Imaging And Intraoperative Findings Of Condylar Bone Changes In Temporomandibular Joint:A Comparative Research

Objective: Explore the best imaging method,areas and types of the condylar bone changes in TMJ by imaging and intraoperative study,so that to improve the accuracy of imaging diagnosis and to provide the clinical basis for TMJ surgery.Methods:1 Case materials: Select 76 patients(88 joints)in our hospital from April2015 to November 2016,all the joints were diagnosed as temporomandibular disorders(Wilkes ?,?stage)by surgery.The clinical data of the patients with condylar bone changes were retrospectively analyzed,including 13 males(16 sides)and 63 females(72 sides).The age ranged from 14 to 67 years(mean age 49.6 years).The patients that suffering from TMJ specific inflammation?tumor?the history of trauma recently?rheumatism,rheumatoid arthritis?collagen vascular disease and other systemic diseases were excepted from this study.All the patients were underwent surgery for the first time.MRI and CT were taken and examined before the operation.The type and the area of the lesion were confirmed under direct vision and they all recorded by photographs.2 Research methods: 88 joints with condylar bone changes were confirmed by surgery,whose preoperative MRI and CT imaging data were retrospectively analyzed.Count the number of the confirmed and missed cases by CT and MRI.The intraoperative findings would to be the standard to compare whether the two methods were the same results.At the same time,observed and record the lesion types of the condylar bone changes(type?: irregularity,erosion;type?: osteophytes,bone warts;type ?:depression,absorption;type ?:flattening,shorter)and the location of condylar bone changes(The condylar surface was divided into four regions:antero-lateral,antero-medial,postero-lateral,postero-medial).Count the incide-nce rate of the four types and areas,then,compere the incidence rate of the four types whether were difference in the four areas of articular surface.Explore the relationship between the areas and the types of the disease basis on intraoperative findings.Compare the results of the types and the areas of condylar bone changes between imaging and intraoperative findings,increase the morphplogy understanding of the condylar bone changes.3 Statistical Methods: All data were analyzed by SPSS20.0 software,the count data using four-meter table and R×C table chi-square test,and significance level was set at P <0.05.Results:1 The MRI detected 83 sides(total 88 sides)of condylar bone changes,the detection rate was 94.3%,CT detected 76 sides(total 88 sides)of condylar bone changes,the detection rate was 86.4%.Compared MRI and CT(P<0.05),statistical analysis showed significance.The detection rate of MRI for condylar bone changes was higher than CT;2 Among the 88 condyles,The incidence rate of irregularity and erosion was 51.1%,osteophytes and bone warts 27.2%,depression and absorption4.5%,flattening and shorter 32.9%,one side of the condyle may be associated with two or more types;3 The incidence rate of the four types of condylar bone changes in antero-lateral was 32.4%,antero-medial 32.4%,postero-lateral 15.5% and postero-medial 19.6%.Condylar bone changes were more likely to occur on the anterior than the posterior;4 The incidence rate of the four types were different in the four areas of articular surface,the difference was statistically significant(P<0.05).Irregular and erosion occurred most frequently in antero-medial,Osteophytes and bone warts occurred most frequently in antero-lateral,The incidence rate of depression and absorption is roughly equal in antero-lateral and antero-medial,Depression and absorption occurred most frequently in antero-medial;5 In surgery when expose the temporomandibular joint cavity,it can be seen that the surface of the condylar bone has different changes,consistent with the preoperative imaging findings,the MRI imaging performance was not as significant as clinical bone changes.(1)MRI images showed condylar cortical bone with uneven thickness,interrupt and fuzzy;In surgery,condylar surface was rugged with locally cartilage and bone hyperplasia or erosion,etc.(2)On the MRI images,condyle bone sclerosis and showed a local sharp protrusion;in surgery,the condylar surface showed blade-shaped,miliary-like,curl-like protrusion changes,isolated osteophyte or bone wart.(3)Condyle bone defective and damage,local depression and cortical bone fuzzy on the MRI images;In surgery,the condylar surface was crater-like,the depression acrossed the surface.(4)On the MRI images,curved anterior was flattened or the entire condylar surface flattened and shorter;In surgery,the anterior was flattened,overall height was reduced and somewhere cancellous bone exposed.Conclusion:1 The detection rate of MRI diagnosis of condylar bone changes was higher than CT basis on surgery.MRI may be the preferred imaging method for the diagnosis of condylar bone changes in clinical practice.2 The incidence rate of temporomandibular joint condylar bone changes were various in the four articular surface.In general,condylar bone changes were more likely to occur on the anterior than the posterior,in which condylar surface irregularity and erosion were the most common,followed by flattened and shorter,osteophytes and bone warts,depression and absorption.3 The morphological feature of the condylar bone changes are much more abundant and obvious than those seen in imaging.Such as bone sclerosis and a local sharp protrusion,blade-shaped or miliary-like protrusion,curl-like,crater-like condyle bone changes.