DIAGNOSIS OF MEDIAL DISPLACEMENT OF THE TEMPOROMANDIBULAR JOINT DISC AND MONITORING OF TREATMENT EFFECTIVENESS USING ULTRASOUND IMAGING: A CLINICAL CASE

Abstract

Displacements of the articular disc of the temporomandibular joint (TMJ) are diagnosed in 70–89 % of patients with internal derangements. Magnetic resonance imaging (MRI) remains the 'gold standard' of TMJ diagnosis. Anterior (ventral) displacements are successfully detected both by MRI and by ultrasound examination (US), which allows assessing the treatment effectiveness in dynamics without limitations on the number of examinations. At the same time, lateral variants of disc dislocation (medial, lateral, as well as ventro-medial and ventro-lateral) are confirmed exclusively by MRI. Because of this, the frequency of monitoring of patients with such disorders does not exceed 1–2 times per year, which reduces the quality of disease control. To date, visualizing lateral (in particular, medial) disc displacements and assessing treatment effectiveness using ultrasound has not been possible due to the absence of an appropriate technique. Thus, the development of an ultrasound technique for detecting lateral displacements of the TMJ articular disc is a relevant task, which will expand the diagnostic capabilities of ultrasound and make treatment control more accessible. Objective. To prove the effectiveness of using ultrasound in visualizing medial displacement of the TMJ disc and monitoring treatment efficacy using the developed technique. Materials and Methods. A 62-year-old female patient Sh. was examined, presenting with complaints of pain and clicking in both TMJs, aural fullness, and tinnitus. Standard ultrasound and MRI were used, as well as our original technique for ultrasound visualization of medial disc displacement of the TMJ (patent for invention No. 2858673). Results. Over 15 months of using an individual occlusal splint, the proposed ultrasound technique revealed positive treatment dynamics in patient Sh.: the thickness of the medial portion of the right TMJ disc decreased from 2,1 mm to 1,1 mm, indicating resolution of the medial disc dislocation. Ultrasound findings were confirmed by post-treatment MRI results. Conclusion. Our developed ultrasound technique effectively diagnoses and quantifies medial displacement of the TMJ disc, serving as an accessible alternative to MRI for monitoring treatment efficacy.