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Delgado-Delgado R, Conde-Vázquez O, Fall FM, Fernández-Rodríguez T. Intraobserver reliability and validity of a single ultrasonic measurement of the lateral condyle-capsule distance in the temporomandibular joint. J Ultrasound 2024; 27:479-485. [PMID: 37653283 PMCID: PMC11333410 DOI: 10.1007/s40477-023-00818-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
PURPOSE The purpose of the study was to examine the reliability and validity of a single lateral condyle-capsule distance (LCCD) measurement while saving on economic costs and clinical resources. METHODS A longitudinal test-retest design was used to assess the reliability and validity of single-examiner measures over 72 TMJ sonographic analyses. Intraclass correlation coefficients (ICC) and a Bland-Altman plot were used to study reliability and validity, comparing the first measurement of the LCCD to the mean of 3 measurements taken one week later by the same examiner. RESULTS ICC show intraobserver reliability of 0.981, 95% confidence intervals (CI) of 0.969 to 0.988. The mean difference between the ultrasound measurements is 0.019 mm (95% CI 0.0005-0.0383) with a standard deviation of 0.080 mm, demonstrating robust validity. The 95% Limits of Agreement (LoA) are - 0.138 for the lower limit and 0.177 for the upper. Mean relative error is 0.009 mm. CONCLUSION Intraobserver reliability of a trained examiner is very high in the single measurement of the LCCD and validity is significant compared to more complex methods. The risk of bias is low since the mean of three LCCD measurements is calculated as opposed to recording only one single measurement.
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Affiliation(s)
- Raquel Delgado-Delgado
- Faculty of Health Sciences, Physical Therapy Department, University of Camilo José Cela, Madrid, Spain
| | - Orlando Conde-Vázquez
- Departamento de Bioloxía Funcional e Ciencias da Saúde, Universidade de Vigo, 36005, Pontevedra, Spain.
| | - Fiona Mc Fall
- Faculty of Health Sciences, Physical Therapy Department, University of Camilo José Cela, Madrid, Spain
| | - Tomás Fernández-Rodríguez
- Faculty of Health Sciences, Physical Therapy Department, University of Camilo José Cela, Madrid, Spain
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Zaman MU, Alam MK, Alqhtani NR, Alqahtani M, Alsaadi MJ, Ronsivalle V, Cicciù M, Minervini G. Effectiveness of ultrasonography in the diagnosis of temporomandibular joint disorders: A systematic review and meta-analysis. J Oral Rehabil 2024. [PMID: 39023186 DOI: 10.1111/joor.13807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 07/02/2024] [Accepted: 07/05/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Temporomandibular disorders (TMDs) pose diagnostic challenges, and selecting appropriate imaging modalities is crucial for accurate assessment. This study aimed to compare the diagnostic accuracy and efficacy of ultrasonography (US) and magnetic resonance imaging (MRI) in identifying TMDs. METHODS A comprehensive meta-analysis was conducted, including studies that compared US and MRI for TMJ disorder assessments. Fixed-effects models were utilized to calculate pooled odds ratios (ORs) and relative risks (RRs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the chi-squared test and I2 statistic. Newcastle-Ottawa scale was used to assess the methodological quality of the studies included. RESULTS Six studies were included, involving a total of 281 participants. The meta-analysis demonstrated that MRI was statistically somewhat better than US in identifying TMJ disorders. The summary OR was 0.64 (95% CI: 0.46-0.90), and the summary RR was 0.80 (95% CI: 0.68-0.95). Heterogeneity among the studies was low (χ2 = 2.73, df = 5, p = .74; I2 = 0%). Demographic variables revealed variations in sample size, gender ratio and mean age across the studies. CONCLUSION This meta-analysis provides evidence that MRI may be more effective than US in diagnosing TMDs. However, the study is limited by the small number of included studies and variations in demographic variables and study designs. Future research with larger samples and standardised protocols is essential to confirm and strengthen these findings. Understanding the diagnostic accuracy of MRI and US for TMJ disorders will aid clinicians in making informed decisions for effective TMJ disorder assessments and patient management.
