Diagnosis Of Disc Displacement Research Articles

Influence of examiner calibration on clinical and MRI diagnosis of temporomandibular joint disc displacement: a systematic review and meta-analysis.

This study aimed to verify the accuracy of clinical protocols for the diagnosis of disc displacement (DD) compared with MRI, considering examiners' calibration. PubMed, Cochrane (Central), Scopus, Web of Science, LILACS, Embase, Science Direct, Google Scholar, and DANS EASY Archive databases were searched. Two reviewers independently screened and selected the studies. A meta-analysis was conducted using the R Statistical software. Results are shown using sensitivity and specificity, and 95% confidence intervals. Of the 20 studies included in the systematic review, only three were classified as low risk of bias. Seventeen studies were included in the meta-analysis. Compared to MRI, clinical protocols showed overall sensitivity and specificity of 0.75 (0.63-0.83) and 0.73 (0.59-0.84) for DD diagnosis, respectively. For DD with reduction, sensitivity was 0.64 (0.48-0.77) and specificity was 0.72 (0.48-0.87). For DD without reduction, sensitivity was 0.58 (0.39-0.74) and specificity 0.93 (0.83-0.97). Only 8 studies reported examiner calibration when performing clinical and/or MRI evaluation; nevertheless, calibration showed a tendency to improve the diagnosis of DD. The sensitivity and specificity of clinical protocols in the diagnosis of DD are slightly below the recommended values, as well as the studies lack calibration of clinical and MRI examiners. Examiner calibration seems to improve the diagnosis of DD.

Impact of Orthodontic-Surgical Treatments on the Signs and Symptoms of Temporomandibular Disorders: A Systematic Review.

Some patients exhibit temporomandibular joint or muscular disorders of the masticatory system before, during, or after orthognathic surgery (OS). These are collectively referred to as temporomandibular disorders (TMDs). This systematic literature review aimed to determine the relationship between orthodontic-surgical treatment and TMDs. An electronic search of the PubMed database, supplemented by a manual search, was performed; the search included any studies published between 2021 (date of the last search in a systematic review of the literature on the subject) and June 2023 that evaluate the prevalence of TMDs during orthodontic-surgical treatment. The diagnosis of TMDs had to be established using the diagnostic algorithm "diagnostic criteria for temporomandibular disorders (DC/TMDs)", and the diagnosis of disc displacement had to be confirmed using magnetic resonance imaging (MRI). The data were extracted and statistically analyzed. Of the 100 results, seven eligible articles were included, representing a total of 529 cases undergoing orthodontic-surgical treatment. A reduction in joint noises (64.8%), arthralgia (57 to 77%), and myalgia (73 to 100%) was found after orthodontic-surgical treatment despite the fact that a minority of patients exhibited these signs and symptoms even though they were asymptomatic before treatment. The effects of OS on disc position were objectively unpredictable. After surgery, the presence of headaches decreased without significance and the risk of their occurrence was very low (1%). The studies converged toward a reduction in the amplitudes of mouth opening and lateral/protrusion movements. Finally, after the treatment, mandibular function was improved. Under the conditions of this study, OS seems to have a positive impact on the signs and symptoms of TMDs; however, it is not possible to predict the consequential effects on the position of the TMJ disc, whether it is initially in a normal position or displaced.

Correlation between TMJ Space Alteration and Disc Displacement: A Retrospective CBCT and MRI Study.

This study aims to determine if a large anterior and reduced posterior/superior joint space is highly predictable for disc displacement. From patients with temporomandibular disorders symptoms, fifty-two experimental joints and fourteen control joints were included. The cone beam computed tomography (CBCT) images were used to calculate posterior-to-anterior (P-A) and superior-to-anterior (S-A) joint space ratios, while disc position was determined using magnetic resonance imaging (MRI). One-way analysis of covariance test and receiver operating characteristics analysis were carried out. The results showed that among the 52 experimental joints, 45 were diagnosed as disc displacement and 7 as normal disc positions (N). All 14 control joints showed normal disc positions. The P-A ratio was 1.46 ± 0.21, 0.99 ± 0.23, and 0.86 ± 0.30 in the control, N, and DD groups, respectively (p < 0.001). The S-A ratio was 1.80 ± 0.27, 1.44 ± 0.33, and 1.08 ± 0.35 in the control, N, and DD groups, respectively (p < 0.001). When an altered P-A ratio and/or S-A ratio are observed on the CBCT, the diagnosis of disc displacement is quite predictable with high sensitivity and specificity.

