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Akkaya G, Dağıstan S, Çağlayan F. Evaluation of the efficacy of pharmacological treatment in patients with temporomandibular joint dysfunctions using ultrasonography. J Prosthet Dent 2024:S0022-3913(24)00303-2. [PMID: 38825430 DOI: 10.1016/j.prosdent.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 06/04/2024]
Abstract
STATEMENT OF PROBLEM Temporomandibular joint dysfunctions (TMDs) are complex problems affecting the temporomandibular joints (TMJs), masticatory muscles, or both. TMDs are considered muscle pain caused by contraction and ischemia in the masticatory muscles, but evaluation of the efficacy of pharmacological treatment is lacking. PURPOSE The purpose of this clinical study was to evaluate the changes in masticatory muscles, joint space, and main arteries supplying the TMJs after pharmacological therapy in patients with TMDs using ultrasonography (USG). MATERIAL AND METHODS The TMJ space, masseter and temporal muscles, temporal superficial artery (TSA), and facial artery (FA) were examined using USG in 30 participants with acute TMD pain before and after 10 days of symptomatic treatment with analgesic and myorelaxant. The bilateral masseter and temporal muscle thicknesses, joint space, and end-diastolic minimum velocity (Ved), minimum end-diastolic minimum velocity (Vmin), peak systolic maximum velocity (Vmax), pulsatility index (PI), and resistance index (RI) values of the TSA and FA were measured and compared before and after pharmacological treatment. The relationship between the masseter muscle thickness and the Ved and Vmin values of the TSA and FA before and after pharmacological treatment was analyzed using the paired sample t test; the relationship between the temporal muscle thickness, TMJ spaces, and Vmax, PI, and RI values of the TSA and FA was analyzed using the Wilcoxon signed-rank test (α=.05). RESULTS A significant difference was found between the right temporal muscle thickness before and after medication (P=.01), whereas no statistically significant difference was found in the left temporal muscle thickness (P>.05). A significant difference was found between pretreatment and posttreatment bilateral masseter thicknesses at rest (right P=.014; left P=.004). No statistically significant difference was found in the bilateral joint space or Vmax, Vmin, Ved, PI, and RI values of the TSA and FA before and after treatment (P>.05). CONCLUSIONS Pharmacological treatment in participants with acute TMD led to a reduction in masseter and temporal muscle thickness but did not significantly affect joint space and local blood flow. USG is a useful diagnostic tool in the diagnosis and follow-up of TMDs.
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Affiliation(s)
- Gülsüm Akkaya
- Researcher, Department of Oral Dental and Maxillofacial Radiology, Faculty of Dentistry, Ataturk University, Erzurum, Turkey
| | - Saadettin Dağıstan
- Professor, Department of Oral Dental and Maxillofacial Radiology, Faculty of Dentistry, Ataturk University, Erzurum, Turkey
| | - Fatma Çağlayan
- Professor, Department of Oral Dental and Maxillofacial Radiology, Faculty of Dentistry, Ataturk University, Erzurum, Turkey.
