Predictive factors of disc perforation of the temporomandibular joint (TMJ)

Abstract

Magnetic resonance imaging (MRI) is the gold standard for diagnosing internal derangement, but its accuracy in detecting disc perforations varies. This cohort study included 92 patients who underwent arthroscopic surgery to identify associated variables. The presence of arthroscopically verified disc perforation served as the primary predictor variable, while the radiologist's diagnosis of disc perforation served as the primary outcome variable. Demographic data, patient signs, and symptoms were considered as covariates. Statistical tests were performed with a significance level of 5%. Logistic regression models were used to predict disc perforation, and diagnostic accuracy was assessed using ROC curves. Among 155 joints analyzed (92 patients: 135 females, 20 male), radiologists' MRI interpretations did not significantly correlate with verified disc perforation (p<0.218), showing 14.3% sensitivity and 92.5% specificity. Age, symptomatic onset, joint noise type, osteoarthritis diagnosis, altered disc shape, and Wilkes classification showed significant associations (p<0.05). A logistic regression model used associated variables for disc perforation. Risk factors: symptom onset time, joint crepitus, osteoarthrosis diagnosis by MRI; joint click as protective. The model demonstrated high diagnostic accuracy (AUC of 0.836, 95% CI_0.76–0.91). Radiologists' MRI interpretation was unreliable, but our model accurately predicted disc perforation. Identifying these factors could guide surgical decisions.