Evaluation of Diagnostic Efficiency of Ultrasonography in Temporomandibular Joint Disorders: A Pilot Study

Yıl 2018, Cilt: 2 Sayı: 1, 12 - 17, 29.06.2018

M. Oguz Borahan , Gaye Keser , Gamze Ulay Filiz Namdar Pekiner

https://doi.org/10.12990/MDJ.2018.12

Öz

Objective: Temporomandibular Joint diseases (TMD) and

disorders refer to a complex of conditions, manifested by pain

in jaw area and associated muscles and limitations in the ability

to make the normal movements of speech, facial expression,

eating, chewing, and swallowing. Ultrasonography (US) is a noninvasive,

cost-effective, easy-to-use imaging method using sound

waves, without ionizing radiation and as a diagnostic procedure

it has been shown to be accurate for the diagnosis of TMD. The

purpose of this pilot study is to evaluate the diagnostic efficacy

of ultrasonography imaging in temporomandibular joint disorders.

Material and Method: The retrospective ultrasonography

images of 20 patients (female, male) who had been referred to

Marmara University, Faculty of Dentistry, Oral Diagnosis and

Radiology Clinic with a complaint related to Temporomandibular

joint (TMJ) were evaluated in terms of condylar surface

irregularities, joint space reduction and joint effusion.

Results: A total of 20 patients ( % 70 female, %30 male, mean

age: 33,75) and 40 TMJ were evaluated and in % 15 erosive –

degenerative changes, in % 82,5 condylar surface flattening and in

% 27,5 increased joint capsule width was observed.

Conclusion: Ultrasonography is a non-invasive technique

suitable for visualization of TMJ and evaluation of TMD in routine

clinical practice.

Anahtar Kelimeler

Temporomandibular Joint Disorders, Ultrasound, Radiology

Temporomandibular Eklem Bozukluklarında Ultrasonografinin Diagnostik Etkinliğinin Değerlendirilmesi: Bir Pilot Çalışma

Öz

Amaç: Temporomandibular eklem hastalıkları (TMD) ve
rahatsızlıkları, çene bölgesinde ve ilgili kaslarda ağrı ile ortaya
çıkan ve normal konuşma, yüz ifadesi, yeme, çiğneme ve yutma
hareketlerini kısıtlayabilen durumları ifade eder. Ultrasonografi
(US), invazif olmayan, düşük maliyetli, kullanımı kolay ve
iyonlaştırıcı radyasyon olmaksızın ses dalgalarının kullanıldığı,
bununla birlikte; diagnostik prosedür olarak TMD teşhisi için
doğruluğu kanıtlanmış bir görüntüleme yöntemidir. Bu pilot
çalışmanın amacı, temporomandibular eklem hastalıklarında
ultrasonografik görüntülemenin tanısal etkinliğinin
değerlendirmektir.
Gereç ve Yöntem: Temporomandibular eklem (TME) ile ilgili
şikayetleri bulunan, Marmara Üniversitesi Diş Hekimliği Fakültesi
Oral Diagnoz ve Radyoloji Kliniğine başvuran 20 hastanın (kadın,
erkek) retrospektif ultrasonografi görüntüleri kondiler yüzey
düzensizlikleri, eklem boşluğunda daralma ve efüzyon açısından
değerlendirilmiştir.
Bulgular: Toplam 20 hasta (% 70 kadın, % 30 erkek, yaş
ortalaması :33,75) ve 40 TME değerlendirilmiş ve % 15 eroziv –
dejeneratif değişiklik, % 82,5 kondiler yüzeyde düzleşme ve % 27
oranlarında artan eklem kapsülü genişliği gözlenmiştir.
Sonuç: Ultrasonografi, TME’ nin görüntülenmesi ve rutin
klinik uygulamada TMD’nin değerlendirilebilmesi için uygun ve
invaziv olmayan bir tekniktir.

