Temporomandibular Eklemi Etkileyen Romatizmal Hastalıklarda Ultrasonografik Görüntülemenin Tanısal Değeri

Öz

Temporomandibular eklem (TME) bozuklukları kompleks yapıda olup, çiğneme, konuşma ve yüz ifadelerindeki etkileri nedeniyle yaşam kalitesini önemli ölçüde etkileyebilir. Romatoid artrit, psoriatik artrit ve sistemik lupus eritematozus gibi romatizmal hastalıklar sıklıkla temporomandibular ekleme etki eder, tanı ve hastalık yönetimini karmaşıklaştırır. Manyetik rezonans görüntüleme (MRG) ve bilgisayarlı tomografi (BT) gibi geleneksel görüntüleme teknikleri tercih edilebilir olmakla birlikte, yüksek maliyetler, erişilebilirlik sorunları ve BT açısından radyasyon maruziyeti ile kullanımları sınırlıdır. Ultrasonografi, hem yumuşak hem de sert doku yapıların gerçek zamanlı görüntülerini sağlayarak tanı doğruluğunu ve hasta yönetimini artıran; düşük maliyetli, invaziv olmayan bir alternatif metod olarak ortaya çıkmaktadır. Bu anlatısal derleme, ultrasonografik görüntülemede, güncel literatür bilgilerini ve son gelişmeleri sentezlemekte, geleneksel yöntemlerle etkinliğini karşılaştırmakta ve ultrason görüntülemenin terapötik stratejileri yönlendirmedeki potansiyelini tartışmaktadır. Ultrasonografinin dinamik değişiklikleri gösterme ve hastalık erken belirtilerini tespit etme yeteneği, özellikle kronik romatizmal durumların yönetiminde değerli kılmaktadır. Ancak, görüntülemenin etkinliği operatörün uzmanlığına bağlıdır ve bu açıdan standart protokollerin gerekli olmaktadır. Bu derleme, romatizmal hastalığı olan hastalarda temporomandibular eklem bozukluklarının tanı ve yönetiminde multidisiplinliner bir yaklaşımın önemini vurgulamakta ve gelecek araştırmalar ve klinik pratiğindeki gelişmeler için yönlendirme sağlamaktadır. Yüksek çözünürlüklü ultrasonografinin entegrasyonu, tanı ve tedavi takibinde oldukça efektif olabilmekte, temporomandibular eklem bozukluklarının erken tespiti ve takibi için hasta dostu, güvenilir ve erişilebilir bir görüntüleme yöntemi olarak karşımıza çıkabilmektedir.

Anahtar Kelimeler

• temporomandibular eklem
• romatizmal hastalıklar
• ultrasonografi

The Diagnostic Role of Ultrasonography in Rheumatic Diseases Affecting the Temporomandibular Joint

Abstract

Temporomandibular joint (TMJ) disorders are complex and can significantly impact quality of life due to their role in mastication, speech, and facial expressions. Rheumatic diseases such as rheumatoid arthritis, psoriatic arthritis, and systemic lupus erythematosus frequently involve the TMJ, complicating diagnosis and management. Conventional imaging techniques like magnetic resonance imaging (MRI) and computed tomography (CT), while effective, are limited by high costs, accessibility issues, and, in the case of CT, radiation exposure. Ultrasonography emerges as a cost-effective, non-invasive alternative that provides real-time images of both soft and hard tissue structures, enhancing diagnostic accuracy and patient management. This narrative review synthesizes current knowledge and recent advancements in ultrasonic imaging, comparing its efficacy with conventional methods and discussing its potential in guiding therapeutic strategies. The ability of ultrasonography to visualize dynamic changes and detect early signs of involvement makes it particularly valuable in managing chronic rheumatic conditions. However, the technique's effectiveness depends on the operator's expertise, and there is a need for standardized protocols. This review also underscores the importance of a multidisciplinary approach in the diagnosis and management of TMJ disorders in rheumatic disease patients and suggests directions for future research and clinical practice improvements. The integration of high-resolution ultrasonography could revolutionize the diagnostic landscape, offering a patient-friendly, accurate, and accessible tool for the early detection and ongoing monitoring of TMJ disorders.

Keywords

• temporomandibular joint
• rheumatic diseases
• ultrasonography

References

1. 1. Hoffmann RG, Kotchen JM, Kotchen TA, Cowley T, Dasgupta M, Cowley AW, Jr. Temporomandibular disorders and associated clinical comorbidities. Clin J Pain 2011; 27(3):268-74.
2. 2. Tonni I, Fossati G, Garo ML, Piancino MG, Cattalini M, Visconti L, Borghesi A. Temporomandibular joint involvement in patients with Juvenile Idiopathic Arthritis: comparison of ultrasonography and magnetic resonance imaging in assessing the periarticular space width. Oral Radiol 2023; 39(4):750-8.
3. 3. Wilkie G, Al-Ani Z. Temporomandibular joint anatomy, function and clinical relevance. Brit Dent J 2022; 233(7):539-46.
4. 4. Morales H, Cornelius R. Imaging Approach to Temporomandibular Joint Disorders. Clin Neuroradiol 2016; 26(1):5-22.
5. 5. Green BN, Johnson CD, Adams A. Writing narrative literature reviews for peer-reviewed journals: secrets of the trade. Journal of chiropractic medicine 2006; 5(3):101-17.
6. 6. Covert L, Mater HV, Hechler BL. Comprehensive management of rheumatic diseases affecting the temporomandibular joint. Diagnostics 2021; 11(3):409.
7. 7. Aliko A, Ciancaglini R, Alushi A, Tafaj A, Ruci D. Temporomandibular joint involvement in rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis. Int J Oral Max Surg 2011; 40(7):704-9.
8. 8. Odabaş B. AS. Temporomandibular Eklem Anatomisi Ve Rahatsızlıkları. Dicle Tıp Dergisi 2008; 35(1):77-85.

