Ultrasonography has acceptable diagnostic efficacy for detection of temporomandibular joint disc displacement

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Temporomandibular disorders (TMDs) result in craniofacial pain, limited mouth opening, temporomandibular joint (TMJ) clicks affecting the joint and related structures.  A prevalence of between 10% to 70% has been reported, and it particularly effects women aged 20 to 40 years. TMDs can be classified into muscular disorders, internal derangement (ID), inflammatory disease, and osteoarthritis. Internal derangement is common and can cause other TMDs.   Magnetic resonance imaging (MRI), computed tomography, arthrography, and ultrasonograpy are all used to image the TMJ. The aim of this review was to assess and explore the reliability of ultrasonography in diagnosing the disc displacement of TMJ.

What did they do

The Medline, Embase and the Chinese Biomedical Literature Databases were searched without language restriction. Diagnostic test accuracy studies that evaluated use of ultrasonography for detecting TMJ disc displacement in patients with any symptoms or clinical signs related to a TMD were included.  Studies also needed to use of MRI as the gold standard and include sensitivity, specificity information with abnormal disc locations defined as ID. Review articles, case reports, case series, were excluded.  study inclusion, data extraction, and risk of bias assessment was performed by two authors in duplicate.

What did they find

  • Fifteen studies (14 cohort studies, 1 case-control study) were included; 6 studies had a low risk of bias, 6 an unclear risk, and 3 a high risk.
  •  Meta-regression indicated that the detected results were not influenced by the types of ultrasonography, image dimensions, types of transducer, and ultrasonic image of the disc (P > .05).
  • The Q* (the point where sensitivity equals specificity on the summary reviewer operator characteristics curve) values of ultrasonography for the closed- and open-mouth positions were 0.79 and 0.91, respectively.
sensitivityspecificitypositive likelihood rationegative likelihood ratiodiagnostic odds ratioQ*
disc displacement with reduction0.760.823.800.3610.950.76
disc displacement without reduction0.790.9180.50.2536.800.92

The authors concluded

The diagnostic efficacy of ultrasonography is acceptable and can be used as a rapid preliminary diagnostic method to exclude some clinical suspicions. However, positive ultrasonographic findings should be confirmed by magnetic resonance imaging. Also, the ability of ultrasonography to detect lateral and posterior displacements is still unclear. More high-quality studies are needed to assess the diagnostic efficacies of some specific ultrasonographic methods. Standards and criteria for ultrasonographic techniques in the diagnosis of disc displacement should be established in the future

Chunjie Li, Naichuan Su, Xianrui Yang, Xiao Yang, Zongdao Shi, Longjiang Li. Ultrasonography for Detection of Disc Displacement of Temporomandibular Joint: A Systematic Review and Meta-Analysis. Journal of Oral and Maxillofacial Surgery

Comment

Previous we higlighted a review by Reneker at al     that loked at  the ability of existing tests to distinguish between TMDs the focus of this well conducted review only focuses on the detection of TMJ disk displacement and the authors nonote that  because,different  TMDs  often present t similar clinical symptoms differential diagnosis can be difficult and lead to misdiagnosis.

 

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Derek Richards

Derek Richards
Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. In 2013 the Centre for Evidence-based Dentistry moved to the Dental Health Services Research Unit in Dundee. Derek has been involved with teaching EBD and a wide range of evidence-based initiatives both nationally and internationally since 1994.

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