Management of internal derangement of temporomandibular joint disc displacement with reduction using two different lines of treatment / Manejo do desarranjo interno do deslocamento de disco temporomandibular com redução utilizando dois tipos diferentes de tratamento

Objetive: This study was to compare the effectiveness of arthrocentesis versus the insertion of anterior repositioning splint (ARS) in improving the mandibular range of motion (MRM) for patients with the temporomandibular joint (TMJ) anterior disc displacement with reduction (ADDwR). Methods: 36 patients diagnosed as ADDwR were recruited and divided randomly into two groups. The first group (G1) was treated by arthrocentesis, and the second (G2) was treated using ARS. All patients were reexamined after six months. Results: Except that for protrusive movement, there were significant differences between the two groups for the percentage changes of the MRM as measured by the amount of pain free opening, unassisted opening, maximum assisted opening, right lateral and left lateral movements (p < 0.05). Conclusion: Within the context of the current study, the non-invasive, lower cost ARS, provided better results in improving the MRM when managing ADDwR cases. (AU)

Objetivo: O presente estudo comparou a eficácia da Artrocentese em relação à inserção da Placa Reposicionadora Anterior (PRA) na melhoria da Amplitude de Movimento Mandibular (AMM) para pacientes que apresentam Deslocamento de Disco Anterior com Redução (DDAcR) da Articulação Temporomandibular (ATM). Método: 36 pacientes diagnosticados como DDAcR foram recrutados e divididos aleatoriamente em dois grupos. O primeiro grupo (G1) foi tratado através da Artrocentese e o segundo (G2), tratado com a PRA. Todos os pacientes foram reexaminados após seis meses. Resultados: Com exceção do movimento protrusivo, houve diferenças significativas entre os dois grupos para as mudanças percentuais das medidas de AMM pela quantidade de abertura sem dor, abertura sem assistência, abertura máxima com assistência, movimentos laterais direitos e laterais esquerdos (p < 0,05). Conclusão: Dentro do contexto do estudo atual, a PRA, não invasiva e de menor custo, proporcionou melhores resultados na melhoria da AMM no gerenciamento de casos de DDAcR (AU)

Clinical factors affecting the outcome of arthocentesis

OBJECTIVES: This study aimed to evaluate the effect of clinical factors on the outcome of arthrocentesis in the treatment of temporomandibular joint (TMJ) internal derangement. MATERIALS AND METHODS: Fifty patients with TMJ internal derangement underwent arthrocentesis using ringer's lactate. The present study evaluated the contribution of the clinical variables of age, time since onset, visual analogue scale (VAS) pain level, and range of motion (ROM) on the outcomes of TMJ arthrocentesis: age (≤25 years, >25 and ≤40 years, >40 and ≤60 years), VAS pain level (≤5, >5 and ≤7, >7 and ≤10), and ROM ( 7 (OR, 11.25; P=0.039), and a maximum vertical opening of < 25 mm (OR, 7.70; P=0.038). CONCLUSION: Lavage of the superior joint space with ringer's lactate resulted in significant reduction in pain and improvement in mouth opening. Patients with a greater inflammatory component and younger patients benefitted more from arthrocentesis. Evaluation of these clinical variables helped in predictive modelling, which may provide clinicians with the opportunity to identify “at-benefit” patients early and initiate specific treatment.

