Zusammenfassung
Das Ziel der Studie ist die Analyse und der Vergleich von klinischen und Magnetresonanz-Befunden
von Diskusadhäsionen bei 14 Patienten.
Nach einer klinischen Untersuchung eines jeden Patienten wurden vier MR-Tomograme
von beiden Kiefergelenken in verschiedenen UK-Positionen analysiert: habituelle Okklusion,
Ruhe-Schwebelage, partielle Mundöffnungs- und maximale Mundöffnungsposition. Die MR-Tomogramme
bestätigen die klinische Diagnose in 12 von 14 Patientenfällen. In 10 von 12 Fällen
mit Diskusadhäsion wurde auf der kontralateralen Gelenkseite ein internal derangement festgestellt. Wir fanden partielle anteriore Diskusverlagerung ohne Reposition in
2 von 12 Patienten und komplette anteriore Diskusverlagerung ohne Reposition in 10
von 12 Patienten. MRI identifizierte in allen Patienten (12/12) ein begrenztes signalarmes
Areal im oberem Gelenkspalt, welches eine Fibrosierung repräsentiert und eine Diskusimmobilität
bedingt. Alle Disken waren verformt und die Diskusreposition war bei keinem Patienten
möglich. Die klinischen Befunde waren: initiales oder intermediäres Gelenkknacken,
Deflexion oder Deviation. Das Knacken war reproduzierbar an der gleichen Stelle der
aktiven oder passiven Unterkieferexkursionsbewegungen.
4 von 12 Patienten hatten eine Limitation der Mundöffnungsbewegung mit fortgeschrittenen
Kiefergelenkssymptomen. Die assoziierten MR-Befunde visualisierten den fixierten Diskus
als ein Hindernis, das die kondyläre Translationsbewegung begrenzte. 8 von 12 Patienten
hatten keine Limitation der Mundöffnung mit geringen (5/8) oder keinen (3/8) klinischen
Symptomen. In dieser Gruppe wurde die Limitation der Diskustranslation im oberen Gelenkspalt
durch eine vergrößerte kondyläre Translation im unteren Gelenkspalt kompensiert. Kondyläre
Fehlstellungen, besonders superiore Malposition mit einer steilen Gelenkbahn und einem
hohen Tuberculum articulare, Arthrose oder traumatischer Insult, scheinen prädisponierende
Faktoren für eine Diskusadhäsion zu sein.
Abstract
The aim of this study is to analyse and compare clinical and MRI findings of adherent
TMJ discs in 14 patients. After a clinical examination of each subject, four magnetic
resonance images of both temporomandibular joints were analysed: habitual occlusion,
free way space, partially open and full mouth position.
Magnetic resonance imaging confirmed the clinical diagnosis in 12 of 14 subjects.
In 10 of the 12 subjects with an adherent disc, internal derangement occurred on the
contralateral side. We found partial anterior disc displacement without reduction
in 2 of 12 patients and complete anterior disc displacement without reduction in 10
of 12 patients. Magnetic resonance imaging detected in all subjects (12/12) a demarcated
low signal area in the upper joint space which represented fibrosis and caused disc
immobility. All discs were distorted and disc reduction was not possible in any of
the patients. Clinical findings were initial or intermediate joint clicking, deflexion
or deviation. Clicking was reproducible at the same point of active or passive mandibular
excursions.
Four of 12 patients had a limitation of open mouth movement with severe TMJ symptoms.
The associated MRI findings visualised the fixed disc as an obstacle which restricted
condyle translation. Eight of 12 patients had no limitation of mouth opening with
mild (5/8) or no (3/8) clinical symptoms. In this group the limited disc translation
in the upper joint space was compensated by an increased condylar translation in the
lower joint space. Condylar displacement, especially superior malposition with steep
joint course and a high articular eminence, arthrosis or traumatic insult, seemed
to be a predisposing factor for disc adhesion.
Schlüsselwörter
Kiefergelenk - Diskusadhäsion - Magnetresonanztomographie - klinische Befunde
Key words
Temporomandibular joint - adherent disc - magnetic resonance imaging - clinical findings
Literatur
- 1
Bewyer D C.
Biomechanical and physiological processes leading to internal derangements with adhesions.
J Craniomandib Disord Oral Fac Pain.
1989;
3
44-51
- 2 Bumann A, Lotzmann U. Funktionsdiagnostik und Therapieprinzipien. In: Rateischak
KH, Wolf HF (Hrsg). Farbatlanten der Zahnmedizin. Bd 12. Thieme, Stuttgart, New York
2000
- 3
Crowley C, Wilkinson T, Piehslinger E, Wilson D, Czerny C.
Correlations between anatomic and MRI sections of human cadaver temporomandibular
joints in the coronal and sagittal planes.
J Orofac Pain.
1996;
10
199-216
- 4
De Laat A, Horvath M, Bossuyt M, Fossion E, Baert A L.
Myogenous or arthrogenous limitation of mouth opening: correlations between clinical
findings, MRI, and clinical outcome.
J Orofac Pain.
1993;
7
150-155
- 5 Dolwick M F, Sanders B. TMJ internal derangement and arthrosis. Mosby, St. Louis
1993
- 6
Dorsay T A, Youngberg R A, Orr F E.
Cine MRI diagnosis and posttherapeutic evaluation of an adherent TMJ disc: a case
report.
J Oral Maxillofac Surg.
1994;
52
1220-1222
- 7
Drace J E, Enzmann D.
