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The aim of the study is to evaluate the effectiveness of high-intensity laser therapy (HILT) in the short and long term in the treatment of patients with the myogenic temporomandibular joint disorder(TMD).This prospective, double-blind, controlled clinical study was conducted on patients with myogenic TMD at a university's oral and maxillofacial surgery clinic. Seventy-six patients were randomized into two groups (HILT, and control group), including 38 patients in one group. The patients were evaluated for pain, the range of motion of the jaw, disability, and quality of life. Assessments were performed before therapy (week 0) and after therapy (weeks 4 and 12). Data were evaluated using SPSS-20 and the level of significance was set at p0.05.There was no significant difference between the groups in terms of socio-demographic characteristics of the groups at the beginning of the study. In the 4th week, the VAS pain score was significantly decreased in the HILT group (47%) compared to the placebo HILT group (4%) (p0.001). The maximum mouth opening was significantly increased in the HILT group (27%) compared to the placebo HILT group (4%) at week 12 (p0.001). The HILT group showed a significant improvement in Jaw Functional Limitation Scale 20 (JFLS-20) and Oral Health Impact Profile (OHIP-14) compared to the placebo HILT group (p0.001 and p0.005 respectively).As a result of the study, it was concluded that HILT is a highly effective, non-invasive therapeutic method for patients with myogenic TMD.

This retrospective study aimed to verify the outcomes of stabilising occlusal splint therapy prescribed to 22 patients with unilateral definite Ménière's disease and comorbid temporomandibular joint disorder.The results of a battery of audiometric and vestibular tests were recorded before and after 6 months of treatment, as well as the scores of disease-specific questionnaires.The average hearing threshold in the affected ear and the acoustic immittance were unchanged. No spontaneous and positional nystagmus were recorded. Caloric hypo-responsiveness and vestibular myogenic evoked responses did not vary. No changes of stabilometric body sway parameters in eyes opened condition and with optokinetic stimulation delivered to the unaffected labyrinth were observed. A significant reduction was recorded in eyes closed condition and with the optokinetic stimulation toward the affected ear. The Tinnitus Handicap Inventory, the Situational Vertigo Questionnaire and the Numeric Pain Rating Scale scores improved. The number of vertigo attacks was reduced.Occlusal splint therapy is a favourable option to reduce aural symptoms of Ménière's disease and comorbid temporomandibular joint disorder, even if its pathophysiological mechanism remains elusive.La terapia occlusale nei pazienti con malattia di Ménière e disordini dell’articolazione temporomandibolare.Questo studio esplora gli effetti dello splint occlusale in 22 pazienti affetti da malattia di Ménière monolaterale e disturbi dell’articolazione temporo-mandibolare.I pazienti sono stati sottoposti a diversi test audiometrici e vestibolari prima e dopo sei mesi di trattamento con splint occlusale, oltre a questionari specifici per la malattia di Ménière.La soglia uditiva media nell’orecchio malato e l’impedenza acustica sono rimaste invariate e non è stato registrato nessun nistagmo clinicamente significativo. I potenziali evocati miogenici non hanno subito variazioni. Il numero di crisi di vertigine si è ridotto significativamente durante il trattamento (p = 0,003). I parametri stabilometrici misurati ad occhi chiusi e con la stimolazione otticocinetica verso il labirinto malato (p 0,0001) sono significativamente migliorati. I punteggi del Situational Vertigo Questionnaire (p = 0,002), del Tinnitus Handicap Inventory (p0,0001) e del Numeric Pain Rating Scale (p0,0001) sono migliorati.La terapia con splint occlusale è efficace nel ridurre alcuni sintomi della malattia di Ménière in comorbidità con il disordine dell’articolazione temporomandibolare, anche se il suo meccanismo fisiopatologico rimane indeterminato.

Temporomandibular joint disorder is defined by pain and/or loss of function of the temporomandibular joint and its associated muscles and structures. Treatments include noninvasive pharmacologic therapies, minimally invasive muscular and articular injections, and surgery. Conservative therapies include nonsteroidal anti-inflammatory drugs, muscle relaxants, benzodiazepines, antidepressants, and anticonvulsants. Minimally invasive injections include botulinum toxin, corticosteroids, platelet-rich plasma, hyaluronic acid, and prolotherapy with hypertonic glucose. With many pharmacologic treatment options and modalities available to the oral and maxillofacial surgeon, mild to moderate temporomandibular joint disorder can be managed safely and effectively to improve symptoms of pain and function of the temporomandibular joint.

BACKGROUND The role of occlusal factors on the occurrence of temporomandibular joint disorders (TMDs) is still unclear and it is tricky for orthodontists to treat malocclusions in patients with TMDs. We report the case of the second orthodontic treatment of an adult female with Class II division 2 malocclusion associated with TMD. With the removal of anterior occlusal interference, TMD symptoms were alleviated and cone beam computed tomography (CBCT) images showed the bilateral condyles shifted forward. CASE SUMMARY This case report presented an orthodontic retreatment of an adult female with TMD and mandibular backward positioning based on CBCT examination and Joint Space Index (JSI) analysis. The left and right JSI values of -38.5 and -52.6 indicated that the position of bilateral condyles had posterior displacement. Ten years prior to this evaluation, she underwent orthodontic treatment resulting in the extraction of two upper premolars and one lower central incisor. The joint symptoms, including pain and sounds, were alleviated along with verified mandibular forward repositioning by extraction of another lower central incisor. CONCLUSION Mandibular backward positioning could be associated with TMD. JSI analysis based on CBCT is a convenient way to examine condylar positions quantitatively.

Studies investigating the relationship between sex hormones, inflammatory mediators and joint disorders have reported that sex hormones affect the pathogenesis of joint disorders. We aimed to investigate temporomandibular joint disorder (TJD) in polycystic ovary syndrome (PCOS) and the possible role of systemic mediators and sex hormones in TJD pathogenesis.PCOS patients (n = 45) and controls (n = 30) aged 20-40 years, were enrolled in this case-control study. TJD diagnosis was performed by the specialist and blood samples were tested in the early follicular phase and on the 21 st (midluteal) day to investigate the levels of estrogen, progesterone, matrix metalloproteinase (MMP) 1-8-9, interleukin (IL)-1ß and Tumor necrosis factor (TNF)-α.TJD incidence was significantly higher in PCOS than the control group (51.1% and 6.9% respectively, p 0.01). Midluteal progesterone (p 0.01) was lower in PCOS group than the controls (p 0.01). TNF-α (p 0.01), MMP 1 (p 0.01) and MMP 8 (p = 0.02) levels were found significantly higher in PCOS than the control group. Further, Progesterone levels were found significantly lower in TJD (+) PCOS patients than TJD (-) PCOS patients. However, significant difference was not found between the PCOS TJD (+) and PCOS TJD (-) patients for estrogen, MMP 1, MMP 8, MMP 9, TNF-α and IL-1ß.TJD frequency was found significantly increased in PCOS patients. Related with this, TJD co-occurrence should be kept in mind in the diagnosing and treatment process of PCOS due to hormonal alteration.

