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Xiang W, Wang M, Cai M, Li Z, Hou B, Pan X. Correlation between craniocervical posture and upper airway dimension in patients with bilateral anterior disc displacement. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101785. [PMID: 38316212 DOI: 10.1016/j.jormas.2024.101785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE To investigate the relationship between upper airway dimension and craniocervical posture in adult patients with bilateral anterior disc displacement and to provide some references for clinical diagnosis and plan formulation in orthodontics. METHODS Based on RDC/TMD (Research Diagnostic Criteria for Temporomandibular Disorder), 98 Patients were divided into three groups by two experienced TMJ (Temporomandibular Joint) specialists: bilateral disc normal position group (BN), bilateral anterior disc displacement with reduction group (ADDWR) and bilateral anterior disc displacement without reduction group (ADDWoR). Inter-group comparison and correlation analysis were performed after 11 craniocervical posture and 15 upper airway dimension measurements finished with Dolphin and Uceph software in Two or Three-dimensional. RESULTS Anterior disc displacement often accompanied with extension of craniocervical posture, as ADDWR and ADDWoR groups have significantly higher cervical curvature and inclination than BN group (P < 0.05). Simultaneously anterior disc displacement often associated with constrained upper airway dimension for the total and each segment upper airway volume were significantly smaller in ADDWR and ADDWoR than BN group (P < 0.05). Correlation analysis revealed that C0-C1 (the distance from the base of the occipital bone (C0) to the posterior arch of the atlas (C1)) is significantly related to the total and each segment upper airway volume reduction (P < 0.05). CONCLUSION There exists markedly close correlation between anterior disc displacement and craniocervical posture forward extension, which may be physiologically adaptive cervical extension to keep oropharyngeal airway unobstructed as upper airway dimension constrained by anterior disc displacement. CLINICAL RELEVANCE These findings allow us to infer the potential consequences if the treatment of anterior disc displacement would result in an improvement of intervertebral relationships and upper airway constraint.
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Affiliation(s)
- Wanfang Xiang
- School of Stomatology, Lanzhou University, Lanzhou 730000, PR China
| | - Min Wang
- School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, PR China
| | - Mingqin Cai
- School of Stomatology, Lanzhou University, Lanzhou 730000, PR China
| | - Zhihui Li
- School of Stomatology, Lanzhou University, Lanzhou 730000, PR China
| | - Binjie Hou
- School of Stomatology, Lanzhou University, Lanzhou 730000, PR China
| | - Xiaojing Pan
- School of Stomatology, Lanzhou University, Lanzhou 730000, PR China.
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Xiang W, Wang M, Li Z, Cai M, Pan X. Correlation between temporomandibular joints and craniocervical posture in patients with bilateral anterial disc displacement. BMC Oral Health 2024; 24:159. [PMID: 38297238 PMCID: PMC10832266 DOI: 10.1186/s12903-024-03892-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 01/12/2024] [Indexed: 02/02/2024] Open
Abstract
OBJECTIVE To study the changes of temporomandibular joints and craniocervical posture in adult patients with bilateral anterior disc displacement, and to explore their correlation, which may provide some clinical value for clinical diagnosis and treatment planning. METHODS Ninety-eight adult patients were divided into 3 groups: 29 patients in bilateral disc normal position group (BN), 33 patients in bilateral Anterior Disc Displacement With Reduction group (ADDWR) and 36 patients in bilateral Anterior Disc Displacement Without Reduction group (ADDWoR). Dolphin and Uceph software were used to measure 14 items of temporomandibular joint and 11 items of craniocervical posture for comparison and correlation analysis between groups. RESULTS There were significant differences in bilateral joint space between three groups. Compared with the BN, the anteroposterior diameter of the condyle was significantly reduced, the condyle was significantly displaced posteriorly and superiorly in the ADDWR and ADDWoR, but the joint fossa width and joint fossa depth did not change significantly. Cervical curvature and inclination were greater in patients with anterior disc displacement than BN, indicating that the craniocervical posture of adult patients with anterior disc displacement was extended and protrusive. CONCLUSION Anterior disc displacement of the temporomandibular joint can displace the condyle upwards and posteriorly and reduce the anteroposterior diameter of condyle, and then make the condyle closer to the wall of articular fossa to induce joint symptoms. Additionally, craniocervical postural position is significantly affected, which may be related to compensate for the effects of airway space.
