Ultrasonography in the Diagnosis of Temporomandibular Disorders: A Meta-Analysis

Abstract

BackgroundThe increased prevalence of temporomandibular disorders (TMDs) requires searching for new, easily accessible diagnostic methods. In addition to routine clinical examination, various methods of imaging temporomandibular joints are available, such as magnetic resonance imaging, computed tomography scans, or scintigraphy. Ultrasound imaging, due to short examination time, low cost, and non-invasiveness, should be recommended as a routine diagnostic procedure. The aim of the study was to investigate whether ultrasound imaging can be used in the diagnosis of temporomandibular joint disorders.Material/MethodsPublications during the period 2006 to March 2017 from the US National Library of Medicine database were selected for analysis by entering the terms “ultrasonography”, “ultrasound”, “USG”, “temporomandibular joint”, “TMJ”, “temporomandibular disorders”, and “TMD”. Papers were chosen if they met the required criteria relating to the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of this diagnostic technique with regard to imaging articular disc displacement, joint effusion, and condylar abnormalities.ResultsThe search yielded 1883 publications, of which 8 were selected that met the criteria for inclusion in the analysis. For articular disc displacement examinations, the following results were obtained: sensitivity 75.6%; specificity 69.1%; accuracy 76.1%; positive predictive value 72.2%; negative predictive value 65.6%. When the examinations of joint effusion and condylar abnormalities were included, the results were respectively 66.9%; 70.8%; 69.9%; 75.8%; and 62.4%.ConclusionsThe use of ultrasonography in the diagnosis of temporomandibular disorders requires standardizing the method as well as further research to confirm its effectiveness.

Shear Wave Elastography in the Evaluation of Temporomandibular Joint Disorders

“…Moreover, no significant correlation was found between the joint space size and the stiffness of the articular disc in either the TMD patients or the controls. An assessment of the joint space size, likewise in our study, has recently been proposed as an alternative to the direct method where the medial part of the joint is obscured by skeletal components (Klatkiewicz et al 2018). According to certain authors, the size of the TMJ space correlates to the volume of the exudate (Bas et al 2011;Johnston et al 2015).…”

“…However, the fact that such a high stiffness of the intermediate part of the disk was found in only one patient with TMD included in our series, and hence both sensitivity and PPV for this parameter equaled zero (Table 2), disqualifies it from the use as a standalone diagnostic measure. Considering the lack of generally accepted standards for ultrasonographic evaluations of TMJs (Klatkiewicz et al 2018) and poor MRI availability in everyday practice, our observations could be of important clinical value. Wide clinical adoption of SWE is predictable in the coming years (Sigrist et al 2017).…”

“…of the entire articular disc based on the assessment of its part available for elastographic examination. The results of the SWE, just like the results of ultrasonographic disc evaluation, should be therefore interpreted with caution (Klatkiewicz et al 2018).…”

Validation of the effectiveness of ultrasonography as a diagnostic method for temporomandibular joint disorders and a comparison with MRI and CBCT

“…For each patient, two ultrasonographic examinations, including static and dynamic studies, were performed on both condyles. A dynamic analysis was performed with the patient continuously closing and opening the mouth to exclude disc displacement (9). The three imaging scans were interpreted by the same researchers (an orthodontist and maxillofacial surgeon experienced in TMDs).…”

Effects of rapid maxillary expansion on temporomandibular joints:

“…9 This same study used ultrasound as the method of analysis of the TMJ, which does not give sharpness and precision in the assessment of articular structures. 10 The current systematic review evaluated the impact of RME on condylar position, disc joint, joint space, and interarticular relationship in growing patients by means of CT or MRI. The studies included were those in which subjects underwent RME only.…”