An ultrasound protocol for temporomandibular joint in juvenile idiopathic arthritis: a pilot study

Abstract

Objectives: As it is well known, the diagnosis of temporomandibular joint (TMJ) involvement in patients affected by Juvenile Idiopathic Arthritis (JIA) is important to avoid the impairment of mandibular growth. In this context, Magnetic Resonance Imaging (MRI) is the gold-standard for detection of TMJ involvement, however it is expensive and requires patients’ collaboration. The aim of this study was to evaluate if ultrasound may be used as an alternative tool to investigate the acute signs of TMJ involvement in JIA patients. Methods: Lateral periarticular space (LPAS) and joint effusion were evaluated by ultrasound in a study Group A of 8 JIA children (11.6±3.5 years old) with 14 TMJs involved, as confirmed by MRI, and in a control Group B of 7 healthy children (9.3±1.2 years old) without temporomandibular disorders (TMD). The LPAS width values were compared between the two groups using the Mann–Whitney test. The ultrasound images of the JIA group were then matched with the corresponding MR images; the Spearman Rank Correlation test and the Bland–Altman test were used to evaluate the differences. Results: The LPAS values in Group A were statistically significantly higher than those in Group B (p < 0.001). There was no overlap of the LPAS values confidence intervals (CIs) between the two groups. No signs of joint effusion were identified in groups A and B. The Spearman test applied to the values of LPAS measured in ultrasound and the corresponding MR images showed a proportional positive correlation with a ρ of 0.623 and a p < 0.05. Conclusions: Ultrasound can detect differences in the TMJ features between JIA patients and healthy patients and it might be used as a follow-up tool in the assessment of TMJ involvement in subject affected by JIA.

The Role of Ultrasound in Temporomandibular Joint Disorders: An Update and Future Perspectives

“…A common feature of TMJ involvement is synovitis, defined as a thickened synovia, joint effusion, and with or without an active synovial inflammation ( 55 ) ( Figure 2 ). Afterward, arthritic changes may occur as reparative or destructive signs, cystic lesions, erosions, flattening of the articular condyle, as well as destructive changes of the articular disk and synovial structures ( 32 , 46 , 47 , 49 , 54 ).…”

“…Moreover, to date, no defined TMJ US pattern has been reported to be peculiar to different TMD. The traditional US imaging protocol includes axial and coronal scans at closed- and open-mouth ( 55 ) ( Figure 3 ).…”

“…The joint space width is measured from the cortical contour of the condyle to the articular capsule at different levels over the condylar cortical line (anterior and lateral levels). The coronal scan position is the most suitable to assess this measurement ( 46 , 55 , 70 ).…”

Role of Ultrasound Evaluation of Temporomandibular Joint in Juvenile Idiopathic Arthritis: A Systematic Review

“…Nine articles were added from the reference list of records considered interesting. After duplicate removal, 253 records were screened, and 20 full-text articles were reviewed to assess their eligibility [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. In total, 13 of them were excluded: 10 because they did not report enough US data, and 3 because of the lack of comparison indicators.…”

“…However, US does need an expert sonographer; from a technical point of view, it cannot penetrate through both bones and dense, soft tissue structures. The US application to detect early signs of TMJ synovitis in children with JIA has provided contradictory results [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. Figure 1 shows US images of TMJ.…”