颞下颌关节上腔造影双层显示对关节盘前移位的X线片影像分析

目的：探讨颞下颌关节上腔造影双侧显示的关节前移位的影像特点。方法：总结１９９４～１９９６ 年间在我院颞下颌关节门诊诊治的颞下颌关节前移位的１９７ 例进行双层显示的颞下颌关节造影。结果：可复性关节盘前移位８２例,占４１．６２％ 。不可复性关节盘前移位１１５ 例,占５８．３８％ ;关节前内移位者７４ 例,占３７．５６％ ,关节盘前外移位者８ 例,占４．０７％ ,单纯性关节前移位者１１５ 例,占５８．３７％ 。结论：颞下颌关节上腔造影双层显示不仅能诊断可复性盘前移和不复性盘前移,同时能够判断关节盘前移位过程中是否存在内外移位。     

37例颞下颌关节盘不可复性前移位患者自然转归的临床及磁共振成像特征分析

目的 了解颞下颌关节盘不可复性前移位患者自然病程的临床、影像学变化及不同年龄段的差异性。方法 选择2016年1月—2023年6月在郑州大学第一附属医院口腔颌面外科就诊的颞下颌关节盘不可复性前移位患者37例（45侧）,男性4例,女性33例,平均年龄23.5岁,平均病程14.4个月。收集初诊及复诊时临床及磁共振成像（MRI）资料,测量关节盘的长度和厚度、关节盘前移角度、髁突高度,使用SPSS 25.0进行统计分析,比较临床及影像学的变化。结果 37例（45侧）患者复诊与初诊相比较：3例3侧自愈为可复性盘前移位;48.4%患者自觉张口受限未缓解或加重;58.3%患者张口疼痛无改善;54.5%咀嚼疼痛无改善;33.3%患者面部偏斜呈现加重趋势,仅1例缓解。关节盘前移角度从初诊时61.63°增长至67.81°,关节盘长度从8.20 mm缩短至7.27 mm,髁突高度从23.17 mm降为22.76 mm,以上差异有统计学意义（P<0.05）,髁突吸收比例上升。青少年组与成人组颞下颌关节盘不可复性前移位患者关节软硬组织变化的差异无统计学意义（P>0.05）。结论 在颞下颌关节盘不可复性...     

颞下颌关节紊乱病磁共振诊断的研究

目的:研究MRI对颞下颌紊乱病诊断的准确性和可信性.方法:利用MRI对19例单侧关节疼痛颞下颌关节紊乱病(TMD)患者38侧关节完成开闭口斜矢状位T1和T2加权成像,观察盘突关系、盘形态改变及关节腔内积液情况.利用关节镜诊断为金标准判定MRI诊断的准确率.同期行灌洗术治疗,分析治疗前后不同时期患者的疼痛值(疼痛直观模拟标尺VAS)变化.结果:MRI检查结果显示在患侧89.47%(17/19)显示不可复性关节盘移位,10.53%(2/19)显示可复性关节盘移位,47.37%(9/19)关节上腔前隐窝出现积液.在健侧15.79%(3/19)显示可复性关节盘移位,无不可复性关节盘移位和腔内积液出现.通过关节镜手术对患侧进行检查,关节盘移位在MRI片上均得到证实,MRI检查的准确率为100%,灌洗术后疼痛100%有显著缓解(P<0.001).结论:颞下颌关节紊乱病与关节盘移位和腔内积液密切相关,通过MRI检查可以准确有效的对颞下颌紊乱病进行诊断,灌洗术对关节疼痛治疗效果显著.     

颞下颌关节上腔造影双层显示对关节盘前移位的X线片影像分析

目的：探讨颞下颌关节上腔造影双侧显示的关节前移位的影像特点。方法：总结１９９４￣１９９６年间在我院颞下颌关节门诊诊治的颞下颌关节前移位的１９７例进行双层显示的颞下颌关节造影。结果：可复性关节盘前移位８２例,占４１．６２％,不可复性关节盘前移位１１５例,占５８．３８％,关节前内移位者７４例,占３７．５６％,关节盘前外移位者８例,占４．０７％,单纯性关节前移位者１１５例,占５８．３７％。结论：颞下颌关     

