Temporomandibular joint imaging: current clinical applications, biochemical comparison with the intervertebral disc and knee meniscus, and opportunities for advancement.

Temporomandibular disorders encompass multiple pathologies of the temporomandibular joint that manifest as middle/inner ear symptoms, headache, and/or localized TMJ symptoms. There is an important although somewhat limited role of imaging in the diagnostic evaluation of temporomandibular disorders. In this manuscript, we provide a comprehensive review of TMJ anatomy, outline potentially important features of TMJ disc ultrastructure and biochemistry in comparison with the intervertebral disc and knee meniscus, and provide imaging examples of the TMJ abnormalities currently evaluable with MRI and CT.

Immunoexpression of constitutive and inducible cyclooxygenase isoforms in distinguishing and accessory structures of synovial joints in rat foetuses.

Joint formation is a developmental process regulated by various factors including bone morphogenetic proteins, transforming and growth factors, etc. Recently, a high expression of cyclooxygenase (COX) isoforms in the foetal cartilaginous elements was also revealed. On the other hand, various joint and skeletal abnormalities were seen in laboratory animal and human offspring, exposed in utero to several COX inhibitors.

MRI in the assessment of internal derangement and pain within the temporomandibular joint: a pictorial essay.

In this pictorial essay we aim to illustrate the normal temporomandibular joint (TMJ) and the common abnormalities of the osseous, cartilaginous and soft tissue components. These include disc (meniscus) displacement, deformities and perforations, abnormalities of disc and condylar movement, joint effusions, synovial proliferation, condylar deformity and erosions, degenerative change and abnormal retrodiscal enhancement.

Relationship between fossa-condylar position, meniscus position, and morphologic change in patients with Class II and III malocclusion.

Objective: To evaluate fossa-condylar-meniscus morphologic changes in patients with skeletal and dental Class III and Class II division 1 and 2 malocclusion to determine which type is related to internal derangement of the temporomandibular joint (TMJ) and whether the variation of TMJ structure is related to a particular type of malocclusion.

Materials And Methods: Seventy-two pretreatment orthodontic patients, ranging in age from 10 to 27 years, underwent examination of the right and left TMJs with corrected Schöller's position radiographs. Bilateral TMJ relationships of the fossa-condyle were examined through subjective evaluation and linear and area measurements.

Comparison of arthrotomographic and magnetic resonance images of 50 temporomandibular joints with operative findings.

Arthrotomography and magnetic resonance imaging (MRI) were carried out on 50 temporomandibular joints (TMJs) in 48 patients who were being considered for surgery for clinically diagnosed internal derangement. The patients presented over a 4-year period with pain and dysfunction which had failed to respond to conservative management. Open surgery was carried out on all TMJs and operative findings compared with the results of imaging.

[Pseudodynamic MR imaging of temporomandibular joint disorders].

Magnetic resonance (MR) imaging of the temporomandibular joint (TMJ) has now been established as a procedure of choice in the evaluation of TMJ disorders. In this study, we evaluated the dynamics of TMJ motion on MR imaging, which resembles arthrography. Sixty-eight TMJs in 38 symptomatic patients and one healthy volunteer were examined using pseudodynamic images with gradient echo sequences using a 0.

A comparison of clinical examination, history, and magnetic resonance imaging for identifying orthodontic patients with temporomandibular joint disorders.

The temporomandibular joint (TMJ) status of 51 juvenile orthodontic patients was assessed with magnetic resonance imaging (MRI), clinical examination, and questionnaire data. The results of this study demonstrated that the prevalence of anterior displacement of the meniscus was 11.8% (6 of 51) as assessed by MRI.

[MRI and arthrography in the evaluation of TMJ disorders].

Arthrosis of the temporomandibular joint (TMJ) is a noninfectious, noninflammatory condition characterized by joint pain, noise (clicking) and abnormal motion. It contains various disease processes, such as abnormalities in the menisci or masticating muscles, subluxation of the condyle and degenerative joint disease. Analysis of the morphology and dynamics of TMJ by means of imaging modalities has become highly advanced since the development of arthrography in the late 1970s.

