Diagnosis of temporomandibular joint disorders: indication of imaging exams

Ferreira, Luciano Ambrosio; Grossmann, Eduardo; Januzzi, Eduardo; Paula, Marcos Vinicius Queiroz de; Carvalho, Antonio Carlos Pires

doi:10.1016/j.bjorl.2015.06.010

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Brazilian Journal of Otorhinolaryngology

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REVIEW ARTICLES • Braz. j. otorhinolaryngol. 82 (03) • May-Jun 2016 • https://doi.org/10.1016/j.bjorl.2015.06.010 copy

Diagnosis of temporomandibular joint disorders: indication of imaging exams^{^☆} ☆ Please cite this article as: Ferreira LA, Grossmann E, Januzzi E, de Paula MVQ, Carvalho ACP. Diagnosis of temporomandibular joint disorders: indication of imaging exams. Braz J Otorhinolaryngol. 2016;82:341-52.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

INTRODUCTION:

Knowledge of the different imaging tests and their appropriate indications is crucial to establish the diagnosis of temporomandibular disorders, especially in patients with overlapping signs and symptoms.

OBJECTIVE:

To present and assess the main diagnostic imaging tests for temporomandibular disorders and rationally discuss their indication criteria, advantages, and disadvantages.

METHODS:

Literature review in the Web of Knowledge, PubMed and SciELO databases, as well as manual search for relevant publications in reference lists of the selected articles.

RESULTS:

Computed tomography and magnetic resonance imaging were considered the gold standard assessments for the temporomandibular joint to evaluate hard and soft tissues, respectively. Each diagnostic method exhibited distinct sensitivity and specificity for the different subtypes of joint dysfunction.

CONCLUSION:

Selecting an evaluation examination based on its accuracy, safety, and clinical relevance is a rational decision that can help lead to an accurate diagnosis and an optimum treatment plan.

Keywords:
Temporomandibular joint disorders; Diagnostic imaging; Temporomandibular joint; Magnetic resonance imaging; X-ray computed tomography; Radiography

Disorders	Assessed sign	Panoramic^{1, 3, 13, 14, 16, 18 and 29}	Transcranial^{1, 3, 13, 14, 16, 17, 18 and 29}	Planigraphy^{1, 3, 13, 14, 16, 18 and 29}	Arthrography^{1, 3, 13, 14, 16, 17, 18, 20 and 29}
Congenital and developmental
Aplasia	Absence of structure	^b	^c	^c	^a
Hypoplasia	Dimensional reduction	^b	^c	^c	^a
Hyperplasia	Dimensional increase	^b	^c	^c	^a
Dysplasia	Structural alteration	^b	^c	^c	^a

Acquired
Neoplasias	Bone formation/destruction	^b	^c	^c	^a
	Soft tissue growth	–	–	–	–
	Metastasis	^a	^a	^a	–

Disc derangement
With reduction	Recapture in MMO	–	–	–	^c
Without reduction	No recapture in MMO	–	–	–	^c
TMJ displacement	Open locking, clinical diagnosis	^a	^c	^c	^a

Inflammatory disorders
Synovitis/capsulitis	Effusion, inflammation, capsular edema	–	–	–	–
Polyarthritis	Polyarticular, cortical alteration, remodeling	^b	^b	^b	^a
Non-inflammatory disorders/primary or secondary osteoarthritis	Uni-/bilateral, cortical alteration, remodeling	^b	^b	^b	^a
Ankylosis	Bone formation, impaired excursion	^c	^c	^c	^b
Fracture (condylar process)	Asymmetry, fracture line	^c	^b	^c	^b
Odontogenic conditions	Cists, tumors, periapical disease	^c	–	–	–
Of the styloid process	Elongation calcification	^c	–	^c	–
Of the major salivary glands	Sialolithiasis, inflammation	^a	–	–	–
Of the condylar excursion (hypo/hyper)	Condylar x mandibular tubercle ratio in MMO	–	^c	^c	^b
Of the joint disc form	TMJ disc form alteration and perforation	–	–	–	^d
Of the adjacent bone structures	Alterations in coronoid and mastoid processes	^c	–	^c	–
Of adjacent soft tissues	Alterations in the ligaments, retrodiscal area, masticatory muscles	–	–	–	–

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] * Corresponding author. E-mail:lucianoaf369@gmail.com (L.A. Ferreira).

Congenital or developmental disorders	Hyperplasia
Acquired disorders	Dysplasia
Disorders of disc derangement	Neoplasias
TMJ displacement (dislocation)	Disc displacement with reduction
Inflammatory disorders	Disc displacement without reduction
Non-Inflammatory disorders	Synovitis and capsulitis
Ankylosis	Polyarthritis
Fracture (condylar process)	Primary osteoarthritis
Aplasia	Secondary osteoarthritis
Hypoplasia

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Diagnosis of temporomandibular joint disorders: indication of imaging exams☆ ☆ Please cite this article as: Ferreira LA, Grossmann E, Januzzi E, de Paula MVQ, Carvalho ACP. Diagnosis of temporomandibular joint disorders: indication of imaging exams. Braz J Otorhinolaryngol. 2016;82:341-52.

ABSTRACT

INTRODUCTION:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Diagnosis of temporomandibular joint disorders: indication of imaging exams^{^☆} ☆ Please cite this article as: Ferreira LA, Grossmann E, Januzzi E, de Paula MVQ, Carvalho ACP. Diagnosis of temporomandibular joint disorders: indication of imaging exams. Braz J Otorhinolaryngol. 2016;82:341-52.