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Thapar PR, Nadgere JB, Iyer J, Salvi NA. Diagnostic accuracy of ultrasonography compared with magnetic resonance imaging in diagnosing disc displacement of the temporomandibular joint: A systematic review and meta-analysis. J Prosthet Dent 2023:S0022-3913(23)00177-4. [PMID: 37076407 DOI: 10.1016/j.prosdent.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 04/21/2023]
Abstract
STATEMENT OF PROBLEM Diagnosing temporomandibular disorders without an adjunctive chairside diagnostic tool has made the management of temporomandibular disorders challenging and subjective. The use of magnetic resonance imaging, considered the standard imaging modality, is hindered because of high cost, a long learning curve, availability, and a longer examination time. PURPOSE The purpose of this systematic review and meta-analysis was to determine whether ultrasonography could be a chairside tool to help clinicians diagnose disc displacement in temporomandibular disorders. MATERIAL AND METHODS An electronic search was conducted of the PubMed (including MEDLINE) and Cochrane Central database and the Google Scholar search engine for articles published from January 2000 to July 2020. Studies were chosen based on the inclusion criteria, which included the diagnostic technique's sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with respect to imaging the displacement of the articular disc. The quality assessment of diagnostic accuracy studies (QUADAS- 2) tool was applied to assess the risk of bias for the included studies. The Meta-Disc 1.4 and RevMan 5.3 software program were used to conduct the meta-analysis. RESULTS Seventeen articles were included in this systematic review, and a meta-analysis of 14 articles was done after applying the inclusion and exclusion criteria. None of the included articles were considered to have applicability concerns; however, 2 articles had a high risk of bias. The sensitivities and specificities for the different selected studies vary substantially from 21% to 95% with a good pooled sensitivity estimate of 71% while the specificities varied from 15% to 96% with a good pooled specificity estimate of 76%. CONCLUSIONS This systematic review and meta-analysis suggested that ultrasonography may have clinically acceptable diagnostic accuracy in diagnosing disc displacement of the temporomandibular joint, allowing the treatment of patients with temporomandibular disorders with greater assurance and success. Additional training in the operation and interpretation of ultrasonography is required to reduce the learning curve and make the use of ultrasonography relevant, straightforward, and routine in dentistry to supplement clinical examination and diagnosis in patients with suspected disc displacement of the temporomandibular joint. The evidence acquired needs to be standardized, and further research is required to provide stronger evidence.
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Affiliation(s)
- Prem R Thapar
- Post graduate student, Department of Prosthodontics and Crown & Bridge, MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India.
| | - Jyoti B Nadgere
- Professor and Head, Department of Prosthodontics and Crown & Bridge, MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Janani Iyer
- Professor, Department of Prosthodontics and Crown & Bridge, MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Neelam A Salvi
- Post graduate student, Department of Prosthodontics and Crown & Bridge, MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India
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Kamel ZSASA, El-Shafey MHR, Hassanien OA, Nagy HA. Can dynamic magnetic resonance imaging replace static magnetic resonance sequences in evaluation of temporomandibular joint dysfunction? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-020-00396-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Static MRI was used as an effective tool for diagnosis of temporomandibular joint dysfunction instead of invasive techniques such as arthroscopy and arthrography. The purpose of this study was to detect whether dynamic MRI can be used instead of static MRI in diagnosis of TMJ dysfunction or not.
Results
According to disc displacement, anterior disc displacement was detected in 29 joints (36.25%) by both static and dynamic MRIs, and medial and lateral disc displacements were detected only by static MRI. Regarding disc mobility, dynamic MRI detects stuck disc in 4 joints versus 2 joints detected by static MRI (p value 0.008). Condylar translation was abnormal in 18 joints (22.5%) by static MRI and in 26 joints (32.5%) by dynamic MRI (p value < 0.001). The detection rate of articular disc for dynamic MRI was 87.5% versus static MRI 92.5% (p value 0.038), and the detection rate of condylar head for dynamic MRI was 97.5% versus static MRI 100% (p value 0.012).
Conclusion
Dynamic MRI cannot replace static MRI in evaluation of TMJ dysfunction; both of them support each other for accurate diagnosis and better image quality.
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Bilgir E, Yıldırım D, Șenturk MF, Orhan H. Clinical and ultrasonographic evaluation of ultrasound-guided single puncture temporomandibular joint arthrocentesis. Cranio 2020:1-10. [PMID: 33267750 DOI: 10.1080/08869634.2020.1853889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objective: To evaluate the effects of successful TMJ treatment on relief of pain, improvement of mandibular movement and capsular width with clinical and ultrasonography (US) findings. In this study, TMJ changes were evaluated by clinical and US examination after US-guided single-puncture arthrocentesis, which represents a novel approach.Methods: Clinical measurements were obtained before each procedure and at 1 day, 7 days, and 3 months thereafter. Capsular width was measured via the US at the 3-month follow-up.Results: Significant improvements were evident at the short term of 3 months post-arthrocentesis with supportive treatment, including splint therapy and jaw exercises.Conclusion: Arthrocentesis in conjunction with splint therapy and jaw exercises demonstrated significant clinical improvement at the short-term follow-up of 3 months. US imaging can be helpful for follow-up evaluation of the pre- and post-treatment capsule width. Longer follow-up studies are necessary to validate the effectiveness of this treatment protocol.
