Quantitative analysis of the distance between articular disc and condyle in patients with temporomandibular disorders

doi:10.3969/j.issn.1674-8115.2025.06.003

Abstract

Abstract:

Objective ·To evaluate the relationships between disc-condyle distance and anterior disc displacement, as well as between disc-condyle distance and disc morphology, in patients with temporomandibular disorders (TMD) using magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ). Methods ·From September 2023 to March 2024, 90 patients (180 TMJs) who visited the TMJ clinic of Department of Stomatology, The Second Affiliated Hospital of Anhui Medical University, with clinical symptoms of TMD and were diagnosed via MRI with either anterior disc displacement or no significant displacement, were included. Clinical data were collected, and MRI images were used to measure the angle of disc displacement, disc-condyle distance, disc length, and thickness. The degree of disc deformation was assessed. The relationships between clinical symptoms and anterior disc displacement, between anterior disc displacement and both disc morphology and disc-condyle distance, and between disc-condyle distance and disc morphology were analyzed. Results ·Among the 90 patients, there were 16 males and 74 females, with a mean age of (28.1±14.5) years. Among the 180 TMJs, 175 had clinical symptoms and 5 were asymptomatic. There were 40 joints with no displacement, 78 with reducible anterior disc displacement, and 62 with irreducible anterior disc displacement. In the joints with irreducible anterior disc displacement, the proportion of those with two or more symptoms was slightly higher at 62.9%, but the difference was not statistically significant compared with the joints with no displacement or reducible anterior disc displacement. MRI assessment revealed that in the joints with irreducible anterior disc displacement, the proportion of disc deformation type Ⅲ or higher was significantly higher compared with the non-displaced joints (P<0.001). The disc length was significantly shorter (P<0.001), and the intermediate zone thickness was significantly greater (P<0.001) compared with the non-displaced joints. The disc displacement angles at centric closure and maximum opening were also significantly larger (P<0.001). The disc-condyle distance was 3.10 (2.70, 3.70) mm for non-displaced joints, 3.40 (3.00, 4.00) mm for joints with reducible anterior disc displacement, and 6.60 (4.78, 7.90) mm for joints with irreducible anterior disc displacement, with significant differences (P<0.001). The disc-condyle distance was 3.10 (2.80, 3.60) mm for type Ⅰ discs, 3.70 (3.10, 4.60) mm for type Ⅱ discs, 5.10 (4.00, 7.30) mm for type Ⅲ discs, and 6.80 (4.98, 8.20) mm for type Ⅳ/Ⅴ discs, with significant differences (P<0.001). The disc-condyle distance was negatively correlated with disc length (r_s=-0.469, P<0.001), positively correlated with intermediate zone thickness (r_s=0.319, P<0.001), and positively correlated with disc displacement angle at centric closure (r_s=0.626, P<0.001). Conclusion ·With increasing severity of disc deformation, intermediate zone thickness, and disc displacement angle at centric closure, as well as decreasing disc length, the disc-condyle distance increases. The disc-condyle distance is an important indicator for MRI assessment of pathological changes in TMD.

Key words: temporomandibular disorders (TMD), magnetic resonance imaging (MRI), temporomandibular joint disc, disc-condyle distance

CLC Number:

R782.6

SUN Lei, DAI Shifeng, CHEN Yuhua, XU Xinyi, JIANG Kele, LI Xiaowen, LI Chengjing, WU Tingting. Quantitative analysis of the distance between articular disc and condyle in patients with temporomandibular disorders[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(6): 684-692.

