X-RAY AND MRI CHARACTERISTICS OF TEMPOROMANDIBULAR JOINT DYSFUNCTION OF COMPRESSION GENESIS

Abstract

Temporomandibular joint (TMJ) dysfunction constitute one of the most common pathologies of the maxillofacial region. According to many authors, more than 65% of population in different countries present with some or other symptoms of TMJ dysfunction. There is a wide choice of imaging procedures that can be used for patients with TMD, and they vary considerably in cost, availability, and quality of information that can be obtained. The mainrole in the diagnosis of diseases of the temporomandibular joints is given by radiological methods of research, which ensure the effectiveness of diagnosis in up to 95% of cases. To date, the method of digital computer radiography in both closed and maximal open positions is widely used for the diagnosis of TMJ dysfunctional conditions. Computed tomography (CT) makes it possible to evaluate, with a higher degree of certainty, osseous changes and relationship between the elements of the joint. Magnetic resonance imaging (MRI) is currently the “gold standard” in medicine. This imaging procedure is the best imaging method for identifying the disc position, joint fluid, bone and soft tissues changes. However, the interpretation of MRI results for patients with TMJ dysfunction is not insufficiently described in various literature sources. In spite of active scientific researches, the differential-diagnostic characteristics of the results of these types of research for patients with compression-dislocation dysfunction causes considerable difficulties until now. The aim of our research is to compere different ways for visualizing the TMJ components of both TMJs of patients with clinical manifestation of compression pain symptom. Object and methods. We studied 93 targeted X-rays of TMJ with closed and open mouth (zonography), 28 computer tomograms and 18 MR images of TMJs of patients with the phenomena of compression-dislocation dysfunction. Zonography was perfomed on the ОP-6 «PantOs», CT scans of TMJ with using of the High Speed DX/I «Siemens», MRI investigation on the apparatus «Siemens Magnetom Aera». Results. On the zonography of TMJ with the closed mouth, the patients noticed a significant narrowing of the articular cavity in the upper and posterior sections on the side of pain phenomena (the condition of compression of the bilaminar zone) and an expansion in the posterior and antero-superior sections on the opposite side. At the same time, the articular head with the mouth open on the side of pain phenomena was on the posterior slope of the articular tubercle without extending to its apex, “drowned” in the articular depression, and on the opposite side it extended to the apex of the articular tubercle anteriorly. Computer tomograms more clearly show anatomical disorders of the joints of the bone components of the articular heads. According to the results of lateral sections of the MRI, the joint disc on the side of painful phenomena with the mouth closed was compressed, which explains the narrowing of the joint gap in the upper and posterior compartments. With the open mouth, the articular disc on the side of the painful phenomena shifted slightly together with the articular head to the front. On the opposite side, where the articular head extended beyond the top of the articular tubercle forward, the articular disc remained in place. The data obtained explain the mechanism of development of painful symptom in compressiondislocation TMJ dysfunction, which consists in displacement of the articular disc in the joint on this side forward and compression in the corresponding articulation behind, compression of the articular head of a large plexus of nerve fibers and vessels located here. Conclusions. Analysis of the results of zonography, CT and MRI studies of the TMJ in patients with compressiondislocation dysfunction has determined the objective relations of all anatomical components of both TMJs and cause of compression pain full symptom, which makes it possible to effectively treat the disease.

Keywords

• tmj
• dysfunction
• zonography
• computer tomography
• magnetic resonance imaging.