Assessing Evaluating and Correlating the Clinical Findings of Temporomandibular Joint Pathology with Orthopantomogram and Magnetic Resonance Imaging – A Cross-Sectional Study

Background: Because of the anatomic complexity of the temporomandibular joint (TMJ) clinician cannot arrive at the accurate diagnosis only by clinical evaluation of TMJ hence would require some special imaging methods and techniques which would facilitate the accurate clinical diagnosis. One such imaging method is orthopantomography (OPG) of TMJ. Even though OPG has various limitations, it provides valuable information of TMJ and seems to be the primary choice of imaging modality for the diagnosis of TMJ pathologies. Magnetic Resonance Imaging (MRI) is considered to be the one of the best imaging technology to assess the soft tissue structures surrounding the TMJ and evolved as the best imaging modality for the diagnosis of disc displacement of TMJ. Aim: The aim of the study is to evaluate the clinical findings of the TMJ pathologies and to compare the findings of the OPG and MRI of the TMJ pathologies. Methodology: This is a cross-sectional observational study with comprised of multi-ethnic groups, selected from amongst those attending our dental c. Fifty subjects reporting to the Department of Oral Medicine and Radiology with TMJ pathologies were selected. Radiological bone changes were evaluated for flattening (flat bony contour deviating from normal convex form) and erosion (area of decreased density of cortical bone and adjacent subcortical bone) by OPG. After that, MRI of TMJ been taken and changes in the disk position was recorded with the help of radiologist. Statistical Analysis: Statistical presentation and analysis of the present study were done using the p value and Chi-square test by SPSSV20. Results: Result obtained from our study showed that pain was present in 28 (56%) patients and only 44% patients having chief complain other than pain such as noise in front of ear while mastication or restricted mouth opening [Table 1] Out of 28 patients with a chief complain of pain, 22 patients (78.57%) were having abnormal/flattened condylar head surface but out of 22 patients with a chief complain other than pain 18 patients (81.82%) were having abnormal/flattened condylar head surface [Table 2]. Out of 28 patients with a chief complain of pain, 18 patients (64.28%) were with an shortened condylar neck and also out of 22 patients with a chief complain other than pain 16 patients (72.72%) were having shortened condylar neck. The result showed statistically non-significant (P &gt; O.05) [Table 3]. Results also showed that 40% patients with Anterior Disc Displacement With Reduction (ADDR) and 50% with Anterior disc displacement without reduction (ADDWR) had abnormal condylar head surface [Table 4]. About 47.05% patients with ADDR and 41.17% with ADDWR had abnormal condylar neck [Table 5]. Even though there was a positive correlation between the OPG and MRI findings of the TMJ pathologies with the clinical findings of TMJ pathologies, result was not statistically significant which might be due to the reduced sample size. Conclusion: Based on the observation, it can be concluded that OPG and MRI provide valuable information regarding the temporomandibular disorders (TMD) and can play a key role in arriving at accurate clinical diagnosis of complex TMJ pathologies. It also makes the clinical diagnosis easy by correlating the clinical findings of the TMD with this imaging modality and helps clinician to arrive at the proper diagnosis and treatment plan at the earliest. This type of studies should be done on large scale in future based on specific parameters for early diagnosis and treatment planning for patients suffering with TMD to provide quality treatment to the patients at initial stage.