Anahtar Kelimeler

Temporomandibular Eklem Bozuklukları, Ultrason, Radyoloji

Kaynakça

• Okeson JP. Management of Temporomandibular Disorders and Occlusion, 7th ed. St. Louis: MO Elsevier; 2013.
• Kavuncu V. Temporomandibular EklemDisfonksiyon Sendromu. In: Göksoy T, ed. Romatizmal Hastalıkların Tanı ve Tedavisi. İstanbul: Yüce Basımevi; 2002; 791-802.
• Odabaş B, Arslan SG. Temporomandibuler Eklem Anatomisi ve Rahatsızlıkları. Dicle Tıp Derg. 2008; 35(1): 77-85.
• Yıldırm D, Alkış Ü. Temporomandibular Eklem Bozukluklarının Değerlendirilmesinde Kullanılan Görüntüleme Yöntemleri. SDÜ Sağlık Bilimleri Enstitüsü Dergisi. 2016; 7(2): 52-56.
• Gallo LM. Modeling of Temporomandibular Joint Function Using MRI and Jaw-Tracking Technologies–Mechanics, Cells Tissues Organs. 2005; 180 (1): 54–68.
• Yengin E. Temporomandibular Rahatsızlıklarda Teşhis ve tedavi. İstanbul: İstanbul Üniversitesi Diş Hekimliği Fakültesi Yayınları; 2000.
• Miloğlu Ö.(2009). Temporomandibular Eklem Disfonksiyonu Olan Hastalardaki Kondiller Kemik Değişikliklerinin İnternal Düzensizlik (Disk Deplasmanı) ile Olan İlişkisinin İncelenmesi. Atatürk Üniversitesi Sağlık Bilimleri Enstitüsü, Doktora Tezi, Erzurum, (Danışman: Prof. Dr. Ahmet Berhan Yılmaz).
• Etoz M, Ozdemir ST, Sıgırlı D, Demirbas¸ AE , Ercan I, Etoz OA, et al. Evaluation of bony structures on panoramic radiographs with statistical shape analysis in patients with temporomandibular joint pain and limited mouth opening. E-J Dent 2013;3:495–500.
• Tanaka E, Detamore MS, Mercuri LG. Degenerative disorders of the temporomandibular joint: etiology, diagnosis, and treatment. J Dent Res 2008;87:296–307.
• De Leeuw R. Orofacial pain. Guidelines for assessment, diagnosis, and management. 4th ed. Hanover Park: Quintessence Publishing; 2008.
• Kundu H, Basavaraj P, Kote S, Singla A, Singh S. Assessment of TMJ Disorders Using Ultrasonography as a Diagnostic Tool: A Review. JCDR 2013;7(12):3116-3120
• Malik A Neelima. Textbook of Oral and Maxillofacial Surgery. 2nd ed; Jaypee Brothers: Delhi.2008;240.
• Pihut M, Szuta M Ferendiuk E, Zenczak – Wieckiewicz D. Differential Diagnostics of Pain in the Course of Trigeminal Neuralgia and Temporomandibular Joint Dysfunction. Biomed Res Int 2014; 2014: 1-7.
• Jank S, Zangeri A, Kloss F, Laimer K, Missmann M, et al. High Resolution ultrasound investigation of the temporomandibular joint in patients with chronic polyarthritis. Int J Oral Maxillofac Surg 2011;40:45-49.
• Truelove EL , Sommers EF, Leresche L, Dworkin SF, von Korff M. Clinical diagnostic criteria for TMD. New classification permits multiple diagnoses. J Am Dent Assoc 1992;123:47-54.
• Katzberg RW, Westesson PL, Tallents RH, Drake CM. Anatomic disorders of the temporomandibular joint disc in asymptomatic subjects. J Oral Maxillofac Surg 1996;54(2):147-155.
• Nekora-Azak A, Evlioğlu G, Ordulu M, Işsevver H, Prevalence of symtoms associated with temporomandibular disorders in a Turkish population. J Oral Rehabil 2006; 33(2):81 – 84.
• Dos Anjos Pontual ML, Freire JS, Barbosa JM, Fraza˜o MA, dos Pontual A Anjos. Evaluation of bone changes in the temporo-mandibular joint using cone beam CT. Dentomaxillofac Radiol 2012;41:24-29.
• Mengel R, Kruse B, Flores-de-Jacoby L. Digital volume tomography in the diagnosis of periodontal defects: an in vitrostudy on native pig and human mandibles. J Periodontol 2005; 76:665–673.
• Melis M, Secci S, Ceneviz C. Use of ultrasonography for the diagnosis of temporomandibular joint disorders: a review. Am J Dent 2007;20(2):73-78.
• Petrikowski CG. Diagnostic Imaging of the Temporomandibular Joint. White SC, Pharoah MJ, 5th ed. Oral Radiology, Principles and İnterpretation. St Louis Missouri: Mosby; 2004: 538-576.
• Brooks SL, Brand JW, Gibbs SJ, Hollender L, Lurie AG, Omnell KA , Westesson PL, White SC. Imaging of The Temporomandibular Joint. A position paper of American Academy of Oral and Maxillofacial Radiology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997; 83 (5): 609- 618.
