Case Challenge

Head and Neck

Neuro

Temporomandibular joint (TMJ)

Temporomandibular Joint (TMJ)

Stephen J Pomeranz

Gain confidence interpreting Temporomandibular Joint (TMJ) MRI Cases w/ MRI Online. Quiz yourself using real-world, interactive scrollable cases & earn CME!

Case Review

Musculoskeletal (MSK)

Neuroradiology

Case 1 - 65-year-old female presents with chronic temporomandibular joint pain

Case 2 - 54-year-old female presents with TMJ pain, clicking, locking, headaches, facial pain

Case 3 - 55-year-old female presents with 40-year history of bilateral temporomandibular joint pain

Case 4 - 53-year-old female presents with disc displacement

Case 5 - 68-year-old female presents with pain to the left sided jaw

Case 6 - 56-year-old female presents with new onset of left-sided TMJ pain

Case 7 - 56-year-old female presents with history of wisdom teeth extraction

Case 8 - 55-year-old male presents with jaw locking

Case 9 - 31-year-old female presents with severe headaches and jaw clicking

Case 10 - 53-year-old female presents with TMJ dysfunction

Case 11 - 66-year-old female presents with bilateral temporomandibular joint dislocation

Case 12 - 31-year-old male presents with extreme jaw, facial, and occipital muscle pain

Case 13 - 59-year-old male presents with temporomandibular joint internal derangement

Case 14 - 49-year-old female presents with bilateral jaw pain

Case 15 - 48-year-old female presents with one year history of right open and close lock

Case 16 - 63-year-old female presents with right temporomandibular joint pain

Case 17 - 39-year-old female presents with pain

Case 18 - 63-year-old male presents with capsulitis of temporomandibular joint

Case 19 - 17-year-old female presents with jaw locking

Case 20 - 24-year-old female presents with left TMJ pain

Case 21 - 28-year-old male presents with difficulty opening mouth wide

Case 22 - 45-year-old female presents with limited range of motion for four months

Case 23 - 17-year-old male presents with TMJ pain

Case 24 - 89-year-old male presents with left jaw pain for four months

Case 25 - 47-year-old female is being evaluated for right disc dislocation

Course Evaluation

Post-Course Activities

This Power Pack is comprised of 25 unique TMJ MRI cases that you can scroll through in our diagnostic web viewer to determine your findings. Quiz yourself and earn CME.

Temporomandibular Joint (TMJ) MRI Cases

<div>HISTORY:&#160;This 55-year-old female presents with 40-year history of bilateral temporomandibular joint pain, right greater than left. Apparent history of zygomatic fracture.(QUIZ ANSWER) NOT A FINDING IN THIS CASE:&#160;Right TMJ: Edema involving the lateral pterygoid muscle.Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS:&#160;RIGHT TMJ: Anterior displacement of the intact articular disc is noted on the closed-mouth view without recapture on the open-mouth view.&#160;No joint effusion or intraarticular loose body. No bursitis.&#160;Anterior osteophyte seen involving the mandibular condyle. Mandibular fossa and glenoid abnormal appearance.&#160;No edema involving the lateral pterygoid muscle. No evidence of locking in the right temporomandibular joint.&#160;LEFT TMJ: Tear of the bilaminar zone with irregular appearance of the disc which is anteriorly displaced on closed-mouth views. Anterolateral and inferior to the articular disc is a 2nd intraarticular object measuring 4mm isointense to disc on all sequences. No recapture of articular disc on open-mouth view.&#160;No joint effusion or bursitis.&#160;Severe arthropathic changes involve the mandibular condyle with subchondral sclerosis.&#160;No myoedema involving lateral pterygoid muscle.&#160;Incidental note made of left concha bullosa at the middle turbinate.&#160;Left temporomandibular joint is locked.&#160;CONCLUSION:&#160;1. Right temporomandibular joint demonstrates anterior displacement of the articular disc in the closed-mouth view without recapture upon mouth opening. Mild mandibular condylar arthropathic change without temporomandibular joint locking. Constellation of findings favor grade 4 of 5 TMJ dysfunction according to Wilkes-Shellhas grading.&#160;2. Left temporomandibular joint demonstrates tear of the bilaminar zone and irregularity of the articular disc with intraarticular 4mm loose body. Loose body may relate to a meniscal fragment, synovial metaplasia or arthropathic loose body. Disc remains in 90 degrees of displacement throughout open- and closed-mouth positions along with severe temporomandibular arthropathic deformity and chondral erosion. Constellation of findings given temporomandibular joint locking as well favor stage 5 of 5 TMJ dysfunction according to Wilkes-Shellhas grading.</div>

Case

Right TMJ: Anterior displacement of the intact articular disc on the closed-mouth view

Right TMJ: Edema involving the lateral pterygoid muscle

Left TMJ: Tear of the bilaminar zone with irregular appearance of the disc

Left TMJ: Anterolateral and inferior to the articular disc is a 2nd intraarticular object isointense to disc

Which of the following is NOT a finding in this case?