Biomedical subjects

Stefan Bertram

Publications and source records attributed to Stefan Bertram.

7 recordsLinked to original sources

PubMed2003

Bone marrow edema of the mandibular condyle related to internal derangement, osteoarthrosis, and joint effusion.

PURPOSE: The purpose of this prospective study was to evaluate whether common magnetic resonance imaging (MRI) variables such as temporomandibular joint (TMJ) internal derangement, osteoarthrosis, and effusion may predict the diagnostic group of bone marrow edema of the mandibular condyle. MATERIALS AND METHODS: The relationship between bone marrow edema and TMJ disc displacement, osteoarthrosis, and effusion was analyzed in MRIs of 120 TMJs in 73 consecutive patients with TMJ pain and/or a clinical diagnosis of TMJ internal derangement type III (disc displacement without reduction). The diagnostic bone marrow edema group was comprised of 54 TMJs in 40 patients with a unilateral or bilateral MRI diagnosis of bone marrow edema. The control group consisted of 66 non-bone marrow edema TMJs in 33 patients with a bilateral MRI finding of an absence of bone marrow edema. A logistic regression analysis was used to compute the odds ratios for internal derangement, osteoarthrosis, and effusion for non-bone marrow edema TMJs (n = 66) versus TMJs with bone marrow edema (n = 54). RESULTS: Using Chi;(2) analysis for pair-wise comparison, the TMJ-related data showed a significant relationship between the MR imaging findings of TMJ bone marrow edema and those of internal derangement (P = .000), osteoarthrosis (P = .000), and effusion (P = .010). Of the MRI variables considered simultaneously in the multiple logistic regression analysis, osteoarthrosis (P = .107) and effusion (P = .102) dropped out as nonsignificant in the diagnostic bone marrow edema group when compared with the control group. The odds ratio for individuals with an internal derangement showing bone marrow edema was strong (3.6:1) and highly significant (P = .000). Significant increases in risk of bone marrow edema occurred with disc displacement without reduction and osteoarthrosis (9.2:1) (P = .000) and disc displacement without reduction and effusion (6.4:1) (P = .002). CONCLUSIONS: The results suggest that the MR imaging findings for TMJ bone marrow edema are related to those of internal derangement, osteoarthrosis, and effusion. However, the data re-emphasize the aspect that internal derangement, osteoarthrosis, and effusion may not be regarded as the unique and dominant factors in defining TMJ bone marrow edema instances.

Adolescent↗

PubMed2003

Relative odds of temporomandibular joint pain as a function of magnetic resonance imaging findings of internal derangement, osteoarthrosis, effusion, and bone marrow edema.

OBJECTIVE: The purpose of this study was to evaluate whether common magnetic resonance (MR) imaging variables such as temporomandibular joint (TMJ) internal derangement, osteoarthrosis, effusion, and bone marrow edema are predictive of the presence of TMJ pain. STUDY DESIGN: The relationship between TMJ pain and TMJ internal derangement, osteoarthrosis, effusion, and bone marrow edema was analyzed in MR images of 338 TMJs in 169 patients with a clinical diagnosis of TMJ pain and dysfunction. Criteria for including a patient with TMJ pain were a report of orofacial pain referred to the TMJ, with the presence of unilateral or bilateral TMJ pain during palpation, function, or unassisted or assisted mandibular opening. The criteria for including a patient with no pain were the absence of TMJ pain during palpation, function, and unassisted or assisted mandibular opening. Application of the criteria resulted in a study group of 129 patients with unilateral TMJ pain, 18 with bilateral TMJ pain, and 22 without TMJ pain. Bilateral sagittal and coronal MR images were obtained to establish the presence or absence of TMJ internal derangement, osteoarthrosis, effusion, and bone marrow edema. Logistic regression analysis was used to compute the odds ratios for internal derangement, osteoarthrosis, effusion, and bone marrow edema for nonpainful TMJs (n = 173) versus painful TMJs (n = 165). RESULTS: For pairwise comparison, the chi(2) test was used; the resultant data showed a significant relationship between the clinical findings of TMJ pain and the MR imaging diagnoses of internal derangement (P =.000), osteoarthrosis (P =.015), effusion (P =.002), and bone marrow edema (P =.016). Of the MR imaging variables considered simultaneously in multiple logistic regression analysis, osteoarthrosis (P =.405), effusion (P =.131), and bone marrow edema (P =.231) dropped out as nonsignificant in the diagnostic TMJ pain group in comparison with the TMJ no-pain group. Significant increases in risk of TMJ pain occurred with disk displacement without reduction in combination with osteoarthrosis and bone marrow edema (3.7:1 odds ratio; P =.000) and with disk displacement without reduction in combination with osteoarthrosis and effusion (2.8:1 odds ratio; P =.000). CONCLUSIONS: The results suggest that TMJ pain is related to internal derangement, osteoarthrosis, effusion, and bone marrow edema. However, the data reemphasize that these MR imaging variables may not be regarded as the unique and dominant factors in defining TMJ pain occurrence.