• Junior Mello C, Saito Cassio O, Filho H. Sonographic evaluation of temporomandibular joint internal disorders. Radiol Bras 2011;44(6): 355-359.
• Hatala MP, Westesson PL, Tallents RH, Katzberg RW. TMJ disc displacement in asymptomatic volunteers detected by MR imaging. J Dent Res 1991;70:278-283.
• Katzberg RW. State of the art temporomandibular joint imaging. Ann R Aust Cell Dent Surg 1989;10:32-52.
• Kirkos LT, Ortendahl DA, Mark AS, Arakawa M. Magnetic resonance imaging of the TMJ disc in asymptomatic volunteers. J Oral Maxillofac Surg 1987;45(10):852-854.
• Elias F, Birman EG, Matsuda CK, Oliveira IR, Jorge WG. Ultrasonographic findings in normal temporomandibular joints. Braz Oral Res 2006;20(1):25-32.
• Tvrdy P. Methods of imaging in the diagnosis of temporomandibular joint disorders. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2007; 151 (1): 133- 136.
• Som PM, Curtin HD. Head and neck imaging, 3th ed. Volume I. St. Louis: Mosby; 1996; 375-433.
• Choi YS, Jung HD, Kim SY, Park HS, Jung YS. Remodelling pattern of the ramus on submentovertex cephalographs after intraoral vertical ramus osteotomy. British Journal of Oral and Maxillofacial surgery 2013; 51 (8): 259-262.
• Hayashi T, Ito J, Koyama J, Yamada K. The accuracy of sonography for evaluation of internal derangement of the temporomandibular joint in asymptomatic elementary school children: comparison with MR and CT. J Neuroradiol 2001; 22 (4): 728-734.
• Tatlı U, Keleş B, Esen E, Öztunç H. Unilateral Kondiler Hiperplazinin Konik Işınlı Bilgisayarlı Tomografi İle Değerlendirilmesi: İki Olgu Sunumu Ve Literatür Derlemesi. Atatürk Üniv Diş Hek Fak Derg 2010; 20 (3): 198-204.
• Scarfe WC, Farman AG, Sukovic P. Clinical Applications of Cone-Beam Computed Tomography in Dental Practice. J Can Dent Assoc 2006; 72 (1): 75-80.
• Thomas, A.E., Kurup, S., Kumar, S.P. et al. Diagnostic efficiency of high-resolution ultrasonography in patients with chronic temporomandibular disorders. Oral Radiol 2016; 32: 160.
• Merritt CRB. Physics of ultrasound. 2nd ed. St. Louis: Mosby;1998. p. 3–55.
• Nebeith YB, Speculand B. Ultrasonography as a diagnostic aid in temporomandibular joint dysfunction. A preliminary investigation. Int J Oral Maxillofac Surg 1991; 20(3):182- 186.
• Stefanoff V, Hausamen JE, van den Berghe P. Ultrasound imaging of the TMJ disc in asymptomatic volunteers. Preliminary report. J Craniomaxillofac Surg. 1992; 20(8):337.
• Motoyoshi M, Kamijo K, Numata K, Namura S. Ultrasonic imaging of the temporomandibular joint: a clinical trial for diagnosis of internal derangement. J Oral Sci 1998;40(2):89- 94.
• Tasaki MM, Westesson PL. Temporomandibular joint: diagnostic accuracy with sagittal and coronal MR imaging. Radiology 1993;186(3):723-729.
• Emshoff R, Bertram S, Rudisch A, Gabner R. The diagnostic value of ultrasonography to determine the temporomandibular joint disk position. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;84(6):688-696.
• Emshoff R, Jank S, Rudisch A, Walch C, Bodner G. Error patterns and observer variations in the high-resolution ultrasonography imaging evaluation of the disk position of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 93(3):369-375.
• Byahatti SM, Ramamurthy BR, Mubeen M, Agnihothri PG. Assessment of diagnostic accuracy of high-resolution ultrasonography in determination of temporomandibular joint internal derangement. Indian J Dent Res 2010 ;21(2):189- 194.
• Dupuy-Bonafé I, Picot MC, Maldonado IL, Lachiche V, Granier I, Bonafé A. Internal derangement of the temporomandibular joint: is there still a place for ultrasound? Oral Surg Oral Med Oral Pathol Oral Radiol 2012 ;113(6):832-840.
• Jank S, Rudisch A, Bodner G, Brandlmaier, Gerhard S, Emshoff R. High-resolution ultrasonography of the TMJ: helpful diagnostic approach for patients with TMJ disorders? J Craniomaxillofac Surg 2001;29(6):366-371.