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Alteration in TMJ
Alteration in TMJ
Alteration in TMJ
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RESEARCH
Alteration of the horizontal mandibular condyle size associated
with temporomandibular joint internal derangement in adult
females
H Kurita*,1, A Ohtsuka1, H Kobayashi1 and K Kurashina1
1
Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
Objectives: The purpose of this retrospective study was to analyse the relationship between
horizontal size of the mandibular condyle and internal derangement (ID) of the
temporomandibular joint (TMJ).
Methods: One hundred and thirty-nine joints in 88 women aged over 18 years were included in
this study. The horizontal condylar size was measured in the antero-posterior and medio-lateral
(ML) dimensions using axial magnetic resonance (MR) images. Radiological ®ndings of ID
were also assessed from MR imaging.
Results: The condyles in the joints with permanent disk displacement were smaller than those
in joints without displacement in both dimensions (Fisher's protected least signi®cant
dierence, P50.05). There were statistically signi®cant correlations between horizontal
condylar size in the ML dimension and both disk morphology and radiological stage of ID
(Spearman's correlation coecient by rank, P50.05).
Conclusions: The results of this study suggest a possible relationship between horizontal
condylar size and disk displacement. It is also suggested that the condyle becomes smaller in the
ML dimension with advancement of ID.
Dentomaxillofacial Radiology (2002) 31, 373 ± 378. doi:10.1038/sj.dmfr.4600727
Introduction
] ]
No displacement (29) 19.0+3.0 8.7+1.7 computed tomography and found that the horizontal
Anterior displacement 18.1+2.9 7.9+1.2 ] size of the condyle in joints with a displaced disk was
with reduction (58) a a
Anterior displacement 17.6+2.7 7.9+1.3
smaller both in the long and short axis than in those
without reduction (52) without a displaced disk.3 Our results were compatible
a
There was a statistically signi®cant dierence between the groups
with theirs. These data suggest that there might be a
(Fisher's protected least signi®cant dierent; P50.05). (Mean+ relationship between the size of the TMJ condyle and
standard deviation, mm) disk displacement.
Dentomaxillofacial Radiology
Condylar size and TMJ ID
H Kurita et al
376
Biconcave Biplanar Biconvex Folded Amorphous Biconcave Biplanar Biconvex Folded Amorphous
Figure 3 Horizontal condyle size in relation to TMJ disk morphology. The correlation between the condyle size in the medio-lateral dimension
and disk morphology is statistically signi®cant (Spearman's correlation coecient by rank, P50.05)
There may be some controversy as to whether joints result in a small condyle because of concurrent
with a small condyle might have a greater tendency for degenerative bony changes. In this study, the condyle
disk displacement or whether disk displacement might size in the ML dimension decreased with advancing
Dentomaxillofacial Radiology
Condylar size and TMJ ID
H Kurita et al
377
Figure 4 Horizontal condylar size in relation to radiological stage of TMJ internal derangement. The correlation between the condyle size in
the medio-lateral dimension and ID stage is statistically signi®cant (Spearman's correlation coecient by rank, P50.05)
stage of ID. This result appears to support the latter at the postero-lateral corner of the condyle may cause
possibility. It was experimentally shown that TMJ disk resorption, resulting in a decreased condyle size in the
displacement could induce reduction of mandibular ML dimension. We think it is fair to speculate that
height and length,5 which implies that disk displace- more pronounced regressive changes occur in the joints
ment may have an adverse eect on condyle growth. where the disk is displaced far to the anterior and the
On the other hand, there was no correlation between disk is severely deformed.
the condyle size in the AP dimension and the The results of this study showed that the TMJ
radiological stage of ID. The mechanism of disk condyle became bigger in the AP dimension in the
displacement is still unclear, and there remains a joints with the most advanced stages of ID. In these
possibility that a small condyle in the AP dimension joints, the TMJ disk is severely and permanently
is one of the predictors for disk displacement. displaced and deformed and is sometimes associated
A possible relationship between the decreased with disk perforation.15,16 Rao et al.22 studied MR
condyle size in the ML dimension and disk morphol- images of 276 TMJ and reported that the altered bony
ogy was suggested in this study. The condyle became morphology (condylar remodeling, erosion, spurring,
smaller in the ML dimension as the disk was deformed. etc.) correlated with the severity of ID, that is, bony
In addition, there was a tendency for the condylar ML changes in the joints with an anterior closed lock were
dimension to decrease as the disk became more noted in 64% compared to 45% with reducible disk.22
anteriorly displaced. Previously, de Leeuw et al.17 It has also been reported that disk perforation could
reported shortening of the condyle in the mediolateral lead to osteoarthritis.21 We speculated that proliferative
direction (reduction of the oval projection) in patients condylar degenerative changes including ¯attening,
with internal derangement and osteoarthrosis. This spurring, and eburnation might be responsible for
®nding is compatible with our ®ndings. Previously, we lengthening of the condyle in the antero-posterior
reported that resorption of the lateral pole of the direction. Legrell et al.5 experimentally induced non-
condyle occurred with advancing stage of ID.18 The reducing disk displacement in rabbits and demon-
TMJ disk is ®rmly ®xed at the medial and lateral poles strated a substantial regressive remodeling resulting in
to the corner region of the posterior aspect of the a change of condyle shape with forward/downward
condyle.19,20 Anterior disk displacement would cause rotation of the enlarged articulating surface. This result
some pathological changes to the lateral disk-condyle is consistent with our speculation.
attachment or to the area of the lateral part of the In conclusion, our results suggested (1) a possible
condyle. We think that regressive condylar remodeling relationship between disk displacement and decreased
Dentomaxillofacial Radiology
Condylar size and TMJ ID
H Kurita et al
378
size of the TMJ condyle, and (2) that the condyle Acknowledgements
became smaller in the ML dimension with advance- We wish to thank the doctors in the Department of
ment of ID. Further study that could clarify a Radiology of Shinshu University School of Medicine for
relationship between condylar bony changes and their assistance in the imaging study of TMJ.
condyle size is needed.
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