de Boer E W J, Dijkstra P U, Stegenga B, de Bont L G M, Spijkervet F K L
Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands; Department of Rehabilitation Medicine, Centre for Rehabilitation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
Br J Oral Maxillofac Surg. 2014 Mar;52(3):241-6. doi: 10.1016/j.bjoms.2013.12.007. Epub 2014 Jan 14.
The objective of this study was to assess the value of cone-beam computed tomographic (CT) images in the primary diagnosis and management of 128 outpatients with disorders of the temporomandibular joint (TMJ). Before a diagnosis was made and treatment planned, the history was taken, physical examination made, and the orthopantomogram studied. After assessment of the cone-beam CT, the oral and maxillofacial surgeon (specialist or resident) was allowed to revise the provisional primary diagnosis and management. The degree of certainty was rated by the clinician before and after the cone-beam CT had been assessed. The primary diagnosis was changed in 32 patients (25%), additional diagnostic procedures were changed in 57 (45%), and the treatment was changed in 15 (12%) (in 4 the treatment was changed to a (minimally) invasive procedure). A total of 74 patients (58%) had their diagnosis and management changed after the cone-beam CT had been assessed. Changes in diagnosis and management were clinically relevant in 9/32 and 9/61 patients, respectively. The clinician's certainty about the primary diagnosis increased after the cone-beam CT had been assessed in 57 patients. Logistic regression analysis showed that the odds in favour of changes in primary diagnosis and management increased when limited mandibular function was a primary symptom, the patient was taking medication for pain, and the articular eminence could not be assessed on OPT. Assessment of cone-beam CT led to changes in primary diagnosis and management in more than half the patients with disorders of the TMJ.
本研究的目的是评估锥形束计算机断层扫描（CT）图像在128例颞下颌关节（TMJ）疾病门诊患者的初步诊断和治疗中的价值。在做出诊断和制定治疗计划之前，先采集病史、进行体格检查并研究曲面断层片。在评估锥形束CT之后，允许口腔颌面外科医生（专科医生或住院医生）修改初步诊断和治疗方案。在评估锥形束CT之前和之后，由临床医生对确定程度进行评级。32例患者（25%）的初步诊断发生了改变，57例（45%）的额外诊断程序发生了改变，15例（12%）的治疗方案发生了改变（其中4例的治疗方案改为（微创）手术）。在评估锥形束CT之后，共有74例患者（58%）的诊断和治疗方案发生了改变。诊断和治疗方案的改变在分别9/32和9/61例患者中具有临床相关性。在评估锥形束CT之后，57例患者对初步诊断的确定性增加。逻辑回归分析表明，当下颌功能受限为主要症状、患者正在服用止痛药物且在曲面断层片上无法评估关节结节时，初步诊断和治疗方案改变的可能性增加。对锥形束CT的评估导致超过一半的颞下颌关节疾病患者的初步诊断和治疗方案发生改变。
