Advertisement

Correlation between the main clinical, imaging, and arthroscopy findings in patients with temporomandibular disorders

Published:August 17, 2022DOI:https://doi.org/10.1016/j.ijom.2022.08.007

      Abstract

      The purpose of this work was to prospectively correlate the most characteristic clinical symptoms of temporomandibular disorders, such as pain and limitation of mouth opening, with the findings of magnetic resonance imaging (disc position, degenerative changes, and effusion) and arthroscopy findings (roofing, synovitis, chondromalacia, adhesions, and perforations). These examinations were performed in 298 patients diagnosed with internal derangement refractory to conservative treatment. The mean age of the patients was 38.59 years; 92.6% were female. The t-test and one-way analysis of variance (ANOVA) were used to correlate the findings. Significant relationships were found between pain and disc displacement without reduction (P = 0.033) and effusion (P = 0.003) on MRI, coinciding with correlations between pain and roofing of 0–25% (P = 0.016) and synovitis (P = 0.001) on arthroscopy. A significant relationship was also observed between mouth opening limitation and the presence of osteoarthrosis (P = 0.018) on MRI, and between mouth opening limitation and synovitis (P = 0.022), chondromalacia (P = 0.002), and adhesions (P < 0.001) on arthroscopy. All of these findings were observed in patients with a poor initial clinical situation, which highlights the considerable potential of correlating these data with imaging and arthroscopy findings.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to International Journal of Oral and Maxillofacial Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Smolka W.
        • Iizuka T.
        Arthroscopic lysis and lavage in different stages of internal derangement of the temporomandibular joint: correlation of preoperative staging to arthroscopic findings and treatment outcome.
        J Oral Maxillofac Surg. 2005; 63: 471-478https://doi.org/10.1016/j.joms.2004.07.021
        • Jung Y.W.
        • Park S.H.
        • On S.W.
        • Song S.I.
        Correlation between clinical symptoms and magnetic resonance imaging findings in patients with temporomandibular joint internal derangement.
        J Korean Assoc Oral Maxillofac Surg. 2015; 41: 125-132https://doi.org/10.5125/jkaoms.2015.41.3.125
        • Sato F.R.L.
        • Lima C.A.A.
        • Tralli G.
        • da Silva R.A.
        Is there a correlation between arthroscopic findings and the clinical signs and symptoms of patients with internal derangement of the temporomandibular joint? A prospective study.
        Int J Oral Maxillofac Surg. 2019; 48: 233-238https://doi.org/10.1016/j.ijom.2018.07.004
        • Fernández-Ferro M.
        • Fernández-Sanromán J.
        • Blanco-Carrión A.
        • Costas-López A.
        • López-Betancourt A.
        • Arenaz-Bua J.
        • Stavaru Marinescu B.
        Comparison of intra-articular injection of plasma rich in growth factors versus hyaluronic acid following arthroscopy in the treatment of temporomandibular dysfunction: a randomised prospective study.
        J Craniomaxillofac Surg. 2017; 45: 449-454https://doi.org/10.1016/j.jcms.2017.01.010
        • Matsubara R.
        • Yanagi Y.
        • Oki K.
        • Hisatomi M.
        • Santos K.C.
        • Bamgbose B.O.
        • Fujita M.
        • Okada S.
        • Minagi S.
        • Asaumi J.
        Assessment of MRI findings and clinical symptoms in patients with temporomandibular joint disorders.
        Dentomaxillofac Radiol. 2018; 4720170412https://doi.org/10.1259/dmfr.20170412
        • Millon-Cruz A.
        • Martín-Granizo R.
        • Encinas A.
        • Berguer A.
        Relationship between intra-articular adhesions and disc position in temporomandibular joints: magnetic resonance and arthroscopic findings and clinical results.
        J Craniomaxillofac Surg. 2015; 43: 497-502https://doi.org/10.1016/j.jcms.2015.02.010
        • Emshoff R.
        • Brandlmaier I.
        • Bertram S.
        • Rudisch A.
