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5b - Answer: 68-year-old female presents with pain to the left sided jaw

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

HISTORY: 

This 68-year-old female presents with pain to the left sided jaw for the past two months.

(QUIZ ANSWER) FINDINGS INCLUDE: 

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: 

Non temporomandibular joint findings: 

Mild inferior maxillary sinus mucosal thickening, left greater than right. 

RIGHT TEMPOROMANDIBULAR JOINT: 

Right temporomandibular joint demonstrates reveals flattening of the mandibular condyle, degenerative osteophyte formation and subchondral sclerosis consistent with osteoarthritic change. Closed mouth view demonstrates a flattened irregular disc which demonstrates mild anterior displacement. On the open mouth view the disc remains anteriorly displaced without reduction. The retrodiscal tissues are also flattened and irregular and not well visualized. 

LEFT TEMPOROMANDIBULAR JOINT: 

Left temporomandibular joint demonstrates prominent flattening of the mandibular condyle, subtle erosions along the condyle and along the temporal bone and degenerative osteophyte formation. Closed mouth view demonstrates a crumbled irregular anteriorly-displaced disc. Open mouth view demonstrates anterior disc displacement without reduction. The retrodiscal tissues are flattened and irregular and not well visualized. 

CONCLUSION: 

1. Severe bilateral osteoarthritic changes within the temporomandibular joint slightly more prominent on the left with flattening of the mandibular condyle, subchondral sclerosis, erosions along the anterior condyle and inferior temporal bone and degenerative osteophyte formation. 

2. Both right and left temporomandibular joints demonstrate flattened irregular articular discs which are displaced anteriorly without evidence for reduction on closed mouth views. 

3. Decreased motion and lack of capture = bilateral closed lock.

LESSON 2, TOPIC 15

Case Challenge: Temporomandibular Joint (TMJ) MRI Cases

Case Challenge

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Content reviewed: August 31, 2021

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