Adolescent↗

PubMed2003

Magnetic resonance imaging predictors of temporomandibular joint pain.

BACKGROUND: The authors conducted a study to evaluate whether temporomandibular joint, or TMJ, disorder subgroups are related to magnetic resonance imaging, or MRI, diagnoses of TMJ internal derangement, or ID; osteoarthrosis, or OA; effusion; and bone marrow edema. METHODS: The TMJ disorder group was composed of 118 subjects with TMJ pain who were assigned a clinical unilateral single diagnosis of a specific TMJ disorder. The control group consisted of 46 subjects who did not have TMJ pain. Sagittal and coronal magnetic resonance images were obtained to establish the prevalence of ID, OA, effusion and bone marrow edema. The authors used a multiple logistic regression analysis to compute the odds ratios, or OR, for MRI features for control subjects versus four groups of subjects who had TMJ pain: ID type I (n = 35), ID type III (n = 39), capsulitis/synovitis (n = 26) and degenerative joint disease, or DJD, (n = 18). RESULTS: MRI diagnoses that did not contribute to the risk of TMJ pain included disk displacement, or DD, with reduction and effusion. Significant increases in the risk of experiencing TMJ pain occurred selectively with DD without reduction (OR = 10.2:1; P = .007) and bone marrow edema (OR = 15.6:1, P = .003) for the ID type III group and with DD without reduction (OR = 11.7:1, P = .054) for the DJD group. Subjects in the group with ID type I were less likely to be associated with an MRI finding of OA than were control subjects (OR = 1:5.6). CONCLUSIONS: While the contribution of MRI variables to the TMJ pain subgroups was not zero, most of the variation in each TMJ pain population was not explained by MRI parameters. Thus, MRI diagnoses may not be considered the unique or dominant factor in defining TMJ disorder populations. CLINICAL IMPLICATIONS: Therapy for subjects with TMJ based on the evaluation of concomitant morphological abnormalities, whether prophylactically or as treatment for TMJ disorders, may be unwarranted.

Adolescent↗

PubMed2002

Clinical versus magnetic resonance imaging findings with internal derangement of the temporomandibular joint: an evaluation of anterior disc displacement without reduction.

PURPOSE: The purpose of this study was to investigate whether the clinical finding of anterior disc displacement without reduction (ADWOR) and pain in the temporomandibular joint (TMJ) is correlated to the magnetic resonance imaging (MRI) findings of TMJ internal derangement (ID). PATIENTS AND METHODS: The TMJ group was composed of 55 TMJ pain patients who were assigned a clinical diagnosis of unilateral ADWOR. The control group consisted of 58 nonpainful TMJ patients. Sagittal and coronal MR images were obtained to establish the incidence and type of ID. RESULTS: Using chi-square analysis, the results showed a significant relationship between the presence of pain and the MRI diagnosis of ID (P =.000) and its type (P =.000). Use of the kappa statistical test indicated poor diagnostic agreement between the presence of pain and the MRI diagnosis of ID (kappa = 0.37) and disc displacement with reduction (kappa = 0.20). The diagnostic agreement for disc displacement without reduction was 78.8%, with a corresponding kappa-value of 0.58, indicating fair agreement between the clinical and the MRI diagnosis. CONCLUSION: The results suggest that TMJ pain associated with ADWOR is correlated with MRI diagnoses of ID and the ID type. These data confirm the use of the clinical diagnostic criteria for disc displacement without reduction as a reliable method of predicting similar MRI diagnoses.

Adult↗

PubMed2002

The biological concept of "internal derangement and osteoarthrosis": a diagnostic approach in patients with temporomandibular joint pain?

