UNIVERSIDADE ESTADUAL PAULISTA
“JÚLIO DE MESQUITA FILHO”
Instituto de Ciência e Tecnologia
Campus de São José dos Campos
ORIGINAL ARTICLE DOI: https://doi.org/10.4322/bds.2023.e3435
1
Braz Dent Sci 2023 Apr/Jun;26 (2): e3435
Efficacy of ultrasonography in diagnosis of temporomandibular
joint soft tissue injury induced by mandibular fractures:
randomized clinical trial
Eficácia da ultrassonografia no diagnóstico de lesões em tecidos moles da articulação temporomandibular induzidas por
fraturas mandibulares: ensaio clínico randomizado
Akram Thabet NASHER
1
, Sam Abdul-kareem DAER
1
, Abdulla Hussan FARHAN
1
, Mohammed Sultan AL-AK’HALI
2,3
,
Nuha Mohammed Ghalb FAREA
4
1 - Sana’a University, Faculty of Dentistry, Department of Oral Surgery, Oral Maxillofacial Surgery. Sana’a, Yemen.
2 - Jazan University, College of Dentistry, Department of Preventive Dentistry. Jizan, Saudi Arabia.
3 - Sana’a University, Faculty of Dentistry, Department of Periodontology. Sana’a, Yemen.
4 - University of Science and Technology, College of Dentistry, Department of Preventive Dentistry. Sana’a, Yemen.
How to cite: Nasher AT, Daer SA, Farhan AH, Al-ak’hali MS, Farea N. Efcacy of ultrasonography in diagnosis of temporomandibular joint
soft tissue injury induced by mandibular fractures: randomized clinical trial. Braz Dent Sci. 2023;26(2):e3435. https://doi.org/10.4322/
bds.2023.e3435
Abstract
Objective: the aim of this study was to evaluate the efcacy of ultrasonography in diagnosis of tempromandibular
joint soft tissue injury after mandibular osteosynthesis.
Material and Methods: ten male patients (20 joint) with age ranged between 20-28 years were collected from
those attending the outpatient clinic of Oral and Maxillofacial Surgery Department, Al-Kuwait Hospital, Sana’a
University. Patients were divided into two groups according to the number of fracture line in the mandible. All
patients were randomly assigned to diagnosis of the soft tissue changes of temporomandibular joint by either
ultrasonography or magnetic resonance image preoperatively, after 2 weeks and 3 months postoperatively.
Results: preoperatively, there was moderate agreement between ultrasonography and magnetic resonance
image in the diagnosis of abnormal ndings in both groups, the difference was not statistically signicant. In
group I, ultrasonography of the temporomandibular joint didn’t detect any abnormal ndings after mandibular
osteosynthesis, meanwhile, magnetic resonance image recorded abnormal ndings 40% and 20% after 2 weeks
and 3 months respectively. In group II, the diagnosis of abnormal ndings was the same (80%) pre and
postoperatively by using magnetic resonance image however, the percent of abnormal ndings was reduced
from 60% preoperatively to 40% postoperatively by using ultrasonography. Conclusion: the ultrasonographic
image was not able to identify or diagnosis the disc position changes after indirect trauma. However, it had to
some extent a role in the identication and diagnosis of effusion in temporomandibular joint.
KEYWORDS
Magnetic resonance imaging; Temporomandibular joint; Ultrasonography; Mandibular fractures; Injury.
Resumo
Objetivo: o objetivo deste estudo consistiu em avaliar a ecácia da ultrassonograa no diagnóstico de lesões nos tecidos
moles da articulação temporomandibular após a osteossíntese mandibular. Material e Métodos: dez pacientes do
sexo masculino (no total de 20 indivíduos) de idades entre 20 e 28 anos foram selecionados do serviço ambulatorial
do Departamento de Cirurgia Oral e Maxilo-facial, Hospital Al-Kuwait, Universidade de Sana’a. Os indivíduos incluídos
foram distribuídos em dois grupos, de acordo com o número de linhas de fratura presentes na mandíbula. Todos os
pacientes foram aleatoriamente alocados e divididos, com base no diagnóstico das alterações dos tecidos moles da
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Braz Dent Sci 2023 Apr/Jun;26 (2): e3435
Nasher AT et al.
