乏血性下顎頭骨壊死のMR所見を呈した顎関節症IV型症例の検討

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Osteoarthrosis associated with findings of avascular necrosis of the mandibular condyle on magnetic resonance imaging was clinically evaluated. The subjects consisted of 5 female unilateral cases, with an average age of 55.4 years who had a mean duration of illness of 15.2 months. The symptoms were a mean interincisal opening distance of 32.8mm with arthralgia in mild to moderate degree, and joint noise (crepitation) in all joints. MRI documented decreasing signal intensity of the condyle with 2 joints in high degree and 3 joints in moderate, as well as variable low signal density of the articular eminence, associated with concomitant anterior disk displacement. X-ray showed deformity of the condyle and eminence. The operative findings disclosed disk rupture and comparatively smooth cartilage with minimum remodeling of the condylar surface; however, avascular evidence was suggested when corticotomy was performed. Four joints underwent diskectomy, condylar shaving, auricular cartilage grafts and corticotomy of the condyle. Arthroscopic corticotomy was applied for 1 joint with mild symptoms. Postoperative symptoms improved to mean opening distance of 41. 4mm and the disappear of arthralgia in 4 joints. The surgical outcome was excellent in 3 joints and good in 2 joints. Follow-up MRI in 2 cases disclosed increasing signal intensity, which suggested recovery of condylar vascularity following corticotomy.<BR>It is suggested that the low-signal intensity on MRI in osteoarthrosis might indicate avascular lesions of the condyle, secondary to degenerative change. Histologic investigations are required to evaluate avascular necrosis of the temporomandibular joints.
社団法人日本口腔外科学会の論文

乏血性下顎頭骨壊死のMR所見を呈した顎関節症IV型症例の検討

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