HARD AND SOFT-TISSUE IMAGING OF THE TEMPOROMANDIBULAR-JOINT 30 YEARS AFTER DIAGNOSIS OF OSTEOARTHROSIS AND INTERNAL DERANGEMENT

Purpose: This article describes the clinical and imaging findings in t he temporomandibular joints (TMJs) of patients 30 years after the init ial diagnosis of osteoarthrosis and internal derangement. Patients and Methods: Fifty-five TMJs with a history of osteoarthrosis and interna l derangement and 37 contralateral TMJs that were asymptomatic 30 year s ago were examined in 46 former patients. To visualize degenerative c hanges of the bony parts of the TMJ, transpharyngeal and transcranial radiographs were made; to visualize disc position, sagittal T1-weighte d magnetic resonance (MR) images were made. For comparison, 22 TMJs of an age-matched control group without complaints related to the mastic atory system were similarly examined. Results: Thirty years after the initial diagnosis of osteoarthrosis and internal derangement, clinical signs in former patients hardly differed from those of control subjec ts. Radiographic signs were significantly more common and more severe in former patients. A high percentage of osteoarthrosis and internal d erangement was seen on MRI in both TMJs with a history of osteoarthros is and internal derangement and in the contralateral TMJs. it appeared that osteoarthrosis and internal derangement in the contralateral TMJ s had developed asymptomatically in most cases. None of the patients h ad required treatment for the contralateral TMJ; only one fourth of th e patients had noticed symptoms. In the control subjects, osteoarthros is and internal derangement were infrequently seen. A significant corr elation was found between disc position and the severity of radiograph ically detectable degenerative changes of the TMJ. Conclusions: It was concluded that 30 years after initial diagnosis there were few clinic al signs of osteoarthrosis and internal derangement, although radiogra phic signs were extensive. Bilateral osteoarthrosis and internal deran gement, with one symptomatic and one asymptomatic TMJ, is a common phe nomenon. Moderate to severe radiographically detectable degenerative c hanges may be the only sign of an underlying internal derangement.