Multidisciplinary team in temporomandibular disorders

Introduction The temporomandibular disorders (TMD) are one of the main concerns regarding orofacial pathologies and there are an ascending number of cases. They are characterised as a group of pathological conditions that may affect the temporomandibular joint (TMJ), the masticatory musculature and/or other adjacent anatomical structures, leading to pain and dysfunction [1]. The multifactorial aetiology of TMD affects a relatively large number of the world population and requires a multidisciplinary evaluation and diagnosis by the clinical team [2]. Among the various elements that constitute the multidisciplinary team we highlight the dentist and the physiotherapist. The dentist as a first-line professional, most of the time is responsible for the identification of patients potentially at risk and for the follow-up of those who already present the disease [3]. On the other hand, the physiotherapist aims to reduce musculoskeletal pain, promote muscle relaxation, reduce muscle hyperactivity, improve function by restoring the quality and quantity of mandibular movements and maximise joint mobility [4]. Description of the clinical case A 24-year-old female patient with a history of temporomandibular disorder and bruxism she presented an non-assisted mouth opening (UMO) of 28 mm and an assisted mouth opening with pain in the masseter and TMJ bilaterally of 29 mm, after the clinical assessment with the DC/TMD protocol we arrived at a diagnosis of disc displacement without reduction (DDwR) with limited opening, degenerative joint disease in the left TMJ, arthralgia (II), myofascial pain (III) in the masseter with pain referred to other anatomical regions. All the assumptions of the Helsinki Declaration have been fulfilled and an informed consent for clinical case of Clinica Dentária Egas Moniz approved by the ethic commission of Instituto Universitário Egas Moniz. The treatment plan consisted of cognitive behavioural therapy (CBT), prescription of muscle relaxants, occlusal splint especially for reduction of overload due to bruxism, infiltration with 1 ml of hyaluronic acid of high molecular weight in the TMJ bilaterally followed by articular mobilisation techniques and neuromuscular and myofascial techniques. The patient was instructed to continue with the physiotherapy. Results The follow up was made 2 months after with 8 sessions of physiotherapy and 1 more hyaluronic acid infiltration bilaterally as protocoled session, we could observe an absence of temporomandibular joint pain, UMO of 42 mm, decreased crepitation, decreased intensity of myofascial pain (I) and (DDwR) without limited opening. Discussion and conclusion The multidisciplinary dentist-physiotherapist team combines inputs from different professions with the aim of promoting the best patient care and represents an added value for the management of the signs/symptoms of patients with temporomandibular dysfunction.

The association between patient rating of their spine surgeon and quality of postoperative outcome.

The Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey was developed by the Centers for Medicare and Medicaid Services as a result of their value-based purchasing initiative. It allows patients to rate their experience with their provider in the outpatient setting. This presents a unique situation in healthcare in which the patient experience drives the marketplace, and since its creation, providers have sought to improve patient satisfaction. Within the spine surgery setting, however, the question remains whether improved patient satisfaction correlates with improved outcomes. All patients who had undergone lumbar spine surgery between 2009 and 2017 and who completed a CG-CAHPS survey after their procedure were studied. Demographic and surgical characteristics were then obtained. The primary outcomes of this study include patient-reported health outcomes measures such as the Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) surveys for both mental health (PROMIS-GH-MH) and physical health (PROMIS-GH-PH), and the visual analog scale for back pain (VAS-BP). A multivariable linear regression analysis was used to assess whether patient satisfaction with their provider was associated with changes in each health status measure after adjusting for potential confounders. The study population included 647 patients who had undergone lumbar spine surgery. Of these, 564 (87%) indicated that they were satisfied with the care they received. Demographic and surgical characteristics were largely similar between the two groups. Multivariable linear regression demonstrated that patient satisfaction with their provider was not a significant predictor of change in two of the three patient-reported outcomes (PROMIS-GH-MH and PROMIS-GH-PH) assessed at 1 year. However, top-box patient satisfaction with their provider was a significant predictor of improvement in VAS-BP scores at 1 year. The authors found that after adjusting for patient-level covariates such as age, diagnosis of disc displacement, self-reported mental health, self-reported overall health, and preoperative patient-reported outcome measure status, a significant association was observed between top-box overall provider rating and 1-year improvement in VAS-BP, but no such association was observed for PROMIS-GH-PH and PROMIS-GH-MH. This suggests that pain-related outcome measures may serve as better predictors of patients' satisfaction with their spine surgeons. Furthermore, this suggests that the current method by which patient satisfaction is being assessed and publicly reported may not necessarily correlate with validated measures that are used within the spine surgery setting to assess surgical efficacy.

Temporomandibular dysfunction in patients with a history of stroke.