关节盘前移位测量与相关因素分析

目的：分析颞下颌关节紊乱病患者的关节盘前移位的程度的相关因素。方法：颞下颌关节紊乱病患者90例，在关节造影片上测量关节盘前移位的角度，分析关节盘前移位的角度与临床症状、关节骨质变化和锻状突位置的关系。结果：①可复性盘前移位者的AOB角显著小于不可复性盘前移位组(P＜0．01)，疾病的迁延，没有导致盘移位程度的增大；②与可复性盘前移位相比，不可复性盘前移位患者慢性期开口度明显变小，关节盘前移位的程度更大。结论：关节盘前移位以及锻状突在关节窝内的非正中位置特征，可能与关节组织结构的改建有关。病程迁延不一定会导致关节盘位置的变化。     

尖牙保护性咬合板治疗颞下颌关节盘前移位的疗效评估

目的:观察尖牙保护性咬合板对颞下颌关节盘前移位的治疗效果,探讨3.0T磁共振成像(MRI)在疗效评估中的作用.方法:以经临床和MRI检查诊断为颞下颌关节盘紊乱病盘前移位的16例患者共26侧关节作为研究对象,接受尖牙保护性咬合板治疗,疗程为3-4个月,治疗前后,测量张口度评估下颌运动功能;视觉模拟评分法(VAS)评估疼痛程度(VAS评分),并复查3.0T MRI并与治疗前进行比较.结果:治疗结束后,患者VAS评分平均为2.08±1.65,显著小于治疗前的7.19±1.58 (P＜0.001);张口度平均为(36.13±5.97) mm,明显大于治疗前的(25.15±6.02) mm(P＜0.001).与治疗前比较,治疗结束后21侧关节的MRI表现变化不明显,仅有5侧关节的MRI表现有明显改变,均显示为关节腔积液减少或消失,其中3侧可复性关节盘前移位的关节盘回复至基本正常位置,另2侧不可复性关节盘前移位,恢复为可复性关节盘前移位.结论:尖牙保护性咬合板治疗颞下颌关节盘前移位能明显减轻疼痛,改善下颌运动功能,MRI表现不能作为评估咬合板疗效的单一标准.     

高分辨率超声诊断颞下颌关节盘前移位的初步临床研究

目的探讨高分辨率超声（HR-US）诊断颞下颌关节紊乱病（TMD）关节盘前移位（ADD）的可行性。方法对40例TMD患者的40侧关节作HR-US（静态图像和动态图像）与关节造影检查。结果HR-US在显示可复性盘前移位与关节造影显示中等一致性,在显示不可复性盘前移位与关节造影显示高度一致性。结论HR-US在诊断ADD方面显示较强的可行性,可以作为ADD诊断方法在临床上应用。     

手法复位结合稳定型咬合板治疗急性颞下颌关节盘不可复性前移位的疗效观察

目的 探讨对急性颞下颌关节盘不可复性前移位保守治疗的认识及治疗策略的选择.方法 总结2018年5月—2020年5月本院颞下颌关节专科门诊诊治的20例急性颞下颌关节盘不可复性前移位患者,行手法复位结合稳定型咬合板治疗,3个月后对所有患者的关节盘复位情况和最大主动张口度进行评价,采用SPSS 24.0对数据进行检验分析.结果 20例患者最大主动张口度明显改善,由治疗前的(27.15±5.91)mm增加到(41.35±4.82)mm;20例患者在治疗结束后复查MRI显示关节盘复位13例(占65％),仍然不可复性盘前移位7例(35％).治疗3个月后最大主动张口度以及关节盘复位情况的比较,差异有统计学意义.结论 手法复位结合稳定型咬合板治疗急性颞下颌关节盘不可复性前移位可以有效恢复患者张口度,改善关节功能以及对于恢复盘-髁关系有较明显的效果.     

