Skip to main content

Advertisement

SpringerLink
Log in

Imaging Approach to Temporomandibular Joint Disorders

  • Review Article
  • Published:
Clinical Neuroradiology Aims and scope Submit manuscript

Abstract

Internal derangement is the most common temporomandibular joint disorder. Degenerative osteoarthritis and trauma are next in frequency. Less common pathology includes rheumatoid arthritis, synovial chondromatosis, calcium pyrophosphate dehydrate deposition disease, pigmented villonodular synovitis, tumors, infection, and osteonecrosis. We provide a systematic approach to facilitate interpretation based on major anatomic structures: disc-attachments, joint space, condyle, and lateral pterygoid muscle. Relevant graphic anatomy and state of the art imaging are discussed in correlation with current clinical and therapeutic highlights of pathologic entities affecting the joint.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18
Fig. 19
Fig. 20
Fig. 21

Similar content being viewed by others

References

  1. National Institute of Dental and Craniofacial Research. Facial pain. 2015. http://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/. Accessed 26 Aug 2015.

  2. Poveda Roda R, Bagan JV, Diaz Fernandez JM, Hernandez Bazan S, Jimenez Soriano Y. Review of temporomandibular joint pathology. Part I: classification, epidemiology and risk factors. Med Oral Patol Oral Cir Bucal. 2007;12(4):E292–8.

    PubMed  Google Scholar 

  3. Maixner W, Diatchenko L, Dubner R, Fillingim RB, Greenspan JD, Knott C, Ohrbach R, Weir B, Slade GD. Orofacial pain prospective evaluation and risk assessment study–the OPPERA study. J Pain. 2011;12(11 Suppl):T4–11 e1–2.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Liu F, Steinkeler A. Epidemiology, diagnosis, and treatment of temporomandibular disorders. Dent Clin North Am. 2013;57(3):465–79.

    Article  PubMed  Google Scholar 

  5. Slade GD, Fillingim RB, Sanders AE, Bair E, Greenspan JD, Ohrbach R, Dubner R, Diatchenko L, Smith SB, Knott C, Maixner W. Summary of findings from the OPPERA prospective cohort study of incidence of first-onset temporomandibular disorder: implications and future directions. J Pain. 2013;14(12 Suppl):T116–24.

    Article  PubMed  Google Scholar 

  6. Isberg A, Hagglund M, Paesani D. The effect of age and gender on the onset of symptomatic temporomandibular joint disk displacement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85(3):252–7.

    Article  CAS  PubMed  Google Scholar 

  7. Guarda-Nardini L, Piccotti F, Mogno G, Favero L, Manfredini D. Age-related differences in temporomandibular disorder diagnoses. Cranio. 2012;30(2):103–9.

    PubMed  Google Scholar 

  8. Moen K, Hellem S, Geitung JT, Skartveit L. A practical approach to interpretation of MRI of the temporomandibular joint. Acta Radiol. 2010;51(9):1021–7.

    Article  PubMed  Google Scholar 

  9. Sommer OJ, Aigner F, Rudisch A, Gruber H, Fritsch H, Millesi W, Stiskal M. Cross-sectional and functional imaging of the temporomandibular joint: radiology, pathology, and basic biomechanics of the jaw. Radiographics. 2003;23(6):e14.

    Article  PubMed  Google Scholar 

  10. Larheim TA, Westesson P, Sano T. Temporomandibular joint disk displacement: comparison in asymptomatic volunteers and patients. Radiology. 2001;218(2):428–32.

    Article  CAS  PubMed  Google Scholar 

  11. Yekkalam N, Wanman A. Prevalence of signs and symptoms indicative of temporomandibular disorders and headaches in 35-, 50-, 65- and 75-year-olds living in Vasterbotten, Sweden. Acta Odontol Scand. 2014;72(6):458–65.

    Article  PubMed  Google Scholar 

  12. Usui A, Akita K, Yamaguchi K. An anatomic study of the divisions of the lateral pterygoid muscle based on the findings of the origins and insertions. Surg Radiol Anat. 2008;30(4):327–33.

    Article  PubMed  Google Scholar 

  13. Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP, List T, Svensson P, Gonzalez Y, Lobbezoo F, Michelotti A, Brooks SL, Ceusters W, Drangsholt M, Ettlin D, Gaul C, Goldberg LJ, Haythornthwaite JA, Hollender L, Jensen R, John MT, De Laat A, de Leeuw R, Maixner W, van der Meulen M, Murray GM, Nixdorf DR, Palla S, Petersson A, Pionchon P, Smith B, Visscher CM, Zakrzewska J, Dworkin SF; International RDC/TMD Consortium Network, International association for Dental Research; Orofacial Pain Special Interest Group, International Association for the Study of Pain. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Groupdagger. J Oral Facial Pain Headache. 2014;28(1):6–27.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Zain-Alabdeen EH, Alsadhan RI. A comparative study of accuracy of detection of surface osseous changes in the temporomandibular joint using multidetector CT and cone beam CT. Dentomaxillofac Radiol. 2012;41(3):185–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Hintze H, Wiese M, Wenzel A. Cone beam CT and conventional tomography for the detection of morphological temporomandibular joint changes. Dentomaxillofac Radiol. 2007;36(4):192–7.

    Article  CAS  PubMed  Google Scholar 

  16. Honda K, Larheim TA, Maruhashi K, Matsumoto K, Iwai K. Osseous abnormalities of the mandibular condyle: diagnostic reliability of cone beam computed tomography compared with helical computed tomography based on an autopsy material. Dentomaxillofac Radiol. 2006;35(3):152–7.

