Emshoff R, Innerhofer K, Rudisch A, Bertram S
Department of Oral and Maxillofacial Surgery, University of Innsbruck, Austria.
Int J Oral Maxillofac Surg. 2001 Apr;30(2):118-22. doi: 10.1054/ijom.2000.0028.
In terms of clinical decision-making in instances of temporomandibular disorders (TMD) and orofacial pain, there is controversy in the literature over the diagnostic significance of the temporomandibular joint (TMJ)-related variable disk-condyle relationship (DCR). The purpose of this study was to investigate whether in patients with TMJ-related pain, the variable of TMJ pain may be linked to magnetic resonance (MR) imaging findings of internal derangement (ID). The study comprised 163 consecutive TMJ pain patients. Criteria for including a patient were report of orofacial pain referred to the TMJ, and the presence of uni- or bilateral TMJ pain during palpation, during function, and/or during unassisted or assisted mandibular opening. Bilateral sagittal and coronal MR images were obtained to establish the prevalence of TMJ ID types. Analysis of the data revealed the presence of TMJ pain to be associated with significantly more MR imaging diagnoses of ID than an absence of ID (P<0.001), and disk displacement without reduction than disk displacement with reduction (P<0.001). Using chi-square analysis, the results showed a significant relationship between the presence of TMJ-related pain and the MR imaging diagnosis of TMJ ID (P=0.001), and TMJ ID type (P=0.000). Use of the Kappa statistical test indicated poor diagnostic agreement between the presence of TMJ pain and the MR imaging diagnosis of ID (K=0.16). The results suggest that the clinical variable of TMJ pain may have a significant effect on the prevalences of MR imaging diagnoses of TMJ ID. The data confirm the biological concept of DCR as a diagnostic approach in patients with signs and symptoms of TMJ-related pain.
在颞下颌关节紊乱病（TMD）和口面部疼痛病例的临床决策方面，文献中对于颞下颌关节（TMJ）相关变量盘 - 髁关系（DCR）的诊断意义存在争议。本研究的目的是调查在患有TMJ相关疼痛的患者中，TMJ疼痛变量是否可能与关节内紊乱（ID）的磁共振（MR）成像结果相关。该研究纳入了163例连续的TMJ疼痛患者。纳入患者的标准是有口面部疼痛放射至TMJ的报告，以及在触诊、功能活动期间和/或在自主或辅助下颌开口时存在单侧或双侧TMJ疼痛。获取双侧矢状位和冠状位MR图像以确定TMJ ID类型的患病率。数据分析显示，与无ID相比，存在TMJ疼痛与ID的MR成像诊断显著更多相关（P<0.001），并且与可复性盘移位相比，不可复性盘移位更多（P<0.001）。使用卡方分析，结果显示TMJ相关疼痛的存在与TMJ ID的MR成像诊断之间存在显著关系（P = 0.001），以及与TMJ ID类型之间存在显著关系（P = 0.000）。使用Kappa统计检验表明TMJ疼痛的存在与ID的MR成像诊断之间的诊断一致性较差（K = 0.16）。结果表明，TMJ疼痛的临床变量可能对TMJ ID的MR成像诊断患病率有显著影响。数据证实了DCR作为TMJ相关疼痛体征和症状患者诊断方法的生物学概念。