Efficacy of ultrasonography in diagnosis of temporomandibular joint soft tissue injury induced by mandibular fractures: randomized clinical trial
Nasher AT et al.
Efficacy of ultrasonography in diagnosis of temporomandibular
joint soft tissue injury induced by mandibular fractures:
randomized clinical trial
INTRODUCTION
The mandibular trauma is one of the
etiologic factors in the development of the
temporomandibular joint (TMJ) soft tissue
changes [1-3]. The diagnosis of temporomandibular
joint disorder after trauma is a challenge. Magnetic
resonance imaging (MRI) is considered the
modality of choice for the evaluation of soft and
hard tissues of the TMJ and is the most accurate
non-invasive method of visualizing the disc-
condyle relation [4-6]. In many institutions MRI
was the preferred examination for TMJ soft tissue
pathology. The disc position and morphology and
the bone structures are clearly visualized on closed
and open mouth images on MRI. In recent years
MRI has become the standard of reference for the
evaluation of the disc-condyle relationship, this
allows dynamic assessment of disc, which is often
the implicated structure in temporomandibular
joint disorders [7-9]. On the other hand, MRI is
an expensive examination because of the cost of
the equipment, facilities, stafng, and replacement
cryogens for the magnet. It is contraindicated in
certain patients, such as those with pacemakers,
intracranial vascular clips, metal particles in the eye
or other vital structures, an implanted or external
medication pump, and A cochlear (inner ear)
implant. Other relative contraindications include
patient obesity, claustrophobia, or an inability to
remain motionless for the examination, which may
take several minutes to complete examination. For
these reasons, this method cannot be classied
as a routine examination [10,11]. The use of
ultrasonography (US) is an alternative diagnostic
method and specific non-invasive technique
enabling dynamic imaging of the TMJ. It is capable
of demonstrating articular capsule, the disc and
the bone boundary of the laterosuperior aspect
of the condyle. Moreover, it is cheap, not time
consuming, high-resolution, comfortable, available
for patients and it can be readily applied without
restrictions [10,12]. Alashiry et al. [13], reported
that the ultrasonography was less sensitive or
specic than was MR imaging in detecting internal
derangement in the TMJ. However, internal
derangement of the TMJ should be suspected if
a distance between the superior surface of the
condyle and the inferior surface of the glenoid
fossa (disc space) more than 7 mm in closed mouth
position and more than 10 mm in opened mouth
position. So the signicance of ultrasonography as
non-invasive and signicantly low cost diagnostic
technique can be used for patients clinically
suspected to have TMJ disorders to exclude the
negative results before request the more expensive
and invasive images especially in patients with
limitation to be examined by MRI such as patients
with artificial metallic devices, vascular clips,
pacemaker or even during pregnancy. However,
US shows agreement with MRI in detecting normal
condyle disc relation, anterior disc displacement
with reduction (ADDWR), and disc displacement
without reduction [14-16]. This study aims
to evaluate the efficacy of ultrasonography in
diagnosis of tempromandibular joint soft tissue
injury after mandibular osteosynthesis.
MATERIAL AND METHODS
Study design
Randomized clinical trials study was
conducted in Yemen from April 2019 to March
2020. 20 Patients of the present study were
collected from those attending the outpatient clinic
of Oral and Maxillofacial Surgery Department,
Al-Kuwait Hospital, Sana’a University.