9. 9. Shaffer SM, Brismee JM, Sizer PS, Courtney CA. Temporomandibular disorders. Part 1: anatomy and examination/diagnosis. J Man Manip Ther 2014; 22(1):2-12.
10. 10. Okeson JP, de Leeuw R. Differential diagnosis of temporomandibular disorders and other orofacial pain disorders. Dent Clin North Am 2011; 55(1):105-20.
11. 11. Zakrzewska JM. Differential diagnosis of facial pain and guidelines for management. Br J Anaesth 2013; 111(1):95-104.
12. 12. Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP, List T, Svensson P, Gonzalez Y, Lobbezoo F, Michelotti A, Brooks SL, Ceusters W, Drangsholt M, Ettlin D, Gaul C, Goldberg LJ, Haythornthwaite JA, Hollender L, Jensen R, John MT, De Laat A, de Leeuw R, Maixner W, van der Meulen M, Murray GM, Nixdorf DR, Palla S, Petersson A, Pionchon P, Smith B, Visscher CM, Zakrzewska J, Dworkin SF Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Groupdagger. J Oral Facial Pain Headache 2014; 28(1):6-27.
13. 13. Gauer RL, Semidey MJ. Diagnosis and treatment of temporomandibular disorders. Am Fam Physician 2015; 91(6):378-86.
14. 14. Sagripanti M, Viti C. Primary headaches in patients with temporomandibular disorders: Diagnosis and treatment of central sensitization pain. Cranio 2018; 36(6):381-9.
15. 15. Garefis P, Grigoriadou E, Zarifi A, Koidis PT. Effectiveness of conservative treatment for craniomandibular disorders: a 2-year longitudinal study. J Orofac Pain 1994; 8(3):309-14.
16. 16. Attanasio R. An overview of bruxism and its management. Dent Clin North Am 1997; 41(2):229-41.
17. 17. Omolehinwa TT, Musbah T, Desai B, O'Malley BW, Jr., Stoopler ET. Neuralgia associated with transcutaneous electrical nerve stimulation therapy in a patient initially diagnosed with temporomandibular disorder. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119(3):e101-4.
18. 18. Volkan-Yazici M, Kolsuz ME, Kafa N, Yazici G, Evli C, Orhan K. Comparison of Kinesio Taping and manual therapy in the treatment of patients with bruxism using shear-wave elastography-A randomised clinical trial. Int J Clin Pract 2021; 75(12) :e14902.
19. 19. Sipahi Calis A, Colakoglu Z, Gunbay S. The use of botulinum toxin-a in the treatment of muscular temporomandibular joint disorders. J Stomatol Oral Maxillofac Surg 2019; 120(4):322-5.
20. 20. Shen YF, Goddard G. The short-term effects of acupuncture on myofascial pain patients after clenching. Pain Pract 2007; 7(3):256-64.
21. 21. De Riu G, Stimolo M, Meloni SM, Soma D, Pisano M, Sembronio S, Tullio A. Arthrocentesis and Temporomandibular Joint Disorders: Clinical and Radiological Results of a Prospective Study. Int J Dent 2013; 2013.
22. 22. Helenius LMJ, Tervahartiala P, Helenius I, Al-Sukhun J, Kivisaari L, Suuronen R, Kautiainen H, Hallikainen D, Lindqvist C, Leirisalo-Repo M. Clinical radiographic and MRI findings of the temporomandibular joint in patients with different rheumatic diseases. Int J Oral Max Surg 2006; 35(11):983-9.
23. 23. Li JM, Zhang XW, Zhang Y, Li YH, An JG, Xiao E, Yan YB. Ankylosing spondylitis associated with bilateral ankylosis of the temporomandibular joint. Or Surg or Med or Pa 2013; 116(6):E478-E84.
24. 24. Ayouni I, Chebbi R, Hela Z, Dhidah M. Comorbidity between fibromyalgia and temporomandibular disorders: a systematic review. Or Surg or Med or Pa 2019; 128(1):33-42.
25. 25. Shivhare P, Ghimire AC, Karishma, Singh A, Gupta V. Temporomandibular Joint Disorders Associated With Psoriatic Arthritis: A Report of Three Cases. Cureus J Med Science 2022; 14(12):e32959.
26. 26. Sklenicka S, Dierks EJ, Jarmin J, Miles C. Pseudogout of the temporomandibular joint: an uncommon cause of temporomandibular joint pain and swelling. Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology 2011; 111(6):709-14.
27. 27. von Schuckmann L, Klotsche J, Suling A, Kahl-Nieke B, Foeldvari I. Temporomandibular joint involvement in patients with juvenile idiopathic arthritis: a retrospective chart review. Scandinavian Journal of Rheumatology 2020; 49(4):271-80.
