关键词: 颞下颌关节紊乱病, 误诊, 病例报道, 文献综述, 系统评价

Abstract:

Objective To summarize all the related reports to explore causes of the misdiagnoses of other diseases as temporomandibular disorder（TMD） and develop strategies in reducing the misdiagnosis, and to assess appropriateness of using“systematic review” in replace of“review” for this kind of literatures. Methods Medline （via OVID）, EMBASE, Chinese BioMedical Literature Database（CBM）, China National Knowledge Infrastructure （CNKI） and VIP Database for Chinese Technical Periodicals（VIP） were searched electronically till December, 2011 for identifying the case reports, case series or “systematic reviews” of misdiagnoses of other diseases as TMD. The eligible studies were selected and extracted by two independent reviewers. All the data were summarized to show distributions of other diseases and classifications of the possible causes of the misdiagnoses. For second aim of the study, some so-called systematic reviews on misdiagnosis in which only case reports or case series being included were also collected, to explore appropriateness of the term “systematic review” for such literatures. Results A total of 21 case r eports or case series involving 57 patients met the inclusive criteria, of which 10 being in Chinese and 11 in English. The 57 patients being misdiagnosed as TMD were suffering from 20 sorts of diseases, such as pericoronitis of the maxillary third molar（43.86%）, nasopharyngeal carcinoma（15.79%）, different kinds of tumors（15.97%） in the orofacial region, etc.. Suspected causes of the misdiagnoses could be classified into 7 categories, such as similar clinical manifestations（33.96%）, confused chief complaints （26.43%）, insufficient understanding of the clinicians（22.64%）, etc.. Thirty five articles naming as systematic review in which case reports or case series on misdiagnoses being included were found through intensive searching, 8 in English and 27 in Chinese. They were narrative reviews in light of congeries of same facts without appraising quality of methodology or validity of the case reports or case series.“Review” should be appropriate term for such literatures and it is no need to use a modern term “systematic review” instead. The later term did not raise any new value to the term“review”. Conclusion The misdiagnoses of other diseases as TMD were mainly caused by similarities in symptoms and clinical signs of the diseases with TMD, and insufficient understandings of the clinicians. It is better to use“review” instead of“systematic review” to describe same type of the literatures.

Key words: temporomandibular disorders, misdiagnosis, case reports, review, systematic review