Tmj Internal Derangement

J Oral Maxillofac Surg
Are Effusion and Bone Marrow Edema Prognostic Indicators for Arthrocentesis and Hydraulic Distention?
Rüdiger Emshoff, MD, DMD,* and Ansgar Rudisch, MD†
Purpose: Arthrocentesis and hydraulic distention of the temporomandibular joint (TMJ) has proven to

be an effective modality in treating patients exhibiting clinical findings consistent with the diagnosis of discdisplacement without reduction. The purpose of this study was to investigate whether the magnetic resonance imaging (MRI) variables of effusion and/or bone marrow edema may predict treatment outcomes of arthrocentesis and hydraulic distention of the TMJ. Patients and Methods: The study group comprised 37 consecutive patients with TMJ pain, who were assigned a unilateral clinical TMJ disorder of TMJpain associated with an internal derangement (ID) type III (disc displacement without reduction) and a TMJ pain side–related MRI diagnosis of disc displacement without reduction associated with osteoarthrosis (OA). Bilateral sagittal and coronal MRI images were obtained immediately before the operation to establish the presence or absence of ID, OA, TMJ effusion, and bone marrow edema. Pain leveland mandibular range of motion (ROM) were assessed preoperatively and compared with the respective 2-month follow-up findings. Outcome criteria for success were a ROM 35 mm and pain reduction 50%. A logistic regression analysis was used to compute the odds ratio for TMJ effusion and bone marrow edema for successful outcomes (n 21) versus unsuccessful (n 16) outcomes. Results: At the 2-monthfollow-up, clinical evaluation showed a significant reduction in TMJ pain during function (P .000), a significant reduction in clinical diagnoses of TMJ disorders (P .016), and a significant increase in ROM (P .000). A significant increase in the risk of an unsuccessful outcome of ROM 35 mm and/or pain reduction 50% occurred with MRI findings of effusion (odds ratio 1:10.8 0.09; P .007). Conclusions: TMJeffusion may prove to be an important prognostic determinant of successful arthrocentesis. However, the data re-emphasize the concept that the prediction of a specific outcome is not a matter of simple linearity, in which the presence of 1 factor may equate with predictive ability, but rather is a function of a complex interaction among different biological variables. © 2007 American Association of Oraland Maxillofacial Surgeons J Oral Maxillofac Surg 65:66-73, 2007 Temporomandibular joint (TMJ) internal derangement (ID) is one of the most common forms of temporomandibular disorder (TMD). The term refers to clinical criteria classifying TMJ disorders but is generReceived from University Clinic Innsbruck, Innsbruck, Austria. *Associate Professor, Department of Oral and Maxillofacial Surgery.†Associate Professor, Department of Radiology. Address correspondence and reprint requests to Dr Emshoff: University Clinic Innsbruck, Department of Oral and Maxillofacial Surgery, Maximilianstrasse 10, 6020 Innsbruck, Austria; e-mail: Ruediger_Emshoff@hotmail.com
© 2007 American Association of Oral and Maxillofacial Surgeons

0278-2391/07/6501-0013$32.00/0 doi:10.1016/j.joms.2005.11.113

ally usedto denote a mechanical fault in the joint interfering with its smooth movement, such as an abnormal positional relationship of the articular disc to the mandibular condyle and the articular eminence. Thus, the term has been used synonymously with disc displacement. The disorders have been associated with characteristic clinical findings, including pain, joint sounds, and irregular or deviated jawfunction.1-4 In patients with an acute-onset loss of TMJ motion (disc displacement without reduction), clinical trials have suggested splint therapy,5,6 arthrocentesis,7,8 arthroscopic lysis and lavage,9,10 and arthrotomy11,12 as therapeutic approaches. The effectiveness of these modalities has not been correlated with a specific 66

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67 costly chronic problems and...