Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
권호 표지

The Validity of Computed to Mography in Diagnosis of Temporomandibular Joint Osteoarthritis

측두하악관절 골관절염 진단에 있어 전산화 단층촬영의 유용성

  • Jeon, Young-Mi (Department of Oral Medicine, College of Dentistry, Yonsei University) ;
  • Choi, Jong-Hoon (Department of Oral Medicine, College of Dentistry, Yonsei University) ;
  • Kim, Seong-Taek (Department of Oral Medicine, College of Dentistry, Yonsei University) ;
  • Kwon, Jeong-Seung (Department of Oral Medicine, College of Dentistry, Yonsei University) ;
  • Ahn, Hyung-Joon (Department of Oral Medicine, College of Dentistry, Yonsei University)
  • 전영미 (연세대학교 치과대학 구강내과학교실) ;
  • 최종훈 (연세대학교 치과대학 구강내과학교실) ;
  • 김성택 (연세대학교 치과대학 구강내과학교실) ;
  • 권정승 (연세대학교 치과대학 구강내과학교실) ;
  • 안형준 (연세대학교 치과대학 구강내과학교실)
  • Published : 2008.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Osteoarthritis is caused by joint degeneration, a process that includes progressive loss of articular cartilage accompanied by attempted repair of articular cartilage, remodeling and sclerosis of subchondral bone, and osteophyte formation. The most common causative factor that either causes or contributes to osteoarthritis is overloading of the articular structures of the joint. The diagnosis of temporomandibular joint(TMJ) osteoarthritis is based on the patient's history and clinical findings such as limited mandibular opening, crepitation and tenderness to palpation on TMJ. The diagnosis is usually confirmed by TMJ radiographs, which will reveal evidence of structural changes in the subarticular bone of the condyle or fossa. Plain radiography techniques such as panoramic, transcranial, transpharyngeal views can be used in most dental offices for evaluation of the TMJs. However, plain radiographs are often limited due to overlapping and distortion of anatomical structures. The aim of this study was to compare the clinical examination and panoramic view with computed tomography for diagnosis of temporomandibular degenerative joint disease, and to compare the findings of condylar bony changes through panoramic radiography with that of computed tomography, hence, to confirm the limitations of clinical and panoramic radiography, and the validity of the computed tomography for diagnosis of temporomandibular degenerative joint disease. The pathophysiology of the TMJ osteoarthritis remains poorly understood, and current treatments are based more on speculation than science, and symptomatic treatments often fail to provide satisfactory pain relief. For diagnosis of TMJ osteoarthritis, clinical examination and radiographic examination for confirmation of the bony changes are essential, and computed tomography are clearly superior to plain radiographs for their limitations.

골관절염은 관절 연골의 점진적인 소실, 연골하 골의 재형성 및 경화, 골증식체 형성을 포함하는 일련의 퇴행 과정에 의해 야기되는 질환으로, 측두하악관절의 과도한 사용이나 전신 질환에 의해서 야기될 수 있다. 측두하악관절 골관절염은 임상적으로는 통증으로 인한 하악운동제한, 염발음, 관절 촉진시 국소적 압통 등의 특징적 소견을 나타내며 방사선 사진 상으로 구조적 골변화가 포함되어야 확진을 내릴 수 있다. 일반적으로 측두하악관절의 평가를 위해 이용할 수 있는 기본적인 방사선 사진은 파노라마 방사선 사진, 횡두개 방사선 사진, 횡인두 방사선 사진 등의 단순 촬영이다. 그러나 이와 같은 단순 촬영은 측두하악관절의 골구조를 평가하는 데 있어 여러 한계점을 지니고 있다. 본 연구에서는 임상 검사 및 파노라마 방사선 사진을 통한 측두하악관절 퇴행성 관절질환의 진단과 전산화 단층촬영 상에 나타나는 퇴행성 골변화를 비교해보고, 하악과두의 골변화 유무를 파노라마 방사선 사진과 전산화 단층촬영을 비교하여 확인함으로써 측두하악관절 퇴행성 관절질환의 진단에 있어 임상 진단 및 파노라마 방사선 사진의 한계와 전산화 단층촬영의 유용성을 알아보았다. 측두하악관절 골관절염은 병인이 명확히 밝혀지지 않았으며 진단 및 치료에 어려움이 있다. 측두하악관절 골관절염의 확진을 위해서는 임상 검사 뿐 아니라 방사선 사진 촬영을 통해 골변화를 확인하는 것이 필요하며 단순 촬영은 여러 가지 제한점과 한계를 가지므로 측두하악관절의 골변화 유무를 확인하기 위해서는 전산화 단층촬영이 유용할 것으로 사료된다.