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Affiliation(s)
- Wanfang Xiang
- School/Hospital of Stomatology, Lanzhou University, Tianshui South Road, Chengguan District, Lanzhou, Gansu Province, 730000, People's Republic of China
| | - Min Wang
- School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, People's Republic of China
| | - Zhihui Li
- School/Hospital of Stomatology, Lanzhou University, Tianshui South Road, Chengguan District, Lanzhou, Gansu Province, 730000, People's Republic of China
| | - Mingqin Cai
- School/Hospital of Stomatology, Lanzhou University, Tianshui South Road, Chengguan District, Lanzhou, Gansu Province, 730000, People's Republic of China
| | - Xiaojing Pan
- School/Hospital of Stomatology, Lanzhou University, Tianshui South Road, Chengguan District, Lanzhou, Gansu Province, 730000, People's Republic of China.
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Signs and Symptoms of Temporomandibular Dysfunction and Radiographic Condylar Morphology in Patients with Idiopathic Condylar Resorption. J Clin Med 2022; 11:jcm11154289. [PMID: 35893380 PMCID: PMC9331313 DOI: 10.3390/jcm11154289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/14/2022] [Accepted: 07/19/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Little is known about the clinical characteristics of idiopathic condylar resorption (ICR). The aim of this study was to examine the signs and symptoms of temporomandibular dysfunction (TMD) and evaluate the morphological characteristics of the condyles in patients with ICR. Methods: Sixty patients with ICR (41 in the bilateral ICR group and 19 in the unilateral ICR group) and forty-one healthy controls were examined. Signs and symptoms of TMD were described, and three-dimensional models of the condyles were measured and analyzed. Results: In total, 81.7% of ICR patients had self-reported symptoms and 78.3% of ICR patients had objective-found signs. The anteroposterior diameter, transverse diameter, height, maximal sectional area, volume of the condyles, axial angle, and the distance from the posterior point of the condyle to the Saggittal standard line were significantly smaller in the ICR condyles compared with the controls (p < 0.05). The condylar neck angle was significantly larger in the ICR condyles compared with the controls (p < 0.05). Conclusions: Most patients with ICR had signs and symptoms of TMD. The prevalence of clicking and opening−closing deviation was significantly different between the bilateral and the unilateral ICR groups. In patients with ICR, the size of the condyles decreased significantly; the condyles also rotated inward, moved forward, and inclined posteriorly.
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Jo JH, Bae S, Gil J, Oh D, Park S, Cheon GJ, Park JW. Limited implication of initial bone scintigraphy on long-term condylar bone change in temporomandibular disorders-Comparison with cone beam computed tomography at 1 year. J Oral Rehabil 2021; 48:880-890. [PMID: 34032306 DOI: 10.1111/joor.13209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/23/2021] [Accepted: 05/18/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The current diagnostic criteria for temporomandibular disorders (TMD) do not require imaging for the diagnosis of degenerative joint disease (DJD) of the temporomandibular joint (TMJ) condyle, and there is a lack of data investigating the effectiveness of imaging modalities in predicting long-term TMJ DJD prognosis. OBJECTIVES To verify the association between initial bone scintigraphy results and long-term DJD bone changes occurring in the TMJ condyle on cone beam computed tomography (CBCT). METHODS Initial bone scintigraphy, panoramic radiography and CBCT results were analysed in relation to long-term (12 months) TMJ DJD bone change on CBCTs in 55 TMD patients (110 joints). Clinical and radiographic indices were statistically analysed among three groups (improved, no change, and worsened) based on long-term TMJ DJD prognosis calculated by destructive change index (DCI). RESULTS Neither the uptake ratio nor visual assessment results from initial bone scintigraphy showed a significant difference according to long-term condylar bone change groups. The cut-off value of bone scintigraphy uptake ratio was 2.53 for long-term worsening of TMJ DJD. Worsening of TMJ DJD was significantly associated with the diagnosis based on panoramic radiography (p = .011) and CBCT (p < .001). Initial DCI (β = -.291, p = .046) had a significant association with long-term worsening of TMJ DJD. CONCLUSION Initial bone scintigraphy results did not show sufficiently close associations with long-term TMJ DJD prognosis. This should be considered in the selection process of imaging modalities for TMJ DJD patients. Future studies are needed to develop prognostic indices that comprise both clinical and imaging contents for improved predictive ability.