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Affiliation(s)
- Elif Bilgir
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Derya Yıldırım
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Suleyman Demirel University, Isparta, Turkey
| | - Mehmet Fatih Șenturk
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Hikmet Orhan
- Department of Biostatistics and Medical Informatics, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey
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Yılmaz D, Kamburoğlu K. Comparison of the effectiveness of high resolution ultrasound with MRI in patients with temporomandibular joint dısorders. Dentomaxillofac Radiol 2019; 48:20180349. [PMID: 30810356 DOI: 10.1259/dmfr.20180349] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To assess the effectiveness of a high resolution ultrasound for temporomandibular joint (TMJ) evaluation in comparison to MRI in patients with TMJ disorders. METHODS Our study comprised 50 patients (35 female and 15 male) with a mean age of 30.61. Clinical examination was performed. Bilateral imaging of TMJ was conducted by using a high-resolution ultrasound and 1.5 Tesla MR. Diagnostic accuracy of ultrasound was assessed for disc displacement and joint effusion in comparison to MRI. Sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and accuracy (Ac) were calculated for ultrasound. Measurements were compared by Bland & Altman and intraclass correlation coefficient (ICC). Significance level was set at p < 0.05. RESULTS Most frequent complaints were noise 42 (84%) and 34 (68%) pain. For disc position assessment with ultrasound for both sides and closed-open mouth, sensitivity, specificity, PPV, NPV and accuracy ranged between, 0.88 - 1, 0.60 - 0.87, 0.70 - 0.97, 0.75 - 1, and 0.84 - 0.98, respectively. For the diagnosis of effusion with ultrasound for both sides, sensitivity, specificity, PPV, NPV and accuracy ranged between 0.65 - 0.81, 0.91 - 1, 0.96 - 1, 0.45 - 0.46 and 0.72 - 0.84, respectively. ICC values calculated for intraobserver agreement for right and left TMJ for all measurements were found to be statistically significant (p < 0.001). ICC values ranged between 0.964 and 0.995 suggesting excellent correlation among ultrasound and MRI. In general, for ultrasound measurements we found a mean difference ranging between -0.182 and +0.130 mm in comparison to MRI. CONCLUSION Ultrasound can be suggested as an adjunct to common imaging modalities in the assessment of TMJ.
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Affiliation(s)
- Dilek Yılmaz
- 1 Department of Dentomaxillofacial Radiology, Dentistry Faculty, Ankara University , Ankara , Turkey
| | - Kıvanç Kamburoğlu
- 1 Department of Dentomaxillofacial Radiology, Dentistry Faculty, Ankara University , Ankara , Turkey
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Almeida FT, Pacheco-Pereira C, Flores-Mir C, Le LH, Jaremko JL, Major PW. Diagnostic ultrasound assessment of temporomandibular joints: a systematic review and meta-analysis. Dentomaxillofac Radiol 2018; 48:20180144. [PMID: 30285469 DOI: 10.1259/dmfr.20180144] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES: The purpose of this systematic review was to determine the diagnostic capability of ultrasound to assess TMJ alterations as disc displacement (DD), joint effusion (JE) and condylar changes (CC) using 3D imaging modalities as reference standard. METHODS: Studies were gathered by searching several electronic databases and partial grey literature up to January eighth, 2018 without restrictions of language and time. The risk of bias was evaluated using the second version of Quality Assessment Tool for Diagnostic of Accuracy Studies-2 (QUADAS-2). The grading of Recommendation, Assessment, Development and Evaluation (GRADEpro system) instrument was applied to assess the level of evidence across the studies. RESULTS: After applying the eligibility criteria, 28 studies were identified and synthesized. All studies were methodologically acceptable presenting low applicability concerns, although none of them fulfilled all QUADAS-2 criteria. The quantitative analysis included 22 studies, 2829 joints in total. The quality of the evidence evaluated by GRADE system suggested moderate confidence in estimating the outcomes. CONCLUSION: This systematic review demonstrated the ultrasound has acceptable capability to screen for DD and JE in TMD patients. For screening of condylar changes, ultrasound needs further studies using CT or CBCT as reference standard to support its use. More advanced imaging such as MRI can thereafter be used to confirm the diagnosis if deemed necessary.
