Robinson de Senna Bernardino, Marques Leandro Silva, França Julieta Petruceli, Ramos-Jorge Maria Letícia, Pereira Luciano José
Vale do Rio Verde University, UNINCOR, Três Corações, MG, Brazil.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Sep;108(3):e117-24. doi: 10.1016/j.tripleo.2009.04.034.
The aim of the present study was to assess the disk-condyle-fossa relationship through magnetic resonance imaging and determine its association with clinical signs and symptoms of temporomandibular disorder in patients with myofascial pain and disk displacement (with and without reduction).
Sixty-two female patients with complaints of pain were clinically examined using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and divided into the following groups: Group I, myofascial pain (n = 19); Group IIa, disk displacement with reduction (n = 32); and Groups IIb and IIc, disk displacement without reduction (n = 11). Classification of disk position was based on the positioning on a clock face (> or < than 11 o'clock) and condylar excursion was determined as (1) the proximal side of the apex of the articular eminence; (2) at the level of the articular eminence; and (3) beyond the apex of the articular eminence. Condylar position was determined in the sagittal images based on Gelb's template (normal, posteriorly displaced). Pain was assessed using a visual analogue scale (VAS). The univariate logistic regression, Mann-Whitney, Kruskall-Wallis and Pearson's correlation tests were used in the statistical analysis (P < or = .05).
No significant association was found between the independent variables (condylar position, disk position, and condylar excursion) and the dependent variables (pain, maximal opening of the mouth, maximal lateral movement). However, there was a significant association between increased condyle excursion and pain (P = .035) and also maximum mouth opening movement was associated with lateral movement (P = .01; r = 0.31).
Increase in condyle excursion may significantly influence pain perception in TMD patients. The type of dysfunction and severity of alterations on the imaging exams were not related to the severity of pain or range of motion of the mandible.
本研究旨在通过磁共振成像评估盘 - 髁 - 窝关系，并确定其与肌筋膜疼痛和盘移位（伴或不伴复位）患者颞下颌关节紊乱的临床体征和症状之间的关联。
对62名主诉疼痛的女性患者使用颞下颌关节紊乱研究诊断标准（RDC/TMD）进行临床检查，并分为以下几组：第一组，肌筋膜疼痛（n = 19）；第二组a，盘移位伴复位（n = 32）；第二组b和第二组c，盘移位不伴复位（n = 11）。盘位置的分类基于钟面定位（大于或小于11点），髁突运动度确定为：（1）关节结节顶点的近端侧；（2）关节结节水平；（3）超过关节结节顶点。根据Gelb模板在矢状图像中确定髁突位置（正常，向后移位）。使用视觉模拟量表（VAS）评估疼痛。统计分析采用单因素逻辑回归、Mann-Whitney、Kruskall-Wallis和Pearson相关性检验（P≤0.05）。
在自变量（髁突位置、盘位置和髁突运动度）和因变量（疼痛、最大开口度、最大侧向运动）之间未发现显著关联。然而，髁突运动度增加与疼痛之间存在显著关联（P = 0.035），并且最大开口运动与侧向运动相关（P = 0.01；r = 0.31）。
髁突运动度增加可能会显著影响颞下颌关节紊乱患者的疼痛感知。成像检查中功能障碍的类型和改变的严重程度与疼痛的严重程度或下颌运动范围无关。