Defining the normal temporomandibular joint: closed-, partially open-, and open-mouth MR imaging of asymptomatic subjects.

Fifty temporomandibular joints (TMJs) in 30 asymptomatic volunteers were imaged with a 1.5-T magnetic resonance (MR) imaging system to determine (a) the normal range of meniscus position, (b) the best definition of a normal TMJ and criteria to distinguish it from a TMJ with significant internal derangements, (c) the significance of certain findings such as joint effusion and disk distortion, and (d) the optimum mouth position(s) to be used for imaging. A method was devised to quantify meniscus displacement in terms of the number of degrees from a 12 o'clock or vertical position (relative to the condyle).

Coronal radiographs and videofluoroscopy improve the diagnostic quality of temporomandibular joint arthrography.

Detection of mediolateral displacement of the temporomandibular joint (TMJ) meniscus and evaluation of the reducibility of this displacement are necessary because surgery is indicated when the displacement is irreducible. During TMJ arthrography, the routine sagittal study does not allow detection of this type of meniscal displacement. In a prospective study of 158 TMJ arthrograms in 83 patients, coronal radiographs were obtained and videofluoroscopy was performed (in addition to routine sagittal films and fluoroscopy) to detect mediolateral shift of the meniscus and to evaluate the reducibility of this displacement.

[The diagnostic importance of different imaging technics in temporomandibular joint dysfunction].

Various imaging techniques enable to explore the Temporo-mandibular joints (T.M.J.

The radiographic and surgical evaluation of meniscal dysfunction of the temporomandibular joint.

A retrospective study of 106 patients who underwent temporomandibular joint surgery for meniscal dysfunction was conducted. The patients were evaluated by tomography and arthrography of the temporomandibular joint and abnormalities of the hard and soft tissue structures were determined by these investigations and compared directly with the findings at surgical examination. Tomography had a high degree of correlation with bony pathology as did arthrography with meniscal displacement.

Correlation of magnetic resonance imaging and surgical findings in patients with meniscal perforation.

Advancement of surgical techniques has made it necessary to accurately diagnose internal derangements. Arthrography and computerized tomography have been used to diagnose the majority of temporomandibular joint disorders; however, these methods have had their disadvantages. Magnetic resonance imaging utilizing surface coils has greatly improved the ability to diagnose meniscus abnormalities without using interarticular injections or ionizing radiation.

Staging of internal derangements of the TMJ with magnetic resonance imaging: preliminary observations.

Although MRI has been reported to be accurate in diagnosing displaced TMJ menisci, it has not been used to characterize the condition of the meniscus. A staging system of internal derangement of the TMJ using MRI signal characteristics and morphology of the meniscus is presented. A normal meniscus has the appearance of a small "drumstick" and is positioned superiorly on the mandibular condyle.

[Study on internal derangement in temporomandibular joint of temporomandibular joint dysfunction syndrome patient in adolescent by means of Fuji Computed Radiography (FCR)].

The aim of this study was to examine the Temporomandibular Joint of the thirty-eight adolescent subjects with Temporomandibular Joint Dysfunction Syndrome by means of Fuji Computed Radiography System (FCR). The following results were obtained: 1) It was indicated that the frequency of occurrence of the backward on the condyle position to fossa in the group with signs of TMJ Dysfunction was higher than the group without signs. Also it was suggested that the central position was a good position as the goal for improved position.

The diagnosis of temporomandibular joint disease: two-compartment arthrography and MR.

