Temporomandibular joint pain and associated magnetic resonance findings: a retrospective study with a control group.

BACKGROUND: To better understand and evaluate clinical usefulness of magnetic resonance imaging (MRI) in diagnosis and treatment of temporomandibular disorders (TMD), parameters for the evaluation are useful. PURPOSE: To assess a clinically suitable staging system for evaluation of MRI of the temporomandibular joint (TMJ) and correlate the findings with age and some clinical symptoms of the TMJ. MATERIAL AND METHODS: Retrospective analysis of 79 consecutive patients with clinical temporomandibular disorder or diagnosed inflammatory arthritis. Twenty-six healthy volunteers were included as controls. Existing data included TMJ pain, limited mouth opening (<30 mm) and corresponding MRI evaluations of the TMJs. RESULTS: The patients with clinical TMD complaints had statistically significantly more anterior disc displacement (ADD), disc deformation, caput flattening, surface destructions, osteophytes, and caput edema diagnosed by MRI compared to the controls. Among the arthritis patients, ADD, effusion, caput flattening, surface destructions, osteophytes, and caput edema were significantly more prevalent compared to the healthy volunteers. In the control group, disc deformation and presence of osteophytes significantly increased with age, and a borderline significance was found for ADD and surface destructions on the condylar head. No statistically significant associations were found between investigated clinical and MRI parameters. CONCLUSION: This study presents a clinically suitable staging system for comparable MRI findings in the TMJs. Our results indicate that some findings are due to age-related degenerative changes rather than pathological changes. Results also show that clinical findings such as pain and limited mouth opening may not be related to changes diagnosed by MRI.

Pattern of recurrence of nonsyndromic keratocystic odontogenic tumors.

OBJECTIVE: To describe and analyze recurrent pattern of KOTs according to time. STUDY DESIGN: This retrospective chart study evaluated histologically confirmed nonsyndromic keratocystic odontogenic tumors (KOT) treated at our institutions between 1975 and 2012. RESULTS: Mean age at time of diagnosis was 48 years, and male/female ratio was 1.8:1. The typical nonsyndromic KOT lesion was most often found in the posterior mandible, had radiographically smooth borders, and was associated with symptoms and clinical findings, perforated bone, with a thin capsule. Anterior jaw KOT were found more frequently in patients 50 years or older, and maxillary KOTs were more frequently infected. Treatment was enucleation (n = 70) or marsupialization with subsequent enucleation (n = 22). Observation time ranged from 0.5 months to 25 years (mean 53 months). Crude recurrence rate was 29%. Risk of recurrence increased until 7 years after treatment and then remained stable. Patients with impaired general health had a significantly increased risk of recurrence. Tumors in the posterior mandible that had bone perforation and a thin capsule and contained keratin showed increased recurrence rates. Although recurrence rates were similar for both treatment groups, the groups differed in size and tumor site; thus, the results of this study need to be confirmed in a prospective study. CONCLUSIONS: Time-dependent recurrence pattern of KOTs is described and analyzed. The following follow-up protocol is suggested for patients with impaired health or large lesions: clinical and radiographic examinations at 2, 4, and 7 years, followed by intervals of 3 to 4 years; for other patients: clinical and radiographic examination at 4, 6, and 8 years, followed by intervals of 3 to 4 years.

A practical approach to interpretation of MRI of the temporomandibular joint.

BACKGROUND: Temporomandibular disorders (TMDs) such as pain, joint sounds, and impaired movement are common, and magnetic resonance imaging (MRI) is now the method of choice for diagnostic assessment. PURPOSE: To describe MR criteria chosen and the amount of temporomandibular joint (TMJ) pathology registered when examining MR images from patients referred to a university hospital for imaging of their TMJs. MATERIAL AND METHODS: The TMJs of 152 consecutive patients, 102 women and 40 men, referred for MRI during an 18 month period were imaged with a 1.5 T imaging system. Twelve asymptomatic students, seven women and five men, gave informed consent and acted as a control group. RESULTS: Moderate to extensive disk displacement was registered in 53% of the patients' TMJs, and 38% of the disks were deformed. Degenerative changes registered were flattening of the condyle heads in 50% of the TMJs and erosion of their cortical surfaces in 30%. Osteophytes were present in 31% of the condyles and bone marrow edema in 30%. Marked to extensive effusion in synovial compartments was registered in 39% of the studied TMJs. In the control group, none of the TMJs showed anterior disk displacement, deformed disks or degenerative changes, but 8 of the 24 joints showed marked effusion. A tendency for a higher amount of disk displacement and deformation was seen among young age groups and more degenerative changes in older age groups, but differences among groups were not significant when tested with chi-square analysis. CONCLUSION: Defined MR criteria that allow for comparative assessment are presented. According to these criteria, a large proportion of the patients referred for MR examination showed morphologic changes indicating TMJ pathology.