Keywords

References

  1. Buckwalter JA, Mankin HJ. Articular cartilage: degeneration and osteoarthritis, repair, regeneration, and transplantation. Instr Course Leet 1998;47: 487-504
  2. Buckwalter JA, Martin JA. Osteoarthritis. Adv Drug Deliv Rev 2006;58(2):150-167 https://doi.org/10.1016/j.addr.2006.01.006
  3. Okeson JP. Management of temporomandibular disorders and occlusion. 6th ed., St. Louis, 2007, Mosby Inc., pp. 322-324
  4. Israel HA, Diamond BE, Saed-Najad F, Ratcliffe A. Correlation between arthroscopic diagnosis of osteoarthritis and synovitis of the human temporomandibular joint and keratan sulfate levels in the synovial fluid. J Oral Maxillofac surg 1997;55(3):210-217 https://doi.org/10.1016/S0278-2391(97)90526-7
  5. Haskin CL, Stephen BM, Ivan LC. Pathogenesis of degenerative joint disease in the human temporomandibular joint. Crit Rev Oral BioI Med 1995;6(3):248-277 https://doi.org/10.1177/10454411950060030601
  6. de Bont LG, Stegenga B. Pathology of temporomandibular joint internal derangement and osteoarthrosis. Int J Oral Maxillofac Surg 1993;22(2):71-74 https://doi.org/10.1016/S0901-5027(05)80805-7
  7. de Bont LG, van der Kuijl B, Stegenga B, Vencken LM, Boering G. Computed tomography in differential diagnosis of temporomandibular joint disorders. Int J Oral Maxillofac Surg 1993;22(4):200-209 https://doi.org/10.1016/S0901-5027(05)80636-8
  8. Stegenga B. Osteoarthritis of the temporomandibular joint organ and its relationship-to disc displacement. J Orofac Pain 2001;15(3):193-205
  9. Stegenga B, de Bont ,LG, Boering' G, Osteoarthrosis as the cause of craniomandibular pain and dysfunction: a unifying concept. J Oral Maxillofac Surg 1989;47 (3) :249- 256 https://doi.org/10.1016/0278-2391(89)90227-9
  10. Dixon DC. Radiographic diagnosis of temporomandibular disorders. Semin Orthod 1995;1:207-221
  11. White SC, Pharaoah MJ, Oral radiology: principles and interpretation. 4th ed., St. Louis, 2000, Mosby Inc., pp. 493-498
  12. Rozencweig D. Three-dimensional tomographic study of the tempore- mandibular articulation. J Periodontol 1975;46(6):348-356 https://doi.org/10.1902/jop.1975.46.6.348
  13. Berrett A. Radiology of the temporomandibular joint. Dent Clin North Am 1983;27:527-540
  14. Cohen H, Ross S, Gordon R. Computerized tomography as a guide in the diagnosis of temporomandibular joint disease. J Am Dent Assoc 1985;110(1):57-60 https://doi.org/10.14219/jada.archive.1985.0281
  15. Coucke ME, Bourgoignie RR, Dermaut LR, Bourgoignie KA, Jacobs RJ, Belgium G. Radiation dose in temporomandibular joint zonography. Oral Surg Oral Med Oral Pathol 1991;71(6):756-762 https://doi.org/10.1016/0030-4220(91)90288-N
  16. Brooks SL, Brand JW, Gibbs J, Hollender L, Lurie AG, Omnell KA, Westesson PL, White SC, Mich AA. Imaging of the temporomandibular joint. A position paper of the American Academy of Oral and Maxillofacial radiology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;83(5):609-618 https://doi.org/10.1016/S1079-2104(97)90128-1
  17. Ludlow JB, Davies KL, Tyndall DA. Temporomandibular joint imaging: a comparative study of diagnostic accuracy for the detection of bone change with biplanar multidirectional tomography and panoramic images. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;80(6):735-743 https://doi.org/10.1016/S1079-2104(05)80259-8
  18. Westesson PL, Katzberg RW, Tallents RH, SanchezWoodworth RE, Svensson SA. CT and MRI of the temporomandibular joint: comparison with autopsy specimens. Am J Roentgenol 1987;148(6): 1165-1171 https://doi.org/10.2214/ajr.148.6.1165
  19. Israel HA, Saed-Najad F, Ratcliffe A. Early diagnosis of osteoarthritis of the temporomandibular joint: correlation between arthroscopic diagnosis of osteoarthritis and synovitis of the human temporomandibular joint and keratan sulfate levels in the synovial fluid. J Oral Maxillofac Surg 1991;49:708-711 https://doi.org/10.1016/S0278-2391(10)80233-2
  20. Westesson PL, Rohlin M. Internal derangement related to osteo- arthrosis in temporomandibular joint autopsy specimens. Oral Surg Oral Med Oral Pathol 1984;57 (1): 17 - 22 https://doi.org/10.1016/0030-4220(84)90251-2