OBJECTIVES: We sought to investigate whether the finding of temporomandibular joint (TMJ)-related pain may be linked to magnetic resonance (MR) imaging findings of TMJ internal derangement and TMJ osteoarthrosis. STUDY DESIGN: The study consisted of 194 consecutive TMJ patients. Criteria for including a patient with a painful TMJ were as follow: report of orofacial pain in the TMJ, with the presence of unilateral or bilateral TMJ pain during palpation, function, and unassisted or assisted mandibular opening. Criteria for including a patient with a nonpainful TMJ were as follow: absence of a TMJ with pain during palpation, function, and unassisted or assisted mandibular opening. Application of the criteria resulted in a study group of 150 patients with unilateral TMJ pain, 10 with bilateral TMJ pain, and 34 without TMJ pain. Bilateral sagittal and coronal MR images were obtained to establish the presence or absence of TMJ internal derangement or osteoarthrosis, or both. RESULTS: A comparison of the TMJ-related data showed a significant relationship between the clinical finding of TMJ pain and the MR imaging diagnoses of TMJ internal derangement (P =.002) and TMJ osteoarthrosis (P =.004). Significant increases in risk of pain occurred with "disk displacement without reduction and osteoarthrosis" (P =.000), "disk displacement without reduction and absence of osteoarthrosis" (P =.000), and "disk displacement with reduction and osteoarthrosis" (P =.036). CONCLUSIONS: The results suggest that TMJ-related pain is correlated with TMJ-related MR imaging diagnoses of internal derangement and osteoarthrosis. The data confirm the biological concept of "internal derangement and osteoarthrosis," yet re-emphasize that internal derangement and osteoarthrosis may not be regarded as the unique and dominant factors in the definition of TMJ pain.

Adolescent↗

PubMed2002

Comparing methods for diagnosing temporomandibular joint disk displacement without reduction.

BACKGROUND: Research is needed to assess the validity of the Clinical Diagnostic Criteria for Temporomandibular Disorders, or CDC/TMD. The authors conducted a prospective, double-blind study to determine whether applying the specific CDC/TMD diagnosis of TMJ internal derangement, or ID, type III would demonstrate good agreement with diagnoses obtained by MRI. METHODS: The study comprised 138 TMJs in 69 subjects who had a clinical diagnosis of unilateral TMJ ID type III (disk displacement without reduction). The authors obtained bilateral sagittal and coronal MRIs to establish the corresponding diagnosis of disk-condyle relationship. RESULTS: For the CDC/TMD interpretations, the positive predictive value of ID type III for disk displacement without reduction was 86 percent, and for the presence of an ID it was 91 percent. The overall diagnostic agreement for ID type III was 78.3 percent with a corresponding K value of 0.57. Most of the disagreement was due to false-positive interpretations of an absence of ID. CONCLUSIONS: The results suggest that using CDC/TMD for ID type III is predictive for the presence of an ID but is not sufficiently reliable for determining disk displacement without reduction. Parameters other than the functional disk-condyle relationship may need to be addressed to account for the biological plausibility of this entity. CLINICAL IMPLICATIONS: A clinical TMJ-related diagnosis of ID type III may need to be supplemented by evidence from an MRI to determine the functional disk-condyle relationship. Investigation of longitudinal evidence, including risk factors, history and response to treatment, appears to be warranted.

Adolescent↗

PubMed2002

Disk displacement of the temporomandibular joint: sonography versus MR imaging.

OBJECTIVE: The purpose of this study was to determine the value of dynamic sonography in the evaluation of internal derangements of a temporomandibular joint (TMJ) during maximal mandibular range of motion. SUBJECTS AND METHODS: Maximal mandibular range of motion was performed during high-resolution sonography of the TMJ in 64 consecutive patients (128 joints; nine males and 55 females; age range, 17-65 years; mean age, 35 years 6 months), all of whom subsequently underwent MR imaging. MR imaging confirmed disk displacement with reduction in 27 joints and disk displacement without reduction in 60 joints of the 128 examined. The high-resolution sonography and MR imaging findings for these 27 and 60 TMJs, respectively, were analyzed. RESULTS: Dynamic high-resolution sonography performed during the maximal range of motion helped to detect 81 instances (93%) of internal derangement, 22 instances (82%) of disk displacement with reduction, and 50 instances (83%) of disk displacement without reduction. There was one false-positive finding for internal derangement. The accuracy of prospective interpretation of high-resolution sonograms of internal derangement, disk displacement with reduction, and disk displacement without reduction was 95%, 92%, and 90%, respectively. CONCLUSION: When real-time images are interpreted by expert radiologists, dynamic sonography performed during maximal mandibular range of motion may provide valuable information about disk displacement of the TMJ.

Adolescent↗