articulação temporomandibular por ultrassonograa ou ressonância magnética no pré-operatório e em intervalos de
2 semanas e 3 meses no pós-operatório. Resultados: no pré-operatório, houve uma concordância moderada entre
a ultrassonograa e a ressonância magnética no diagnóstico de achados anormais em ambos os grupos; a diferença
não foi estatisticamente signicativa. No grupo I, a ultrassonograa da articulação temporomandibular não revelou
quaisquer achados anormais após a osteossíntese mandibular, enquanto a ressonância magnética registou achados
anormais em 40% e 20% dos casos após 2 semanas e 3 meses, respectivamente. No grupo II, o diagnóstico das
anormalidades por ressonância magnética foi o mesmo (80%) no pré e pós-operatório; contudo, a percentagem de
casos anormais por ultrassonograa foi reduzida de 60% no pré-operatório para 40% no pós-operatório. Conclusão:
a imagem ultrassonográca não foi capaz de detectar alterações de posição do disco após trauma indireto. Entretanto,
em certa medida, contribuiu para a identicação e diagnóstico de efusão na articulação temporomandibular.
PALAVRAS-CHAVE
Ressonância magnética; Articulação temporomandibular; Ultrassonograa; Fraturas mandibulares; Lesão.
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Braz Dent Sci 2023 Apr/Jun;26 (2): e3435
Nasher AT et al.
Efficacy of ultrasonography in diagnosis of temporomandibular joint soft tissue injury induced by mandibular fractures: randomized clinical trial
Nasher AT et al.
Efficacy of ultrasonography in diagnosis of temporomandibular
joint soft tissue injury induced by mandibular fractures:
randomized clinical trial
Inclusion and exclusion criteria
Any patient with an age range between 20 and
30 years and had one fracture line or more in the
mandible and scheduled for reduction and xation
of the fracture line by miniplate osteosynthesis was
included in this study. Patients that have a previous
temporomandibular joint disorder, previous surgery
in the temporomandibular joint and those that have
condylar or sub condylar fractures were excluded
from this study. Patients were included according
to their commitment to attend the specied periods
for clinical and radiological diagnosis, so any patient
who did not return for clinical and radiographical
evaluations was excluded.
Ethical approval
All of the participants provided written
informed consent before they were enrolled in
this study. This study was approved by the Sana’a
University, Faculty of Dentistry prior to the study
IRB Reg. No: 25/ 10-3-2019.
Sampling method
Patients were divided into two groups
according to the number of fracture line in the
mandible. Group I: patients having one fracture line.
Group II: patients having more than one fracture
line. Each of both groups was consisted of 5 patients,
scheduled for reduction and xation of fracture
line by miniplate osteosynthesis. Both groups of
patients were randomly assigned to diagnosis of
the soft tissue changes of temporomandibular joint
by either ultrasonography or Magnetic resonance
image preoperatively, after 2 weeks and 3 months
postoperatively.
Clinical oral examination
The clinical diagnosis was made by a
specialist in oral and maxillofacial surgery. The
assessment of the temporomandibular joint in
both sides was carried out clinically by asking
the patient about any change that he feel after
trauma. Palpation of condylar movement as
well as measurement of interincisal distance
(protrusion, lateral excursions) were taken for
each patient [17].
Imaging tests
Imaging tests were done by a well
experience radiologist at Kuwait Hospital using
ultrasonography [13] Figure 1 and Magnetic
resonance imaging [9] Figures 2A and 2B to conrm
the existed situation of the temporomandibular joint
preoperatively and compare it with the postoperative
intervals after two weeks and three months.
Magnetic resonance imaging was performed on 1.5
teslaiv super conductive magnet (Philips, Gyroscan,
Intera, Netherlands) using temporomandibular
joint coil. The imaging protocol consisted of
temporomandibular joint imaging by utilizaing T1,
T2, and proton density images performed in closed
mouth, and maximum mouth opening (for both
sides). The bite block device was used to stabilize
the patient’s jaw in the open mouth position. All
images were obtained in spin echo technique. The
patient was laid in the supine position and resting
within the surface coil holders.
The imaging was taken in different planes
and different pulse sequences. All patients had
T1, T2, and proton density weighed images taken
using repetition (TR) and echo (TE) times in
magnetic resonance machines.
The coronal images were obtained in planes
parallel to the long axis of condyles in the closed
mouth position. While, the sagittal scout was
planned parallel to the orbitomeatal line at the
level of auditory canal.
