1. Temporomandibular joint disc pathology; Correlation between the Clinical, Radiologic, Surgical findings and the Outcome. Mousa A. (PhD, MRCSEd). AlBabtain Centre for Burn & Plastic surgery- Ibn Sina Hospital.
Introduction
Temporomandibular joint dysfunction is defined as heterogeneous collection of signs and symptoms that can be generally characterized by the presence of pain, TMJ noise, and disruption of normal function of the joint as limitation of jaw motion. It includes clinical problems that involve maticatory musculature, joint, or both. TMDs can be caused by many etiological factors, which may be overlapped and/or exacerbated by each other. Etiological causes like trauma history, irregularities in occlusion, and myofascial pain.
Patients & methods
The study included 30 patients aged between years (mean 32.2 years) of both sexes; 11 males and 19 females. The main complains were pain and tenderness in TMJ region, clicking or popping sound, with/without limited mouth opening.
Clinical assessment: History taking and questionnaire, Clinical Examination
TMJ examination: Range of motion, TMJ palpation, Joint auscultation.
Radiologic assessment: Panorama, CT scan, Magnetic resonance imaging (MRI).
Management of disc pathology: Initial conservative management, then Operation by Disc exploration procedure (arthrotomy): Disc plication with repositioning, Disc suspension with/without high condylar head shave, and Discectomy.
Result:
1 - MRI proved superiority over other radiologic modalities in disc pathology diagnosis.
2 - Percentage of clinically diagnosed Disk displacement with reduction (DDWR)compatible with MRI was 67.8% (19 joints with DDWR were compatible with same radiologic diagnosis, and 9 joints with DDWR were missed clinically). Percentage of clinically diagnosed joints with Disk displacement without reduction (DDWOR) compatible with MRI was 72.2% (16 joints were diagnosed as DDWOR compared to 22 joints with same diagnosis by MRI).
3 - Nine cases with disc displacement were missed clinically and were detected by MRI; 3 joints of them with DDWR and 6 with DDWOR.
4 - Accuracy of clinical assessment of joints with DDWR in relative to surgical findings was 50% (i.e.: 3 joints out of 6 were correctly diagnosed by clinical examination).
5 - Accuracy of clinical assessment for joints with DDWOR in relative to surgical findings was 66.6% (i.e.: 16 joints out of 24 were correctly diagnosed by clinical examination).
6 - Comparison of MRI with surgical findings in surgically operated cases revealed the followings: Accuracy of MRI assessment for joints with DDWR in relative to surgical findings was 83.3% (i.e.: 5 joints out of 6 were correctly diagnosed by MRI). Accuracy of MRI diagnosis for joints with DDWOR in relative to surgical findings was 91.6% (i.e.: 22 joints out of 24 with DDWOR were diagnosed correctly by MRI).
Conclusion: TMJ disc displacement with/without reduction and disc deformation are of the most common causes of TMJ disorders.
- Trauma and anxiety are the main etiologic initiating and perpetuating factors of disc pathology. There is always overlap between etiologic factors.
- Pain or clicking alone are not reliable predictor of TMJ disc displacement.
- There is a strong relationship between maximal mouth opening distance below 38mm and disc displacement without reduction diagnosis.
- MRI is the radiologic image of choice for disc pathology diagnosis
- Management should be started with initial conservative management.
- Surgery is the only choice of management of advanced disc pathology disorders .
- Arthrotomy (open disc surgery) procedures showed acceptable results and solved most disc displacement pathology complain.
Acknowledment: My special thanks & gratitude to Prof. Hassan Badran, (Plastic surgery department - Ain Shams University- Cairo), Prof. Mohamad Almassry( Alexandria University- maxillofacial & Oral surgery dep.), Prof. Ayman Abomakarem Shaker (Plastic surgery department - Ain Shams University- Cairo) for their endless assistance , sincere advices, & scientific revisions and help to achieve this study.