KHẢO SÁT ĐẶC ĐIỂM LÂM SÀNG VÀ HÌNH ẢNH CẮT LỚP ĐIỆN TOÁN Ở BỆNH NHÂN THOÁI HÓA KHỚP THÁI DƯƠNG HÀM

Abstract

Background: Temporomandibular joint osteoarthritis (TMJOA) is a common intra-articular disorder with various clinical manifestations. Identifying the association between clinical symptoms and osseous changes on computed tomography (CT) may support early diagnosis and appropriate treatments. Objective: To investigate the clinical characteristics and CT findings in patients with temporomandibular joint osteoarthritis. Subjects and Methods: A cross-sectional study was conducted on 54 patients diagnosed with TMJOA at the National Hospital of Odonto-Stomatology, Ho Chi Minh City, based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Clinical features and osseous changes on computed tomography (CT) of the temporomandibular joint were collected and analyzed. Results: A total of 54 patients (108 joints) were included; females predominated (female-to-male ratio of 3:1), with a mean age of 39.96 years. Regarding clinical symptoms, 83% of temporomandibular joints (TMJs) exhibited pain, 25% presented with clicking sounds, 63% with crepitus, and 28% of patients experienced limited mouth opening. Occlusal characteristics showed various abnormalities, including deep bite (24.1%), open bite (18.5%), bilateral posterior tooth loss (42.6%), and posterior tooth wear (55.6%). On CT imagings, 51% of TMJs demonstrated signs of degenerative changes. Among these, condylar erosion (45.5%), osteophyte formation (43.6%), and subcortical cysts (41.8%) were the most prevalent findings. The majority of the lesions had a average size of approximately 2.4 mm. Grade 2 osteoarthritic changes accounted for the highest proportion (69.1%). Crepitus was the only clinical sign that showed a significant association with the radiographic diagnosis of temporomandibular joint osteoarthritis on CT imaging (p = 0.046). A  significantly correlation was also observed between joint pain and condylar erosion, as well as between crepitus and osteophyte formation (p = 0.032 and p = 0.025, respectively). Conclusion: The most common clinical features in patients with temporomandibular joint osteoarthritis are joint pain and crepitus. Crepitus shows a significantly association with the diagnosis of osteoarthritis on CT imaging. Clinically, patients presenting with joint crepitus and pain should routinely examined with CT/CBCT to confirm the diagnosis and enable early treatment.