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Affiliation(s)
- Mahmud Uz Zaman
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Prince Sattam Bin Abdullaziz University, Al-Kharj, Saudi Arabia
| | - Mohammad Khursheed Alam
- Preventive Dentistry Department, College of Dentistry, Jouf University, Sakaka, Saudi Arabia
- Department of Dental Research Cell, Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College and Hospitals, Chennai, India
- Department of Public Health, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, Bangladesh
| | - Nasser Raqe Alqhtani
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Prince Sattam Bin Abdullaziz University, Al-Kharj, Saudi Arabia
| | - Mana Alqahtani
- Department of Surgery, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia
| | - Mohammed J Alsaadi
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam Bin Abdullaziz University, Al-Kharj, Saudi Arabia
| | - Vincenzo Ronsivalle
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, Catania, Italy
| | - Marco Cicciù
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, Catania, Italy
| | - Giuseppe Minervini
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, India
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
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Lee YH, Chun YH, Bae H, Lee JW, Kim HJ. Comparison of ultrasonography-based masticatory muscle thickness between temporomandibular disorders bruxers and temporomandibular disorders non-bruxers. Sci Rep 2024; 14:6923. [PMID: 38519584 PMCID: PMC10960048 DOI: 10.1038/s41598-024-57696-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/20/2024] [Indexed: 03/25/2024] Open
Abstract
To compare masticatory muscle thickness in patients with temporomandibular disorders (TMDs) during rest and clenching, and by body position, using ultrasonography. This prospective study included 96 patients with TMD (67 females, 29 males; mean age: 40.41 ± 17.88 years): group 1, comprising 66 patients with TMD without bruxism (TMD_nonbruxer), and group 2, comprising 30 patients with concurrent TMD and bruxism (TMD_bruxer). In patients with TMD, bruxism was correlated with the presence of tinnitus, muscle stiffness, sleep problems, psychological stress, and restricted mouth opening. The masseter muscle significantly thickened during clenching (11.16 ± 3.03 mm vs 14.04 ± 3.47 mm, p < 0.001), whereas the temporalis muscle showed no significant increase in thickness from resting to clenching in an upright position (7.91 ± 1.98 vs 8.39 ± 2.08, p = 0.103). Similarly, during clenching in the supine position, the masseter muscle was significantly thicker compared with rest (11.24 ± 2.42 vs 13.49 ± 3.09, p < 0.001), but no significant difference was observed in temporal muscle thickness (8.21 ± 2.16 vs 8.43 ± 1.94, p = 0.464). In comparison between two groups, the average thickness of the masseter muscle was greater among TMD_bruxers than among TMD_nonbruxers in both the upright and supine positions (all p < 0.05). In the generalized lineal model, female sex (B = - 1.018, 95% confidence interval [CI] - 1.855 to - 0.181, p = 0.017) and bruxism (B = 0.868, 95% CI 0.567 to 1.169, p = 0.048) significantly predicted changes in masseter muscle thickness. Female sex (B = - 0.201, 95% CI - 0.299 to - 0.103, p = 0.011), increased age (B = - 0.003, 95% CI - 0.005 to 0.000, p = 0.038), and muscle stiffness (B = - 1.373, 95% CI - 2.369 to - 0.376, p = 0.007) were linked to decreased temporal muscle thickness. Comparing TMD nonbruxer and bruxer muscle thicknesses in upright and supine positions revealed significant increased thickness in the masseter muscle during clenching but not in the temporalis muscle. Masseter muscle thickness varied significantly by sex, body position, and resting/clenching, notably influenced by bruxism. These findings emphasize the relevance of these factors in clinical examinations of patients with TMD.
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Affiliation(s)
- Yeon-Hee Lee
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University, Kyung Hee University Dental Hospital, #613 Hoegi-dong, Dongdaemun-gu, Seoul, 02447, South Korea.
| | - Yang-Hyun Chun
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University, Kyung Hee University Dental Hospital, #613 Hoegi-dong, Dongdaemun-gu, Seoul, 02447, South Korea
| | - Hyungkyu Bae
- Division in Anatomy and Developmental Biology, Department of Oral Biology, BK21 FOUR Project, Human Identification Research Institute, Yonsei University College of Dentistry, Seoul, South Korea
| | - Jung-Woo Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, 02447, South Korea
| | - Hee-Jin Kim
- Division in Anatomy and Developmental Biology, Department of Oral Biology, BK21 FOUR Project, Human Identification Research Institute, Yonsei University College of Dentistry, Seoul, South Korea
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Xiang W, Wang M, Li Z, Cai M, Pan X. Correlation between temporomandibular joints and craniocervical posture in patients with bilateral anterial disc displacement. BMC Oral Health 2024; 24:159. [PMID: 38297238 PMCID: PMC10832266 DOI: 10.1186/s12903-024-03892-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 01/12/2024] [Indexed: 02/02/2024] Open
Abstract
OBJECTIVE To study the changes of temporomandibular joints and craniocervical posture in adult patients with bilateral anterior disc displacement, and to explore their correlation, which may provide some clinical value for clinical diagnosis and treatment planning. METHODS Ninety-eight adult patients were divided into 3 groups: 29 patients in bilateral disc normal position group (BN), 33 patients in bilateral Anterior Disc Displacement With Reduction group (ADDWR) and 36 patients in bilateral Anterior Disc Displacement Without Reduction group (ADDWoR). Dolphin and Uceph software were used to measure 14 items of temporomandibular joint and 11 items of craniocervical posture for comparison and correlation analysis between groups. RESULTS There were significant differences in bilateral joint space between three groups. Compared with the BN, the anteroposterior diameter of the condyle was significantly reduced, the condyle was significantly displaced posteriorly and superiorly in the ADDWR and ADDWoR, but the joint fossa width and joint fossa depth did not change significantly. Cervical curvature and inclination were greater in patients with anterior disc displacement than BN, indicating that the craniocervical posture of adult patients with anterior disc displacement was extended and protrusive. CONCLUSION Anterior disc displacement of the temporomandibular joint can displace the condyle upwards and posteriorly and reduce the anteroposterior diameter of condyle, and then make the condyle closer to the wall of articular fossa to induce joint symptoms. Additionally, craniocervical postural position is significantly affected, which may be related to compensate for the effects of airway space.
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Affiliation(s)
- Wanfang Xiang
- School/Hospital of Stomatology, Lanzhou University, Tianshui South Road, Chengguan District, Lanzhou, Gansu Province, 730000, People's Republic of China
| | - Min Wang
- School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, People's Republic of China
| | - Zhihui Li
- School/Hospital of Stomatology, Lanzhou University, Tianshui South Road, Chengguan District, Lanzhou, Gansu Province, 730000, People's Republic of China
| | - Mingqin Cai
- School/Hospital of Stomatology, Lanzhou University, Tianshui South Road, Chengguan District, Lanzhou, Gansu Province, 730000, People's Republic of China
| | - Xiaojing Pan
- School/Hospital of Stomatology, Lanzhou University, Tianshui South Road, Chengguan District, Lanzhou, Gansu Province, 730000, People's Republic of China.