Counseling is considered a first-line conservative therapy with respect to temporomandibular joint disorders (TMJD). Nowadays, 50 to 80% of patients acquire health information from the internet before turning to professionals. The purpose of this study has been to investigate the quality of information about TMJD that patients can obtain from YouTube. A YouTube.com search was conducted using the terms “temporomandibular joint disorder”; “limited movement of the mandible”; and “mandibular joint pain”. The videos identified were assessed independently by two panels of three professional and lay reviewers with HONcode, modified DISCERN (MD) and the global quality scale (GQS). A total of 106 videos were included. The professional reviewers reported a mean HONcode score of 4.148 ± 1.314 and a mean MD score of 2.519 ± 1.267, testifying to a modest general quality of the videos. The mean GQS score was 2.987 ± 1.012 for the professional and 3.469 ± 0.891 for the lay reviewers (p < 0.001). The correlations between the ratings were significant between the reviewers within the same group but not between the two groups. The presence of animations significantly influenced the GQS score expressed by the lay reviewers (p = 0.011) but not that of the professionals (p = 0.640). The quality of the information on TMJD on YouTube is generally of poor quality. Healthcare systems and professionals should be prepared to correct misinformation and build trusting relationships with patients which are based on quality counseling. Similarly, academic institutions should produce quality content that leads patients with TMJD toward a correct diagnostic-therapeutic process.

Objectives In the present study, the effects of sagittal split ramus osteotomy (SSRO) combined with intraoral vertical ramus osteotomy (IVRO) for the treatment of asymmetric mandible in class Ⅲ malocclusion patients were assessed and the postoperative stability of the mandibular condyle and the symptoms of temporomandibular joint disorder (TMD) evaluated. Materials and Methods A total of 82 patients who underwent orthognathic surgery for the treatment of facial asymmetry or mandibular asymmetry at the Department of Oral and Maxillofacial Surgery, Dong-A University Hospital, from 2016 to 2021 were selected. The patients that underwent SSRO with IVRO were assigned to Group I (n=8) and patients that received bilateral SSRO (BSSRO) to Group II (n=10, simple random sampling). Preoperative and postoperative three-dimensional computed tomography (CT) axial images obtained for each group were superimposed. The condylar position changes and degree of rotation on the superimposed images were measured, and the changes in condyle based on the amount of chin movement for each surgical method were statistically analyzed. Results Group I showed a greater amount of postoperative chin movement. For the amount of mediolateral condylar displacement on the deviated side, Groups I and II showed an average lateral displacement of 0.07 mm and 1.62 mm, respectively, and statistically significantly correlated with the amount of chin movement (P=0.004). Most of the TMD symptoms in Group I patients who underwent SSRO with IVRO showed improvement. Conclusion When a large amount of mandibular rotation is required to match the menton to the midline of the face, IVRO on the deviated side is considered a technique to prevent condylar torque. In the present study, worsening of TMD symptoms did not occur after orthognathic surgery in any of the 18 patients.

PURPOSE Biomarkers represent objective indicators of normal processes, pathology, or responses to therapeutic intervention. The purpose of this study is to evaluate the levels of proinflammatory cytokines in synovial fluid of the temporomandibular joint (TMJ) and to investigate whether there is a correlation between elevated levels and disease progression. MATERIALS AND METHODS This is a prospective study that included patients who were diagnosed with internal derangement according to magnetic resonance imaging and were classified according to Wilkes's classifications. After failing to improve with conservative treatment, they were referred for TMJ arthroscopy. During arthroscopy, synovial fluid was collected for biomarker analyses that included the investigation of levels of proinflammatory cytokines: tumor necrosis factor (TNF-α), interleukin 6 (IL-6), and vascular endothelial growth factor (VEGF). The Mann-Whitney U test was used for differences between subgroups for TNF-α, IL-6, and VEGF. RESULTS During the study period, 22 patients presented with a TMJ disorder and met the criteria of the study. There was a statistically significant correlation between the levels of VEGF, TNF-a, and osteoarthritis (P

Aim and objective Force platforms are widely used to evaluate the relationship between bodily posture and jaw positions. The aim and objective of this clinical prospective study was to evaluate the effect of occlusal splints on bodily posture using force platforms. Materials and methods Forty-seven female patients with temporomandibular disorders (TMD) underwent a clinical and postural examination before and during an occlusal treatment with an upper splint. Six postural stabilometric examinations were performed under different visual conditions. Postural stability was assessed using a force platform (SATEL). Subjects were evaluated in static and dynamic conditions, with open and closed eyes, at baseline, at 1 week, and at 3 months. Changes in stabilometric parameters (sway area and sway length) were assessed and compared. Results In static and dynamic positions, the sway surface area decreased significantly after the occlusal guard placement with closed eyes (p-value, 0.012). Likewise, the sway surface area decreased significantly in the dynamic lateral position with closed eyes (p-value, 0.018) and in anteroposterior dynamic position with open eyes (p-value, 0.031). The mean sway length decreased significantly after the placement of the occlusal guard when participants were in the lateral position with open eyes (p-value, 0.025) and in the anteroposterior position with open eyes (p-value, 0.014). On a 3-month assessment, the mean surface and mean length decreased significantly after the placement of the occlusal guard for practically all the static and dynamic positions. Conclusion The sway surface area and sway length decreased significantly with the use of occlusal splints Clinical significance: In female patients with TMD, the use of an occlusal splint is associated with a postural improvement evaluated by posturo-stabilometric tests.

Objective: To discover the extent of the connection between occlusal plane asymmetry and the rest tone of the four muscle groups of the orofacial region with temporomandibular joint pathology.Methods: Eighty-seven subjects were divided into two groups. The following methods were applied: clinical examination, roentgenological examination, and electromyography. Data were evaluated and statistically analyzed.Results: The variability of occlusal plane inclination in relation to the porion plane was 0-4.6o.The tonus of masseter muscle was higher in the experimental group: 1.45 mV more than in the control group: 1.23 mV (p < 0.05).Conclusion: Asymmetry of the occlusal plane inclination was found for nearly all subjects in both groups. It can be compensated for by adaptation mechanisms and does not cause temporomandibular joint disorders. Undertaken research shows the existence of a proven correlation between TMJ disorders and the resting tonus of the masseter muscle.

