Magnetic Resonance Imaging for Temporomandibular Joint Internal Derangement and Osteoarthritis - A Prospective Study

Management of temporomandibular joint (TMJ) osteoarthritis (OA) is a challenging issue in modern gnathology and maxillofacial surgery. Identifying various signs of TMJ OA, their relationship with internal derangement and studying the features of combined (uni-, bilateral) pathology contribute to an accurate assessment of TMJ condition and appropriate management. Conventionally, besides clinical examination, this state was diagnosed by computed tomography. However, magnetic resonance imaging (MRI) allows the assessment of both bone and soft tissue. The aim of the study was to identify the correlation between degenerative changes in bone structures and various forms of internal TMJ disorders based on MRI data, as well as to assess the morphofunctional changes in the TMJ in cases of uni-, bilateral joint pathology.

Two hundred and twenty-two patients (444 joints) underwent a clinical examination and MRI of the TMJ (Siemens Magnetom Verio MRI scanner Germany 3.0 T). Exclusion criteria included systemic diseases, joint trauma and prior treatments.

Osteodegeneration predominated in cases of anterior disc displacement without reduction (ADDWoR): osteophytes on the condylar head (74.8%), flattening (40.2%), erosions (31.8%) and subchondral sclerosis (88.8%). As the degree of disc displacement progressed, the decrease of volume of condyle, changed from 373.8 mm² with normal disc position (NDP) to 251.3 mm² with ADDWoR. In cases with NDP, unilateral OA was present in 2.3% of and bilateral OA in 4.1%. Bilateral displacement is characterised by bilateral OA in 26.1%, whereas unilateral OA in 12.2%. There is a positive correlation between the position of the disc in the sagittal projection and degenerative changes.

Strong correlation was identified between degenerative changes in the bone structures of the TMJ and various types of internal disorders.