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1b - Answer: 65-year-old female presents with chronic temporomandibular joint pain

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

HISTORY: 

This 65-year-old female presents with chronic temporomandibular joint pain, left greater than right. Patient currently unable to open mouth. No history of surgery or trauma.

(QUIZ ANSWER) NOT A FINDING IN THIS CASE: 

Right temporomandibular joint: Demonstrates subluxation / dislocation.

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

FINDINGS:

Right articular disc intact with normal positioning during open mouth and complete capture during closed mouth and closed mouth with wax bite images. Normal appearance of the mandibular condyle, articular eminence, and glenoid fossa. No subcortical osteoedema. No right temporomandibular joint effusion. Bilobed 1.2cm posterior capsular pseudocyst. No temporomandibular joint subluxation/dislocation. Intact superolateral and inferolateral pterygoid muscles. 

Left temporomandibular joint demonstrates perforation at the intermediate zone of the articular disc. Disc demonstrates anteromedial displacement on closed mouth view but recaptures on open view and closed with wax bite view. Arthropathic deformity of the mandibular condyle noted with arthropathic shallow articular eminence. No subcortical osteoedema. No joint effusion. No temporomandibular joint subluxation/dislocation. Superolateral and inferolateral pterygoid muscles on the left intact. 

CONCLUSION: 

1. Left temporomandibular joint demonstrates anteromedial displacement of the articular disc with mouth closure and disc recapture with mouth opening and recapture when biting down on wax. Associated arthropathic deformity of the articular eminence and marked arthropathic deformity of the mandibular condyle with perforation of the articular disc at its intermediate zone. 

2. 1.2cm posterior capsular pseudocyst emanating from the right temporomandibular joint capsule.

LESSON 2, TOPIC 3

Case Challenge: Temporomandibular Joint (TMJ) MRI Cases

Case Challenge

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Content reviewed: August 31, 2021

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