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TMJ and Disk Deformation Imaging

Magnetic resonance imaging (MR) is an effective tool for viewing the temporomandibular joint (TMJ). Unfortunately, it has proved disadvantageous in providing dynamic, high-resolution images. Recently, using sequential images taken over a short time span researchers have been able to view opening and closing of the mouth, with details of the movement, in high-resolution graphics. This tool allows access to more information about disk deformation and derangement in TMJ patients. The authors of this current study wanted to correlate their finding from these pseudodynamic MR images with clinical signs and symptoms in TMJ patients.

62 TMJ patients were involved in the study. The authors assessed disk deformation, pattern of disk and condyle movement, and extent of condyle translation and joint effusion during jaw movements with images from video.

The authors saw flexure disk deformation emerge in the thin intermediate zone to the posterior band of the disk in TMJ. The observed disk deformations were categorized as either upward disk deformation or downward disk deformation. The authors also saw that if the joints had disk reduction, the deformation would disappear; if not, it would remain.

Certain trends became apparent in their research. Upward disk deformation generally did not have the TMJ sound, but was marked by TMJ pain. Also upward deformation had jaw opening restriction and anterior displacement without disk reduction. The clinical symptoms of upward and downward deformations differed in the intensity of the symptom. The table below displays the different scores:

The authors argue that the results strongly suggest that determining the classification of the deformation will correlate with the signs and symptoms of TMJ patients. As well, upward deformation may be a more advanced stage of TMJ. They conclude that, "the identification and description of the types of disk deformations may be an important step toward further understanding of the dynamic of the TMJ and their relationship to clinical signs and symptoms."

Yoshida H, Hirohata H, Onizawa K, et al. Flexure deformation of the temporomandibular joint disk in pseudodynamic magnetic resonance images. Oral Surgery, Oral Medicine, Oral Pathology 2000;89:104-111.

 

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