Prevalence of metabolic syndrome in euthyroid patients in Perambalur District

Background: Euthyroid diseases are frequently observed in clinical practice. They comprise both functional abnormalities such as overproduction and underproduction of thyroid hormone as a consequence of intrinsic thyroid diseases, as well as the development of structural abnormalities like goiter, adenoma or carcinoma. In community surveys, prevalence rates of elevated TSH levels – indicating impaired thyroid hormone secretion – range from 4–10% while prevalence rates of decreased TSH levels – indicating thyroid hormone overproduction – range from 0.7–1.5 %. Aim of this study: To assess the thyroid function, in euthyroid subjects, is associated with components of the metabolic syndrome parameters. Materials and methods: The study was conducted in the Department of Biochemistry at Dhanalakshmi Srinivasan Medical College and Hospital, Siruvachur, Perambalur District, Trichy. Total of 100 cases was included in the study homeostasis model assessment for insulin resistance (HOMA- IR) metabolic syndrome was defined according to the national cholesterol education program’s adult treatment panel III criteria. Results: The T4 (FT4) was significantly associated with total cholesterol (standardized beta (β) = - 0.059; P = 0.014), low-density lipoprotein cholesterol (β = -0.068; P = 0.004), high-density lipoprotein cholesterol (β = 0.100; P < 0.001), and triglycerides (β = -0.102; P < 0.001). Both FT4 and TSH were significantly associated with HOMA-IR (β = -0.133; P <0.001 and β = 0.055; P = 0.024, respectively). Median HOMA-IR increased from 1.42 in the highest tertile of FT4 to 1.66 in the lowest tertile of FT4. FT4 was significantly related to four of five components of the metabolic syndrome (abdominal obesity, triglycerides, high-density lipoprotein cholesterol, and blood pressure), independent of insulin resistance.

Relationship between the mandibular hypoplasia and temporomandibular joint internal derangement in adolescents with skeletal class Ⅱ malocclusion / 中华口腔医学杂志

Mandibular hypoplasia is very common clinically. Studies have reported that temporomandibular joint internal derangement (TMJID) might manifest as mandibular retrusion, and whether there is a direct correlation between them remains controversial in academia. On the other hand, for adolescent patients with skeletal class Ⅱ malocclusion, the growth of mandible could be motivated by orthopedic force, and then the mandibular retrusion corrected. However, if TMJID is the direct cause of mandibular retrusion, orthopedic treatment will not have a significant effect on it. Base on literature review and analysis as well as our own research, this article will review the distribution of structural abnormalities of the temporomandibular joint in adolescents with mandibular hypoplasia and its association with skeletal class Ⅱ malocclusion, as well as the effect of TMJID on the treatment of skeletal class Ⅱ malocclusion in adolescents.

Correlation between gender, temporomandibular joint disc position and clinical findings in patients with temporomandibular disorder / Correlação entre sexo, posição do disco da articulação temporomandibular e os resultados clínicos em pacientes com disfunção temporomandibular

OBJECTIVE: The objective of this study was to assess gender differences in temporomandibular joint disc position using magnetic resonance imaging and to check for symptoms in patients with temporomandibular disorders. MATERIALS AND METHODS: Eighty-seven consecutive patients (70 females and 17 males) were evaluated. Bilateral magnetic resonance imaging was performed to determine the temporomandibular joint disc positions; these were divided into four diagnostic categories: no disc displacement, right disc displacement, left disc displacement and bilateral disc displacement. The clinical data assessed were pain on muscle and temporomandibular joint palpation. The data were analyzed using the Fisher's exact test, chi-square test or analysis of variance. Significance was set at p ≤ .05. RESULTS: The study population had more females (80.5%) than males (19.5%) and the mean age of females (31 ± 11 years) was lower than the mean age of males (41± 12 years). Bilateral disc displacement was significantly most frequent in females. Clinical examination showed more pain on muscle palpation for female than for male patients. CONCLUSION: Women had a higher frequency of temporomandibular joint disc displacement, as well as a larger number of painful points on muscle palpation than men.

RESUMO OBJETIVO: O objetivo deste estudo foi avaliar as diferenças de gênero na posição do disco da articulação temporomandibular usando ressonância magnética para verificar se há sintomas em pacientes com disfunção temporomandibular. MATERIAIS E MÉTODOS: Foram avaliados oitenta e sete pacientes consecutivos (70 mulheres e 17 homens); foi realizada ressonância magnética bilateral para determinar as posições do disco da articulação temporomandibular; estes foram divididos em quatro categorias diagnósticas: nenhum deslocamento de disco, deslocamento de disco a direita, deslocamento de disco a esquerda e deslocamento de disco bilateral. Os dados clínicos avaliados foram: dor a palpação no músculo e na articulação temporomandibular. Os dados foram analisados utilizando o teste exato de Fisher, teste do qui-quadrado ou análise de variância. Significância foi de p ≤ 0,05. RESULTADOS: A população do estudo tinha mais mulheres (80,5%) que homens (19,5%). O deslocamento blateral de disco foi significativamente mais frequente no sexo feminino. O exame clínico mostrou mais dor à palpação muscular para mulheres do que para homens. CONCLUSÃO: As mulheres apresentaram uma maior frequência de deslocamento de disco da articulação temporomandibular, bem como um maior número de pontos dolorosos à palpação muscular do que os homens.

