[Observation of dynamic position and morphological changes of temporomandibular joint discs under Angle's classification].

Abstract

Objective: To observe the dynamic changes of the temporomandibular joint (TMJ) disc in joint movement under different Angle's classification, providing reference for understanding joint functional movement and providing a basis for more accurate clinical imaging diagnosis. Methods: A total of 30 patients (13 males and 17 females) with temporomandibular disorders who were admitted to Beijing Friendship Hospital, Capital Medical University and General Hospital of the People's Liberation Army from January 2022 to April 2024 were enrolled. Thirty adults (13 males and 17 females) with different Angle's classification, with an average age of (34.4±8.5) years, were subjected to dynamic imaging of their TMJ from the closed position to the maximum opening position, and then to the closed position using MRI. The position and morphological changes of the articular discs were observed. Results: The results showed that volunteers with no displacement of the articular disc in class Ⅰ, Ⅱ, and Ⅲ relationships had different shapes of the articular disc during open and closed mouth movements. However, in the maximum opening position, the articular disc were all located directly below the maxillary nodules, and their shape is double concave. In terms of irreversible anterior displacement of the articular disc, in class Ⅰ Angle, the posterior zone of the disc contacts the anterior inclined plane of condyle from the maximum opening position back to the front of the closing position. In class Ⅱ, the posterior zone of the disc contacts the anterior inclined plane of condyle from the beginning of opening position to maximum opening position. In class Ⅲ, the posterior zone of the disc is always in contact with the anterior inclined plane of condyle throughout the entire movement process. And among them, the articular disc presents a forward displacement state at the closing position, its morphology undergoes folding phenomenon. When the openness is 2.5 cm, the articular disc moves up to a certain extent, and is closer to the anterior inclined plane of condyle, and its shape is also partially changed. When the openness is 4.3 cm, the shape of the articular disc, located between the anterior inclined plane of the joint node and the posterior inclined plane of the condyle, is typical double concave, which is sufficient to show that the articular disc is reversible when maximum opening position is reached. In terms of reversible anterior disc displacement, in class Ⅰ Angle, the posterior zone of the disc contact with the anterior inclined plane of condyle at the beginning of the opening position and the end of the closing position. In classⅡ Angle, the posterior zone of the articular disc is not in contact with the anterior inclined plane of condyle. In class Ⅲ Angle, the posterior zone of the articular disc contact with the anterior inclined plane of condyle at the end of the closing position. Conclusions: Multi level dynamic MR imaging data of the temporomandibular joint can dynamically observe the movement of the temporomandibular joint, intuitively and accurately display the position and shape of the articular disc during movement, and can serve as a useful supplement to static conventional MR imaging of the TMJ. The patient's TMJ needs to reach the maximum opening position in order to determine whether the joint disc displacement can be reversible or not.