Does professional background influence in temporomandibular joint tissues evaluation by magnetic resonance imaging?

Abstract

The temporomandibular joint (TMJ) poses challenges in the therapeutics and diagnosis due to its anatomical and physiological complexities. TMJ pain and dysfunction are common occurrences and may result from a variety of etiological factors, both of traumatic and nontraumatic nature, categorized as muscle dysfunctions and arthrogenic dysfunctions. The syndrome comprising the symptoms produced by these factors bears some resemblance to muscle and arthrogenic conditions and is collectively called TMJ disorder (TMD). [1,2] While clinical evaluation methods are loosely based on inspection, palpation, and performance tests, imaging examinations afford more consistent details in the investigation process and make the differential diagnosis of TMD easier. More specifically, due to its high-resolution capabilities and efficiency, with no side effects, magnetic A B S T R A C T Context: Imaging examinations afford more consistent details than clinical evaluation in the investigation process and make the differential diagnosis of temporomandibular joint (TMJ) disorders (TMDs) easier. Aims: This study aimed to check agreement among professionals from different fields of work evaluating TMDs using magnetic resonance imaging (MRI) and based on ten diagnoses criteria: Position, shape and recapture of joint disk, joint mobility, degenerative changes, bone changes, condyle position, effusion, intramedullary edema, and avascular necrosis. Methods: An oral and maxillofacial radiologist, a medical radiologist, and a dental surgeon specialized in TMD and orofacial pain interpreted 152 MRI taken from 76 patients. A scenario simulating daily activities was devised, which neither calibration nor discussion of criteria was assessed. Interobserver agreement was measured using the Kappa coefficient. Results: Poor agreement was observed in avascular necrosis; a slight agreement was recorded in form and position of the joint disk, condyle position, effusion; fair agreement in TMJ mobility and disk recapture; moderate to almost perfect agreement in condylar changes, degenerative changes, and intramedullary edema. Conclusion: Professionals from different areas that interpret TMJ disorders using MRI did not agree on the diagnoses, especially for the soft-tissue changes.