Characteristics of Articular Fossa and Condyle in Patients With Temporomandibular Joint Complaint

8/10/2019 Characteristics of Articular Fossa and Condyle in Patients With Temporomandibular Joint Complaint

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Abstract. OBJECTIVES: To investigate thetemporomandibular joint (TMJ) characteristics of

patients who have temporomandibular disordercomplaints with multislice computed tomogra-phy imaging.

PATIENTS AND METHODS: Between January2011 and March 2012, 37 patients whose ageranged from 18 to 60 years underwent Computedtomography imaging of the bilateral temporo-mandibular joints for TMJ complaints at our Insti-tution. Twenty one patients without temporo-mandibular joint complaints serves as controlgroup. Differences between the mean depths ofthe right and left side mandibular fossa and com-parisons between patient and control groupswere assessed by analysis student t test.

RESULTS: The age range of 37 patients (28 fe-males and 9 males) was 18 to 60 (mean age: 37.5)years. The mean depths of the mandibular fossawere 8.56 0.8 mm and 8.71 0.7 mm for the rightand left sides (p < 0.05). The mean anterior jointspaces were 1.920.6 mm and 2.100.7 mm forthe right and left sides, respectively (p> 0.05). Themean superior joint spaces were 2.980.7 mmand 2.820.8 mm for the right and left sides (p >0.05). The mean posterior joint spaces were2.310.7 mm and 2.170.6 mm for the right andleft sides, respectively (p> 0.05).

The mean values for the measurement of theanteroposterior (AP) diameter of the condylarprocess were 7.561.1 mm for the right side and

7.231.3 mm for the left side (p> 0.05).The meanvalues for the measurement of the mediolateral(ML) diameter of the condylar process were16.972.1 mm for the right side and 17.172.7mm for the left side (p> 0.05).

CONCLUSIONS: Measurements of mandibularfossa and joint space had not differ in patientsof TJS (temporo joint space). But, AP and MLmeasurements of condyles were statistically dif-ference between patients and controls.

Key Words:Temporomandibular joint, Computed tomography,

Diagnosis.

EuropeanReview forMedical andPharmacologicalSciences

Characteristics of articular fossa andcondyle in patients with temporomandibular

joint complaintA. OKUR*, M. ZKIRIS**, Z. KAPUSUZ**, S. KARAAVUS***, L. SAYDAM

Department of Radiology; *Department of Otolaryngology, Head and Neck Surgery and**Department of Nuclear Medicine, Bozok University Medical Faculty, Yozgat, Turkey

Corresponding Author:Mahmut zkiris, MD; e-mail: [email protected] 2131

Introduction

The expression temporomandibular disorders(TMDs) is a collective term embracing a num-ber of clinical problems that involve the mastica-tory musculature, the temporomandibular con-sists of patient history, physical evaluation and,in most chronic cases, behavioral joint (TMJ)and associated structures, or both1. The goldstandard of diagnosis of TMDs consists of pa-tient history, physical evaluation and, in mostchronic cases, behavioral or psychological as-sessments. Treatment has been also plannedbased on symptoms such as dysfunction and/or

pain

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.Controversy exists over the value of the tem-poromandibular joint (TMJ) condylar position inthe fossa. Many clinicians associate the concen-tric position to the normal individuals and theretruded position to the dysfunctional condition.The condylar position is an end product of manydynamic changes such as growth and remodel-ing, functional matrix activities, occlusal alter-ation2. It is suggested that diagnosis and treat-ment of TMJ disorders should not be based sole-ly on the radiographics position of the condyle.Consideration of general body conditions is an

essential part of total patient management. Theoptimal condylar position has been a controver-sial subject in dentistry for many years3.

Several imaging techniques exist for evaluat-ing the TMJ. X-Ray and panoramic imaging canbe used for initial screening for osseous abnor-malities and to rule out gross pathology such asfractures and advanced degenerative joint dis-ease. Magnetic resonance imaging (MRI) pro-vides optimal information about the disk and itsrelationship. Computed tomography (CT) is theimaging method of choice for the evaluation of

the osseous anatomy and lesions of the TMJ4

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Characteristic Value

Gender Female 28Male 9

Age Female 36.93 15.6Male 39.50 13.8

Joint Right 19Left 18

Clinical Pain during palpation 37characteristics Joint sound 13

Difficulty of movements 11Denture 8

Table I.Demographic characteristic of all patients.

Figure 1.A, CT images; right, greatest mediolateral diam-eter of the mandibular condylar process; left, greatest an-teroposterior diameter of the mandibular condylar process.

