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Severity-Graded MRI-Detected TMJ Effusion Is Associated With Pain and Dysfunction in Temporomandibular Disorder
Yeon-Hee Lee1,2, Seong-Woo Jang3, Seonggwang Jeon4
1School of Dentistry, Dental Research Institute, Seoul National University, Seoul, Republic of Korea.
Background:
Temporomandibular joint (TMJ) effusion on magnetic resonance imaging (MRI) is considered a radiologic sign of intra-articular inflammation; however, its clinical relevance to pain and mandibular dysfunction remains inconsistent.
Objective(S):
The objective of this study is to determine whether severity-graded MRI-detected TMJ effusion is associated with pain intensity and dysfunction in patients with temporomandibular disorders (TMD).
Methods:
This retrospective clinical imaging study included 221 patients with TMJ arthralgia diagnosed according to the Diagnostic Criteria for TMD (DC/TMD Axis I). TMJ effusion was assessed using 3.0-T MRI and classified as Grade 0 (non-effusion), Grade 1 (mild effusion), or Grade 2 (moderate-to-severe effusion). Pain and dysfunction were evaluated using the visual analog scale (VAS), dysfunction index (DI), palpation index (PI), craniomandibular index (CMI), symptom duration, and associated clinical symptoms. Group comparisons and multivariable logistic regression analyses were performed.
Results:
Compared with the non-effusion group, the effusion group showed significantly higher VAS (5.08 ± 2.16 vs. 3.45 ± 2.09, p < 0.001), DI (0.29 ± 0.24 vs. 0.21 ± 0.23, p = 0.014), and CMI (0.27 ± 0.26 vs. 0.18 ± 0.24, p = 0.025), as well as longer symptom duration (17.25 ± 32.34 vs. 6.34 ± 11.89 months, p < 0.001). Across effusion grades, VAS, DI, PI, and CMI increased significantly in a dose-response manner (all p < 0.01). In multivariable analyses, female sex (OR, 2.78; 95% CI, 1.55-4.97), higher VAS (OR, 2.03; 95% CI, 1.51-2.72), higher CMI (OR, 1.68; 95% CI, 1.26-2.25), TMJ noise (OR, 2.05; 95% CI, 1.17-3.59), locking (OR, 2.45; 95% CI, 1.39-4.30), and tinnitus (OR, 2.28; 95% CI, 1.30-4.02) were independently associated with effusion presence. Female sex (OR, 3.29; 95% CI, 1.47-7.38), higher VAS (OR, 2.11; 95% CI, 1.46-3.04), and higher CMI (OR, 1.71; 95% CI, 1.24-2.36) were independently associated with Grade 2 effusion.
Conclusions:
Severity-graded MRI-detected TMJ effusion is associated with greater pain intensity and dysfunction in patients with TMJ arthralgia, supporting its interpretation as a clinically meaningful imaging marker rather than an incidental radiologic finding.
Insights
Temporomandibular joint (TMJ) effusion on MRI correlates with increased pain and dysfunction in TMJ arthralgia patients. This study shows that graded TMJ effusion severity is a clinically significant indicator of patient symptoms.
Area of Science:
- Radiology
- Orthopedics
- Pain Management
Background:
- Temporomandibular joint (TMJ) effusion on MRI is often linked to intra-articular inflammation.
- However, its direct clinical significance regarding pain and mandibular dysfunction is not consistently established.
Purpose of the Study:
- To investigate the association between the severity of MRI-detected TMJ effusion and pain intensity/dysfunction in patients with temporomandibular disorders (TMD).
Main Methods:
- A retrospective analysis of 221 patients with TMJ arthralgia was conducted.
- TMJ effusion was graded (0, 1, or 2) via 3.0-T MRI, and pain/dysfunction were assessed using VAS, DI, PI, and CMI.
- Statistical analyses included group comparisons and multivariable logistic regression.
Main Results:
- Patients with TMJ effusion exhibited significantly higher VAS, DI, CMI, and longer symptom duration compared to those without effusion.
- A dose-response relationship was observed between effusion grades and increased VAS, DI, PI, and CMI.
- Female sex, higher VAS, higher CMI, TMJ noise, locking, and tinnitus were independently associated with effusion presence.
Conclusions:
- Severity-graded TMJ effusion detected by MRI is significantly associated with increased pain and dysfunction in TMJ arthralgia patients.
- These findings support the interpretation of TMJ effusion as a clinically meaningful imaging marker, not merely an incidental finding.
