Diagnostic ultrasound assessment of temporomandibular joints: a systematic review and meta-analysis

Abstract

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.

Hand-Carried Ultrasonography Instrumentation in the Diagnosis of Temporomandibular Joint Dysfunction

“…More advanced imaging such as MRI can be used after a positive screening with ultrasound to confirm TMD diagnosis if deemed necessary [ 25 ].…”

Influence of Ultrasound Examination on Diagnosis and Treatment of Temporomandibular Disorders

“…In general, overview changes observed in this study included effusions, different stages of articular surface destruction, posterior disc ligament fibre damage, articular disc deformation and displacement. Numerous authors emphasize [ 9 , 14 , 17 , 19 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ] that ultrasound examination is extremely accurate in determining the direction of the intra-articular disc displacement or it can rule it out. Furthermore, it provides valuable information for planning for an occlusal splint and choosing supportive treatment.…”

“…The list of observed pathologies was much longer than expected. Based on the literature, the results of USG offer the possibility of differential diagnosis in cases of inflammation (e.g., in juvenile rheumatoid or idiopathic arthritis) or the presence of degenerative changes, which are an indication for a different form of rehabilitation [ 27 , 28 ].…”

Evaluating the Effect of Conservative Therapy in Patients with Wilkes Stage III Temporomandibular Joint Derangement

“…Another negative aspect is the low number of patients (31 patients), which was affected by the conditions for the inclusion of patients in the study. The third negative factor is the evaluation of disc position using ultrasound examination alone, whereas much greater accuracy is achieved with magnetic resonance imaging (Almeida et al, 2019). On the other hand, ultrasound examination is readily available (waiting time for magnetic resonance imaging of the TMJ is up to 6 weeks at the authors' workplace) and may be performed immediately, with a clear advantage from an economic perspective.…”