Temporomandibular eklem disfonksiyonunda dejeneratif değişiklikler ve efüzyonun klinik ve manyetik rezonans görüntüleme bulgularıyla karşılaştırmalı değerlendirilmesi


Thesis Type: Doctorate

Institution Of The Thesis: Marmara University, Institute of Health Sciences, Department of Oral and Maxillofacial Radiology, Turkey

Approval Date: 2013

Thesis Language: Turkish

Student: MEHMET ALİ ELÇİN

Supervisor: Şebnem Erçalık Yalçınkaya

Abstract:

TMD diagnosis consists of clinical examination and usually magnetic resonance imaging(MRI). The aim of this study was to evaluate 1)The efficacy of Research Diagnostic Criteria for Temporomandibular Disorders(RDC/TMD) and 2)The association of disc displacement "with/without reduction"(DDwR/DDwoR), degenerative changes of condylar head and intraarticular effusion between each variable. A total of 240 TMJs of 120 patients(18-54 year-old,104 female/16 male) with TMD complaints were evaluated with RDC/TMD and MRI. Of the patients, thirty (sixty TMJs) comprised the control group. MRI was carried out with a 1.5-Tesla imaging unit(Siemens Symphony Maestro Class). T1, T2-weighted bilateral images at both closed and maximum opening mouth positions were taken. Joint effusion area was assessed in T2-weighted MRI. Boundary of the effusion was selected manually and then calculated by a software programme(Osirix® Dicom Viewer). Chi-square, kappa, ICC, McNemar and t tests were used for the statistical analysis that was done by SPSS for Windows 17.0. Of the 180 TMJs, 42 presented DDwR, 75 DDwoR, 103 condyle degeneration and 78 effusion. Of the joints with effusion, 43,5% revealed DDwoR(p=0,027) and 70,5% condyle degeneration(p=0,005). Of the 123 TMJs with myofacial pain; 75,6% showed DD(p=0,0001), 69,1% degenerative changes(p=0,0001) and 52,8% effusion(p=0,0001). All joints showing extreme effusion regarded as 'score 3'(>0.4 cm2) revealed DDwoR and degeneration. When compared to the gold standard MRI, RDC/TMD diagnoses were found to be statistically nonsignificant in the diagnosis of internal derangement and condyle degeneration(?=0,473 and ?=0,217 respectively). Based on the findings of this study, it can be concluded that there is a positive relationship between DD, condyle degeneration and effusion. Findings of this study revealed that use of RDC/TMD in the diagnosis of TMDs has limitations and MRI is essential for the definite diagnosis