Temporomandibular Joint Findings Research Articles

Analysis of the correlation between chewing side preference and disc displacement types and clinical symptoms in patients with anterior disc displacement of temporomandibular joint

Objective: To analyze the clinical symptoms and types of disc displacement of patients with anterior disc displacement (ADD) of temporomandibular joint (TMJ) and to explore the correlation between chewing side preference (CSP) and the clinical symptoms and types of disc displacement of ADD patients. Methods: This was a cross-sectional study of the ADD patients diagnosed by clinical symptoms and MRI findings of TMJ in the Department of Stomatology, General Hospital of Chinese PLA from January 2018 to December 2019. A total of 111 ADD patients [33 males and 78 females, aged(31.0±10.9) years old] were included. The patients were divided into two groups according to whether they had CSP: non-CSP group (n=40) and CSP group (n=71). The clinical symptoms and types of ADD were observed and recorded. According to the specific side of CSP in the CSP group, the patients were further divided into the ipsilateral side and the contralateral side of CSP. The pain, TMJ sounds and the ADD types were also observed. Chi square test was used to compare the pain, TMJ sounds, limited mouth opening and ADD types of the two groups. Binary Logistic regression model was used to analyze the correlation between CSP and clinical symptoms and ADD characteristics. Results: The incidence of pain in the CSP group [89% (63/71)] was significantly higher than that in the non-CSP group [70% (28/40)] (P<0.05). In CSP patients, the incidences of pain and joint sounds on the ipsilateral side of CSP were significantly higher than that on the contralateral side (P<0.05). MRI showed that the incidence of bilateral ADD in the CSP group [58%(41/71)] was significantly higher than that in the non-CSP group [37%(15/40)] (P<0.05).There were significant differences in the incidences of no disc displacement (DD), anterior disk displacement with reduction(ADDwR) and anterior disk displacement without reduction (ADDwoR) between ipsilateral and contralateral joints of the CSP patients (P<0.05). There were no significant differences in the incidences of no DD, ADDwR and ADDwoR between left and right joints of the non-CSP patients (P>0.05). The incidence of ADDwoR in ipsilateral side of the CSP patients was significantly higher than that in contralateral side (P<0.05). Pain (OR=3.375) and the side of disc displacement (OR=2.278) in patients with ADD were positively correlated with CSP (P<0.05). Conclusions: The clinical symptoms and types of disc displacement between patients with and without CSP were significantly different. The incidences of pain and bilateral disc displacement in the CSP group were significantly higher than those in the non-CSP group. In addition, the incidences of pain, TMJ sounds and anterior disk displacement without reduction on the ipsilateral side of patients with CSP were significantly higher than those on the contralateral side. The pain symptoms and side of disc displacement were positively related to CSP.

Association between degenerative temporomandibular joint disorders, vertical facial growth, and airway dimension

BackgroundThe goal of this study was to determine whether preexisting degenerative temporomandibular joint (TMJ) disorders are associated with hyperdivergent facial phenotype and decreased airway dimensions. MethodsCone-beam computed tomography scans of adult female and male individuals, 16 years of age and older, distributed in a case group defined as those with degenerative temporomandibular joint disorder (dTMJD; n = 31) or controls with normal TMJ findings (n = 242) were included. Odds ratios were calculated based on facial type and gender. Analysis of variance was used to compare the airway volume and cross section and mandibular measurements between the groups. ResultsCondylar, ramus, and mandibular heights were significantly smaller in the case group compared with the control group. The odds of having a long face subject was significantly higher (P < 0.00001) in the dTMJD group than in the control group with 81% of the dTMJD subjects versus 11% of the control group having long vertical facial dimensions. The smallest cross-sectional area of the airway of the dTMJD group was significantly narrower (P < 0.0361) compared with the controls. Within the control group, ramus height and mandibular alveolar housing for central incisors were significantly smaller (P < 0.0001; P < 0.007) in the long face subjects. ConclusionsThe study shows that a long facial type is associated with findings of degenerative TMJ disorders and related condylar growth disturbances. These degenerative and growth changes may contribute to specific skeletal and dentofacial adaptations resulting in smaller condylar process, mandibular ramus, and body height; thinner alveolar housing at the lower incisor region; and smaller cross-sectional area of the airway.