Background: The temporomandibular joint (TMJ) is certainly one of the most complex joints in the human body. The American Academy of Orofacial Pain defines temporomandibular joint disorder (TMD) as a set of disorders involving the masticatory muscles, the TMJ, and associated structures. It is pointed as the main cause of non-dental pain in the orofacial region, including head, face and related structures. The most common TMD symptoms involve joint, chewing and face pain. There may also be crackling when opening and closing the mouth, earache, tinnitus, dizziness, dislocations, limitation of movement and painful tenderness to palpation. Stroke causes sequelae in subjects that include motor disorders, speech or language disorders, and swallowing disorders. Approximately 50% of patients with hemiparesis after stroke are known to have facial control deficiency, weakened orofacial and mandibular functions. Objective: To evaluate patients with a history of stroke, seeking a possible relationship with TMD, the pain associated with this change, and the limitations of range of motion related to the presence of hemibody spasticity in patients post stroke. Methods: The sample consisted of 19 patients of both genders, aged 55 to 70 years, who had suffered stroke. It was used the RDC/TMD for TMD diagnosis, Pressure Pain Threshold test, Ashworth scale, and Sanny Fleximeter for cervical ROM evaluation, being the statistical analysis performed by the software Bioestat version 5.3. Results: TMD was diagnosed in 81.8% of the sample, and of these, 45.4% had a diagnosis of disc displacement with reduction. Conclusion: There was an increase in the muscle tone and the pressure pain threshold, and a decrease in cervical spine ROM, related to the affected side and diagnosed with this disorder, observing that the muscle alterations caused by stroke may be predisposing factors to patients, to the development of muscle TMD or even joint TMD.

Temporomandibular joint dysfunction – sequential infiltration protocol of sodium hyaluronate at different molecular weights

Introduction: The temporomandibular dysfunction (TMD) it’s a collective expression that encompasses clinical alterations in chewing muscles, temporomandibular joints (TMJ), and/or associated estructures. The viscosuplementation (VS) is a minimally invasive technique which consistis of intra-articular injection of sodium hyaluronate (SH) for the improvement of lubrification and joint biomechanics and elimination or decrease of pain. The aim of this study was to evaluate, through a series of cases, the efficacy of a viscosupplementation protocol with SH in different molecular weights, in the signs and syntptoms of joint TMJ and in patients’quality of life [1–3]. Materials and methods: this study was approved by the Ethics Committee of Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (CAAE-24911314.3.0000.5149) and registered in the Brazilian Registry of Clinical Trials (RBR-6759yz). Is a case series that describes the efficacy of a viscosupplementation protocol in intra-articular temporomandibular disorders. Ten patients with a diagnosis of disc displacement and/or osteoarthritis according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were submitted to four monthly injections of low or medium molecular weight HA. Pain, mandibular function, image analysis by tomography and magnetic resonance, and quality of life were assessed at baseline and follow-ups (1 and 6 months). Results: Pain, jaw range-of-motion, mandibular function, and quality of life improved at follow-up evaluations. Osteoarthritis changes decreased, and 20% of patients improved mandibular head excursion after treatment. Resolution of effusion and improvement in disc morphology were observed for most patients. This viscosupplementation protocol reduced pain and symptoms associated with internal derangement of temporomandibular joint, improved quality of life, and showed benefits from both low and medium molecular weight HA in alternate cycles. Discussion and conclusions: These results suggest the effectiveness of the VS protocol in the control and relief of the signs and symptoms of TMD, and the great therapeutic potential of this technique.

Effectiveness of Sequential Viscosupplementation in Temporomandibular Joint Internal Derangements and Symptomatology: A Case Series.