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Khachatryan Z, Hambartsoumian T, Tatintsyan L, Burnazyan S, Hakobyan G. Efficacy of the transcutaneous electrostimulation in treatment dysfunctions of the TMJ associated with occlusion distortions. BMC Oral Health 2023; 23:937. [PMID: 38017420 PMCID: PMC10683287 DOI: 10.1186/s12903-023-03662-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/13/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND The study evaluation of the effectiveness the method of electrostimulation in treatment TMJ associated with occlusion disorders with the use of a patches by the company "Aganyan''. METHODS The study included 54 patients with temporomandibular dysfunction syndrome who had previously undergone endodontic dental treatment. In patients temporomandibular disorders (TMD) determined on the basis of Diagnostic criteria for temporomandibular disorders(DC/TMD).All patients had occlusion disorders due to errors after dental filling restoration. To diagnose the TMJ, a CT scan was used. The complex therapy also included therapy and with the use of a patches by the company "Aganyan''. The wearable patch includes a flexible substrate, a binder an adhesive layer, with an electrode foil attached to it. Patients applied one patch behind each TMJ. The patches were applied for eight hours every third day for three months. All the patients were given full-fledged endodontic treatment and restoration of the crown part, taking into account anatomical features. RESULTS The dynamics of the complex treatment of patients diagnosed with TMJ dysfunction syndrome showed that after treatment, the clinical symptoms gradually decreased and disappeared at the end of treatment. CT scan a year after treatment showed a normal ratio of TMJ elements. Сomplex treatment was effective in 87% of patients, after 3-5 months gradually decreased pain, noise in the joints, restriction of opening and closing of the mouth disappeared. Patients recovered their chewing functions, psycho-emotional state. CONCLUSION The results of the studies revealed a positive effects for the complex treatment dysfunctions syndrome TMJ the using the patches by the company "Aganyan" through electrical stimulation with low intensity.
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Affiliation(s)
- Zhanna Khachatryan
- Dept. of Therapeutic Stomatology, Yerevan State Medical University after M. Heratsi, Dental Clinic Pail, Yerevan, Armenia
| | - Tsovinar Hambartsoumian
- Dept. of Oral and Maxillofacial Surgery, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - Lyudmila Tatintsyan
- MC ArtMed, Yerevan, Armenia
- Dept. of Therapeutic Stomatology, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - Seda Burnazyan
- Dept. Oral and Maxillofacial Surgery, Yerevan State Medical University after M. Heratsi, 0028 Kievyan str. 10 ap. 65, Yerevan, Armenia
| | - Gagik Hakobyan
- Dept. Oral and Maxillofacial Surgery, Yerevan State Medical University after M. Heratsi, 0028 Kievyan str. 10 ap. 65, Yerevan, Armenia.
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Li C, Zhou J, Shi Y, Ye Z, Zhang C, Hou R, Li Z, You M. Diagnostic efficacy of quantitative ultrasonography for anterior disc displacement of the temporomandibular joint. Quant Imaging Med Surg 2023; 13:6446-6455. [PMID: 37869327 PMCID: PMC10585577 DOI: 10.21037/qims-23-401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/21/2023] [Indexed: 10/24/2023]
Abstract
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.
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Affiliation(s)
- Chenyang Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Oral Medical Imaging, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jinbo Zhou
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Oral Medical Imaging, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yuchao Shi
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Oral Medical Imaging, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zelin Ye
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Oral Medical Imaging, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Chunmiao Zhang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Oral Medical Imaging, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Ruilai Hou
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Oral Medical Imaging, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhongjie Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Temporomandibular Joint, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Meng You
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Oral Medical Imaging, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Maranini B, Ciancio G, Mandrioli S, Galiè M, Govoni M. The Role of Ultrasound in Temporomandibular Joint Disorders: An Update and Future Perspectives. Front Med (Lausanne) 2022; 9:926573. [PMID: 35795636 PMCID: PMC9251198 DOI: 10.3389/fmed.2022.926573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/24/2022] [Indexed: 12/11/2022] Open
Abstract
Temporomandibular joint (TMJ) disorder is the second most common chronic pain condition affecting the general population after back pain. It encompasses a complex set of conditions, manifesting with jaw pain and limitation in mouth opening, influencing chewing, eating, speaking, and facial expression. TMJ dysfunction could be related to mechanical abnormalities or underlying inflammatory arthropathies, such as rheumatoid arthritis (RA) or juvenile idiopathic arthritis (JIA). TMJ exhibits a complex anatomy, and thus a thorough investigation is required to detect the TMJ abnormalities. Importantly, TMJ involvement can be completely asymptomatic during the early stages of the disease, showing no clinically detectable signs, exposing patients to delayed diagnosis, and progressive irreversible condylar damage. For the prevention of JIA complications, early diagnosis is therefore essential. Currently, magnetic resonance imaging (MRI) is described in the literature as the gold standard method to evaluate TMJ. However, it is a high-cost procedure, not available in all centers, and requires a long time for image acquisition, which could represent a problem notably in the pediatric population. It also suffers restricted usage in patients with claustrophobia. Ultrasonography (US) has emerged in recent years as an alternative diagnostic method, as it is less expensive, not invasive, and does not demand special facilities. In this narrative review, we will investigate the power of US in TMJ disorders based on the most relevant literature data, from an early screening of TMJ changes to differential diagnosis and monitoring. We then propose a potential algorithm to optimize the management of TMJ pathology, questioning what would be the role of ultrasonographic study.
