RESEARCH - Clinical, radiographic, and MRI findings of the TMJ in patients with different rheumatic diseases

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Int J Oral Maxillofac Surg. 2006 Nov;35(11):983-9. Epub 2006 Oct 18.

Clinical, radiographic and MRI findings of the temporomandibular joint

in patients with different rheumatic diseases.

Helenius LM, Tervahartiala P, Helenius I, Al-Sukhun J, Kivisaari L,

Suuronen R, Kautiainen H, Hallikainen D, Lindqvist C, Leirisalo-Repo

M.

Departments of Oral and Maxillofacial Diseases, Helsinki University

Hospital, Helsinki, Finland.

The aim of this study was to investigate the condition of the

temporomandibular joint (TMJ) in patients with different rheumatic

diseases, and report correlations between the clinical, radiographic

and magnetic resonance imaging (MRI) findings. The 67 patients were

divided into four groups: 16 with rheumatoid arthritis (RA), 15 with

mixed connective tissue disease (MCTD), 18 with ankylosing spondylitis

(AS) and 18 with spondyloarthropathy (SPA). They were clinically

examined, and panoramic tomography, lateral panoramic radiography and

MRI of the TMJ were performed. MRI showed reduced articular cartilage

in 25% (4/16) of RA, 0% (0/15) of MCTD, 17% (3/18) of AS and 17%

(3/18) of SPA patients. Condylar changes included erosion, osteophytes

and abnormal shape. Disc alterations included perforation, abnormal

anterior position and decreased movement. These abnormalities were

most frequent in RA patients, and least frequent in MCTD and SPA

patients. Crepitation and reduced maximum opening of the mouth

correlated with abnormalities of the disc and articular cartilage as

shown by MRI. Severe condylar erosion in panoramic tomograms

significantly correlated with MRI findings of condylar erosion

(P<0.01), diminished thickness of condylar cartilage, abnormal

condylar shape, and abnormal shape of the temporal surface of the TMJ

(P< or =0.001). The presence of crepitation, limited mandibular

movement and/or pain on movement of the jaw often indicated structural

damage to the TMJ. Panoramic radiographs provide an alternative method

to MRI but, to obtain a more detailed anatomic picture, MRI is

recommended for patients with acute unexplained pain or as part of

preoperative work up. A panoramic recording is not indicated when MRI

is planned.

PMID: 17052893

http://www.ncbi.nlm.nih.gov/pubmed/17052893

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