Analysis of related factors to internal derangement in temporomandibular joint dysfunction patients using magnetic resonance imaging

Fumi Mizuhashi; Ichiro Ogura; Yoshihiro Sugawara; Makoto Oohashi; Ryo Mizuhashi; Hisato Saegusa

doi:10.4103/jomr.jomr_11_21

ORIGINAL ARTICLE

Year : 2021 | Volume : 9 | Issue : 2 | Page : 35-39

Analysis of related factors to internal derangement in temporomandibular joint dysfunction patients using magnetic resonance imaging

Fumi Mizuhashi¹, Ichiro Ogura², Yoshihiro Sugawara³, Makoto Oohashi⁴, Ryo Mizuhashi³, Hisato Saegusa³
¹ Department of Removable Prosthodontics, The Nippon Dental University School of Life Dentistry, Niigata, Japan
² Oral and Maxillofacial Radiology, The Nippon Dental University School of Life Dentistry, Niigata, Japan
³ Comprehensive Dental Care, The Nippon Dental University Niigata Hospital, Niigata, Japan
⁴ Dental Anesthesia and General Health Management, The Nippon Dental University Niigata Hospital, Niigata, Japan

Date of Submission	30-Apr-2021
Date of Decision	17-May-2021
Date of Acceptance	20-May-2021
Date of Web Publication	30-Aug-2021

Correspondence Address:
Fumi Mizuhashi
Department of Removable Prosthodontics, The Nippon Dental University School of Life Dentistry, Niigata, 1-8 Hamaura-Cho, Chuo-ku, Niigata, Niigata, 951-8580
Japan

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jomr.jomr_11_21

Abstract

Background/Aim: The aim of this study was to investigate the related factors to internal derangement in the temporomandibular joint (TMJ) dysfunction patients using magnetic resonance imaging (MRI). Methods: We reviewed the MRI of 60 TMJs that were examined MRI and diagnosed with internal derangement. Characteristics of the patients with internal derangement such as gender, age, TMJ pain, disturbance of mouth opening, and joint effusion were examined. Statistical analyses of each characteristic such as gender, TMJ pain, disturbance of mouth opening, and joint effusion were performed by cross-tabulation. The age difference was analyzed using Mann–Whitney test. The relationships between internal derangement and gender, age, TMJ pain, disturbance of mouth opening, and joint effusion were also analyzed by logistic multivariate regression analysis. Results: The occurrence of internal derangement was different by gender (P = 0.021), and the number was larger on women. The presence of disturbance of mouth opening was significantly larger on disc displacement without reduction compared to that on disc displacement with reduction (P = 0.027). Age, TMJ pain, and joint effusion were not different between disc displacement with reduction and disc displacement without reduction. The result of logistic multivariate regression analysis showed that gender and disturbance of mouth opening were related to the higher risk of internal derangement (P < 0.05). Conclusions: These results suggested that internal derangement would be easier to occur on women, and the disturbance of mouth opening was occurring easily on disc displacement without reduction.

Keywords: Internal derangement, magnetic resonance imaging, temporomandibular joint dysfunction

How to cite this article:
Mizuhashi F, Ogura I, Sugawara Y, Oohashi M, Mizuhashi R, Saegusa H. Analysis of related factors to internal derangement in temporomandibular joint dysfunction patients using magnetic resonance imaging. J Oral Maxillofac Radiol 2021;9:35-9

How to cite this URL:
Mizuhashi F, Ogura I, Sugawara Y, Oohashi M, Mizuhashi R, Saegusa H. Analysis of related factors to internal derangement in temporomandibular joint dysfunction patients using magnetic resonance imaging. J Oral Maxillofac Radiol [serial online] 2021 [cited 2023 Mar 29];9:35-9. Available from: https://www.joomr.org/text.asp?2021/9/2/35/325042

Introduction

Temporomandibular joint dysfunction (TMD) is defined as the disorders that involving the masticatory muscles, the temporomandibular joint (TMJ), and the associated structures.^[1] Prevalence of TMD is quite common and the incidence is reported as 28%–69%.^[2],[3],[4] The prevalence of symptoms is mostly pronounced between the age of 20 and 40 years,^[5] and four times higher in women than men in the younger population.^[3],[5],[6] The most common conditions of TMD are pain-related and internal derangement.^[7] Internal derangement has been defined as an abnormal positional relationship between the disc and the condyle, articular eminence, and/or articular fossa,^[8] and one of the most frequent disorders of TMJ.^[9] On internal derangement, anterior disc displacement is most frequently found in comparison to the posterior and lateral dislocation.^[10] Anterior disc displacement may be either anterior displacement with reduction or without reduction.^[11] Anterior disc displacement with reduction is the condition that the disc is anterior to the condyle in the closed mouth position and returns to its normal position when the jaw is opened. On the other hand, anterior disc displacement without reduction in the condition that the disc is anterior to the condyle in the closed mouth position and does not return to its normal position when the jaw is opened.^[12]