Figure 1 - (A) Transverse and (B) scan ultrasonography in closed and
open of temporomandibular joint showing hypoechoic disc appear
slightly larger which indirectly indicated effusion.
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Braz Dent Sci 2023 Apr/Jun;26 (2): e3435
Nasher AT et al.
Efficacy of ultrasonography in diagnosis of temporomandibular joint soft tissue injury induced by mandibular fractures: randomized clinical trial
Nasher AT et al.
Efficacy of ultrasonography in diagnosis of temporomandibular
joint soft tissue injury induced by mandibular fractures:
randomized clinical trial
The gap or interval between slices was
0.5 to 1.5 mm for the sagittal images, while,
for the coronal images it was reduced to about
0.3 mm. T1-weighed images were taken with
TR less than 1000 and TE less than 50, while
the proton density weighed images were taken
with TR more than 1000 and TE less than
50. T2-weighed images were taken with TR
more than 1000 and TE more than 80. The
slice thickness was 3 mm. Magnetic resonance
image findings for soft tissue changes in the
temporomandibular joint in the current study
where presented in the form of effusion, anterior
disc displacement with reduction (ADDWR),
limitation of translatory movement, subluxation
and thickening in the lateral pterygoid muscle,
while ultrasonographic image ndings for soft
tissue changes where presented only in the form
of effusion. Ultrasonographic image Ultrasound
(Toshiba, Xario 200) was done using a linear
probe of longitudinal and transverse scan, with a
frequency of 7.5 MHz. This probe was placed over
the TMJ, perpendicular to the zygomatic arch and
parallel to the mandibular ramus and tilted until
the best view was achieved. This was carried out
while the patient set in an upright position, and
the transducer positioned against the patient
face. Static and dynamic (during movement of
condyle) evaluations were usually performed at
different mouth opening positions.
Statistical analysis
The statistical package for social sciences
(SPSS, IBM, and Chicago, USA version 20.0).
The descriptive analysis was presented as mean
and standard deviations (SD)
Student’s t-test was used to compare between
the two groups. Paired t-test was used to study
the changes by time within group. Friedman’s test
was used to study the changes by time in internal
derangement findings. Agreement between
the two modalities (MRI and US) was tested
using Kappa Statistic Kappa statistic values are
interpreted as follows; 0-0.2: weak agreement,
0.2-0.4: fair agreement, 0.4-0.6: moderate
agreement, 0.6-0.8: good agreement, 0.8-0.99:
very good agreement while a value of 1 indicates
perfect agreement. The signicance level was set
at p ≤ 0.05.
RESULT
At the begging of the study 20 patients were
enrolled in this study, 10 patients didn’t return
for clinical and radiological evaluations at the
determined intervals so they were excluded.
Preoperatively, MRI showed 1 normal case (20%)
and 4 abnormal cases (80%) while US showed
2 normal case (40%) and 3 abnormal cases (60%)
Figure 3. There was moderate agreement between
ultrasonography and magnetic resonance image
in diagnosis of normal and abnormal ndings
in both groups (Kappa statistic = 0.545), the
difference was not statistically signicant. In group
I, Ultrasonography of the temporomandibular
joint didn’t detect any abnormal ndings after
mandibular osteosynthesis (all the cases were
normal (100%), however, Magnetic resonance
image recorded abnormal findings 40% and
20% after 2 weeks and 3 months respectively
Figure 3. Agreement measure (Kappa statistic)
could not be computed because all the cases
postoperatively were normal by ultrasonography.
In group II, MRI showed 1 normal case (20%)
and 4 abnormal cases (80%) while US showed
2 normal cases (40%) and 3 abnormal cases
(60%) at preoperative period Figure 4. There was
Figure 2 - T2- weighted sagittal image in closed mouth position
showing effusion in both sides of temporomandibular joint in group
II preoperatively. (A) right side; (B) left side.
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Braz Dent Sci 2023 Apr/Jun;26 (2): e3435
Nasher AT et al.
