MR Imaging of the temporomandibular joint (TMJ): normal exam in closed/open-mouth and dynamic sequences

MR Imaging of the temporomandibular joint (TMJ): normal exam in closed/open-mouth and dynamic sequences

MR Imaging of the temporomandibular joint (TMJ): normal exam in closed/open-mouth and dynamic sequences


Introduction

Magnetic Resonance Imaging (MRI) is the reference non-invasive imaging technique for the evaluation of the temporomandibular joint (TMJ), especially for the study of the articular disk (meniscus) and surrounding structures in TMJ dysfunction (or TMJ disorder, defined as an abnormal relationship of the disk and the mandibular condyle).
The ability of MRI to produce precise images of the joint and surrounding structures without the use of ionizing radiation, which is a possible concern associated with conventional imaging techniques such as X-rays and CT scans, is one of the main reasons for using MRI for the TMJ.
MRI allows radiologists to evaluate the anatomy and function of the TMJ and its surrounding structures, including the articular disk, the bones, muscles and ligaments. The TMJ can be affected by abnormal dynamics of the disk-condyle complex, degenerative arthritis, inflammatory arthritis, and crystal arthropathy. Less commonly, neoplasms and abnormal morphologic features of the condyle can also be causes of TMJ symptoms. 
Even in the presence of metal implants, such as dental braces or dental fillings, MRI for the TMJ can provide clear images of the joint. 
MRI can also be used to evaluate the soft tissue surrounding the TMJ, including the muscles of mastication like the temporalis, masseter and lateral pterygoid muscles. This is important because these muscles play a key role in the function of the TMJ and can be affected by various disorders, such as temporomandibular joint dysfunction (TMD) and temporomandibular joint arthritis (TMJ arthritis).
 

Material and methods

This MR of the temporomandibular joint was carried out on a healthy female patient, using a Siemens 3T MRI (except for the dynamic sequence, performed on a 1.5T MRI on a different patient). 
This imaging technique includes the use of dual surface coils, in sagittal oblique thin sections of 2 mm (proton-density weighted and T1-weighted sequences) in both closed-and open-mouth positions.
Furthermore, a dynamic study was performed during progressive mouth opening with cine MR imaging.
Coronal T2 FS and axial T2 images were added but are less relevant in the study of the TMJ disorders.
The anatomical structures were labeled by Antoine Micheau MD (Radiologist, Montpellier – France).
 

There is no content here

  • Terminologia anatomica: international anatomical terminology By the Federative Committee on Anatomical Terminology (FCAT).  Stuttgart:  Georg Thieme Verlag.  ISBN-10: 3-13-114361-4. ISBN-13: 978-3-13-114361-7
  • Tomas X, Pomes J, Berenguer J, Quinto L, Nicolau C, Mercader JM, Castro V. MR imaging of temporomandibular joint dysfunction: a pictorial review. Radiographics. 2006 May-Jun;26(3):765-81. doi: 10.1148/rg.263055091. PMID: 16702453.
  • Internal Derangements of the Temporomandibular Joint Oral and Maxillofacial Surgery for the Clinician, 2021 ISBN : 978-981-15-1345-9 Gary Warburton
  • Petscavage-Thomas JM, Walker EA. Unlocking the jaw: advanced imaging of the temporomandibular joint. AJR Am J Roentgenol. 2014 Nov;203(5):1047-58. doi: 10.2214/AJR.13.12177. PMID: 25341144