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Affiliation(s)
| | | | - Carlos Flores-Mir
- 1 School of Dentistry, University of Alberta , Edmonton, AB , Canada
| | - Lawrence H Le
- 2 Radiology and Diagnostic Imaging, University of Alberta , Edmonton, AB , Canada
| | - Jacob L Jaremko
- 2 Radiology and Diagnostic Imaging, University of Alberta , Edmonton, AB , Canada
| | - Paul W Major
- 1 School of Dentistry, University of Alberta , Edmonton, AB , Canada
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Klatkiewicz T, Gawriołek K, Pobudek Radzikowska M, Czajka-Jakubowska A. Ultrasonography in the Diagnosis of Temporomandibular Disorders: A Meta-Analysis. Med Sci Monit 2018; 24:812-817. [PMID: 29420457 PMCID: PMC5813878 DOI: 10.12659/msm.908810] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background The increased prevalence of temporomandibular disorders (TMDs) requires searching for new, easily accessible diagnostic methods. In addition to routine clinical examination, various methods of imaging temporomandibular joints are available, such as magnetic resonance imaging, computed tomography scans, or scintigraphy. Ultrasound imaging, due to short examination time, low cost, and non-invasiveness, should be recommended as a routine diagnostic procedure. The aim of the study was to investigate whether ultrasound imaging can be used in the diagnosis of temporomandibular joint disorders. Material/Methods Publications during the period 2006 to March 2017 from the US National Library of Medicine database were selected for analysis by entering the terms “ultrasonography”, “ultrasound”, “USG”, “temporomandibular joint”, “TMJ”, “temporomandibular disorders”, and “TMD”. Papers were chosen if they met the required criteria relating to the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of this diagnostic technique with regard to imaging articular disc displacement, joint effusion, and condylar abnormalities. Results The search yielded 1883 publications, of which 8 were selected that met the criteria for inclusion in the analysis. For articular disc displacement examinations, the following results were obtained: sensitivity 75.6%; specificity 69.1%; accuracy 76.1%; positive predictive value 72.2%; negative predictive value 65.6%. When the examinations of joint effusion and condylar abnormalities were included, the results were respectively 66.9%; 70.8%; 69.9%; 75.8%; and 62.4%. Conclusions The use of ultrasonography in the diagnosis of temporomandibular disorders requires standardizing the method as well as further research to confirm its effectiveness.
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Affiliation(s)
- Tomasz Klatkiewicz
- Department of Oral Rehabilitation, Division of Prosthodontics, University of Medical Sciences, Poznań, Poland
| | - Krzysztof Gawriołek
- Department of Oral Rehabilitation, University of Medical Sciences, Poznań, Poland
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8
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Hechler BL, Phero JA, Van Mater H, Matthews NS. Ultrasound versus magnetic resonance imaging of the temporomandibular joint in juvenile idiopathic arthritis: a systematic review. Int J Oral Maxillofac Surg 2017; 47:83-89. [PMID: 28802761 DOI: 10.1016/j.ijom.2017.07.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 06/04/2017] [Accepted: 07/19/2017] [Indexed: 01/07/2023]
Abstract
A systematic review of published articles on ultrasound (US) and magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ) in juvenile idiopathic arthritis (JIA) was performed to answer the question "What is the sensitivity and specificity of US as compared to MRI in diagnosing acute and chronic joint changes in patients with JIA?" The most recent evidence was sought in published articles via a search of the PubMed, Ovid, and Embase databases. Article appraisal was performed by two reviewers. Nineteen articles reporting prospective or ambispective studies comparing US to MRI in TMJ imaging were found. Six of these articles were specific to JIA patients. The heterogeneity of these articles made comparison difficult. Of the acute and chronic changes assessed (disk displacement, joint effusion, bony deformity), only joint effusion was appropriately assessed by multiple authors, with US having a sensitivity of 0-72% and specificity of 70-83% as compared to MRI. There was a paucity of studies specific to JIA, with many studying adult, non-rheumatic patients. This systematic review found that dynamic imaging with high-resolution US improves sensitivity and specificity compared to static, low-resolution US. Additionally, there is evidence to suggest that US imaging following a baseline MRI can increase US sensitivity and specificity and may have a future role in disease surveillance.