The reliability and accuracy of two-compartment temporomandibular joint (TMJ) arthrography was compared with MR imaging on the basis of an analysis of surgical findings obtained from joints that had been studied preoperatively with arthrography or MR or, in some cases, both procedures. Seven hundred forty-three consecutive TMJ arthrograms were successfully obtained in a total of 443 patients by using a single 27-gauge needle and a two-compartment technique in each joint. There was a 100% correlation with surgical findings in 218 radiologically abnormal joints operated on within 90 days of arthrography with respect to the presence or degree of meniscus displacement and normal or abnormal disk morphology and function.

Temporomandibular joint: MR imaging of internal derangements and postoperative changes.

Nineteen abnormal temporomandibular joints (TMJs) imaged with high-field-strength surface-coil MR are presented to illustrate specific changes associated with disk derangement, trauma, and previous surgery. Cases were selected from a series of 248 TMJ MR studies in 144 patients (9-68 year old, 130 females and 14 males) performed during a 5-month period. Surgical findings were available for correlation in 44 of the 248 joints studied.

Clinical and arthrographic evaluation of the location of temporomandibular joint pain.

Two hundred five patients were prospectively examined for temporomandibular joint pain. Arthrograms were performed on 222 joints (188 unilateral and 17 bilateral). Pain in the ear occurred more frequently in arthrographically normal patients and in nonreducing meniscus patients compared with reducing meniscus patients.

[Surgical treatment of temporomandibular joint dysfunctions by Myrhaug's technic. Apropos 60 interventions].

The treatment of the chronic diseases of the temporomandibular joint is always difficult. At one moment or another, surgical treatment is discussed, proposed and performed. Many operations have been described to make the temporo-mandibular joint recovering its normal movements.

Remodeling of the temporomandibular joint disk and posterior attachment in disk displacement specimens in relation to glycosaminoglycan content.

In meniscus displacement pathosis, the anterior part of the posterior attachment is subjected to abnormal compressive loading. This study presents evidence that the loaded tissue is capable of producing glycosaminoglycans of the sort that are found in the disk and articular surfaces of the articular eminence and mandibular condyle.

Sideways dislocation of the temporomandibular joint meniscus: the edge sign.

Seventy temporomandibular joint arthrograms of 49 patients with symptoms of internal joint derangement were reviewed. Twenty-three of these arthrograms (33%) were abnormal but atypical for anteriorly dislocated meniscus. The lower temporomandibular joint space had a well-defined edge located inferiorly, which was attributed to pressure from a sideways-dislocated meniscus.

[Nuclear magnetic resonance tomography of the temporomandibular joint. Comparison with computerized tomography and arthrography].

79 patients aged 6 to 66 years (9 men and 70 women) with abnormalities of the TMJs were examined by magnetic resonance tomography (132 joints) and the results were compared with CT (16 joints) and arthrography (39 joints). Magnetic resonance tomography showed forward luxation of the meniscus in 82 joints (62%). In 34 joints (26%) the meniscus spontaneously resumed normal position when the mouth was open, but in 48 joints (36%) the displacement was permanent.

Normal and abnormal temporomandibular joints as demonstrated by magnetic resonance imaging.

Magnetic resonance imaging of the temporomandibular joint (TMJ) was performed on two normal volunteer subjects and two symptomatic subjects using a 0.15 T resistive magnet. A spin echo pulse sequence with a TE of 38 ms and a TR of 500 ms was employed.

Internal derangements of the temporomandibular joint evaluated with direct sagittal CT: a prospective study.

Direct sagittal computed tomography (CT) was performed in 454 patients thought to have internal derangement of the temporomandibular joint (TMJ). Of 905 joints examined, 71 were subsequently studied using arthrography and/or surgery. Sensitivity was 91.

Overview of computed tomography of the temporomandibular joint.

Computed tomography of the temporomandibular joint has been shown to be an accurate method of assessing the position of the disk. To date, we have examined over 500 patients with this modality and have found it also to be effective in the evaluation of other osseous and soft tissue abnormalities. An overview of temporomandibular joint pathology is presented, including the range of osteoarthritic changes from spur formation to complete fusion.