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Affiliation(s)
- Jung Hwan Jo
- Department of Oral Medicine, Seoul National University Dental Hospital, Seoul, Korea
| | - Sungwoo Bae
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Joonhyung Gil
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dongkyu Oh
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seoeun Park
- Department of Oral Medicine, Seoul National University Dental Hospital, Seoul, Korea.,Department of Oral Medicine and Oral Diagnosis, School of Dentistry, Seoul National University, Seoul, Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Ji Woon Park
- Department of Oral Medicine, Seoul National University Dental Hospital, Seoul, Korea.,Department of Oral Medicine and Oral Diagnosis, School of Dentistry, Seoul National University, Seoul, Korea.,Dental Research Institute, Seoul National University, Seoul, Korea
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Hilgenberg-Sydney PB, Schenato LF, Marques HB, de Paiva Bertoli FM, Bonotto D. Interexaminer reliability for tomographic findings in temporomandibular joint degenerative disease and its agreement with clinical diagnosis: a blinded controlled cross sectional study. Oral Radiol 2021; 38:155-161. [PMID: 34028658 DOI: 10.1007/s11282-021-00539-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the interexaminer reliability for tomographic findings in degenerative temporomandibular joint disease and its agreement with clinical diagnosis. METHODS Women aged 18 and 60 years were invited to participate in this research. All participants were evaluated by a single experienced examiner according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Group 1 was comprised of TMJs with Degenerative Joint Disease (DJD). Group 2 was comprised of healthy TMJs, without any signs and/or symptoms of TMD. All CBCT images were evaluated by 2 calibrated examiners for the image evaluation criteria but blinded for the clinical diagnosis. RESULTS From the 194 women evaluated, 41 were included, with a mean age of 35.23 (± 14.06) years. Group 1 was comprised of 26 TMJs with DJD and group 2 of 36 asymptomatic TMJs. The interexaminer reliability was κ = 0.706 (p < 0.000), while agreement between clinical and tomographic findings were κ = 0.301 (p = 0.01) and κ = 0.273 (p = 0.02) for each examiner. The use of CBCT as a diagnostic test had shown sensitivity and specificity values of 61.5% and 75%, respectively. CONCLUSIONS The interexaminer reliability for tomographic findings was strong. However, the agreement between clinical and tomographic findings was reasonable, for both examiners.
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Affiliation(s)
- Priscila Brenner Hilgenberg-Sydney
- Restorative Dentistry Department, Federal University of Paraná, Av. Prefeito Lothário MeissnerJardim Botânico, Curitiba (Paraná), 632 - 80210-170, Brazil.
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L K SK, Zachariah GP, Chandran S. Ultrasonography: A step forward in temporomandibular joint imaging. A preliminary descriptive study. Clin Pract 2019; 9:1134. [PMID: 31341577 PMCID: PMC6610715 DOI: 10.4081/cp.2019.1134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/21/2019] [Indexed: 11/23/2022] Open
Abstract
Ultrasonography (USG) is a cost-effective and noninvasive imaging modality commonly employed for imaging the abdominal region and extremities. Currently, with the availability of higher frequency probes and higher resolution devices, USG imaging of the temporomandibular joint (TMJ) looks promising. The aim is to evaluate and demonstrate the role of USG as an imaging modality of TMJ by visualizing the static and dynamic relationship of the joint, assessment of joint space and eliciting reproducibility at both open and closed mouth positions. 30 volunteers were selected based on the inclusion criteria in line with the research diagnostic criteria/temporomandibular disorders guidelines. High-resolution USG (≥12 MHz) of the right TMJ (chosen for uniformity) was done in the left decubitus position on (n=30) volunteers. The joint disc movement was directly visualized during opening and closing motions. The vertical joint space was assessed using the firmware and accurate reproducibility was checked. At the closed mouth position, the measured values ranged from 0.2 mm to 0.7 mm with a median of 0.05 cm and a mean of 0.4±0.15 mm. At the position of maximal mouth opening, the measured values ranged from 0.9 mm to 1.5 mm with a median of 1.1 mm and a mean of 1.1±0.17 mm. USG enables visualization of the dynamic relationship between joint structures, with particular importance to the condyle and disc position. The articular disc appears on the USG as a thin layer of hyperechogenicity surrounded by a hypoechoic halo, located between 2 hyperechoic lines viz, the condyle and the articular eminence We recommend ultrasonographic imaging as a noninvasive diagnostic technique with relatively high specificity for patients with temporomandibular disorders.
