Temporomandibular Joint Internal Derangement Score (TIDS): novel magnetic resonance imaging assessment score and its relation to invasive treatment in patients with clinical temporomandibular joint pathology

Abstract

Purpose: A new magnetic resonance imaging (MRI) based scoring system for temporomandibular joint (TMJ) internal derangement was developed to predict disease severity and the likelihood of invasive treatment.

Patients and methods: Reports and images from bilateral TMJ MRI studies of 100 consecutive patients with TMJ pain were retrospectively reviewed. A Temporomandibular Joint Internal Derangement Score (TIDS) score was composed of 6 MRI characteristics: joint effusion, disc displacement, disc nonrecapture, disc degenerative changes, abnormal condyle translation, and condyle arthritis. The primary endpoint was whether disease severity merited invasive treatment (arthrocentesis, arthroscopy, arthroplasty, or discectomy). Primary analyses were conducted as univariate regression, with the level of significance set at p < .05. Multivariate regression was also used to assess the impacts of each variable upon the need for invasive treatment.

Results: Invasive treatment was performed in 29 patients and planned in an additional 9 patients. Patients with clinical bilateral pathology were no more likely to undergo invasive treatment than those with unilateral clinical pathology. Statistically significant correlations were found between bilateral invasive treatment and the presence of bilateral joint effusions (p = 0.0037) and disc displacement (p = 0.014), as well as with increasing values of right TIDS (p = 0.0015) and bilateral TIDS (p = 0.0090). Bilateral TIDS of greater than 6 was correlated with both bilateral invasive treatment (p = 0.0033) and with invasive treatment of any kind (p = 0.041). In each instance of TIDS > 6, the patient demonstrated multiple signs of bilateral TMJ pathology. On multivariate regression, only disc recapture failed to trend towards statistical significance in both the six and twelve component regressions, which trended towards significance only in the twelve component analysis.

Conclusion: A TIDS score was developed to serve as an adjunct to the clinical assessment of TMJ pathology. Bilateral TIDS score greater than 6 was statistically significantly correlated with the severity of TMJ pathology.

Keywords: Medical imaging.

Fig. 1

Joint effusion: Oblique sagittal T2 weighted magnetic resonance image of the temporomandibular joint in the closed mouth position demonstrates an area of high signal intensity (arrow) that represents a moderate effusion.

Fig. 2

TMJ disc location and translation: Oblique sagittal proton density magnetic resonance images of the temporomandibular joint (A) in the closed mouth position demonstrate normal disc position. The angle between the posterior band (short white arrow) and the 12-o'clock line is less than ±10°. Normal disc morphology is seen with the intermediate zone (white arrow) interposed between the articular condyle and temporal bone. The same sequence in the open mouth position (B) demonstrates normal condylar translation and expected disc position between the condyle and temporal eminence centered in the intermediate zone.

Fig. 3

Disc displacement with and without recapture: Oblique sagittal T2 weighted magnetic resonance images of the temporomandibular joint demonstrate that the disc is anteriorly displaced in the closed mouth position (arrow, A) but returns to the normal position – between the condyle and temporal eminence (recapture) on open mouth proton density sequence (arrow, B). Oblique sagittal proton density magnetic resonance image of the temporomandibular joint demonstrates that the disc is anteriorly displaced in the closed mouth position (arrow, C) and remains displaced (no recapture) from its normal location in open mouth position (arrow, D).

Fig. 4

Deformed, degenerated, and displaced TMJ disc: Oblique sagittal T1 weighted magnetic resonance image of the temporomandibular joint demonstrates a deformed degenerated disc with abnormal intrinsic signal intensity and anterior disc displacement (arrow).

Fig. 5

Condylar arthritis: Oblique sagittal proton density and T2 weighted magnetic resonance images of the temporomandibular joints demonstrate anterior spurring (long arrow, A), flattening of the condyle (short arrow, A), and bone marrow edema (arrow, B).