as plain radiographs and single-contrast arthrograms are unsatisfactory for this purpose. Establishing the clinical diagnosis of a torn glenoid labrum may be difficult, as not all patients with such tears have a history of a previous shoulder dislocation. The glenoid labrum is seen distinctly on double-contrast arthrotomography, and tears are manifested by truncation or blunting of the anteroinferior lip. We compared the anatomy of the normal shoulder as seen in double-contrast arthrotomography with that seen in patients with surgically proved tears of the glenoid labrum. Double-contrast arthrotomography is an accurate method of assessing the integrity of the glenoid labrum, and it has important implications for the operative management of patients with trauma to the shoulder.