Role of Magnetic Resonance Imaging in the Clinical Diagnosis of the Temporomandibular Joint

Abstract

Temporomandibular joint (TMJ) abnormalities cannot be reliably assessed by a clinical examination. Magnetic resonance imaging (MRI) may depict joint abnormalities not seen with any other imaging method and thus is the best method to make a diagnostic assessment of the TMJ status. In patients with temporomandibular joint disorder (TMD) referred for diagnostic imaging the predominant TMJ finding is internal derangement related to disc displacement. This finding is significantly more frequent than in asymptomatic volunteers, and occurs in up to 80% of patients consecutively referred for TMJ imaging. Moreover, certain types of disc displacement seem to occur almost exclusively in TMD patients, namely complete disc displacements that do not reduce on mouth opening. Other intra-articular abnormalities may additionally be associated with the disc displacement, predominantly joint effusion (which means more fluid than seen in any asymptomatic volunteer) and mandibular condyle marrow abnormalities (which are not seen in volunteers). These conditions seem to be closely related. Nearly 15% of TMD patients consecutively referred for TMJ MRI will have joint effusion, of whom about 30% will show bone marrow abnormalities. In a surgically selected material of joints with histologically documented bone marrow abnormalities nearly 40% showed joint effusion. Disc displacement is mostly bilateral, but joint effusion seems to be unilateral or with a lesser amount of fluid in the contralateral joint. Abnormal bone marrow is also mostly unilateral. Many patients have unilateral pain or more pain on one side. In a regression analysis the self-reported in-patient TMJ pain side difference was positively dependent on TMJ effusion and condyle marrow abnormalities, but negatively dependent on cortical bone abnormalities. Of the joints with effusion only one fourth showed osteoarthritis. Thus, there seems to be a subgroup of TMD patients showing more severe intra-articular pathology than disc displacement alone, and mostly without osteoarthritis. It should, however, be emphasized that patients with TMJ effusion and/or abnormal bone marrow in the mandibular condyle seem to constitute only a minor portion (less than one fourth) of consecutive TMD patients referred for diagnostic TMJ imaging. The majority of patients have internal derangement related to disc displacement, but without accompanying joint abnormalities. In patients with rheumatoid arthritis and other arthritides TMJ involvement may mimick the more common TMDs. Using MRI it is possible, in most cases, to distinguish these patients from those without synovial proliferation.

Correlation between temporomandibular joint morphology and disc displacement by MRI

“…2,7,[9][10][11][12][13][14][15][16][17] MRI is considered the gold standard imaging modality for evaluating TMJ discs, as it produces images of excellent soft-tissue contrast. 10,[18][19][20] Moreover, it is a non-invasive examination that is free of ionizing radiation. 16,20,21 Therefore, the aim of this study was to evaluate the morphology of the articular disc and condyle in the coronal and axial views and to correlate these findings with the position of the articular disc, using MRI.…”

A quantitative analysis of splint therapy of displaced temporomandibular joint disc

“…DD can only occur in the intercuspal occlusion position (DD with reduction) or during condyle movements when opening the mouth (DD without reduction). Magnetic resonance imaging (MRI) is a noninvasive diagnostic method for the analysis of arthrogenic TMDs that enables a qualitative as well as a quantitative analysis of the structures within the joint, as well as the soft tissues, especially those of the disc (Hugger 2002;Larheim 2005).…”

High prevalence of temporomandibular joint arthritis at disease onset in children with juvenile idiopathic arthritis, as detected by magnetic resonance imaging but not by ultrasound

“…Consequently, the diagnosis of TMJ arthritis has increasingly been based on evidence obtained by imaging. Ultrasound (US), MRI, and orthopantomogram have all been used in the evaluation and diagnosis of both active TMJ arthritis and chronic TMJ arthritis (11)(12)(13)(14).…”