Management of open bite that developed during treatment for internal derangement and osteoarthritis of the temporomandibular joint / 대한치과교정학회지

This case report describes the orthodontic treatment performed for open bite caused by internal derangement (ID) and osteoarthritis (OA) of the temporomandibular joint (TMJ). A Japanese woman, aged 31 years and 11 months, referred to our department by an oral surgeon had an open bite with clockwise rotation of the mandible and degeneration of the condyle. The overbite was corrected through intrusion of the maxillary and mandibular molars using mini-screw implants to induce counterclockwise rotation of the mandible. Then, the mandibular second premolars were extracted and comprehensive orthodontic treatment was performed to establish a Class I molar relationship with distalization of the maxillary arch and to eliminate anterior crowding. Following treatment, her facial profile improved and a functional and stable occlusion was achieved without recurrence of the TMJ symptoms. These results suggest that orthodontic intrusion of the molars is one of the safer and less stressful alternatives for the management of open bite due to degeneration of the condyles caused by ID and OA of TMJ.

Evaluation of articular eminence morphology and inclination in TMJ internal derangement patients with MRI / Evaluación de la morfología e inclinación de la eminencia articular en pacientes con trastorno interno de ATM con MRI

Articular eminence morphology and inclination are reported to be two predisposing factors for the internal derangement (ID). The purpose of this study is to investigate the relationship between the inclination and morphology of the articular eminence and ID. The study included 70 temporomandibular joints with ID in 35 patients: 51 joints had disc displacements with reduction (DDWR) and 19 joints had disc displacements without reduction (DDWOR). All subjects underwent bilateral high resolution magnetic resonance imaging scans which were performed in the sagittal and coronal planes with mouths closed and opened. Articular eminence morphology was characterized as box, sigmoid, flattened, or deformed. Articular eminence inclination was measured at three positions: steep (from 60° to 90°), moderate (from 30° to 60°) and shallow (from 15° to 30°). The images were divided into two; DDWR and DDWOR, and these two criteria were compared. The images of the two groups were compared; while flattened form was occurred with the highest incidence in the DDWOR group, sigmoid form was the most frequent in the DDWR group and articular eminence inclination was found steeper than it was for the DDWOR group. The steepness of the articular eminence may not have a predisposing effect on the development of disc displacements.

La morfología e inclinación de la eminencia articular son reportados como dos factores predisponentes para el trastorno interno (TI). El propósito de este estudio fue investigar la relación entre la inclinación y la morfología de la eminencia articular y el TI. El estudio incluyó a 70 articulaciones temporomandibulares, con TI en 35 pacientes: 51 articulaciones con desplazamiento discal con reducción (DDCR) y 19 de las articulaciones tuvieron desplazamiento discal sin reducción (DDSR). Todos los sujetos fueron sometidos a imágenes de resonancia magnética bilaterales de alta resolución que se realizaron en los planos sagital y coronal con la boca cerrada y abierta. La morfología articular la eminencia se caracterizó como una caja, sigmoide, aplanada, o deforme. La inclinación de la eminencia articular se midió en tres posiciones: empinada (de 60 ° a 90 °), moderada (entre 30 ° a 60 °) y poco profunda (entre 15 ° y 30 °). Las imágenes fueron divididos en dos; DDCR y DDSOR, y estos criterios fueron comparados. Al comparar las imágenes de ambos grupos, la forma aplanada se observó con mayor incidencia en el grupo de DDSR, la forma sigmoide fue la más frecuente en el grupo de DDCR y la inclinación de la eminencia articular se encontró más pronunciada que en el grupo DDSR. La inclinación de la eminencia articular puede no tener un efecto predisponente en el desarrollo de los desplazamientos de disco.

