Relationship between disk position and degenerative bone changes in temporomandibular joints of young subjects with TMD. An MRI study.

UNLABELLED: This study determines the frequency and relationship between disk position and degenerative bone changes in temporomandibular joints in children and adolescent patients with internal derangement. Study design: TMJ, MRI of 88 patients were analyzed (average age: 14.7 years-old, range age: 10-18 years-old), female n = 65 (73.9%) and male n = 23 (26.1%). Images obtained were used to determine the frequency of disk position, joint effusion (JE) and degenerative bone changes (OA). Images were assessed by a calibrated radiologist (Kappa = 0.82). RESULTS: No significant association was found between disk displacement with reduction and degenerative bone changes (Chi2 = 9.894; OR = 0.375; p = 0.0017), nor disk without displacement (Chi2 = 9.448; OR = 0.223; p = 0.0021). A significant association was found between disk displacement without reduction and degenerative bone changes (Chi2 = 30.951; OR = 6.304; p = 0.0001). CONCLUSIONS: There is a significant association between disk displacement without reduction and degenerative bone changes (p = 0.0001) in children and adolescent patients with TMD.

Manifestaciones óseas de las enfermedades degenerativas de la articulación temporomandibular disfuncionada estudio tomográfico / Bone manifestations of degenerative diseases in temporomandibular joint with internal derangements tomography study

El objetivo del presente estudio retrospectivo fue determinar el tipo y frecuencia de las alteraciones óseas degenerativas en la Articulaciones Temporo-Mandibulares (ATM) de pacientes con diagnóstico clínico de Trastorno Temporomandibular (TTM) por medio de Tomografía Computarizada (TAC). Se reclutaron 180 pacientes consecutivos que clínicamente presentan TTM de las ATM. Los criterios de exclusión fueron: pacientes menores de 16 años, pacientes mayores de 65 años, pacientes portadores de prótesis dentarias removibles, enfermedades sistémicas como artritis por microcristales de ácido úrico, osteoartrosis sistémica, hiperlaxitud-ligamentaria, malformaciones anatómicas, enfermedades quísticas, tumorales, historia de trauma o cirugía de las ATM. Todos los pacientes fueron examinados por medio de TAC. Los estudios imagenológicos de las ATM formaron los siguientes seis Grupos: A: Aplanamiento de Vertiente anterior de Cóndilo; B: Aplanamiento de Apófisis transversa del temporal; C: Erosiones e irregularidades de las corticales de las superficies óseas Funcionales; D: Osteofitos; E: Quístes Subcondrales; F: Resorción Condilar Progresiva. Los datos fueron analizados estadísticamente por medio del programa SPSS v15.0. Total de ATM examinadas: n=360; Total de ATM con alteraciones degenerativas: n=192(53,3%); Aplanamiento condilar n=169(88%); Aplanamiento de la apófisis transversa del temporal n=84(43%); Erosiones corticales: n=98(51%); Osteofitos: n=11(5,7%); Quistes Subcondrales n=35(18,2%) y Resorción Condilar Progresiva n=3(1,5%). Las alteraciones óseas de mayor frecuencia en la ATM disfuncionada fueron: Aplanamiento de ápex condilar, erosiones y aplanamiento de Apófisis transversa del temporal en orden decreciente. Menores manifestaciones fueron Quistes subcondrales, Osteofitos y Resorción Condilar Progresiva.

The objective of the present study was to determine frequency of bone degeneratives diseases in the Temporo Mandibular joint, clinically diagnosed as Temporo Mandibular Disorders (TMD), by CT scan, before treatment. Were recruited 180 consecutives patients that clinically presented TMD. They were examined by CT scan. The exclusion criteria were: patients below 16 years and above 65 years of age, patients using removable dental prosthetics, patients that presented systemic disease such as Gout Disease, Osteoarthrosis and hypermobility, anatomic structural alterations, Cyst or Tumour disease and TMJ surgery. The TMJ images studies formed the following six groups: A: Flattened of condyle apex; B: Flattened of protuberance of the Temporal Bone; C: Erosions and irregularities of cortical bone in functional area; D: Osteophytes; Sub-chondral Cysts; E: Progressive Condyle Reabsorption. Data were analyzed by SPSS v15.0 software. Total Examined TMJ: n=360; Degenerative Bone Disease manifestations in TMJ: 192 (53,3%); Flattened of functional area of mandibular condyle n=169 (88%); Flattened of temporal Bone n=84 (43%); Erosions and irregularities of cortical bone: n=98 (51%); Osteophytes: n=11 (5,7%); Subchondral cysts: n=35 (18,2%) and Progressive Condyle Reabsorption n=3 (1,5%). The most frequent bone alterations in DTM were: Flattened of apex condyle, cortical erosions and irregularities and temporal bone flattened. Lower manifestations were subchondral cysts, osteophytes and avascular necrosis, when DTM are studied by CT scan.