Magnetic resonance imaging (MRI) is currently the gold standard for the diagnosis of TMD.^[13],[14] MRI is important to diagnose the internal derangement because it directly visualizes the articular disk in both the open-mouth and closed-mouth positions.^[15] The accuracy of MRI is reported to be 95% in the assessment of disk position or form and 93% in the assessment of osseous changes.^[16] Effusion is the state of accumulation of joint fluid in the joint spaces and surrounding tissue, and joint effusion is defined in MRI as bright T2 signals.^[17]

The correlation between joint pain and disc position has not been cleared enough.^[18] Most cases of disc displacement with reduction are not accompanied by pain; however, some joint inflammation may cause painful symptoms.^[19] The relationship between internal derangement and joint effusion is also still unclear.^[20] Thus, the relationship between the clinical symptoms and MRI findings has not been cleared enough. The aim of this study was to investigate the related factors to internal derangement in TMJ dysfunction patients using MRI.

Methods

This study was approved by the ethics committee of our institution. We reviewed the MRI of 60 TMJs (10 males, 50 females; range age 14–71 years, mean age 43.4 ± 16.5 years) that were examined MRI and diagnosed to internal derangement in TMJ dysfunction in our university hospital from February 2020 to July 2020. The images were independently evaluated by two dentists and any discrepancies were resolved by consensus.

The MRI (1.5 Tesla MR unit; EXCELART Vantage MRT-2003; Canon Medical Systems, Otawara, Japan) with a surface coil for the TMJ included proton density-weighted sagittal and coronal imaging at the closed mouth position and the maximum mouth opening position (repetition time/echo time 2000 ms/18 ms, field of view 130 mm × 130 mm, matrix size 256 × 224 and 1 acquisition) and T2-weighted sagittal and coronal imaging at the closed mouth position and the maximum mouth opening position (repetition time/echo time 3500 ms/100 ms, field of view 130 mm × 130 mm, matrix size 256 × 192 and 2 acquisition).^[21]

Characteristics of the patients with internal derangement such as gender, age, pain, disturbance of mouth opening, and joint effusion were examined. The pain was determined as the pain at TMJ, and disturbance of mouth opening was decided as the mouth opening distance <40 mm. Joint effusion was examined at the T2-weighted imaging on MRI. The relationships between internal derangement and gender, age, TMJ pain, disturbance of mouth opening, and joint effusion were also examined to confirm the related factors to internal derangement in TMJ dysfunction patients.

Statistical analyses of each characteristic such as gender, TMJ pain, disturbance of mouth opening, and joint effusion on the patients with internal derangement were performed by cross-tabulation. When statistical significance was found by cross-tabulation, residual analysis was performed. The age difference was analyzed by Mann–Whitney test. The relationships between internal derangement and gender, age, TMJ pain, disturbance of mouth opening, and joint effusion were analyzed by logistic multivariate regression analysis. Statistical analysis was performed using statistical analysis software (SPSS 17.0, SPSS JAPAN, Tokyo, Japan), and differences of α < 0.05 were considered significant.

Results

[Figure 1] indicates MR image of one patient with disc displacement with reduction, and [Figure 2] indicates MR image of one patient with disc displacement without reduction.

Figure 1: Magnetic resonance imaging of the right temporomandibular joint in a 29-year-old woman without the right temporomandibular joint pain. (a) Proton density-weighted sagittal oblique cross-section imaging at the closed mouth position shows disc displacement. (b) Proton density-weighted sagittal oblique cross-section imaging at the maximum mouth opening position shows disc displacement with reduction. (c) T2-weighted sagittal oblique cross-section imaging at the maximum mouth opening position does not show temporomandibular joint effusion