Viscosupplementation is a minimally invasive technique that replaces synovial fluid by intra-articular injection of hyaluronic acid (HA). Although effective in some joints, there is not conclusive evidence regarding temporomandibular disorders. This case series described the efficacy of a viscosupplementation protocol in intra-articular temporomandibular disorders. Ten patients with a diagnosis of disc displacement and/or osteoarthritis by Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were submitted to four monthly injections of low or medium molecular weight HA. Pain, mandibular function, image analysis by tomography and magnetic resonance, and quality of life were assessed at baseline and follow-ups (1 and 6 months). Pain, jaw range-of-motion, mandibular function, and quality of life improved at follow-up evaluations. Osteoarthritis changes decreased, and 20% of patients improved mandibular head excursion after treatment. Resolution of effusion and improvement in disc morphology were observed for most patients. This viscosupplementation protocol reduced pain and symptoms associated with internal derangement of temporomandibular joint, improved quality of life, and showed benefits from both low and medium molecular weight HA in alternate cycles.

High-resolution ultrasonography in assessing temporomandibular joint disc position.

The purpose of this study was to determine the diagnostic value of high-resolution ultrasonography (US) in temporomandibularjoint (TMJ) disc displacements. A number of 74 patients (148 TMJs) with signs andsymptoms of TMJ disorders, according to the Research Diagnostic Criteria for Temporomandibular Disorders, were includedin this study. All patients received US and magnetic resonance imaging (MRI) of both TMJs 1 to 5 days after the clinicalexamination. MRI examinations were performed using 1.5 T MRI equipment (Siemens Avanto, Siemens, Erlangen). Ultrasonographicexamination was performed on a Hitachi EUB 8500 (Hitachi Medical Corp., Tokyo, Japan) scanner with L 54 M6.5-13 MHz linear transducer. MRI depicted 68 (45.95%) normal joints, 47 (31.76%) with disc displacement withreduction, 33 (22.3%) with disc displacement without reduction and 34 (22.97%) with degenerative changes. US detected 78(52.7%) normal joints, 37 (25%) with disc displacement with reduction, 33 (22.3%) with disc displacement without reductionand 21 (14.19%) with degenerative changes. Compared to MRI, US showed a sensitivity of 93.1%, specificity of 87.88%,accuracy of 90.32%, a positive predictive value of 87.1% and a negative predictive value of 93.55% for overall diagnosis ofdisc displacement. The Youden index was 0.81. Based on our results, high-resolution ultrasonography showed high sensitivity, specificity and accuracy in the diagnosis of TMJ disc displacement. It could be a valuable imaging techniquein assessing TMJ disc position. The diagnostic value of high-resolution ultrasonography depends strictly on the examiner'sskills and on the equipment used.

Outcomes and patient satisfaction following individualized physical therapy treatment for patients diagnosed with temporomandibular disc displacement without reduction with limited opening: A cross-sectional study

Objective: To investigate physical therapy treatment outcomes and patient satisfaction in patients with a diagnosis of disc displacement without reduction with limited opening (DDWoR wLO).Methods: Records of 97 patients with DDWoR wLO who received physical therapy in one outpatient clinic were used in this cross-sectional study. Outcomes included number of visits, maximum active interincisal opening, self-reported pain, and patient satisfaction.Results: The average number of physical therapy visits per patient was 5.5, and there were significant improvements in pain rating and interincisal opening following physical therapy. Effect sizes for these comparisons were large (>1.0). Mean patient satisfaction responses across all symptom areas was consistent with patients being more than less satisfied following treatment.Discussion: Individualized physical therapy treatment is an effective conservative intervention to improve mouth opening, reduce pain, and provide patient satisfaction in patients with one specific sub-type of temporomandibular disorder (TMD), DDWoR wLO.

Diagnosis of disk displacement using real-time MRI: Clinical report of two patients

The clinical application of real-time magnetic resonance imaging (MRI) for the diagnosis of temporomandibular joint disk displacement (DD) with and without reduction is presented. In 2 patients with presumed DD, real-time MRI at 15 frames per second was performed during the natural opening and closing of the mouth. In one patient unilateral DD with reduction and in the other patient bilateral DD without reduction were observed. In contrast with conventional static MRI, real-time MRI moving images of temporomandibular joint DD offer comprehensive information about the dynamics of all involved structures, which in turn promises more reliable diagnoses. Real-time MRI is more rapid, more reliable, more informative, and less stressful for patients with temporomandibular disorders (TMDs).

Diagnostic criteria for temporomandibular disorders (DC/TMD): interexaminer reliability of the Finnish version of Axis I clinical diagnoses.

