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

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files

HISTORY: 

This 31-year-old male presents with extreme jaw, facial, and occipital muscle pain. No known injury. Patient was working with a chiropractic-like doctor to relieve some abdomen issues two months prior. Patient does not think that this doctor is responsible for his new pain though the pain started after his neck was adjusted. TMJ pain, anterior jaw pain, and pain in the back of the head that travels down the neck x1.5m worsening progressively. Stiffness in the jaw and neck that makes it difficult to swallow. Two past jaw surgeries with metal hardware for under bite correction three years and 11 years prior. No past comparison.

(QUIZ ANSWER) IS A FINDING IN THIS CASE: 

Left TMJ: Mandibular condyle is remodeled and hypoplastic.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

FINDINGS:

LEFT: Condylar head is irregularly shaped and slightly hypoplastic. Condylar head is normally located within the condylar fossa.

Condylar fossa is normally shaped and the articular eminence is not flattened, however small erosions are present along the dorsal aspect of the articular eminence.

No evidence of avascular necrosis.

Medial and lateral positioning of the condylar head is normal.

Parapharyngeal and masticator spaces are normal.

No entrapped masses or abnormalities sitting within the condylar fossa preventing the condyle from lying in the normal joint space or cavity are noted.

Articular disc is normally located approximately at the 12 o'clock position.

Articular disc is diminutive in size and atrophic.

On open mouth imaging, no excursion is present as the mandibular condyle remains within the condylar fossa with the articular disc unchanged in position. Findings related to either complete lock or technique.

RIGHT: Condylar head is markedly remodeled and slightly hypoplastic. Condylar head is normally located within the condylar fossa.

Condylar fossa is normally shaped.

Articular eminence is flattened and markedly hypoplastic/remodeled with small erosions.

Medial and lateral positioning of the condylar head is normal.

Parapharyngeal and masticator spaces are normal.

No entrapped masses or abnormalities sitting within the condylar fossa preventing the condyle from lying in the normal joint space or cavity are noted.

Articular disc is normally located approximately at the 12 o'clock position.

Articular disc is diminutive in size and hypoplastic.

On open mouth imaging, no excursion is present as the mandibular condyle remains within the condylar fossa with the articular disc unchanged in position. Findings related to either complete lock or technique.

CONCLUSION: 

Remodeled and hypoplastic left mandibular condyle with a flattened remodeled left articular eminence with small erosions. Slightly remodeled and hypoplastic right mandibular condyle. Both mandibular condyles remain within the condylar fossa on open mouth imaging compatible with either complete lock or related to technique. Articular discs remain at the 12 o'clock position and are diminutive in size and hypoplastic.

LESSON 2, TOPIC 36

Case Challenge: Temporomandibular Joint (TMJ) MRI Cases

Case Challenge

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Content reviewed: August 31, 2021

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