Defining the normal temporomandibular joint: closed-, partially open-, and open-mouth
MR imaging of asymptomatic subjects.
Radiology.
1990;
177
67-75
- 8
Eberhard D, Bantleon H P, Steger W.
The efficacy of anterior repositioning splint therapy studied by magnetic resonance
imaging.
Eur J Orthod.
2002;
24
343-353
- 9
Eberhard D, Bantleon H P, Steger W.
Functional magnetic resonance imaging of temporomandibular joint disorders.
European Journal of Orthodontics.
2000;
22
489-497
- 10 Gray R J, Davies S J, Quayle A A. Temporomandibular disorders: a clinical approach. British
Dental Journal. Maxmillan Press, London 1995
- 11
Harms S E, Wilk R M, Wolford L M, Chiles D G, Milam S B.
The temporomandibular joint: magnetic resonance imaging using surface soils.
Radiology.
1985;
157
133-136
- 12
Holmlund A, Axelsson S.
Efficacy of arthroscopic lysis and lavage in patients with chronic locking of the
temporomandibular joint.
Int J Oral Maxillofac Surg.
1994;
23
262-265
- 13
Isberg A, Isacsson G.
Tissue reactions associated with internal derangement of the temporomandibular joint.
Acta Odont Scand.
1986;
44
159-166
- 14
Kamminishi R M, Davis C L.
Temporomandibular joint arthroscopic observations of superior space adhesions.
Oral Maxillofacial Surg Clin N Am.
1989;
1
103-109
- 15
Katzberg R W, Bessette R W, Tallents R H, Plewes D B, Manzione J V, Schenk J F. et
al .
Normal and abnormal temporomandibular joint: MR imaging with surface coil.
Radiology.
1986;
158
183-189
- 16
Kircos L T, Orthendahl D A, Mark A S, Arakawa M.
Magnetic Resonance Imaging of the TMJ disc in asymptomatic volunteers.
J Oral Maxillofac Surg.
1987;
45
852-857
- 17 Larheim T A. Imaging of the temporomandibular joint in rheumatic disease. In: Westesson
PL, Katzberg R (eds). Imaging of the temporomandibular joint. Williams & Wilkins,
Baltimore 1991; 133-153
- 18
Minz S S.
Craniomandibular dysfunction in children and adolescents: a review.
J Craniomand Pract.
1993;
11
224-231
- 19
Moffett B C, Johnson L C, McGabe J B, Askew H C.
Remodeling in the adult human temporomandibular joint.
Am J of Anat.
1964;
115
119-124
- 20
Montgomery M T, Van Sickels J E, Harms S E, Trash W J.
Arthroscopic TMJ surgery: Effects on signs, symptoms, and disc position.
J Oral Maxillofac Surg.
1989;
47
1263-1271
- 21
Nuelle D G, Alpern M C, Ufema J W.
Arthroscopic Perspective of the Temporomandibular Joint.
J Clin Orthop.
1987;
21
110-114
- 22
Paesani D, Westesson P L, Hatala M P, Tallents R H, Brooks S L.
Accuracy of clinical diagnosis for TMJ internal derangement and arthrosis.
Oral Surg Oral Med Oral Pathol.
1992;
73
360-363
- 23
Paesani D, Westesson P -L, Hatala M P, Tallents R H, Kurita K.
Prevalence of temporomandibular joint internal derangement in patients with craniomandibular
disorders.
Am J Orthod Dentofac Orthop.
1992;
101
41-47
- 24
Pereira F J, Lundh H, Westesson P L.
Morphologic changes in the temporomandibular joint in different age groups. An autopsy
inverstigation.
Oral Surg Oral Pathol.
1994;
78
279-287
- 25
Rao V M, Farole A, Karasick D.
Temporomandibular joint dysfunction: correlation of MR imaging, arthography, and arthoscopy.
Radiology.
1990;
174
663-667
- 26
Raustia A M, Pyhtinen J, Peru H.
Clinical, magnetic-resonance imaging and surgical findings in patients with temporomandibular
joint disorder - a survey of 47 patients.
Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verf.
1994;
160
406-411
- 27
Roditi G H, Duncan K A, Needham G, Redpath T W.
Temporomandibular joint MRI: a 2-D gradient-echo technique.
Clinical Radiology.
1997;
52
441-444
- 28
Schellhas K P, Pollei S R, Wilkes C H.
Pediatric internal derangements of the temporomandibular joint: effect of facial development.
Am J Orthod Dentofac Orthop.
1993;
104
51-59
- 29
Steenks M H, Bleys R L, Witkamp T D.
Temporomandibular joint structures: a comparison between anatomic and magnetic resonance
in a sagittal and an angulated plane.
J Orofac Pain.
1994;
8
120-135
- 30
Stegenga B, de Bon L G, Boering G.
Osteoarthrosis as the cause of craniomandibular pain and dysfunction: a unifying concept.
J Oral Maxillo Surg.
1989;
47
249-256
- 31
Toller P A.
Opaque arthography of the temporomandibular joint.
Int J Oral Surg.
1974;
31
17-28
- 32
Van Hoe L, Ceseleyn L, Claeys T, Bertrand P, Van Wilderode W, Depuyt T.
Arthrographic imaging of post-traumaic temporomandibular joint disorders.
Acta Stomatol Belg.
1992;
89
169-179
- 33
Wise S W, Conway W F, Laskin D M.
Temporomandibular joint clicking only on closure: report of a case and explantion
of the cause.
J Oral Maxillofac Surg.
1993;
51
1272-1273
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