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ORIGINAL ARTICLE
Year : 2022  |  Volume : 10  |  Issue : 2  |  Page : 45-48

Examination for the factors contribute to joint effusion in patients with internal derangement on temporomandibular joint disorder


1 Department of Removable Prosthodontics, The Nippon Dental University School of Life Dentistry at Niigata, Niigata, Japan
2 Department of Oral and Maxillofacial Radiology, The Nippon Dental University School of Life Dentistry at Niigata, Niigata, Japan
3 Department of Dental Functional Occlusal Treatment, The Nippon Dental University Graduate School of Life Dentistry, Niigata, Japan
4 Department of Comprehensive Dental Care, The Nippon Dental University Niigata Hospital, Niigata, Japan
5 Department of Dental Anesthesia and General Health Management, The Nippon Dental University Niigata Hospital, Niigata, Japan

Date of Submission03-Jun-2022
Date of Decision14-Jun-2022
Date of Acceptance21-Jun-2022
Date of Web Publication22-Jul-2022

Correspondence Address:
Fumi Mizuhashi
1-8 Hamaura-cho, Chuo-ku, Niigata, 951-8580
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jomr.jomr_17_22

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  Abstract 


Background/Aim: The aim of this study was to investigate the factors contribute to the joint effusion in the patients with internal derangement on temporomandibular joint (TMJ) disorder. Methods: We reviewed the 83 TMJs that were diagnosed as internal derangement (anterior disc displacement with or without reduction) by magnetic resonance imaging. Joint effusion was diagnosed using T2-weighted images. The differences in the presence of joint effusion according to the gender, age, diagnosis, and TMJ pain were analyzed using cross-tabulation or Mann–Whitney test. The relationship between joint effusion and gender, age, diagnosis, and TMJ pain was analyzed by logistic multivariate regression analysis. Results: The presence of joint effusion was larger on anterior disc displacement without reduction (χ2[1] = 7.47, P = 0.006) and the TMJ with pain (χ2[1] = 7.50, P = 0.006). The results of logistic multivariate regression analyses indicated that the diagnosis of anterior disc displacement without reduction was significant in TMJ with joint effusion (odds ratio = 3.299, P = 0.036) and the TMJ with pain was also significant in TMJ with joint effusion (odds ratio = 4.413, P = 0.007). The gender and age showed no relationships with joint effusion. Conclusions: The results of this study made it clear that joint effusion was easier to occur in the TMJ of anterior disc displacement without reduction and in the TMJ with pain. Anterior disc displacement without reduction and TMJ pain would be related to the higher risk of joint effusion.

Keywords: Internal derangement, joint effusion, temporomandibular joint disorder


How to cite this article:
Mizuhashi F, Ogura I, Watarai Y, Suzuki T, Mizuhashi R, Oohashi M, Saegusa H. Examination for the factors contribute to joint effusion in patients with internal derangement on temporomandibular joint disorder. J Oral Maxillofac Radiol 2022;10:45-8

How to cite this URL:
Mizuhashi F, Ogura I, Watarai Y, Suzuki T, Mizuhashi R, Oohashi M, Saegusa H. Examination for the factors contribute to joint effusion in patients with internal derangement on temporomandibular joint disorder. J Oral Maxillofac Radiol [serial online] 2022 [cited 2022 Dec 3];10:45-8. Available from: https://www.joomr.org/text.asp?2022/10/2/45/351669




  Introduction Top


Temporomandibular joint disorders (TMD) are characterized by craniofacial pain involving the temporomandibular joint (TMJ) or masticatory muscles, sounds of the jaw (clicking, popping, grating, and crepitus), and limitations of jaw function.[1],[2] Concerning the sound of the jaw, clicking during opening or closing the mouth is associated with disk displacement with reduction, and crepitus is related to articular surface disruption and osteoarthritis.[3] The prevalence of TMD is reported as 22.6% of worker.[4] Another study reported that TMD is occurring as 10%–15% of adult, and only 5% of the TMD patients need the treatment.[5],[6],[7] The gender with TMD is two times higher in women than men,[8],[9] and the symptom of myofascial pain is three times higher in women than men.[10],[11],[12] The prevalence of TMD is high between the age of 20–40 years.[8],[11],[13],[14]

Internal derangement is defined as an abnormal positional relationship between the disc and the condyle, articular eminence, and/or articular fossa.[15] Internal derangement is most frequently observed in TMD patients[16],[17],[18],[19] which confirmed in 77%–89% on the TMD patients.[16],[17] Among the internal derangement, the prevalence of anterior disc displacement with reduction is most frequent, and followed by anterior disc displacement without reduction.[20],[21]

Magnetic resonance imaging (MRI) is necessary for the diagnosis of internal derangement.[22] The precise evaluation of the position and the form of the articular disc can be performed with a probability of 95% and that of the change of the bone can be performed with a probability of 93%.[23] On the MRI image, the disc displacement is diagnosed on proton-density emphatic images, and joint effusion is confirmed on T2 emphatic images. Joint effusion is reported to reflect the inflammatory change.[24],[25] However, the other reports showed that joint effusion can be observed on the TMJ not accompanied by pain,[26],[27],[28] and this does not have just one point of view.

The aim of this study was to investigate the relationship between the appearance of joint effusion and gender, age, diagnosis, and TMJ pain, and examine the factors that contribute to the appearance of joint effusion.


  Methods Top


This retrospective study was approved by the ethics committee of our institution. We reviewed the MRI images of 83 TMJs (46 patients, 11 males, 35 females; range age 14–76 years, mean age 43.5 ± 16.6 years) that were examined using MRI for the diagnosis of internal derangement, and verified the internal derangement in our university hospital from February to August 2020. The images were independently evaluated by two dentists and any discrepancies were resolved by consensus.

