Department of Oral and Maxillofacial Surgery, (Head of Department FW. Neukam, Prof, MD, DMD, PhD, Dr. h. c.), Friedrich-Alexander-University Erlangen-Nuremberg, Glueckstrasse 11, 91054 Erlangen, Germany.
Institute of Radiology, (Head of Department M. Uder, Prof, MD), Friedrich-Alexander-University Erlangen-Nuremberg, Maximiliansplatz 1, 91054 Erlangen, Germany.
J Craniomaxillofac Surg. 2018 Aug;46(8):1167-1171. doi: 10.1016/j.jcms.2017.12.029. Epub 2018 Jan 4.
INTRODUCTION: Magnetic resonance imaging has been established as the gold standard for assessment of the temporomandibular joint. Apart from an excellent assessment of the soft tissues it has the advantage not to expose the patient to ionizing radiation. There is a lack of literature concerning the correlation between pain intensity and radiological findings of the temporomandibular joint. Moreover there is the question of whether a progressive degeneration of the cartilaginous components is accompanied by an increasing degeneration of the osseous parts of the mandibular joint and vice versa. Therefore, this study aims at analyzing correlations between pain and radiological findings. Furthermore, the link between osseous and cartilaginous degeneration is studied. MATERIALS AND METHODS: 91 patients who attend our outpatient clinic for temporomandibular disorders are included in this prospective study. Apart from a detailed anamnesis and clinical examination - adapted to the Research Diagnostic Criteria for Temporomandibular Disorders -magnetic resonance imaging of both mandibular joints is performed. Pain intensity is measured using the visual analog scale. To assess and grade the radiological findings a classification system is established. The evaluation of the osseous components is based on the classification of osteoarthritis by Kellgren and Lawrence whereas the rating of the cartilaginous components is adapted to the Research Diagnostic Criteria for Temporomandibular Disorders. Correlations are verified by Spearman-Rho. RESULTS: 83,5% of all patients are female. Most of the time, both sides are affected (47.25%). Women state an average pain of 5.7 (±2.4), men 3.5 (±2.5). 182 discs are examined and assessed with our classification system. Most discs (n = 71) show no pathological changes. The majority of patients show no dislocation (n = 104). The most common forms of dislocation are anterior dislocations (n = 51). The majority of patients show no changes in the osseous component (n = 115). Weak to moderate correlations are found between disc and bone degeneration. Moderate to strong correlations are found between left and right TMJ. CONCLUSIONS: The classification system which is designed and applied during the study proves to be a reliable and practical Instrument. A standardized evaluation of pathologies concerning the temporomandibular joint is possible by using this system. Numerous patients attending our outpatient clinic do not show any signs of degenerative dysfunctions in the mandibular joints. Degenerations of the osseous components tend to be connected with degenerations of the cartilaginous components and vice versa. The question remains if in the future new procedures in imaging will be able to record pathologies not yet detected.
简介:磁共振成像已被确立为评估颞下颌关节的金标准。除了对软组织的出色评估外,它还有一个优点,即不会使患者暴露在电离辐射下。关于疼痛强度与颞下颌关节的放射学发现之间的相关性,文献还很缺乏。此外,还有一个问题是,软骨成分的进行性退化是否伴随着下颌关节骨部分的退化,反之亦然。因此,本研究旨在分析疼痛与放射学发现之间的相关性。此外,还研究了骨与软骨退化之间的联系。 材料和方法:本前瞻性研究纳入了 91 名在我们的颞下颌关节门诊就诊的患者。除了详细的病史和临床检查(根据颞下颌关节紊乱的研究诊断标准进行)外,还对双侧下颌关节进行磁共振成像。使用视觉模拟量表测量疼痛强度。为了评估和分级放射学发现,建立了一个分类系统。骨成分的评估基于 Kellgren 和 Lawrence 的骨关节炎分类,而软骨成分的评估则适应颞下颌关节紊乱的研究诊断标准。通过 Spearman-Rho 验证相关性。 结果:所有患者中,83.5%为女性。大多数情况下,两侧都受到影响(47.25%)。女性平均疼痛评分为 5.7(±2.4),男性为 3.5(±2.5)。检查并使用我们的分类系统评估了 182 个关节盘。大多数关节盘(n=71)没有病理变化。大多数患者没有脱位(n=104)。最常见的脱位形式是前脱位(n=51)。大多数患者的骨成分没有变化(n=115)。关节盘和骨退化之间存在弱到中度的相关性。左右 TMJ 之间存在中度到高度的相关性。 结论:在研究过程中设计和应用的分类系统被证明是一种可靠且实用的工具。通过使用该系统,可以对颞下颌关节的病变进行标准化评估。许多在我们的门诊就诊的患者在颌骨关节中没有显示出任何退行性功能障碍的迹象。骨成分的退化往往与软骨成分的退化有关,反之亦然。问题是,未来的成像新技术是否能够记录尚未发现的病变。
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