Ross H. Tallents

Classification and prevalence of temporomandibular joint disk displacement in patients and symptom-free volunteers

The purposes of this study were to develop a classification system for disk displacement in the temporomandibular joint (TMJ) and to study the prevalence of the various types of TMJ disk displacement in patients and symptom-free volunteers. The study was based on bilateral MRIs of 243 patients and 57 symptom-free volunteers. Eight different types of disk displacements were identified in addition to the superior disk position and a tenth indeterminate category. Superior disk position was observed bilaterally in 18% of the patients and bilaterally in 70% of the symptom-free volunteers.

Anatomic disorders of the temporomandibular joint disc in asymptomatic subjects

PURPOSE This study determined the prevalence and specific anatomic types of disc displacement in asymptomatic versus symptomatic subjects using magnetic resonance imaging (MRI). PATIENTS AND METHODS A detailed MRI assessment was performed on both temporomandibular joints (TMJ) in 76 volunteers and 102 successive patients. Attention was placed on the functional aspects of disc displacement with and without reduction and on the anatomic aspects of disc displacement in the anterior, lateral, medial, anterolateral, and anteromedial directions. These assessments were made by radiologists blinded to the clinical information. RESULTS Disc displacement was found in at least one joint in 25 of 76 (33%) of asymptomatic subjects and 79 of 102 (77%) of symptomatic subjects. The anatomic types of disc displacement between groups was not statistically significant (P = .55). However, there was a significant difference between asymptomatic and symptomatic subjects, with an odds ratio of 3.91 for disc displacement with reduction and 42.71 for disc displacement without reduction (P < .001). CONCLUSION Although there was a 33% prevalence of disc displacement in asymptomatic volunteers, there was a highly significant difference in the prevalence of internal derangement in symptomatic subjects. Bruxing was statistically linked to TMJ disc displacement and could explain the anatomic variation in abnormal disc position.

Magnetic resonance imaging of the temporomandibular joint meniscus

This report describes early experience with magnetic resonance imaging (MRI) of the temporomandibular joint meniscus in which surface coil technology was used. The results suggest remarkable imaging capabilities and speed with noninvasive methods.

Prevalence of temporomandibular joint internal derangement in patients with craniomandibular disorders

To determine the prevalence of temporomandibular joint internal derangement in patients with signs and symptoms of craniomandibular disorders, bilateral imaging was performed in a consecutive series of 115 patients with signs and symptoms of craniomandibular disorders. Ninety patients (78%) had different stages of unilateral or bilateral internal derangement, and 25 patients (22%) had normal temporomandibular joints bilaterally. Out of 230 joints, 60 showed disk displacement with reduction, 8 showed disk displacement without reduction, and 29 showed disk displacement without reduction associated with anthrosis. The study indicates that almost 80% of patients with signs and symptoms of craniomandibular disorders have different forms of internal derangement.

Accuracy of clinical diagnosis for TMJ internal derangement and arthrosis

This study investigated the accuracy of clinical examination in determining the status of the temporomandibular joint with respect to internal derangement and arthrosis. A series of 110 patients was given standard clinical examinations followed by bilateral imaging with arthrography and/or magnetic resonance imaging. There was agreement between the clinical diagnosis and the imaging finding in 95 joints (43%). In the other 125 joints (57%), the clinical diagnosis did not agree with imaging findings. There were false-positive clinical diagnoses in 39 joints and false-negative clinical diagnoses in 31 joints. In the other 55 joints the clinical diagnosis correctly indicated that the joint was abnormal but was incorrect about the stage of abnormality. On the basis of the overall diagnostic accuracy of 43%, it was concluded that a clinical examination is not reliable for determining the status of the joint in patients with signs and symptoms of temporomandibular joint internal derangement.

