Ultrasonography: A step forward in temporomandibular joint imaging. A preliminary descriptive study

The effect of a combined rehabilitation program on the temporomandibular joint in systemic sclerosis evaluated by ultrasound exam

PURPOSE

Temporomandibular joint (TMJ) involvement is frequent in Systemic Sclerosis (SSc). Dysfunction and X-ray changes of TMJ were described only in few observational studies. Treatment as well has been seldom considered. Aim of the present study was to evaluate the effects on TMJ of two specifically designed physiotherapy protocols.

METHODS

The study group included 26 SSc outpatients (22 females and 4 males with mean age ± SD 59.08 ± 10.31 years). Thirteen patients were randomly assigned to a treatment (protocol 1) including home exercises for TMJ and thirteen to a treatment (protocol 2) including home exercises and a combined procedure. The rehabilitation effects on the TMJ were evaluated by ultrasound examination (UE) in static and dynamic phases. UE was performed in all patients before and at the end of the treatment and after a follow up (8 weeks).

RESULTS

Both rehabilitation protocols induced a significant improvement (protocol 1: p < 0.01 and protocol 2: p < 0.005) of mouth opening with a long-lasting effect. Protocol 2 was more effective than protocol 1. A significant increase of bilateral condyle-head temporal bone distance was detected by UE at the end of both treatments. It was maintained at follow-up in patients treated with Protocol 2.

CONCLUSIONS

The present investigation shows that a rehabilitation program characterized by home exercises with a combined procedure is useful to recover the function of TMJ. The data also show that UE is helpful in the evaluation of TMJ in SSc and in the assessment of the efficacy of the rehabilitation programs.

An Algorithm for Jaw Pain among Divers

Background: Temporomandibular disease (TMD) is commonly seen, and divers also experience pain in the temporomandibular joint (TMJ) or masticatory muscles. This article aims to provide a tool for diving physicians or medical professionals involved in diving medicine since jaw pain among divers is a pertinent subject and can be challenging to evaluate without some background in dentistry or maxillofacial surgery. Method: A basic algorithm was developed to provide a tool to differentiate jaw pains experienced by divers. Three brief case studies were developed, and five diving physicians were tasked with diagnosing the cases using the algorithm. Additionally, simple exercises and massage techniques that can benefit patients with TMD, particularly immediately after diving, are outlined. Results: All five diving physicians successfully diagnosed the cases using the algorithm. However, three of them were unable to diagnose the first case (disc luxation) without consulting the algorithm. Nevertheless, all physicians acknowledged the utility of the algorithm. Conclusions: Jaw pain in divers can stem from diverse causes, but effective treatment options exist. Our study findings provide valuable insights to assist diving physicians in making accurate diagnoses and guiding appropriate patient management, which may include referrals to specialists such as dentists, maxillofacial surgeons, or orthodontists.

Diagnostic efficacy of quantitative ultrasonography for anterior disc displacement of the temporomandibular joint

Background

Ultrasonography has been applied as an alternative method in the assessment of temporomandibular joint (TMJ) pathology including anterior disc displacement (ADD). However, a concrete screening or diagnostic method which is feasible in clinical practice has not yet been established. The study aimed to establish a quantitative ultrasonographic method and determine its diagnostic efficacy for ADD of the TMJ.

Methods

A total of 75 joints were allocated to either the normal disc position (NDP) group or the ADD group using magnetic resonance imaging (MRI) as the reference standard. Longitudinal scans of the lateral articular compartment were obtained by a 14-MHz L-shaped linear array transducer. The width of the lateral joint space (LJS), the upper lateral joint space (ULJS), and the lower lateral joint space (LLJS), as well as the position of the lateral articular disc edge (ADE), were investigated by stepwise logistic regression analysis to identify significant indicators of ADD and to build a diagnostic model. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were computed at the optimal cut-off value.

Results

MRI detected 25 joints in the NDP group and 50 joints in the ADD group. Correlation analysis indicated that all 4 variables were associated with ADD. With the best performance of the area under the receiver operating characteristic (ROC) curve (AUC) of 0.939, LJS and ULJS were identified as predictors of ADD and subsequently adopted to build a diagnostic model by stepwise logistic regression. The optimal cut-off value of the 2-variable regression model for diagnosing ADD was 0.800, with a sensitivity of 82%, specificity of 96%, PPV of 97.6%, NPV of 72.7%, and an accuracy of 86.7%.

Conclusions

The quantitative ultrasonographic diagnostic method showed promising diagnostic efficacy. It has the potential to be used for ADD screening in future clinical practice.

Use of ultrasonography in the diagnosis of temporomandibular disorders: a prospective clinical study

OBJECTIVES

Panoramic radiographs, computed tomography, and magnetic resonance imaging (MRI) are traditionally used for imaging temporomandibular joint (TMJ) and its pathologies. Besides these radiographic techniques, the recent use of ultrasonography (US) in diagnosing joint diseases has been introduced. However, there is no prospective clinical study examining the application of US in imaging of Temporomandibular Disorders (TMD) patients. Therefore, this study aimed to determine the features of the joint and surrounding structures in the US in TMD patients.

METHODS

320 patients fulfilled the inclusion criteria, and 100 of these individuals accepted to participate in the study. This study evaluated 200 TMJ; including the right TMJ and left TMJ of 100 patients. The study was designed as a clinical single-blind observational device trial.

RESULTS

It has been seen that women are 3.54 times more likely to have muscle pain than men. It has been determined that the probability of joint pain increased as the joint space with the mouth closed increased. It has been seen that women are 3.61 times more likely to experience headaches than men.

CONCLUSIONS

The US, which is becoming increasingly common in dentistry, can be used as an aid in TMD diagnoses. US will not be sufficient when it is desired to evaluate the TMJ joint area more precisely and clearly in patients who will be planned for advanced surgical intervention. Therefore, it may be necessary to refer for MRI. The values of our findings will be a reference in TMD diagnoses.

CLINICALTRIALS

GOV ID

NCT04452110.

VALUE OF ULTRASONOGRAPHY METHOD IN THE DIAGNOSIS OF TEMPOROMANDIBULAR DISORDERS AND PATIENT MANAGEMENT MONITORING. CASE REPORT

Value of ultrasonography method in the diagnosis of temporomandibular disorders and patient management monitoring is underestimated. Application of ultrasonography in the diagnosis of patients with temporomandibular disorders in many countries is limited. The main advantage and feature of the method is the ability to conduct examination in dynamics (during the function). Its safety and availability allow applying the method often and at different stages of diagnosis and treatment. So, ultrasonography fully satisfies the needs of primary diagnosing. MRI remains the recognized «gold standard» for the diagnosis of temporomandibular disorders. A case report which is presented, demonstrates the relevance and scope of diagnostic information obtained by ultrasonography, and their verification and clarification with the use of magnetic resonance imaging. Upon comparing the results of USG and MRI described in the clinical case report, we can conclude that ultrasound is quite sensitive and specific in diagnosing anterior disc displacement and blocked movement of the head of the mandible.