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13b - Answer: 59-year-old male presents with temporomandibular joint internal derangement

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

HISTORY: 

This 59-year-old male presents with temporomandibular joint internal derangement; right jaw clicking and limited opening intermittently for years. Symptoms became acutely worse six weeks ago, and he could hardly open.

(QUIZ ANSWER) IS A FINDING IN THIS CASE: 

All of the above.

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

FINDINGS:

Right-sided American Dental Association class 4 meniscal subluxation with capture (partial internal derangement). No lock.

In the open mouth position there is normal translation of the mandibular condylar head under the articular eminence bilaterally. The articular disc has a bowtie shape both on the right and left side. There is normal anterior translation. 

Subtle irregularity right greater than left condylar head consistent with early arthritis / arthrosis. 

CONCLUSION: 

1. Bilateral mild arthrosis but with small penetrating erosions. 

2. Right-sided American Dental Association class 4 meniscal subluxation with capture (partial internal derangement). No lock.

3. Left sided normal meniscal position and capture.

LESSON 2, TOPIC 39

Case Challenge: Temporomandibular Joint (TMJ) MRI Cases

Case Challenge

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Content reviewed: August 31, 2021

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