Η συμβολή των απεικονιστικών τεχνικών στη διάγνωση της δυσλειτουργίας της κροταφογναθικής διάρθρωσης σε ασθενείς με φλεγμονώδεις ρευματοπάθειες

Abstract

Many of the rheumatic diseases are characterized by inflammation and damage to the joints and their surrounding structures, mediated by the immune system. Although the exact aetiology of these diseases is in general unknown, most appear to be of multifactorial origin. It is believed that the inciting event, such as an infection or other exogenous challenge, initiates a pathological process in an individual susceptible because of genetic factors. Of the inflammatory arthritic diseases those of rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis have been included in the study. AIM: The aim of the present study is to investigate the subjective clinical and the objective radiographic changes of the temporomandibular joint in patients with active temporomandibular disorder. The patients selected have a known history of an inflammatory arthritis present. More specifically the following were investigated: The frequency of symptoms present at the TMJ of patients with a known inflammatory rheumatoid condition, the radiographic findings of the TMJ in the patients, the correlation of the clinical and radiographic findings, and finally the correlation of the various radiographic methods used and their comparison. MATERIALS AND METHODS: Of the 70 patients examined, a total of 40 patients were included in the study. Patients with a history of osteoarthritis, occlusal problems, injury of the TMJ, and other conditions that could cause TMJ syndrome were excluded from the study. Therefore a total of 80 TMJs were evaluated both clinically and radiologically. Clinical evaluation included the examination of the patient with an altered Helkimo index to measure three parameters of the joint, the function of the joint, the muscular condition of the joint and the joint condition, as well as a total index score. Radiological evaluation included a panoramic radiograph of the TMJs that was taken and a computer tomography of the joints. In the panoramic radiographs taken, isolation of the TMJs was done using the JLA view program, while in the CT scans of the patients all scans were taken with closed mouth, with a distance of 0.5 mm per slice. The parameters examined were: 1) bony changes of the condyle (flattening, erosion, osteophytes, sclerosis, resorption), 2) the position of the condyle in the mandibular fossa (anterior, concentric, posterior), 3) the joint space (increased, normal, reduced, bony contact between the condyle and the mandibular fossa), 4) bony changes of mandibular fossa (erosion, sclerosis, resorption, normal). All images, both panoramic radiographs and the Ct scans of the patients were examined for the above parameters by two oral surgeons under the same conditions. RESULTS: There were no statistically significant differences found between the two observers or between the two joints of the same patient (right and left) on the panoramic radiographs. For the case of CT scans there were significant differences between the joint space of right and left joints, while in the ANOVA performed differences were found for the evaluation of the bony changes of the condyle. CONCLUSIONS: From the clinical section of the study, it can be concluded that there is no correlation between the duration of the disease present, and the symptoms the patients present, and that there is no correlation between the age of the patients, and the presenting symptoms they had. From the radiographic section it can be concluded that there were no significant differences found between the two radiographic methods selected for both joints, and therefore when a proper simple radiograph is taken and well evaluated, the conclusions drawn from it are well based and there is no need for further examinations.