Magnetic resonance imaging findings of internal derangement, osteoarthrosis, effusion, and bone marrow edema before and after performance of arthrocentesis and hydraulic distension of the temporomandibular joint.

OBJECTIVES To investigate whether temporomandibular joint (TMJ) internal derangement type III and capsulitis/synovitis are related to magnetic resonance imaging (MRI) diagnoses of internal derangement, osteoarthrosis (OA), effusion, and/or bone marrow edema (BME), and whether arthrocentesis is associated with changes in diagnoses of internal derangement, OA, effusion, and/or BME. STUDY DESIGN The study comprised 28 patients with a clinical unilateral TMJ disorder of internal derangement type III and capsulitis/synovitis. Bilateral MRI was immediately performed preoperatively and at a 2-month follow-up. RESULTS There was a significant relationship between TMJ internal derangement type III and capsulitis/synovitis and TMJ internal derangement (P = .000), effusion (P = .036), and BME (P = .002). MRI showed a significant decrease in diagnoses of TMJ BME ((P = .018). CONCLUSIONS MRI variables of internal derangement, effusion, and BME were related to TMJ internal derangement type III and capsulitis/synovitis; however, arthrocentesis was only associated with a significant change in diagnoses of TMJ BME.

[1]  M. Dolwick Intra-articular disc displacement. Part I: Its questionable role in temporomandibular joint pathology. , 1995, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[2]  J. Beltrán,et al.  Joint effusions: MR imaging. , 1986, Radiology.

[3]  G. Dimitroulis,et al.  Temporomandibular joint arthrocentesis and lavage for the treatment of closed lock: a follow-up study. , 1995, The British journal of oral & maxillofacial surgery.

[4]  P. Westesson,et al.  Osteoarthritis and abnormal bone marrow of the mandibular condyle. , 1999, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[5]  A. Ratcliffe,et al.  Osteoarthritis and synovitis as major pathoses of the temporomandibular joint: comparison of clinical diagnosis with arthroscopic morphology. , 1998, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[6]  R. Emshoff,et al.  Are internal derangement and osteoarthrosis linked to changes in clinical outcome measures of arthrocentesis of the temporomandibular joint? , 2003, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[7]  P. Westesson,et al.  Temporomandibular joint: diagnostic accuracy with sagittal and coronal MR imaging. , 1993, Radiology.

[8]  C. Pharaboz,et al.  Clinical diagnosis compared with findings of magnetic resonance imaging in 242 patients with internal derangement of the TMJ. , 1995, Journal of orofacial pain.

[9]  B. Stegenga,et al.  Hard and soft tissue imaging of the temporomandibular joint 30 years after diagnosis of osteoarthrosis and internal derangement. , 1996, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[10]  Toshikazu Suzuki,et al.  Does joint effusion on T2 magnetic resonance images reflect synovitis? Part 3. Comparison of histologic findings of arthroscopically obtained synovium in internal derangements of the temporomandibular joint. , 2003, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[11]  R. Martín-Granizo,et al.  Effusion in magnetic resonance imaging of the temporomandibular joint: a study of 123 joints. , 1998, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[12]  S. Dworkin,et al.  Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. , 1992, Journal of craniomandibular disorders : facial & oral pain.

[13]  P. Westesson,et al.  MR grading of temporomandibular joint fluid: association with disk displacement categories, condyle marrow abnormalities and pain. , 2001, International journal of oral and maxillofacial surgery.

[14]  R. Emshoff,et al.  Temporomandibular joint internal derangement type III: relationship to magnetic resonance imaging findings of internal derangement and osteoarthrosis. An intraindividual approach. , 2001, International journal of oral and maxillofacial surgery.

[15]  R. Emshoff,et al.  Clinical versus magnetic resonance imaging findings with internal derangement of the temporomandibular joint: an evaluation of anterior disc displacement without reduction. , 2002, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[16]  B. Lindgren,et al.  The relationship between clinical and MRI findings in patients with unilateral temporomandibular joint pain. , 2001, Journal of the American Dental Association.

[17]  S. Maddali Bongi,et al.  A comparison of ultrasonography and magnetic resonance imaging in the evaluation of temporomandibular joint involvement in rheumatoid arthritis and psoriatic arthritis. , 2003, Rheumatology.

[18]  Q. Anderson,et al.  Pressure-Pain Thresholds and MRI Effusions in TMJ Arthralgia , 2001, Journal of dental research.

[19]  S. Dworkin,et al.  Clinical diagnostic criteria for TMD. New classification permits multiple diagnoses. , 1992, Journal of the American Dental Association.

[20]  P. Westesson,et al.  Osteonecrosis of the temporomandibular joint: correlation of magnetic resonance imaging and histology. , 1999, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[21]  T. A. Larheim,et al.  Rheumatic disease of the temporomandibular joint: MR imaging and tomographic manifestations. , 1990, Radiology.

[22]  P. Dijkstra,et al.  Therapeutic outcome assessment in permanent temporomandibular joint disc displacement. , 1999, Journal of oral rehabilitation.