颞下颌关节增强磁共振成像研究

目的：探讨磁共振对比增强剂Gd—DTPA对颞下额关节紊乱病的临床诊断意义。方法：对12名临床诊断为颞下颌关节紊乱病患进行磁共振增强前后扫描，观察影像增强效果。结果：Gd—DTPA对关节盘位置正常的关节闭口斜矢状位前伸部及张口位双板区具有显的增强效果；对可复性及不可复性关节盘前移位张闭口位前伸部及双板区均有明显的增强效果；对冠状位也有明显增强效果。结论：磁共振对比增强剂的增强效果明确，为提高临床诊断准确性及作为磁共振常规扫描的辅助手段提供理论依据。     

颞下颌关节造影术在诊断不可复性关节盘前移位中的价值

自１９４４年Ｎｏｒｇａａｒｄ把颞下颌关节造影术应用于临床以来,颞下颌关节造影术已成为某些关节病特别是关节盘前移位诊断的重要手段。本文通过对３６例不可复性关节盘前移位患者的临床及影像学资料的分析,以探讨这种有创伤性的影像学诊断方法在不可复性关节盘前移位...     

Magnetic resonance imaging evaluation of temporomandibular joint disc deformities in relation to type of disc displacement.

PURPOSE: This study was undertaken to assess the relationship between the temporomandibular joint (TMJ) disc deformity and the type of internal derangement. PATIENTS AND METHODS: One hundred thirty-three TMJs of 72 patients (53 female and 19 male) with intracapsular dysfunction were studied using clinical and magnetic resonance imaging examinations. RESULTS: Of the 133 TMJ discs, 41.35% had no deformity, whereas 18% of the discs were folded, 19.55% were lengthened, 9.77% were round, 7.51% were biconvex, and 3.75% had thick posterior bands. The frequency of disc deformity was greater with anterior disc displacement without reduction than in cases of anterior disc displacement with reduction (P <.001). Folded and round discs were most common in cases with TMJ anterior disc displacement without reduction (P <.0001). An increase in length was seen in 56.75% of the cases with anterior disc displacement with reduction, whereas 100% of nonreducing discs were mainly folded or rounded. Crepitation was correlated with folded and round disc deformities, whereas lengthening was the feature of reducing discs associated with early and intermediate clicking. CONCLUSIONS: The results show that the degenerative changes in the TMJ disc are influenced by the degree and the type of disc displacement. The more advanced the internal derangement, the more deteriorated the disc configuration.     

The efficacy of anterior repositioning splint therapy studied by magnetic resonance imaging

Magnetic resonance images (MRIs) were obtained of 52 temporomandibular joints (TMJs) of 30 patients with TMJ disease, before insertion of an anterior repositioning splint. Ten TMJs showed a normal disc-condyle relationship. Pathological findings were partial or complete anterior disc displacement with disc reduction (n = 18), without (n = 7), or with partial reduction (n = 4) or non-reducing joints combined with osteoarthrosis (n = 13). Associated clinical findings were joint clicking, painful TMJ movements with or without condyle limitation, deviation, or crepitus. The clinical evaluation when compared with the MRIs correlated in 75 per cent of cases. Immediate post-insertion MRIs showed recapture of discs with a protrusive splint in 15 out of 18 reducing displacements. Recapture of the disc was seen in only two out of four joints with anterior disc displacement with partial disc reduction. There was no recapture in non-reducing joints. In severe cases of internal derangement with a wide range of disc displacement combined with changes of the osseous joint surfaces, the recapturing of the articular disc with an anterior repositioning appliance was unsuccessful (0 of 13). The follow-up for pain relief after one week showed a significant reduction of symptoms, despite the fact that recapture of the dislocated disc occurred in only 17 of the 42 pathological TMJs. The possibility for disc recapture depends on the disc-condyle position and configuration, the integrity of the posterior attachment, and the degree of degenerative changes of the intra-articular structures, such as osteophytosis, condylar erosion, or flattening of the articular disc. This diagnostic information influences the method of treatment of TMJ disorders. In non-reducing joints or in the later stages of internal derangement of the TMJ, it is not possible to achieve a normal disc-condyle relationship using protrusive splints.     

