Objective : To survey the current situation and analyze the relevant influencing factors of sleep quality in adolescent patients with temporomandibular joint anterior disc displacement. Methods: This study has been reviewed and approved by the Ethics Committee, and informed consent has been obtained from patients. A convenience sampling method was used to investigate 120 adolescent patients with temporomandibular joint anterior disc displacement in the outpatient department of stomatology in a grade A tertiary hospital in Shanghai using the general data questionnaire, the Pittsburgh sleep quality index scale (PSQI), the Chinese middle school student mental health scale (MMHI-60) and the pain visual analog scale (VAS). Descriptive analysis, single factor analysis, correlation analysis and multiple regression analysis were used to explore the relevant influencing factors. Results: The PSQI score of adolescent patients with temporomandibular joint anterior disc displacement in this study was 7.77 ± 4.63. There was a statistically significant difference in sleep quality among patients with different academic pressures and levels of sleep bruxism (P<0.05). The sleep quality score was positively correlated with the pain score (r = 0.45, P<0.001) and positively correlated with the psychological score (r = 0.74, P<0.001). The degree of pain can affect the patient's sleep quality, and those with good mental health have better sleep quality. The results of regression analysis showed that academic stress (OR = 2.511, 95% CI =1.307 ~ 4.828), bruxism (OR = 3.694, 95% CI = 1.394 ~ 9.791), pain score (OR = 2.104, 95% CI =1.095 ~ 4.041) and psychological score (OR = 1.039, 95% CI = 1.021 ~ 1.058) were statistically significant. Conclusion The sleep quality of adolescent patients with temporomandibular joint anterior disc displacement is generally poor. Academic pressure, sleep bruxism, pain and mental health are the influencing factors of sleep quality.

OBJECTIVETo retrospectively analyze the advantages and disadvantages of radiographic methods commonly used for diagnostic of condylar fractures.

METHODSFrom Jan 2002 to Nov 2013, 290 patients (405 condylars) in the temporomandibular joint (TMJ) division of Ninth People's Hospital Shanghai Jiao Tong University School of Medicine were diagnosed as condylar fractures. Panoramic films and CT were taken in all patients to check and count the amount of condylar fractures, including intracapsular condyle fracture (type A, B, C and M), condylar neck fracture and subcondylar fracture. MRI was also taken in 119 patients with 174 condylar fractures to check the position of TMJ disc. The data were analyzed and compared among the three examinations in the diagnosis of the condylar fractures.

RESULTSPanoramic films showed 79.8% (323/405) condylar fractures. Among condylar fractures, intracapsular condylar fractures, condylar neck fractures and subcondylar fractures accounted for 48.9% (198/405), 20.3% (82/405) and 10.6% (43/405) respectively. CT showed 64.0% (259/405) intracapsular condylar fractures, 24.0% (97/405) condylar neck fractures and 12.1% (49/405) subcondylar fractures. Among intracapsular condylar fractures, Type A fracture was the most common type of ICF, which accounted for 48.7% (126/259), followed by Type B fracture, which accounted for 30.9% (80/259) and Type M fracture, 12.4% (32/259). Type C fracture was the least type which accounted for 8.1% (21/259). According to the diagnostic criteria of CT, there were 10 condylar neck fractures misdiagnosed with intracapsular condylar fractures. MRI showed 94.9% (129/136) TMJ disc displacement in intracapsular condylar fractures, 53.6% (15/28) in condylar neck fractures and 60.0% (6/10) in subcondylar fractures. Among intracapsular condylar fractures, there were 95.3% (61/64) TMJ disc displacement in type A, 95.2% (40/42) in type B, 89.0% (8/9) in type C, and 95.2% (20/21) in type M. There was significant difference of TMJ disc displacement between intracapsular condylar fractures and condylar neck fractures or subcondylar fractures (P < 0.05), and no significant difference between condylar neck fractures and subcondylar fractures (P < 0.05). There was also no significant difference among various type of intracapsular condylar fractures.

CONCLUSIONSPanoramic films can initially diagnose condylar fractures but with the high misdiagnosis rate for intracapsular fractures, minor fractures and fractures without fragment displacement. CT, especially coronal CT, should be considered for positioning fracture lines and confirming the displacement angle of fragment. MRI should also be used to determine the position of TMJ disc in intracapsular condylar fractures.

China ; Humans ; Joint Capsule ; Joint Dislocations ; Magnetic Resonance Imaging ; Mandibular Condyle ; Mandibular Fractures ; diagnostic imaging ; Radiography, Panoramic ; Retrospective Studies ; Temporomandibular Joint ; Temporomandibular Joint Disc ; Temporomandibular Joint Disorders ; diagnostic imaging ; Tomography, X-Ray Computed