• A retrospective analysis of 540 operated cases (740 joints) of internal derangements of the temporomandibular joint was carried out Observations of this patient population provided the basis for describing pathological variations of internal derangements Radiologic studies, including tomograms and arthrograms or magnetic resonance scans, and surgical/pathological findings were correlated with clinical data in each case It was found that clinical manifestations varied in a characteristic way and were directly related to the degree of pathological change and time course Various stages of internal derangements were identified Pathophysiological mechanisms responsible for the observed changes, as well as clinical signs and symptoms and causal factors, were discussed Internal derangements are organic lesions that appear to be progressive and are probably of traumatic origin The view is given that internal derangements represent the basic pathological entity responsible for clinical manifestations of what has been known as the temporomandibular joint pain-dysfunction syndrome or similarly described conditions Effective clinical management takes on new importance because progression to advanced degenerative states may occur (Arch Otolaryngol Head Neck Surg1989;115:469-477)

Internal Derangements of the Temporomandibular Joint: Pathological Variations

Objective As part of the Multisite Research Diagnostic Criteria For Temporomandibular Disorders (RDC/TMD) Validation Project, comprehensive temporomandibular joint diagnostic criteria were developed for image analysis using panoramic radiography, magnetic resonance imaging (MRI), and computerized tomography (CT). Study design Interexaminer reliability was estimated using the kappa (κ) statistic, and agreement between rater pairs was characterized by overall, positive, and negative percent agreement. Computerized tomography was the reference standard for assessing validity of other imaging modalities for detecting osteoarthritis (OA). Results For the radiologic diagnosis of OA, reliability of the 3 examiners was poor for panoramic radiography (κ = 0.16), fair for MRI (κ = 0.46), and close to the threshold for excellent for CT (κ = 0.71). Using MRI, reliability was excellent for diagnosing disc displacements (DD) with reduction (κ = 0.78) and for DD without reduction (κ = 0.94) and good for effusion (κ = 0.64). Overall percent agreement for pairwise ratings was ≥82% for all conditions. Positive percent agreement for diagnosing OA was 19% for panoramic radiography, 59% for MRI, and 84% for CT. Using MRI, positive percent agreement for diagnoses of any DD was 95% and of effusion was 81%. Negative percent agreement was ≥88% for all conditions. Compared with CT, panoramic radiography and MRI had poor and marginal sensitivity, respectively, but excellent specificity in detecting OA. Conclusion Comprehensive image analysis criteria for the RDC/TMD Validation Project were developed, which can reliably be used for assessing OA using CT and for disc position and effusion using MRI.

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Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analysis.

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

https://www.dental.theclinics.com/article/S0011-8532(13)00031-1/pdf

Epidemiology, Diagnosis, and Treatment of Temporomandibular Disorders

Various imaging techniques for the temporomandibular joint are discussed with respect to uses, strengths, and limitations. An imaging protocol is outlined for evaluating patients with a wide variety of temporomandibular joint related signs and symptoms.

Imaging of the temporomandibular joint: A position paper of the American Academy of Oral and Maxillofacial Radiology

Internal derangement of the temporomandibular joint: Morphologic description with correlation to joint function

The risk of damage to facial nerve, superficial temporal vessels, disk, and articular surfaces during arthroscopic examination of the temporomandibular joint

Arthrography of the temporomandibular joint is widely performed in clinical practice The diagnostic accuracy of this technique has not been systematically evaluated Therefore, findings from transcranial single-contrast, lower-compartment videoarthrography of 58 temporomandibular joint autopsy specimens were correlated with postmortem morphology Arthrographic diagnosis of disk position and perforation was confirmed in 47 joints (81%) Misinterpretations were made in 11 joints; nine concerned disk position and two concerned perforation Analysis of the misinterpretations revealed that inability of arthrography to allow differentiation of lateral from medial resulted in four false-negative diagnoses and one false-positive diagnosis Variation of joint anatomy with disk deformation resulted in four false-positive diagnoses of anterior disk position The number of false diagnoses in clinical practice might be reduced if transcranial single-contrast, lower-compartment videoarthrography is followed by multila

Jonas Liedberg

Papers

Internal derangement of the temporomandibular joint: Morphologic description with correlation to joint function

The risk of damage to facial nerve, superficial temporal vessels, disk, and articular surfaces during arthroscopic examination of the temporomandibular joint

Temporomandibular joint: correlation between single-contrast videoarthrography and postmortem morphology.

Sideways and rotational displacement of the temporomandibular joint disk: diagnosis by arthrography and correlation to cryosectional morphology.

Diagnostic accuracy of upper compartment arthroscopy of the temporomandibular joint: Correlation with postmortem morphology