Relationship between sounds and disc displacement of the temporomandibular joint using magnetic resonance imaging

Bisi, Maurício André; Chaves, Karen Dantur Batista; Puricelli, Edela; Ponzoni, Deise; Martins, Eleutério Araújo

doi:10.1590/S1980-65232010000100008

Abstracts

PURPOSE: Magnetic resonance imaging (MRI) is useful for interpreting temporomandibular joint (TMJ) disorders including disc displacement. This study aimed to evaluate the relationship between TMJ sounds and disc displacement with and without reduction by clinical examination and MRI. METHODS: A sample of 58 patients was clinically examined when after being referred to MRI due to signs and symptoms of unilateral or bilateral TMJ disc displacement. The diagnosis obtained using MRI was compared with the clinical findings for the presence or absence of articular sounds. RESULTS: Most patients (n=39; 67%) had joint sounds manifested as clicking; the other 19 patients (33%) did not present sounds. Among the 39 patients with sounds, bilateral clicking was observed in 29 (74%), and unilateral clicking in 10 (26%) patients. Unilateral clicking was equally observed on the right and left sides, each occurring in 5 five patients (13%). CONCLUSION: The results suggest that articular sounds do not occur exclusively in TMJ with disc displacement with reduction. The presence or absence of joint sounds will not suffice as the only aspect criterion to be considered in the differential diagnosis of disc displacement with and without reduction.

Temporomandibular joint; disc displacement; joint sounds; magnetic resonance imaging

OBJETIVO: A ressonância magnética nuclear (RMN) é de grande utilidade para o diagnóstico das desordens temporomandibulares, inclusive o deslocamento de disco é muito comum. O objetivo deste estudo foi avaliar a relação entre ruído articular e deslocamento de disco com e sem redução por meio de avaliação clinica e ressonância magnética nuclear. METODOLOGIA: O estudo examinou 58 pacientes clinicamente, que foram submetidos à RMN quando apresentavam de sinais e sintomas de deslocamento de disco uni ou bilateral. O diagnóstico obtido pela RMN foi comparado com os achados clínicos relativos à presença ou não de ruído articular. RESULTADOS: Dos 58 indivíduos estudados, 39 (67%) apresentaram ruído articular do tipo click, os restantes 19 (33%) não apresentaram ruídos. Dos 39 com ruído, a ocorrência bilateral foi de 29 (74%) e unilateral em 10 (26%) casos, sendo 5 (13%) do lado direito e 5 (13%) do lado esquerdo. CONCLUSÃO: Os resultados demonstraram que os ruídos articulares não estão restritos a articulações com deslocamento de disco com redução. A presença ou ausência de ruído articular não devem ser os únicos aspectos considerados para o diagnóstico diferencial entre deslocamento de disco com e sem redução.

Articulação temporomandibular; deslocamento de disco; ruído articular; imagem por ressonância magnética

ORIGINAL ARTICLE

Relationship between sounds and disc displacement of the temporomandibular joint using magnetic resonance imaging

Relação entre ruído e deslocamento de disco da articulação temporomandibular utilizando imagem de ressonância magnética

Maurício André Bisi^{I, II}; Karen Dantur Batista Chaves^I; Edela Puricelli^I; Deise Ponzoni^I; Eleutério Araújo Martins^II

^IFederal University of Rio Grande do Sul, Porto Alegre, RS, Brazil

^IIABO-RS, Porto Alegre, RS, Brazil

^{Correspondence} Correspondence: Mauricio André Bisi R. Conde D'Eu, 1405 B Caxias do Sul, RS - Brasil 95076-090 E-mail: maubisi@hotmail.com

ABSTRACT

PURPOSE: Magnetic resonance imaging (MRI) is useful for interpreting temporomandibular joint (TMJ) disorders including disc displacement. This study aimed to evaluate the relationship between TMJ sounds and disc displacement with and without reduction by clinical examination and MRI.

METHODS: A sample of 58 patients was clinically examined when after being referred to MRI due to signs and symptoms of unilateral or bilateral TMJ disc displacement. The diagnosis obtained using MRI was compared with the clinical findings for the presence or absence of articular sounds.

RESULTS: Most patients (n=39; 67%) had joint sounds manifested as clicking; the other 19 patients (33%) did not present sounds. Among the 39 patients with sounds, bilateral clicking was observed in 29 (74%), and unilateral clicking in 10 (26%) patients. Unilateral clicking was equally observed on the right and left sides, each occurring in 5 five patients (13%).

CONCLUSION: The results suggest that articular sounds do not occur exclusively in TMJ with disc displacement with reduction. The presence or absence of joint sounds will not suffice as the only aspect criterion to be considered in the differential diagnosis of disc displacement with and without reduction.

Key words: Temporomandibular joint; disc displacement; joint sounds; magnetic resonance imaging

RESUMO

OBJETIVO: A ressonância magnética nuclear (RMN) é de grande utilidade para o diagnóstico das desordens temporomandibulares, inclusive o deslocamento de disco é muito comum. O objetivo deste estudo foi avaliar a relação entre ruído articular e deslocamento de disco com e sem redução por meio de avaliação clinica e ressonância magnética nuclear.

