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6b - Answer: 56-year-old female presents with new onset of left-sided TMJ pain

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

HISTORY: 

This 56-year-old female presents with new onset of left-sided TMJ pain. History of parotidectomy.

(QUIZ ANSWER) FALSE STATEMENT: 

Mild swelling on fluid-sensitive sequences in the region of the bilaminar zone of the right TMJ. (Should be left TMJ)

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

FINDINGS:

Both temporomandibular joints demonstrate normal morphology regarding the condylar fossae, articular eminences and normal disc morphology. No evidence for effusion or arthrosis (no spurring, deformity, erosions or marrow signal abnormality in the mandibular condyles). 

Coronal oblique views demonstrate no evidence for medial or lateral subluxation. 

Open-mouth views demonstrate normal anterior translation bilaterally. 

On both open- and closed-mouth views the posterior band maintains its normal position at 12 o'clock with respect to the condylar head. 

Mildly increased signal intensity noted in the region of the bilaminar zone on the left side on fluid-sensitive imaging is compatible with some swelling in the posterior aspect of the lower compartment. This area contains neurovascular structures and may be a source of pain. 

Normal appearance of the superior and inferior tendinous bellies of the lateral pterygoids. 

IMPRESSION:

Mild swelling on fluid-sensitive sequences in the region of the bilaminar zone of the left TMJ compatible with some swelling and inflammation involving the posterior aspect of the lower compartment, an area known to contain neurovascular structures and may be a pain generator. 

Normal morphology of the TMJs bilaterally and normal dynamics of the left-sided TMJ between open- and closed-mouth imaging. No evidence for internal derangement per se. No evidence for arthrosis. 

Left sided otomastoid air cell inflamation.

LESSON 2, TOPIC 18

Case Challenge: Temporomandibular Joint (TMJ) MRI Cases

Case Challenge

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Content reviewed: August 31, 2021

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