Temporomandibular joint: MR imaging
Section snippets
History of diagnostic imaging of the temporomandibular joint and related patient symptoms
In the past, the temporomandibular joint (TMJ) traditionally was imaged with only conventional x-ray film, such as plain transcranial film and tomography (Fig. 1). These techniques provided relatively useful information about osseous changes in the joint; however, they did not give any information about soft tissue abnormalities, despite multiple attempts to indirectly diagnose such abnormalities using plain film. In the late 1970s, it became obvious that plain film findings of osseous
Normal anatomy of the temporomandibular joint
A sagittal view of a normal TMJ from an anatomic specimen is shown in Fig. 4. The TMJ disk is a biconcave fibrous structure located between the mandibular condyle and the temporal component of the joint. The disk is round to oval with a thick periphery and thin center. In a sagittal section, the normal disk appears biconcave, and the thicker anterior and posterior parts of the disk are called the anterior and posterior bands [13]. When the mandible is in the closed-mouth position, the disk is
Sequence of temporomandibular joint MR imaging
MR imaging of the TMJ is preferably performed with a long repetition time (TR) and short echo time (TE); therefore, a proton density-weighted sequence can best depict disk derangements Fig. 5, Fig. 6, Fig. 7 [14], [15]. T2-weighted images with long TR and long TE are not always appropriate for visualizing anatomic structures; however, they are useful in detecting tumors, inflammatory conditions, and joint effusion in the joint spaces. T2-weighted images are also useful in assessing disk status
Disk displacement
Disk displacement categories include anterior, anterolateral, anteromedial, lateral, medial, and posterior displacements [21]. The combination of anterior and lateral or medial displacement is called rotational displacement, whereas pure lateral or pure medial displacement is called sideways displacement [19]. Pure lateral and pure medial sideways displacements of the disk also occur but not as commonly as in combination with an anterior displacement [19], [22], [23]. When interpreting MR
Summary
Diagnostic imaging of TMJ has improved remarkably in the last 20 years. Various abnormalities related to the TMJ have been identified, which has led to a better understanding of these abnormalities. There are several possible sources of TMJ pain, such as bone marrow alterations of the mandibular condyle, impingement and compression of the retrodiskal tissue, inflammatory changes in the retrodiskal tissue, inflammatory changes in the joint space resulting in joint effusion, and capsulitis. The
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