B,CT images; depth of mandibular fossa.

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The purpose of this study was to emphasize thejoint characteristics of patients with TMJ com-plaints, using multislice CT imaging technique.

Patients and Methods

Thirty seven patients (28 women, 9 men) withTMJ complaints such as TMJ pain during palpa-tion, joint sounds, difficulty of jaw movementsand chewing, underwent computed tomography(CT) imaging of the bilateral TMJs. Patients witha history of general arthritis or other connectivetissue diseases, treatment with immunosuppres-sive drugs, any organ diseases, general infection,and trauma-induced joint disorders, age under 18

or over 60 years were excluded from the study.Twenty one patients (15 women, 6 men) with-

out TMJ complaints age ranged from 18 to 60years serves as control group (Table I). The con-trol group was comprised of patients withparanasal sinus tomography because of the TMJcould be viewed by paranasal CT. All patientswere informed and provided written consent ac-cording to the principles presented in the Decla-ration of Helsinki. The study was approved bythe Ethics Committee of Bozok University Med-ical Faculty. All patients were evaluated by mul-

tislice computed tomography examinations(MSCT; Philips Medical System, Brillance 64,Best, The Netherlands) in the supine position.After lateral scenograms, examinations consistedof 0.625 mm-thickness images with bone algo-rithms. Axial images were obtained for the TMJand were constituted reformat coronal and sagit-tal images with bone and soft tissue algorithms.Depth of the mandibular fossa, anterior jointspace, superior joint space and posterior jointspace were determined based on sagittal plane

images. The measurements of sagittal plane wereperformed from the most inferior point of audito-ry meatus. The greatest anteroposterior diameterof the mandibular condylar process and the great-est mediolateral diameter of the mandibularcondylar process were described based on axialplane images5,6 (Figure 1).

Statistical AnalysisThe SPSS software program version 13.0 (SPSS

Inc., Chicago, IL, USA) was used for data manage-ment and statistical analyses. Parameters were ex-pressed as mean SD. Differences between themean depths of the right and left side mandibularfossa and comparisons between patient and controlgroups were assessed by analysis student ttest. Sta-

tistical significance was considered at p< 0.05.

Results

Between January 2011 and March 2012, 37patients whose age ranged from 18 to 60 years

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Patient group Control group

Right side Left side Right side Left sidemean SD mean SD p mean SD mean SD p

Depth mandibular fossa 8.56 0.8 8.71 0.7 > 0.05 9.09 1.1 9.09 1.1 > 0.05Anterior joint space 1.92 0.6 2.10 0.7 > 0.05 1.9 0.6 1.87 0.6 > 0.05Superior joint space 2.98 0.7 2.82 0.8 > 0.05 2.65 0.6 2.51 0.6 > 0.05Posterior joint space 2.31 0.7 2.17 0.6 > 0.05 1.91 0.5 1.85 0.6 > 0.05Mediolateral diameter of condylar process 16.97 2.1 17.17 2.7 > 0.05 18.38 3.5 18.09 2.3 > 0.05Anteroposterior diameter of condylar process 7.56 1.1 7.23 1.3 > 0.05 7.93 2.3 7.66 1.0 > 0.05

Table II.Scanning parameters for CT imaging (mm).

Characteristics of articular fossa and condyle in patients with temporomandibular joint complaint

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condyle are smooth and the condyle is placedsymmetrically in the fossa. The joint space isuniform7. The distribution of functional load maybe different according to morphology of joint.Since, shape and function are closely related, itcan be suggested that both the condyle and themandibular fossa may differ in shape in subjectswith various TMJ complaints8.

TMJ pain and disfunction are common andimportant clinical problems7. SymptomaticTMJ dysfunction affects 28% of the adult pop-ulation, of which a smaller, but significant, per-centage experiencing severe impairment. It isestimated that 17,800,000 workdays are losteach year for every 100,000,000 full-timeworking adults in the United States due to dis-

abling temporomandibular disorders9. The clin-ical problem is complex, because TMJ dysfunc-tion is multifactorial.

Computed tomography (CT) is an excellenttool for evaluating the normal anatomy of TMJ.CT scanning can depict bony and soft-tissuechanges that are not detectable using convention-al radiography. CT scanning remains the goldstandard for cross sectional anatomy of theTMJ10. Moreover, shorter scan times and refor-matting techniques such as multiplanar recon-struction provide invaluable advantages over sin-

gle section scanners

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. CT is also frequently usedfor evaluation of potential pathology in the near-by tissues. Although MRI has certain advantagesin evaluation of soft tissues, CT gives excellentinformation regarding the soft tissues and has thebenefit of providing detailed images of the neigh-boring parts of temporal bone and skull base4,10.