The epidemiologic study of the patients with temporomandibular joint disorders, using Research Diagnostic Criteria for TMD (RDC/TMD): Preliminary Report

PURPOSE: This epidemiologic research was carried out to investigate the degree and aspects of symptoms of patients suffered from TMD using RDC/TMD. SUBJECTS AND METHODS: Subjects were the patients who had visited to SNUBH dental clinic from Jan. 2005 to Dec. 2005, and total 117 patients were included (M: 22, F:95). The signs and symptoms of physical, psychological and behavioral factors were retrospectively evaluated by questionnaires in the RDC/TMD. The patients were examined through clinical and radiological method, and diagnosed by same investigator. They were divided into 3 groups such as osteoarthritis group (group 1), internal deragnement (group 2), myofascial pain dysfunction syndrome group (MPDS, group 3). In addition, in patient with complex diagnosis they were divided into subgroups in detail (ex. group 1+group 2). In the questionnaire, several items were selected to calculate the graded pain score (grade 0~IV), depression and vegetative symptoms, nonspecific physical symptoms(pain items included) and nonspecific physical symptoms(pain items excluded) in each group. RESULTS: As a result of classification by diagnostic criteria of this study, the patients were distributed to 45 % of group 1, 47 % of group 2, 8 % of group 3 in this study. In younger patients (under 25-year old, n=40), group 2 was occupied 57 % (n=23) and group 1 was 35 % , group 3 was 8 %, while group 1 was occupied 75 % in elderly-patients (over 40-year old, n=28) in present study (group 2: 21 % , group 3: 4 %). In the analysis of depression and vegetative symptoms, majority of patients in Group 2 were included in 'normal? and in Group 3 it appeared to have larger proportion of 'moderate' & 'severe' than others. According to nonspecific physical symptoms, there have been tendencies of higher ratio of 'severe' in patients with MPDS. In graded pain score, more than half (58 %) of subjects were included in grade 0 and low disability (Grade I and II), and 27 % were revealed high disability (grade III, IV).

The epidemiologic study of the patients with temporomandibular joint disorders, using Research Diagnostic Criteria for TMD (RDC/TMD): Preliminary Report

PURPOSE: This epidemiologic research was carried out to investigate the degree and aspects of symptoms of patients suffered from TMD using RDC/TMD. SUBJECTS AND METHODS: Subjects were the patients who had visited to SNUBH dental clinic from Jan. 2005 to Dec. 2005, and total 117 patients were included (M: 22, F:95). The signs and symptoms of physical, psychological and behavioral factors were retrospectively evaluated by questionnaires in the RDC/TMD. The patients were examined through clinical and radiological method, and diagnosed by same investigator. They were divided into 3 groups such as osteoarthritis group (group 1), internal deragnement (group 2), myofascial pain dysfunction syndrome group (MPDS, group 3). In addition, in patient with complex diagnosis they were divided into subgroups in detail (ex. group 1+group 2). In the questionnaire, several items were selected to calculate the graded pain score (grade 0~IV), depression and vegetative symptoms, nonspecific physical symptoms(pain items included) and nonspecific physical symptoms(pain items excluded) in each group. RESULTS: As a result of classification by diagnostic criteria of this study, the patients were distributed to 45 % of group 1, 47 % of group 2, 8 % of group 3 in this study. In younger patients (under 25-year old, n=40), group 2 was occupied 57 % (n=23) and group 1 was 35 % , group 3 was 8 %, while group 1 was occupied 75 % in elderly-patients (over 40-year old, n=28) in present study (group 2: 21 % , group 3: 4 %). In the analysis of depression and vegetative symptoms, majority of patients in Group 2 were included in 'normal? and in Group 3 it appeared to have larger proportion of 'moderate' & 'severe' than others. According to nonspecific physical symptoms, there have been tendencies of higher ratio of 'severe' in patients with MPDS. In graded pain score, more than half (58 %) of subjects were included in grade 0 and low disability (Grade I and II), and 27 % were revealed high disability (grade III, IV).

