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

Abstract

Internal derangement (ID) in the temporomandibular joint (TMJ) is defined as a mechanical problem of the joint that interferes with its function. It is attributed to an abnormal interaction among the articular disc, condyle, and joint eminence. The aim of this study is to evaluate diagnostic efficacy of non-invasive hand-carried ultrasonography instrumentation (US) to provide high-level images for a correct diagnosis of ID. Twenty-eight ID patients, 15 female and 13 males, were examined both clinically and by MRI images in order to achieve a diagnosis of ID (using Helkimo index). Then, they were submitted to US examination with a 12 MHz transducer by using hand-carried instrumentation by a clinician that was blind to their diagnosis and clinical data. TMJ US examination was performed with the mouth closed and mouth open, with proper technique. Each position was then evaluated with two different orientations of the transducer. US showed acceptable results in identifying bone structures. Lower values of diagnostic efficacy were obtained for disc position during joint movements with respect to MRI images. MRI still represents the gold standard for the identification of joint structures. If not corroborated by clinical and anamnestic data, the diagnostic efficacy of US in identifying the position of the disc during opening and closing jaw movements appears limited than compared to MRI.

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

“…Similar results were found in other studies ( 77 ), and in particular, following progressive employment of transducer with higher frequency, of 10 MHz or more, allow a better sensitivity, ranging from 60% to 90% ( 30 , 40 , 42 , 45 ). Specifically, a recent review ( 28 ) found that high-resolution US (HR-US), defined as a US resolution of 12 MHz or more, improves sensitivity and specificity in the detection of TMJ involvement as compared to low-resolution US (LR-US), defined as a US resolution of <12 MHz ( 28 , 31 ).…”

Comparison between ultrasound and magnetic resonance imaging of the temporomandibular joint in juvenile idiopathic arthritis: A systematic review

“…The disc position was not checked in any of the included studies probably because previous outcomes on patients with TMD were confusing. Only a few authors observed some abnormalities in the disc‐condyle relationship through US, 43,51–55 however, it is overall accepted that US is not useful neither accurate to diagnose TMJ disc displacements 36,43,56–60 when a discrimination between displacement with or without reduction is needed 43,54 …”

“…36,46 The disc position was not checked in any of the included studies probably because previous outcomes on patients with TMD were confusing. Only a few authors observed some abnormalities in the disc-condyle relationship through US, 43,[51][52][53][54][55] however, it is overall accepted that US is not useful neither accurate to diagnose TMJ disc displacements 36,43,[56][57][58][59][60] when a discrimination between displacement with or without reduction is needed. 43,54 About the detection of intraarticular effusion in the TMJ area, Manfredini et al 54 stated that US remains potentially useful as an alternative imaging technique with a good accuracy, 48 even though the challenging analysis of TMJ capsular width is in only 2 mm.…”

Retromolar canal: Frequency in a Polish population based on CBCT and clinical implications – a preliminary study

“…Magnetic resonance imaging is the gold standard for diagnosis and treatment planning in the disorders of articular disk. 22,23 With the use of MRI, examinations are performed with closed and opened mouth, and mostly static images are taken with an uncomfortable and expensive instrument. Ultrasound (US) examinations overcome these limitations.…”