Temporomandibular Joint Imaging: Practical Application of Available Technology

Wilkes²,

Baker³

1989

Headache

We studied one hundred patients with suspected temporomandibular joint (TMJ) arthropathy in whom 64 also complained of headache and/or facial pain, using high field surface coil magnetic resonance (MR) imaging, and found that headache and facial pain are commonly observed in association with inflammatory arthropathy of the TMJ. Each patient complained of pain and/or tenderness localized to the immediate vicinity of at least one TMJ. Pathologic joint effusion was demonstrated by MR in 88 of the painful joints studied. Significant meniscus displacement, with or without meniscus deformity and alteration of intrinsic signal intensity was present in 94 of the 100 painful joints examined. Fascial inflammation and atrophy of the ipsilateral muscles of mastication were observed occasionally with painful joints. There were no mechanical TMJ symptoms, such as joint clicking, crepitus or locking in 14 internally deranged and painful joints, 12 of which exhibited joint effusion and local inflammation. At least 80 patients described occlusal changes within 12 months of imaging. 28 of the pathologic joints in the series underwent subsequent meniscectomy, including routine histologic evaluation of surgical material. We conclude that internal derangement and inflammation of the TMJ should be considered in patients with unexplained headache and/or facial pain, even if mechanical TMJ symptoms are absent.

Section: Introductionmentioning

confidence: 99%

Facial Pain, Headache, and Temporomandibular Joint Inflammation

Wilkes²,

Baker³

1989

Headache

“…Pain has been commonly associated with TMJ arthrography, dissuading many clinicians from using this procedure for evaluating symptomatic patients [12,33]. The use of a thin needle and single skin puncture permits a skilled arthrographer to opacify both joint compartments with a minimum of patient discomfort and soft-tissue trauma.…”

Section: Arthrographymentioning

confidence: 99%

“…protruded posteroanterior views of the skull base and mandible, combined with tightly collimated closed-and openmouth lateral TMJ tomograms [22,25,33]. These screening radiographic procedures provide valuable information with regard to side-to-side skull base and condylar symmetry , condyle positioning within the glenoid fossa, and the presence or absence of degenerative bony changes.…”

mentioning

confidence: 99%

The diagnosis of temporomandibular joint disease: two-compartment arthrography and MR

American Journal of Roentgenology

Wilkes

Omlie

et al. 1988

The reliability and accuracy of two-compartment temporomandibular joint (TMJ) arthrography was compared with MR imaging on the basis of an analysis of surgical findings obtained from joints that had been studied preoperatively with arthrography or MR or, in some cases, both procedures. Seven hundred forty-three consecutive TMJ arthrograms were successfully obtained in a total of 443 patients by using a Single 27gauge needle and a two-compartment technique in each joint. There was a 100% correlation with surgical findings in 218 radiologically abnormal joints operated on within 90 days of arthrography with respect to the presence or degree of meniscus displacement and normal or abnormal disk morphology and function. In 604 patients 1052 TMJs were studied with high-field-strength surface-coil MR. Surgical findings were available for correlation in 170 of the joints studied. Forty-three joints were studied with both twocompartment arthrography and MR. Eight operated joints had been imaged successfully with both two-compartment arthrography and MR. Both methods of evaluation provided highly reliable and accurate information regarding meniscus position and shape. Arthrography was superior to MR in detecting capsular adhesions and the presence or absence of perforation of the disk or meniscus attachments. Simple meniscectomy (with or without insertion of a temporary Silastic TMJ implant) was the most frequently performed surgical procedure in the series, followed by meniscus repositioning procedures. Joint effusions, failed TMJ implants, and avascular necrosis were demonstrated best with MR. Soft-tissue lesions, including intrinsic degeneration of the meniSCUS, anomalous muscle development, muscle atrophy, tendinitis, and injuries such as contusions and hematomas, were demonstrated only with MR. Partial-flip-angle GRASS (gradient-recalled acquisition in the steady state) techniques permit both fast scanning and study of functional joint dynamics. Joint fluid may appear as high signal intensity on GRASS images because of T2*-weighting. We recommend MR as the procedure of choice for diagnosis of uncomplicated internal derangements of the TMJ. Two-compartment arthrography with videofluoroscopy is an important ancillary procedure that should be performed whenever capsular adhesions or perforations are suspected and not demonstrated with MR and whenever MR is inconclusive.

Three-Dimensional Computed Tomography in Maxillofacial Surgical Planning

Archives of Otolaryngology - Head and Neck Surgery

Deeb²,

Wilkes³

et al. 1988

\s=b\ Fifty-four maxillofacial three-dimensional computed tomographic examinations were performed during a 12-month period for the purpose of surgical planning. Pathologic entities in the series included trauma, neoplasia, cleft palate, and other developmental anomalies. Computer-assisted mandibular disarticulation was performed routinely after each study to permit direct viewing of the mandible or maxilla in isolation. Three-dimensional computed tomography is a useful technique for maxillofacial surgical planning. (Arch Otolaryngol Head Neck Surg 1988;114:438-442) Three-di mensi onal computed to¬ mography (CT) is a valuable tech¬ nique for the planning of skeletal, plastic, and maxillofacial surgical procedures.113 Anatomic measure¬ ments can be made from three-dimen¬ sional display images and manufactured life-sized models, and spatial relationships may be analyzed from desired perspectives.7·8·10 Three-dimen¬ sional views provide key information to the radiologist and surgeon that may not be apparent on either conven¬ tional roentgenograms or axial CT images alone. MATERIALS AND METHODSFifty-four maxillofacial three-dimen¬ sional CT studies (29 female and 25 male subjects, aged 6 to 59 years) were per¬ formed in 12 months on a spectrum of abnormalities, including the following: anomalous development (including clefts), 18 patients; trauma (mostly posttraumatic deformities), 12 patients; neoplasia, four patients; and infection/inflammation, four patients. Ten patients being evaluated for permanent dental implants were also studied. There were also six miscellaneous entities that were scanned. Computed to¬ mographic examinations were performed on a fourth-generation CT scanner (GE 9800) using overlapping or consecutive (stacked) 1.5-and 3-mm-thick axial or cor¬ onal CT scans through the area of interest. Most patients with mandibular conditions were scanned in axial projection stopping at the inferior orbital rim, so as to exclude the eyes from direct radiation exposure. Patients were secured within the head holder with tape and sedated when neces¬ sary, to ensure a motion-free study.Mandibular examinations were performed using overlapping 3-mm-thick axi¬ al images at 2-mm scan intervals. Consecu¬ tive (stacked) 1.5-mm-thickness scans were performed through the temporomandibular joints (TMJs). Cleft palates were scanned with either overlapping 3-mmthickness scans or consecutive 1.5-mmthick scans, depending on the size of the area of interest and patient limitations. Following each CT study, data were input to a three-dimensional processor (Dimen¬ sional Medicine Ine) for rendering of dis¬ crete voxel faces, later viewed in two dimensions on a specialized viewing appa¬ ratus (also Dimensional Medicine Ine). Two-dimensional roentgenographic im¬ ages were routinely obtained in various projections and viewed by both radiologist and clinician.Mandibular disarticulations were per¬ formed by three different specially trained radiologie technologists. Disarticulation required painstaking manual removal of specific a...