TMJ Disc Displacement Angle Analysis in MRI: A New Proposal

Objective: To evaluate the co relation of clinical symptoms and MRI findings of TMJ in symptomatic Temporomandibular Dysfunction (TMD) patients. Material and Method: MRI TMJ scan of 25 patients were evaluated. The subjects had clinical evidence of reciprocal TMJ clicking or restricted mouth opening. This study determined the variability of temporomandibular joint (TMJ) disk position in antero-posterior aspect of the joint using magnetic resonance imaging (MRI). Disk position was evaluated on MRI by measuring the angle formed by a line through the middle of the condyle and tangential to the posterior-most aspect of the disk. Joint effusion was checked using T2 weighted image sequence. Thickness of superior and inferior head of lateral pterygoid muscle was measured. These MRI findings were then correlated statistically to clinical findings. Results: Out of 50 TMJ's (25 patients); 40% had biconcave shape (no deformity), 16% cases showed lengthened disc, 12% cases showed a flattened disc, 12% cases showed thick posterior band. Varying degrees of disc displacement was associated with disc shape deformity. Increased thickness of Inferior head of lateral Pterygoid had statistically strong association with pain. Conclusion: A strong positive co relation was seen between the clinical and MRI findings in symptomatic TMD patients. Further using this, a new Disc Displacement angle measurement method and classification of disc shape was proposed for better disc evaluation.

Incidental findings in patients who underwent cone beam computed tomography for implant treatment planning

The aim of this study is to determine the type, frequency, and location of incidental findings in the maxillofacial region in patients undergoing cone beam computed tomography (CBCT) scan for implant treatment.[5]. In this study, 300 patients who underwent CBCT imaging for implant treatment planning were evaluated retrospectively. Patients were evaluated in four different categories, namely, maxillary sinus pathologies, temporomandibular joint (TMJ) findings, dentoalveolar findings, and soft-tissue calcifications. In maxillary sinus pathologies, we categorized patients by mucosal thickening, polypoidal lesion, air-liquid level, total opacification, oroantral fistula, periapical lesion related with maxillary sinus, antrolith, hypoplasia, and foreign body presence. In the TMJ findings category, we evaluated patients for erosion, osteophyte, sclerosis, flattening, and bifid condyle. For dentoalveolar findings, we looked for the residual root and impacted tooth. In soft-tissue calcifications, we examined patients for tonsillolith, sialolith, lymph node calcification, styloid ligament calcification, carotid artery calcifications, and osteoma cutis. Mucosal thickening was mostly seen in maxillary sinus pathology. One hundred and forty-eight (49.3%) of the patients had at least one TMJ incidental finding. We detected at least one impacted tooth in 17 (5.7%) patients' maxilla and 14 (4.7%) patients' mandibles. The most frequently seen calcification was styloid ligament calcification. There was no statistically significant relationship between the age groups and incidental findings (P > 0.05). Oral radiologists should be aware of incidental findings and evaluate the possibilities of underlying diseases in a comprehensive way, and if there is a concern about the finding, they should refer the patient to the relevant specialist.

Evaluation of the Prevalence of Temporomandibular Joint Involvement in Rheumatoid Arthritis Using Research Diagnostic Criteria for Temporomandibular Disorders

Temporomandibular joint (TMJ) disorders, known as TMDs, are significant public health problems and may result in pain and disability. In order to determine the prevalence of clinical/subjective TMD in rheumatoid arthritis (RA), we used the research diagnostic criteria (RDC)/TMD axes. We assessed the anti-cyclic citrullinated protein (anti-CCP)-related TMD in RA for the first time. Fifty-two RA patients were compared to 47 healthy controls with regard to complete blood count (CBC), serology, acute phase reactants (APR), and TMJ dysfunction. The anti-CCP antibody showed a significant correlation with the development of clinical TMD (P=0.001, 95% confidence interval (CI)=12.4%-35.6%). A prevalence of 50% was calculated through the RDC/TMD for such disorders. In RA patients, statistically significant differences were observed between the groups with and without clinical TMD regarding psychological depression and physical symptoms. According to the results, a significant correlation was found between the anti-CCP antibody and TMD. Therefore, when this antibody is detected in the blood serum, the treatment must be initiated. The RDC/TMD used in this study assessed the prevalence of TMJ dysfunction in conformity with RA-associated TMJ findings previously obtained through other conventional methods.