Figures/Tables 8

TrendMD

References 34

[1]	DE LEEUW R, KLASSER G D. Orofacial pain: guidelines for assessment, diagnosis, and management[M]. 6th ed. Hanover Park: Quintessence Publishing, 2018.
[2]	AIELLO V, FERRILLO M, MAROTTA N, et al. Temporomandibular joint arthritis in rheumatic diseases patients: which are the effective rehabilitative approaches for pain relief? A systematic review[J]. BMC Musculoskelet Disord, 2025, 26(1): 159.
[3]	BADRI O, DAVIS C M, WARBURTON G. Arthroscopic management and recent advancements in the treatment of temporomandibular joint disorders[J]. Br J Oral Maxillofac Surg, 2024, 62(9): 820-825.
[4]	WARZOCHA J, GADOMSKA-KRASNY J, MROWIEC J. Etiologic factors of temporomandibular disorders: a systematic review of literature containing diagnostic criteria for temporomandibular disorders (DC/TMD) and research diagnostic criteria for temporomandibular disorders (RDC/TMD) from 2018 to 2022[J]. Healthcare (Basel), 2024, 12(5): 575.
[5]	BERNKOPF E, NARDONE M, CAPRIOTTI V. Follow-up clarifications concerning the authors' reply to the 'look at the elephant!' comment on 'prevalence of temporomandibular disorders in adult obstructive sleep apnoea patients: a cross-sectional controlled study'[J]. J Oral Rehabil, 2024, 51(10): 2234-2236.
[6]	DWORKIN S F, LERESCHE L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique[J]. J Craniomandib Disord, 1992, 6(4): 301-355.
[7]	SCHIFFMAN E, OHRBACH R, TRUELOVE E, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group[J]. J Oral Facial Pain Headache, 2014, 28(1): 6-27.
[8]	AZMA R, HAREENDRANATHAN A, LI M X, et al. Automated pediatric TMJ articular disk identification and displacement classification in MRI with machine learning[J]. J Dent, 2025, 155: 105622.
[9]	TAMIMI D, JALALI E, HATCHER D. Temporomandibular joint imaging[J]. Radiol Clin North Am, 2018, 56(1): 157-175.
[10]	AKAI H, YASAKA K, SUGAWARA H, et al. Faster acquisition of magnetic resonance imaging sequences of the knee via deep learning reconstruction: a volunteer study[J]. Clin Radiol, 2024, 79(6): 453-459.
[11]	LI C J, ZHANG Q B. Comparison of magnetic resonance imaging findings in 880 temporomandibular disorder patients of different age groups: a retrospective study[J]. BMC Oral Health, 2022, 22(1): 651.
[12]	WOJCIECHOWSKA B, SZARMACH A, MICHCIK A, et al. Association between clinical manifestations in temporomandibular joint disorders and corresponding radiographic findings[J]. J Clin Med, 2024, 13(16): 4886.
[13]	ITURRIAGA V, BORNHARDT T, VELASQUEZ N. Temporomandibular joint: review of anatomy and clinical implications[J]. Dent Clin North Am, 2023, 67(2): 199-209.
[14]	ZHU J Y, GONG Y J, ZHENG F J, et al. Relationships between functional temporomandibular joint space and disc morphology, position, and condylar osseous condition in patients with temporomandibular disorder[J]. Clin Oral Investig, 2024, 28(3): 193.
[15]	CHEN B Y, LI C J. The relationship between the articular disc in magnetic resonance imaging and the condyle in cone beam computed tomography: a retrospective study[J]. J Stomatol Oral Maxillofac Surg, 2024, 125(5S1): 101940.
[16]	张国来, 廖彦阳, 吴美娜, 等. 颞下颌关节盘前移位患者盘-髁复合体MRI特征及盘周附着半量化评级研究[J]. 核磁共振成像, 2024, 15(2): 7-13.
	ZHANG G L, LIAO Y Y, WU M N, et al. Study on MRI features of disc-condylar complex and semiquantitative evaluation of peridisc attachment in cases of temporomandibular joint disc displacement[J]. Chinese Journal of Magnetic Resonance Imaging, 2024, 15(2): 7-13.
[17]	KOCA C G, GÜMRÜKÇÜ Z. Does clinical findings correlate with magnetic resonance imaging (MRI) findings in patients with temporomandibular joint (TMJ) pain? A cross sectional study[J]. Med Oral Patol Oral Cir Bucal, 2020, 25(4): e495-e501.
