Yatani H, Sonoyama W, Kuboki T, Matsuka Y, Orsini M G, Yamashita A
Department of Fixed Prosthodontics, Okayama University Dental School, Japan.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Jun;85(6):647-53. doi: 10.1016/s1079-2104(98)90030-0.
The objective of this study was to evaluate the diagnostic accuracy of a clinical examination for diagnosing anterior disk displacement with reduction.
A series of 273 consecutive patients with temporomandibular disorders were clinically examined according to well-defined criteria. The patients were examined for clicking by digital palpation during maximal mouth opening and closing (the Clicking test). When clicking was identified, two additional tests were performed: one determined whether the clicking was eliminated at a protruded position, and the other determined whether the clicking became louder when the patient's mandible was manipulated toward the eminences. Bilateral magnetic resonance images were subsequently obtained from all patients; the clinical examination findings were then compared to the imaging-based diagnoses of the temporomandibular joint status to assess the diagnostic accuracy of the clinical findings.
Although the predictability of identifying anterior disk displacement with reduction by clicking was relatively low, it increased to an acceptable level when the additional tests were used. The overall accuracy for the Clicking test combined with either of the other tests was about 90%.
Our results suggest that anterior disk displacement with reduction can be diagnosed with considerable accuracy through the use of a clinical examination only.
本研究的目的是评估临床检查对诊断可复性盘前移位的诊断准确性。
根据明确的标准对连续273例颞下颌关节紊乱患者进行临床检查。在患者最大开口和闭口时通过数字触诊检查弹响（弹响试验）。当发现弹响时，进行另外两项检查：一项检查确定在突出位置时弹响是否消失，另一项检查确定当患者下颌向关节结节移动时弹响是否变大。随后对所有患者进行双侧磁共振成像检查；然后将临床检查结果与基于影像学的颞下颌关节状态诊断进行比较，以评估临床检查结果的诊断准确性。
尽管通过弹响来识别可复性盘前移位的可预测性相对较低，但当使用另外两项检查时，其可预测性提高到了可接受的水平。弹响试验与另外两项检查中的任何一项相结合的总体准确率约为90%。
我们的结果表明，仅通过临床检查就可以相当准确地诊断可复性盘前移位。