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Affiliation(s)
- Surej Kumar L K
- Department of Oral and Maxillofacial Surgery, PMS College of Dental Science and Research, Thiruvananthapuram, India
| | - Georgie P Zachariah
- Department of Oral and Maxillofacial Surgery, PMS College of Dental Science and Research, Thiruvananthapuram, India
| | - Sumesh Chandran
- Department of Oral and Maxillofacial Surgery, PMS College of Dental Science and Research, Thiruvananthapuram, India
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Almeida FT, Pacheco-Pereira C, Flores-Mir C, Le LH, Jaremko JL, Major PW. Diagnostic ultrasound assessment of temporomandibular joints: a systematic review and meta-analysis. Dentomaxillofac Radiol 2018; 48:20180144. [PMID: 30285469 DOI: 10.1259/dmfr.20180144] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES: The purpose of this systematic review was to determine the diagnostic capability of ultrasound to assess TMJ alterations as disc displacement (DD), joint effusion (JE) and condylar changes (CC) using 3D imaging modalities as reference standard. METHODS: Studies were gathered by searching several electronic databases and partial grey literature up to January eighth, 2018 without restrictions of language and time. The risk of bias was evaluated using the second version of Quality Assessment Tool for Diagnostic of Accuracy Studies-2 (QUADAS-2). The grading of Recommendation, Assessment, Development and Evaluation (GRADEpro system) instrument was applied to assess the level of evidence across the studies. RESULTS: After applying the eligibility criteria, 28 studies were identified and synthesized. All studies were methodologically acceptable presenting low applicability concerns, although none of them fulfilled all QUADAS-2 criteria. The quantitative analysis included 22 studies, 2829 joints in total. The quality of the evidence evaluated by GRADE system suggested moderate confidence in estimating the outcomes. CONCLUSION: This systematic review demonstrated the ultrasound has acceptable capability to screen for DD and JE in TMD patients. For screening of condylar changes, ultrasound needs further studies using CT or CBCT as reference standard to support its use. More advanced imaging such as MRI can thereafter be used to confirm the diagnosis if deemed necessary.
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Affiliation(s)
| | | | - Carlos Flores-Mir
- 1 School of Dentistry, University of Alberta , Edmonton, AB , Canada
| | - Lawrence H Le
- 2 Radiology and Diagnostic Imaging, University of Alberta , Edmonton, AB , Canada
| | - Jacob L Jaremko
- 2 Radiology and Diagnostic Imaging, University of Alberta , Edmonton, AB , Canada
| | - Paul W Major
- 1 School of Dentistry, University of Alberta , Edmonton, AB , Canada
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Junhasavasdikul T, Abadeh A, Tolend M, Doria AS. Developing a reference MRI database for temporomandibular joints in healthy children and adolescents. Pediatr Radiol 2018; 48:1113-1122. [PMID: 29789889 DOI: 10.1007/s00247-018-4142-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/16/2018] [Accepted: 04/16/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Recognition of normal temporomandibular joints (TMJs) is essential to assess arthropathic changes. Few, if any, prior studies have evaluated the morphological appearance of growing TMJs by magnetic resonance (MR) examinations in the pediatric population. OBJECTIVE This study aimed to determine normative osseous appearance of growing TMJs according to age and gender, both qualitatively and quantitatively, concerning structural and bone marrow changes. MATERIALS AND METHODS From 1,036 MR scans screened, one joint was included from each of 157 patients (76% female; 2-18 years) presenting with at least one normal-appearing TMJ was included. Quantitatively, mandibular condyle was characterized by measuring the following: (i) head-neck angle, (ii) anteversion angle, (iii) condylar dimensions (mediolateral, craniocaudal and anteroposterior [AP]) and (iv) condylar volume. Furthermore, qualitative categorization of condylar shape, into one of three types, and condylar bone marrow type was performed. RESULTS The head-neck angle significantly correlated with age (bivariable regression β =0.60, P<0.001), indicating an increase of 1.6 degrees per year. Except for AP diameter of condyles, all other mandibular dimensions and condylar volume increased with age (β =0.20-0.59, P≤0.001-0.004). Significant age difference was observed among the different condylar shapes (P<0.001), indicating a change from rounded head without anterior tilt to rectangular head with anterior tilt. Lastly, mandibular condylar size, measured by volume and by AP and mediolateral dimensions, appeared larger in males. CONCLUSION The morphology of the mandibular condyles changes with age. During development, the shape of the condyles changes from round to rectangular in contour with the development of the anterior condylar tilt, as measured by the head-neck angle.
