Diagnostic quality of dynamic high-resolution ultrasonography of the TMJ--a pilot study.

The aim of this study was to compare sensitivity, specificity, accuracy and positive and negative predictive value for high-resolution ultrasonography (HR-US) in diagnosing degenerative changes, effusion and disk displacement using magnetic resonance imaging (MRI) as a reference. Over a period of 6 months, 100 patients with TMJ disorders (200 TMJs) were investigated by an experienced radiologist with HR-US and magnetic resonance imaging (MRI). The MRI investigation showed degenerative changes in 190 joints (95%), while an effusion was found in 59 (29.5%) joints. At closed-mouth position a disc dislocation was found in 138 joints (69%) and in maximum-mouth-opening position disc dislocation was diagnosed in 76 joints (38%). In the determination of degenerative changes HR-US showed a sensitivity of 94%, a specificity of 100% and an accuracy of 94%. In the detection of effusion HR-US yielded a sensitivity of 81%, a specificity of 100% and an accuracy of 95%. In the determination of disk displacement at closed-mouth position HR-US showed a sensitivity, specificity and an accuracy of 92% each. At maximum-mouth-opening position HR-US reached a sensitivity of 86%, a specificity of 91% and an accuracy of 90%. The results of the current study imply that HR-US is a valuable diagnostic imaging method of the TMJ which can be used as an alternative method to a MRI-investigation, but is yet not able to replace it. Further studies have to be done to reduce false-negative results.

[Interobserver variation of the sonographic diagnosis of orbital floor fractures and fractures of the infraorbital margin]. / Reliabilität der sonographischen Diagnostik von Orbitabodenfrakturen und Frakturen des Infraorbitalrandes.

PURPOSE: The aim of the study was to evaluate the interobserver variation of the ultrasound diagnosis of orbital floor fractures and fractures of the infraorbital rim. MATERIAL AND METHODS: A total of 25 patients with a clinical diagnosis of an orbital trauma were investigated prospectively by computed tomography (CT) and ultrasonography (US). Inter-observer variation was calculated using the lambda coefficient (lambda). The US images were reassessed by two inexperienced investigators. RESULTS: The lambda value for the US investigation of the orbital floor showed poor reliability comparing the US findings with the results of the re-investigators. The comparison between the two re-investigators showed a good reliability for the US evaluation of the orbital floor. The lambda for the US investigation of the infraorbital margin showed a good reliability comparing the US findings with the results of the both re-investigators. The comparison of the two re-investigators showed a good reliability as well. CONCLUSION: Ultrasound is not yet an alternative method for the evaluation of orbital floor fractures and fractures of the infraorbital margin. To replace CT which is accepted as the current gold standard, further studies have to be done to reach a better diagnostic quality of the method and to achieve a better calibration of the investigations.

The diagnostic value of ultrasonography in the detection of orbital floor fractures with a curved array transducer.

The aim of the study was to investigate the diagnostic value of ultrasonography (US) in orbital floor fractures and orbital rim fractures with a curved array scanner. Over a period of 10 months, 60 patients with an orbital trauma have been investigated. Orbital trauma was defined by clinical and ophthalmologic investigation. Computed tomography (CT) was used as the reference method to evaluate the diagnostic value of US in the determination of an orbital floor fracture and was performed by a well-experienced radiologist. Coronal and sagittal images were made. The US investigation was performed with a 7.5 MHz curved array transducer.The US investigation of the infraorbital rim showed a sensitivity of 94% and a specificity of 92% with a diagnostic accuracy of 92%. The positive predictive value (PPV) reached 91% and the negative predictive value (NPV) reached 92%, while the US investigation of the orbital floor showed a sensitivity of 95% and a specificity of 100% with a diagnostic accuracy of 98%. PPV reached 100% and NPV reached 77%. Ultrasonography is a cost-effective and widely available method without disadvantages such as radiation exposure. The results in the current study imply that ultrasonography can be used as an alternative method in the investigation of orbital floor fractures.

[Imaging diagnosis of medial and lateral orbital wall fractures. Sonography versus computed tomography]. / Bildgebende Diagnostik von medialen und lateralen Orbitawandfrakturen. Ultraschall versus CT.

PURPOSE: The purpose of the study was to evaluate the diagnostic value of a curved array scanner in the diagnosis of medial and lateral orbital wall fractures. MATERIAL AND METHODS: Fifty-three patients with the clinical diagnosis of an orbital trauma were investigated prospectively within a period of 16 months by CT and ultrasonography. The intraoperative findings were used as a reference. RESULTS: CT reached a sensitivity of 100% and a specificity of 96% in the diagnosis of medial orbital wall fractures, while ultrasound yielded a sensitivity of 80% and a specificity of 96%. There was no significant difference found between CT and ultrasonography ( p=0.402). In the investigation of lateral orbital wall fractures, CT reached a sensitivity of 88% and a specificity of 87%, while ultrasonography yielded a sensitivity of 97% and a specificity of 95%. Ultrasonography achieved significantly better results than CT ( p=0.008). CONCLUSION: The ultrasound investigation with a curved array scanner could be used as an additional method in the diagnosis of medial and lateral orbital wall fractures. Further technical improvements of the transducers need to be developed to increase the sensitivity of ultrasound in the diagnosis of medial orbital wall fractures.

[Post-traumatic ocular motility in orbital floor fractures]. / Posttraumatische Bulbusmotilität bei Orbitabodenfrakturen.

PURPOSE: The aim of this study was to evaluate post-traumatic ocular motility in orbital floor fractures in relation to the severity of the fracture and concomitant injuries. MATERIAL AND METHODS: Over a period of 6 years, data from 435 patients with orbital floor fractures were re-evaluated. Ocular motility was divided into abduction, adduction, upgaze and downgaze movements. RESULTS: In 54.3% of the cases, there was a reduction in ocular motility. A reduced motility with a movement >20 degrees was found in most of the cases. Concomitant injuries to the eye resulted in a significant increase in the reduction of motility. This reduction depended on the severity of the orbital floor fracture. A reduced upgaze movement was the most common complication in all types of fractures. CONCLUSION: Ocular motility can act as an indication of the severity of the orbital fracture. Concomitant injuries to the eye resulted in a higher incidence of reduced ocular motility.