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Affiliation(s)
- B L Hechler
- Department of Oral and Maxillofacial Surgery, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA
| | - J A Phero
- Department of Oral and Maxillofacial Surgery, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA
| | - H Van Mater
- Department of Rheumatology, Duke University Hospitals, Durham, North Carolina, USA
| | - N S Matthews
- Department of Oral and Maxillofacial Surgery, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA.
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9
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Katzberg RW, Conway WF, Ackerman SJ, Gonzales TS, Kheyfits V, Cronan MS. Pilot Study to Show the Feasibility of High-Resolution Sagittal Ultrasound Imaging of the Temporomandibular Joint. J Oral Maxillofac Surg 2016; 75:1151-1162. [PMID: 28039006 DOI: 10.1016/j.joms.2016.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/03/2016] [Accepted: 12/03/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE To show the feasibility of acquiring high-resolution sagittal ultrasound (US) images of the temporomandibular joint (TMJ). PATIENTS AND METHODS We used commercially available US probes to assess the TMJ via a transoral soft tissue window to acquire sagittal images. Magnetic resonance imaging and clinical correlation were compared with the US findings by the consensus assessment of 2 of the senior investigators. RESULTS The sample was composed of 10 TMJs (6 participants) with an age range of 34 to 71 years and a male-female ratio of 3:1. The condyle and subcondylar surface were visible in 10 of 10 joints (100%), the disc in 7 of 10 joints (70%), and the pterygoid muscles in 6 of 10 joints (60%). In the 5 joints with magnetic resonance correlation, disc position and configuration were confirmed in all cases. CONCLUSIONS We show the first sagittal transoral sonograms of the TMJ disc and associated joint components.
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Affiliation(s)
- Richard W Katzberg
- Research Professor of Radiology, Department of Radiology, Medical University of South Carolina, Charleston, SC.
| | - William F Conway
- Professor of Radiology and Chief of Musculoskeletal Radiology, Department of Radiology, Medical University of South Carolina, Charleston, SC
| | - Susan J Ackerman
- Professor of Radiology, Vice Chair of Clinical Radiology, and Chief of Ultrasound, Department of Radiology, Medical University of South Carolina, Charleston, SC
| | - Theresa S Gonzales
- Professor, Department of Stomatology, and Director of Chronic Orofacial Pain Management, Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina, Charleston, SC
| | - Valeriy Kheyfits
- Assistant Professor of Radiology, Department of Radiology, University of Rochester School of Medicine, Rochester, NY
| | - Michael S Cronan
- Chief Sonographer, Department of Radiology, University of California Davis Medical Center, Sacramento, CA
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10
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Diagnostic efficiency of high-resolution ultrasonography in patients with chronic temporomandibular disorders. Oral Radiol 2015. [DOI: 10.1007/s11282-015-0224-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Johnston K, Bird L, Bright P. Temporomandibular joint effusion and its relationship with perceived disability assessed using musculoskeletal ultrasound and a patient-reported disability index. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2015; 23:90-6. [PMID: 27433242 DOI: 10.1177/1742271x14568608] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The relationship between effusion of the temporomandibular joint (TMJ) and patient-reported disability is poorly researched. This pilot study explored the link between TMJ inflammation as measured by ultrasound and patient disability assessed by the Steigerwald Maher TMD Disability Index (SMTDI). The study design used a prospective correlational approach involving a sample with TMJ dysfunction (TMD). Twenty-four patients were recruited from the European School of Osteopathy and a Kent dental practice. Participants completed the SMTDI to determine the level of TMD (symptomatic score >20). A SonoSite SLA "Hockey Stick" [13-6 MHz] musculo-skeletal transducer was placed over the TMJ in a transverse direction and effusion was calculated indirectly by measuring capsular width. An upper left quadrant protocol was used throughout. A regression analysis was run with participants' gender, age and capsular width as predictor variables modelled against reported SMTDI. Larger capsular widths were found to be significant predictors of SMTDI scores (r = 0.803, p < 0.0001). The patient profile matched with the previous studies and the TMD sufferer population, indicating external validity. Results suggest that the SMTDI could be integrated into practice life as a quick, accessible and easy tool to monitor patients' progress and assess levels of inflammation, without the need for repetitive imaging. The study design proved reproducible and a larger scale study is indicated.
