The clinicoradiologic predictability of perforations of the soft tissue of the temporomandibular joint.

One hundred thirty-one arthrographic examinations of temporomandibular joints were performed on 119 patients. The relationships between clinical symptoms, tomographic findings, and soft-tissue perforation were examined. Perforations of the articular disk or posterior attachment were revealed in 58 joints. Joints with crepitation showed a high frequency of perforation (20 of 22). Pain in the joint area and limitation of opening correlated to disk reduction. Perforations were observed in 12 of 21 joints with continuous pain. Osseous changes were detected in 89 joints. Joints with abnormal radiodensity (erosion, sclerosis) combined with abnormal shape (pocket erosion, osteophyte formation, deformity) showed a high frequency of perforation (41 of 45), which corresponded to 84% in this study. In those cases with osseous change or crepitation, positive predictive values of perforation were both 91%. These types of osseous change and their clinical significance might predict soft-tissue perforation with high accuracy before an arthrogram is performed.