[18]	张盈盈, 伊景如, 潘初. 颞下颌关节紊乱患者关节盘软骨形态学改变的MR定量研究[J]. 临床放射学杂志, 2024, 43(11): 1865-1871.
	ZHANG Y Y, YI J R, PAN C. Quantitative MR study of morphological changes in articular disc cartilage in patients with temporomandibular disorders[J]. Journal of Clinical Radiology, 2024, 43(11): 1865-1871.
[19]	ARAYASANTIPARB R, TSUCHIMOCHI M. Quantification of disc displacement in internal derangement of the temporomandibular joint using magnetic resonance imaging[J]. Odontology, 2010, 98(1): 73-81.
[20]	YANG Z J, WANG M G, MA Y W, et al. Magnetic resonance imaging (MRI) evaluation for anterior disc displacement of the temporomandibular joint[J]. Med Sci Monit, 2017, 23: 712-718.
[21]	XIE Q Y, YANG C, HE D M, et al. Will unilateral temporomandibular joint anterior disc displacement in teenagers lead to asymmetry of condyle and mandible? A longitudinal study[J]. J Craniomaxillofac Surg, 2016, 44(5): 590-596.
[22]	ZHANG Q, YE Z, WU Y G, et al. Nonlinear relationship between temporomandibular joint disc displacement distance and disc length: a magnetic resonance imaging analysis[J]. J Clin Med, 2022, 11(23): 7160.
[23]	LI Z Y, ZHOU J L, YU L X, et al. Disc-condyle relationship alterations following stabilization splint therapy or arthrocentesis plus hyaluronic acid injection in patients with anterior disc displacement: a retrospective cohort study[J]. Oral Radiol, 2023, 39(1): 198-206.
[24]	傅开元, 胡敏, 余强, 等. 颞下颌关节常规MRI检查规范及关节盘移位诊断标准的专家共识[J]. 中华口腔医学杂志, 2020, 55(9): 608-612.
	FU K Y, HU M, YU Q, et al. Experts consensus on MRI examination specification and diagnostic criteria of temporomandibular joint disc displacement[J]. Chinese Journal of Stomatology, 2020, 55(9): 608-612.
[25]	DRACE J E, ENZMANN D R. Defining the normal temporomandibular joint: closed-, partially open-, and open-mouth MR imaging of asymptomatic subjects[J]. Radiology, 1990, 177(1): 67-71.
[26]	PERSCHBACHER S. Chapter 27: temporomandibular joint abnormalities[M]//WHITE S C, PHAROAH M J. Oral radiology: principles and interpretation. 7th ed. St. Louis: Mosby, 2013: 492-523.
[27]	INCESU L, TAŞKAYA-YILMAZ N, OĞÜTCEN-TOLLER M, et al. Relationship of condylar position to disc position and morphology[J]. Eur J Radiol, 2004, 51(3): 269-273.
[28]	WANG M Q, CAO H T, GE Y L, et al. Magnetic resonance imaging on TMJ disc thickness in TMD patients: a pilot study[J]. J Prosthet Dent, 2009, 102(2): 89-93.
[29]	HU Y K, YANG C, XIE Q Y. Changes in disc status in the reducing and nonreducing anterior disc displacement of temporomandibular joint: a longitudinal retrospective study[J]. Sci Rep, 2016, 6: 34253.
[30]	AKHTER R. Epidemiology of temporomandibular disorder in the general population: a systematic review[J]. Adv Dent Oral Health, 2019, 10(3): 555787.
[31]	MAIZLIN Z V, NUTIU N, DENT P B, et al. Displacement of the temporomandibular joint disk: correlation between clinical findings and MRI characteristics[J]. J Can Dent Assoc, 2010, 76: a3.
[32]	LIU Z J, YAMAGATA K, KUROE K, et al. Morphological and positional assessments of TMJ components and lateral pterygoid muscle in relation to symptoms and occlusion of patients with temporomandibular disorders[J]. J Oral Rehabil, 2000, 27(10): 860-874.
[33]	TOGNINI F, MANFREDINI D, MONTAGNANI G, et al. Is clinical assessment valid for the diagnosis of temporomandibular joint disk displacement?[J]. Minerva Stomatol, 2004, 53(7/8): 439-448.
[34]	闫森, 乔永明, 段亮伟. 37例颞下颌关节盘不可复性前移位患者自然转归的临床及磁共振成像特征分析[J]. 华西口腔医学杂志, 2024, 42(1): 82-88.
	YAN S, QIAO Y M, DUAN L W. Analysis of clinical changes and magnetic resonance imaging features of 37 patients with temporomandibular joint disc condylar complex with anterior disc displacement without reduction[J]. West China Journal of Stomatology, 2024, 42(1): 82-88.