The validity of transcranial radiography in diagnosis of internal derangement / 대한치과교정학회지

The purpose of this study was to determine whether association exists between temporomandibular joint (TMJ) characteristics in transcranial radiographs and TMJ internal derangement and to evaluate the validity of transcranial radiographs in diagnosis of internal derangement. Transcranial radiographs and magnetic resonance imaging (MRI) of 113 TMJs from 76 subjects were used for this study and all TMJs were classified into 3 groups according to the results of MRI: normal disk position, disk displacement with reduction, and disk displacement without reduction. Transcranial analysis included linear measurement of joint spaces and condylar head angle measurement. To determine any relationship between transcranial measurements according to disk displacement, one-way ANOVA was used. The results showed that condyle-fossa relationship in standard transcranial radiographs had no relationships with disk displacement. And, as disk displacement progressed, condylar angle between head and neck increased significantly. This result can be interpreted that condylar head angle reflects structural hard tissue change according to internal derangement progress. But this is insufficient in the determination of internal derangement. Therefore, although still clinically helpful, the validity of standard transcranial radiographs to diagnose TMJ internal derangement was questioned.

Preliminary study on the effect of inflamed TMJ synovial fluid on the intracellular calcium concentration and differential expression of iNOS and COX-2 in human immortalized chondrocyte C28/I2

OBJECTIVE: The objective of this study was to examine the hypothesis that inflammatory synovial fluid from TMJ internal derangement initiates a transient increase in intracellular calcium concentration ([Ca2+]i) in chondrocytes and the induced Ca2+ signaling affects iNOS/COX-2 gene expression patterns following exposure to inflamed synovial fluid. MATERIALS AND METHODS: Two female adult patients with symptoms of TMD who agreed to participate in the study were selected for this study. Immortalized human juvenile costal chondrocyte C-28/I2 was grown to 80% confluency and synovial fluids from two patients were added respectively to culture media for 24 hours at the concentration of 100ng/10ml. Confocal laser scanning microscope (CLSM) was used to examine changes of intracellular calcium concentration ([Ca2+]i). RT-PCR was performed to identify the expression profile of IL-1alpha, iNOS, COX-2. RESULTS: Increased [Ca2+]i was observed in chondrocytes subjected to inflamed synovial fluid compared to control cultures and in respective cultures exposed to inflamed synovial fluids from each patient, IL-1beta, COX-2 mRNA were detected. However, in neither case iNOS mRNA was expressed. IL-1alpha, COX-2, and iNOS mRNA were expressed in control culture. CONCLUSION: Our results show that immortalized chondrocytes cultured with inflamed synovial fluids from patients diagnosed as disc displacement without reduction and limitation in mouth opening showed increased calcium concentration and expression of COX-2 while inhibiting the production of iNOS, which in turn could adversely affect the chondrocytes in at least short term by hindering physiologic role of NO against inflammatory cascades. These findings suggest that inflamed synovial fluid may differentially regulate the transcriptomes of relevant inflammatory mediators, especially iNOS/COX-2 axis in chondrocytes through adjusting calcium transients.

The effect of intra-articular injection of hyaluronic acid after arthrocentesis in treatment of internal derangements of the TMJ

This study was designed to investigate the effect of intra-articular injection of hyaluronic acid for the treatment of internal derangements of the temporomandibular joint(TMJ). Sixteen patients with internal derangements of TMJ in 1 male and 15 females aged 68 to 18 years comprised the study material. The patients'complaint was limited mouth opening and pain during function. Patients were divided into 3 groups(articular disc displacement with reduction, articular disc displacement without reduction, osteoarthritis group). The preauricular area was disinfected anesthetized locally with 2% lidocaine hydrochloride. Arthrocentesis was performed. Hyaluronic acid(1.5 cc) was then injected into the superior compartment of the TMJ. Active range of motion exercises were instituted at approximately 24 hours postoperatively. Antibiotics and NSAID, three times daily by mouth, was prescribed for 3 days. Clinical evaluation of the patients was done before the procedure, immediately after the procedure, final follow-up visit postoperatively. Pain during function was assessed using visual analog scales(VAS). Maximal mouth opening was recorded as a distance between upper incisal edge and lower incisal edge. Intra-articular injection of hyaluronic acid caused significant reduction of pain during function, significant increase of maximal opening range. These findings suggest that intra-articular injection of hyaluronic acid is useful for decreasing patient reports of pain while increasing functional mobility of the mandible in internal derangements of the TMJ.