Temporomandibular joint sounds in asymptomatic volunteers

Abnormalities within the temporomandibular joints often produce audible sounds. Electronic recording of joint sounds has been used as a method of staging internal derangement. This study had three objectives: first, to determine whether the characterization of temporomandibular sounds can provide a sensitive and accurate measure for the presence or absence of joint abnormalities in asymptomatic volunteers; second, to evaluate the reproducibility of the sounds, when present, with successive recordings; and third, to evaluate the sound characteristics to determine their predictability for the types of internal derangement. Fifty asymptomatic volunteers (100 joints) were evaluated with an electronic device for the presence of joint sounds. Of the patients, 24% (N = 50, five men and seven women) (16% of all joints) had one or two abnormal joints as diagnosed by magnetic resonance imaging. Forty-four percent of all joints had identifiable sounds; 50% of the sounds were produced when the condyle was located at the apex of the articular eminence. Sounds often occurred in the early opening phase of jaw movement in joints diagnosed as normal by magnetic resonance imaging. Finally, the characteristics of these events did not produce adequate separation to stage the internal derangement.

Bilateral internal derangements of temporomandibular joint: Evaluation by magnetic resonance imaging

Two hundred eleven patients with signs and symptoms of temporomandibular joint (TMJ) internal derangements were referred for magnetic resonance imaging. Both TMJs of each patient were routinely evaluated in this prospective investigation. With 422 joints examined, 29% (61) of the patients had bilaterally normal findings, 21% (45) of the patients had one normal side and one abnormal side, and 50% (105) of the patients showed bilateral internal derangements. This clinical study demonstrated a high likelihood of bilateral internal derangements in patients with symptoms of TMJ internal derangements.

The clinical predictability of internal derangements of the temporomandibular joint

The value of clinical parameters as predictors of the arthrographic findings in patients with temporomandibular joint (TMJ) pain and dysfunction was examined in this study. We developed a series of simplified clinical prediction rules based on previous studies correlating clinical signs and symptoms with arthrographic diagnosis of the condition of the TMJ meniscus. One hundred eighty-six patients with signs and symptoms of TMJ dysfunction were clinically examined before TMJ arthrography. Arthrograms were performed on 246 joints (126 unilateral, 60 bilateral). The rules predicted 91 of the 246 joints to be normal when actually 59 were shown to be normal arthrographically. The rules slightly underpredicted those patients with positive arthrographic findings for internal derangements. Although there were some individual variations in the predictability of unilateral versus bilateral arthrograms (patients), there was very little overall difference, 58% and 60%, respectively. This study confirms previous suggestions that clinical findings alone are not consistently accurate in diagnosing the exact type of TMJ internal derangements depicted by arthrographic criteria.

Orthodontics and temporomandibular joint internal derangement

The purpose of this investigation is to compare the prevalence of internal derangement of the temporomandibular joints (TMJ) in asymptomatic volunteers versus symptomatic subjects using magnetic resonance imaging (MRI), with a detailed comparison to clinical signs and symptoms and with attention to a prior history of orthodontic treatment. Bilateral MRI scans were obtained of the TMJs in 76 asymptomatic volunteers and 102 symptomatic patients. A comparison was made to the clinical signs and symptoms, a history of orthodontic treatment, and to the MR findings. The MRI scans were reviewed using established criteria for disk displacement and the reviewers were blinded as to the clinical information. Our results show a prevalence of disk displacement in 25 of 76 (33%) volunteers and 79 of 102 (77%) patients with a statistically significant difference (p < 0.001). No statistical link was noted between a history of prior orthodontic treatment and internal derangement of the TMJ.

Magnetic resonance imaging findings in asymptomatic volunteers and symptomatic patients with temporomandibular disorders

Internal derangement has been suggested to be a cause of temporomandibular disorders. This study compared magnetic resonance imaging findings in 82 asymptomatic volunteers and 263 symptomatic patients. Disk displacement was observed in 33% of the asymptomatic volunteers and 84% of the symptomatic patients. The prevalence of trauma, headache, and other joint problems was more common in symptomatic patients. A history of general anesthesia and orthodontic treatment was not increased in the symptomatic population compared with asymptomatic volunteers. This study suggests that disk displacement is more common in symptomatic subjects.