  21. Kopp S, Rockler B. Relationship between clinical and radiographic findings in patients with mandibular pain or dysfunction. Acta Radiol Diagn 1979;20(3): 465-477 https://doi.org/10.1177/028418517902000309
  22. Yoshimura Y, Yoshida Y, Oka M, Miyoshi M, Uemura S. Long-term evaluation of non-surgical treatment of osteoarthrosis of the temporomandibular joint. Int J Oral Surg 1982;11(1):7-13 https://doi.org/10.1016/S0300-9785(82)80042-2
  23. Hansson LG, Hansson T, Peters son A. A comparison between clinical and radiologic findigns in 259 temporomandibular joint patients. J Prosthet Dent 1983;50(1):89-94 https://doi.org/10.1016/0022-3913(83)90172-5
  24. Mejersjo C, Hollender L. TMJ Pain and dysfunction: relation between clinical and radiographic findings in the short and long-term. Scand J Dent Res 1984;92(3):241-248
  25. Pereira FJ Jr, Lundh H, Westesson PL. Morphologic changes in the temporomandibular joint in different age groups. An autopsy investigation. Oral Surg Oral Med Oral Pathol 1994;78(3):279-287 https://doi.org/10.1016/0030-4220(94)90055-8
  26. Broussard JS Jr. Derangement, osteoarhtritis, and rheumatoid arthritis of the temporomandibular joint: implications, diagnosis, and management. Dent Clin North Am 2005;49(2):327-342 https://doi.org/10.1016/j.cden.2004.10.003
  27. Oliveria SA, Felson DT, Reed JI, Cirillo PA, Walker AM. Incidence of symptomatic hand, hip, and osteoarthritis among patients in a health maintenance organization. Arthritis Rheum 1995;38(3):1134-1141 https://doi.org/10.1002/art.1780380817
  28. Bouvier M, Zimmy ML: Effects of mechanical loads on surface morphology of the condylar cartilage of the mandible in rats. Acta Anat 1987;129(4):293-300 https://doi.org/10.1159/000146418
  29. Lawrence JS, Bremner JM, Bier F. Osteoarthrosis. prevalence in the population and relationship between symptoms and x-ray changes. Ann Rheum Dis 1966;25(1):1-24 https://doi.org/10.1136/ard.25.1.1
  30. Ageberg G, Inkapool I. Craniomandibular disorders in an urban Swedish population. J Craniomendib Disord 1990;4(3):154-164
  31. MacEntee MI, Weiss R, Morrison BJ, WaxlerMorrison NE. Mandibular dysfunction in an institutionalized and predominantly elderly population. J Oral Rehabil 1987;14(6):523-529 https://doi.org/10.1111/j.1365-2842.1987.tb00748.x
  32. Quinn JH, Bazan NG. Identification of prostaglandin E2 and leukotriene B4 in the synovial fluid of painful, dysfuctional temporomandibular joints. J Oral Maxillofac Surg 1900;48:968-971 https://doi.org/10.1016/0278-2391(90)90011-P
  33. Kamelchuk LS, Major PW. Degenerative disease of the ternporo- mandibular joint. J Orofac Pain 1995;9:168-180
  34. Cibere J. Do we need radiographs to diagnose osteoarthritis? Best Pract Res Clin Rheumatol 2006;20(1):27-38 https://doi.org/10.1016/j.berh.2005.08.001
  35. Mawani F, Lam EWN, Heo G, Raboud DW, Major PW, Alberta E. Condylar shape analysis using panoramic radiography units and conventional tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;99(3):341-348 https://doi.org/10.1016/j.tripleo.2004.07.011
  36. Crow HC, Parks E, Campbell JH, Stucki DS, Daggy J. The utility of panoramic radiography in temporomandibular joint assessment. Dentomaxillofac Radiol 2005;34(2):91-95 https://doi.org/10.1259/dmfr/24863557
  37. Larheim T A. Current trends in temporomandibular joint imaging. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;80(5):555-576 https://doi.org/10.1016/S1079-2104(05)80154-4
  38. A vrahami E, Horowitz I, Cohn DF. Computed tomography of the temporo-mandibular joint. Cornput Radiol 1984;8(4):211-216 https://doi.org/10.1016/0730-4862(84)90125-2
  39. Janzen DL, Connell DG, Munk PL. Current imaging of temporomandibular joint abnormalities: a pictorial essay. Can Assoc Radiol J 1998;49(1):21-34
  40. Muir CB, Goss AN. The radiologic morphology of asymptomatic temporomandibular joints. Oral Surg Oral Med Oral Pathol 1990;70(3):349-354 https://doi.org/10.1016/0030-4220(90)90154-K