Reliability of magnetic resonance for temporomandibular joint disc perforation: A 12 years retrospective study.

The aim of this study was to evaluate the reliability of magnetic resonance imaging (MRI) in detecting disc perforations in the temporomandibular joint (TMJ), and to establish diagnostic criteria for this purpose. The retrospective analysis included patients who had undergone preoperative MRI and TMJ arthroscopy at the same hospital. Direct and indirect signs of disc abnormalities on MRI were compared with arthroscopic findings of disc perforation. Out of 355 joints evaluated in 185 patients, arthroscopy confirmed disc perforations in 14.7% of cases. Several MRI findings were significantly associated with disc perforation, including anterior disc displacement without reduction (ADDwoR), signal alterations in the mid-disc area, disc deformity (SAMD), retrocondylar disc fragments, osteophytes, condylar bone marrow degeneration (CBMD), and joint effusion in both joint spaces (ESJS-EIJS). Regression analysis revealed that SAMD, osteophytes, and CBDM were strongly associated with disc perforation. The ROC curve showed that MRI had an AUC = 0.791, with a sensitivity of 88.5% and a specificity of 61.5%. Two diagnostic methods, one based on three findings (osteophytes, ADDwoR, and SAMD) and one based on two direct signs (ADDwoR and SAMD), yielded high sensitivity and specificity values of 80.4% and 69.8%, and 84.3% and 62.5%, respectively. In conclusion, MRI demonstrated acceptable accuracy in the detection of TMJ disc perforations, with specific diagnostic criteria offering high sensitivity and specificity. Significant MRI indicators of disc perforation included SAMD, osteophytes, and CBDM. This study provides valuable information on the use of MRI as a diagnostic tool for TMJ disc perforations.

Airways cephalometric norms from a sample of Caucasian Children.

BACKGROUND: The diagnosis of the respiratory pattern and the analysis of airway dimension using lateral cephalometric radiographs include the study of the adenoid region, free air space of the nasopharynx and oropharynx, soft palate and posterior part of the tongue. The objective of this study is to identify the airways cephalometric norms from a sample of Caucasian children, in relation to gender, age and type of malocclusion. MATERIAL AND METHODS: A total of 480 patients of both sexes were included in the study, the age ranged between 6-12 years. The radiographic records were analyzed using the Nemoceph® 11.3.0 software and the diagnosis of skeletal class was performed using the Steiner analysis. The cephalometric measurements used for the study were PNS-AD1, AD1-Ba, PNS-Ba, Ptm-Ba, PNS-H and the upper and lower airways according to McNamara analysis. The comparative analysis was performed using only upper and lower airways variables. RESULTS: The mean values for each variable in the total sample were 23.2 mm (PNS-Ad1), 24.7 mm (Ad1-Ba), 47.6 mm (PNS-Ba), 45.7 mm (Ptm-Ba), 30.0 mm (PNS-H), 9.3 mm (upper airway) and 11.5 mm (lower airway). According to gender, all variables were greater in the boys group except for the lower airway. In relation to age, the mean values increased with age except for the lower airway and the AD1-Ba variables. In patients with skeletal Class I greater dimensions of the upper and lower airways were observed. CONCLUSIONS: In this Caucasian sample, it has been observed a tendency of minor airway dimensions in patients with skeletal Class II, lower age range female gender. It has been observed only significant differences between age and skeletal class for lower airways variable and, in relation to upper airways variable the results were significant in relation to age. Key words:Child development, Diagnostic XRay, Cephalometry, Respiratory system diagnostic imaging.

Long-term clinical outcomes of arthroscopic discopexy with resorbable pins.