28. 28. Tonni I, Borghesi A, Tonesi S, Fossati G, Ricci F, Visconti L. An ultrasound protocol for temporomandibular joint in juvenile idiopathic arthritis: a pilot study. Dentomaxillofac Rad 2021; 50(8):20200399.
29. 29. Abramowicz S, Kim S, Prahalad S, Chouinard A, Kaban L. Juvenile arthritis: current concepts in terminology, etiopathogenesis, diagnosis, and management. Int J Oral Max Surg 2016; 45(7):801-12.
30. 30. Granquist EJ. Treatment of the temporomandibular joint in a child with juvenile idiopathic arthritis. Oral and Maxillofacial Surgery Clinics 2018; 30(1):97-107.
31. 31. Aktuna Belgin C, Serindere G, Orhan K. Contemporary imaging modalities for temporomandibular joint: An update and review. Journal of Experimental & Clinical Medicine 2021; 38.
32. 32. Grassi W, Cervini C. Ultrasonography in rheumatology: an evolving technique. Annals of the rheumatic diseases 1998; 57(5):268-71.
33. 33. Manfredini D, Guarda-Nardini L. Ultrasonography of the temporomandibular joint: a literature review. Int J Oral Max Surg 2009; 38(12):1229-36.
34. 34. Maranini B, Ciancio G, Mandrioli S, Galiè M, Govoni M. The role of ultrasound in temporomandibular joint disorders: an update and future perspectives. Frontiers in Medicine 2022; 9:926573.
35. 35. Ramadan A, Tharwat S, Abdelkhalek A, Eltoraby EE. Ultrasound detected synovitis, tenosynovitis and erosions in hand and wrist joints: a comparative study between rheumatoid and psoriatic arthritis. Reumatologia/Rheumatology 2021; 59(5):313-22.
36. 36. McAlindon T, Kissin E, Nazarian L, Ranganath V, Prakash S, Taylor M, Bannuru RR, Srinivasan S, Gogia M, McMahon MA, Grossman J, Kafaja S, FitzGerald J.American College of Rheumatology report on reasonable use of musculoskeletal ultrasonography in rheumatology clinical practice. Arthritis care & research. 2012;64(11):1625-40.
37. 37. Khudayberdiyevich ZS, Abdurakhmanovich KO, Servetovna AA, Maratovna KY. Possibilities and Prospects of Ultrasound Diagnostics in Rheumatology. Central Asian Journal of Medical and Natural Science 2022; 3(5):570-82.
38. 38. Di Matteo A, Mankia K, Azukizawa M, Wakefield RJ. The role of musculoskeletal ultrasound in the rheumatoid arthritis continuum. Current rheumatology reports 2020; 22:1-12.
39. 39. Talmaceanu D, Lenghel LM, Bolog N, Stanila RP, Buduru S, Leucuta DC, Rotar H, Baciut M, Baciut G. High-resolution ultrasonography in assessing temporomandibular joint disc position. Medical Ultrasonography 2018; 20(1):64-70.
40. 40. Hysa E, Lercara A, Cere A, Gotelli E, Gerli V, Paolino S, Pizzorni C, Sulli A, Smith V, Cutolo M. Temporomandibular disorders in immune-mediated rheumatic diseases of the adult: a systematic review. Seminars in Arthritis and Rheumatism; 2023: Elsevier.
41. 41. Dong X, He S, Zhu L, Dong T, Pan S, Tang L, Zhu Z. 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 Max Surg 2015; 44(7):852-8.
42. 42. Manfredini D, Tognini F, Melchiorre D, Bazzichi L, Bosco M. Ultrasonography of the temporomandibular joint: comparison of findings in patients with rheumatic diseases and temporomandibular disorders. A preliminary report. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 2005; 100(4):481-5.
43. 43. Dervis E, Dervis E. The prevalence of temporomandibular disorders in patients with psoriasis with or without psoriatic arthritis. Journal of Oral Rehabilitation 2005; 32(11):786-93.
44. 44. Jalal RA, Ahmed KM, Saeed SM, Qaradaghi TA. Correlation of clinical findings of temporomandibular joint with serological results in rheumatoid arthritis patients. Clinical and Experimental Dental Research 2022; 8(5):1270-6.
45. 45. Almășan O, Hedeșiu M, Băciuț M, Buduru S, Dinu C. Psoriatic arthritis of the temporomandibular joint: A systematic review. Journal of Oral Rehabilitation 2023; 50(3):243-55.
46. 46. Celiker R, Gökçe-Kutsal Y, Eryilmaz M. Temporomandibular joint involvement in rheumatoid arthritis: Relationship with disease activity. Scandinavian journal of rheumatology 1995; 24(1):22-5.