METODOLOGIA: O estudo examinou 58 pacientes clinicamente, que foram submetidos à RMN quando apresentavam de sinais e sintomas de deslocamento de disco uni ou bilateral. O diagnóstico obtido pela RMN foi comparado com os achados clínicos relativos à presença ou não de ruído articular.

RESULTADOS: Dos 58 indivíduos estudados, 39 (67%) apresentaram ruído articular do tipo click, os restantes 19 (33%) não apresentaram ruídos. Dos 39 com ruído, a ocorrência bilateral foi de 29 (74%) e unilateral em 10 (26%) casos, sendo 5 (13%) do lado direito e 5 (13%) do lado esquerdo.

CONCLUSÃO: Os resultados demonstraram que os ruídos articulares não estão restritos a articulações com deslocamento de disco com redução. A presença ou ausência de ruído articular não devem ser os únicos aspectos considerados para o diagnóstico diferencial entre deslocamento de disco com e sem redução.

Palavras-chave: Articulação temporomandibular; deslocamento de disco; ruído articular; imagem por ressonância magnética

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Received: February 20, 2009

Accepted: November 6, 2009

1. Prinz JF. Physical mechanisms involved in the genesis of temporomandibular joint sounds. J Oral Rehabil 1998;25:706-14.
2. Honda K, Natsumi Y, Urade M. Correlation between MRI evidence of degenerative condylar surface changes, induction of articular disc displacement and pathological joint sounds in the temporomandibular joint. Gerodontology 2008;25:251-7.
3. Gray RJM, Davies SJ, Quayle AA. Temporomandibular disorders: a clinical approach. London: British Dental Journal, 1995.
4. Limchaichana N, Nilsson H, Ekberg EC, Nilner M, Petersson A. Clinical diagnoses and MRI findings in patients with TMD pain. J Oral Rehabil 2007;34:237-45.
5. Miller TL, Katzberg RW, Tallents RH, Bessette RW, Hayakawa K. Temporomandibular joint clicking with nonreducing anterior displacement of the meniscus. Radiology 1985;154:121-4.
6. Müller-Leisse C, Augthun M, Bauer W, Roth A, Günther R. Anterior disc displacement without reduction in the temporomandibular joint: MRI and associated clinical findings. J Magn Reson Imaging 1996;6:769-74.
7. Barclay P, Hollender LG, Maravilla KR, Truelove EL. Comparison of clinical and magnetic resonance imaging diagnoses in patients with disk displacement in the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:37-43.
8. Benbelaid R, Fleiter B. Sensitivity and specificity of a new MRI method evaluating temporo-mandibular join disc-condyle relationships : an in vivo study. Surg Radiol Anat 2006;28:71-5.
9. Brooks SL, Westesson PL. Temporomandibular joint: value of coronal MR images. Radiology 1993;188:317-21.
10. Tasaki MM, Westesson PL, Raubertas RF. Observer variation in interpretation of magnetic resonance images of the temporo-mandibular joint. Oral Surg Oral Med Oral Pathol 1993;76:231-4.
11. Held P, Moritz M, Fellner C, Behr M, Gmeinwieser J. Magnetic resonance of the disk of the temporomandibular joint: MR imaging protocol. Clin Imaging 1996;20:204-11.
12. Westesson PL, Katzberg RW, Tallents RH, Sanchez-Woodworth RE, Svensson SA, Espeland MA. Temporomandibular joint: comparison of MR images with cryosectional anatomy. Radiology 1987; 164:59-64.
13. Omnell KA. Historical review of temporomandibular joint arthrography. In: Moffet BC, Westesson PL editors. Diagnosis of internal derangements of the temporomandibular joint. Seattle: University of Washington Continuing Dental Education; 1984. p. 1-3.
14. Major PW, Kinniburgh RD, Nebbe B, Prasad NG, Glover KE. Tomographic assessment of temporomandibular joint osseous articular surface contour and spatial relationships associated with disc displacement and disc length. Am J Orthod Dentofacial Orthop 2002; 121:152-61.
15. Sener S, Akgünlü F. Correlation of different MRI characteristics of anterior disc displacement with reduction and without reduction. J Contemp Dent Pract 2005;6:26-36.
16. Emshoff R, Innerhofer K, Rudisch A, Bertram S. Clinical versus magnetic resonance imaging findings with internal derangement of the temporomandibular joint: an evaluation of anterior disc displacement without reduction. J Oral Maxillofac Surg 2002;60:36-41.
17. Okeson JP. Dores bucofaciais de bell. 6. ed. São Paulo: Quintessence; 2006.
18. Isberg A. Disfunção da articulação temporomandibular: um guia para o clinico. São Paulo: Artes Médicas Editora; 2005.
19. Lundh H, Westesson PL, Kopp S. Anterior repositioning splint in the treatment of temporomandibular joints with reciprocal clicking: comparison with a flat occlusal splint and an untreated control group. Oral Surg Oral Med Oral Pathol 1985;60:131-6.
20. Kurita H, Ohtsuka A, Kobayashi H, Kurashina K. The relationship between the degree of disk displacement and ability to perform disk reduction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90: 16-20.

