Clinical Predictability of Temporomandibular Joint Disc Displacement

Abstract

Single items from a typical clinical examination have proved disappointing in their predictive value for temporomandibular joint (TMJ) disc displacement. Only one criterion (the 12 o'clock) is used to diagnose normal disc position. According to this criterion, the posterior band of the disc should be located at the top of the condyle, at the 12 o'clock position. The purpose of this study was to determine which signs and symptoms provide a valid prediction of the condition of the joint based on 4 magnetic resonance imaging (MRI) criteria used to define normal disc position. Sagittal MRI and clinical findings of 137 temporomandibular disorder patients and 23 normal asymptomatic volunteers were used. Three calibrated and blinded observers interpreted the images. Disc position with the mouth closed was evaluated based on 4 MRI criteria: 12, 11, 10 o'clock, and the intermediate zone. Disc position with the mouth open was determined based on one criterion. It was considered normal if the intermediate zone of the disc was located between the condyle and the articular eminence. Joints were classified as normal or as having disc displacement with or without reduction. The sensitivity and specificity of multiple clinical parameters for predicting the condition of the joint established by each of these 4 gold-standard MRI criteria were then determined. Regarding disc displacement with reduction, significant differences were observed in the sensitivity and specificity of all of the clinical parameters used to predict the imaging diagnosis established by each of the criteria. Concerning disc displacement without reduction, no significant differences were observed. The intermediate zone criterion was the criterion that most accurately reflected the condition of the joint. The clinical predictability of the disorder diagnosed according to this criterion suggests that clinical findings alone are too often nonspecific as predictors of the imaging stage of disc displacement. However, we found that combining the most sensitive clinical items to predict the disorder and using an overall criterion for positivity to interpret the results led to an impressive increase in the specificity of the combination, enabling false-positive diagnoses to be excluded.

Diagnostic Accuracy of Clinical Tests and Signs of Temporomandibular Joint Disorders: A Systematic Review of the Literature

“…17,23,31,33 Orsini et al 23 further studied the diagnostic accuracy of a lack of joint sound associated with DDNR and the elimination of a click in a jaw with DDR placed in an anterior position. 23 Reciprocal clicking in the diagnoses of DDR and DDNR was discussed by 1 study.…”

“…17,23,31,33 Orsini et al 23 further studied the diagnostic accuracy of a lack of joint sound associated with DDNR and the elimination of a click in a jaw with DDR placed in an anterior position. 23 Reciprocal clicking in the diagnoses of DDR and DDNR was discussed by 1 study. 31 Two of the articles addressing joint click were of lower quality, 31,33 again, because of the unclear description of the execution of the index test (sign) and the reference standard to allow reproduction.…”

“…These articles also blinded the interpreters of the index test and the reference standard, eliminating a potential for bias. 17,18,23 When summarized, the sensitivity and specificity values ranged from 2% to 89% and 14% to 97%, respectively. The LR+ ranged from a low of 0.08 to a high of 15.2.…”

Magnetic Resonance Signal Intensity from Retrodiscal Tissue Related to Joint Effusion Status and Disc Displacement in Elderly Patients with Temporomandibular Joint Disorders

“…Abnormality in shape and displacement of the articular disc were evaluated by PDW images and classified into 4 categories as follows: normal superior disc position with normal function, disc displacement with reduction, disc displacement without reduction, or disc displacement without reduction associated with osteoarthritis 15) , that is to say, there were one normal-function group and 3 abnormalfunction groups.…”

“…Decreased signal intensities from retrodiscal tissue on T1 images were associated with the later stages of disc displacement 27) . Increased signal intensities from retrodiscal tissue on T2-weighted (T2W) images were reportedly higher in painful joints 15) . However, there have been no studies on the relationships among an increase and/or decrease in signal intensities in retrodiscal tissue, joint fluid status and pathological disc condition as a phenomenon of aging.…”