de Leeuw R, Boering G, van der Kuijl B, Stegenga B
Department of Oral and Maxillofacial Surgery, University Hospital, Groningen, The Netherlands.
J Oral Maxillofac Surg. 1996 Nov;54(11):1270-80; discussion 1280-1. doi: 10.1016/s0278-2391(96)90480-2.
This article describes the clinical and imaging findings in the temporomandibular joints (TMJs) of patients 30 years after the initial diagnosis of osteoarthrosis and internal derangement.
Fifty-five TMJs with a history of osteoarthrosis and internal derangement and 37 contralateral TMJs that were asymptomatic 30 years ago were examined in 46 former patients. To visualize degenerative changes of the bony parts of the TMJ, transpharyngeal and transcranial radiographs were made; to visualize disc position, sagittal T1-weighted magnetic resonance (MR) images were made. For comparison, 22 TMJs of an age-matched control group without complaints related to the masticatory system were similarly examined.
Thirty years after the initial diagnosis of osteoarthrosis and internal derangement, clinical signs in former patients hardly differed from those of control subjects. radiographic signs were significantly more common and more severe in former patients. A high percentage of osteoarthrosis and internal derangement was seen on MRI in both TMJs with a history of osteoarthrosis and internal derangement and in the contralateral TMJs. It appeared that osteoarthrosis and internal derangement in the contralateral TMJs had developed asymptomatically in most cases. None of the patients had required treatment for the contralateral TMJ; only one fourth of the patients had noticed symptoms. In the control subjects, osteoarthrosis and internal derangement were infrequently seen. A significant correlation was found between disc position and the severity of radiographically detectable degenerative changes of the TMJ.
It was concluded that 30 years after initial diagnosis there were few clinical signs of osteoarthrosis and internal derangement, although radiographic signs were extensive. Bilateral osteoarthrosis and internal derangement, with one symptomatic and one asymptomatic TMJ, is a common phenomenon. Moderate to severe radiographically detectable degenerative changes may be the only sign of an underlying internal derangement.
本文描述了骨关节炎和关节内紊乱初诊30年后患者颞下颌关节（TMJ）的临床及影像学表现。
对46例曾患骨关节炎和关节内紊乱的患者的55个TMJ以及30年前无症状的对侧37个TMJ进行了检查。为观察TMJ骨部分的退行性改变，拍摄了经咽和经颅X线片；为观察盘状位置，拍摄了矢状面T1加权磁共振（MR）图像。作为对照，对22个年龄匹配且无咀嚼系统相关主诉的TMJ进行了类似检查。
骨关节炎和关节内紊乱初诊30年后，曾患患者的临床体征与对照者几乎无差异。曾患患者的X线体征明显更常见且更严重。在有骨关节炎和关节内紊乱病史的TMJ以及对侧TMJ的MRI检查中，均发现高比例的骨关节炎和关节内紊乱。似乎对侧TMJ的骨关节炎和关节内紊乱在大多数情况下是无症状发展的。没有患者需要对侧TMJ进行治疗；只有四分之一的患者注意到了症状。在对照者中，很少见到骨关节炎和关节内紊乱。发现盘状位置与TMJ影像学可检测到的退行性改变的严重程度之间存在显著相关性。
得出的结论是，初诊30年后骨关节炎和关节内紊乱的临床体征很少，尽管X线体征广泛。双侧骨关节炎和关节内紊乱，一个TMJ有症状而另一个无症状，是一种常见现象。影像学可检测到的中度至重度退行性改变可能是潜在关节内紊乱的唯一迹象。
