Temporomandibular Joint Internal Derangement Score (TIDS): novel magnetic resonance imaging assessment score and its relation to invasive treatment in patients with clinical temporomandibular joint pathology

Abstract

PurposeA new magnetic resonance imaging (MRI) based scoring system for temporomandibular joint (TMJ) internal derangement was developed to predict disease severity and the likelihood of invasive treatment.Patients and methodsReports and images from bilateral TMJ MRI studies of 100 consecutive patients with TMJ pain were retrospectively reviewed. A Temporomandibular Joint Internal Derangement Score (TIDS) score was composed of 6 MRI characteristics: joint effusion, disc displacement, disc nonrecapture, disc degenerative changes, abnormal condyle translation, and condyle arthritis. The primary endpoint was whether disease severity merited invasive treatment (arthrocentesis, arthroscopy, arthroplasty, or discectomy). Primary analyses were conducted as univariate regression, with the level of significance set at p < .05. Multivariate regression was also used to assess the impacts of each variable upon the need for invasive treatment.ResultsInvasive treatment was performed in 29 patients and planned in an additional 9 patients. Patients with clinical bilateral pathology were no more likely to undergo invasive treatment than those with unilateral clinical pathology. Statistically significant correlations were found between bilateral invasive treatment and the presence of bilateral joint effusions (p = 0.0037) and disc displacement (p = 0.014), as well as with increasing values of right TIDS (p = 0.0015) and bilateral TIDS (p = 0.0090). Bilateral TIDS of greater than 6 was correlated with both bilateral invasive treatment (p = 0.0033) and with invasive treatment of any kind (p = 0.041). In each instance of TIDS > 6, the patient demonstrated multiple signs of bilateral TMJ pathology. On multivariate regression, only disc recapture failed to trend towards statistical significance in both the six and twelve component regressions, which trended towards significance only in the twelve component analysis.ConclusionA TIDS score was developed to serve as an adjunct to the clinical assessment of TMJ pathology. Bilateral TIDS score greater than 6 was statistically significantly correlated with the severity of TMJ pathology.

Interdisciplinary Approach to the Temporomandibular Joint Osteoarthritis—Review of the Literature

“…Most often the temporomandibular joint current MR images are obtained using 1.5-T MRI systems [31][32][33][34][35][36][37][38]. Manoliu et al [38] quantitatively and qualitatively compared MRI images of TMJ using two different protocols at 1.5 T and at 3.0 T. According to the authors, imaging at 3.0 T is recommended because of significantly better quality, visibility and delineation of anatomical structures, including articular disc and masticatory muscles.…”

Classification of temporomandibular joint internal derangement based on magnetic resonance imaging and clinical findings of 435 patients contributing to a nonsurgical treatment protocol

“…The most recent classification of internal derangement was based on the scoring of MRI abnormalities (100 patients) without clinical correlation and without a proposed treatment protocol 58 .…”

Volume Isotropic Turbo Spin Echo Acquisition Magnetic Resonance Imaging Pulse Sequence in Assessment of Temporomandibular Disorders

“…Cortical bone changes, being a common sequel of long standing temporomandibular disorders (26) and a primary feature in cases of osteoarthritis (27) , rendered its detection one of the secondary diagnostic findings in MR images. Regarding the delineation of TMJ related cortical bone, there was statistically significant difference between VISTA and traditional 2D proton density images.…”