Abstract
ObjectivesThe 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 methodsPubmed 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.ResultsA 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%.ConclusionsUsing 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 relevanceUS 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.
Highlights
Temporomandibular disorders (TMDs) are a type of musculoskeletal disorders with pain that compromise masticatoryClin Oral Invest (2018) 22:2599–2614 condition that may be accompanied by a limited mouth opening and a deviation of the jaw to the affected side [7]
The present review shows that for almost all the included studies, the positive predictive value (PPV) and negative predictive value (NPV) for disc displacements (DDs)-CM, DD at maximum mouth-opening position (DD-MMO), DD with reduction (DDWR), and DD without reduction (DDWoR) exceeded the prior probabilities to a large extent
We evaluated the accuracy of US for DD at closed mouth position (DD-CM) and DD-MMO in several subsamples of included studies
Summary
Clin Oral Invest (2018) 22:2599–2614 condition that may be accompanied by a limited mouth opening and a deviation of the jaw to the affected side [7]. It is reported that DDWR is mostly a stable, pain-free, and lifelong condition of the joint [2]. In a small minority of patients, the disc loses its capacity to reduce on opening [2]. The loss of disc reduction may be accompanied by signs and symptoms of a closed lock-like painful and limited mouth opening [2]. There are indications that DDWR or DDWoR may either retard or arrest condylar growth and may be related to mandibular retrognathia and/or facial asymmetry, though these skeletal consequences are probably rare and small [2]
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