INTRODUCTION: Discopexy using resorbable pins is an arthroscopic technique to treat internal derangement of the TMJ, restoring the normal relationship between disc, condyle, and temporal bone. The objective of our study was to assess the 5-year clinical outcome of a series of patients treated with this technique. METHODS: A study was conducted on a series of patients who underwent arthroscopic discopexy using resorbable pins between January 2007 and February 2018. All the patients were refractory to conservative treatment and classified as Wilkes stage III. Clinical data were recorded at 1-year, 3-year, and 5-year visits. Pre- and postoperative evaluation parameters were: joint pain (VAS scale), mandibular movements (mm), and articular locking and clicking. RESULTS: The study included 33 patients and the technique was performed in 38 joints. Mouth opening increased significantly with each visit after surgery compared with preoperative scores (mean value of 10.65 mm, p < 0.001), with the mean value increasing significantly at the 5-year visit in relation to the mean value obtained at the 3-year visit. Patients reported significant decreases in pain after surgery, obtaining VAS values of under 10 at the 5-year visit (mean improvement of 56.95 points, p < 0.001). CONCLUSIONS: Discopexy using resorbable pins resulted in a good and stable clinical outcome at the long-term follow-up.

Discopexy using resorbable pins in temporomandibular joint arthroscopy: Clinical and magnetic resonance imaging medium-term results.

PURPOSE: To describe the use of resorbable pins for disc fixation in a series of patients and their medium-term outcomes. MATERIALS AND METHODS: A study was conducted in 26 patients who underwent operative arthroscopic surgery and discopexy using resorbable pins. All patients were refractory to conservative treatment and presented, in at least one joint, anterior disc displacement without reduction on magnetic resonance imaging (MRI). Pre- and postoperative evaluation parameters were disc position on MRI, maximal interincisal opening, lateral movements, joint pain, and articular locking and clicking. RESULTS: The technique was performed in 34 joints, and 47 pins were inserted. Mouth opening increased significantly, from a mean of 31.24 mm preoperatively to 39.57 mm 1 year postoperatively (p < 0.05). Patients reported a decrease in pain, obtaining values on a visual analogue scale (1-100) of less than 20 after 1 year postsurgery (mean improvement 47.9 points, p < 0.05). Analyzing 1-year MRI findings, in 65% of joints the discs were repositioned and in 20% of joints discs were in a more posterior position. CONCLUSIONS: The use of resorbable pins is a useful technique for disc fixation and shows medium-term improvement in clinical parameters and mandibular function. However, further studies are needed to evaluate a longer follow-up, joint morphologic changes, and disc stability on imaging.

Relationship between intra-articular adhesions and disc position in temporomandibular joints: Magnetic resonance and arthroscopic findings and clinical results.

OBJECTIVE: The objective of this study was to evaluate the relationship between intra-articular adhesions (IA) and disc position on magnetic resonance imaging (MRI) and direct arthroscopic vision, and to compare the presence of IA and clinical symptoms in patients diagnosed with internal derangements (ID) of temporomandibular joint (TMJ), along with their clinical outcomes. METHODS: A total of 67 patients (134 TMJs) were included in the study. All patients were refractory to previous conservative treatment, and MRI was performed before surgery in all cases. The incidence of IA was evaluated in relation to disc displacement, type of displacement (with or without reduction), and stage of ID according to the Wilkes-Bronstein classification. Patients were divided into an adhesion and non-adhesion group. The association between the two groups with respect to preoperative clinical parameters (maximal interincisal opening, locking duration, joint pain, patient age) and postoperative parameters at 6 and 12 months was evaluated. RESULTS: The incidence of IA was 44% and the most common location was the anterior recess of the joint. IA were found in 58.3% of the joints with disc displacement without reduction, and in 28.9% of those with disc displacement with reduction (p < 0.05). In joints with well-positioned discs, adhesions were found in 15% of the cases. Patient age and locking duration were significantly higher in the adhesions group (p < 0.05). In relation to clinical outcome, there was no clinically relevant difference between groups at 6 and 12 months. CONCLUSIONS: In TMJ with disc displacement without reduction, the presence of IA was significantly higher than in joints with well-positioned discs or displacement with reduction, which leads to the hypothesis that disc hypomobility is an important factor in the genesis of adhesions.