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颞下颌关节紊乱病的临床表现与相应影像学表现之间的关联。

Association between Clinical Manifestations in Temporomandibular Joint Disorders and Corresponding Radiographic Findings.

作者信息

Wojciechowska Barbara, Szarmach Arkadiusz, Michcik Adam, Wach Tomasz, Drogoszewska Barbara

机构信息

Department of Maxillofacial Surgery, Medical University of Gdansk, 17 Mariana Smoluchowskiego Street, 80-214 Gdansk, Poland.

2nd Department of Radiology, Medical University of Gdansk, 17 Mariana Smoluchowskiego Street, 80-214 Gdansk, Poland.

出版信息

J Clin Med. 2024 Aug 19;13(16):4886. doi: 10.3390/jcm13164886.

DOI:10.3390/jcm13164886
PMID:39201027
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11355193/
Abstract

: Temporomandibular disorders are common conditions characterized by discomfort within the temporomandibular joints, acoustic changes, and restricted mandibular movement. Accurate diagnosis and subsequent treatment rely heavily on clinical examination, but it is often necessary to add radiological examinations to the diagnostics. Magnetic Resonance Imaging (MRI) is the gold standard for visualizing the disc, while cone-beam computed tomography (CBCT) is primarily used for evaluating condylar morphology. Ultrasound (US) serves as a real-time imaging modality for soft tissues. The objective of the present study was to explore the association between clinical manifestations observed in patients with temporomandibular joint disorders and corresponding radiographic findings. : A total of 63 adult patients (51 female and 12 male) with temporomandibular joint disorders were included in this cross-sectional study. Each patient underwent a clinical examination, followed by appropriate radiological examinations (MRI, CBCT, or US). The level of statistical significance was set at an alpha of 0.05. The Shapiro-Wilk test assessed the normality of numerical variables. The Wilcoxon rank sum test compared two independent groups with non-normally distributed data. Relationships between categorical variables were evaluated using the Pearson chi-square test or Fisher's exact test. The Kendall tau (τ) method analyzed the correlation between two binary variables. : The analysis included 63 patients with TMD, predominantly females (80.95%). Ages ranged from 18 to 74 years with a median of 39 years. In the CBCT study, we observed rarefied changes in the left bone structures in patients with bruxism ( = 0.010). MRI and ultrasound imaging revealed changes in patients with limited jaw opening: erosions in the right mandibular head on ultrasound ( = 0.008) and abnormal right bone structures on MRI ( = 0.009). In CBCT, asymmetry in the left joint space was correlated with a high incidence of right side muscle tension ( = 0.004). Additionally, both CBCT and ultrasound showed a correlation between muscle tension and erosion ( = 0.040 in ultrasound, = 0.020 in CBCT). Acoustic changes, when compared with radiological imaging, were evident in all three studies, like temporomandibular joint pain or palpation. : Our study compared three radiographic imaging methods with clinical examinations to assess their correlation with clinical symptoms. Each imaging technique provided unique insights depending on the specific symptoms presented. The observed correlations varied, highlighting the unique contributions of each modality to the diagnostic process. This underscores the importance of employing multiple diagnostic approaches for a thorough assessment of the temporomandibular joint. However, a limitation of our study is the small sample size and the uneven distribution of participants among the groups. Additionally, not all patients underwent every imaging modality.

摘要

颞下颌关节紊乱病是常见病症,其特征为颞下颌关节内不适、声学变化以及下颌运动受限。准确诊断及后续治疗在很大程度上依赖临床检查,但在诊断过程中通常还需要增加影像学检查。磁共振成像(MRI)是观察关节盘的金标准,而锥形束计算机断层扫描(CBCT)主要用于评估髁突形态。超声(US)是软组织的实时成像方式。本研究的目的是探讨颞下颌关节紊乱病患者的临床表现与相应影像学检查结果之间的关联。

本横断面研究纳入了63例患有颞下颌关节紊乱病的成年患者(51例女性和12例男性)。每位患者均接受了临床检查,随后进行了适当的影像学检查(MRI、CBCT或US)。统计学显著性水平设定为α = 0.05。Shapiro-Wilk检验评估数值变量的正态性。Wilcoxon秩和检验比较两个数据分布非正态的独立组。分类变量之间的关系使用Pearson卡方检验或Fisher精确检验进行评估。Kendall tau(τ)方法分析两个二元变量之间的相关性。

分析纳入了63例颞下颌关节紊乱病患者,其中女性占主导(80.95%)。年龄范围为18至74岁,中位数为39岁。在CBCT研究中,我们观察到磨牙症患者左侧骨结构有稀疏变化(P = 0.010)。MRI和超声成像显示张口受限患者有变化:超声显示右侧下颌头有侵蚀(P = 0.008),MRI显示右侧骨结构异常(P = 0.009)。在CBCT中,左侧关节间隙不对称与右侧肌肉紧张的高发生率相关(P = 0.004)。此外,CBCT和超声均显示肌肉紧张与侵蚀之间存在相关性(超声中P = 0.040,CBCT中P = 0.020)。与影像学检查相比,声学变化在所有三项研究中都很明显,如颞下颌关节疼痛或触诊。

我们的研究比较了三种影像学检查方法与临床检查,以评估它们与临床症状的相关性。每种成像技术根据所呈现的特定症状提供了独特的见解。观察到的相关性各不相同,突出了每种检查方法对诊断过程的独特贡献。这强调了采用多种诊断方法对颞下颌关节进行全面评估的重要性。然而,我们研究的一个局限性是样本量小以及各组参与者分布不均。此外,并非所有患者都接受了每种成像检查。

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