Efficacy of ultrasonography in diagnosis of temporomandibular joint soft tissue injury induced by mandibular fractures: randomized clinical trial
Nasher AT et al.
Efficacy of ultrasonography in diagnosis of temporomandibular
joint soft tissue injury induced by mandibular fractures:
randomized clinical trial
moderate agreement (Kappa statistic = 0.545),
however, this agreement was not statistically
significant. After 2 weeks, MRI showed 1
normal case (20%) and 4 abnormal cases (80%)
while US showed 2 normal cases (40%) and
3 abnormal cases (60%). There was moderate
agreement (Kappa statistic = 0.545). However,
this agreement was not statistically signicant.
After 3 months; MRI showed 1 normal case
(20%) and 4 abnormal cases (80%) while US
showed 3 normal cases (60%) and 2 abnormal
cases (40%). There was fair agreement (Kappa
statistic = 0.286). However, this agreement was
not statistically signicant. Within the groups,
there was no statistically signicant difference
between magnetic resonance image ndings in
the two groups preoperatively, after 2 weeks as
well as after 3 months. However, there were two
cases in group II that have persisted anterior disc
displacement with reduction at the end of the
study. While in group I one case was persisted
with anterior disc displacement with reduction
at the nal interval of that study (Table I). There
was one case in group I presented with limited
translatory movement two weeks postoperatively
and disappeared totally by the end of this
study. While, in group II there were two cases
presented with limited translatory movement
preoperatively as well as two weeks postoperative
and disappeared at the end of three months
interval (Table I).
In comparison between ultrasonography
ndings in the two groups; there was no statistically
signicant difference between ultrasonography
ndings in the two groups preoperatively as well
as after 3 months (Table II).
However, after 2 weeks, there was a
statistically signicant difference between the
two groups, the group II showed statistically
signicant higher prevalence of effusion than
Group I. In both MRI and US; effusion was
subsided at two weeks and 3 month intervals
in group I, there was statistically significant
difference within group I. While, the preoperative
effusion in group II was persisted at two weeks
interval and then slightly reduced at the end of
the study, there was no statistically signicant
difference within group II at different intervals.
Figure 3 - Agreement between MRI and US findings in Group I.
Figure 4 - Agreement between MRI and US findings in Group II.
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Braz Dent Sci 2023 Apr/Jun;26 (2): e3435
Nasher AT et al.
Efficacy of ultrasonography in diagnosis of temporomandibular joint soft tissue injury induced by mandibular fractures: randomized clinical trial
Nasher AT et al.
Efficacy of ultrasonography in diagnosis of temporomandibular
joint soft tissue injury induced by mandibular fractures:
randomized clinical trial
Additionally, the difference between both groups
was not statistically signicant (Tables I and II).
DISCUSSION
MRI is a golden tool for imaging the soft
tissue of temporomandibular joint [18,19].
The percent of abnormal findings which
detected by MRI postoperatively were higher
than findings detected by ultrasonography in
both groups in this study and at the different
observation periods. According to our ndings,
ultrasonography increases the specicity which
refers to the proportion of those who do not have
the condition that received a negative result on
this diagnostic test, which leads to a minimum
number of false-positive diagnoses. While MRI
increases the sensitivity, which refers to the
proportion of those who have the condition that
received a positive result on this diagnostic test,
which leads to a minimum number of false-
negative diagnose. This was clearly obvious in
this study by increasing abnormal cases either
before or after the treatment which was detected
by MRI and increased normal cases which were
detected by US investigation.
The magnetic resonance imaging is the most
reliable diagnostic procedure for an objective
noninvasive assessment of intracapsular soft
tissue and the joint morphology. It has some
limitations such as the cost and inavialability.
