Diagnostic ultrasound assessment of temporomandibular joints: a systematic review and meta-analysis

Abstract

Objectives:: The purpose of this systematic review was to determine the diagnostic capability of ultrasound to assess TMJ alterations as disc displacement (DD), joint effusion (JE) and condylar changes (CC) using 3D imaging modalities as reference standard.

Methods:: Studies were gathered by searching several electronic databases and partial grey literature up to January eighth, 2018 without restrictions of language and time. The risk of bias was evaluated using the second version of Quality Assessment Tool for Diagnostic of Accuracy Studies-2 (QUADAS-2). The grading of Recommendation, Assessment, Development and Evaluation (GRADEpro system) instrument was applied to assess the level of evidence across the studies.

Results:: After applying the eligibility criteria, 28 studies were identified and synthesized. All studies were methodologically acceptable presenting low applicability concerns, although none of them fulfilled all QUADAS-2 criteria. The quantitative analysis included 22 studies, 2829 joints in total. The quality of the evidence evaluated by GRADE system suggested moderate confidence in estimating the outcomes.

Conclusion:: This systematic review demonstrated the ultrasound has acceptable capability to screen for DD and JE in TMD patients. For screening of condylar changes, ultrasound needs further studies using CT or CBCT as reference standard to support its use. More advanced imaging such as MRI can thereafter be used to confirm the diagnosis if deemed necessary.

Keywords: systematic review; temporomandibular joint; temporomandibular joint disorder; ultrasound.

Figure 1.

Flow Diagram of literature search and selection criteria adapted from PRISMA.

Figure 2.

Risk of bias and applicability concerns graph: review authors’ judgments about each domain presented as percentages across included studies. (A) Risk of bias graph; (B) Risk of bias summary.

Figure 3.

Forest plot with the diagnostic test accuracy (DTA) of each study (sensitivity, specificity and 95% confidence interval) and heterogeneity assessment. (A) Forest plot with the diagnostic test accuracy (DTA) for US to DD assessment; (B) Forest plot with the diagnostic test accuracy (DTA) for US to JE assessment; (C) Forest plot with the diagnostic test accuracy (DTA) for US to CC assessment.

Figure 4.

Receiver operating characteristic (ROC) curves for each group. (A) ROC curve for US to DD assessment; (B) ROC curve for US to JE assessment; (C): ROC curve for US to CC assessment.

Figure 5.

Publication bias assessment. Deeks’ funnel plot with superimposed regression line. (A) Deeks’ funnel plot for US to DD assessment; (B) Deeks’ funnel plot for US to JE assessment; (C) Deeks’ funnel plot for US to CC assessment.