Introdução: As desordens do complexo craniomandibular são caracterizadas por distúrbios musculoesqueléticos que estão intimamente ligados ao seu difícil diagnóstico, em virtude da etiologia multifatorial da disfunção temporomandibular. Objetivo: Averiguar a possível relação existente da prevalência de sintomatologia da disfunção temporomandibular em universitários com o período do curso, de acordo com as variáveis de grau da disfunção, período matriculado, gênero sexual e idade. Material e método: O estudo foi composto por 182 acadêmicos, na qualidade de voluntário, compreendidos do segundo ao décimo período, regularmente matriculados no 2o semestre do curso de Odontologia, no ano de 2019, em uma universidade privada de São José do Rio Preto-SP, Brasil. O questionário utilizado foi proposto pela Academia Americana de Dor Orofacial, contendo dez questões com respostas objetivas do tipo sim/não, acerca dos sintomas mais frequentes de dor orofacial e disfunção temporomandibular. O Índice Anamnésico de Fonseca foi utilizado para avaliar o grau de disfunção dos estudantes, com valor de 0 ou 10 pontos por questão, totalizando a somatória de até 100 pontos. Resultados: Os voluntários mais acometidos pela sintomatologia foram os presentes no oitavo e décimo período do curso, havendo menor prevalência nos integrantes do quarto período. Verificou-se que o gênero feminino obteve maior prevalência de sintomatologia quando comparado ao masculino, com faixa etária de 18 a 47 anos de idade. Conclusão: A prevalência da sintomatologia de disfunção temporomandibular em universitários parece ter relação à época do curso, pois os estudantes matriculados nos estágios finais do curso demonstraram maior predomínio de disfunção temporomandibular.

Objectives - The aim of the study was to assess the prevalence of symptoms indicative of temporomandibular disorders (TMD) in an adult population in Troms County in Northern Norway, as well as the associations between TMD and socio-demographic factors, dental status, self-reported general, and oral health as well as oral health related quality of life (OHQoL). Methods - Data were collected from a structured questionnaire and a clinical examination of a random sample of almost 2000 adults, 20–79-year-old, in Troms County in Northern Norway. Results - Women had a higher prevalence of all self-reported and clinical signs of pain and dysfunction in the temporomandibular complex compared to men. For both genders, sounds from the temporomandibular joint (TMJ) upon clinical examination was the most common symptom, followed by pain to palpation of jaw muscles. Headache was the most common of the self-reported symptoms and sounds from the TMJ the second most common. Young women had a higher prevalence of self-reported headache and jaw- and face pain compared to middle-aged and elderly women. TMD-related symptoms of pain were significantly associated with poor self-reported general health and correlated with OHQoL as assessed by the oral health impact profile 14 questionnaire. Conclusion - Being women and having moderate to poor self-reported general health were associated with clinical signs and self-reported symptoms of pain in the jaw, face and head region. Self-reported symptoms of TMD correlated more strongly with OHQoL than clinical signs.

Chronic pain and functional impairment associated with temporomandibular joint (TMJ) disorders (TMD) considerably reduce oral health-related quality of life (OHRQoL). In the present study we have assessed the influence of prolotherapy in patients with TMD by the subjective measurement of QoL using the Oral Health Impact Profile-14 (OHIP-14). Twenty-five patients diagnosed with TMD (mean (range) age 38 (18 - 70) years) were included. They had all undergone dextrose prolotherapy to the TMJ at regular time intervals (four times at intervals of two weeks) using the method suggested by Hemwall-Hackett. They were asked to answer the OHIP-14 questionnaire before and two years after prolotherapy. Seven domains of OHRQoL were rated on a 5-point Likert scale from 0 (never) to 4 (very often). Domain scores and total OHIP-14 scores were compared using inferential statistics (chi squared and Wilcoxon signed rank tests). Prolotherapy was effective over time, as all the domains' mean scores decreased considerably after treatment. The total mean score before prolotherapy was 21.20, which was extensively reduced to 13.08 after prolotherapy (p=0.001). There was statistically significant improvement in all domains, including functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap (p≤0.005 in all cases). We concluded that prolotherapy has a promising role in the improvement of OHRQoL of patients with TMD, and its beneficial effects persist at least two years after treatment.

Background The purpose of this study was to analyze cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI) findings in temporomandibular joint disorder (TMD) patients and to comprehensively assess the relationships between these imaging findings and clinical symptoms. Methods A total of 754 temporomandibular joints (TMJs) in 377 patients with clinical symptoms of TMD who underwent both CBCT and MRI examinations were retrospectively reviewed. Clinical symptoms included TMJ pain, TMJ sound, and limitation of mouth opening. Oral radiologists evaluated osseous changes of the condylar head on CBCT, as well as the disc configuration, internal derangement, and joint effusion on MRI. The frequency of CBCT and MRI findings and the mean and standard deviation of age were analyzed. Logistic regression analysis was used to identify associations between these imaging findings and clinical symptoms using SPSS version 25.0 for Windows (IBM Corp., Armonk, NY, USA). The model fit was evaluated using the Hosmer and Lemeshow test. Results TMD patients consisted of 294 females and 83 males, and the age group of 20-39 accounted for 47.2% of the patients. Normal findings regarding osseous changes of the condylar head on CBCT were found in 65.1% of the patients. On MRI, a change in disc configuration was found in 54.9% of the patients, internal derangement in 62.6%, and joint effusion in 46.0%. TMJ pain was significantly associated with sclerosis [odds ratio (OR): 3.81], disc displacement without reduction (DDWOR) (OR: 3.22), grade 2 joint effusion (OR: 2.33), and grade 3 joint effusion (OR: 5.54). TMJ sound was significantly associated with disc displacement with reduction (DDWR) (OR: 3.04), DDWOR (OR: 2.50), grade 2 joint effusion (OR: 2.37), and grade 3 joint effusion (OR: 3.23). Limitation of mouth opening was significantly associated with flattened disc configuration (OR: 2.08), folded disc configuration (OR: 2.30), and grade 3 joint effusion (OR: 2.85). Conclusions CBCT findings had little to do with clinical symptoms. In contrast, MRI findings, including disc configuration, internal derangement, and joint effusion, were associated with clinical symptoms. These results suggest that MRI should be recommended over CBCT for the proper diagnosis of TMD patients.

