This document discusses MRI anatomy and pathology related to the temporomandibular joint (TMJ). It includes the following key points:
1. Normal MRI shows a crescent-shaped disk in the TMJ. Coronal views identify surrounding muscles and bones like the mandibular ramus.
2. Internal derangement is a common cause of TMJ dysfunction where the disk is abnormally positioned relative to the articulating surfaces. Common types of disk displacement include anterior, anterolateral, and anteromedial.
3. Disk displacement is assessed based on the angle between the posterior band of the disk and vertical line, with over 10 degrees considered abnormal. Symptoms correlate better with displacement
This document discusses MRI anatomy and pathology related to the temporomandibular joint (TMJ). It includes the following key points:
1. Normal MRI shows a crescent-shaped disk in the TMJ. Coronal views identify surrounding muscles and bones like the mandibular ramus.
2. Internal derangement is a common cause of TMJ dysfunction where the disk is abnormally positioned relative to the articulating surfaces. Common types of disk displacement include anterior, anterolateral, and anteromedial.
3. Disk displacement is assessed based on the angle between the posterior band of the disk and vertical line, with over 10 degrees considered abnormal. Symptoms correlate better with displacement
This document discusses MRI anatomy and pathology related to the temporomandibular joint (TMJ). It includes the following key points:
1. Normal MRI shows a crescent-shaped disk in the TMJ. Coronal views identify surrounding muscles and bones like the mandibular ramus.
2. Internal derangement is a common cause of TMJ dysfunction where the disk is abnormally positioned relative to the articulating surfaces. Common types of disk displacement include anterior, anterolateral, and anteromedial.
3. Disk displacement is assessed based on the angle between the posterior band of the disk and vertical line, with over 10 degrees considered abnormal. Symptoms correlate better with displacement
This document discusses MRI anatomy and pathology related to the temporomandibular joint (TMJ). It includes the following key points:
1. Normal MRI shows a crescent-shaped disk in the TMJ. Coronal views identify surrounding muscles and bones like the mandibular ramus.
2. Internal derangement is a common cause of TMJ dysfunction where the disk is abnormally positioned relative to the articulating surfaces. Common types of disk displacement include anterior, anterolateral, and anteromedial.
3. Disk displacement is assessed based on the angle between the posterior band of the disk and vertical line, with over 10 degrees considered abnormal. Symptoms correlate better with displacement
Sommer OJ, Aigner F, Rudisch A, Gruber H, Fritsch H, Millesi W and Stiskal M. Cross-sectional and Functional Imaging of the Temporomandibular Joint: Radiology, Pathology, and Basic Biomechanics of the Jaw. Radiographics. 2003. http://radiographics.rsnajnls.org/cgi/content/full/e14v1 MRI Anatomy - Normal lateral ptygeroid attachments. Attachments of the LPM are normally thin. A – Inferior LPM attachment. B – Superior LPM attachement. C - Inferior LPM attachment. D - Inferior LPM attachment (open mouth). Thicker due to muscle contraction. PATHOLOGY Disk location is extremely important because a displaced disk is a critical sign of TMJ dysfunction. The most frequent cause of TMJ dysfunction is Internal Derangement. INTERNAL DERRANGEMENT Internal derangement of the TMJ is a specific term defined as the abnormal positional and functional relationship between the disk and the articulating surfaces. Displacement may be partial or complete Most common displacement is Anterior Anterolateral Anteromedial Other displacement (10%) Medial Lateral Posterior (rare) Internal Derrangement The combination of two types of displacement (anterolateral) has been referred to as rotational displacement. Pure lateral or medial displacement has been referred to as sideways displacement In partial disk displacement, the lateral disk is displaced anteriorly and the more medial part is still in a normal superior position. What is disk displacement??? The junction of the posterior band and the bilaminar zone should fall within 10 degrees of vertical to be within the 95th percentile of normal (closed mouth). Controversy Tallents et al and Katzberg et al. demonstrated that a large number (~33%) of asymptomatic volunteers may exceed 10 degrees. Rammelsberg et al suggested that disk displacement up to 30 degrees could be considered normal. Correlation with symptoms may be more useful. Helms and Kaplan use the intermediate zone as reference (position between the condyle and temporal bone). This does not take in account the position of the posterior band.
Molinari et al. Sem Ultrasound, CT, and MRI. 2007;
28(3):192-204. Partial displacement Closed jaw Posterior band at the 10 O'clock position Partial disk anterior displacement.
Sommer, OJ et al. Cross-sectional and Functional Imaging of the Temporomandibular Joint: Radiology, Pathology, and Basic Biomechanics of the Jaw. Radiographics 2003;23:14 Complete anterior disk displacement – closed jaw Angle between the posterior band (dashed line) and the vertical solid line is 50 degrees
Thomas et al. MR Imaging of the Temporomandibular Joint Disfunction: A Pictorial Review. Radiographics 2006; 26:765-781. Som PM, Curtin HD Head and Neck Imaging 3rd ed Mosby 1996. Complete anterior disk displacment with associated abnormal disk shape. Closed position Top – Complete anterior displacement with a rounded disk Bottom – Complete anterior displacement with irregularity and flattening of the disk. Condyle irregularity.
Thomas et al. MR Imaging of the Temporomandibular Joint Disfunction: A Pictorial Review. Radiographics 2006; 26:765-781. Som PM, Curtin HD Head and Neck Imaging 3rd ed Mosby 1996. Functional aspects of displacement What happens to an anteriorly displaced disk during mouth opening? Functional aspects of displacement There are 2 different possibilities: Disk displacement with reduction Disk displacement without reduction Normal Translation
Courtsy of Rosalyn Cheng
Anterior disk displacement with reduction Courtsy of Rosalyn Cheng
The Journal of Prosthetic Dentistry Volume 49 Issue 4 1983 (Doi 10.1016 - 0022-3913 (83) 90318-9) Lawrence A. Weinberg - The Role of Stress, Occlusion, and Condyle Position in TMJ Dysfunction-Pain
The Journal of Prosthetic Dentistry Volume 49 Issue 4 1983 (Doi 10.1016 - 0022-3913 (83) 90318-9) Lawrence A. Weinberg - The Role of Stress, Occlusion, and Condyle Position in TMJ Dysfunction-Pain
