What Role Does Synovitis Play in Craniomandibular Dysfunction (CMD)? A 3T-MRI Study

Abstract

Purpose The purpose of the present study was to investigate the degree and clinical relevance of synovitis in craniomandibular dysfunction.

Materials and Methods In total, 140 temporomandibular joints were examined using a 3 T MRI scanner. Quantitative analysis of synovial enhancement was performed and interrelated with arthrosis deformans, degenerative disc disease, joint effusion, bone marrow edema and restriction of motion.

Results We found a statistically high and significant correlation between the degenerative changes as mentioned above and the intensity of synovial enhancement.

Conclusion The study shows that typical MRI findings in CMD patients are often combined with signs of synovitis. Presumably joint inflammation has an effect on the clinical signs and symptoms and also the prognosis of CMD. These results should be taken into consideration when selecting treatment.

Key Points: 

• 3T-MRI using a dedicated coil is the method of first choice in the examination of CMD syndrome.

• MR imaging allows quantification of increased synovial enhancement.

• There is a highly significant correlation between degenerative changes of the disc or cartilage and synovitis.

• Results of the study are relevant for the clinical assessment and therapy of CMD syndrome.

Citation Format

• Stimmer H, Ritschl L, Goetz C et al. What Role Does Synovitis Play in Craniomandibular Dysfunction (CMD)? A 3T-MRI Study. Fortschr Röntgenstr 2019; 191: 924 – 931

Key words

MR-imaging - temporomandibular joint - arthrosis - intraarticular disc - synovitis