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Affiliation(s)
- Beatrice Maranini
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- *Correspondence: Beatrice Maranini
| | - Giovanni Ciancio
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Stefano Mandrioli
- Department of Cranio-Maxillofacial Surgery, Unit of Cranio-Maxillofacial Surgery, University of Ferrara, Ferrara, Italy
| | - Manlio Galiè
- Department of Cranio-Maxillofacial Surgery, Unit of Cranio-Maxillofacial Surgery, University of Ferrara, Ferrara, Italy
| | - Marcello Govoni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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Diagnostic Value of High-Resolution Ultrasound for the Evaluation of Capsular Width in Temporomandibular Joint Effusion. Life (Basel) 2022; 12:life12040477. [PMID: 35454967 PMCID: PMC9029928 DOI: 10.3390/life12040477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
Aim: The aim of this study was to evaluate if the increased temporomandibular joint (TMJ) capsular thickness, measured by ultrasound (US), is associated with the presence of effusion, diagnosed using MRI imaging. Materials and Methods: 102 patients with signs and symptoms of temporomandibular disorders were included in the study. Each patient underwent US and MRI examinations, 1 to 5 days following clinical examination. The US was performed with an 8−40 MHz linear transducer operating at 20 MHz. The MRI was performed using a 1.5 T MRI device. The ROC curve was analyzed to identify the optimal cut-off value for capsular distention, which can be interpreted as an indirect sign of TMJ effusion. Results: The capsular width values were found to be between 0.7 and 3.6 mm. The best cut-off value was 2.05 mm with a sensitivity of 55.9% and a specificity of 94.7%. The next optimal cut-off value was 1.75 mm with a sensitivity of 67.6% and a specificity of 82.4%. The area under the ROC curve was 0.78 (95% CI 0.68, 0.87, p < 0.05). Conclusions: Ultrasound-measured capsular width can be interpreted as an indirect sign of TMJ effusion. The critical cut-off for capsular width was 2 mm.
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Pihut M, Gala A, Obuchowicz R, Chmura K. Influence of Ultrasound Examination on Diagnosis and Treatment of Temporomandibular Disorders. J Clin Med 2022; 11:jcm11051202. [PMID: 35268289 PMCID: PMC8911463 DOI: 10.3390/jcm11051202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 01/28/2022] [Accepted: 02/21/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Disorders of the masticatory muscles and temporomandibular joints as well as the surrounding craniofacial structures are called temporomandibular disorders. These are dental diseases affecting an increasing number of people with a multifactorial etiology. Noninvasive ultrasonography imaging of temporomandibular joints was performed to obtain more detailed information on joint pathologies. Material and Methods: The aim of the study was to assess the influence of ultrasound examinations of the temporomandibular joints on the diagnosis and treatment planning in patients with temporomandibular disorders. The study included 110 patients examined with the use of the Research Diagnostic Criteria for Temporomandibular Disorders questionnaire, axis I and II, after which the initial treatment plan was created. All patients underwent an ultrasound examination of the temporomandibular joints. Results: The results reveal numerous morphological changes within the joint structures in all treatment groups. Comparative statistical analyses of symptoms were performed between study groups. Conclusions: The number of pathologies in the myofascial pain group was much higher than expected and required introduction of additional treatment procedures. Further studies confirming these results and the effectiveness of ultrasound diagnostic of temporomandibular disorders are recommended.
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Affiliation(s)
- Małgorzata Pihut
- Prosthodontic Department, Dental Institute, Jagiellonian University Medical College, 30-663 Krakow, Poland; (M.P.); (A.G.)
| | - Andrzej Gala
- Prosthodontic Department, Dental Institute, Jagiellonian University Medical College, 30-663 Krakow, Poland; (M.P.); (A.G.)
| | - Rafał Obuchowicz
- Department of Diagnostic Imaging, Jagiellonian University Medical College, 30-663 Krakow, Poland;
| | - Karolina Chmura
- Prosthodontic Department, Dental Institute, Jagiellonian University Medical College, 30-663 Krakow, Poland; (M.P.); (A.G.)
- Correspondence:
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Quantitative assessment of temporomandibular disc and masseter muscle with shear wave elastography. Oral Radiol 2021; 38:49-56. [PMID: 33818734 DOI: 10.1007/s11282-021-00524-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess the normal stiffness values of temporomandibular joint disc (TMJ) and masseter muscle by shear wave elastography (SWE) in a healthy adult population. This may be helpful in diagnosing and understanding the mechanism of temporomandibular disorders (TMD). METHODS This prospective study evaluated a total of 160 healthy adult volunteers (77 males, 83 females). The stiffness values of anterior, intermediate and posterior parts of the TMJ disc and masseter muscle were measured. Study cohort was classified into four groups based on age. Additionally, we investigated the changes in mean shear wave elasticity (kPa) and shear wave velocity(m/s) values of disc parts and masseter muscle in closed and open mouth positions, and the correlation of these SWE values with age and gender. RESULTS Mean stiffness values of the disc were 37.02 ± 23.75 kPa and 3.28 ± 1.09 m/s in the anterior part, 30.47 ± 18.89 kPa and 2.97 ± 1.04 m/s in the intermediate part, 22.61 ± 13.97 kPa and 2.55 ± 0.88 m/s in the posterior part. Stiffness values showed significant decrease in the posterior part compared to the rest of the disc both in males and females. No significant differences in mean stiffness values of masseter muscle related to mouth position, age or gender. CONCLUSION This study provides the normative quantitative elasticity values of disc and masseter muscle which could be a reference point for upcoming studies. Disc elasticity values are higher in women than men. Maybe this is one of the reason why TMD is more common in women. TMJ disc stiffness was significantly lower in the posterior part. SWE is a useful imaging method that can be used with routine ultrasonography in evaluation of the TMJ disc and masticatory muscles .
