Journals / Selçuk Tıp Dergisi / 2001 / Cilt: 17 - Sayı: 2
Clinical diagnosis compared with findings of magnetic resonance imaging in internal derangement of the temporomandibular joint
- Journal
- Selçuk Tıp Dergisi
- Pages
- 91–98
- DOI
- —
Abstract
Internal derangement of temporomandibular joint (TMJ) has been described as abnormal relationship beetween the disc, articular eminence, fossa and condyl. In this study it was compared to magnetic resonance imaging and clinical findings of internal derangement of TMJ. Hundered seventy nine joints of hundered patients, who were referred from Selçuk University Faculty of Dentistry with claim of internal derangement in their TMJ were examined by MRI. Examination was performed at closed and opened mouth position in T1, T2, proton weighted oblique sagittal plane and closed mouth position in coronal plane. These joints were joints was divided into four groups as normal, reducted (RA), Irreducted (IRA) and with or without degenerative joint changes according to MRI findings. Clinically they were classified as in early, intermediate and late stage. Most of the cases were in intermediate (%37) and late (%43) stages. In early, intermediate, late stages the joints were determined normal: 66%, 42%, 10%; RA :26%, 44%, 23%; IRA: 8%, 14%, 67% by MRI respectively. In RA and IRA joints pain 64%, 83%, limited mouth opening 23%, 66%, clicing 62%, 26%, crepition 11%, 39% were found by clinical examination, respectively. Degenerative change of osseos component at the joints were frequently seen in the joints with IRA and crepitation. In the clinical examination of TME were significant findings. Also the presence of osseos degenerative changes, which could not be determined by clinical examination, are very important. Because they influence the treatment type and effctivity. We think that in determination of TME joint disfunction, clinical examination and MR findings should be evaluated together.
Özet
Temporomandibular eklemin (TME) iç yapi bozukluklari disk, artiküler eminens, fossa ve mandibular kondil arasindaki anormal iliski olarak tanimlanmaktadir. Çalismamizda TME iç yapi bozukluklarinin tanisinda klinik muayene ile manyetik rezonans görüntüleme bulgularinin korelasyonu arastirildi. TME sikayeti olan 100 hasta (179 eklem) Manyetik Rezonans Görüntüleme''de (MRG) agiz kapali ve açik T1, T2 ve proton agirlikli oblik sagittal; agiz kapali T1 agirlikli koronal kesitler alinarak incelendi. Eklemler MR bulgularina göre normal, redükte (RA), irredükte (IRA) ve beraberinde dejeneratif degisikliklerin gözlendigi dört gruba; klinik bulgularina göre erken, ara ve geç dönem olmak üzere üç gruba ayrildi. Siklikla geç (%43) ve ara (%37) dönem olgularla karsilasildi. Ara dönemdeki eklemlerin %42'si normal, %44'ü redükte anterior (RA), %14'ü irredükte anterior (IRA); geç dönemdekilerin çogu IRA (%67), 0%23'ü RA, %10'u normaldi. Erken dönemdekilerin ise %66'si normal, %26'si RA, %8'i IRA olarak saptandi. IRA'li eklemlerin klinik muayenelerinde %83'ünde agri, %66'sinda agiz açikliginda azalma, %39'unda krepitasyon, %26'sinda klik; RA'li eklemlerin ise %64'ünde agri, %62'sinde klik, %23'ünde agiz açikliginda azalma ve %11'inde krepitasyon bulundu. Kemik komponentlerdeki dejenerasyon siklikla IRA'li ve krepitasyon bulunan eklemlerde izlendi. Klinik muayenede klik sesi redükte, kroniklesmis agri ve agiz açikliginda azalma irredükte disk yer degistirmesi için anlamli bulunmustur. Ayrica klinik muayenede degerlendirilemeyen osseoz degisikliklerin saptanmasi özellikle tedavi seçiminde ve cevabinda önemli oldugu için TME disfonksiyonlarinda klinik muayene ile MRG bulgulari birlikte degerlendirilmelidir.