Disc displacement	Asymptomatic	With one symptom	With two or more symptoms	P value
No disc displacement/n(%)	1 (2.5)	21 (52.5)	18 (45.0)	0.115
Anterior disc displacement with reduction/n(%)	3 (3.8)	43 (55.1)	32 (41.0)
Anterior disc displacement without reduction/n(%)	1 (1.6)	22 (35.5)	39 (62.9)

Disc displacement	Asymptomatic	With one symptom	With two or more symptoms	P value
No disc displacement/n(%)	1 (2.5)	21 (52.5)	18 (45.0)	0.115
Anterior disc displacement with reduction/n(%)	3 (3.8)	43 (55.1)	32 (41.0)
Anterior disc displacement without reduction/n(%)	1 (1.6)	22 (35.5)	39 (62.9)

Item	No displacement	Anterior disc displacement with reduction	Anterior disc displacement without reduction	P value
Type/n(%)				<0.001
Ⅰ	24 (60)	36 (46.2)^①	5 (8.1)^①②
Ⅱ	16 (40)	29 (37.2)	9 (14.5)
Ⅲ	0 (0)	9 (11.5)	14 (22.6)
Ⅳ/Ⅴ	0 (0)	4 (5.1)	34 (54.8)
Disc length/mm	9.41±1.40	9.64±1.79	6.46±1.61^①②	<0.001
Disc thickness/mm
Anterior band	2.40 (2.00, 2.60)	2.20 (2.10, 2.63)	2.30 (2.08, 2.73)	0.759
Intermediate band	0.90 (0.80, 0.90)	0.90 (0.80, 1.00)	1.00 (0.90, 1.20)^①③	<0.001
Posterior band	2.95 (2.80, 3.08)	2.90 (2.70, 3.00)	2.90 (2.60, 3.23)	0.648
Displacement angle/(°)
Closed-mouth position	8.75 (0.69, 11.03)	25.74 (18.83, 56.24)^①	95.97 (85.86, 106.36) ^①②	<0.001
Maximum opening position	-65.32 (-81.38, -41.68)	-51.56 (-77.58, -33.09)	79.62 (64.11, 88.44)^①②	<0.001
Disc-condyle distance/mm	3.10 (2.70, 3.70)	3.40 (3.00, 4.00)	6.60 (4.78, 7.90)^①②	<0.001

Item	No displacement	Anterior disc displacement with reduction	Anterior disc displacement without reduction	P value
Type/n(%)				<0.001
Ⅰ	24 (60)	36 (46.2)^①	5 (8.1)^①②
Ⅱ	16 (40)	29 (37.2)	9 (14.5)
Ⅲ	0 (0)	9 (11.5)	14 (22.6)
Ⅳ/Ⅴ	0 (0)	4 (5.1)	34 (54.8)
Disc length/mm	9.41±1.40	9.64±1.79	6.46±1.61^①②	<0.001
Disc thickness/mm
Anterior band	2.40 (2.00, 2.60)	2.20 (2.10, 2.63)	2.30 (2.08, 2.73)	0.759
Intermediate band	0.90 (0.80, 0.90)	0.90 (0.80, 1.00)	1.00 (0.90, 1.20)^①③	<0.001
Posterior band	2.95 (2.80, 3.08)	2.90 (2.70, 3.00)	2.90 (2.60, 3.23)	0.648
Displacement angle/(°)
Closed-mouth position	8.75 (0.69, 11.03)	25.74 (18.83, 56.24)^①	95.97 (85.86, 106.36) ^①②	<0.001
Maximum opening position	-65.32 (-81.38, -41.68)	-51.56 (-77.58, -33.09)	79.62 (64.11, 88.44)^①②	<0.001
Disc-condyle distance/mm	3.10 (2.70, 3.70)	3.40 (3.00, 4.00)	6.60 (4.78, 7.90)^①②	<0.001