The association between oral examination findings and computed tomographic appearance of the equine temporomandibular joint.

The temporomandibular joint (TMJ) forms the junction between the maxilla and mandible. Movement of the jaw and resulting masticatory forces have been extensively studied in the horse; however, less is known about the inter-relationship between this joint and oral and dental pathology. To determine the association between specific oral and dental pathologies and anatomical variations of the TMJ imaged with computed tomography (CT) in horses with asymptomatic TMJs. Retrospective cross-sectional study. Horses (n=201) from three practices with a complete oral examination and skull or upper cervical CT study were reviewed. Age, breed, sex, clinical presentation, oral examination findings, slice width and practice were recorded. Alterations in contour and density of the mandibular condyle, mandibular fossa and intra-articular disc were also documented. Logistic regression, corrected for clustering by practice, was used to determine whether CT anatomical variations were significantly associated with the oral examination findings. Horses categorised as having abnormal TMJs were older than those with normal TMJ. Horses with periodontal disease were less likely to have abnormal TMJ findings compared with horses with no oral pathology. In contrast, horses with infundibular disease were more likely to have TMJ abnormalities. Due to the cross-sectional nature of the study, it was difficult to establish whether oral pathology preceded TMJ abnormalities. Despite examining over 200 horses of varying ages, the biological significance of the observed associations between oral, or dental disease and anatomically appreciable temporomandibular joint disorders remains uncertain.

Non-replaced Mandibular First Molars and Temporomandibular Joint Dysfunction

Background: Mandibular first molars serve as key teeth of occlusion. Non replacement of these teeth may affect stability of the dentition and have long term effects on the Temperomandibular joint. The purpose of this study was to observe the association between nonreplaced mandibular molars and temporomandibular joint dysfunction (TMD). Methods: A total of 174 patients, both male and female with missing mandibular first molars, were included in the study. The changes due to non-replacement of mandibular molars were observed clinically. Temporomandibular joint (TMJ) was examined for clinical and radiographic changes. Intra oral findings were correlated with TMJ findings. Results: Supra eruption of opposing maxillary molars and drift of adjacent teeth had a significant association with asymptomatic clicking of the TMJ. Further, patients with deep bite had radiographic findings of condylar flattening. Clicking of the TMJ was a frequent finding in patients with longer duration of molar loss. Conclusion: Missing molars not only have periodontal implications but also far reaching effects on the condylar health of the associated TMJ. Nepal Journal of Medical Sciences | Volume 03 | Number 01 | January-June 2014 | Page 57-62 DOI: http://dx.doi.org/10.3126/njms.v3i1.10360

Mandibular ramus length and condylar changes in Juvenile Idiopathic Arthritis

Background Universal recommendation of the evaluation of the temporomandibular joint (TMJ) involvements in juvenile idiopathic arthritis (JIA) is still not available. Aim To assess the valuability of TMJ symtoms or findings as an indicator of mandibular involvement. Subjects and methods 62 (42 girls) out of 305 children with JIA aged 3-17 years and followed-up at the Paediatric Rheumatology OPD in Oulu University Hospital were involved in this cross-sectional study. Group 1 had new TMJ symptoms or findings and group 2 chronic TMJ symptoms or findings. Subjects were examined by a paediatric rheumatologist and by a dentist.The control group consisted of 68 healthy children (28 girls). We examined OPGs both from patients (mean age 10.4; range 3-17) and controls (9.3 years; range 6-14) and measured mandibular ramus lenght on OPG (the distance between point Condylion and point Gonion). We calculated the percential difference of the lenght of the contralateral ramus. Condylar changes were graded in five point scale (Billiau et al 2007).