        Relative odds of temporomandibular joint pain as a function of magnetic resonance imaging findings of internal derangement, osteoarthrosis, effusion, and bone marrow edema.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003; 95: 437-445https://doi.org/10.1067/moe.2003.95
        • Westesson P.L.
        • Brooks S.L.
        Temporomandibular joint: relationship between MR evidence of effusion and the presence of pain and disk displacement.
        AJR Am J Roentgenol. 1992; 59: 559-563https://doi.org/10.2214/ajr.159.3.1503025
        • Kaneyama K.
        • Segami N.
        • Yoshimura H.
        • Honjo M.
        • Demura N.
        Increased levels of soluble cytokine receptors in the synovial fluid of temporomandibular joint disorders in relation to joint effusion on magnetic resonance images.
        J Oral Maxillofac Surg. 2010; 68: 1088-1093https://doi.org/10.1016/j.joms.2009.10.027
        • Thomas N.
        • Harper D.E.
        • Aronovich S.
        Do signs of an effusion of the temporomandibular joint on magnetic resonance imaging correlate with signs and symptoms of temporomandibular joint disease.
        Br J Oral Maxillofac Surg. 2018; 56: 96-100https://doi.org/10.1016/j.bjoms.2017.11.011
        • Katzberg R.W.
        • Westesson P.L.
        • Tallents R.H.
        • Anderson R.
        • Kurita K.
        • Manzione Jr, J.V.
        • Totterman S.
        Temporomandibular joint: MR assessment of rotational and sideways disk displacements.
        Radiology. 1988; 169: 741-748https://doi.org/10.1148/radiology.169.3.3186996
        • Vogl T.J.
        • Eberhard D.
        • Randzio J.
        • Schmid C.
        • Lissner J.
        KST-Diagnostik des “internal derangement” des Temporomandibulargelenkes [MR tomographic diagnosis of internal derangement of the temporomandibular joint].
        Radiologe. 1991; 31: 537-544
        • Tasaki M.M.
        • Westesson P.L.
        Temporomandibular joint: diagnostic accuracy with sagittal and coronal MR imaging.
        Radiology. 1993; 186: 723-729https://doi.org/10.1148/radiology.186.3.8430181
        • Vogl T.J.
        • Lauer H.C.
        • Lehnert T.
        • Naguib N.N.
        • Ottl P.
        • Filmann N.
        • Soekamto H.
        • Nour-Eldin N.E.
        The value of MRI in patients with temporomandibular joint dysfunction: correlation of MRI and clinical findings.
        Eur J Radiol. 2016; 85: 714-719https://doi.org/10.1016/j.ejrad.2016.02.001
        • Roh H.S.
        • Kim W.
        • Kim Y.K.
        • Lee J.Y.
        Relationships between disk displacement, joint effusion, and degenerative changes of the TMJ in TMD patients based on MRI findings.
        J Craniomaxillofac Surg. 2012; 40: 283-286https://doi.org/10.1016/j.jcms.2011.04.006
        • Nitzan D.W.
        The process of lubrication impairment and its involvement in temporomandibular joint disc displacement: a theoretical concept.
        J Oral Maxillofac Surg. 2001; 59: 36-45https://doi.org/10.1053/joms.2001.19278
        • Schiffman E.L.
        • Velly A.M.
        • Look J.O.
        • Hodges J.S.
        • Swift J.Q.
        • Decker K.L.
        • Anderson Q.N.
        • Templeton R.B.
        • Lenton P.A.
        • Kang W.
        • Fricton J.R.
        Effects of four treatment strategies for temporomandibular joint closed lock.
        Int J Oral Maxillofac Surg. 2014; 43: 217-226https://doi.org/10.1016/j.ijom.2013.07.744
        • Fernández Sanromán J.
        • Fernández Ferro M.
        • Costas López A.
        • Arenaz Bua J.
        • López A.
        Does injection of plasma rich in growth factors after temporomandibular joint arthroscopy improve outcomes in patients with Wilkes stage IV internal derangement? A randomized prospective clinical study.
        Int J Oral Maxillofac Surg. 2016; 45: 828-835https://doi.org/10.1016/j.ijom.2016.01.018
        • McCain J.P.
