Suenaga Shigeaki, Nagayama Kunihiro, Nagasawa Taisuke, Indo Hiroko, Majima Hideyuki J
Department of Maxillofacial Radiology, Division of Oncology, Kagoshima University Graduate School of Medical and Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan.
Department of Orthodontics and Dentofacial Orthopedics, Kagoshima University Graduate School of Medical and Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan.
Jpn Dent Sci Rev. 2016 Nov;52(4):93-106. doi: 10.1016/j.jdsr.2016.04.004. Epub 2016 Sep 5.
The causes of pain symptoms in the temporomandibular joint (TMJ) and masticatory muscle (MM) regions may not be determined by clinical examination alone. In this review, we document that pain symptoms of the TMJ and MM regions in patients with temporomandibular disorders (TMDs) are associated with computed tomography and magnetic resonance (MR) findings of internal derangement, joint effusion, osteoarthritis, and bone marrow edema. However, it is emphasized that these imaging findings must not be regarded as the unique and dominant factors in defining TMJ pain. High signal intensity and prominent enhancement of the posterior disk attachment on fat saturation T2-weighted imaging and dynamic MR imaging with contrast material are closely correlated with the severity of TMJ pain. Magnetic transfer contrast, MR spectroscopy, diffusion tensor imaging, and ultrasonography findings have helped identify intramuscular edema and contracture as one of the causes of MM pain and fatigue. Recently, changes in brain as detected by functional MR neuroimaging have been associated with changes in the TMJ and MM regions. The thalamus, the primary somatosensory cortex, the insula, and the anterior and mid-cinglate cortices are most frequently associated with TMD pain.
颞下颌关节（TMJ）和咀嚼肌（MM）区域疼痛症状的病因可能无法仅通过临床检查来确定。在本综述中，我们记录了颞下颌关节紊乱病（TMDs）患者的TMJ和MM区域疼痛症状与内部紊乱、关节积液、骨关节炎和骨髓水肿的计算机断层扫描及磁共振（MR）表现相关。然而，需要强调的是，这些影像学表现绝不能被视为定义TMJ疼痛的唯一和主导因素。脂肪饱和T2加权成像及动态增强MR成像上关节盘后附着的高信号强度和明显强化与TMJ疼痛的严重程度密切相关。磁共振转移对比、磁共振波谱、扩散张量成像及超声检查结果有助于将肌肉内水肿和挛缩确定为MM疼痛和疲劳的病因之一。最近，功能磁共振神经成像检测到的大脑变化与TMJ和MM区域的变化相关。丘脑、主要躯体感觉皮层、脑岛以及前扣带回和中扣带回皮层与TMD疼痛最为相关。