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Affiliation(s)
- Katie Johnston
- European School of Osteopathy, University of Greenwich, Maidstone, Kent, UK
| | - Lance Bird
- European School of Osteopathy, University of Greenwich, Maidstone, Kent, UK
| | - Phillip Bright
- European School of Osteopathy, University of Greenwich, Maidstone, Kent, UK
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Dong XY, He S, Zhu L, Dong TY, Pan SS, Tang LJ, Zhu ZF. The diagnostic value of high-resolution ultrasonography for the detection of anterior disc displacement of the temporomandibular joint: a meta-analysis employing the HSROC statistical model. Int J Oral Maxillofac Surg 2015; 44:852-8. [PMID: 25702588 DOI: 10.1016/j.ijom.2015.01.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 10/29/2014] [Accepted: 01/16/2015] [Indexed: 12/16/2022]
Abstract
The study aimed to assess the diagnostic value of high-resolution ultrasonography (HR-US) in the detection of anterior disc displacement (ADD) of the temporomandibular joint. Relevant trials reported in MEDLINE, the Chinese National Knowledge Infrastructure Database, the Chinese Biomedical Literature Database, and Embase were identified. A manual search was also performed. The quality of retrieved data was evaluated using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria. Data were extracted and cross-checked, and a statistically rigorous meta-analysis was performed using a hierarchical summary receiver operating characteristic model (HSROC). The clinical utility of results was assessed using Fagan nomograms (Bayes theory). All data were evaluated using Stata software. A total 11 studies including 1096 subjects were included in the analysis; all reported the utility of HR-US for the diagnosis of ADD with reduction (ADDWR) and without reduction (ADDWoR). For ADDWR, the weighted sensitivity and specificity were 0.83 (95% confidence interval (CI) 0.78-0.88) and 0.85 (95% CI 0.76-0.92) respectively. The lambda value was 3.41 (95% CI 2.37-4.46) and the Fagan nomogram pre-test probability 58%, with a positive likelihood ratio (LR) of 6.01. The positive post-test probability was 89%, with a negative LR of 0.20. The negative post-test probability was 21%. The positive increase in diagnostic utility was 31% and the negative decrement in that value 37%. For ADDWoR, the weighted sensitivity and specificity values were 0.72 (95% CI 0.59-0.81) and 0.90 (95% CI 0.86-0.93), respectively. The lambda value was 3.69 (95% CI 2.39-4.99) and the Fagan nomogram pre-test probability 38%, with a positive LR of 7.00. The positive post-test probability was 82%, with a negative LR of 0.32. The negative post-test probability was 16%. The increase in diagnostic utility was 44% and the negative decrement in that value 22%. HR-US delivers acceptable performance when used to diagnose ADD, being superior for the detection of ADDWoR than ADDWR, and exhibiting a lower negative diagnostic value in the detection of ADDWoR than ADDWR. HR-US may serve as a new method for the rapid diagnosis of ADD. The method has the advantages of simplicity and low cost. Given the uncertainty in some of the estimated values, more high-quality studies are needed to assess that diagnostic efficacy.