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Eraslan R, Kılıç K, Etöz M, Soydan D. The evaluation of agreement between high-frequency ultrasonography and research diagnostic criteria for the diagnosis of temporomandibular joint internal derangements. J Indian Prosthodont Soc 2021; 20:387-393. [PMID: 33487966 PMCID: PMC7814687 DOI: 10.4103/jips.jips_136_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/22/2020] [Accepted: 08/31/2020] [Indexed: 11/04/2022] Open
Abstract
Aim The aim of this study is to compare the diagnosis of patients with temporomandibular joint (TMJ) internal derangements which had been diagnosed using Research Diagnostic Criteria/Temporomandibular Disorders (RDC/TMD) with the dynamic high resolution sonography findings. Settings and Design Axis I section of RDC/TMD form had been applied to participants. Participants were divided into three groups as healthy TMJ, disc displacement with reduction, and disc displacement without reduction. The diagnoses had been compared with the dynamic high-resolution sonography findings. Materials and Methods Twelve of the patients had been treated with laser therapy, whereas 13 patients were treated with stabilization splint. Seventeen patients were treated with anterior repositioning splint (n = 42). After the application of different treatment modalities, the position of the articular disc had been determined with Axis I of RDC/ TMD form and dynamic high-resolution sonography. The findings were compared and statistically analyzed. Statistical Analysis Used Statistical analyses of data were analyzed with Turcosa Cloud (Turcosa Ltd Co, Turkey). Results For the right TMJ, pretreatment and posttreatment ultrasonography (USG) diagnoses and RDC/ TMD clinical diagnoses were found similar (κ = 0.125-0.008). No statistically significant relationship was found (P > 0.05). For the left TMJ, pretreatment USG diagnosis and RDC/TMD clinical diagnose were found similar (κ = 0.070). No statistically significant relationship was found (P > 0.05). For the left TMJ, posttreatment USG diagnosis and RDC/TMD clinical diagnose were compared. A statistically significant difference was found (κ = 0.256). A statistically significant relationship was found (P < 0.05). Conclusions Axis 1 of RDC/TMD form which is used for the diagnosis of internal derangements and dynamic high resolution sonography was not found in the agreement.
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Affiliation(s)
- Ravza Eraslan
- Department of Prosthodontics, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
| | - Kerem Kılıç
- Department of Prosthodontics, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
| | - Meryem Etöz
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
| | - Damla Soydan
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
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Ultrasonography-guided arthrocentesis versus conventional arthrocentesis in treating internal derangement of temporomandibular joint: a systematic review. Clin Oral Investig 2020; 24:3771-3780. [PMID: 32594307 DOI: 10.1007/s00784-020-03408-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/10/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This systematic review assessed the clinical question: 'Does ultrasonography (USG)-guided arthrocentesis provide better outcomes than conventional arthrocentesis in patients with temporomandibular disorder (TMD)?' MATERIALS AND METHODS The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. An initial search was performed on electronic databases-including Medline, PubMed, and Cochrane Library-followed by manual and reference searches until the date September 27, 2019. The articles selected were evaluated for study and patient characteristics, arthrocentesis procedure details, and treatment outcomes (post-operative pain, maximum mouth opening (MMO), procedure time, and attempts of needle positioning). Risk of bias was assessed with the Cochrane Consumers and Communication Review Group's data extraction template and Critical Appraisal Skills Programme (CASP). RESULTS Out of the 325 initially identified articles, four studies with 144 patients were included in the final qualitative analysis. No significant differences were found in pain reduction and improved MMO between sample groups receiving conventional arthrocentesis and USG-guided arthrocentesis. Needle positioning attempts and procedural times were conflicting between the two groups. CONCLUSIONS This systematic review found that the outcomes of USG-guided arthrocentesis were not superior to conventional arthrocentesis. Conflicting data was found in the attempts of needle positioning and procedural time. Standardized treatment protocols and data from well-designed USG-guided arthrocentesis randomized clinical trials were lacking. CLINICAL RELEVANCE Arthrocentesis with or without USG guidance are both effective for treating patients with TMD to reduce pain and to improve MMO. USG-guided arthrocentesis was not found to be superior to conventional arthrocentesis.
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L K SK, Zachariah GP, Chandran S. Ultrasonography: A step forward in temporomandibular joint imaging. A preliminary descriptive study. Clin Pract 2019; 9:1134. [PMID: 31341577 PMCID: PMC6610715 DOI: 10.4081/cp.2019.1134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/21/2019] [Indexed: 11/23/2022] Open
Abstract
Ultrasonography (USG) is a cost-effective and noninvasive imaging modality commonly employed for imaging the abdominal region and extremities. Currently, with the availability of higher frequency probes and higher resolution devices, USG imaging of the temporomandibular joint (TMJ) looks promising. The aim is to evaluate and demonstrate the role of USG as an imaging modality of TMJ by visualizing the static and dynamic relationship of the joint, assessment of joint space and eliciting reproducibility at both open and closed mouth positions. 30 volunteers were selected based on the inclusion criteria in line with the research diagnostic criteria/temporomandibular disorders guidelines. High-resolution USG (≥12 MHz) of the right TMJ (chosen for uniformity) was done in the left decubitus position on (n=30) volunteers. The joint disc movement was directly visualized during opening and closing motions. The vertical joint space was assessed using the firmware and accurate reproducibility was checked. At the closed mouth position, the measured values ranged from 0.2 mm to 0.7 mm with a median of 0.05 cm and a mean of 0.4±0.15 mm. At the position of maximal mouth opening, the measured values ranged from 0.9 mm to 1.5 mm with a median of 1.1 mm and a mean of 1.1±0.17 mm. USG enables visualization of the dynamic relationship between joint structures, with particular importance to the condyle and disc position. The articular disc appears on the USG as a thin layer of hyperechogenicity surrounded by a hypoechoic halo, located between 2 hyperechoic lines viz, the condyle and the articular eminence We recommend ultrasonographic imaging as a noninvasive diagnostic technique with relatively high specificity for patients with temporomandibular disorders.