Moreover, the soft tissue of temporomandibular
joint can be predicted through using MRI and also
has direct proportion to the severity of condylar
Table I - Comparison between temporomandibular joint soft tissue changes findings by MRI in two groups
Period Group / Findings
Group 1 Group 2
P
-value
Frequency % Frequency %
Pre-operative
Effusion 3 60 3 60
1.000
ADDWR 1 20 1 20
Limited translatory
movement
0 0 2 40
Thickening in lateral
pterygoid muscle
0 0 1 20
Subluxation 0 0 1 20
No change 1 20 1 20
2 weeks
Effusion 0 0 3 60
0.172
ADDWR 1 20 1 20
Limited translatory
movement
1 20 2 40
No change 3 60 1 20
3 months
Effusion 0 0 2 40
0.127ADDWR 1 20 2 40
No change 4 80 1 20
*Significant at p ≤ 0.05.
Table II - Comparison between the temporomandibular joint soft tissue changes findings by US at different time period in two groups
Period Group / Findings
Group 1 Group 2
P
-value
Frequency % Frequency %
Pre-operative
Effusion 3 60 3 60
1.000
No change 2 40 2 40
2 weeks
Effusion 0 0 3 60
0.038*
No change 5 100 2 40
3 months
Effusion 0 0 2 40
0.114
No change 5 100 3 60
P-value 0.050* 0.368
*Significant at p ≤ 0.05.
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Braz Dent Sci 2023 Apr/Jun;26 (2): e3435
Nasher AT et al.
Efficacy of ultrasonography in diagnosis of temporomandibular joint soft tissue injury induced by mandibular fractures: randomized clinical trial
Nasher AT et al.
Efficacy of ultrasonography in diagnosis of temporomandibular
joint soft tissue injury induced by mandibular fractures:
randomized clinical trial
injury of the mandible [8]. The effusion was
only the soft tissue change in TMJ after indirect
trauma. In both US and MRI, there were gradual
reducing in the effusion in group I at two weeks
until it disappeared at the end of the study
(Tables I and II) while it decreased slightly at
the three-month interval in group II. This can
be explained, due to the more severe trauma in
group II that induce much more inammatory
changes in TMJ. This was in agreement with
Yun and Kim [1], and Goldberg [2]. However,
it was contradicting the study of Yu et al. [3]
who reported soft tissue changes in condylar
fracture patients only. While it seems to have
mild change in cases of trauma without condylar
fracture as it was confirmed in this study by
both radiographical techniques US and MRI.
The performance of US to diagnosis of effusion
was similar to performance of MRI. This was in
agreement with Yılmaz and Kamburoğlu [19]
whose concluded the assessment of anterior
disc position and effusion along with highly
accurate measurements by ultrasound. However,
ultrasonography seems to have some limitations.
Unfortunately, one of the major shortcomings
of US was abnormal reflection of ultrasound
when they intercept hard tissue, added to that
the accuracy of US was operator dependent that
mean experience of the radiologist to interpret
the sonogram may affect the diagnosis [6].
Furthermore, the anatomical characteristics of
the temporomandibular joint make interpretation
of sonogram very difcult and also the quality of
the probe may affect the diagnosis [6]. Persisted
three cases with anterior disc displacement with
reduction at the nal interval of this study as a
result of indirect trauma to the TMJ consistent
with many studies results which found an
association between indirect trauma and disk
displacement [7,8]. Disappearing the three cases
of limited translatory movement at the end of
three months interval (Table I) was explained
by either the effect of severance of trauma or
the effect of effusion in the soft tissue of TMJ.
Then it was disappeared after subsidence of
that effusion. Moreover, there were subluxation
and thickening in lateral pterygoid muscle
in group II preoperatively and disappeared
totally by the end of this study. The difference
between results depend on the severity of impact
force and the status of temporomandibular
joint soft tissue before trauma were unknown.