Comparison of MRI findings with clinical symptoms in temporomandibular joint internal derangement / 대한구강악안면방사선학회지

PURPOSE: To determine the clinical correlation of magnetic resonance imaging (MRI) findings of temporomandibular joint internal derangements. MATERIALS AND METHODS: The MR images of 150 TMJs in 75 patients were analyzed. The clinical symptoms were pain in the preauricular area and masticatory muscles and TMJ sounds. RESULTS: There was a statistically significant relationship between the MRI diagnoses of different types of disc displacements and clinical findings of pain, clicking, and crepitus. The risk of TMJ pain was increased when the disc displacement without reduction occurred at the same time in combination with the osteoarthrosis and effusion. CONCLUSION: Regardless of the results, the data indicate that each of these MR imaging variables may not be regarded as the unique and dominant factor in defining TMJ pain occurrence.

Effusion in magnetic resonance imaging of the temporomandibular joint / 대한구강악안면방사선학회지

PURPOSE: The purpose of this study was to investigate the distribution and frequency of temporomandibular joint (TMJ) effusion in magnetic resonance (MR) images of patients with disc displacements. MATERIALS AND METHODS: On T2 weighted MR images of 148 TMJs taken from 74 patients presenting with TMJ pain and dysfunction, we assessed the cases showing TMJ effusion, defined as an amount of fluid that exceeded the maximum amount seen in a control group of asymptomatic volunteers. The amount of TMJ fluid was graded as: I (none or minimal), II (moderate), III (marked), and IV (extensive), according to a standard set by a reference. Disc displacement categories were also recorded. RESULTS: Of the 148 TMJs examined in this study, 52 joints (35.1%) presented with joint effusion, 24 (16.2%) showing bilateral joint effusion. 38 joints showed upper joint space effusion, 3 showed lower joint space effusion, and 11 showed both upper and lower joint space effusion. 96 joints (64.9%) had grade I joint fluid, 27 (18.2%) grade II, 15 (10.1%) grade III, and 10 (6.8%) grade IV. 80.0% of the joints presenting with grade IV effusion showed disc displacement without reduction. CONCLUSION: Joint effusion was found not only in upper, but also in lower joint spaces. The higher the effusion grade, the greater the frequency of disc displacement without reduction.

Appliance of Interocclusal Splint as Initial Treatment of TMJ Dysfunction

TMJ dysfunction has difficulties for diagnosing and treating, and its symptoms are variable. TMJ dysfunction is classified as muscular problem, capsular problem, ligamentous problem, internal derangement, or condylar dislocation etc. Treatment modalities for TMJ dysfunction are surgical or conservative one, but they haven't be standardized. Because of anatomical complexities and difficulties of surgical approaches, conservative treatment have been preferred. We've had 30 cases having impressed capsular tightness or internal derangement. They have made an appeal for pain on TMJ area, ROM limitation of joint, clicking etc. We have used the interocclusal splint as treatment modality. In general, the interocclusal splint is classified as the stabilization splint, the repositioning splint, the pivot splint, the soft splint etc. We have applied the stabilization splint or the repositioning splint to the patients according to diagnosis or symptoms. The interocclusal splint is reported to induced the changing activities of muscle, altering the stress or loading of the joint and recapturing or changing condyle- disc-fossa position. As a result, the pain has become reduced and ROM limitation of joint was improved, clicking is eliminated initially. From January 2001 to May 2002, we treated 30 patients who having TMJ dysfunction. Our treatment modality was performed that the interocclusal splints were worn full time for one to four weeks, then phased out. During the mean 10.5 months of follow-up period there had been significant improvements in pain, ROM limitation of joint and clicking. After 6 months, there had been no recurrence in pain and ROM limitation of joint, but 2 cases recurred in clicking that has disappeared. The appliance of interocclusal splint has been an effective method for the initial nonsurgical treatment of the symptoms of TMJ dysfunction. However, more in-depth study by long term follow-up is needed to evaluate recurrence.

