Magnetic resonance imaging findings of internal derangement in temporomandibular joints without a clinical diagnosis of temporomandibular disorder

Abstract

The purpose of this study was to assess the prevalences of magnetic resonance (MR) imaging findings of internal derangement (ID) in temporomandibular joints (TMJs) without a specific clinical diagnosis of temporomandibular disorder (TMD), and to investigate whether in this TMJ group the variable of pain may be linked to MR imaging findings of ID. The study comprised 109 patients, who were assigned a clinical uni- or bilateral TMJ-related diagnosis of 'absence of TMD'. Bilateral sagittal and coronal MR images were obtained subsequently to establish the prevalence of TMJ ID. An MR imaging diagnosis of ID was found in 99 (55.9%) of the 177 TMJs investigated. About 30.3% of the closed mouth-related TMJ positions characterized by disc displacement presented with anterior disc displacement, while 27.3% had anterolateral and 25.3% anteromedial disc displacement. Analysis of the data revealed the presence of TMJ pain to be associated with significantly more MR imaging diagnoses of disc displacement without reduction than disc displacement with reduction (P < 0.05), while there was no significant difference in the prevalences of ID and those of absence of ID (P > 0.05). Using chi-square analysis, no significant relationship was found between the presence of TMJ pain and the MR imaging diagnosis of TMJ ID (P=0.93). Use of the kappa statistical test indicated poor diagnostic agreement between the presence of TMJ pain and the MR imaging diagnosis of ID (kappa=0.01). The results suggest TMJs with a clinical diagnosis of 'absence of TMD' to be associated with a high rate of IDs, while in these instances the clinical variable of TMJ pain may have no effect on prevalences of MR imaging diagnoses TMJ ID. The data confirm the aspect of clinical diagnostic criteria as an unreliable instrument in predicting MR imaging diagnoses of TMJ ID.

MRI analysis of the relationship between bone changes in the temporomandibular joint and articular disc position in symptomatic patients

“…Our data showed that pain is not a reliable predictor of internal derangement, which is in agreement with the findings of other studies. 4,6,11 Regarding the type of disc displacement observed in the present study, the proportion of DDwoR was higher than that of DDwR (23% vs 12.8%) which is in agreement with the findings of Emshoff et al 12,16 but in disagreement with the findings of another study where 82.5% of cases had disc displacement, of which 59.5% demonstrated reduction with opening and 40.5% did not reduce. Anterior disc displacement is common (44%) and sideways displacement is rare (4%).…”

“…3,5,9,11,12,[14][15][16][17][18][19] Nevertheless, the absence of TMD signs has been associated with high rates of internal derangement, which confirms that a clinical diagnosis of internal derangement is not a reliable tool to predict an imaging diagnosis of internal derangement. 6 From the 148 TMJs studied, 94 (63.5%) presented N, 34 (23%) presented DDwoR, 19 (12.8%) presented DDwR and 1 (0.7%) presented PD (Table 1). Based on these data, only 36.48% of the study sample was classified as presenting internal derangement, which is in disagreement with the findings of Emshoff et al 16 who reported a strong correlation between pain and internal derangement (64.4%).…”

“…The results confirm the relationship between internal derangement and osteoarthritis. Emshoff et al 6 evaluated the relationship between clinical and imaging diagnosis of internal derangement and the results confirmed that clinical diagnosis is not a reliable tool when compared with imaging findings.…”

ANKH Polymorphisms and Clicking of the Temporomandibular Joint in Dental Residents

“…On the other hand, past studies applying a magnetic resonance imaging method have found anterior disc displacement in 20 % of clinically asymptomatic individuals [29,35]. As a clinical assessment method was used to detect TMJ conditions in this study, the potential mixture of asymptomatic anterior disc displacement and normal subjects in the control group could result in a similar distribution of the ANKH genotypes between the cases and the controls.…”

“…Before inclusion, informed consent was sought from all participants. Each was checked for the history of TMD and was assessed with standard clinical procedures including evaluation of mandibular range of motion, joint pain and joint sounds [29]. As TMJ clicking accompanying with other joint symptoms indicated different types of TMD and/or medical conditions [6][7][8], participants appearing with any joint symptoms but clicking were excluded from this study.…”