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Figure 2: Magnetic resonance imaging of the left temporomandibular joint in a 68-year-old woman with the left temporomandibular joint pain. (a) Proton density-weighted sagittal oblique cross-section imaging at the closed mouth position shows disc displacement. (b) Proton density-weighted sagittal oblique cross-section imaging at the maximum mouth opening position shows disc displacement without reduction. (c) T2-weighted sagittal oblique cross-section imaging at the maximum mouth opening position shows temporomandibular joint effusion

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[Table 1] shows the characteristics of the patients with internal derangement. The result indicated that the occurrence of internal derangement was different by gender (χ² (1) =5.357, P = 0.021, V = 0.299), and the number of internal derangement was larger on women in comparison with men both on disc displacement with reduction and disc displacement without reduction. Age was not different between disc displacement with reduction and disc displacement without reduction (P = 0.071), but the age tended to be higher on disc displacement without reduction. Concerning TMJ pain, there was no statistically significant difference between the presence and absence of TMJ pain to the occurrence of disc displacement with reduction and disc displacement without reduction (χ² (1) =0.152, P = 0.696, V = 0.050). The presence of disturbance of mouth opening was different between the disc displacement with reduction and disc displacement without reduction, and the presence of disturbance of mouth opening was larger on disc displacement without reduction (χ² (1) =4.922, P = 0.027, V = 0.286). The presence of joint effusion was not statistically significantly different between disc displacement with reduction and disc displacement without reduction (χ² (1) =2.308, P = 0.129, V = 0.196).

Table 1: Characteristics of the patients with internal derangement

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[Table 2] shows the result of logistic multivariate regression analysis in the patients with internal derangement. Gender was related to the higher risk of internal derangement, and the odds ratio was 6.408 (95% confidence interval: 1.029–39.902, P = 0.047). Disturbance of mouth opening was also related to the higher risk of internal derangement, and the odds ratio was 4.725 (95% confidence interval: 1.314–16.998, P = 0.017).

Table 2: Logistic multivariate regression analysis in the patients with internal derangement

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Discussion

Prevalence of TMD is quite common and the most common conditions of TMD are pain-related and internal derangement.^[7] This study investigated the related factors to internal derangement in TMJ dysfunction patients using MRI.

Characteristics of the patients with internal derangement were investigated in this study. Concerning gender, the result showed that the occurrence of internal derangement was statistically significantly larger on women in comparison to men both on disc displacement with reduction and disc displacement without reduction. This result was consistent with the results of the previous reports.^{[22],[23],[24],[25]} The reason of this result could be considered that the structure of TMJ on women is weaker than that on men.^[26] The mean age of the patients in this study was 39.3 years on disc displacement with reduction and 47.0 years on disc displacement without reduction. It was reported that the susceptible age for TMD is 20–40 years old.^{[22],[27],[28],[29]} The age of the patients in this study was higher than that reported in the previous studies. This study investigated the patients with internal derangement who visited our university hospital; therefore, the number of youth patients would not be so much. TMJ pain was not different between disc displacement with reduction and disc displacement without reduction. Disc displacement is reported to exist on about 33% of the asymptomatic volunteers.^{[30],[31],[32]} Previous studies suggested that the existence of disc displacement is unlikely to be the cause of pain, but disc displacement is a predisposing factor that increases the risk of symptoms of TMD.^[33],[34] Therefore, TMJ pain was not differed by the condition of disc displacement. Concerning the disturbance of mouth opening, disc displacement without reduction showed larger incidence in comparison with disc displacement with reduction. It is scientifically defined that nonreducing disc displacement with the maximum mouth opening is a condition in which the original disc is moved from its position between the condyle and the articular fossa to a forward, medial or lateral position, associated with limitation of mouth opening.^[35] Therefore, it was suggested that disc displacement without reduction causes disturbance of mouth opening. Joint effusion was not different between disc displacement with reduction and disc displacement without reduction. The relationship between joint effusion and internal derangement is mentioned to be unclear.^[20] One study indicated that there are no relations between joint effusion and anterior disc displacement.^[36] The result of this study supported the previous study.

The result of logistic multivariate regression analysis in the patients with internal derangement showed that gender and disturbance of mouth opening were related to the higher risk of internal derangement. In the limit of this study, it was suggested that internal derangement on MRI was occurring easily on women and the patients with disturbance of mouth opening. In the future study, the other clinical characteristics of the patients with internal derangement should be investigated with increased number of subjects.

Conclusions

This study investigated the related factors to internal derangement in TMJ dysfunction patients using MRI. The results suggested that internal derangement would be easier to occur on women, and the disturbance of mouth opening was occurring easily on disc displacement without reduction.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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