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Abstract
Internal derangement is the most common cause of temporomandibular disorders. It is defined as an abnormal positional relationship of the articular disc to the condyle and the articular eminence.
ID is classified into two main subgroups : anterior disc displacement with reduction ( ADDR ) and anterior disc displacement without reduction (ADDWR). TMJ disc displacement has been classified into five stages of ID by the widely accepted classification of Wilkes 1989 .
This study was performed to a) assess the different stages of TMJ ID clinically and radiographically using magnetic resonance imaging and to b) Assess the relation between the stage of internal derangement the type of disc deformity or displacement and the clinical symptoms and signs .
The study group consisted of 36 TMJs in 25 patients referred to the Oral and Maxillofacial Surgery Clinic Faculty of Oral and Dental Medicine Cairo University.
Patients were evaluated using a thorough medical and dental history , profound clinical examination and radiographic examination using magnetic resonance imaging .
Anterior disc displacement with reduction was present in 22 joints while anterior disc displacement with out reduction was present in 14 joints. Stage I ID was detected in 7 joints , stage II in 15 joints stage III is 4 joints and stage IV in 7 joints and stage V in 3 joints. from the results of the present study the following conclusions could be achieved : -
* TMJ disc derangement was significantly related to the patient’s clinical signs and symptoms. Considering this fact the application and accuracy of a convenient and comprehensive clinical index to diagnose TMJ disorders is of utmost importance.
* Despite the currently proven association between disc displacement and clinically manifested TMJ pain and dysfunction , yet ,disc derangement has a high prevelance in asymptomatic volunteers . Thus reliability on clinical criteria alone in diagnosing TMJID is not recommended .
* MRI should be considered for patients of TMJID if the initial history examination findings or conventional imaging suggest clinically significant pathology or in cases with failure of the conservative treatment and if assessment of the hard and soft tissues via MRI will affect the diagnosis prognosis or treatment plan .
* Proton density and T1 weighted MR images in the sagittal plane can provide valuable information about disc position disc morphology and degenerative joint changes .
* Reduced maximal opening of the mouth reduced maximal laterotrusion pain and tenderness of the masticatory muscles are predicting symptoms that indicate radiological examination of the TMJ is desirable .