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Affiliation(s)
- Thitiporn Junhasavasdikul
- Department of Medical Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave., 2nd floor, Toronto, ON, M5G1X8, Canada.,Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Aryan Abadeh
- Department of Medical Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave., 2nd floor, Toronto, ON, M5G1X8, Canada
| | - Mirkamal Tolend
- Department of Medical Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave., 2nd floor, Toronto, ON, M5G1X8, Canada
| | - Andrea S Doria
- Department of Medical Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave., 2nd floor, Toronto, ON, M5G1X8, Canada. .,Research Institute, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada.
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Talmaceanu D, Lenghel LM, Bolog N, Hedesiu M, Buduru S, Rotar H, Baciut M, Baciut G. Imaging modalities for temporomandibular joint disorders: an update. ACTA ACUST UNITED AC 2018; 91:280-287. [PMID: 30093805 PMCID: PMC6082607 DOI: 10.15386/cjmed-970] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 02/05/2018] [Accepted: 02/13/2018] [Indexed: 12/20/2022]
Abstract
The diagnosis and management of temporomandibular disorders (TMD) require both clinical and imaging examinations of the temporomandibular joint (TMJ). A variety of modalities can be used to image the TMJ, including magnetic resonance imaging (MRI), computed tomography (CT), cone beam CT, ultrasonography, conventional radiography. The present review outlines the indications of the most frequently used imaging techniques in TMD diagnosis. Because of the anatomic complexity of the TMJ, imaging can be difficult. Choosing the proper imaging technique is essential. Conventional radiography, nowadays, is of limited interest. The use of flat plane films for TMJ pathology is not sufficient, because this joint requires three dimensional imaging views. Osseous changes are better visualized with CT and cone beam CT. Cone beam CT provides high-resolution multiplanar reconstruction of the TMJ, with a low radiation dose, without superimposition of the bony structures. MRI is a noninvasive technique, considered to be the gold standard in imaging the soft tissue components of the TMJ. MRI is used to evaluate the articular disc in terms of location and morphology. Moreover, the early signs of TMD and the presence of joint effusion can be determined. High-resolution ultrasonography is a noninvasive, dynamic, inexpensive imaging technique, which can be useful in diagnosing TMJ disc displacements. The diagnostic value of high-resolution ultrasonography is strictly dependent on the examiner's skills and on the equipment used.