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Affiliation(s)
- X Y Dong
- Department of Stomatology, Wenzhou Integration Traditional Chinese and Western Medicine Hospital Affiliated to Zhejiang Chinese Medicine University, Wenzhou, China
| | - S He
- Department of Stomatology, No.118th Hospital of PLA, Wenzhou, China.
| | - L Zhu
- School & Hospital of Stomatology, Wenzhou Medical University, Wenzhou, China
| | - T Y Dong
- Department of Laboratory, People's Hospital of Haining, Haining, China
| | - S S Pan
- School & Hospital of Stomatology, Wenzhou Medical University, Wenzhou, China
| | - L J Tang
- Department of Stomatology, People's Hospital of Lishui, Lishui, China
| | - Z F Zhu
- Department of Stomatology, Xiaoshan Traditional Chinese Medicine Hospital, Hangzhou, China
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13
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Martins FL, Salum FG, Cherubini K, Oliveira R, de Figueiredo MAZ. Contribution of Ultrasonography to the Diagnosis of Submucosal and Subcutaneous Nodular Lesions of the Oral and Maxillofacial Region: Analysis of Cases. J Maxillofac Oral Surg 2014. [PMID: 26225066 DOI: 10.1007/s12663-014-0714-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the contribution of ultrasonography in the establishment of the diagnosis of nonspecific nodular lesions of the oral soft tissues. We determined the indication of use and reliability of ultrasonography in the field of dentistry, considering whether it was of value in the conclusive diagnosis of these pathologies. MATERIALS AND METHODS We recruited 65 patients from the Oral Medicine Unit of São Lucas Hospital, who had submucosal and subcutaneous nodules, without established diagnosis. They were subjected to ultrasonography of the lesion, carried out with standardization of the protocol and equipment, utilizing a Doppler system. The ultrasonographic report was prepared by an experienced professional, noting the imaging characteristics as well as the possibility of diagnosis. Two calibrated examiners analyzed the data, comparing the ultrasonographic report with the final diagnosis. Accordingly, we used established scoring, where zero corresponded to no contribution to the final diagnosis, 1 helped in the management of the case, and 2 when imaging determined the diagnosis. RESULTS A zero score was obtained for 12.3 % of the examinations performed, and 1 and 2 accounted for respectively 41.5 and 46.1 %, totaling a contribution of about 88 %. Ultrasonography was of value in the diagnosis of vascular lesions in 93.3 % and of neoplasms in 87.5 %. In the salivary gland diseases, it contributed to the final diagnosis in 75 %. CONCLUSION The results demonstrated that ultrasonography is an effective tool in the determination of the definitive diagnosis of nonspecific nodular lesions of the soft tissues of the oral and maxillofacial region.
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Affiliation(s)
- Felipe Leal Martins
- Oral Medicine Unit, São Lucas Hospital, Dentistry School, Pontifical Catholic University of Rio Grande do Sul (PUCRS), 6690 Ipiranga avenue - 2nd floor/room 231, Porto Alegre, RS CEP 90610-000 Brazil
| | - Fernanda Gonçalves Salum
- Oral Medicine Unit, São Lucas Hospital, Dentistry School, Pontifical Catholic University of Rio Grande do Sul (PUCRS), 6690 Ipiranga avenue - 2nd floor/room 231, Porto Alegre, RS CEP 90610-000 Brazil
| | - Karen Cherubini
- Oral Medicine Unit, São Lucas Hospital, Dentistry School, Pontifical Catholic University of Rio Grande do Sul (PUCRS), 6690 Ipiranga avenue - 2nd floor/room 231, Porto Alegre, RS CEP 90610-000 Brazil
| | - Roberto Oliveira
- Brazilian College of Radiology, São Paulo, Brazil ; Clinical Radiology Unit, Radiology and Ecography Foundation of Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Maria Antonia Zancanaro de Figueiredo
- Oral Medicine Unit, São Lucas Hospital, Dentistry School, Pontifical Catholic University of Rio Grande do Sul (PUCRS), 6690 Ipiranga avenue - 2nd floor/room 231, Porto Alegre, RS CEP 90610-000 Brazil ; Serviço de Estomatologia do Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Av. Ipiranga, 6690 - 2º andar/sala 231, Porto Alegre, RS CEP 90610-000 Brazil
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14
