RESUMO
The aim of this study was to investigate temporomandibular joint (TMJ) pain and magnetic resonance imaging characteristics in 104 TMJs with and 58 without degenerative changes of the condyle, such as osteophytes, erosion, avascular necrosis, subcondral cyst and intra-articular loose bodies. TMJ images were also assessed for flattening, retropositioning and hypomobility of condyle and disc displacement. Comparison of the TMJ side-related data showed a significant relationship between disc displacement without reduction (DDwoR) and the presence of degenerative bony changes (p=0.00). Flattening, retropositioning and hypomobility of condyle showed no significant difference in relation to the presence or absence of degenerative bony changes. Retropositioning of the condyle was significantly associated to disc displacement with reduction (DDwR) (p=0.00), while condylar hypomobility was significantly more frequent in TMJ with DDwoR (p<0.05). Independent of the presence or type of DD, TMJ pain was more frequent in the presence of degenerative bony changes. When considering only DDwR, TMJ pain was significantly associated to a degenerative condition (p=0.03). When there were no degenerative bony changes, TMJ pain was significantly more frequent in DDwoR (p=0.04). Despite the present findings, the absence of symptoms in some patients with condylar bony changes suggests that the diagnosis of osteoarthritis should be established by evaluation of magnetic resonance images in association with clinical examination.
Assuntos
Imageamento por Ressonância Magnética/métodos , Côndilo Mandibular/patologia , Transtornos da Articulação Temporomandibular/diagnóstico , Adolescente , Adulto , Idoso , Cistos Ósseos/diagnóstico , Cistos Ósseos/patologia , Dor Facial/diagnóstico , Dor Facial/patologia , Feminino , Humanos , Luxações Articulares/diagnóstico , Luxações Articulares/patologia , Corpos Livres Articulares/diagnóstico , Corpos Livres Articulares/patologia , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico , Osteoartrite/patologia , Osteonecrose/diagnóstico , Osteonecrose/patologia , Osteófito/diagnóstico , Osteófito/patologia , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Disco da Articulação Temporomandibular/patologia , Transtornos da Articulação Temporomandibular/patologiaRESUMO
A case is reported of a 43-year-old female patient presenting bilateral osteochondritis dissecans (OCD) of the temporomandibular joint (TMJ), in different stages for each side, associated with avascular necrosis (AVN) of the right condyle. Additionally observed was anterior disk displacement without reduction for both sides. We have proposed an adaptation of the previous classification of OCD for cases affecting the TMJ. We have also stressed the fundamental role of panoramic radiography on the diagnosis of stage 3 and stage 4 OCD of the TMJ. In relation to MRI, we have recommended sagittal (slice thickness of 2 mm) and coronal (slice thickness of 1 mm) fast spin-echo proton density-weighted sequences to better identify bone lesions (stage 1 and 2) and also localize osteochondral loose bodies; and coronal (slice thickness of 1 mm) fat-suppressed fast spin-echo T2 weighted sequence to better evaluate OCD (stable or unstable) and the features of the occasionally associated AVN (acute or chronic).
Assuntos
Osteocondrite Dissecante/diagnóstico , Transtornos da Articulação Temporomandibular/diagnóstico , Adulto , Feminino , Humanos , Aumento da Imagem , Luxações Articulares/diagnóstico , Corpos Livres Articulares/diagnóstico , Imageamento por Ressonância Magnética , Côndilo Mandibular/patologia , Doenças Mandibulares/diagnóstico , Osteocondrite Dissecante/classificação , Osteonecrose/diagnóstico , Radiografia Panorâmica , Disco da Articulação Temporomandibular/patologiaRESUMO
A 25-year-old active-duty police officer was found to have an intra-articular foreign body on radiographic study of his left knee joint. He had a gunshot wound to the midthigh 54 months prior to the presentation of symptoms. The bullet was lodged in the soft tissue without involving neurovascular structures. The patient complained of limited range of motion of the joint and a "rattle" sensation of the knee. Arthroscopically, a deformed metallic foreign body was found and retrieved. There was no injury inside the joint related to the loose body. These findings were consistent with a migrating bullet from the midthigh to the knee joint. The patient recovered uneventfully and returned to work.