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

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

HISTORY: 

This 48-year-old female presents with one year history of right open and close lock with TMJ crepitus and pain with function. Wilkes stage 5 right TMJ osteoarthritis. Patient has had problems with right jaw for about a year, locking up occasionally, grinding sound in ear, popping. No surgery. No cancer.

(QUIZ ANSWER) NOT A FINDING IN THIS CASE: 

Left TMJ: Arthrosis.

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

FINDINGS:

Left Temporomandibular Joint: Closed-mouth projection demonstrates 30-degree displacement on the left but recapture with normal translation in the open-mouth projection. No arthrosis on the left. 

Right Temporomandibular Joint: Right TMJ is arthropathic and remodeled and sclerotic. Large effusion. Extruded ADA Class 4 displacement. Partial lock demonstrated with force but diminished translation in the open-mouth projection. Shallow sclerotic fossa bone-on-bone changes. Macerated disc persistently anteriorly displaced. Remodeled articular eminence and condylar fossa.

CONCLUSION: 

1. Arthropathic sclerotic remodeled right TMJ with extruded ADA Class 4 meniscal displacement (and complete internal derangement), arthritis, and partial lock. Meniscal rupture, retracted attachments. Remodeled articular eminence and condylar fossa.

2. 30-degree anterior displacement (ADA Class 2) on the left with normal recapture in open-mouth projection; therefore, partial internal derangement.

LESSON 2, TOPIC 45

Case Challenge: Temporomandibular Joint (TMJ) MRI Cases

Case Challenge

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Content reviewed: August 31, 2021

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