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Affiliation(s)
- Daniel Talmaceanu
- Department of Cranio-Maxillofacial Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Lavinia Manuela Lenghel
- Department of Radiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Mihaela Hedesiu
- Department of Radiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Smaranda Buduru
- Department of Prosthodontics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Horatiu Rotar
- Department of Cranio-Maxillofacial Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihaela Baciut
- Department of Cranio-Maxillofacial Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Grigore Baciut
- Department of Cranio-Maxillofacial Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Coombs MC, Bonthius DJ, Nie X, Lecholop MK, Steed MB, Yao H. Effect of Measurement Technique on TMJ Mandibular Condyle and Articular Disc Morphometry: CBCT, MRI, and Physical Measurements. J Oral Maxillofac Surg 2018; 77:42-53. [PMID: 30076808 DOI: 10.1016/j.joms.2018.06.175] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/28/2018] [Accepted: 06/26/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Accurate description of the temporomandibular size and shape (morphometry) is critical for clinical diagnosis and surgical planning and the design and development of regenerative scaffolds and prosthetic devices and to model the temporomandibular loading environment. The study objective was to determine the 3-dimensional morphometry of the temporomandibular joint (TMJ) condyle and articular disc using cone-beam computed tomography (CBCT), magnetic resonance imaging (MRI), and physical measurements of the same joints using a repeated measures design and to determine the effect of the measurement technique on temporomandibular size and shape. MATERIALS AND METHODS Human cadaveric heads underwent a multistep protocol to acquire physiologically meaningful measurements of the condyle and disc. The heads first underwent CBCT scanning, and solid models were automatically generated. The superficial soft tissues were dissected, and intact TMJs were excised and underwent MRI scanning, with solid models generated after manual segmentation. After MRI, the intact joints were dissected, and physical measurements of the condyle and articular disc were performed. The CBCT-based model measurements, MRI-based model measurements, and physical measurements were standardized, and a repeated measures study design was used to determine the effect of the measurement technique on the morphometric parameters. RESULTS Multivariate general linear mixed effects models showed significant effects for measurement technique for condylar morphometric outcomes (P < .001) and articular disc morphometric outcomes (P < .001). The physical measurements after dissection were larger than either the CBCT-based or MRI-based measurements. Differences in imaging-based morphometric parameters followed a complex relationship between imaging modality resolution and contrast between tissue types. CONCLUSIONS Physical measurements after dissection are still considered the reference standard. However, owing to their inaccessibility in vivo, understanding how the imaging technique affects the temporomandibular size and shape is critical toward the development of high-fidelity solid models to be used in the design and development of regenerative scaffolds, surgical planning, prosthetic devices, and anatomic investigations.
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Affiliation(s)
- Matthew C Coombs
- Postdoctoral Fellow, Department of Bioengineering, Clemson University, Clemson, SC; and Department of Oral Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Daniel J Bonthius
- MD/PhD Student, Department of Bioengineering, Clemson University, Clemson, SC
| | - Xingju Nie
- Research Associate, Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC
| | - Michael K Lecholop
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Medical University of South Carolina, Charleston, SC
| | - Martin B Steed
- Professor and Department Head, Department of Oral and Maxillofacial Surgery, Medical University of South Carolina, Charleston, SC
| | - Hai Yao
- Professor, Department of Bioengineering, Clemson University, Clemson, SC; and Department of Oral Health Sciences, Medical University of South Carolina, Charleston, SC.
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Diagnostic value of ultrasonography for the detection of disc displacements in the temporomandibular joint: a systematic review and meta-analysis. Clin Oral Investig 2018; 22:2599-2614. [PMID: 29455373 PMCID: PMC6097040 DOI: 10.1007/s00784-018-2359-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 01/23/2018] [Indexed: 02/07/2023]
Abstract
Objectives The aim was to assess the added diagnostic value of ultrasonography (US) for establishing the presence or absence of disc displacements (DDs) in temporomandibular joints (TMJs). Materials and methods Pubmed and EMBASE were searched electronically to identify diagnostic accuracy studies that assessed the diagnostic value of US for the diagnosis of DD, using Magnetic resonance imaging (MRI) as the reference standard. Meta-analyses were performed with Metadisc 1.4 and RevMan 5.3. Results A total of 16 studies qualified for meta-analyses. For the diagnosis of DD at closed mouth position (DD-CM) and DD at maximum mouth-opening position (DD-MMO), the added values of a positive result with US for ruling in DD-CM and DD-MMO were 22 and 41%, while those of a negative result with US for ruling out DD-CM and DD-MMO were 30 and 20%. For the diagnosis of DD with reduction (DDWR) and DD without reduction (DDWoR), the added values of a positive result in US for ruling in DDWR and DDWoR were 35 and 41%, while those of a negative result in US for ruling out DDWR and DDWoR were 21 and 27%. Conclusions Using MRI as reference standard, the added values of both positive predictive values and negative predictive values of US for ruling in and ruling out DDs are sufficient in the decision-making in dental practice. Clinical relevance US can be a good imaging tool to supplement clinical examination findings in patients with suspected DDs. Combined static and dynamic examinations using high-resolution US should be preferred.