Diagnostic Criteria to Differentiate Medial Meniscal Injury from Degenerative Changes on 99mTc-MDP Knee SPECT in Patients with Chronic Knee Pain / 대한핵의학회잡지

PURPOSE: In patients with chronic knee pain, the diagnostic performance of 99mTc-MDP knee SPECT for internal derangement of knee is deteriorated due to degenerative changes. In this study, we tried to establish diagnostic criteria to differentiate medial meniscal injury (MMI) from degenerative change (DC) when the uptake is increased in medial compartment. MATERIALS AND METHODS: A total of 49 knee SPECT of the patients with chronic (more than 3 months) knee pain, which showed increased 99mTc-MDP uptake in the medial compartment, were included in this study. The diagnosis was confirmed by arthroscopy. On knee SPECT, 3 diagnosic criteria for MMI were investigated. In Criterion I, MMI was diagnosed when crescentic uptake was observed in the medial tibial plateau. In Criterion II, crescentic uptake was further classified into anterior, mid, posterior, and diffuse patterns, according to the location of maximal uptake; and only crescentic mid, posterior, and diffuse patterns were diagnosed as MMI. In Criterion III, MMI was diagnosed when medial tibial plateau showed higher activity then medial femoral condyle. The diagnostic performance of the 3 criteria was compared. RESULTS: The sensitivity and specificity were 93% and 14% in Criterion I, 89% and 38% in Criterion II, and 75% and 67% in Criterion III, respectively. Criterion III had significantly improved diagnostic performance, especially, specificity. CONCLUSION: In this study, we established a practical diagnostic criterion to differentiate MMI from DC on knee SPECT. The result is helpful to improve the diagnostic value of knee SPECT as a screening test for chronic knee pain.

Incidence of Internal Derangement of Knee in the case of Total Knee Arthroplasty

PURPOSE: To evaluate the incidence and types of internal derangement of the knee, observed during total knee arthroplasty in patients with degenerative osteoarthritis and to correlate the findings with preoperative clinical presentations. MATERIALS AND METHODS: From January 1996 to January 2002, 435 patients(622 cases) with degenerative osteoarthritis who underwent total knee arthroplasty were analyzed for the presence of meniscal or cruciate ligament injuries. The type, site and patterns of injuries of the meniscus were recorded. Then the patients were categorized into group I; without meniscal injuries and group II; with meniscal injuries. Comparative analyses were also made between the two groups according to age, height, body weight, hospital for special surgery score(HSS score), the knee society clinical rating system(TKSCRS) score, and injuries of ACL and PCL. RESULTS: The medial meniscal injury is the most frequently involved type and was found in 288 cases(46.3%). Midportion to posterior horn location and midportion radial and posterior horn complex patterns showed the most cases in respect to site and pattern of meniscal injury. ACL injury was found in 48 cases while 55 cases showed PCL injury. Preoperative range of motion(I: 128.5 +/-9.7 degree, II: 114.8 +/-15.5 degree) and knee functional tests, such as, HSS score(I: 61.9 +/-14.0, II: 56.8 +/-14.9) and TKSCRS score(I: 97.3 +/-27.3, II: 81.1 +/-31.1) were significantly low in group II(p<0.05). Average age was 64.3 years in group I and 67.8 years in group II respectively. And age ranges were higher in group II(p<0.05). Injury of ACL and PCL were more common in group II. CONCLUSION: Meniscus injuries that were frequently seen in total knee arthroplasty have clinical relations to the patient 's ages, range of motion, function.