Recently, updated diagnostic criteria for temporomandibular disorders (DC/TMD) were published to assess TMD in a standardised way in clinical and research settings. The DC/TMD protocol has been translated into Finnish using specific cultural equivalency procedures. To assess the interexaminer reliability using the Finnish translations of the DC/TMD-FIN Axis I clinical diagnostic assessment instruments. Reliability assessment data were collected during a 1-day DC/TMD Examiner Training Course at the University of Turku, Finland, in collaboration with the International DC/TMD Training and Calibration Center in Malmö University. Clinical TMD examinations according to the Finnish pre-final version of the DC/TMD Axis I assessment protocol were performed by four experienced TMD specialists on altogether 16 models. Kappa coefficient, overall percentage agreement (%A) as well as positive (PA) and negative (NA) agreements were used to define the reliability. Myofascial pain with referral, headache attributed to TMD and disc displacement (DD) without reduction without limited opening showed excellent kappa values (range 0·87-1·00). Fair-to-good reliability was observed for diagnoses of myalgia (k = 0·67), arthralgia (k = 0·71) and DD with reduction (k = 0·64). The PA was high for all pain-related diagnoses and DD without reduction without limited opening (medians ≥83%), and acceptable for DD with reduction (median 67%). The NA was high (medians ≥87%) for all DC/TMD diagnoses, except for myalgia which showed acceptable NA (median 75%). The %A was high for all assessed diagnoses (medians >85%). The findings of this study showed DC/TMD-FIN Axis I to demonstrate sufficiently high reliability for pain-related TMD diagnoses.

Longitudinal Stability of Common TMJ Structural Disorders

The longitudinal course of temporomandibular joint (TMJ) disc displacement (DD) and degenerative joint disease (DJD) has never been conclusively described with magnetic resonance imaging and computed tomography, respectively. This 8-y observational study’s objective was to assess the longitudinal stability of DD and DJD among 401 subjects. The Validation Project provided baseline measures; follow-up was performed in the TMJ Impact Project. With magnetic resonance imaging, 2 radiologists rendered a consensus diagnosis of normal/indeterminate, DD with reduction, or DD without reduction. Computed tomography consensus diagnoses included normal/indeterminate, grade 1 DJD, or grade 2 DJD. Radiologist reliability was assessed by kappa; a Hui-Walter model was used to estimate, after accounting for diagnostic disagreement, the frequency of diagnostic progression and reversal. Permutation tests were used to test the statistical influence of concurrent baseline diagnoses on diagnostic changes at follow-up. Of 789 baseline joint-specific soft tissue diagnoses of DD, 598 (76%) joints showed no change; 109 (14%) demonstrated progression; and 82 (10%) had reversal. Of 794 joints with baseline joint-specific hard tissue diagnoses of DJD, progression was observed in 122 (15%) joints, no change in 564 (71%), and reversal in 108 (14%). Radiologist reliability (kappa) was 0.73 (95% CI, 0.64 to 0.83) for DD and 0.76 (95% CI, 0.68 to 0.83) for DJD. After accounting for the influence of diagnostic disagreement, progression of hard tissue diagnoses in the right TMJ occurred in 15.2% of subjects (95% CI, 10.5% to 20.8%) and reversal in 8.3% (95% CI, 4.9% to 12.3%); results were similar for soft tissue diagnoses and the left TMJ. Concurrent baseline soft tissue diagnoses were associated with hard tissue diagnostic changes at follow-up (P < 0.0001). Baseline hard tissue diagnoses showed no statistical association with soft tissue changes at follow-up (P = 0.11). Longitudinally, 76% of baseline TMJ soft tissue diagnoses and 71% of the baseline hard tissue diagnoses remained stable. Diagnostic reversal and progression were confirmed for both soft and hard tissues.