        • de la Rua H.
        • Le Blanc W.G.
        Correlation of clinical, radiographic, and arthroscopic findings in internal derangements of the TMJ.
        J Oral Maxillofac Surg. 1989; 47: 913-921https://doi.org/10.1016/0278-2391(89)90373-x
        • McCain J.P.
        • Sanders B.
        • Koslin M.G.
        • Quinn J.H.
        • Peters P.B.
        • Indresano A.T.
        Temporomandibular joint arthroscopy: a 6-year multicenter retrospective study of 4831 joints.
        J Oral Maxillofac Surg. 1992; 50: 926-930https://doi.org/10.1016/0278-2391(92)90047-4
        • Holmlund A.B.
        • Axelsson S.
        Temporomandibular arthropathy: correlation between clinical signs and symptoms and arthroscopic findings.
        Int J Oral Maxillofac Surg. 1996; 25: 178-181https://doi.org/10.1016/s0901-5027(96)80024-5
        • Tzanidakis K.
        • Sidebottom A.J.
        How accurate is arthroscopy of the temporomandibular joint? A comparison of findings in patients who had open operations after arthroscopic management failed.
        Br J Oral Maxillofac Surg. 2013; 51: 968-970https://doi.org/10.1016/j.bjoms.2013.05.149
        • González-García R.
        • Rodríguez-Campo F.J.
        • Monje F.
        • Sastre-Pérez J.
        • Gil-Díez Usandizaga J.L.
        Operative versus simple arthroscopic surgery for chronic closed lock of the temporomandibular joint: a clinical study of 344 arthroscopic procedures.
        Int J Oral Maxillofac Surg. 2008; 37: 790-796https://doi.org/10.1016/j.ijom.2008.04.022
        • González-García R.
        The current role and the future of minimally invasive temporomandibular joint surgery.
        Oral Maxillofac Surg Clin N Am. 2015; 27: 69-84https://doi.org/10.1016/j.coms.2014.09.006
        • Sato J.
        • Segami N.
        • Nishimura M.
        • Kaneyama K.
        • Demura N.
        • Yoshimura H.
        Relation between the expression of vascular endothelial growth factor in synovial tissues and the extent of joint effusion seen on magnetic resonance imaging in patients with internal derangement of the temporomandibular joint.
        Br J Oral Maxillofac Surg. 2003; 41: 88-94https://doi.org/10.1016/s0266-4356(02)00295-4
        • Larheim T.A.
        • Katzberg R.W.
        • Westesson P.L.
        • Tallents R.H.
        • Moss M.E.
        MR evidence of temporomandibular joint fluid and condyle marrow alterations: occurrence in asymptomatic volunteers and symptomatic patients.
        Int J Oral Maxillofac Surg. 2001; 30: 113-117https://doi.org/10.1054/ijom.2000.0018
        • González-García R.
        • Rodríguez-Campo F.J.
        Arthroscopic lysis and lavage versus operative arthroscopy in the outcome of temporomandibular joint internal derangement: a comparative study based on Wilkes stages.
        J Oral Maxillofac Surg. 2011; 69: 2513-2524https://doi.org/10.1016/j.joms.2011.05.027
        • Wilkes C.H.
        Internal derangements of the temporomandibular joint. Pathological variations.
        Arch Otolaryngol Head Neck Surg. 1989; 115: 469-477https://doi.org/10.1001/archotol.1989.01860280067019
        • Dimitroulis G.
        A new surgical classification for temporomandibular joint disorders.
        Int J Oral Maxillofac Surg. 2013; 42: 218-222https://doi.org/10.1016/j.ijom.2012.11.004
        • Schiffman E.
        • Ohrbach R.
        • Truelove E.
        • Look J.
        • Anderson G.
        • Goulet J.P.
        • List T.
        • Svensson P.
        • Gonzalez Y.
        • Lobbezoo F.
        • Michelotti A.
        • Brooks S.L.
        • Ceusters W.
        • Drangsholt M.
        • Ettlin D.