The Mri-Based Comparison Of Normal- And Abnormal-Side Retrodiscal Tissue, And Relationship Between Clinical Examination & The Mri Findings Of Retrodiscal Tissue In Patients With Unilateral Tmj Internal Derangement

The study was performed to investigate the comparison of relative signal intensity of normal- and abnormal-side retrodiscal tissue, and relationship between clinical examination, joint effusion and relative signal intensity of retrodiscal tissue in patients with unilateral TMJ internal derangement. The study group comprised 19 females and 9 males, with a mean age of 29 years. After measurements of the signal intensity were made on the MR imager for the T2 weighted images on retrodiscal tissue and brain gray matter, we calculated relative value and tried to find relationship between clinical examination, joint effusion and relative signal intensity on normal- and abnormal-side. The results are as follows. 1. The gray matter is an appropriate reference point. 2. The relative signal intensity is high significantly in abnormal-side retrodiscal tissue compared with normal-side retrodiscal tissue. 3. The relative signal intensity is high significantly in painful joints compared with nonpainful joints and in joints with joint effusion compared with joints without joint effusion. 4. The relative signal intensity in normal joints, joints with reduction and joints without reduction is increased in order significantly.

Evaluation of bone and disc configuration in TMJ internal derangement / 대한구강악안면방사선학회지

PURPOSE: To investigate bone and disc configuration on MR images in internal derangement related to age. MATERIALS AND METHODS: MR images of 150 TMJs in 107 patients were analyzed to determine the morphologic changes. Two groups were distinguished to be correlated with age. Group 1 consisted of TMJs that were diagnosed as having anterior disc displacement with reduction (ADDwR), and Group 2 consisted of TMJs that were diagnosed as having anterior disc displacement without reduction (ADDwoR). We assessed the configuration of the articular disc, degree of anterior disc displacement, and osseous changes of TMJs. RESULTS: The third decade (83 of 150 joints) was most frequent in this study. In the ADDwR group biconcave discs was most frequent at all ages except fifth decade, but in the ADDwoR group deformed discs was most frequent at third and forth decades. In the ADDwR group slightly displaced discs was most frequent at all ages, but in the ADDwoR group severely displaced discs was most frequent at second decade, and the degree of disc displacement was increased with aging over 30 years of age. TM joints showed osseous changes in 17% of the ADDwR group, and in 30% of the ADDwoR group. MR findings of osseous changes of the TMJ were not found to be significantly correlated with age. CONCLUSION: The prevalence of deformation of disc, displacement of disc, and osseous changes of TMJ was higher in the ADDwoR group than in the ADDwR group. MR findings of disc configuration and degree of disc displacement were found to be correlated with age.

MRI study of temporomandibular joint disorder in orthodontic patients / 대한치과교정학회지

Magnetic resonance imaging(MRI) of the temporomandibular joint(TMJ) is very useful method to diagnose internal derangement of the TMJ because of its high specificity for identification of condyle-disc relationships. The purpose of this study was to evaluate the existence, incidence and severity of internal derangement of th TMJ by the MRI of patients who are suspected to have TMJ disorder. MRI sample was composed of 50 subjects(10 males, 40 females) and the mean age was 22.9 years. 43 subjects of the sample were found to have positive findings. 56% of the subjects with positive findings had ADD(anterior disc displacement) without reduction, and 65% had internal derangement of bilateral joints. Distributions in the types of malocclusion in patients with positive findings, the Angle's classification had shown : the largest 41.9% for Cl II (39.6 for Cl II div 1 and 2.3% for Cl II div 2), 37.2% for Cl III, and 2.3% for the nuidentified. 8.6% of the subjects with positive findings had facial asymmetry and 55.8% had openbite. We can conclude that the percentage of CI II is the highest in patients with internal derangement of the TMJ. Openbite or facial symmetry is considered to be uncompensated or compensated deformity which results from facial skeleton remodeling in the process of degenerative joint disease(DJD) due to TMJ degeneration. Therefore it is recommended to screen the patients with facial asymmetry or openbite by MRI before the beginning of orthodontic treatment. Differential diagnosis is essential because the tendency of relapse is high after the orthodontic treatment and continuous observation of TMJ is needed in patients with TMJ disorder.