Correspondence:

Mauricio André Bisi

R. Conde D'Eu, 1405 B

Caxias do Sul, RS - Brasil 95076-090

E-mail:

maubisi@hotmail.com

Publication Dates

Publication in this collection
26 Aug 2011
Date of issue
2010

History

Received
20 Feb 2009
Accepted
06 Nov 2009

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Prinz JF. Physical mechanisms involved in the genesis of temporomandibular joint sounds. J Oral Rehabil 1998;25:706-14.

[2] 2. Honda K, Natsumi Y, Urade M. Correlation between MRI evidence of degenerative condylar surface changes, induction of articular disc displacement and pathological joint sounds in the temporomandibular joint. Gerodontology 2008;25:251-7.

[3] 3. Gray RJM, Davies SJ, Quayle AA. Temporomandibular disorders: a clinical approach. London: British Dental Journal, 1995.

[4] 4. Limchaichana N, Nilsson H, Ekberg EC, Nilner M, Petersson A. Clinical diagnoses and MRI findings in patients with TMD pain. J Oral Rehabil 2007;34:237-45.

[5] 5. Miller TL, Katzberg RW, Tallents RH, Bessette RW, Hayakawa K. Temporomandibular joint clicking with nonreducing anterior displacement of the meniscus. Radiology 1985;154:121-4.

[6] 6. Müller-Leisse C, Augthun M, Bauer W, Roth A, Günther R. Anterior disc displacement without reduction in the temporomandibular joint: MRI and associated clinical findings. J Magn Reson Imaging 1996;6:769-74.

[7] 7. Barclay P, Hollender LG, Maravilla KR, Truelove EL. Comparison of clinical and magnetic resonance imaging diagnoses in patients with disk displacement in the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:37-43.

[8] 8. Benbelaid R, Fleiter B. Sensitivity and specificity of a new MRI method evaluating temporo-mandibular join disc-condyle relationships : an in vivo study. Surg Radiol Anat 2006;28:71-5.

[9] 9. Brooks SL, Westesson PL. Temporomandibular joint: value of coronal MR images. Radiology 1993;188:317-21.

[10] 10. Tasaki MM, Westesson PL, Raubertas RF. Observer variation in interpretation of magnetic resonance images of the temporo-mandibular joint. Oral Surg Oral Med Oral Pathol 1993;76:231-4.

[11] 11. Held P, Moritz M, Fellner C, Behr M, Gmeinwieser J. Magnetic resonance of the disk of the temporomandibular joint: MR imaging protocol. Clin Imaging 1996;20:204-11.

[12] 12. Westesson PL, Katzberg RW, Tallents RH, Sanchez-Woodworth RE, Svensson SA, Espeland MA. Temporomandibular joint: comparison of MR images with cryosectional anatomy. Radiology 1987; 164:59-64.

[13] 13. Omnell KA. Historical review of temporomandibular joint arthrography. In: Moffet BC, Westesson PL editors. Diagnosis of internal derangements of the temporomandibular joint. Seattle: University of Washington Continuing Dental Education; 1984. p. 1-3.

[14] 14. Major PW, Kinniburgh RD, Nebbe B, Prasad NG, Glover KE. Tomographic assessment of temporomandibular joint osseous articular surface contour and spatial relationships associated with disc displacement and disc length. Am J Orthod Dentofacial Orthop 2002; 121:152-61.

[15] 15. Sener S, Akgünlü F. Correlation of different MRI characteristics of anterior disc displacement with reduction and without reduction. J Contemp Dent Pract 2005;6:26-36.

[16] 16. Emshoff R, Innerhofer K, Rudisch A, Bertram S. Clinical versus magnetic resonance imaging findings with internal derangement of the temporomandibular joint: an evaluation of anterior disc displacement without reduction. J Oral Maxillofac Surg 2002;60:36-41.

[17] 17. Okeson JP. Dores bucofaciais de bell. 6. ed. São Paulo: Quintessence; 2006.

[18] 18. Isberg A. Disfunção da articulação temporomandibular: um guia para o clinico. São Paulo: Artes Médicas Editora; 2005.

[19] 19. Lundh H, Westesson PL, Kopp S. Anterior repositioning splint in the treatment of temporomandibular joints with reciprocal clicking: comparison with a flat occlusal splint and an untreated control group. Oral Surg Oral Med Oral Pathol 1985;60:131-6.

[20] 20. Kurita H, Ohtsuka A, Kobayashi H, Kurashina K. The relationship between the degree of disk displacement and ability to perform disk reduction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90: 16-20.