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3b - Answer: 55-year-old female presents with 40-year history of bilateral temporomandibular joint pain

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

HISTORY: 

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: 

Right TMJ: Edema involving the lateral pterygoid muscle.

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

FINDINGS: 

RIGHT TMJ: Anterior displacement of the intact articular disc is noted on the closed-mouth view without recapture on the open-mouth view. 

No joint effusion or intraarticular loose body. No bursitis. 

Anterior osteophyte seen involving the mandibular condyle. Mandibular fossa and glenoid abnormal appearance. 

No edema involving the lateral pterygoid muscle. No evidence of locking in the right temporomandibular joint. 

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. 

No joint effusion or bursitis. 

Severe arthropathic changes involve the mandibular condyle with subchondral sclerosis. 

No myoedema involving lateral pterygoid muscle. 

Incidental note made of left concha bullosa at the middle turbinate. 

Left temporomandibular joint is locked. 

CONCLUSION: 

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. 

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.

LESSON 2, TOPIC 9

Case Challenge: Temporomandibular Joint (TMJ) MRI Cases

Case Challenge

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Content reviewed: August 31, 2021

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