Abstract:Objectives: The aim of this study was to investigate the correlation between the lateral pterygoid muscle (LPM) attachment type and temporomandibular joint (TMJ) disc position on sagittal and coronal MR scans. Methods: 191 patients (148 females, 43 males), aged 14-60 years, underwent MR investigations of the TMJs in the intercuspal position (IP) and open-mouth position (OMP). The disc position was evaluated on oblique sagittal and coronal images in the IP and OMP on many MRI sections showing all portions of th… Show more
“…However, in another MRI study of patients presenting with symptoms of TMD after sustaining whiplash injury, >50% of the patients had abnormal TMJ and LPM features . Considering that the LPM moves the TMJ forward and because the superior LPM is connected to the disc, LPM attachment to the TMJ disc may be correlated with disc displacement . In addition, because the masticatory muscles function cooperatively and elaborately during jaw movement, the pathological changes in the LPM will ultimately affect other masticatory muscle pathologies.…”
Whiplash injury is an initiating or aggravating factor of temporomandibular disorder (TMD). Although there are sex‐related differences in the mechanism of pain perception and pain control, there is a lack of research on differences in TMD after whiplash injury. We aimed to evaluate sex‐related differences in the clinical symptoms and magnetic resonance imaging (MRI) findings of patients with TMD attributed to whiplash injury. This retrospective, cross‐sectional study included 100 patients (50 women; 50 men; mean age, 37.60 years) who visited our oro‐facial pain clinic with symptoms of TMD after whiplash injury. All patients underwent detailed evaluations for history of trauma, and their clinical and MRI findings were comprehensively assessed. Women with TMD after whiplash injury perceived more pain and presented more tenderness upon palpation than did men with TMD. In addition, women showed higher volume (58% vs 26%) and signal changes (54% vs 20%) in the lateral pterygoid muscle (LPM) and more anterior disc displacement without reduction (ADDWoR) (40% vs 20%) than did men. The presence of ADDWoR (odds ratio, 10.58; P = 0.007) and condylar degeneration (odds ratio, 9.30; P = 0.015) predicted LPM volume; stressful conditions (beta = 1.34; P = 0.011) correlated with increased visual analogue scale scores, and sleep problem was associated with an increased palpation index (PI) (beta = 0.42; P < 0.001) and neck PI (beta = 0.49; P < 0.001) scores only in women. Our results showed sex‐specific differences in pain intensity, distribution of clinical and abnormal MRI findings, and their relationships, and these differences should be considered when treating patients with TMD.
“…However, in another MRI study of patients presenting with symptoms of TMD after sustaining whiplash injury, >50% of the patients had abnormal TMJ and LPM features . Considering that the LPM moves the TMJ forward and because the superior LPM is connected to the disc, LPM attachment to the TMJ disc may be correlated with disc displacement . In addition, because the masticatory muscles function cooperatively and elaborately during jaw movement, the pathological changes in the LPM will ultimately affect other masticatory muscle pathologies.…”
Whiplash injury is an initiating or aggravating factor of temporomandibular disorder (TMD). Although there are sex‐related differences in the mechanism of pain perception and pain control, there is a lack of research on differences in TMD after whiplash injury. We aimed to evaluate sex‐related differences in the clinical symptoms and magnetic resonance imaging (MRI) findings of patients with TMD attributed to whiplash injury. This retrospective, cross‐sectional study included 100 patients (50 women; 50 men; mean age, 37.60 years) who visited our oro‐facial pain clinic with symptoms of TMD after whiplash injury. All patients underwent detailed evaluations for history of trauma, and their clinical and MRI findings were comprehensively assessed. Women with TMD after whiplash injury perceived more pain and presented more tenderness upon palpation than did men with TMD. In addition, women showed higher volume (58% vs 26%) and signal changes (54% vs 20%) in the lateral pterygoid muscle (LPM) and more anterior disc displacement without reduction (ADDWoR) (40% vs 20%) than did men. The presence of ADDWoR (odds ratio, 10.58; P = 0.007) and condylar degeneration (odds ratio, 9.30; P = 0.015) predicted LPM volume; stressful conditions (beta = 1.34; P = 0.011) correlated with increased visual analogue scale scores, and sleep problem was associated with an increased palpation index (PI) (beta = 0.42; P < 0.001) and neck PI (beta = 0.49; P < 0.001) scores only in women. Our results showed sex‐specific differences in pain intensity, distribution of clinical and abnormal MRI findings, and their relationships, and these differences should be considered when treating patients with TMD.
