Co-operative Study on the Pathologic Process of the Articular Disk in Patients with Internal Derangements of the Temporomandibular Joint

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The purpose of this study is to gain more information about pathologic process in the disks of internal derangements. TMJ fluorarthorography on 327 joints in 280 patients were performed.1. Arthrographic results showed that abnormal disk movements were found in 222 joints (67.9%). These diagnosis were as follows, anterior displacement without reduction was 155 joints (69.8%), anterior displacement with reduction was 57 joints (25.7%), incoordination was 8 joints (3.6%) and posterior displacement with reduction was 2 joints (0.9%). Disk deformity were found in 81 joints 24.8%). These diagnosis were as follows, perforation and rupture were 56 joints (69.1%), adhesion was 18 joints (22.2%) and abnormal thickness was 7 joints (8.6%).2. Inferolateral approach method was used under local or general anesthesia, arthroscope was inserted to upper joint compartment and examined the findings. Arthroseopic findings were narrowing of the space, hyperemid, existence of fibrous mass and discal perfora … More tion. Arthroseopic finding of fibrous adhesion was observed in 18 joints, those were fibrous band running up to down from anterior pouch to medial wall, close contact between folded disk and anterior attachment, and fibrous bar in the intra-synovial space.3. The Color X-ray CT images processing system developed previously was improved to reconstruct three-dimensional images of coronal, sagittal, and oblique processing from a series of original axial scan data of the X-ray CT scanner. The color-reformatted images reconstructed for TMJ bone and soft tissues clearly and various soft tissues such as muscular and fatty tissues are easily distinguishable. However, the double contrast arthrographic CT data is not suitable for color- reformatted image reconstruction. This study shows the sagittal scan image with typical deformity of the condyle and anterior displacement of disk was demonstrated. This study shows the coronal scan image with anteromedial displacement of disk.4. Former our study described the presence of degenerative changes (decreased or loss of elastin), thickened arterial wall and calcification in the disks of internal derangements. Histopathological observation was examined 10 resected TMJ disks under diskectomy. Results of this study demonstrate degenerative changes in the central posterior part of the disks, and increased amount of vascularity in the posterior band. Less