MRI (1.5 Tesla MR unit; EXCELART Vantage MRT-2003; Canon Medical Systems, Otawara, Japan) was used for the diagnosis of TMD. Proton-density emphatic images included the TMJ with a surface coil, and weighted sagittal and coronal imaging at the mouth closing 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). T2 emphatic images weighted sagittal and coronal imaging at the mouth closing 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).[29]

Joint effusion was diagnosed using T2 emphatic images. The differences in the presence of joint effusion according to the gender, diagnosis, and TMJ pain were analyzed using cross-tabulation, and that according to age was analyzed by Mann–Whitney test. The relationship between joint effusion and gender, age, diagnosis, and TMJ pain was analyzed by logistic multivariate regression analysis. On logistic multivariate regression analysis, each factor was categorized (the absence of joint effusion was categorized to 0 and presence of joint effusion was categorized to 1, man was categorized to 0 and woman was categorized to 1, anterior disc displacement with reduction was categorized to 0 and anterior disc displacement without reduction was categorized to 1, and absence of TMJ pain was categorized to 0 and presence of TMJ pain was categorized to 1). Statistical analysis was performed using statistical analysis software (SPSS 17.0, SPSS JAPAN, Tokyo, Japan), and differences of α <0.05 were considered statistically significant.


  Results Top


[Figure 1] shows one of the MRI images examined in this study. Proton-density emphatic images show anterior disc displacement both at the mouth closing position [Figure 1]a and the maximum mouth opening position [Figure 1]b. T2 emphatic image shows joint effusion on superior articular cavity [Figure 1]c.
Figure 1: Magnetic resonance imaging of the right temporomandibular joint in a 54-year-old woman with 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 without reduction. (c) T2-weighted sagittal oblique cross-section imaging at the closed mouth position shows temporomandibular joint effusion

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[Table 1] shows the characteristics of 83 TMJs examined in this study. The result indicated that the appearance of joint effusion was recognized in 26 TMJs, and joint effusion was not occurred in 57 TMJs. Concerning the gender, woman was about three times of man (63 TMJs were woman and 20 TMJs were man), however, there was not statistical difference between woman and man for the occurrence of joint effusion (χ2[1] = 3.26, P = 0.071, V = 0.20). The mean age without joint effusion was 44.6 ± 15.3 years old, and that with joint effusion was 41.3 ± 17.6 years old (P = 0.514). Concerning the diagnosis, anterior disc displacement with reduction was recognized in 47 TMJs, and anterior disc displacement without reduction was confirmed in 36 TMJs. The existence of joint effusion was larger on the TMJs of anterior disc displacement without reduction (χ2[1] = 7.47, P = 0.006, V = 0.30). TMJ pain was found in 33 TMJs, and 50 TMJs did not come out TMJ pain. Joint effusion was highly recognized on the TMJ with pain (χ2[1] = 7.50, P = 0.006, V = 0.30).
Table 1: Characteristics of 83 temporomandibular joints examined in this study

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[Table 2] shows the result of logistic multivariate regression analysis investigating the relationship between joint effusion and gender, age, diagnosis, and TMJ pain. The results indicated that diagnosis and TMJ pain were related to the highly risk of the occurrence of joint effusion. The odds ratio on diagnosis was 3.299 (95% confidence interval [CI]: 1.082–10.060, P = 0.036) and that on TMJ with pain was 4.413 (95% CI: 1.494–13.030, P = 0.007). The gender and age showed no relationships with joint effusion risk.
Table 2: Result of logistic multivariate regression analysis

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  Discussion Top


Joint effusion is stated to reflect the inflammatory change; however, this does not have just one point of view. This study investigated the relationship between the appearance of joint effusion and gender, age, diagnosis, and TMJ pain, and examined the factors that contribute to the appearance of joint effusion.

Concerning the diagnosis, the result showed that the occurrence of joint effusion was statistically significantly larger at anterior disc displacement without reduction compared to anterior disc displacement with reduction. One report mentioned that joint effusion is not related to the anterior disc displacement,[30] however, the result of this study did not agree to that report. The result of this study was consistent with the results of the previous reports[24],[31],[32] that showed the correlation between joint effusion and disc displacement without reduction. The amount and matter of the joint fluid change according to the condition occurring at TMJ.[27] It was considered that large load would be applied to the surface of the synovial membrane on the TMJ of anterior disc displacement without reduction, and exudate would be accumulated in joint cavity, and then joint effusion would be appeared.

Joint effusion was highly recognized on the TMJ with pain compared to that without pain. This result was consistent with the results of the previous reports[27],[33] that showed the correlation between joint effusion and pain. On the other hand, some reports mentioned that there is no relationship between joint effusion and pain.[24],[34] Some inflammatory response would be occurring in TMJ on the TMJ with pain, and vascular permeability would be exacerbated by the congestion or hyperplasia of synovial tissue, and then blood cell constituent and inflammatory mediator exuded in TMJ. Therefore, joint effusion would be easily occurred at the TMJ with pain.

The result of logistic multivariate regression analysis which investigated the relationship between joint effusion and gender, age, diagnosis, and TMJ pain made it clear that anterior disc displacement without reduction and TMJ pain was the highly risk of the occurrence of joint effusion. This result suggested that joint effusion was related to some symptoms at TMD.

In the limit of this study, it was suggested that joint effusion is stated to reflect the inflammatory change of TMJ, and anterior disc displacement without reduction and TMJ pain contribute to the appearance of joint effusion.


  Conclusions Top


This study investigated the factors that contribute to the appearance of joint effusion. The results suggested that the appearance of joint effusion was related to the anterior disc displacement without reduction and TMJ pain.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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