“…Apart from apparent need when LPM and/or MPM are a particular reason for the direct or referred pain with developed MTPs, there also is a diagnostic application for LPM injections as well as the potentiality to treat certain types of TMJ internal derangements [ 70 ]. Litko et al, in the study based on MR scans of 191 patients, determined three main patterns of LMP attachment to the TMJ’s disc–condyle complex and stated a positive correlation primarily between anteromedial displacement of the disc and the presence of LMP head inserting solely the TMJ capsule [ 71 ]. Importantly, it was highlighted that the attachment type is most likely just a cofactor of the internal derangements and there have to be other factors, such as trauma or a disrupted joint structure, for the displacements to occur [ 71 ].…”
Section: Discussionmentioning
confidence: 99%
“…Litko et al, in the study based on MR scans of 191 patients, determined three main patterns of LMP attachment to the TMJ’s disc–condyle complex and stated a positive correlation primarily between anteromedial displacement of the disc and the presence of LMP head inserting solely the TMJ capsule [ 71 ]. Importantly, it was highlighted that the attachment type is most likely just a cofactor of the internal derangements and there have to be other factors, such as trauma or a disrupted joint structure, for the displacements to occur [ 71 ]. In the cases discussed, application of the botulinum toxin into the LMPs may allow for treatment of the derangements as well as aid in the diagnosis of the acoustic symptoms originating from TMJ, as weakening the LMPs should result in a reduction of the reciprocal click [ 70 , 72 ].…”
(1) Background: Myofascial pain is an important cause of disability among the whole population, and it is a common symptom of temporomandibular joint disorders (TMDs). Its management techniques vary widely; however, in recent years, there has been a growing interest especially in needling therapies within masticatory muscles, due to their simplicity and effectiveness in pain reduction. (2) Methods: The construction of the following study is based on PICOS and PRISMA protocols. A systematic literature search was conducted based on the PubMed and BASE search engines. Searching the abovementioned databases yielded a total of 367 articles. The screening procedure and analysis of full texts resulted in the inclusion of 28 articles for detailed analysis. (3) Results: According to analyzed data, clinicians manage myofascial pain either with wet or dry needling therapies. The most thoroughly studied approach that prevails significantly within the clinical trials is injecting the botulinum toxin into the masseter and temporalis. Other common methods are the application of local anesthetics or dry needling; however, we notice the introduction of entirely new substances, such as platelet-rich plasma or collagen. In the analyzed articles, the target muscles for the needling therapies are most commonly localized by manual palpation although there are a variety of navigational support systems described: EMG, MRI or EIP electrotherapy equipment, which often aid the access to located deeper lateral and medial pterygoid muscle. (4) Conclusions: Needling therapies within masticatory muscles provide satisfactory effects while being simple, safe and accessible procedures although there still is a need for high quality clinical trials investigating especially injections of non-Botox substances and needling within lateral and medial pterygoid muscles.
“…This influence started with plain radiographic techniques, like transcranial and trans-orbital techniques (8,9) and flourished with conventional tomography (10) , and extended to contemporary X-ray based crosssectional techniques like multislice and cone beam computed tomography (11,12) and even non-ionizing radiation dependent modalities, like MRI (13) . In some cases the outline of the condyle is not clear enough in axial MR images (14) , this lack of clarity is due to either changes in the condyle itself or due to insufficient quality of localizing axial cuts.…”
They constitute 20-40% of the causes of oro-facial pain, which is considered a large percentage when compared with dental problems that constitute 50% of them (1,2) . Temporomandibular disorders as a whole are one of the diagnostic dilemmas that face the dentists because of its diversity (3) . Despite that history taking and clinical examination may be
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