Manifestaciones óseas de las enfermedades degenerativas de la articulación temporomandibular (ATM) disfuncionada: estudio tomográfico / Bone manifestation of degenerative disease in temporomandibular joint (TMJ) with internal deragements: tomography study

El objetivo del presente estudio retrospectivo fue determinar el tipo y frecuencia de las alteraciones óseas degenerativas en la Articulaciones Temporo-Mandibulares (ATM) de pacientes con diagnóstico clínico de Trastorno Temporomandibular (TTM) por medio de Tomografía Computada (TAC). Se reclutaron 180 pacientes consecutivos que clínicamente presentan TTM de las ATM. Los criterios de exclusión fueron: pacientes menores de 16 años, pacientes mayores de 65 años, pacientes portadores de prótesis dentarias removibles, enfermedades sistémicas como artritis por microcristales de ácido úrico, osteoartrosis sistémica, hiperlaxitud-ligamentaria, malformaciones anatómicas, enfermedades quísticas, tumorales, historia de trauma o cirugía de las ATM. Todos los pacientes fueron examinados por medio de TAC. Los estudios imagenológicos de las ATM formaron los siguientes seis Grupos: A: Aplanamiento de Vertiente anterior de Cóndilo; B: Aplanamiento de Apófisis transversa del temporal; C: Erosiones e irregularidades de las corticales de las superficies óseas Funcionales; D: Osteofitos; E: Quístes Subcondrales; F: Resorción Condilar Progresiva. Los datos fueron analizados estadísticamente por medio del programa SPSS v15.0. Total de ATM examinadas: n=360; Total de ATM con alteraciones degenerativas: n=192(53,3%); Aplanamiento condilar n=169(88%); Aplanamiento de la apófisis transversa del temporal n=84(43%); Erosiones corticales: n=98(51%); Osteofitos: n=11(5,7%); Quístes Subcondrales n=35(18,2%) y Resorción Condilar Progresiva n=3(1,5%). Las alteraciones óseas de mayor frecuencia en la ATM disfuncionada fueron: Aplanamiento de ápex condilar, erosiones y aplanamiento de Apófisis transversa del temporal en orden decreciente. Menores manifestaciones fueron Quístes subcondrales, Osteofitos y Resorción Condilar Progresiva

The objective of the present study was to determine frequency of bone degeneratives diseases in the Temporo Mandibular joint, clinically diagnosed as Temporo Mandibular Disorders (TMD), by CT scan, before treatment. Were recruited 180 consecutives patients that clinically presented TMD. They were examined by CT scan. The exclusion criteria were: patients below 16 years and above 65 years of age, patients using removable dental prosthetics, patients that presented systemic disease such as Gout Disease, Osteoarthrosis and hypermobility, anatomic structural alterations, Cyst or Tumour disease and TMJ surgery. The TMJ images studies formed the following six groups: A: Flattened of condyle apex; B: Flattened of protuberance of the Temporal Bone; C: Erosions and irregularities of cortical bone in functional area; D: Osteophytes; Sub-chondral Cysts; E: Progressive Condyle Reabsorption. Data were analyzed by SPSS v15.0 software. Total Examined TMJ: n=360; Degenerative Bone Disease manifestations in TMJ: 192 (53,3%); Flattened of functional area of mandibular condyle n=169 (88%); Flattened of temporal Bone n=84 (43%); Erosions and irregularities of cortical bone: n=98 (51%); Osteophytes: n=11 (5,7%); Subchondral cysts: n=35 (18,2%) and Progressive Condyle Reabsorption n=3 (1,5%). The most frequent bone alterations in DTM were: Flattened of apex condyle, cortical erosions and irregularities and temporal bone flattened. Lower manifestations were subchondral cysts, osteophytes and avascular necrosis, when DTM are studied by CT scan

Vacuum phenomenon in the temporomandibular joint: a clinical, computed tomography and magnetic resonance case report.

A 28-year-old woman presented with a history of clicking and mandibular clenching. She was studied clinically and with axial and coronal CT. The patient was going through a tense emotional period and reported tightening of her teeth (clenching); she was under psychological and neurological treatment for depression including pharmacological therapy. She presented slight pain only at maximum mouth opening at the right temporomandibular joint (TMJ) and in the lateral pole on palpation; there was no coincidence between initial and maximal interocclusal contacts because of premature dental contacts. She showed occlusal group function in the right side and canine guidance in the left side with a right contact of balance, local muscular pain in the right deep masseter muscle and in the superior and middle portion of the right trapezium on palpation. On CT, a spherical area of 3 mm diameter with an average density of -647 HU (SD+/-4.7) was found in the upper and posterior area of the lower space of the right TMJ, together with a thicker lower synovial tissue. This observation was confirmed by MRI. Like other joints, the TMJ could present vacuum phenomenon images inside synovial tissue in the presence of degenerative disease. It is important for radiologists to recognize this rare entity.