A Case of Synovial Chondromatosis of Temporomandibular Joint with Numerous Loose Bodies

Here, we report a case of synovial chondromatosis of the temporomandibular joint (TMJ) with numerous loose bodies. A 56-year-old woman was examined in the oral surgery department for trismus and pain in the left TMJ when opening the mouth. Imaging indicated TMJ synovial chondromatosis, and the patient was referred to our department for further examination. Her facial features were symmetrical, and no occlusal abnormalities were found. The maximum mouth opening was 30 mm, and movement of the left mandibular condyle was restricted and accompanied by pain and joint sounds. Panoramic radiography showed deformation of the left mandibular condyle and radiopaque lesions surrounding it. Computed tomography showed numerous small granules around the left mandibular condyle, some of which were calcified. Magnetic resonance imaging showed anterior disc displacement without reduction in the left TMJ and hypointense lesions on T2-weighted images. Bone scintigraphy showed an accumulation in the area of the left TMJ. Based on the diagnosis of the left TMJ synovial chondromatosis, the lesions were removed, and plastic surgery on the mandibular condyle was performed under general anesthesia. We removed 386 white loose bodies. Histopathologically, the loose bodies were consistent with synovial chondromatosis lesions. The postoperative course was uneventful, with no recurrence or TMJ dysfunction approximately 5 years after the surgery, indicating that open surgery is the best course of intervention in such cases.

Diagnostic efficacy of CBCT, MRI and CBCT–MRI fused images in determining anterior disc displacement and bone changes of temporomandibular joint

Objectives: To evaluate the diagnostic efficacy of CBCT–MRI fused image for anterior disc displacement and bone changes of temporomandibular joint (TMJ), which are the main imaging manifestations of temporomandibular disorders (TMD). Methods: Two hundred and thirty-one TMJs of 120 patients who were diagnosed with TMD were selected for the study. The anterior disc displacement, bone defect and bone hyperplasia evaluated by three experts were used as a reference standard. Three residents individually evaluated all the three sets of images, which were CBCT images, MRI images and CBCT-MRI fused images from individual CBCT and MRI images in a random order for the above-mentioned three imaging manifestations with a five-point scale. Each set of images was observed at least 1 week apart. A second evaluation was performed 4 weeks later. Intra- and interobserver agreements were assessed using the intraclass correlation coefficient (ICC). The areas under the ROC curves (AUCs) of the three image sets were compared with a Z test, and p < 0.05 was considered statistically significant. Results: One hundred and forty-five cases were determined as anterior disc displacement, 84 cases as bone defect and 40 cases as bone hyperplasia. The intra- and interobserver agreements in the CBCT-MRI fused image set (0.76–0.91) were good to excellent, and the diagnostic accuracy for bone changes was significantly higher than that of MRI image set (p＜0.05). Conclusions CBCT-MRI fused images can display the disc and surrounding bone structures simultaneously and significantly improve the observers’ reliability and diagnostic accuracy, especially for inexperienced residents.

The Accuracy of High Resolution Ultrasound in the Diagnosis of TMJ Disc Displacement in Comparison With MRI

Background The temporomandibular joint disorders (TMD) have been a major source of pathology. Being only second to chronic low back pain as a cause of pain and disability. MRI is currently considered the gold standard method for imaging of the TMJ. USG is a non-invasive, inexpensive procedure. And can provide a potential sensitive tool for diagnosis of anterior disc displacement. Aim of the work The aim of this study is to compare between the accuracy of ultrasound and MRI in diagnosis of TMJ disc displacement. Patients and Methods This study was carried out at the Radiology Department, Ain Shams University Hospitals. Twenty one patients with clinically suspected TMJ disc displacement underwent ultrasound (US) and MRI examination. Results The overall sensitivity of the US to diagnose disc displacement compared to MRI reached (94.7%), specificity (91.3%), Positive Predictive value (90.0%), Negative Predictive Value (95%) and accuracy (92.9%). The results indicated 1.8 mm was the most accurate cut-off distance between the articular capsule and the anterior surface of the mandibular condyle for diagnosis of MR positive disc displacement.

Prognostic Indicators of Yang’s Arthroscopic Technique for Management of Temporomandibular Joint Anterior Disc Displacement: Part 1- Clinical Predictors.

In order to optimize the patient selection for specific treatment modality and to achieve favorable treatment outcomes, prognostic indicators impacting the results are important to analyze. This longitudinal retrospective study aimed to analyze various prognostic factors impacting the surgical outcomes following Yang’s arthroscopic discopexy for management of temporomandibular joint anterior disc displacement using success criteria based on pain, maximal interincisal opening, diet, and quality of life. Furthermore, a quantitative MRI assessment of disc position and condylar height was performed pre- and postoperatively. Multinomial analysis was used to evaluate various prognostic variables including gender, age, duration of illness, Wilkes staging, parafunctional habits, and splint/orthodontic therapy. A total of 169 patients (234 joints) were included. The outcome was categorized as excellent (n = 67/39.6%), good (n = 72/42.6%), improved (n = 22/13.01%) or poor (n = 8/4.73%) with a success rate of 95.26%. Patients aged from 11–15 years old were significantly more likely to be in the good outcome group (odds ratio (OR), 0.20; P < 0.05). Also, patients with shorter duration of illness (OR, 0.29; P < 0.05) and with Wilkes stage III (OR, 0.11; P < 0.05) were more likely to be in the improved outcome group. Better outcomes can be achieved at younger patients with shorter disease history and earlier Wilkes staging.

A comparative study of the effects of the anterior disc displacement with reduction and without reduction on the components of the temporomandibular joint by using magnetic resonance imaging – A Retrospective study

Background: Internal derangement of the temporomandibular joint (TMJ) results in anterior disc displacement with reduction (ADDR), the disc is ante- riorly displaced in the closed position whereas in the opened position the disc returns to its normal location. In anterior disc displacement without reduction (AD- DWR), the disc is anteriorly displaced in the closed po- sition but does not return to its original location in the opened position. Here we studied and compared the effects of the ADDR and the ADDWR on the components of the TMJ by using the magnetic resonance imaging technique (MRI). Methods and materials: From the archival MRI records, 214 joints from 107 patients were included. The selec- tion criteria for the patients complaints as TMJ pain, clicking, limited mouth opening, headache, jaw tenderness and difficulty in eating. MRI records with sequences Proton Density (PD), PD FAT SAT and T2* gradient in the closed position and T2* gradient echo in the opened position. Data analysis and frequency distribution of explanatory variables by disc position in the open state was performed using chi-square test Results: Statistically significant differences were observed between the variables such as the joint space (closed position), disc morphology (closed position) and range of movement (opened position) among the ADDR and the ADDWR. In ADDWR, 20.3% demonstrated narrowed joint space and 1.6% with widened joint space, while in ADDR, 2.5% of joints had narrowed joint space and 0% widened joint space. Same was observed with abnormal disc morphology and rang of movement. Conclusion: The disc deformity is more in ADDWR compared to ADDR which can be seen as an alteration in the signal intensity. The malaligned disc could lead to the narrowing of the joint space and decreased range of movement in the ADDWR affected individuals.