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Rodrigues-Bigaton D, de Castro EM, Pires PF. Factor and Rasch analysis of the Fonseca anamnestic index for the diagnosis of myogenous temporomandibular disorder. Braz J Phys Ther 2017; 21:120-126. [PMID: 28460710 PMCID: PMC5537471 DOI: 10.1016/j.bjpt.2017.03.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/13/2016] [Accepted: 06/02/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Rasch analysis has been used in recent studies to test the psychometric properties of a questionnaire. The conditions for use of the Rasch model are one-dimensionality (assessed via prior factor analysis) and local independence (the probability of getting a particular item right or wrong should not be conditioned upon success or failure in another). OBJECTIVE To evaluate the dimensionality and the psychometric properties of the Fonseca anamnestic index (FAI), such as the fit of the data to the model, the degree of difficulty of the items, and the ability to respond in patients with myogenous temporomandibular disorder (TMD). METHODS The sample consisted of 94 women with myogenous TMD, diagnosed by the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), who answered the FAI. For the factor analysis, we applied the Kaiser-Meyer-Olkin test, Bartlett's sphericity, Spearman's correlation, and the determinant of the correlation matrix. For extraction of the factors/dimensions, an eigenvalue >1.0 was used, followed by oblique oblimin rotation. The Rasch analysis was conducted on the dimension that showed the highest proportion of variance explained. RESULTS Adequate sample "n" and FAI multidimensionality were observed. Dimension 1 (primary) consisted of items 1, 2, 3, 6, and 7. All items of dimension 1 showed adequate fit to the model, being observed according to the degree of difficulty (from most difficult to easiest), respectively, items 2, 1, 3, 6, and 7. CONCLUSION The FAI presented multidimensionality with its main dimension consisting of five reliable items with adequate fit to the composition of its structure.
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Affiliation(s)
- Delaine Rodrigues-Bigaton
- Programa de Pós-graduação em Ciências do Movimento Humano, Universidade Metodista de Piracicaba (UNIMEP), Piracicaba, SP, Brazil
| | - Ester M de Castro
- Programa de Pós-graduação em Ciências do Movimento Humano, Universidade Metodista de Piracicaba (UNIMEP), Piracicaba, SP, Brazil
| | - Paulo F Pires
- Programa de Pós-graduação em Ciências do Movimento Humano, Universidade Metodista de Piracicaba (UNIMEP), Piracicaba, SP, Brazil.
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Comparative cone-beam computed tomography evaluation of the osseous morphology of the temporomandibular joint in temporomandibular dysfunction patients and asymptomatic individuals. Oral Radiol 2017; 34:31-39. [DOI: 10.1007/s11282-017-0279-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 02/21/2017] [Indexed: 11/25/2022]
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14
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Dong XY, He S, Zhu L, Dong TY, Pan SS, Tang LJ, Zhu ZF. The diagnostic value of high-resolution ultrasonography for the detection of anterior disc displacement of the temporomandibular joint: a meta-analysis employing the HSROC statistical model. Int J Oral Maxillofac Surg 2015; 44:852-8. [PMID: 25702588 DOI: 10.1016/j.ijom.2015.01.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 10/29/2014] [Accepted: 01/16/2015] [Indexed: 12/16/2022]
Abstract
The study aimed to assess the diagnostic value of high-resolution ultrasonography (HR-US) in the detection of anterior disc displacement (ADD) of the temporomandibular joint. Relevant trials reported in MEDLINE, the Chinese National Knowledge Infrastructure Database, the Chinese Biomedical Literature Database, and Embase were identified. A manual search was also performed. The quality of retrieved data was evaluated using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria. Data were extracted and cross-checked, and a statistically rigorous meta-analysis was performed using a hierarchical summary receiver operating characteristic model (HSROC). The clinical utility of results was assessed using Fagan nomograms (Bayes theory). All data were evaluated using Stata software. A total 11 studies including 1096 subjects were included in the analysis; all reported the utility of HR-US for the diagnosis of ADD with reduction (ADDWR) and without reduction (ADDWoR). For ADDWR, the weighted sensitivity and specificity were 0.83 (95% confidence interval (CI) 0.78-0.88) and 0.85 (95% CI 0.76-0.92) respectively. The lambda value was 3.41 (95% CI 2.37-4.46) and the Fagan nomogram pre-test probability 58%, with a positive likelihood ratio (LR) of 6.01. The positive post-test probability was 89%, with a negative LR of 0.20. The negative post-test probability was 21%. The positive increase in diagnostic utility was 31% and the negative decrement in that value 37%. For ADDWoR, the weighted sensitivity and specificity values were 0.72 (95% CI 0.59-0.81) and 0.90 (95% CI 0.86-0.93), respectively. The lambda value was 3.69 (95% CI 2.39-4.99) and the Fagan nomogram pre-test probability 38%, with a positive LR of 7.00. The positive post-test probability was 82%, with a negative LR of 0.32. The negative post-test probability was 16%. The increase in diagnostic utility was 44% and the negative decrement in that value 22%. HR-US delivers acceptable performance when used to diagnose ADD, being superior for the detection of ADDWoR than ADDWR, and exhibiting a lower negative diagnostic value in the detection of ADDWoR than ADDWR. HR-US may serve as a new method for the rapid diagnosis of ADD. The method has the advantages of simplicity and low cost. Given the uncertainty in some of the estimated values, more high-quality studies are needed to assess that diagnostic efficacy.
