Four-dimensional computed tomography evaluation of condylar movement in a patient with temporomandibular joint osteoarthritis

Publication date: Available online 16 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Masaya Akashi, Takumi Hasegawa, Satoru Takahashi, Takahide Komori
Temporomandibular joint osteoarthritis (TMJ-OA) is a disease of the bone, cartilage, and supporting tissues of the joint. Patients with advanced TMJ-OA often suffer from symptoms such as pain, swelling, and joint dysfunction, and sometimes required surgical intervention when conservative treatment is not effective. The etiology of TMJ-OA remains elusive. The usefulness of four-dimensional computed tomography (4DCT) in motion analyses of various joints has been recently reported. This article introduces a novel imaging technique of 4DCT which aims to identify kinematic features that may be associated with the etiology of TMJ-OA. In a 69-year-old female patient with severe TMJ-OA, 4DCT evaluation of the condylar movement was performed. During the scan, she was instructed to masticate a cookie normally and her natural condylar movement during mastication was evaluated. The coronal 4DCT motion images revealed that the synovial cavity was narrower on the affected side than on the non-affected side. Repeated friction between the articular surface of the condyle and the caudal surface of the articular eminence was observed during natural mastication. Although friction between the condyle and the articular eminence has been considered as a factor in the initiation and progression of TMJ-OA in previous experimental studies using animals, this is the first study to directly visualize the friction between the atrophic and flattened condylar surface and the articular eminence. 4DCT is a novel imaging technique with the potential to assess kinematic features that cannot be visualized with other imaging modalities in patients with TMJ disease.



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