        • Gaul C.
        • Goldberg L.J.
        • Haythornthwaite J.A.
        • Hollender L.
        • Jensen R.
        • John M.T.
        • De Laat A.
        • de Leeuw R.
        • Maixner W.
        • van der Meulen M.
        • Murray G.M.
        • Nixdorf D.R.
        • Palla S.
        • Petersson A.
        • Pionchon P.
        • Smith B.
        • Visscher C.M.
        • Zakrzewska J.
        • Dworkin S.F.
        • International RDC/TMD Consortium Network
        • International Association for Dental Research
        • Orofacial Pain Special Interest Group
        • International Association for the Study of Pain
        Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinicaland research applications: recommendations of the International RDC/TMDConsortium Network* and Orofacial Pain Special Interest Group.
        J Oral Facial Pain Headache. 2014; 28: 6-27https://doi.org/10.11607/jop.1151
        • Larheim T.A.
        Role of magnetic resonance imaging in the clinical diagnosis of the temporomandibular joint.
        Cells Tissues Organs. 2005; 180: 6-21https://doi.org/10.1159/000086194
        • Segami N.
        • Suzuki T.
        • Sato J.
        • Miyamaru M.
        • Nishimura M.
        • Yoshimura H.
        Does joint effusion on T2 magnetic resonance images reflect synovitis? Part 3. Comparison of histologic findings of arthroscopically obtained synovium in internal derangements of the temporomandibular joint.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003; 95: 761-766https://doi.org/10.1067/moe.2003.243
        • Quinn J.H.
        Arthroscopic and histologic evidence of chondromalacia in the temporomandibular joint.
        Oral Surg Oral Med Oral Pathol. 1990; 70: 387-392https://doi.org/10.1016/0030-4220(90)90165-o
        • Martin-Granizo R.
        • Correa-Muñoz D.C.
        Chondromalacia as pathological finding in arthroscopy of the temporomandibular joint: a retrospective study.
        J Craniomaxillofac Surg. 2018; 46: 82-89https://doi.org/10.1016/j.jcms.2016.11.006
        • Murakami K.
        • Segami N.
        • Moriya Y.
        • Iizuka T.
        Correlation between pain and dysfunction and intra-articular adhesions in patients with internal derangement of the temporomandibular joint.
        J Oral Maxillofac Surg. 1992; 50: 705-708https://doi.org/10.1016/0278-2391(92)90102-6
        • Machon V.
        • Levorova J.
        • Hirjak D.
        • Drahos M.
        • Foltan R.
        Temporomandibular joint disc perforation: a retrospective study.
        Int J Oral Maxillofac Surg. 2017; 46: 1411-1416https://doi.org/10.1016/j.ijom.2017.05.008
        • Nakaoka K.
        • Hamada Y.
        • Holmlund A.B.
        • Saito T.
        • Arai G.
        • Horiuchi T.
        • Mishima A.
        • Seto K.
        The changes of joint effusion on MRI and arthroscopic findings after visually guided TMJ irrigation correlated to the clinical outcome.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 108: 99-104https://doi.org/10.1016/j.tripleo.2008.11.019
        • Kim J.Y.
        • Jeon K.J.
        • Kim M.G.
        • Park K.H.
        • Huh J.K.
        A nomogram for classification of temporomandibular joint disk perforation based on magnetic resonance imaging.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2018; 125: 682-692https://doi.org/10.1016/j.oooo.2018.02.009
        • Gynther G.W.
        • Holmlund A.B.
        • Reinholt F.P.
        Synovitis in internal derangement of the temporomandibular joint: correlation between arthroscopic and histologic findings.
        J Oral Maxillofac Surg. 1994; 52 (discussion 918): 913-917https://doi.org/10.1016/s0278-2391(10)80066-7
        • Stegenga B.
        • de Bont L.G.
        • Boering G.
        Osteoarthrosis as the cause of craniomandibular pain and dysfunction: a unifying concept.
        J Oral Maxillofac Surg. 1989; 47: 249-256https://doi.org/10.1016/0278-2391(89)90227-9