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Affiliation(s)
- X Y Dong
- Department of Stomatology, Wenzhou Integration Traditional Chinese and Western Medicine Hospital Affiliated to Zhejiang Chinese Medicine University, Wenzhou, China
| | - S He
- Department of Stomatology, No.118th Hospital of PLA, Wenzhou, China.
| | - L Zhu
- School & Hospital of Stomatology, Wenzhou Medical University, Wenzhou, China
| | - T Y Dong
- Department of Laboratory, People's Hospital of Haining, Haining, China
| | - S S Pan
- School & Hospital of Stomatology, Wenzhou Medical University, Wenzhou, China
| | - L J Tang
- Department of Stomatology, People's Hospital of Lishui, Lishui, China
| | - Z F Zhu
- Department of Stomatology, Xiaoshan Traditional Chinese Medicine Hospital, Hangzhou, China
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15
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Kundu H, Basavaraj P, Kote S, Singla A, Singh S. Assessment of TMJ Disorders Using Ultrasonography as a Diagnostic Tool: A Review. J Clin Diagn Res 2013; 7:3116-20. [PMID: 24551747 DOI: 10.7860/jcdr/2013/6678.3874] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 10/28/2013] [Indexed: 01/28/2023]
Abstract
Temporomandibular disorders affect nearly 10-70% of population. Hence, a proper diagnosis of temporomandibular disorders using appropriate diagnostic aids is required. Thus, the purpose of this review was to check the use of ultrasonography as a diagnostic aid in the detection of TMJ disorders.A literature review was performed in Pub Med Central and Cochrane library using Mesh Terms - 'ultrasonography' and 'TMJ disorders'. Out of the total 113 titles appeared, 38 were related to the research question. Further search criteria were applied to the articles, out of which 11 articles fulfilled the criteria and were selected for the review. Two articles which were hand searched were also included. Sensitivity of ultrasonography in detecting TMJ disorders in a majority of articles ranged from 41%-90% in disc displacement, when MRI was taken as the gold standard. In case of TMJ Effusion and Condylar effusion, sensitivities ranged from 20-80% and 83% respectively. It was also seen that sensitivity increased with increase in frequency of transducer. In the available literature, it was found that ultrasonography was an acceptable diagnostic tool for detection of disc displacement, condylar erosion and articular effusion.
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Affiliation(s)
- Hansa Kundu
- Postgraduate Student, Department of Public Health Dentistry, D.J College of Dental Sciences and Research , Modinagar, Ghaziabad, Uttar Pradesh, India
| | - P Basavaraj
- Professor and Head of Department, Department of Public Health Dentistry, D.J College of Dental Sciences and Research , Modinagar, Ghaziabad, Uttar Pradesh, India
| | - Sowmya Kote
- Reader, Department of Public Health Dentistry, D.J College of Dental Sciences and Research , Modinagar, Ghaziabad, Uttar Pradesh, India
| | - Ashish Singla
- Senior Lecturer, Department of Public Health Dentistry, D.J College of Dental Sciences and Research , Modinagar, Ghaziabad, Uttar Pradesh, India
| | - Shilpi Singh
- Senior Lecturer, Department of Public Health Dentistry, D.J College of Dental Sciences and Research , Modinagar, Ghaziabad, Uttar Pradesh, India
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