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Affiliation(s)
- Surej Kumar L K
- Department of Oral and Maxillofacial Surgery, PMS College of Dental Science and Research, Thiruvananthapuram, India
| | - Georgie P Zachariah
- Department of Oral and Maxillofacial Surgery, PMS College of Dental Science and Research, Thiruvananthapuram, India
| | - Sumesh Chandran
- Department of Oral and Maxillofacial Surgery, PMS College of Dental Science and Research, Thiruvananthapuram, India
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Azlağ Pekince K, Çağlayan F, Pekince A. The efficacy and limitations of USI for diagnosing TMJ internal derangements. Oral Radiol 2019; 36:32-39. [PMID: 30719601 DOI: 10.1007/s11282-019-00376-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/28/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION This study was conducted to determine the effectiveness of ultrasonographic imaging for diagnosing temporomandibular joint internal derangements. MATERIALS AND METHODS Ultrasonographic and magnetic resonance imaging scans of temporomandibular joints were obtained bilaterally in 55 patients who had temporomandibular joint disorders and who were diagnosed with temporomandibular joint internal derangements following a clinical examination. Diagnostic accuracy of ultrasonographic imaging was assessed considering magnetic resonance imaging as the gold standard method. RESULTS When the results of ultrasonographic imaging and magnetic resonance imaging were compared, the diagnostic accuracy of ultrasonographic imaging was 0.81 for detecting TMJ disc displacement. The diagnostic accuracy of ultrasonographic imaging in detecting TMJ disc position was 0.81 in the closed-mouth position and 0.93 in the open-mouth position. CONCLUSION As a noninvasive and reproducible imaging method acquiring dynamic images, ultrasonographic imaging is a successful method in the evaluation of temporomandibular joint disc displacement.
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Affiliation(s)
- Kader Azlağ Pekince
- Department of Oral Diagnosis and Radiology, Faculty of Dentistry, Karabük University, Karabük, Turkey.
| | - Fatma Çağlayan
- Department of Oral Diagnosis and Radiology, Faculty of Dentistry, Atatürk University, Erzurum, Turkey
| | - Adem Pekince
- Department of Oral Diagnosis and Radiology, Faculty of Dentistry, Karabük University, Karabük, Turkey
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Ho KY, Laskowski B, Garcia D, Hardy CJ, Puentedura E. Measurement of anterior translation of the mandibular condyle using sonography. J Phys Ther Sci 2019; 31:116-121. [PMID: 30774218 PMCID: PMC6348191 DOI: 10.1589/jpts.31.116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 10/24/2018] [Indexed: 12/17/2022] Open
Abstract
[Purpose] To establish a standardized sonographic approach to quantify anterior
translation of the mandibular condyle during mouth opening by examining the reliability of
image acquisition and processing, and to understand how anterior condylar translation
contributes to mouth opening. [Participants and Methods] Twenty-eight participants without
temporomandibular disorder (TMD) participated. During day 1 of data collection, all
participants performed maximal mouth opening while an examiner recorded anterior condylar
translation using sonography. The mouth opening range of motion was also obtained. On day
2 of data collection, the same procedure was performed on 6 participants that participated
in day 1 of data collection. To establish reliability of image processing, 3 examiners
measured condylar translations on 2 separate days. To determine reliability of image
acquisition, images obtained from 2 days of data collection were analyzed. [Results]
Excellent intra-class correlation coefficients (ICCs) and small standard errors of
measurement (SEMs) for image acquisition and processing were shown. A significant, linear
model was found to describe the relationship between condylar anterior translations and
mouth opening. [Conclusion] Anterior condylar translation during mouth opening can be
reliably measured using sonography. The linear relation between condylar motion and mouth
opening can be used to guide clinical practices.
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Affiliation(s)
- Kai-Yu Ho
- Department of Physical Therapy, University of Nevada, Las Vegas: 4505 S. Maryland Parkway, Box 453029 Las Vegas, NV 89154, USA
| | - Brooke Laskowski
- Department of Physical Therapy, University of Nevada, Las Vegas: 4505 S. Maryland Parkway, Box 453029 Las Vegas, NV 89154, USA
| | - Danielle Garcia
- Department of Physical Therapy, University of Nevada, Las Vegas: 4505 S. Maryland Parkway, Box 453029 Las Vegas, NV 89154, USA
| | - Christensen J Hardy
- Department of Physical Therapy, University of Nevada, Las Vegas: 4505 S. Maryland Parkway, Box 453029 Las Vegas, NV 89154, USA
| | - Emilio Puentedura
- Department of Physical Therapy, University of Nevada, Las Vegas: 4505 S. Maryland Parkway, Box 453029 Las Vegas, NV 89154, USA.,Doctor of Physical Therapy Program, Baylor University, USA
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Díaz DZR, Müller CEE, Gavião MBD. Ultrasonographic study of the temporomandibular joint in individuals with and without temporomandibular disorder. J Oral Sci 2019; 61:539-543. [DOI: 10.2334/josnusd.18-0278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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17
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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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Talmaceanu D, Lenghel LM, Bolog N, Hedesiu M, Buduru S, Rotar H, Baciut M, Baciut G. Imaging modalities for temporomandibular joint disorders: an update. ACTA ACUST UNITED AC 2018; 91:280-287. [PMID: 30093805 PMCID: PMC6082607 DOI: 10.15386/cjmed-970] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 02/05/2018] [Accepted: 02/13/2018] [Indexed: 12/20/2022]
Abstract
The diagnosis and management of temporomandibular disorders (TMD) require both clinical and imaging examinations of the temporomandibular joint (TMJ). A variety of modalities can be used to image the TMJ, including magnetic resonance imaging (MRI), computed tomography (CT), cone beam CT, ultrasonography, conventional radiography. The present review outlines the indications of the most frequently used imaging techniques in TMD diagnosis. Because of the anatomic complexity of the TMJ, imaging can be difficult. Choosing the proper imaging technique is essential. Conventional radiography, nowadays, is of limited interest. The use of flat plane films for TMJ pathology is not sufficient, because this joint requires three dimensional imaging views. Osseous changes are better visualized with CT and cone beam CT. Cone beam CT provides high-resolution multiplanar reconstruction of the TMJ, with a low radiation dose, without superimposition of the bony structures. MRI is a noninvasive technique, considered to be the gold standard in imaging the soft tissue components of the TMJ. MRI is used to evaluate the articular disc in terms of location and morphology. Moreover, the early signs of TMD and the presence of joint effusion can be determined. High-resolution ultrasonography is a noninvasive, dynamic, inexpensive imaging technique, which can be useful in diagnosing TMJ disc displacements. The diagnostic value of high-resolution ultrasonography is strictly dependent on the examiner's skills and on the equipment used.