Incidental findings in maxillofacial region detected by cone beam computed tomography

The purpose of this study was to determine the location, nature, and occurrence of incidental maxillofacial findings on cone beam computed tomography (CBCT) scans performed for maxillofacial diagnostic purposes. CBCT images of 207 consecutive patients (129 females and 78 males) were examined. The sample consisted of 85 temporomandibular joint (TMJ) disorder patients, 45 paranasal sinusitis patients, 30 obstructive sleep apnea syndrome patients, 15 implant patients, and 32 others. The overall rate of incidental findings was 92.8%. The highest rate of incidental findings was in the airway area (51.8%), followed by impacted teeth (21.7%), TMJ findings (11.1%), endodontic lesions (4.3%), condensing osteitis (1%), and others (2.9%). The airway incidental findings included mucosal thickening (21.3%), deviation of the nasal septum (12.6%), conchal hypertrophy (11.1%), bullous concha (3.9%), and retention cysts (2.9%). The impacted teeth consisted of third molars (18.8%) and canines (2.9%). The incidental findings for the TMJ patients were erosion of the condyle (4.8%), osteophytes (3.4%), and bifid condyle (2.9%). Oral radiologists should be aware of possible incidental findings and should be vigilant about comprehensively evaluating possible underlying diseases.

TMJ disorders and pain: Assessment by contrast-enhanced MRI

Though magnetic resonance (MRI) is a widely accepted standard for the assessment of patients with temporomandibular joint (TMJ) disorders, efforts to correlate symptoms to MRI findings have often given controversial results. Aim of this study was to investigate the correlation between TMJ pain and findings of contrast-enhanced MRI. Thirty-eight consecutive patients with TMJ dysfunction syndrome (study group) were examined with MRI. Protocol included T2 turbo spin-echo sequence, T1 spin-echo sequence, and T2 gradient-echo (acquired with closed jaw, at intermediate and maximal opening). Post-contrast phase was obtained through a fat sat 3D T1 gradient-echo sequence (VIBE). Post-contrast findings in the study group were matched with those obtained in a control group of 33 patients submitted to MRI of the paranasal sinuses. Statistically significant difference was found between condylar medullary bone enhancement in painful TMJ, in painless TMJ and control group. In addition the average thickness of joint soft tissue enhancement in painful TMJ was superior to painless TMJ ( p < 0.0001) and to control group. On multivariate logistic regression analysis, the odds ratio that a painful TMJ showed disk displacement, osteoarthrosis, effusion and JST enhancement were 3.05, 3.18, 1.2 and 11.36, respectively. Though not histologically proven, TMJ enhancement could reflect the presence of inflammation in painful joints. Furthermore, the administration of contrast could be of help for the assessment of patients with orofacial pain, particularly when clinical exploration is insufficient to ascribe the pain to TMJ.

Incidental findings in the maxillofacial area with 3-dimensional cone-beam imaging

The purposes of this study were to evaluate the location, nature, and occurrence of incidental findings in maxillofacial structures on 3-dimensional cone-beam volumetric scans done for dental diagnostic purposes and to look for associations between these findings and symptoms in orthodontic patients. Images from 500 consecutive maxillofacial 3-dimensional scans were examined. The patient sample consisted of 252 orthodontic patients, 172 implant patients, 33 endodontic patients, 34 temporomandibular joint (TMJ) disorder patients, and 10 others. The overall rate of incidental findings was 24.6% (123 patients of 500). The highest rate of incidental findings was in the airway area (18.2%), followed by TMJ findings (3.4%), endodontic findings (1.8%), and others (1.2%). In the orthodontic group, the incidences were airway findings, 21.4%; TMJ findings, 5.6%; and endodontic lesions, 2.3%. Only 22% of the airway findings, such as mucosal thickness, polyps, and retention cysts, were correlated with clinical signs and symptoms. For clinical diagnosis, the data should be interpreted with a full history of clinical signs and symptoms, and with detailed communications with radiological colleagues and other specialists to comprehensively evaluate possible underlying diseases.