As a rule form and function are considered tobe closely linked, within this context the mor-phology of the TMJ might be related to function-al forces. Because the mandible and TMJ can beloaded differently in person with diverse dentofa-cial morphologies11.

(mean age: 37.5) underwent CT imaging of thebilateral TMJs for TMJ complaints at our Institu-tion. Of these, 28 were female and 9 were male.Joint complaints of nineteen patients were at theright side and eighteen patients were at the leftside. The descriptive statistics for each measure-ment are shown in Table II. The mean depths ofthe mandibular fossa were 8.56 0.8 mm and8.71 0.7 mm for the right and left sides (p 0.05). The mean su-perior joint spaces were 2.980.7 mm and2.820.8 mm for the right and left sides (p >0.05). The mean posterior joint spaces were2.310.7 mm and 2.170.6 mm for the right and

left sides, respectively (p> 0.05).The mean values for the measurement of the

anteroposterior diameter of the condylar processw e r e 7 . 5 6 1 . 1 m m f o r t h e r i g h t s i d e a n d7.231.3 mm for the left side (p > 0.05). Themean values for the measurement of the medio-lateral diameter of the condylar process were16.972.1 mm for the right side and 17.172.7mm for the left side (p> 0.05).

Discussion

The temporomandibular joint is a synovialjoin t whic h is formed by th e condyl e of th emandible, mandibular fossa and articular emi-nence of the temporal bone at the base of theskull4. Unlike most other joints of the body,which have cartilaginous coverings, the articulat-ing surfaces of the TMJ are covered by a thinlayer of dense fibrous tissue. Mediolateral di-mension of condyle is approximately twice thananteroposterior dimension of condyle. Mandibu-lar condyle is oriented perpendicular to the ramusof the mandible. The articular surfaces of


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Several papers pointed out that the relation-ships between the disc position and condyle po-sition. Burley12, evaluated the articular struc-tures of the temporal bone in patients with dif-ferent types of malocclusions (Classes I, II, andIII) and showed that they do not produce func-tional stimuli capable of altering the contour ofthe anterior wall of the mandibular fossa. Therehas been limited information about the relation-ship between the clinical signs or symptoms andthe condyle position.

Most studies aiming at the evaluating the TMJby means of CT have considered malocclusionjoint5,6,13,14. In this study, by using the same meth-ods, comparison a statistical was performed be-tween the findings obtained from the patients

with temporomandibular joint syndrome and nor-mal subjects. Christiansen et al15 observed intheir CT study that anterosuperior joint spacewas smallest in normal TMJ compared with thesuperior and posterosuperior joint space. Ikedaand Kawamura16 f o un d t h at n o nc e nt e r edcondyles, with posterior joint space larger thanthe anterior joint spaces. In our study, we foundthat anterior joint space was smallest and superi-or joint space was largest in patients with TMJcomplaints and controls statistically. There wasno significant difference between the two groups.

The axial slice is the most appropriate ap-proach to assess the symmetry between thecondyles in the anteroposterior (AP) and medio-lateral (ML) aspects.This also permits measuringthe real dimensions of the condyles1. Our find-ings did not show statistically significant differ-ences between the right and left condylarprocess. But, there was statistically difference be-tween patients and controls in of AP and MLmeasurements of condyle. Measurements ofcondyle were found smaller in patient with TMJcomplaints.

Condyle and fossa differ in shape among pa-

tients with malocclusion, that is still controver-sial. While some investigators showed correla-tions between these two variables, the others re-ported no relationship between them. The sagittalslice is the most appropriate for assessing thecondyle-fossa relationship. The depth of themandibular fossa can also be determined by thistechnique1. Our results showed no significant dif-ferences between the right and left sides for ante-rior, superior, posterior articular spaces and depthof fossa. This similarity can be explained becauseof the fact that it can be affected by the two sides,

although patients have unilateral symptom.

All measurements of left joint were larger thanmeasurements of right joint in patient with TJS. Incontrast, measurements of left joint were smallerthan right joint in controls. In our study, condyleirregularity was demonstrated in some subjectswith of no clinical and statistical significance.

Conclusions

Measurements of mandibular fossa and jointspace do not have any differences in patients oftemporo joint spaces (TJS). However, AP andML measurements of condyles were statisticallydifference between the patients and controls.

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Characteristics of articular fossa and condyle in patients with temporomandibular joint complaint

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Characteristics of Articular Fossa and Condyle in Patients With Temporomandibular Joint Complaint