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

Westesson, Per‐Lennart; Katzberg, Richard W.; Tallents, Ross H.; Sanchez-Woodworth, Roberto E.; Svensson, Sören

doi:10.2214/ajr.148.6.1165

Cited by 171 publications

(71 citation statements)

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“…However, its ability to detect osseous abnormalities is still considered poor or moderate and confirmation with CT or CBCT is needed. 10,4 Osseous abnormalities can be identified with soft tissue pathology and this has clinical significance. [11][12][13][14] They can lead to changes in the occlusion or conylar position on the affected side 13,14 or can be associated with perforations 15 and pain, 12 even in cases without disc displacement.…”

Section: Discussionmentioning

confidence: 99%

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Usefulness of cone beam computed tomography in temporomandibular joints with soft tissue pathology

Alkhader¹,

Kuribayashi²,

Ohbayashi³

et al. 2010

Dentomaxillofacial Radiology

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Objective: The aim of the study was to evaluate the usefulness of cone beam CT (CBCT) in temporomandibular joints (TMJs) with soft tissue pathology. Methods: 106 TMJs of 55 patients with temporomandibular disorder (TMD) were examined by MRI and CBCT. MR images were used for the evaluation of disc displacement, disc deformity, joint effusion and obscurity of temporal posterior attachment (TPA). CBCT images were evaluated for the presence or absence of osseous abnormalities. The x 2 test was used to analyse the association between MRI and CBCT findings. Results: MRI of 106 TMJs revealed disc displacement, disc deformity, joint effusion and obscurity of the TPA in 68, 73, 28 and 27 joints, respectively. Of the 68 TMJs with disc displacement, anterior disc displacement without reduction (ADDWR) was seen most frequently (47/68). CBCT imaging found 65 TMJs were characterized by the presence of osseous abnormalities and were significantly associated with disc deformity and ADDWR (P , 0.05). There was no statistically significant association between the presence of joint effusion and obscurity of TPA and TMJ osseous abnormalities. Conclusions: TMD patients with confirmed ADDWR or disc deformity on MRI are at risk of having osseous abnormalities in the TMJ and further examination with CBCT is recommended.

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Section: Discussionmentioning

confidence: 99%

“…MRI is considered the prime imaging of choice for the evaluation of soft tissue components of the TMJ [4][5][6] and should precede cone beam CT (CBCT) for cases in which the diagnosis of soft tissue pathology is a concern, or in cases where ionizing radiation should be avoided.…”

Section: Introductionmentioning

confidence: 99%

Usefulness of cone beam computed tomography in temporomandibular joints with soft tissue pathology

Alkhader¹,

Kuribayashi²,

Ohbayashi³

et al. 2010

Dentomaxillofacial Radiology

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“…74 While identification of crepitus is reliable (κ = 0.85), 74 a computed tomography scan is recommended as the gold standard for diagnosing osseous pathologies (osteoarthritis, osteoarthrosis). 3,64,74,85 If no joint noise or pain with palpation is reported or observed, then the clinician should consider that joint pathology is not present or may not need intervention. Special Tests Though not part of the DC/ TMD, special tests of joint loading to discern joint pain are described by clinical experts.…”

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confidence: 99%

A Proposed Diagnostic Classification of Patients With Temporomandibular Disorders: Implications for Physical Therapists

