Temporomandibular Joint

Ovid: Musculoskeletal Imaging Companion

Editors: Berquist, Thomas H.
Title: Musculoskeletal Imaging Companion, 2nd Edition
> Table of Contents > Chapter 2 – Temporomandibular Joint

Chapter 2
Temporomandibular Joint
Thomas H. Berquist


FIGURE 2-1 Normal TMJ in the sagittal (A) and coronal (B) planes.


Imaging of the TMJ can be accomplished with multiple
methods. Routine radiographs, computed tomography, and magnetic
resonance imaging (MRI) are used most commonly in our practice.
Routine radiographs:
  • Anteroposterior
  • Towne
  • Oblique views of each TMJ
Computed tomography:
  • 120 kVp, 270 mA, 25-cm field of view (FOV)
  • 1- to 2-mm axial sections with bone and soft tissue windows
  • Reformatted sagittal and coronal images with 1.0-mm sections
MRI—basic approach:
  • 3-inch dual-coupled coils
  • FOV: 10 to 12 cm 256 × 256 matrix, one excitation
  • Axial scout images (20/5, 40 degrees FA, 256 × 128 matrix, 4- to 5-mm–thick sections) through the TMJ
Technique 1:
  • Sagittal or oblique sagittal images in
    the closed and open positions, 256 × 256 matrix, and three
    acquisitions. T1-weighted (spin-echo 416/17) images (3 mm thick). Fast
    spin-echo (turbo spin-echo 300/19) images (3 mm thick).
    Coronal fast spin-echo (turbo spin-echo 1500/19) images
    optional if disc poorly visualized on sagittal images or medial or
    lateral displacement is suspected.
Technique 2—motion studies:
  • Sagittal gradient-echo images (4-mm–thick
    sections, 80/11, 30 degrees FA, 256 × 256 matrix, one acquisition, FOV
    10–12 cm). Each image obtained as mouth is opened with incremental
    device (3 mm per image). Images obtained from closed to open. Cine-loop
    motion created.
  • Optional coronal T1- or T2-weighted images.
Suggested Reading
Berquist TH, Helms CA. The temporomandibular joint. In: Berquist TH, ed. MRI of the musculoskeletal system, 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2006:98–120.
Gibbs SJ, Simmons C. A protocol for magnetic resonance imaging of the temporomandibular joints. Cranio 1998;16:236–241.


Internal Derangement


FIGURE 2-2 Disc displacement categories: normal (A), anterior displacement (B), partial anterior displacement in lateral joint (C), partial anterior displacement in medial joint (D), rotational anterolateral displacement (E), rotational anteromedial displacement (F), lateral displacement (G), medial displacement (H), posterior displacement (I).


Suggested Reading
S, Kino K, Amagasa T, et al. Clinical and magnetic resonance imaging
study of unilateral sideways disc displacement of the temporomandibular
joint. J Med Dent Sci 2002;49:89–94.
V, Desiate A, Bellin R, et al. Magnetic resonance imaging of
temporomandibular disorders: classification, prevalence, interpretation
of disc displacement and deformation. Dentomaxillofac Radiol 2000;29:353–361.
MM, Westesson PL, Isberg MA. Classification and prevalence of
temporomandibular joint disk replacement in patients and symptom-free
volunteers. Am J Orthod Dentofacial Orthop 1996;109:249–262.


Anterior Disc Displacement
FIGURE 2-3 (A) Anterior disc displacement without (left) and with (right) reduction. Sagittal gradient echo (80/11, 30 degrees FA) images demonstrate a normal disc in open-mouth position (B) and an anteriorly displaced disc (arrow) (C).


Suggested Reading
Foucart JM, Carpenter P, Pajoni D, et al. MR of 732 TMJs: Anterior, rotational, partial, and sideways disc displacements. Eur J Radiol 1998;28:86–94.
H, Ohtsuka A, Kobayashi H, et al. Resorption of the lateral pole of the
mandibular condyle in temporomandibular disc displacement. Dentomaxillofac Radiol 2001;39:88–91.
X, Pernu H, Pyhtinen J, et al. MRI findings concerning the lateral
pterygoid muscle in patients with symptomatic TMJ hypermotility. Cranio 2001;19:260–268.


LAteral Disc Displacement
FIGURE 2-4 (A) Sagittal spin-echo 500/10 image does not clearly identify the disc. (B) Coronal spin-echo 500/10 image shows lateral displacement (arrows).
Suggested Reading
Foucart JM, Carpenter P, Pajoni D, et al. MR of 732 TMJs: Anterior, rotational, partial, and sideways disc displacements. Eur J Radiol 1998;28:86–94.


FIGURE 2-5 (A) Towne view demonstrating bilateral condylar neck fractures (arrows). (B) Coned-down lateral view demonstrating TMJ dislocation (broken lines define condyle and eminence).
Suggested Reading
P, Leonardi R, Marino S, et al. Intracapsular fractures of the
mandibular condyle: Diagnosis, treatment, and anatomic and pathologic
evaluations. J Craniofacial Surg 2003;14(2):184–191.


FIGURE 2-6 Posttraumatic arthritis with narrowing on the right (A) and an osteochondral defect (arrow) and subluxation on the left (B).



FIGURE 2-7 Osteoarthritis and internal derangement on sagittal (A), axial (B), and coronal (C) computed tomography images. There is joint space narrowing and asymmetry with osteophyte formation.
FIGURE 2-8 Sagittal T1-weighted MR image with anterior disc displacement (arrow) and a condylar osteophyte (open arrow).
Suggested Reading
Westesson PL. Structural hard-tissue changes in temporomandibular joints with internal derangement. Oral Surg Med Oral Pathol 1985;59:220–224.


Miscellaneous Arthropathies
FIGURE 2-9 Coronal MRI in a patient with RA. There is extensive pannus formation bilaterally (arrows).
Suggested Reading
A, Pedersen TK, Herlin T, et al. Contrast-enhanced magnetic resonance
imaging as a method to diagnose early inflammatory changes in the
temporomandibular joint in children with juvenile rheumatoid arthritis.
J Rheumatol 1998;25:1406–1412.
Ogus H. Rheumatoid arthritis of the temporomandibular joint. Br J Oral Surg 1975;12:275–284.




FIGURE 2-10 A 65-year-old patient with jaw swelling. Anteroposterior radiograph demonstrates a large benign osteoma (arrows).
Suggested Reading
Unni KK. Dahlin’s bone tumors: General aspects and data on 11,087 cases. 5th ed. Philadelphia: Lippincott-Raven; 1996.

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