Comparison of ultrasonography and magnetic resonance imaging in the evaluation of temporomandibular joint disc displacement

The aim of this work was to evaluate the accuracy and reliability of ultrasonography in the diagnosis of temporomandibular joint (TMJ) disc position abnormalities compared with magnetic resonance imaging (MRI). Participants in this study were 41 consecutive patients with signs and symptoms of temporomandibular disorders. All 82 TMJs were evaluated to detect disc position abnormalities by means of ultrasonography and MRI, performed by blinded operators. The accuracy of ultrasonography was evaluated with respect to MRI. Ultrasonography demonstrated good accuracy in the evaluation of disc position, showing a sensitivity of 65.8% and a specificity of 80.4%, resulting in a positive likelihood ratio of 3.35, a negative likelihood ratio of 0.42, and a diagnostic odds ratio of 7.97. The predictive positive and negatives values were respectively 77.1% and 70.2% and the overall agreement between the two radiological techniques was 73.1%. Ultrasonography proved to be accurate in detecting normal disc position and the presence of abnormalities in disc-condyle relationship but not so useful for the distinction between disc displacement with and without reduction.     

Comparison of clinical and magnetic resonance imaging diagnoses in patients with TMD history

The aim of this study was to evaluate the diagnostic accuracy of a well-defined clinical examination for diagnosing anterior disc displacement with and without reduction. A series of 40 patients with temporomandibular disorder (TMD) history were examined according to well-defined routine criteria. This examination included detailed history-taking, standardized clinical head and neck examination that included measurements of the range of motion, palpation of the temporomandibular joints and muscles of mastication for pain and auscultation of joint sounds. Magnetic resonance images of the joints were used as 'gold standard'. Diagnostic accuracy of the clinical examination was 83% for determining normal disc-condyle relationship, 72% for diagnosing anterior disc displacement with reduction, and 81% for diagnosing anterior disc displacement without reduction. Our results suggest that anterior displacement of the disc can be diagnosed with considerable accuracy using a well-defined clinical examination only. Therefore, we conclude that not all patients with TMD symptoms require magnetic resonance imaging examination before treatment.     

Eminectomy and discoplasty for correction of the displaced temporomandibular joint disc

Eminectomy with or without a subsequent discoplasty was performed on 30 patients (36 joints) with internal derangement of the temporomandibular joint (TMJ) confirmed either arthrographically or with magnetic resonance imaging. The importance of the inclination of the TMJ eminence and the therapeutic value of eminectomy are discussed. The TMJs were clinically evaluated before and at least 1 year after surgery in respect to opening function and symptoms. The results were promising (86.8% of the patients felt better). In five patients with a preoperative diagnosis of anterior disc displacement with reduction, only an eminectomy was performed. In these five cases eminectomy alone was sufficient to restore normal TMJ function.     

Variability of disk position in asymptomatic volunteers and patients with internal derangements of the TMJ

This study determined the variability of temporomandibular joint (TMJ) disk position in medial, central, and lateral aspects of the joint using magnetic resonance imaging (MRI). Subjects had clinical evidence of reciprocal TMJ clicking (N = 123) or restricted mandibular motion (N = 52). Eighty-nine asymptomatic volunteers provided a control group. Disk position was quantified on MRI by measuring the angle formed by a line through the middle of the condyle and perpendicular to the Frankfort plane and a line through the same midpoint of the condyle and tangential to the posterior-most aspect of the disk. The disk position in asymptomatic TMJs varied considerably with a tendency toward farther anterior placement in more lateral images. In 47 TMJs from a total of 52 TMJs (90%), restricted mobility was associated with anterior disk displacement (ADD) without reduction. The disk position demonstrated a mean displacement of 77 degrees without significant differences at the medial and lateral aspects of the condyle. One hundred TMJs from a total of 123 TMJs (81%) with reciprocal clicking demonstrated ADD with reduction. Tomograms revealed larger lateral displacements or rotational displacements in these joints, whereas medial images frequently showed similar ranges of disk positions as compared with asymptomatic TMJs. The results suggest that disk positions of up to +15 degrees on medial tomograms and +30 degrees on lateral tomograms should be regarded as normal variations. Furthermore, multisection analysis of all parasagittal images improved the separation between disk displacement and asymptomatic TMJs.     