Estudo de prevalência das disfunções temporomandibulares articulares em estudantes de instrumentos de sopro

ObjectiveThe purpose of this study was to assess the prevalence of temporomandibular joint disorders in wind instrument players and to establish the relationship between the practice of a wind instrument and the development of temporomandibular disorders. Materials and MethodsA cross‐sectional observational descriptive study, was conducted to determine the prevalence of temporomandibular joint disorders in students of winds instruments, at Escola Profissional de Artes da Beira Interior (Covilhã ‐ Portugal), using the Portuguese version of the Research Diagnostic Criteria for Temporomandibular Disorders and to evaluate possible risk factors associated with it. Analysis was performed using IBM© SPSS© Statistics vs.20.0 (α=0.05). ResultsIt was found a prevalence of 68.3% of individuals with temporomandibular joint pathology, of which 29.3% were diagnosed with disc displacement (DD) with reduction, 14.6% DD without reduction without limited opening, 17.1% with arthralgia, 24.4% with osteoarthritis and 19.5% with osteoarthrosis. None of the observed students had a diagnosis of DD without reduction with limited opening. A significant age difference of the wind instrument players was detected for the intra‐articular temporomandibular disorders (ANOVA, p=0.014), being the ones without diagnosis significantly younger than the ones with DD with reduction (T.Scheffé, p=0.021), but no difference was detected between the ones with DD without reduction/without limitation and the others. There was not an association between diagnosis and the type of instrument played (p>0.05). ConclusionIn multivariable analysis, risk factors associated with the development of temporomandibular disorder were, age and the interaction age and years of instrument practice.

Physical therapy and anesthetic blockage for treating temporomandibular disorders: A clinical trial

Purpose: the aim of this study was to evaluate the use of physical therapy and anesthetic blockage of the auriculotemporal nerve as a treatment for temporomandibular joint disorders. Methods: the sample comprised of twenty patients with a diagnosis of disc displacement with/ without reduction and arthralgia according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD Axis I Group IIa, IIb and IIIa). Ten patients (group 1) underwent a cycle of eight anesthetic blockages of the auriculotemporal nerve with injections (1 per week) of 1 ml of bupivacaine 0.5% without vasoconstrictor for 8 weeks. The other 10 patients (group 2) received anesthetic blockage and physical therapy (massage and muscular stretching exercises). After the end of treatment all patients were evaluated at baseline, 1st week, 4th week and 2 months. The t-Student and F (ANOVA) tests were used for statistical analysis, with a significance rate of 5%. Results: there was a significant difference when both groups were compared according to VAS score (p=0.027). There was no significant difference for the other variables: MMO and jaw protrusion. Conclusion: the anesthetic blockage and physical therapy, when used together, are effective in the reduction of pain in patients with TMD. Key words:Temporomandibular joint disorders, physical therapy, physiotherapy and nerve block, local anesthetic, bupivacaine.

Lavage treatment of painful jaw movements at disc displacement without reduction. A randomized controlled trial in a short-term perspective

This study compared the short-term efficacy of two treatments (local anesthetics (A) and local anesthetics and lavage (AL)) in patients with permanently displaced discs and temporomandibular disorder (TMD) pain. 45 patients participated in the single-blind randomized controlled trial. All patients had received: a Research Diagnostic Criteria/TMD diagnosis of disc displacement without reduction; and magnetic resonance imaging confirmation of non-reducing disc displacement. Participants were randomized to treatment with A or AL and were assessed at baseline and at 1 and 3 month follow-ups. The primary outcome measure defining success was reduction in pain intensity of at least 30% during jaw movement. At the 3 month follow-up, the success rate was 76% for A and 55% for AL. Both groups reported similar pain relief with no significant difference between the groups. Similar trends were observed for outcome measures in the physical functioning, emotional functioning, and global improvement domains with no significant difference between the groups. Use of lavage to supplement extra-articular local anesthetic treatment of painful jaw movements at non-reducing discs does not appear to improve TMD pain and mouth opening capacity in the short term.

