Temporomandibular joint involvement in rheumatoid arthritis; clinical, tomographic and magnetic resonance imaging study, a new MRI scoring system

The primary objective of this study was to create a new MRI scoring system for assessment of tembromandibular joints [TMJs] arthritic changes in rheumatoid arthritis [RA] based on the precise TMJ tomographic scoring system adopted in 2004[1]. The second aim was to assess the correlation and compare the sensitivity between the new MRI scoring system and the previously established tomographic one. Finally was to correlate the TMJ image findings with the RA clinical disease activity score and disease duration. Twenty RA patients represented forty TMJs were included in the study and recruited from the Rheumatology and Rehabilitation department, Cairo University Hospitals. Full history taking and thorough rheumatologic and intra oral clinical examination were carried out. The patients' disease activity score with three variables [DAS-3]; the Ritchie articular index [RAI], swollen joint count [0-44] and ESR, was recorded. Bilateral TMJ conventional tomography and MRI were done to all patients. Anew MRI scoring system for the severity of TMJ arthritic changes was created based on the TMJ tomographic scoring system[1]. This newly scoring system termed as RA-TMJ-MRI-S states for Rheumatoid Arthritis in TMJ by Magnetic Resonance Imaging Score. The new RA-TMJ-MRI-S not only showed a very high statistical correlation to tomographic scoring system [p = 0.0000] but also demonstrated a respectable sensitivity in early detection of the arthritic changes in TMJ. There was no correlation between the MRI or tomography findings and the DAS-3 or the disease duration. It is recommended to use the new RA-TMJ-MRI-S system; the first MRI scoring system of TMJ that was proved to be superior to the tomographic scoring system, when proper assessment and follow up of the TMJ in RA patients are needed

Color Doppler sonography in assessment of mental artery blood flow

Blood supply of the mandible is an important determinant of the healing process after injury or operation. This fact makes it clear that mandibular hypoperfusion and ischemia are particular problems in the elderly patients and in those who have had radiotherapy. Doppler sonography is widely used to assess blood flow in most major arteries and several of the smaller arteries in the body. Though to our knowledge, its use in the mandible to assess central blood flow has not yet been described. This study was designed to assess the feasibility of using Color Doppler Sonography to evaluate the characteristics of blood flow in the mental artery which would indicate the blood flow in the inferior alveolar artery and to compare between results obtained from control group and that obtained from atherosclerotic patients. Thirty subjects with different ages [22-69 years] were included in this study and comprised two groups; atherosclerotic and control group on whom color Doppler Sonographic examination of the external carotid artery and the mental artery on both sides [Right and Left] was carried out. Results of this study revealed a significant difference between mental and external carotid arteries' indices within the two included groups. Also a significant correlation was proved between mental and external carotid arteries' indices and advancement in age within the two groups. A strong correlation was recorded between mental artery - resistive index and external carotid artery- resistive index within each of the two groups. No wonder that, as the mandibular blood supply is an important factor contributing for many clinical dental problems, its assessment is considered critical in the overall evaluation of healing of the mandible