• References

• 1 Poveda Roda R, Diaz Fernandez JM, Hernandez Bazan S. et al. A review of temporomandibular joint disease (TMJD). Part II: Clinical and radiological semiology. Morbidity processes. Med Oral Patol Cir Bucal 2008; 13: E102-E109
• 2 Bender SD. Temporomandibular disorders, Facial Pain, and Headaches. Headache 2012; 52 (Suppl. 01) 22-25
• 3 Hoffmann RG, Kotchen JM, Kotchen TA. et al. Temporomandibular disorders and associated clinical comorbidities. Clin J Pain 2011; 27: 268-274
• 4 Butts R, Dunning J, Perreault T. et al. Pathoanatomical characteristics of temporomandibular dysfunction: Where do we stand? (Narrative review part 1). J bodyw Mov Ther 2017; 21: 534-540
• 5 Vogl TJ, Lauer HC, Lehnert Z. et al. The value of MRI in patients with temporomandibular joint dysfunction: Correlation of MRI and clinical findings. Eur J Radiol 2016; 85: 714-719
• 6 Farina D, Bodin C, Gandolfi S. et al. TMJ disorders and pain: assessment by contrast enhanced MRI. Eur J Radiol 2009; 70: 25-30
• 7 Manoliu A, Spinner G, Wyss M. et al. Quantitative and qualitative comparison of MR imaging of the temporomandibular joint at 1,5 and 3,0 T using an optimized high-resolution protocol. Dentomaillofac Radiol 2016; 45: 20150240
• 8 Vogl TJ, Eberhard D, Randzio J. et al. MR tomographic diagnosis of internal derangement of the temporomandibular joint. Radiologe 1991; 31: 537-544
• 9 Von Kalle T, Winkler P, Stuber T. Contrast-enhanced MRI of normal temporomandibular joints in children – is there enhancement or not?. Rheumatology (Oxford) 2013; 52: 363-367
• 10 McQueen FM. The MRI view of synovitis and tenosynovitis in inflammatory arthritis: implications for diagnosis and management. Ann N Y Acad Sci 2009; 1154: 21-34
• 11 Resnick CM, Vakilian PM, Breen M. et al. Quantifying temporomandibular joint synovitis in children with juvenile idiopathic arthritis. Arthritis Care Res 2016; 68: 1795-1802
• 12 Peacock ZS, Vakilian P, Caruso P. et al. Quantifying synovial enhancement of the pediatric temporomandibular joint. J Oral Maxilllofac surg 2016; 74: 1937-1945
• 13 Caruso P, Buch K, Rincon S. et al. Optimization of quantitative dynamic postgadolineum MR-technique using normalized ratios for the evaluation of temporomandibular joint synovitis in patients with juvenile idiopathic arthritis. Am J Neurorad 2017; 38: 2344-2350
• 14 Arvidsson LZ, Smith HJ, Flato B. et al. Temporomandibular joint findings in adults with longstanding juvenile idiopathic arthritis: CT and MR imaging assessment. Radiology 2010; 256: 191-200
• 15 Tasali N, Cubuk R, Aricak M. et al. Temporomandibular joint (TMJ) pain revisited with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Eur J Radiol 2012; 81: 603-608
• 16 Thomas N, Harper DE, Aronovich S. Do signs of an effusion of the temporomandibular joint on magnetic resonance imaging correlate with signs and symptoms of temporomandibular joint disease?. Br J Oral Maxillofac Surg 2018; 56: 96-100
• 17 Matsubara R, Yanagi Y, Oki K. et al. Assessment of MRI findings and clinical symptoms in patients with temporomandibular joint disorders. Dentomaxillofac Radiol 2018; 47: 20170412
• 18 Wahaj A, Hafeez K, Zafar MS. Association of bone marrow edema with temporomandibular joint (TMJ) osteoarthritis and internal derangements. Cranio 2017; 35: 4-9
• 19 Takahara N, Nakagawa S, Sumikura K. et al. Association of temporomandibular joint pain according to magnetic resonance imaging findings in temporomandibular disorder patients. J Oral Maxillofac surg 2017; 75: 1848-1855
• 20 Güler N, Uckan S, Imirzalioglu P. et al. Temporomandibular joint internal derangement: relationship between joint pain and MR grading of effusion and total protein concentration in the joint fluid. Dentomaxillofac Radiol 2005; 34: 175-181
• 21 Roemer FW, Kassim Javaid M, Guermazi A. et al. Anatomical distribution of synovitis in knee osteoarthritis and its association with joint effusion assessed on non-enhanced and contrast-enhanced MRI. Osteoarthritis Cartilage 2010; 18: 1269-1274
• 22 Wang XD, Zhang JN, Gan YH. et al. Current understanding of pathogenesis and treatment of TMJ osteoarthritis. J Dent Res 2015; 94: 666-673
• 23 Kaneyama K, Segami N, Yoshimura H. et al. Increased levels of soluble cytokine receptors in the synovial fluid of temporomandibular joint disorders in relation to joint effusion on magnetic resonance images. J Oral Maxillofac Surg 2010; 68: 1088-1093
• 24 Güven O, Tekin U, Salmanoglu B. et al. Tumor necrosis factor-alpha levels in the synovial fluid of patients with temporomandibular joint internal derangement. J Craniomaxillofac Surg 2015; 43: 102-105
• 25 Ernberg M. The role of molecular pain biomarkers in temporomandibular joint internal derangement. J Oral Rehabil 2017; 44: 481-491
• 26 Kiga N, Tojyo I, Matsumoto T. et al. Expression of lumican and fibromodulin following interleukin-1 beta stimulationof disc cells of the human temporomandibular joint. Eur J Histochem 2011; 55: e11
• 27 Stoll ML, Good J, Sharpe T. et al. Intra-articular corticoid injections to the temporomandibular joints are safe and appear to be effective therapy in children with juvenile idiopathic arthritis. J Oral Maxillofac Surg 2012; 70: 1802-1807
• 28 El-Hakim IE, Abdel-Hamid IS, Bader A. Temporomandibular joint response to intraarticular dexamethasone injection following mechanical arthropathy: a histological study in rats. Int J Maxillofac Surg 2005; 34: 305-310
• 29 Machon V, Sedy J, Klima K. et al. Arthroscopic lysis and lavage in patients with temporomandibular anterior disc displacement without reduction. Int J Oral Maxillofac Surg 2012; 41: 109-113
• 30 Emshoff R, Gerhard S, Ennemoser T. et al. Magnetic resonance imaging findings of internal derangement, osteoarthrosis, effusion and bone marrow edema before and after performance of arthrocentesis and hydraulic distension of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 101: 784-790