Radiographic assessment of temporomandibular joint pain and dysfunction in the pediatric age-group.

During a five-year period, a total of 150 patients (131 girls and 19 boys) with an average age of 14 years (range 7-16 years), with signs and symptoms of temporomandibular joint dysfunction were referred for imaging in the diagnostic radiology department. These patients were evaluated by multidirectional tomography to both joints, arthrography, computed tomography (CT), or magnetic resonance (MR) of one or both joints. Fifty-six (37 percent) of the 150 patients had plain tomographic, CT or MR evidence of degenerative arthritis of one or both sides (18/150 12 percent with bilateral degenerative joint disease). Internal derangements of the TMJ related to meniscal displacements and dysfunction were detected in 128 patients (85 percent). Twenty-nine patients (29/150: 20 percent) suffered from bilateral internal derangements. This clinical study demonstrates that internal derangements do occur in the pediatric age-group: the high percentages of both internal derangements and degenerative joint disease suggest a cautious clinical acceptance of imaging for internal derangements in the young patient. This reluctance to study these patients should be minimized by the new, noninvasive imaging modality available in magnetic resonance.

Bilateral internal derangements of temporomandibular joint: evaluation by magnetic resonance imaging.

Two hundred eleven patients with signs and symptoms of temporomandibular joint (TMJ) internal derangements were referred for magnetic resonance imaging. Both TMJs of each patient were routinely evaluated in this prospective investigation. With 422 joints examined, 29% (61) of the patients had bilaterally normal findings, 21% (45) of the patients had one normal side and one abnormal side, and 50% (105) of the patients showed bilateral internal derangements. This clinical study demonstrated a high likelihood of bilateral internal derangements in patients with symptoms of TMJ internal derangements.

Comparison of arthrographic findings of the temporomandibular joint with palpation of the muscles of mastication.

Two hundred five patients were examined for temporomandibular joint pain and dysfunction and specifically for tenderness to muscle palpation. Arthrograms were performed on 222 joints (188 unilateral and 17 bilateral). Significant findings were ascertained for the middle portion of the temporal muscle in "normal" patients versus "with and without meniscus reduction" patients. The superficial masseter muscle was more tender in "normal" patients and in "reducing meniscus" patients than in "without meniscus reduction" patients. The medial pterygoid muscle was more tender in "normal" patients and in "without meniscus reduction" patients than in "reducing meniscus" patients. Though there are some significant findings with respect to muscle palpation, by itself muscle palpation is not a specific indicator of temporomandibular joint internal derangement.

Clinical and arthrographic evaluation of the location of temporomandibular joint pain.

Two hundred five patients were prospectively examined for temporomandibular joint pain. Arthrograms were performed on 222 joints (188 unilateral and 17 bilateral). Pain in the ear occurred more frequently in arthrographically normal patients and in nonreducing meniscus patients compared with reducing meniscus patients. The location of pain in front of the ear, in the temples, or in the neck or the degree of pain intensity did not correlate to specific meniscal abnormalities. No correlation between the distribution and the character of headaches was observed. Pain characterization alone does not clinically separate meniscal abnormalities.

Temporomandibular joint: comparison of MR images with cryosectional anatomy.

The accuracy of magnetic resonance (MR) imaging in the assessment of internal derangements of the temporomandibular joint (TMJ) has not been systematically evaluated. We obtained multiple 3-mm-thick sagittal and coronal MR images of 15 fresh TMJ autopsy specimens and compared the MR imaging findings with observations in corresponding sagittal cryosections. MR imaging correctly delineated the position of the disk in 11 (73%) joints and incorrectly delineated it in four (27%) joints. Disk configuration was depicted accurately in nine (60%) joints, inaccurately in five (33%), and was not visible in one (7%). Errors observed with sagittal MR images were correlated with mediolateral alterations of disk position. These abnormalities were depicted in coronal images, however. Osseous anatomy was correctly assessed in nine joints (60%). MR imaging demonstrated the margin between the disk and its attachments, which is not possible by arthrography. MR imaging is an acceptable alternative to other imaging modalities for assessing soft and hard tissues of the TMJ.

CT and MR of the temporomandibular joint: comparison with autopsy specimens.

CT and MR imaging have been advocated for use in the diagnosis of disorders of the temporomandibular joint. A systematic comparison of these imaging techniques has not been made. We performed direct sagittal CT and sagittal MR on 15 fresh temporomandibular joint autopsy specimens and compared our diagnoses with cryosectional findings in a blinded fashion. We found no statistically significant differences between these procedures in detecting bony abnormalities or disk position. However, a side-by-side comparison between the CT and MR images demonstrated that MR depicted the soft-tissue anatomy of the joint with greater detail than did CT. Thus, MR clearly displayed the disk when it was positioned either superiorly or anteriorly, whereas CT only showed the disk adequately when it was positioned anteriorly. MR further showed the configuration of the disk and the borderlines between the disk and its attachments; these relationships could not be assessed from CT images. This experimental study indicates that MR is superior to CT for depiction of soft-tissue changes, whereas CT is superior in showing osseous abnormalities. Clinical confirmation of these results is necessary before one method can be definitively recommended over the other for clinical studies.

Comparison of internal derangements of the TMJ with occlusal findings.

Two hundred five patients were examined because of temporomandibular joint pain and dysfunction. Arthrograms were performed on 222 joints (188 unilateral and 17 bilateral). No significant differences were found between arthrographic groups with respect to Angle classification, horizontal and vertical overlap, posterior tooth wear, missing posterior teeth, cuspid-protected occlusion, balancing-side contacts, deflective occlusion, and clenching of the teeth. Tilted teeth on the contralateral side were more common in cases of reducing meniscal dislocation than in cases of normal meniscus position or of nonreducing meniscal dislocation.

Clinical and arthrographic evaluation of temporomandibular joint sounds.

Two hundred five patients were examined for temporomandibular joint pain and dysfunction. Arthrograms were performed on 222 joints (188 unilateral and 17 bilateral). Patients with joint sounds suspected of being caused by meniscus displacement with reduction were evaluated. Seventy-two patients (38%), were suspected of "clicking" (a reducing meniscus), but only 53 had arthrographic findings of a reducing meniscus. Further evaluation of this patient group revealed that only 41 probably could be candidates for a protrusive splint. This represents only 57% (41 of 72) of patients with "clicking" who may be candidates for protrusive splint treatment.