Harrison¹,

Thorp²,

Ritzline³

2014

J Orthop Sports Phys Ther

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Researchers and expert clinicians in orofacial pain have long acknowledged the Differential DiagnosisIn addition to the musculoskeletal structures (TMJ and the masticatory muscles) and the psychological factors discussed, orofacial pain may result from or be exacerbated by (1) primary HAs (migraine, cluster, tension type, other primary); (2) secondary HAs related to systemic problems such as cardiovascular and rheumatoid disorders and disorders related to the cervical spine, ears, sinuses, eyes, medications, and dental structures; and (3) cranial and peripheral neuralgias and central nervous system disorders.The following provides an overview of the physical therapy examination for people presenting with HAs and/or orofacial pain. The examination will consist of the history, screens for contributing psychological factors, a systems screen, cervical spine screen, and specific examination of the TMJ and masticatory muscles. PHYSICAL THERAPY EXAMINATION HistoryA thorough history will help identify the possible source(s) of the orofacial pain and provide a screen for other causative or contributing factors. 17,22,61,74,75 Red flags related to cardiac history (eg, angina or history of myocardial infarction) and brain function (eg, sudden-onset severe HAs, weakness, or slurred speech) must be investigated early in the history taking. Information about the nature of the pain will be critical in determining the possibility of primary HAs (migraine, cluster) (TABLE 3) and secondary HAs related to the eyes, ears, sinus, dental structures, medication complications, and/or neurologic types of pain. Unrelenting pain unrelated to musculoskeletal function is an indication for referral. Information about cervical dysfunction is essential to determine whether the cervical spine is causing or exacerbating the HA/facial pain. Medication history is important to determine potential negative interactions, rebound HAs from overuse (as occurs with nonsteroidal anti-inflammatory drugs), or withdrawal.Key questions have been examined and determined to have strong sensitivity and specificity in incriminating TMDs as the source of pain. 22,29 The initiating question is, "Have you had pain or stiffness in the face, jaw, temple, in front of the ear, or in the ear in the past month?" A positive response should be followed with a question about whether the symptoms are altered by any of the following jaw activities: chewing, talking, singing, yawning, kissing, moving the jaw. 22,29,74,75 The other key inquiry is directed toward identifying the presence of a disc displacement 22,74 : "Have you ever had your jaw lock or catch so that it would not open all the way? If so, was this limitation in jaw opening severe enough to interfere with your ability to eat? Have you ever noticed clicking, popping, or other sounds in your joint?" 74 importance of the psychological domain in causing and/or maintaining pain, and in upregulating peripheral and central neural structures involved in nociception. 22,32,74,75 Central nervous system differences in the t...

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“…[5][6][7][8] However, its diagnostic value for assessing the presence or absence of TMJ disc perforation is limited. As a clinical modality, arthroscopic surgery has been shown to be a safe and effective technique that improves the state and function of TMJ disorder patients.…”

Section: Introductionmentioning

confidence: 99%

Correlation between disc displacements and locations of disc perforation in temporomandibular joint

Liu

Zhang

Chen

et al. 2009

International Journal of Oral and Maxillofacial Surgery

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Objectives: The aim of this study was to investigate the correlation between disc displacement types and locations of disc perforation in the temporomandibular joint (TMJ). Methods: 157 patients (162 joints) with disc perforation observed through arthroscopy were included in this study. The types of disc displacement were analysed by TMJ MRI before operation. The locations of disc perforation under arthroscopy were recorded. The correlation between types of disc displacement and locations of disc perforation was analysed by Fisher's exact test. Results: Medial disc perforation was observed in 55.6% of patients with anterolateral displacement without reduction, but was observed in only 3.7% of patients with pure anterior displacement, and was not observed in patients with anteromedial displacement without reduction. There was a statistically significant difference between these groups in the incidence of medial disc perforation. Conclusions: There is a correlation between different disc displacements and locations of disc perforation. The incidence of medial disc perforation in patients with anterolateral displacement was significantly higher. The types of disc displacement may have direct influence over the locations of disc perforation.

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

Cited by 171 publications

References 0 publications

Usefulness of cone beam computed tomography in temporomandibular joints with soft tissue pathology

Usefulness of cone beam computed tomography in temporomandibular joints with soft tissue pathology

A Proposed Diagnostic Classification of Patients With Temporomandibular Disorders: Implications for Physical Therapists

Correlation between disc displacements and locations of disc perforation in temporomandibular joint

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