Background and Objectives: Awareness of temporomandibular joint disorder (TMD) is fairly concerning in management of physiotherapy as patients often seek for treatment from orthodontics when pain become their main concerns. In this case, cervical aspects are often overlooked in the treatment of temporomandibular joint disorder. This study aims to determine the effect of cervical extensor strengthening on severity of temporomandibular joint disorder. Methods: A randomized controlled trial study was carried out for 4 weeks to determine the effect of cervical extensor strengthening on severity of temporomandibular joint disorder among university students. A total of 40 participants were recruited via convenient sampling method. Subjects were randomly assigned into two groups: experimental group (E) and control group (C) through lottery randomization. Subjects in experimental group were instructed to perform 1 set of cervical extensor strengthening with 10 repetitions and goldfish exercises whereas subjects in control group were asked to perform goldfish exercises only. A pre-test and post-test severity of TMD, maximal mouth opening and maximal isometric cervical extensor strength were measured for both groups. Results: After 4 weeks of training, there was significant difference in pre-test and post-test severity of TMD and maximal mouth opening for both E and C group. On the other hand, there was significant difference of pre and post-test of maximal isometric cervical extensor strength in experimental group. There was no significant difference in post-test for severity of TMD (p=0.67), maximal mouth opening (p=0.21) and maximal isometric cervical extensor strength (p=0.40) between two groups. Conclusions: The study concluded that, 4 weeks of anti-gravity cervical extensor strengthening exercises protocol showed there was no significantly difference of the severity of TMD and maximal mouth opening between both control and experimental group. On the other hand, goldfish exercises showed significant improvement of maximal mouth opening and reduction in severity of TMD after 4 weeks of intervention period.

The management of TMD is difficult and controversial. Treatment options for TMD include patient education, behavior therapy, physiotherapy, occlusal splint therapy, drug therapy, occlusal adjustments, surgical intervention, and combined treatment. The purpose of this article is to review the different type of occlusal splints and their role in managing TMDs.

Objective: To assess the self-perceived pain perception (PP) and whole salivary cortisol levels (CL) among adolescents with and without temporomandibular disorders (TMD).Methods: Adolescents between 15 and 17 years were included. Participants were categorized into three groups: Group 1: patients with TMD; Group 2: nocturnalbruxers without TMD; and Group 3: controls. Demographic data CL and self-rated PP were assessed. A p-value < 0.05 was proposed as statistically significant.Results: Fifty-four patients (18 per group) were included. Scores of self-rated PP in the affected TMJ were higher in Group 1 than Group 2 (p < 0.001). Whole salivary CL were higher in groups 1 and 2 (p < 0.01) than in Group 3. Whole salivary CL were higher in Group 2 than Group 3 (p < 0.05).Conclusion: Whole salivary CL are higher in adolescents with TMD, and there is a direct relationship between self-rated PP in the TMJ area and salivary CL.

Objectives This study aims to evaluate the effectiveness of upper Michigan occlusal splint (OS) compared to mandibular OS in terms of pain, range of motion (ROM), and muscle activity as assessed by surface electromyography (sEMG) in patients affected by muscle-related temporomandibular disorders (TMD). Patients and methods In this randomized-controlled trial, a total of 40 adult patients (13 males, 27 females; mean age: 47.2±12.8 years; range, 22 to 56 years) with a diagnosis of myofascial pain, lasting from at least three months on at least one masseter muscle. The patients were randomly allocated into two groups: Group 1 (n=20) using upper Michigan OS and Group 2 (n=20) using mandibular OS. At baseline (T0), at one (T1), three (T2), and six months (T3), the following outcomes were assessed: myofascial pain by Visual Analog Scale (VAS) and ROM of mandible movements, activity of the main masticatory muscles through sEMG. Results There were no significant intra-group differences in the outcome measures assessed in both groups. However, Group 2 had a significantly higher right lateral mandibular ROM at T2 (7.1±3.1 vs. 9.8±2.3, respectively; p

Primary head and neck osteosarcomas (HNOS) arising from skull base are rare. It may be difficult to detect in the early stage. We discuss the symptoms that should be noted in daily clinical practice. We aimed to present a case of an osteosarcoma (OS) arising from the mandibular fossa of the temporal bone that was initially misinterpreted as temporomandibular disorder (TMD). Since TMD is a common disease, other rare serious diseases can be misinterpreted as TMD at an early stage. Spontaneous pain, swelling, maximal diameter of mouth opening of less than 20 mm, long-term trismus, and neurological symptoms, may be useful in the differential diagnosis of TMD. If there is a possibility that it is not TMD, it may be better to employ other diagnostic modalities such as CT or MRI to investigate the possibility of HNOS.

Background: Temporomandibular joint disorder is a prevalent orofacial pain condition involving sensitization and activation of trigeminal nociceptive neurons. Dietary supplementation with a proanth...

Highlights • MMTAH is a new clinical entity, misdiagnosed as temporomandibular joint disorder. • MMTAH is diagnosed based on a square mandible, cord-like masseter muscle aponeurosis, and limited mouth-opening. • Aponeurectomy combined with coronoidectomy is the treatment of choice for a better prognosis. • It is important to evaluate the patient’s compliance with mouth-opening training before surgery., Introduction Masticatory muscle tendon-aponeurosis hyperplasia (MMTAH) is a new clinical entity that presents mainly with trismus due to hyperplasia of the masseter aponeurosis and temporalis muscle tendon. However, the etiological factors of this disease are unknown; it is often mistreated as temporomandibular joint disorder (TMD). Presentation of case We report a 32-year-old female patient complaining of bilateral pain in her jaw and difficulty opening her mouth. She was first diagnosed as TMD and treated with a splint; however, her symptoms did not improve. Clinical examination revealed a square mandible, tenderness in the left and right temporalis muscles and masseter muscles, and tenderness along the anterior border of the masseter muscle. Her maximum mouth-opening was 30 mm. Short TI inversion recovery magnetic resonance imaging showed areas of low intensity at the anterior border of the masseter muscle and around the coronoid process where the temporalis muscle tendon attaches. Consequently, the diagnosis made based on the clinical and radiographic findings was MMTAH. Bilateral coronoidectomy was performed, followed by a rehabilitation program for six months. The maximum opening was maintained at 48 mm two years after the operation. Discussion MMTAH was treated as type 1 TMD until it was recognized as a new disease at the conference for the Japanese Society for Oral and Maxillofacial Surgeons. Since then, many clinicians have become aware of this particular condition, and different treatment modalities have been proposed. Conclusion Clinicians should consider MMTAH as a differential diagnosis when the patient’s chief complaint is gradually decreasing mouth-opening.

