Comparison of Clinical, Instrumental and Imaging Methods in Diagnosis of Temporomandibular Disorders

Svrha: Osim kliničke procjene u ovom se radu željelo procijeniti i snimke kondilarnih kretnji dobivenih kompjutorskom aksiografi jom u slučaju temporomandibularnih poremećaja kod zdravih osoba i dislokacije diska te prema njihovoj težini rangirane MR-snimke tragova dobivenih u drugim položajima zgloba. Materijal i metode: Analizirano je 18 slučajeva s mišićnim poremećajima (16 ženskih i 2 muška pacijenta prosječne dobi 32,06±15,99) i 11 pacijentica (prosječna dob 25,27±10,05) kod kojih su na pregledu magnetskom rezonancijom bili uočeni različiti stupnjevi intrakapsularnih poremećaja. U kontrolnoj skupini bilo je 6 žena te 4 muškarca prosječne dobi 22,20±2,39. Svi su bili na kompjutorskoj aksiografi ji. Analizirane su i magnetske snimke pacijentata s intrakapsularnim poremećajima. Proučavani su i zvuk zgloba te raspon kretanja mandibule. Podaci su obrađeni statistički (Mann-Whitneyevim U testom, Student t-testom, One-way ANOVA-om i Chi-Squarom α=0,05). Rezultati: Razlike u kretnji otvaranja usta između (dviju) skupina s TMP-om i one kontrolne bile su neznatne (p=0,27). Kad je riječ o čeljusnim zglobovima, razlike između skupina s unutarnjim poremećajem i onih s mišićnim bile su također beznačajne (p=0,09). Kod asimptomatske kontrolne skupine duljina staze čeljusnih zglobova bila je uglavnom simetrična i normalnog raspona. Duljina staze kod skupine s mišićnim poremećajem bila je općenito slična onoj u kontrolnoj skupini, ali kretnje, kad su se ponavljale, nisu bile tako dobre kao kod kontrolne skupine. Duljine staze kod pacijenata s različitim stupnjevima poremećaja dijagnosticiranih magnetskom rezonancijom, bile su kraće od normalnih i bilo je odstupanja, pa i križanja puteva. Zaključak: Osim pažljivog kliničkog pregleda, koristile su se i dijagnostičke tehnike temeljene na promjeni funkcije te sustavi za analizu slika. Koštane strukture, posebice meka tkiva čeljusnih zglobova, mogu se pregledati magnetskom rezonancijom te se može ocijeniti njihov međusobni odnos. Kod metode koja daje podatke o funkcionalnom stanju zgloba, mogu se dobiti objektivni podaci te odrediti postupak liječenja.Objective: In addition to the clinical evaluation, it was aimed to assess the traces obtained by computerized axiography of the condylar movements in temporomandibular disorders (TMD) in healthy individuals together with disc displacements and staged MRI images of these traces obtained in other joint positions. Material and Methods: 18 cases with muscle disorders (16 women and 2 men with mean ages; 32.06±15.99) and 11 cases (11 women, mean age 25.27 ±10.05) observed to have intraarticular disorders at different degrees as a result of MRI evaluation. The control group consisted of 10 cases (6 women and 4 men with mean ages; 22.20 ±2.39). Computerized axiography recordings of all cases were taken. MRI images taken from the cases with intraarticular disorders were evaluated. Joint sounds and mandibular range of motion were evaluated. Data were analyzed statistically. (Mann Whitney-U, Student t-test, One-way ANOVA and Chi-Square α=0.05). Results: The differences between TMD groups and control groups as regards the degrees of mouth opening movement were insignificant (p=0.27). The difference between the internal derangement and muscle disorder groups regarding TMJ sounds were insignificant (p=0.09). The length of the tracings of the asymptomatic control group as regards TMJs was generally symmetrical and in normal range. The tracings of the muscle disorder group were generally similar to those of the control group, however, the reproducibility of the movement was not as good as that in the control group. The tracings of patients with different stages as diagnosed by MRI were shorter than normal, and deviations on pathways in all cases, and crossings in some, were observed. Conclusion: In addition to careful clinical evaluation, function-based diagnosis techniques and imaging systems were utilised. Bony structures and especially soft tissues of the TMJ can be examined by means of MRI and the relations of the tissues with each other can be evaluated. In the method rendering information about the functional condition of the joint, objective data can be filed and the process of treatment can be evaluated