Relationship between temporomandibular joint disc position and configuration on magnetic resonance imaging

Magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ) has been shown to be of great value in the detection of displacements and delineation of the disc configuration in patients suspected of having internal derangements. The present study was conducted in temporomandibular joints of 144 patients in order to investigate whether an association exists between disc position, disc reduction and disc configuration as seen on MRI. Sagittal proton density-weighted MRIs of 288 TMJs (144 patients) were taken with the mouth closed and opened, and the position and configuration of the articular disc were assessed. The results showed that joints with a superior disc position barely demonstrated disc deformation while in joints with anteriorly displaced dises, disc deformation occurred more frequently (p<0.001). Non-reduction of the disc was associated with disc deformation whereas disc reduction was associated with the normal biconcave disc configuration (p<0.001). These data suggest that an association exists between disc displacement and disc deformation and between disc deformation and the degree of anterior disc displacement.     

颞下颔关节磁共振FIESTA动态成像的诊断价值

目的:探讨颞下颌关节(TMJ)磁共振FIESTA动态成像的诊断价值.方法:对40例患者80侧TMJ进行常规静态磁共振扫描和斜矢状位FIESTA动态磁共振扫描.由2名医师分别对每侧TMJ FIESTA动态扫描时关节盘的位置、髁突的骨质改变和关节腔积液情况进行诊断,并与常规静态磁共振扫描诊断结果进行比较.结果:80侧TMJ磁共振FIESTA动态图像中,对关节盘移位的诊断,72侧与静态磁共振扫描结果相符,准确率为90％;对髁突骨质改变和关节腔积液的诊断,所有病例与静态磁共振结果完全相符,准确率达100％.结论:TMJ磁共振FIESTA动态图像诊断颞下颌关节内紊乱(TMJID)具有一定价值,但单凭动态检查结果不够全面,必须与常规静态磁共振扫描相结合.     

Low bone mineral density and temporomandibular joint derangement in young females

AIMS: To analyze the bone mineral density (BMD) in a group of young female patients with a disc displacement in at least 1 temporomandibular joint (TMJ) as well as in a group of age-matched young females with a normal condyle-disc relationship. METHODS: Fifty-six young female patients with anterior disc displacement based on magnetic resonance imaging (MRI) and 40 age- and gender-matched controls with asymptomatic TMJs were recruited for this study. Subjects between 18 and 30 years were recruited. Based on the MRI findings, 10 of the 40 subjects in the control group also had anterior disc displacement. In all, 16 subjects had an anterior disc displacement with reduction (DDwR), 50 had an anterior disc displacement without reduction (DDw/oR), and 30 had a normal condyle-disc relationship. BMD was measured in the lumbar area by means of dual-energy x-ray absorptiometry. The relationship between the 3 types of condyle-disc relationship and BMD was then analyzed. RESULTS: Patients with a DDw/oR had a significantly lower mean BMD value in the lumbar area than the subjects with a normal condyle-disc relationship (P < .05, analysis of variance, post-hoc with Bonferroni test). Twenty-two (44%) of 50 patients with DDw/oR had osteopenia. CONCLUSION: Low BMD is often associated with DDw/oR in young Taiwanese female patients.     

Condylar disc relationships and vibration energy in asymptomatic class I 9- to 12-year olds

A proper diagnosis is the key to successful treatment. The purpose of this study was to evaluate the temporomandibular joints (TMJ) by means of lateral and anteroposterior cephalograms, transcranial temporomandibular radiographs, magnetic resonance imaging (MRI), and TMJ electrovibratography (EVG) in asymptomatic and orthodontically untreated Angle Class I subjects. The study sample comprised 31 (13 boys, 18 girls) asymptomatic Class I children with a mean age of 9.7 years. The lateral cephalometric findings revealed that the subjects were mesofacial with an Angle Class I skeletal relationship, and the anteroposterior cephalograms showed a symmetrical craniofacial skeleton. Transcranial TMJ radiographs showed that the TMJs on both sides were symmetrically positioned. The time-frequency distributions of sounds from both right and left TMJs showed a wide range, and the vibrations measured by EVG were considerable. The MRI revealed unilateral disc displacement with reduction in four of the 31 subjects (13%), bilateral disc displacement with reduction in three subjects (10%), and bilateral disc displacement without reduction in one subject (3%). The data confirm that a standardized clinical examination to determine the status of the joint is not an efficient tool. This study suggests that the clinical diagnosis should be supported by extensive TMJ evaluation techniques.