Temporomandibular joint (TMJ) disorder and bruxism may cause individuals to experience extreme pain in the region of jaw and head. The associated musculature and the joint are placed at a STRAINED position which manifests as unbearable pain. This pain may radiate to face, neck and some may even develop migraine, all of which can have painful and a debilitating effect on an individual. This paper describes the case where a patient who was suffering from TMJ pain from 8 years using multiple occlusal splints over the course of years but showed no signs of relief thus, impairing the quality of life. TMD's constitute a group of disease with overlapping similar sign and symptoms. In this case, the patient was diagnosed and treated with the NTI-tSS appliance, with a 6 month follow up showing almost complete resolution of the symptoms enhancing the quality of life.

Purpose: This study investigated the relationships among characteristics of maxillomandibular asymmetry in patients with menton deviation and temporomandibular joint (TMJ) disc conditions, includin...

Purpose: The aim of this study was to evaluate the correlation between early loss of first permanent molar (FPM) and temporomandibular joint disorder (TMD) symptoms in the children. Materials and Methods: 99 children (aged between 8 and 16) who had their FPM/s extracted at least two years ago were included in this study. The patients had clinical examination of oral status and temporomandibular joint (TMJ). Magnetic resonance imaging (MRI) findings were also evaluated with TMD symptoms. The correlation between the number of FPM loss and TMD symptoms was statistically analyzed. Results: Only one FPM loss was recorded in 59 children, while 34 had two FPM loss and 7 had three or four FPM extracted. 10 of these children (10.1%) had at least one TMD symptoms. A positive correlation was found between the number of FPM loss and at least one TMD symptom. Conclusion: The results of this study have shown the early loss of FPM has significant impact on TMD. The occlusion variations associated with eruption sequence and early FPM loss should be carefully followed to prevent TMD.

Objective. The aim of this systematic review was to evaluate the effectiveness of laser application in temporomandibular joint disorder. Methods. PubMed, SCOPUS, Science Direct, Web of Science, and Google Scholar electronic databases were searched systematically with restricting the languages to only English and year (January 2001 to March 2020), and studies were selected based on the inclusion criteria. Study quality and publication bias were assessed by using the Robvis, a software package of R statistical software. Results. This systematic review included 32 studies (1172 patients) based on the inclusion and exclusion criteria. Most of the studies reported significant reduction of pain by the use of the laser during TMD treatment. Two-thirds of the study (78.13%) found a better outcome comparing with conventional one. According to Robvis, 84.4% of the studies were high methodological studies with low risk of bias. Conclusion. TMD patients suffer with continuous pain for long time even after conventional treatment. Laser therapy shows a promising outcome of pain reduction for TMD patients. Therefore, laser therapy can be recommended for the TMD patients’ better outcome. This trial is registered with PROSPERO (CRD42020177562).

Occlusal features that deviate from normative values have been historically considered risk factors for temporomandibular joint (TMJ) disorders. Nowadays, a putative association between dental occlusion and TMJ disorders remains controversial, with research findings on associations being inconsistent and inconclusive. We hypothesized that putative occlusal features identified during adolescence are associated with TMJ clicking later in life. The Dunedin Multidisciplinary Health and Development Study is a longitudinal birth cohort study investigation of 1,037 children (48.4% female) born in Dunedin, New Zealand, between April 1, 1972, and March 31, 1973, and assessed repeatedly since then. Associations between posterior crossbite, overbite, and overjet at age 15, as well as both self-reported and clinically assessed TMJ clicking sounds at age 45, were studied. Data were analyzed using multivariate logistic regression, after controlling for sex, emotional style, self-reports of tooth clenching and sleep bruxism, and history of orthodontic treatment. Self-reported and examiner-reported TMJ clicking at age 45 affected 18.3% and 23.8% of the study sample, respectively, and were not associated with the presence of a posterior crossbite or abnormal overjet/overbite values during adolescence. Self-reported history of tooth clenching and emotional style were associated with self-reported TMJ clicking later in life. In addition, there is a suggestion that high overbite during adolescence is negatively associated with TMJ clicking later in life. A history of orthodontic treatment was not associated with TMJ clicking. Abnormal occlusal features, such as posterior crossbite and high and low overjet/overbite in adolescence, are not associated with higher prevalence of TMJ clicking later in life. Personality also appears to influence self-reports of TMJ clicking later in life.

Objective: To evaluate the maximum bite force (MBF) in subjects with and without Temporomandibular Dysfunction (TMD), in threedifferent positions (sitting, lying and standing). Methods: The sample consisted of 60 individuals, aged between 19 and 35 years,who were divided into two groups: with TMD (n = 30) and without TMD (n = 30). First, the RDC/TMD questionnaire was applied and,after diagnosis, all of the subjects selected were submitted to the measurement of MBF, on each side (right and left), in three differentpositions (sitting, lying and standing), by means of a digital gnatodynamometer. Results: No significant difference in mean MBF was foundbetween the two groups; however, the mean MBF for the subjects, comparing the same side and different positions, was significantlydifferent, being smaller when the individual was lying down. Conclusions: According to the results, it was concluded that the MBF isinfluenced by the change of position.

Objectives The present study aimed to evaluate any relationship between elongated styloid process (ESP) and temporomandibular joint disc displacement (TMJD). Study design: A retrospective cohort study. Setting: Dentomaxillofacial Radiology division of Erciyes University Dental Hospital. Participants: Ninety-four temporomandibular joints (TMJs) of 47 patients were allocated in this study. Intervention-disease: Two experienced dentomaxillofacial radiologists have interpreted all CBCT and MR images. Patients who referred with TMJ disorders were classified according to temporomandibular joint's disc status as normal disc position (ND), displacement with reduction (DWR) and displacement without reduction (DWoR). Methods Main outcome measures: Interpretation of styloid chain calcification pattern and styloid processes length measured linearly on reconstructed sagittal slices of CBCT. Randomization: Cone beam computed tomography (CBCT) and magnetic resonance (MR) images of 154 patients who were admitted between September 1, 2012 and September 1, 2019. Only 47 of them fulfilled the study requirements. Blinding: Single blind of the outcome measurements and interpretations of MR images. Results Total 94 TMJs of 47 patients disc status groups were analyzed and defined as DWoR (n = 25), DWR (n = 32), and ND (n = 37). On multivariate analysis, no statistical significant differences were found between groups in terms of styloid process lengths. Mean SP length and standard deviation of disc status groups (DWoR, DWR, and ND) are 35.5 (+/- 9.8) mm, 34.6 (+/- 9.2) mm, and 38.3 (+/- 8.9) mm, respectively. When patients were grouped individually according to their post-MRI diagnosis, the mean styloid process length in the non-temporomandibular joint disc displacement (non-TMJD) patients (47.9 +/- 10.8) was significantly higher than the TMJD patients (36.1 +/- 9.3). In this study, there is no intervention to cause any harm or side effects. Conclusion Our results indicate that styloid-stylohyoid syndrome may be misdiagnosed with temporomandibular joint disorder (TMD).