MR of 2270 TMJs: prevalence of radiographic presence of otomastoiditis in temporomandibular joint disorders

Objective : The purpose of this study is to determine the prevalence of radiographic presence of otomastoiditis while examining temporomandibular joint (TMJ) disorders in magnetic resonance images (MRI) in a series of 2270 temporomandibular joint magnetic resonance images and to examine the relationship between otomastoiditis and TMJ disorders. Materials and methods : 2270 temporomandibular joint magnetic resonance images and patients’ data were retrospectively investigated. Magnetic resonance images were obtained from the patients who referred to Osaka University Dental Hospital Outpatient Clinic with TMJ complaints for the last four years (from January 1998 to January 2003). The patients, who were diagnosed as otomastoiditis based on their temporomandibular joint magnetic resonance images, were sent to Osaka University Hospital Department of Otolaryngology for a medical consultation in order to have their pathologies certified following their MR process. Age and sex were recorded for all patients and for otomastoiditis cases; location of the disease, symptoms of patients and TMJ findings were noted as well. Results : Seven patients were diagnosed as acute otomastoiditis and one patient diagnosed as chronic active otitis media with cholesteatoma in the series of 2270 MR, which were representing a prevalence of 0.39%. Neurilemoma diagnosed in left mastoid process in one patient. The final diagnoses of all patients were made after medical consultation. Conclusion : While examining temporomandibular joint magnetic resonance images; it is not only important to examine just the TMJ structures, but also to look at the nearby anatomical features to check evidence for inflammatory disease.

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.

Temporomandibular joint radiographic findings in adolescents.

Radiographic findings in temporomandibular joints (TMJ) of asymptomatic adolescents have been reported, probably because such patients are unlikely to undergo routine TMJ radiography. The purpose of this prospective study was to document radiographic findings in TMJ's of adolescents without a history of TMJ dysfunction to determine prevalence of osseous, positional and functional abnormalities. Corrected sagittal TMJ tomographs in closed and open positions from pre-orthodontic records of 498 adolescent patients aged 8 to 15 years old were studied by one observer. Positional, functional or osseous abnormalities were each found in less than 10% of TMJ's. One percent of joints demonstrated marked limited mobility. There was no significant difference between right and left sides. Our results suggest that routine radiography of TMJ's in adolescents is not a useful screening too although longitudinal studies are necessary to determine whether asymptomatic adolescent patients with radiographic abnormalities will develop signs and symptoms of TMJ dysfunction.

MRT des Kiefergelenks

The retro-articular vascular plexus of the temporomandibular joint (TMJ) is of great importance for the function of this joint. Aim of this study was to determine the amount of increase of signal intensity in the retro-articular vascular plexus after intravenous injection of contrast medium and to figure out potential advantages of this procedure. The posterior band of the articular disc--a landmark in the diagnosis of disc dislocations--becomes prominent after injection of contrast medium. Forty-five temporomandibular joints were studied before, and after intravenous injection of contrast medium with magnetic resonance imaging (MRI) using T1-weighted images in parasagittal plane. In all cases a measurable increase of signal intensity was demonstrable in healthy volunteers as well as in patients with normal or pathological TMJ findings. In 53.3% of cases the posterior band was better differentiable after administration of contrast medium. In patients with suspicion of pathological features in series without contrast medium, in 27.3% of those cases administration of contrast medium led to a more precise--"diagnostic"--evaluation of disc location. The study emphasizes the use of contrasts medium for evaluations of disc dislocation with MRI in cases of pathological or unclear findings in precontrast MRI series.

がく関節疾患診断におけるＣＴ ｓｃａｎの有用性 Ｉ 対照症例

The use of computed tomography (CT) in the temporomandibular joint (TMJ) is discussed. The CT scan is useful in diagnosing TMJ disfunction. This article reviews the value of CT in the normal findings of TMJ.