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Affiliation(s)
- Daniel Talmaceanu
- Department of Cranio-Maxillofacial Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Lavinia Manuela Lenghel
- Department of Radiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Mihaela Hedesiu
- Department of Radiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Smaranda Buduru
- Department of Prosthodontics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Horatiu Rotar
- Department of Cranio-Maxillofacial Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihaela Baciut
- Department of Cranio-Maxillofacial Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Grigore Baciut
- Department of Cranio-Maxillofacial Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Ultrasonographic evaluation of submucosal thickness in oral submucous fibrosis patients: a cross-sectional study. Pol J Radiol 2018; 83:e280-e288. [PMID: 30627248 PMCID: PMC6323594 DOI: 10.5114/pjr.2018.76795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/04/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate the role of ultrasonography in oral submucous fibrosis (OSMF) patients. Material and methods A total of 150 subjects were divided equally into six groups (Group I: 25 healthy subjects; Group II: 25 healthy subjects with habit; Group III: 25 OSMF stage I; Group IV: 25 OSMF stage II; Group V: 25 OSMF stage III; and Group VI: 25 stage OSMF IVA). The grading of OSMF were done according the clinical classification given by Khanna and Andrade (2005). After fulfilling inclusion and exclusion criteria each subject underwent extraoral ultrasonographic evaluation of submucosal thickness and vascularity in terms of peak systolic velocity (PSV), bilaterally on buccal and labial mucosa. Furthermore, statistical comparison of each group was done, and sensitivity and specificity of USG measurements was obtained in comparison with clinical diagnosis. The statistical analysis was performed using SPSS ver. 20.0. Results A statistically significant increase in mean submucosal thickness was shown, and a decrease in PSV with the advancement of severity of the OSMF. In ultrasonographic diagnosis of OSMF, the reported submucosal thickness had a sensitivity, specificity, PPV, NPV, and accuracy was 80%, 100%, 100%, 71.4%, and 87%, respectively, but PSV failed to classify the lesion. Conclusions Because the severity of the disease showed a direct relationship with submucosal thickness and an inverse relationship with PSV, habit-induced mucosal alteration in submucosal thickness can be seen on USG, which cannot be appreciated on clinical examination. Hence, USG can be a promising tool for early diagnosis, assessment of the severity, and evaluation of prognosis of OSMF.
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Diagnostic value of ultrasonography for the detection of disc displacements in the temporomandibular joint: a systematic review and meta-analysis. Clin Oral Investig 2018; 22:2599-2614. [PMID: 29455373 PMCID: PMC6097040 DOI: 10.1007/s00784-018-2359-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 01/23/2018] [Indexed: 02/07/2023]
Abstract
Objectives The aim was to assess the added diagnostic value of ultrasonography (US) for establishing the presence or absence of disc displacements (DDs) in temporomandibular joints (TMJs). Materials and methods Pubmed and EMBASE were searched electronically to identify diagnostic accuracy studies that assessed the diagnostic value of US for the diagnosis of DD, using Magnetic resonance imaging (MRI) as the reference standard. Meta-analyses were performed with Metadisc 1.4 and RevMan 5.3. Results A total of 16 studies qualified for meta-analyses. For the diagnosis of DD at closed mouth position (DD-CM) and DD at maximum mouth-opening position (DD-MMO), the added values of a positive result with US for ruling in DD-CM and DD-MMO were 22 and 41%, while those of a negative result with US for ruling out DD-CM and DD-MMO were 30 and 20%. For the diagnosis of DD with reduction (DDWR) and DD without reduction (DDWoR), the added values of a positive result in US for ruling in DDWR and DDWoR were 35 and 41%, while those of a negative result in US for ruling out DDWR and DDWoR were 21 and 27%. Conclusions Using MRI as reference standard, the added values of both positive predictive values and negative predictive values of US for ruling in and ruling out DDs are sufficient in the decision-making in dental practice. Clinical relevance US can be a good imaging tool to supplement clinical examination findings in patients with suspected DDs. Combined static and dynamic examinations using high-resolution US should be preferred.
