Changes of the symptoms following surgical treatment of temporomandibular joint internal derangement with disc adhesion

CHANGES OF REFERRED SYMPTOMA FOLLOWING SURGICAL TREATMENT IN PATIENTS DIAGNOSED AS TMJ INTERNAL DERANGEMENT

A RETROSPECTIVE STUDY ON THE RELATIONSHIP BETWEEN MRI EVIDENCE OF TEMPOROMANDIBULAR JOINT EFFUSION AND CLINICO-SURGICAL FINDINGS

PURPOSE: Although joint effusion caused by the inflammatory changes of synovium has been known to be associated with joint pain, it is still controversial. This study is to clarify the relationship between the evidence of joint effusion seen high signal intensity in T2-weighted magnetic resonance imaging and clinico-surgical findings. MATERIALS AND METHODS: All of the patients were diagnosed as temporomandibular joint internal derangement and received unilateral open surgery. The authors classified the joint effusion as four categories by size and shape: degree 0-no evidence; degree 1a-a line of high signal along articular surface in unfolded disc; degree 1b-high signal spot in the folded disc; degree 2-pooling in the anterior recess and folded disc; degree 3-pooling in the glenoid fossa and along articular eminence. The authors evaluated clinical and surgical findings. RESULTS: Two-hundred eighty-nine patients(242 females) with mean age of 30.2 years(range: 14 to 74) were included. High signal intensity was seen in 166 joints(57.4%): degree 1 in 82 joints, degree 2 in 69 joints(23.9%), degree 3 in 15 joints(5.2%). Maximal mouth opening of degree 0 group was 38.07mm, degree 1: 36.34mm, degree 3: 33.47mm. Mean TMJ pain score of the joint effusion groups was 1.58, no evidence group was 1.41. Click of degree 0 group was 44.7%, degree 3 was 43.4%. Crepitus of degree 0 group was 17.1%, degree 3 was 26.7%. Mean pain score of headache of degree 0 group was 1.80, degree 2 was 1.22. Neck and shoulder pain of degree 0 group was 50.4%, degree 1 was 39.0%. Perforation, adhesion, hyperemia of degree 0 was 27.6%, 35.8%, 18.7%, degree 2: 23.2%, 29.0%, 29.3%(degree 1). CONCLUSIONS: TMJ pain, TMJ sound and surgical findings did not relate significantly to the joint effusion of TMJ, but referred symptoms such as headache, neck and shoulder pain were less severe in the joint effusion groups.