whereas the improvement of results are due
to the reduction of fracture and healing of soft
tissue. Although, ultrasonography was used for
imaging and diagnosis of internal derangement
of temporomandibular joint [11,16], the present
study has proved that the magnetic resonance
image was superior than ultrasound in diagnosis of
temporomandibular joint soft tissue changes after
trauma. MRI seems to provide a clear anatomic
picture of soft tissue with temporomandibular
joint area specially the disc in sagittal plane. Also
it had a high diagnostic accuracy and considered
the prime imaging modality for assessment of soft
tissue of temporomandibular joint. Unlike MRI,
the ultrasound used for imaging and diagnosis of
internal derangement of the TMJ was insufcient
to detect disc displacement. This was explained
by high accuracy of MRI as a golden tool for
imaging the soft tissue of temporomandibular
joint [19]. While, the anatomical structures of the
surrounding bone and the rest of shortcomings of
the ultrasound may reduce the accuracy of TMJ
soft tissue imaging. This was in accordance with
Uysal et al. [4], Katzberg [5], and Bas et al. [16].
Future studies should target a large number of
patients and a longer period of follow up.
The sample included only men because
the female patients who came with facial bone
fractures to the clinic of Oral Maxillofacial Surgery
- Al-Kuwait Hospital- Sana’a- Yemen were very
rare. This may be due to the conditions of the
war in Yemen and the nature of the conservative
Yemeni society, which forces women to sit at
home (most of the women are housewives).
While the most common cause of fractures is
trafc accidents.
We recognize that there were some
limitations to this study. Most of the patients
in the Al-Kuwait Hospital, in Sana’a city, come
from rural areas located so far from the capital
city which make following them very difcult, so
after enrolling 20 patients at the beginning of the
study, 10 of these patients didn’t come for follow
up. Patient education plays a positive role in the
of tempromandibular joint soft tissue healing
after mandibular osteosynthesis, however patient
education was not considered in this study.
CONCLUSION
Ultrasonography has some shortcoming and
limitations, this was obvious in both groups and
at the different observation periods however,
it had a beneficial role in identification and
diagnosis of effusion in temporomandibular joint.
8
Braz Dent Sci 2023 Apr/Jun;26 (2): e3435
Nasher AT et al.
Efficacy of ultrasonography in diagnosis of temporomandibular joint soft tissue injury induced by mandibular fractures: randomized clinical trial
Nasher AT et al.
Efficacy of ultrasonography in diagnosis of temporomandibular
joint soft tissue injury induced by mandibular fractures:
randomized clinical trial
Magnetic resonance imaging was proved to have
a high quality imaging and still the golden tool
for imaging of the temporomandibular joint soft
tissue changes.
Acknowledgements
We would like to express us deep gratitude
with true sense of thanks for all who helped us
in nishing this work.
Author’s Contributions
ATN: Collection the data and writing the
methodology. SAD: Analysis the data and
writing the duscssion. AHF: Collection the data,
analysis the data and writing the manuscript.
MSA: Analyzed the data and led the writing. NF:
Analysis the data, statistic analysis and writing
part of the duscssion.
Conict of Interest
The authors declare that they have no
conict of interests. Funding The authors declare
that no nancial support was received.
Funding
This research did not receive any specic
grant from funding agencies in the public,
commercial, or not-for-prot sectors.
Regulatory Statement
This study was conducted in accordance with
all the provisions of the local human subjects. A
prior permission from the Institutional Review
Board at College of Dentistry, Sana’a University,
and a signed consent from the patient had
preceded the collection of information and
interview for the current case report.
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9
Braz Dent Sci 2023 Apr/Jun;26 (2): e3435
Efficacy of ultrasonography in diagnosis of temporomandibular
joint soft tissue injury induced by mandibular fractures:
randomized clinical trial
Nasher AT et al.
Efficacy of ultrasonography in diagnosis of temporomandibular joint soft tissue injury induced by mandibular fractures: randomized clinical trial
Nasher AT et al.
Efficacy of ultrasonography in diagnosis of temporomandibular
joint soft tissue injury induced by mandibular fractures:
randomized clinical trial
Date submitted: 2022 Feb 20
Accept submission: 2023 Jan 05
Mohammed Sultan Al-ak’hali
(Corresponding address)
Jazan University, College of Dentistry, Department of Preventive Dentistry, Jizan,
Saudi Arabia.
Email: sultanperiodontics@gmail.com
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