Background: The temporomandibular joint (TMJ) is certainly one of the most complex joints in the human body. The American Academy of Orofacial Pain defines temporomandibular joint disorder (TMD) as a set of disorders involving the masticatory muscles, the TMJ, and associated structures. It is pointed as the main cause of non-dental pain in the orofacial region, including head, face and related structures. The most common TMD symptoms involve joint, chewing and face pain. There may also be crackling when opening and closing the mouth, earache, tinnitus, dizziness, dislocations, limitation of movement and painful tenderness to palpation. Stroke causes sequelae in subjects that include motor disorders, speech or language disorders, and swallowing disorders. Approximately 50% of patients with hemiparesis after stroke are known to have facial control deficiency, weakened orofacial and mandibular functions. Objective: To evaluate patients with a history of stroke, seeking a possible relationship with TMD, the pain associated with this change, and the limitations of range of motion related to the presence of hemibody spasticity in patients post stroke. Methods: The sample consisted of 19 patients of both genders, aged 55 to 70 years, who had suffered stroke. It was used the RDC/TMD for TMD diagnosis, Pressure Pain Threshold test, Ashworth scale, and Sanny Fleximeter for cervical ROM evaluation, being the statistical analysis performed by the software Bioestat version 5.3. Results: TMD was diagnosed in 81.8% of the sample, and of these, 45.4% had a diagnosis of disc displacement with reduction. Conclusion: There was an increase in the muscle tone and the pressure pain threshold, and a decrease in cervical spine ROM, related to the affected side and diagnosed with this disorder, observing that the muscle alterations caused by stroke may be predisposing factors to patients, to the development of muscle TMD or even joint TMD.

Standard TMJ is the key to the morphology of the face as it enables the occlusive function and spatially situates the chin. The diagnosis of the temporomandibular joint disorders is made intricate not only by the multifactorial etiology of these pathologies but also by the difficulty to comprehend the pain felt by the patient. Through a review of the literature and our respective practices (over 30 years) and teachings, this article surveys the main principles of temporomandibular joint disorder. As numerous writers have focused on the problems created by TMJ pathologies, it's only natural that various therapeutic approaches be suggested. What primarily matters is that they lead to a stabilization of the occlusion. As far as diagnosis is concerned, only a precise and rigorous protocol - followed by everyone - can produce a therapeutic result that would be acceptable for each patient. The orthodontist can and must be the coordinator of the cross-disciplinary team. He steps in over 72 % of temporomandibular joint disorder cases and proposes the most conservative, cheapest, and the best cost/benefit ratio for the patient.

Objective: To evaluate pain control in patients with joint and muscle pain in temporomandibular disorder (TMD) diagnosis treated with oral non-steroidal anti-inflammatory drugs (NSAIDs). Methods: The systematic research was conducted via Pubmed, Scopus, Web of Science, Google Scholar, and Cochrane databases. Results: Four full-text randomized-controlled trials (RCTs) were considered eligible. This systematic review included 164 patients whose VAS scores were assessed before and after therapy. In the selected studies, a strong heterogeneity in the diagnosis and in the use of different types and prescriptions of NSAIDs was highlighted. These limitations had to be considered to understand whether a clinical recommendation could be made. Eventually, all patients treated with NSAIDs showed an improvement in pain. Conclusion: The use of oral NSAIDs as the first approach to control joint and muscle pain is sustained by the current scientific literature, but further investigations on this topic are still needed.

To explore and analyze the pain characteristics and countermeasures to improve intraoperative pain for patients with temporomandibular joint disorder during treatment of orthodontics. The patients were randomly divided into control group and the observation group. The control group received routine nursing. It is found in the study that the occurrence of pain in orthodontic treatment is accompanied by certain regular changes, and there is little difference between the proportion of masticatory pain and occlusal pain. In the observation group, the total clinical effective rate increased after nursing (P

Introduction Granulomatosis with polyangiitis (GPA), is a rare systemic disease that if left untreated, it may lead to death within 6 - 12 months. This case report describes a 15-year- old female with a fourteen- month history of epiphora, nasal breathing difficulties, headaches and jaw pain. The patient reported having various medical procedures attempted to address her symptoms. The classical presentation of strawberry gingivitis led to the diagnosis of GPA. Based on a multi language search, this is the first reported case, that GPA is mistaken as Temporomandibular Joint Disorders (TMD). Case presentation A 15- year- old female with nearly fourteen months of numerous complaints, including headaches and jaw pain, was referred for an Orofacial Pain (OFP) consultation. The patient had completed a dental examination and was prescribed chlorhexidine for gingivitis control. The OFP examination was not consistent with signs and symptoms of TMD. However, the gingival appearance of strawberry gingivitis was suggestive of GPA. A rheumatologist confirmed the diagnosis of GPA based on the clinical interview, serology testing and dental findings. A course of rituximab and corticosteroids, and regular dental cleanings were recommended. A four- month follow-up visit demonstrated complete resolution of her jaw pain and headaches. Gingival tissue appeared normal. Conclusion This case emphasizes the need for familiarity with systemic diseases that can present oral manifestations. It also stresses the importance for dental professionals to be knowledgeable of differential diagnoses for TMD, headaches and autoimmune disorders. This article is protected by copyright. All rights reserved.

This article aims to provide the practitioner with therapeutic options to treat a broad spectrum of acute and chronic orofacial pain syndromes. The focus will be nonsurgical that the oral health care physician can implement to treat this population of patients. The World Health Organization estimated that more than 1 in every 3 people suffers from acute or chronic pain. This article is primarily devoted to medication management once the diagnosis of neuropathic pain, a true trigeminal neuralgia, or a variant of trigeminal neuralgia often referred to as traumatic neuropathic pain or traumatic trigeminal neuralgia.

