Yatani H, Suzuki K, Kuboki T, Matsuka Y, Maekawa K, Yamashita A
Department of Fixed Prosthodontics, Okayama University Dental School, Japan.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Jun;85(6):654-60. doi: 10.1016/s1079-2104(98)90031-2.
The objective of this study was to evaluate the diagnostic accuracy of patient history and clinical signs as confirmed by magnetic resonance imaging examination for diagnosing anterior disk displacement without reduction.
A series of 273 consecutive patients with temporomandibular disorders were clinically examined according to well-defined criteria. Patients were first asked if they had a history of clicking. The following clinical characteristics of anterior disk displacement without reduction were then assessed: (1) maximal mouth opening less than 40 mm; (2) deflection of the mandible to the affected side at the maximal mouth opening position; (3) limitation of condylar translation on palpation during maximal mouth opening; (4) preauricular pain during mandibular movements; and (5) crepitation. Bilateral magnetic resonance images were obtained for all patients, and the magnetic resonance imaging interpretation was compared with the clinical examination findings to assess the diagnostic accuracy of the clinical findings.
The sensitivity was considerably low in contrast with the relatively high specificity for all six clinical parameters tested. The overall accuracies of the clinical parameters ranged from 71% to 81%.
Our results suggest that the predictability of historical or clinical findings to differentiate anterior disk displacement without reduction from other diagnoses is not high.
本研究的目的是评估通过磁共振成像检查确诊的患者病史和临床体征对诊断不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。首先询问患者是否有弹响史。然后评估不可复性盘前移位的以下临床特征：（1）最大开口度小于40mm；（2）最大开口位时下颌偏向患侧；（3）最大开口时触诊髁突平移受限；（4）下颌运动时耳前区疼痛；（5）摩擦音。对所有患者均进行双侧磁共振成像检查，并将磁共振成像解读结果与临床检查结果进行比较，以评估临床检查结果的诊断准确性。
与所测试的所有六个临床参数相对较高的特异性相比，敏感性相当低。临床参数的总体准确率在71%至81%之间。
我们的结果表明，病史或临床检查结果将不可复性盘前移位与其他诊断区分开来的可预测性不高。