[23]  M. W. Marshall,et al.  Arthroscopic surgery for treatment of closed lock. , 1991, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[24]  M. Dolwick,et al.  Temporomandibular joint arthrocentesis: a simplified treatment for severe, limited mouth opening. , 1991, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[25]  R. Takagi,et al.  The association of temporomandibular joint pain with abnormal bone marrow in the mandibular condyle. , 2000, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[26]  J. Gelineck,et al.  Contrast enhanced magnetic resonance imaging as a method to diagnose early inflammatory changes in the temporomandibular joint in children with juvenile chronic arthritis. , 1998, The Journal of rheumatology.

[27]  Toshikazu Suzuki,et al.  Does joint effusion on T2 magnetic resonance images reflect synovitis? Part 2. Comparison of concentration levels of proinflammatory cytokines and total protein in synovial fluid of the temporomandibular joint with internal derangements and osteoarthrosis. , 2002, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[28]  H. Hall Intra-articular disc displacement Part II: Its significant role in temporomandibular joint pathology. , 1995, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[29]  A. Ratcliffe,et al.  Correlation between arthroscopic diagnosis of osteoarthritis and synovitis of the human temporomandibular joint and keratan sulfate levels in the synovial fluid. , 1997, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[30]  Toshikazu Suzuki,et al.  Prognostic factors in arthrocentesis of the temporomandibular joint: evaluation of 100 patients with internal derangement. , 2001, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[31]  R. Emshoff,et al.  Relationship between temporomandibular joint pain and magnetic resonance imaging findings of internal derangement. , 2001, International journal of oral and maxillofacial surgery.

[32]  J. Konishi,et al.  MRI evidence of high signal intensity and temporomandibular arthralgia and relating pain. Does the high signal correlate to the pain? , 1996, The British journal of oral & maxillofacial surgery.

[33]  P. Westesson,et al.  Magnetic resonance imaging of the temporomandibular joint. Increased T2 signal in the retrodiskal tissue of painful joints. , 1995, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[34]  N. Segami,et al.  Importance of the changes in joint effusion shown by magnetic resonance imaging before and after arthroscopic lysis and lavage of the temporomandibular joint. , 2002, British Journal of Oral and Maxillofacial Surgery.

[35]  C. Turkelson,et al.  Meta-analysis of surgical treatments for temporomandibular articular disorders. , 2003, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[36]  T. A. Larheim,et al.  Rheumatic and nonrheumatic disease in the temporomandibular joint: gadolinium-enhanced MR imaging. , 1992, Radiology.

[37]  R. Emshoff,et al.  Prognostic indicators of the outcome of arthrocentesis: a short-term follow-up study. , 2003, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[38]  R. Emshoff,et al.  The biological concept of "internal derangement and osteoarthrosis": a diagnostic approach in patients with temporomandibular joint pain? , 2002, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[39]  B. Stegenga,et al.  Radiographic signs of temporomandibular joint osteoarthrosis and internal derangement 30 years after nonsurgical treatment. , 1995, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[40]  R. Gassner,et al.  Effect of arthrocentesis and hydraulic distension on the temporomandibular joint disk position. , 2000, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[41]  P. Westesson,et al.  Temporomandibular joint: relationship between MR evidence of effusion and the presence of pain and disk displacement. , 1992, AJR. American journal of roentgenology.

[42]  M Ostergaard,et al.  Magnetic resonance imaging-determined synovial membrane and joint effusion volumes in rheumatoid arthritis and osteoarthritis: comparison with the macroscopic and microscopic appearance of the synovium. , 1997, Arthritis and rheumatism.

[43]  R. Emshoff,et al.  Magnetic resonance imaging findings of internal derangement and effusion in patients with unilateral temporomandibular joint pain. , 2001, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[44]  S. Dworkin,et al.  Grading the severity of chronic pain , 1992, Pain.

[45]  N. Segami,et al.  Short-term treatment outcome study for the management of temporomandibular joint closed lock. A comparison of arthrocentesis to nonsurgical therapy and arthroscopic lysis and lavage. , 1995, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[46]  R. Emshoff,et al.  Magnetic resonance imaging predictors of temporomandibular joint pain. , 2003, Journal of the American Dental Association.

[47]  N. Segami,et al.  Does joint effusion on T2 magnetic resonance images reflect synovitis? Comparison of arthroscopic findings in internal derangements of the temporomandibular joint. , 2001, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[48]  R. Emshoff,et al.  Validity of clinical diagnostic criteria for temporomandibular disorders: clinical versus magnetic resonance imaging diagnosis of temporomandibular joint internal derangement and osteoarthrosis. , 2001, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[49]  K. Murakami,et al.  Outcome of arthrocentesis for temporomandibular joint with closed lock at 3 years follow-up. , 1996, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[50]  T. A. Larheim,et al.  Temporomandibular joint abnormalities associated with rheumatic disease: comparison between MR imaging and arthrotomography. , 1992, Radiology.

[51]  D. Sartoris,et al.  The effect of arthroscopic surgical lysis and lavage of the superior joint space on TMJ disc position and mobility. , 1989, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[52]  R. Emshoff,et al.  Determining predictor variables for treatment outcomes of arthrocentesis and hydraulic distention of the temporomandibular joint. , 2004, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[53]  G. Clark,et al.  Arthroscopic treatment of temporomandibular joint locking resulting from disc derangement: two-year results. , 1991, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.