Background There is limited data on Pakistani dental students perceived competence in managing orofacial pain (OFP). This study aims to evaluate dental students self-perceived competence regarding the management of orofacial pain. Methods This cross-sectional study was conducted in Karachi at randomly selected two public and four private dental schools. This survey was conducted online from November 2020 to December 2020 in six dental schools. A questionnaire link was sent to the 475 students. A chi-square test and independent-sample t-test were conducted to assess the frequency distribution and compare mean scores of knowledge, diagnosis, and management parameters. Results Of the 475 students, 280 students filled the online survey leaving a response rate of 59%. A significant number of fourth-year students, 65 (51%, p = 0.005), feels knowledgeable regarding neuropathic pain compared to third-year students. The majority of the fourth-year students, 100 (78%, p = 0.010), feel comfortable managing intraoral pain. Almost all the students reported thinking that they need more knowledge related to five types of OFP. The fourth-year students had high mean scores related to knowledge, comfort in diagnosing and managing OFP categories. Conclusion This study found that dental students perceived competence regarding orofacial pain management varies in relation to specific categories, being lowest for psychogenic pain.

Background The systemic immune-inflammation index (SII) has been demonstrated to be a valid biomarker of a patient's immunological and inflammatory state, with the ability to accurately predict outcomes in a variety of disease conditions. In the absence of comparable studies, we intended to examine the relevance of pretreatment SII in predicting the success rates of temporomandibular joint arthrocentesis (TMJA) at 1-week, 1-month, and 6-month periods, defined as maximum mouth opening (MMO) > 35 mm and VAS ≤ 3. Methods A sum of 136 patients with disc displacement without reduction (DDwo-red) who underwent TMJA was included. For each patient, pre-TMJA SII was calculated as; SII = Platelets × neutrophils/lymphocytes. Additionally, baseline MMO and VAS measurements were recorded for each patient. The success criteria of TMJA included MMO > 35 mm and VAS ≤ 3. The optimal pre-TMJA SII cutoff that predicts TMJA success was determined using receiver operating characteristic (ROC) curve analysis. The primary endpoint was the link between the pre-treatment SII and TMJA success (simultaneous achievement of MMO > 35 mm and VAS ≤ 3). Results The median pre-TMJA jaw locking duration, maximum mouth opening (MMO), and visual analog score (VAS) were 7 days, 24 mm, and 8, respectively. The overall TMJA success rates were determined as 80.1%, 91.9%, and 69.1% at 1-week, 1-month, and 6-months, respectively. The results of ROC curve analysis exhibited the optimal SII cutoff at 526 (AUC: 67.4%; sensitivity: 66.7%; specificity: 64.2%) that grouped the patients into two subgroups: Group 1: SII ≤ 526 (N = 81) and SII > 526 (N = 55), respectively. Spearman correlation analysis revealed a strong inverse relationship between the pretreatment SII values and the success of TMJA 1-week (rs: − 0.83; P = 0.008) and 1-month, (rs: − 0.89; P = 0.03). Comparative analyses displayed that TMJA success rates at 1-week (87.7% vs. 69.1%; P = 0.008) and 1-month (96.2% vs. 80%; P = 0.03) were significantly higher in the SII ≤ 526 than SII > 526 group, respectively, while the 6-month results favored the SII ≤ 526 group with a trend approaching significance (P = 0.084). Conclusion The current study's findings suggested the SII as a unique independent prognostic biomarker that accurately predicts treatment outcomes for up to 6 months. Trial registration The results of this research were retrospectively registered.

Temporomandibular joint disorders (TMJD) have complex and diverse etiologies. Various classifications have been created in order to better describe and to guide the treatments correctly of these disorders. Wilkes classification is the most accepted among these classifications. A more comprehensive and understandable classification has been developed by Dimitroulis to eliminate the short comings of other classifications. In this case we aimed to present category 5 catastrophic TMJD with radiological findings according to this new classification.

INTRODUCTION: Temporomandibular disorders (TMDs) are clinically significant conditions which can be a source of acute or chronic orofacial pain and dysfunction including limitation of mandibular movement. Simple lysis and lavage in the upper joint space which washes out inflammatory mediators were found to be highly effective in reestablishing normal maximum interincisal opening (MIO), jaw function and relieving the symptoms despite the disc position not have been corrected. OBJECTIVES: To evaluate the efficiency of arthrocentesis, used normal saline, followed by injection of dextrose 50%, in a single injection protocol, for management of patients with TMDs. MATERIALS AND METHODS: This study was conducted on fourteen TMD patients have been diagnosed on the bases of the clinical data and MRI findings. The selected patients were divided equally into two groups, each group comprising of seven patients. The group-A: has been treated by arthrocentesis followed by 2 ml of dextrose 50% injected into the superior compartment of TMJ. The group-B: has been treated with arthrocentesis alone. All patients have been evaluated at the end of the 24 hours, 1st, 2nd, 3rd, 4th, 5th and 6th weeks postoperatively. RESULTS: unassisted mouth opening showed an increase at all time intervals. There was a significant improvement in pain, the range of motion, joint effusion and joint sounds. CONCLUSIONS: Arthrocentesis followed by 50% dextrose injection is superior to arthrocentesis alone in reducing impairment in patients with TMDs on its clinical outcome.

Synovial chondromatosis (SC) of the temporomandibular joint is a pseudoneoplastic condition characterized by benign cartilaginous metaplasia of synovial tissue mesenchymal residues with intra-articular nodule formation. TMJ involvement is rare. Interposition of loose bodies in the articular space can generate pressure, leading to glenoid fossa erosion with intracranial extension. The aim of this study was to present six SC cases with intracranial extension treated using a surgical procedure. All the patients were treated with open surgery. The superior compartment of the TMJ was opened widely to carefully remove the metaplasic mass. Temporal synovectomy was then performed. Attention was paid to preserving the integrity of the articular disc. The exposed dura mater was also preserved. No material was used to reconstruct the gap in the glenoid fossa. A 1-year follow-up showed no swelling or pain. Patients demonstrated good recovery of mouth opening, with improvement over previous mouth limitations. Morphological studies, performed using MRI and CT, showed complete anatomical recovery of the TMJ and total bone reconstruction of the glenoid fossa. Simple removal of intra-articular nodules, with TMJ arthroplasty and articular disk preservation, represents an efficient treatment option for full anatomical and functional recovery in synovial chondromatosis of the temporomandibular joint with glenoid fossa erosion of less than 1 cm2.

