Maranini Beatrice, Ciancio Giovanni, Mandrioli Stefano, Galiè Manlio, Govoni Marcello
Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
Department of Cranio-Maxillofacial Surgery, Unit of Cranio-Maxillofacial Surgery, University of Ferrara, Ferrara, Italy.
Front Med (Lausanne). 2022 Jun 20;9:926573. doi: 10.3389/fmed.2022.926573. eCollection 2022.
Temporomandibular joint (TMJ) disorder is the second most common chronic pain condition affecting the general population after back pain. It encompasses a complex set of conditions, manifesting with jaw pain and limitation in mouth opening, influencing chewing, eating, speaking, and facial expression. TMJ dysfunction could be related to mechanical abnormalities or underlying inflammatory arthropathies, such as rheumatoid arthritis (RA) or juvenile idiopathic arthritis (JIA). TMJ exhibits a complex anatomy, and thus a thorough investigation is required to detect the TMJ abnormalities. Importantly, TMJ involvement can be completely asymptomatic during the early stages of the disease, showing no clinically detectable signs, exposing patients to delayed diagnosis, and progressive irreversible condylar damage. For the prevention of JIA complications, early diagnosis is therefore essential. Currently, magnetic resonance imaging (MRI) is described in the literature as the gold standard method to evaluate TMJ. However, it is a high-cost procedure, not available in all centers, and requires a long time for image acquisition, which could represent a problem notably in the pediatric population. It also suffers restricted usage in patients with claustrophobia. Ultrasonography (US) has emerged in recent years as an alternative diagnostic method, as it is less expensive, not invasive, and does not demand special facilities. In this narrative review, we will investigate the power of US in TMJ disorders based on the most relevant literature data, from an early screening of TMJ changes to differential diagnosis and monitoring. We then propose a potential algorithm to optimize the management of TMJ pathology, questioning what would be the role of ultrasonographic study.
颞下颌关节（TMJ）紊乱是继背痛之后影响普通人群的第二常见慢性疼痛病症。它包含一系列复杂的病症，表现为颌部疼痛和张口受限，影响咀嚼、进食、说话及面部表情。TMJ功能障碍可能与机械性异常或潜在的炎性关节病有关，如类风湿关节炎（RA）或幼年特发性关节炎（JIA）。TMJ解剖结构复杂，因此需要进行全面检查以检测TMJ异常。重要的是，在疾病早期TMJ受累可能完全没有症状，无临床可检测到的体征，这会使患者延迟诊断，并导致髁突进行性不可逆损伤。因此，为预防JIA并发症，早期诊断至关重要。目前，文献中将磁共振成像（MRI）描述为评估TMJ的金标准方法。然而，它成本高昂，并非所有中心都能提供，且图像采集需要很长时间，这在儿科人群中尤其成问题。对于幽闭恐惧症患者，其使用也受到限制。近年来，超声检查（US）已成为一种替代诊断方法，因为它成本较低、非侵入性且不需要特殊设备。在这篇叙述性综述中，我们将根据最相关的文献数据，研究US在TMJ紊乱中的作用，从TMJ变化的早期筛查到鉴别诊断和监测。然后我们提出一种潜在的算法来优化TMJ病理的管理，并质疑超声检查的作用是什么。
