Evaluation of the relation between the horizontal condylar angle and the internal derangement of the TMJ - a magnetic resonance imaging study

Abstract

ABSTRACT:This research aimed at assessing the relation between the horizontal condylar angle (HCA) and the internal derangement (ID) of the temporomandibular joint (TMJ), as a result of interference by the TMJ disk, in individuals undergoing magnetic resonance (MR) scans. The sample included a total of 144 TMJs (sagittal and coronal views) of 72 subjects, 15 of whom were male and 57 female, with ages ranging from 15 to 70. The scans were made in a Signa system (GE) model at a magnetic field magnitude of 1.5 T. Sixty-eight TMJs were found to be normal, while 46 showed anterior displacement with reduction. Of these, 41 had some kind of adaptive change in the condyle, while 5 showed degenerative changes. Anterior displacement without reduction was found in 29 joints, 12 of which showed adaptative changes in the condyle, while 17 showed degenerative changes. Only one posterior displacement of the articular disk was recorded. For the TMJs in which disk displacement was found, such values achieved 24.69º on the right side, and 22.94º on the left side. Hence, it was possible for us to conclude that the HCA tends to increase in those TMJs where ID is present. For contralateral TMJs, a strong association was observed between HCA values (57.8%), state of normality (69.7%), and ID (66.7%). To corroborate such findings, a correlation between contralateral HCA values (63.31%) and the diagnosis for contralateral TMJs (68.05%) was determined. Thus, we could infer that there is a tendency between contralateral TMJs to share characteristics and conditions. DESCRIPTORS: Temporomandibular joint; Nuclear magnetic resonance; Temporomandibular joint disk. RESUMO:Esta pesquisa teve por objetivo avaliar a relação entre o valor do ângulo horizontal do côndilo (AHC) e o desarranjo interno (DI), por interferência do disco da articulação temporomandibular (ATM), de indivíduos indicados para exame por ressonância magnética (RM). A amostra perfez um total de 144 ATMs (cortes sagital e coronal) de 72 indivíduos, na faixa etária de 15 a 70 anos, 15 do gênero masculino e 57 do gênero feminino. Os exames foram procedidos em um sistema modelo Signa (GE), magnitude de 1,5 T para o campo magnético. Sessenta e oito ATMs apresentaram uma condição de normalidade e 46 apresentaram deslocamento anterior do disco articular com redução. Dessas, 41 expressaram algum tipo de alteração adaptativa no côndilo e cinco, alterações degenerativas. Vinte e nove articulações mostraram deslocamento anterior do disco articular sem redução, sendo que 12 dessas apresentaram alterações adaptativas do côndilo e 17, alterações degenerativas. Foi registrado apenas um caso de deslocamento posterior do disco articular. O valor médio encontrado para o AHC do lado direito foi de 22,09º e para o lado esquerdo foi de 21,47º, para aquelas ATMs que se apresentaram em condições de normalidade. Para as ATMs com deslocamento de disco, esses valores foram de 24,69º para o lado direito e 22,94º para o lado esquerdo. Desse modo, foi-nos possível concluir que existe uma tendência ao aumen...

Evaluation of bone changes in the temporomandibular joint using cone beam CT

“…In our study, the high prevalence of flattening may be explained by the possibility that this bone change represents an adaptive alteration, 18,29 the first change of a progressive disease 22 or degenerative change secondary to internal derangement. 24,30 Flattening is also considered a degenerative alteration resulting from overload on the TMJ and it may be related to the involvement of the masseter and temporal muscles.…”

“…In our study, with the exception of patients aged 80-89 years, the prevalence of bone changes increased with age, as reported by Foucart et al, 19 who assessed the TMJs of patients with disc displacement without reduction, and in agreement with LeResche, 15 who found that pain in the TMJ region occurs in approximately 10% of the population over the age of 18 years. However, Cruzoé-Rebello et al 18 and Isberg et al 20 did not find an association between increased age and an increase in bone changes; they found that a greater number of individuals aged between 20 and 49 years showed TMJ changes.…”

“…The greater occurrence in women may be explained by the hormonal influences of oestrogen and prolactin, which may exacerbate degradation of cartilage and articular bone in addition to stimulating a series of immunological responses in the TMJ. 12,17 Nevertheless, Cruzoé-Rebello et al 18 observed that both men and women share the same a b c Figure 2 Lateral slices of the temporomandibular joint (TMJ) in maximum opening. The classification of condylar mobility was (a) hypomobility, (b) normal mobility and (c) hypermobility Women 63 25 187 75 250 78 Men 29 42 40 58 69 22 Total 92 29 227 71 319 100 Age group (years) 10-29 21 40 31 60 52 16 30-39 29 31 64 69 93 30 40-49 16 26 46 74 62 19 50-59 11 24 35 76 46 14 60-69 9 24 29 76 38 12 70-79 1 6 15 94 16 5 80-89 5 42 7 58 12 4 Total 92 29 227 71 319 100 n, number of patients TMJ bone changes evaluation using CBCT characteristics with regards to internal derangements and found that hormonal factors do not seem to play a significant role in the manifestation of internal derangements in TMJs.…”

“…When assessing the influence of horizontal angulation on the degenerative bone changes in the TMJ, Cruzoé-Rebello et al 18 suggested that one joint influences the other and for that reason they cannot be considered separately, as in the study by Nebbe et al 21 and Alexious et al 16 The movements of the mandible are co-ordinated by both joints, which are functionally unified, and the functional unification could justify the high prevalence of bilateral bone changes, as observed by Katzberg 22 and in our study. Moreover, in our study, in spite of having a higher prevalence of left-side TMJs with bone changes, the difference was not significant compared with the prevalence on the right side.…”

Temporomandibular joint osteoarthritis: cone beam computed tomography findings, clinical features, and correlations

“…Some researchers have found no correlation between increasing age and degenerative bone changes. 11,12 High rates of pain, ordered in intensity from high to low, were recorded for the function of the TMJ at rest, during mastication, yawning, and phonation, and on lateral and posterior palpation (from 84.2% to 23.1%). Pain during mandibular function might be related to the degenerative changes present on the articular surface of the joint, since this is exposed to increased loading during mandibular function, while joint pain during palpation may be the result of pathological changes in the lateral and posterior parts of the condyle.…”