Objectives: To measure the inclination 1. Height of articular eminence using CBCT; 2. To measure the length and width of condyles using CBCT. 3. To evaluate and compare above changes in pain and non painful joints. Aim: The aim of the present study is to assess the morphological changes of articular eminence and condyle in temporomandibular joint disorder patients. Materials and Methods: This study was conducted on 50 patients (i.e.100 joints), in which 23 are males and the rest 27 are females. These 50 patients are divided into two groups, in which, patients with painful joints are considered as study group and non painful joints were kept as control group. Statistical Analysis and Results: Independent sample t-test was used to determine the differences in height and inclination of articular eminence and condylar length and width. Pearson correlation coefficient used to find the relation between two quantitative variables of articular eminence height and inclination with condylar width and length. There exists no difference in pain and non painful joints in TMJ patients (p>0.05). Conclusion: In the present study there were no significant changes in morphology of articular eminence and condyle in pain and non painful joints. Keywords: Articular eminence, Condyle, CBCT, TMDs, TMJ, Imaging.

Introduction Botulinum toxin has been used mainly in the treatment of muscular temporomandibular joint disorders (TMD) and hyperactivity of the masticatory muscles. It is used also as a therapeutic option to relieve pain and help in functional recovery from dental, oral and maxillofacial surgery. The aim of our study was to investigate the efficacy of botulinum toxin injection in the treatment of muscular TMD. Materials and methods Of the 200 temporomandibular joint patients who applied for treatment, 25 patients with muscular dysfunction of the origin were included in the study. This patient group received drug, drug - physical therapy, occlusal splint therapy and botulinum toxin. These treatments were performed step by step. Botulinum toxin was applied, in accordance with reflex measurement in electromyography guidelines to nine patients whose results were not success from the other treatments had not been successful. Measurements were taken of bite force, pain and mouth openness. Results Sixteen patients were treated with drug-physical therapy-occlusal splint therapy, and botulinum toxin treatment was found to be successful in the case of nine patients. No side effects were observed at six months follow-up. Conclusion Botulinum toxin injection for the treatment of muscular temporomandibular joint disorder is a viable treatment option in the case of patients who do not respond to conservative treatment methods.

AIMS To better understand the experiences of individuals who must alter the types of food they eat because of having a chronic temporomandibular joint disorder (TMD) and the digestive issues that these alterations produce. METHODS Six participants answered open-ended questions during semi-structured interviews about their experiences with TMD-related changes in diet and digestion. These interviews, held face-to-face with the participants in a nonclinical environment, were recorded and transcribed. Interpretive phenomenology was used to arrange and analyze the narrative data collected. RESULTS The authors identified three common themes among the participants: (1) constipation and bloating; (2) loss of chewing function; and (3) weight change. For each of these themes, participants expressed physiologic and psychologic complications, which were largely unaddressed by their health care providers. CONCLUSION These findings highlight the need for health care providers to establish nutritional guidelines for TMD individuals at risk of physiologic and psychologic comorbidities. Health care intervention programs to treat people living with chronic TMD pain and that provide nutritional guidance will help decrease medical crises and the need for expensive interventions and will better assist these patients.

Primary biliary cholangitis is a slow-progressing autoimmune disease of the liver characterized by the presence of portal inflammation and immune-mediated destruction of the intrahepatic bile ducts. Herein, we report a case of temporomandibular joint disorder that concurred with primary biliary cholangitis. A 54-year-old woman presented to us with severe pain on the left side of the temporomandibular joint and difficulty in mouth opening. We used pharmacotherapy, occlusal sprint, and arthrocentesis for the treatment; however, there was no improvement. Magnetic resonance imaging revealed malposition of the articular disk on the left side of the joint and joint effusion. Thus, we performed arthroscopic surgery under general anesthesia. Postoperatively, she developed impaired liver function and itchiness of the skin. A liver biopsy was performed by a hepatologist, and a diagnosis of primary biliary cholangitis was made, as suspected. The temporomandibular joint pain and trismus persisted postoperatively; however, these symptoms improved after primary biliary cholangitis therapy. Thus, we suggest a relationship between temporomandibular joint disorder and primary biliary cholangitis from this disease trajectory and suspect that interleukin-17 may play an important role in the pathogenesis of temporomandibular joint disorder.

Whiplash-associated disorder (WAD) has a close relationship to and functional linkage with the neck and jaw. Studies show an association between orofacial pain and cervical pain and confirm intersegmental nociceptive connections between the trigeminal regions and the cervical spine. We present six cases of WAD-associated orofacial neuralgia. The objective of this study is to present a series of cases of neuralgia-like pain following WAD. Six cases of WAD-associated orofacial neuralgic pain are presented. Neuralgia was identified based upon history, examination, and successful pain management with specific medications for neuralgia. Five out of the six cases were initially diagnosed and treated with limited efficacy as temporomandibular joint disorder (TMD) with continuing pain and were subsequently diagnosed and treated with efficacy as trigeminal neuralgia. MRI and CT scan may suggest cervical spine changes mostly at C2–3, C3–4, and C5–6. Traditional therapy for musculoskeletal pain had no impact upon orofacial pain in patients with neuralgia-like pain following WAD. These cases show that development of neuralgia-like pain may have delayed onset following WAD. Clinical presentation and diagnosis of neuralgia were confirmed upon control of pain with use of carbamazepine or oxcarbazepine. To our knowledge, these cases represent the first report of WAD-related orofacial neuralgia and suggest the potential for neuralgia-like pain to occur following WAD and that clinical diagnosis is needed to lead to effective therapy.

The present study aimed to clarify the reliabilities of four characteristic appearances, subchondral cyst, erosion, generalized sclerosis, and osteophyte, for evaluation of degenerative diseases with osseous changes in the temporomandibular joint (TMJ) using panoramic TMJ projection imaging and computed tomography (CT), and to investigate the imaging features of these modalities for subchondral cyst with reference to its magnetic resonance imaging (MRI) features. The reliabilities (κ values) of panoramic TMJ projection and CT images were determined by three radiologists for each characteristic appearance of TMJ osseous changes in 146 condyles. The features of cyst-like areas on CT images with agreement among the three radiologists were investigated for size, location, and continuity with the joint space together with MRI signal intensity and surrounding edema-like lesions. Panoramic TMJ projection images showed moderate and substantial agreements for erosion and osteophyte evaluations, respectively; while CT images showed substantial agreements for subchondral cyst, erosion, and osteophyte evaluations. Cyst-like areas on CT images were predominantly located in the central parts and 69 of 86 (80.2%) areas showed no communication with the joint space. Cyst-like areas with diameters exceeding 2 mm showed high or moderate MRI signal intensities. Edema-like lesions were observed in 10 of 28 (29.4%) condyles. The reliabilities of panoramic TMJ projection and CT images were clarified for each characteristic appearance. The results support the bone contusion theory for the formation of subchondral cysts in the TMJ. A possible improvement in reliability is suggested relative to MRI findings.