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Razek AAKA, Al Mahdy Al Belasy F, Ahmed WMS, Haggag MA. Assessment of articular disc displacement of temporomandibular joint with ultrasound. J Ultrasound 2014; 18:159-63. [PMID: 26191103 DOI: 10.1007/s40477-014-0133-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 09/20/2014] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To assess pattern of articular disc displacement in patients with internal derangement (ID) of temporomandibular joint (TMJ) with ultrasound. MATERIALS AND METHODS Prospective study was conducted upon 40 TMJ of 20 patients (3 male, 17 female with mean age of 26.1 years) with ID of TMJ. They underwent high-resolution ultrasound and MR imaging of TMJ. The MR images were used as the gold standard for calculating sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) of ultrasound for diagnosis of anterior or sideway displacement of the disc. RESULTS The anterior displaced disc was seen in 26 joints at MR and 22 joints at ultrasound. The diagnostic efficacy of ultrasound for anterior displacement has sensitivity of 79.3 %, specificity of 72.7 %, accuracy of 77.5 %, PPV of 88.5 %, NPV of 57.1 %, PLR of 2.9 and NLR of 0.34. The sideway displacement of disc was seen in four joints at MR and three joints at ultrasound. The diagnostic efficacy of ultrasound for sideway displacement has a sensitivity of 75 %, specificity of 63.6 %, accuracy of 66.7 %, PPV of 42.8, NPV of 87.5 %, PLR of 2.06, and NLR of 0.39. CONCLUSION We concluded that ultrasound is a non-invasive imaging modality used for assessment of anterior and sideway displacement of the articular disc in patients with ID of TMJ.
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Affiliation(s)
| | | | - Wael Mohamed Said Ahmed
- Department of Oral and Maxillofacial Surgery, Mansoura Faculty of Dentistry, Mansoura, Egypt
| | - Mai Ahmed Haggag
- Department of Oral and Maxillofacial Surgery, Mansoura Faculty of Dentistry, Mansoura, Egypt
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15
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Kundu H, Basavaraj P, Kote S, Singla A, Singh S. Assessment of TMJ Disorders Using Ultrasonography as a Diagnostic Tool: A Review. J Clin Diagn Res 2013; 7:3116-20. [PMID: 24551747 DOI: 10.7860/jcdr/2013/6678.3874] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 10/28/2013] [Indexed: 01/28/2023]
Abstract
Temporomandibular disorders affect nearly 10-70% of population. Hence, a proper diagnosis of temporomandibular disorders using appropriate diagnostic aids is required. Thus, the purpose of this review was to check the use of ultrasonography as a diagnostic aid in the detection of TMJ disorders.A literature review was performed in Pub Med Central and Cochrane library using Mesh Terms - 'ultrasonography' and 'TMJ disorders'. Out of the total 113 titles appeared, 38 were related to the research question. Further search criteria were applied to the articles, out of which 11 articles fulfilled the criteria and were selected for the review. Two articles which were hand searched were also included. Sensitivity of ultrasonography in detecting TMJ disorders in a majority of articles ranged from 41%-90% in disc displacement, when MRI was taken as the gold standard. In case of TMJ Effusion and Condylar effusion, sensitivities ranged from 20-80% and 83% respectively. It was also seen that sensitivity increased with increase in frequency of transducer. In the available literature, it was found that ultrasonography was an acceptable diagnostic tool for detection of disc displacement, condylar erosion and articular effusion.
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Affiliation(s)
- Hansa Kundu
- Postgraduate Student, Department of Public Health Dentistry, D.J College of Dental Sciences and Research , Modinagar, Ghaziabad, Uttar Pradesh, India
| | - P Basavaraj
- Professor and Head of Department, Department of Public Health Dentistry, D.J College of Dental Sciences and Research , Modinagar, Ghaziabad, Uttar Pradesh, India
| | - Sowmya Kote
- Reader, Department of Public Health Dentistry, D.J College of Dental Sciences and Research , Modinagar, Ghaziabad, Uttar Pradesh, India
| | - Ashish Singla
- Senior Lecturer, Department of Public Health Dentistry, D.J College of Dental Sciences and Research , Modinagar, Ghaziabad, Uttar Pradesh, India
| | - Shilpi Singh
- Senior Lecturer, Department of Public Health Dentistry, D.J College of Dental Sciences and Research , Modinagar, Ghaziabad, Uttar Pradesh, India
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