Ultrasonography for Detection of Disc Displacement of Temporomandibular Joint: A Systematic Review and Meta-Analysis

To assess the diagnostic efficacy of ultrasonography in detecting disc displacement of the temporomandibular joint. MEDLINE (using OVID, 1950 to April 2011), EMBASE (1980 to April 2011), and the Chinese Biomedical Literature Database (1978 to April 2011) were searched electronically. In addition, relevant journals and reference lists of the included studies were manually searched for any eligible studies on diagnostic accuracy. Two authors performed the study inclusion, data extraction, and risk of bias assessment in duplicate. Meta-analysis was performed with MetaDisc 1.4. Fifteen studies were included in this meta-analysis; 6 studies had a low risk of bias, 6 studies an unclear risk, and 3 studies a high risk. Meta-regression indicated that the detected results were not influenced by the types of ultrasonography, image dimensions, types of transducer, and ultrasonic image of the disc (P > .05). The Q* values of ultrasonography for the closed- and open-mouth positions were 0.79 and 0.91, respectively. The diagnostic efficacy of disc displacement with reduction had a sensitivity of 0.76, a specificity of 0.82, a positive likelihood ratio of 3.80, a negative likelihood ratio of 0.36, a diagnostic odds ratio of 10.95, an area under the curve of 0.83, and a Q* of 0.76. The diagnostic efficacy of disc displacement without reduction had a sensitivity of 0.79, a specificity of 0.91, a positive likelihood ratio of 80.5, a negative likelihood ratio of 0.25, diagnostic odds ratio of 36.80, an area under the curve of 0.97, and a Q* of 0.92. The diagnostic efficacy of ultrasonography is acceptable and can be used as a rapid preliminary diagnostic method to exclude some clinical suspicions. However, positive ultrasonographic findings should be confirmed by magnetic resonance imaging. Also, the ability of ultrasonography to detect lateral and posterior displacements is still unclear. More high-quality studies are needed to assess the diagnostic efficacies of some specific ultrasonographic methods. Standards and criteria for ultrasonographic techniques in the diagnosis of disc displacement should be established in the future.

Analysis of Criteria for MRI Diagnosis of TMJ Disc Displacement and Arthralgia.

Aims. To improve diagnostic criteria for TMJ disc displacement (DD). Methods. The standard protocol for MRI diagnosis of DD, using a 12 o'clock reference position, was compared to an alternative protocol. The alternative protocol involves the functional relationship between the condyle and articular eminence, using a line perpendicular to the posterior slope of the eminence as a reference for disc position. The disc location was examined using both protocols, and disc diagnoses were compared in their relationship with joint pain. Statistical analyses included P value, sensitivity, specificity, odds ratio, and kappa statistic. Results. 58 MRIs were interpreted. 36 subjects reported arthralgia; 22 did not. Both protocols demonstrated significance (standard P = 0.004, alternative P < 0.001) for the ability to predict arthralgia. The odds of arthralgia increased in DD patients diagnosed by standard methods 9.71 times and in DD diagnosed by alternative means 37.15 times. The diagnostic sensitivity decreased 30% using the alternative versus the standard protocol (0.6389 versus 0.9444), while specificity increased 60% (0.9545 versus 0.3636). Conclusions. A stronger relationship occurs between DD and arthralgia when using a function-based protocol. The alternative protocol correctly identifies subjects without arthralgia, who by standard methods would be diagnosed with DD, as having nondisplaced discs, providing a more clinically relevant assessment of TMJ disc displacement.

The impact of imaging technologies on temporomandibular joint disorder diagnosis

Medline, the Cochrane Library databases and reference list of review articles were searched. Three examiners selected publications. To be included the publication had to elucidate the diagnostic thinking efficacy and/or therapeutic efficacy of MRI and/or CT in the diagnosis of disc displacement, inflammatory disorders (capsulitis, synovitis) and osteoarthrosis of the temporomandibular joint (TMJ). Publications related to trauma, tumours, systemic diseases, synovial chondromatosis; cadaver studies; narrative literature reviews; and studies of other TMJ imaging methods were excluded. Data were extracted by three examiners with disputes being settled by consensus. Study quality was assessed using the QUADAS tool.(1) No synthesis was performed as only one study was identified. One study was judged relevant. This study evaluated evidence of the efficacy of MRI in the diagnosis of disc position and configuration, disc perforation, joint effusion, and osseous and bone marrow changes in the temporomandibular joint, but no publication reported diagnostic thinking efficacy or therapeutic efficacy. The absence of studies on the therapeutic efficacy of MRI and CT on TMJD reinforces the need for investment in decision-making studies; meanwhile, sectional imaging tests should be prescribed with caution, especially when health budgets are limited.