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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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Suenaga S, Nagayama K, Nagasawa T, Indo H, Majima HJ. The usefulness of diagnostic imaging for the assessment of pain symptoms in temporomandibular disorders. JAPANESE DENTAL SCIENCE REVIEW 2016; 52:93-106. [PMID: 28408961 PMCID: PMC5390340 DOI: 10.1016/j.jdsr.2016.04.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 04/14/2016] [Accepted: 04/26/2016] [Indexed: 12/30/2022] Open
Abstract
The causes of pain symptoms in the temporomandibular joint (TMJ) and masticatory muscle (MM) regions may not be determined by clinical examination alone. In this review, we document that pain symptoms of the TMJ and MM regions in patients with temporomandibular disorders (TMDs) are associated with computed tomography and magnetic resonance (MR) findings of internal derangement, joint effusion, osteoarthritis, and bone marrow edema. However, it is emphasized that these imaging findings must not be regarded as the unique and dominant factors in defining TMJ pain. High signal intensity and prominent enhancement of the posterior disk attachment on fat saturation T2-weighted imaging and dynamic MR imaging with contrast material are closely correlated with the severity of TMJ pain. Magnetic transfer contrast, MR spectroscopy, diffusion tensor imaging, and ultrasonography findings have helped identify intramuscular edema and contracture as one of the causes of MM pain and fatigue. Recently, changes in brain as detected by functional MR neuroimaging have been associated with changes in the TMJ and MM regions. The thalamus, the primary somatosensory cortex, the insula, and the anterior and mid-cinglate cortices are most frequently associated with TMD pain.
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Affiliation(s)
- Shigeaki Suenaga
- Department of Maxillofacial Radiology, Division of Oncology, Kagoshima University Graduate School of Medical and Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
| | - Kunihiro Nagayama
- Department of Orthodontics and Dentofacial Orthopedics, Kagoshima University Graduate School of Medical and Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
| | - Taisuke Nagasawa
- Department of Maxillofacial Radiology, Division of Oncology, Kagoshima University Graduate School of Medical and Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
| | - Hiroko Indo
- Department of Maxillofacial Radiology, Division of Oncology, Kagoshima University Graduate School of Medical and Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
| | - Hideyuki J. Majima
- Department of Maxillofacial Radiology, Division of Oncology, Kagoshima University Graduate School of Medical and Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
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Kirkhus E, Gunderson RB, Smith HJ, Flatø B, Hetlevik SO, Larheim TA, Arvidsson LZ. Temporomandibular joint involvement in childhood arthritis: comparison of ultrasonography-assessed capsular width and MRI-assessed synovitis. Dentomaxillofac Radiol 2016; 45:20160195. [PMID: 27383060 DOI: 10.1259/dmfr.20160195] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Ultrasonography is an effective, low-cost, low-threshold and convenient diagnostic tool in childhood arthritis, but its value in temporomandibular joint (TMJ) involvement is not clear. The purpose of our study was to explore the reliability of ultrasonography to assess TMJ inflammation using contrast-enhanced MRI as reference standard, in order to deduce cut-off values for TMJ capsular width to detect enhanced synovial thickening (synovitis). METHODS 124 ultrasonography and MRI examinations in 55 patients [mean age 12.4 ± 3.5 years (±standard deviation)], the majority obtained within 1 day, were scored for subcondylar and condylar capsular width (ultrasonography images) and amount of synovitis (MR images). The correlations of these findings were calculated. A receiver operating characteristic (ROC) curve analysis, with MRI findings as reference standard, was obtained. RESULTS The correlation between ultrasonography-assessed capsular width and MRI-assessed amount of synovitis was moderate both at the subcondylar and condylar level [Spearman's rho (ρ): 0.483; p < 0.001 and 0.347; p < 0.001 respectively]. The ROC curve indicated the best discriminatory ability at the subcondylar level with an area under the curve of 0.77 (95% confidence interval 0.69-0.85) and a cut-off value of 1.2 mm (sensitivity 72%, specificity 70%) for the capsular width. CONCLUSIONS A moderate correlation between ultrasonography-assessed capsular width and MRI-assessed synovitis was found in childhood arthritis with the best discriminatory ability at the subcondylar level. This indicates that ultrasonography may be a valuable diagnostic tool in the initial assessment of TMJ inflammation.
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Affiliation(s)
- Eva Kirkhus
- 1 Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Blindern, Oslo, Norway.,2 Department of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Nydalen, Oslo, Norway
| | - Ragnhild B Gunderson
- 2 Department of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Nydalen, Oslo, Norway
| | - Hans-Jørgen Smith
- 1 Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Blindern, Oslo, Norway.,2 Department of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Nydalen, Oslo, Norway
| | - Berit Flatø
- 1 Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Blindern, Oslo, Norway.,3 Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Nydalen, Oslo, Norway
| | - Siri O Hetlevik
- 1 Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Blindern, Oslo, Norway.,3 Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Nydalen, Oslo, Norway
| | - Tore A Larheim
- 4 Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, Blindern, Oslo, Norway
| | - Linda Z Arvidsson
- 4 Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, Blindern, Oslo, Norway
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Evirgen Ş, Kamburoğlu K. Review on the applications of ultrasonography in dentomaxillofacial region. World J Radiol 2016; 8:50-58. [PMID: 26834943 PMCID: PMC4731348 DOI: 10.4329/wjr.v8.i1.50] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/06/2015] [Accepted: 12/04/2015] [Indexed: 02/06/2023] Open
Abstract
Use of ultrasonography (US) in dentomaxillofacial region became popular in recent years owing to increasing radiation dose concerns and economic limitations. It helps to visualize fine detail of the surface structure of the oral and maxillofacial tissues without ionizing radiation. In diagnostic ultrasound, high frequency sound waves are transmitted into the body by a transducer and echoes from tissue interface are detected and displayed on a screen. Sound waves are emitted via piezoelectric crystals from the ultrasound transducer. US technique can be used in dentomaxillofacial region for the examination of bone and superficial soft tissue, detection of major salivary gland lesions, temporomandibular joint imaging, assessment of fractures and vascular lesions, lymph node examination, measurement of the thickness of muscles and visualization of vessels of the neck. It has the potential to be used in the evaluation of periapical lesions and follow up of periapical bone healing. Also, it may be used for the evaluation of periodontal pocket depth and for the determination of gingival thickness before dental implantology.
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