Ultrasound assessment of increased capsular width as a predictor of temporomandibular joint effusion

Manfredini, Daniele; Tognini, F; Melchiorre, Daniela; Zampa, Virna; Bosco, Mario

doi:10.1259/dmfr/25091144

Cited by 44 publications

(55 citation statements)

References 20 publications

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“…23 The majority of symptomatic participants (75%) had mean capsular widths spanning 0.19 cm or above. This is above the level found by Manfredini et al 18 to be a good critical level to assess effusion. However, histological and biomarker studies would be needed to fully assess the accuracy of using ultrasound to diagnose inflammation.…”

Section: Discussionmentioning

confidence: 45%

“…Ultrasound diagnosis of effusion has been favourably compared to the gold standard MRI scan, especially when the capsular width is above 1.950 mm. 18 It should be noted that it has been reported that the TMJ is one of the hardest joints in the body to scan, 19 and a standard protocol for diagnosing TMJ derangement has not been agreed upon by ultrasonographers. 20 No prior studies on correlation between TMJ effusion and patient disability have been undertaken.…”

Section: Introductionmentioning

confidence: 99%

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Temporomandibular joint effusion and its relationship with perceived disability assessed using musculoskeletal ultrasound and a patient-reported disability index

Bird

Bright

2015

Ultrasound

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The relationship between effusion of the temporomandibular joint (TMJ) and patient-reported disability is poorly researched. This pilot study explored the link between TMJ inflammation as measured by ultrasound and patient disability assessed by the Steigerwald Maher TMD Disability Index (SMTDI). The study design used a prospective correlational approach involving a sample with TMJ dysfunction (TMD). Twenty-four patients were recruited from the European School of Osteopathy and a Kent dental practice. Participants completed the SMTDI to determine the level of TMD (symptomatic score >20). A SonoSite SLA ''Hockey Stick'' [13-6 MHz] musculo-skeletal transducer was placed over the TMJ in a transverse direction and effusion was calculated indirectly by measuring capsular width. An upper left quadrant protocol was used throughout. A regression analysis was run with participants' gender, age and capsular width as predictor variables modelled against reported SMTDI. Larger capsular widths were found to be significant predictors of SMTDI scores (r ¼ 0.803, p < 0.0001). The patient profile matched with the previous studies and the TMD sufferer population, indicating external validity. Results suggest that the SMTDI could be integrated into practice life as a quick, accessible and easy tool to monitor patients' progress and assess levels of inflammation, without the need for repetitive imaging. The study design proved reproducible and a larger scale study is indicated.

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Section: Discussionmentioning

confidence: 45%

Section: Introductionmentioning

confidence: 99%

Temporomandibular joint effusion and its relationship with perceived disability assessed using musculoskeletal ultrasound and a patient-reported disability index

Bird

Bright

2015

Ultrasound

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“…20 To discriminate between internal derangement joints with and without effusion, a cut-off value of 1.65 mm was found. 21 Manfredini et al 23 proposed a capsular width cut-off value of 2 mm, assessed at the condylar level in a longitudinal scan, as an indirect marker of TMJ effusion in adults with temporomandibular dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Temporomandibular joint involvement in childhood arthritis: comparison of ultrasonography-assessed capsular width and MRI-assessed synovitis

Kirkhus

Gunderson

Smith

et al. 2016

Dentomaxillofacial Radiology

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Objectives: Ultrasonography is an effective, low-cost, low-threshold and convenient diagnostic tool in childhood arthritis, but its value in temporomandibular joint (TMJ) involvement is not clear. The purpose of our study was to explore the reliability of ultrasonography to assess TMJ inflammation using contrast-enhanced MRI as reference standard, in order to deduce cut-off values for TMJ capsular width to detect enhanced synovial thickening (synovitis). Methods: 124 ultrasonography and MRI examinations in 55 patients [mean age 12.4 ± 3.5 years (±standard deviation)], the majority obtained within 1 day, were scored for subcondylar and condylar capsular width (ultrasonography images) and amount of synovitis (MR images). The correlations of these findings were calculated. A receiver operating characteristic (ROC) curve analysis, with MRI findings as reference standard, was obtained. Results:The correlation between ultrasonography-assessed capsular width and MRIassessed amount of synovitis was moderate both at the subcondylar and condylar level [Spearman's rho (r): 0.483; p , 0.001 and 0.347; p , 0.001 respectively]. The ROC curve indicated the best discriminatory ability at the subcondylar level with an area under the curve of 0.77 (95% confidence interval 0.69-0.85) and a cut-off value of 1.2 mm (sensitivity 72%, specificity 70%) for the capsular width. Conclusions: A moderate correlation between ultrasonography-assessed capsular width and MRI-assessed synovitis was found in childhood arthritis with the best discriminatory ability at the subcondylar level. This indicates that ultrasonography may be a valuable diagnostic tool in the initial assessment of TMJ inflammation.

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“…The differentiation between the articular disc and capsule was undertaken in accordance with the criteria of Emshoff et al, 13 who reported that the two hyperechoic lines in TMJ sonograms are related to the condylar head and articular eminence cortices and the hypoechoic area between them is produced by the articular disc. In contrast, Manferedini et al 14 suggested that these hyperechoic lines are the articular capsule and the lateral condylar wall. The study described here was double-blind.…”

Section: Methodsmentioning

confidence: 94%

“…5,6 Some authors have recently reported the application of high-resolution ultrasonography (HR-US) to the examination of the TMJ and other joints of the body. [7][8][9][10][11][12][13][14][15] Ultrasonography is a noninvasive, low-cost imaging technique that is readily accessible and easy to perform. The use of harmless ultrasound waves instead of ionizing radiation also means that ultrasonography is more accepted by patients.…”

Section: Introductionmentioning

confidence: 99%

Clinical evaluation of internal joint derangement using sonography

et al. 2008

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Objectives. Currently, the most precise method for imaging the soft tissue of the temporomandibular joint (TMJ) is magnetic resonance imaging (MRI), but this technique is often unavailable because of its high cost or is otherwise unsuitable. In the absence of complete information about the TMJ disc, treatment decisions are based only on the results of clinical exams and conventional radiography of TMJ hard tissues. This study was performed to evaluate the accuracy of high-resolution ultrasonography (HR-US) in the detection of TMJ disc displacement. Methods. MRI and sonography were performed on 16 TMJs in ten patients who were diagnosed with anterior disc displacement (ADD), and the fi ndings of the sonography and MRI examinations were compared. Results. All cases of ADD diagnosed by sonography were confi rmed by MRI. Conclusion. HR-US is a reliable technique for imaging the TMJ disc that can be used for TMJ diagnosis and treatment planning.

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Ultrasound assessment of increased capsular width as a predictor of temporomandibular joint effusion

Abstract: Analysis of ROC curve appears to reveal that the critical area is around the 2 mm value for TMJ capsular width. These findings need to be refined by further studies assessing the smallest detectable difference in capsular width, with attention to reliability of interobserver observations.

Cited by 44 publications

References 20 publications

Temporomandibular joint effusion and its relationship with perceived disability assessed using musculoskeletal ultrasound and a patient-reported disability index

Temporomandibular joint effusion and its relationship with perceived disability assessed using musculoskeletal ultrasound and a patient-reported disability index

Temporomandibular joint involvement in childhood arthritis: comparison of ultrasonography-assessed capsular width and MRI-assessed synovitis

Clinical evaluation of internal joint derangement using sonography

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