    Article  CAS  PubMed  Google Scholar 

  17. Alkhader M, Kuribayashi A, Ohbayashi N, Nakamura S, Kurabayashi T. Usefulness of cone beam computed tomography in temporomandibular joints with soft tissue pathology. Dentomaxillofac Radiol. 2010;39(6):343–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Gauer RL, Semidey MJ. Diagnosis and treatment of temporomandibular disorders. Am Fam Physician. 2015;91(6):378–86.

    PubMed  Google Scholar 

  19. Hunter A, Kalathingal S. Diagnostic imaging for temporomandibular disorders and orofacial pain. Dent Clin N Am. 2013;57(3):405–18.

    Article  PubMed  Google Scholar 

  20. Lamot U, Strojan P, Surlan Popovic K. Magnetic resonance imaging of temporomandibular joint dysfunction-correlation with clinical symptoms, age, and gender. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116(2):258–63.

    Article  PubMed  Google Scholar 

  21. Larheim TA. Role of magnetic resonance imaging in the clinical diagnosis of the temporomandibular joint. Cells Tissues Organs. 2005;180(1):6–21.

    Article  PubMed  Google Scholar 

  22. Vaid YN, Dunnavant FD, Royal SA, Beukelman T, Stoll ML, Cron RQ. Imaging of the temporomandibular joint in juvenile idiopathic arthritis. Arthritis Care Res. 2014;66(1):47–54.

    Article  Google Scholar 

  23. Rao VM, Bacelar MT. MR imaging of the temporomandibular joint. Neuroimaging Clin N Am. 2004;14(4):761–75.

    Article  PubMed  Google Scholar 

  24. Yen P, Katzberg RW, Buonocore MH, Sonico J. Dynamic MR imaging of the temporomandibular joint using a balanced steady-state free precession sequence at 3 T. AJNR Am J Neuroradiol. 2013;34(3):E24–6.

    Article  CAS  PubMed  Google Scholar 

  25. Wang EY, Mulholland TP, Pramanik BK, Nusbaum AO, Babb J, Pavone AG, Fleisher KE. Dynamic sagittal half-Fourier acquired single-shot turbo spin-echo MR imaging of the temporomandibular joint: initial experience and comparison with sagittal oblique proton-attenuation images. AJNR Am J Neuroradiol. 2007;28(6):1126–32.

    Article  CAS  PubMed  Google Scholar 

  26. Stehling C, Vieth V, Bachmann R, Nassenstein I, Kugel H, Kooijman H, Heindel W, Fischbach R. High-resolution magnetic resonance imaging of the temporomandibular joint: image quality at 1.5 and 3.0 Tesla in volunteers. Invest Radiol. 2007;42(6):428–34.

    Article  PubMed  Google Scholar 

  27. Katzberg RW, Westesson PL, Tallents RH, Drake CM. Anatomic disorders of the temporomandibular joint disc in asymptomatic subjects. J Oral Maxillofac Surg. 1996;54(2):147–53.

    Article  CAS  PubMed  Google Scholar 

  28. Rammelsberg P, Pospiech PR, Jager L, Pho Duc JM, Bohm AO, Gernet W. Variability of disk position in asymptomatic volunteers and patients with internal derangements of the TMJ. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;83(3):393–9.

    Article  CAS  PubMed  Google Scholar 

  29. Orsini MG, Kuboki T, Terada S, Matsuka Y, Yatani H, Yamashita A. Clinical predictability of temporomandibular joint disc displacement. J Dent Res. 1999;78(2):650–60.

    Article  CAS  PubMed  Google Scholar 

  30. Wilkes CH. Internal derangements of the temporomandibular joint. Pathological variations. Arch Otolaryngol Head Neck Surg. 1989;115(4):469–77.

    Article  CAS  PubMed  Google Scholar 

  31. Liu XM, Zhang SY, Yang C, Chen MJ, X YC, Haddad MS, Yun B, Chen ZZ. Correlation between disc displacements and locations of disc perforation in the temporomandibular joint. Dentomaxillofac Radiol. 2010;39(3):149–56.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Westesson P, Otonari-Yamamoto M, Sano T, Okano T. Anatomy, pathology, and imaging of the temporomandibular joint. In: Som PM, Curtin HD, editors. Head and neck imaging. Mosby: Elsevier; 2011.

    Google Scholar 

  33. Suenaga S, Sonoda S, Oku T, Abeyama K, Noikura T. MRI of the temporomandibular joint disk and posterior disk attachment before and after nonsurgical treatment. J Comput Assist Tomogr. 1997;21(6):892–6.

    Article  CAS  PubMed  Google Scholar 

  34. Westesson PL, Paesani D. MR imaging of the TMJ. Decreased signal from the retrodiskal tissue. Oral Surg Oral Med Oral Pathol. 1993;76(5):631–5.

    Article  CAS  PubMed  Google Scholar 

  35. Larheim TA. Temporomandibular joint. In: Larheim TA, Westesson P-L, editors. Maxillofacial imaging. Berlin: Springer; 2006. pp. 143–77.

    Google Scholar 

  36. Guler N, Uckan S, Imirzalioglu P, Acikgozoglu S. Temporomandibular joint internal derangement: relationship between joint pain and MR grading of effusion and total protein concentration in the joint fluid. Dentomaxillofac Radiol. 2005;34(3):175–81.

    Article  CAS  PubMed  Google Scholar 

  37. Suenaga S, Abeyama K, Noikura T. Gadolinium-enhanced MR imaging of temporomandibular disorders: improved lesion detection of the posterior disk attachment on T1-weighted images obtained with fat suppression. AJR Am J Roentgenol. 1998;171(2):511–7.

    Article  CAS  PubMed  Google Scholar 

  38. Suenaga S, Ogura T, Matsuda T, Noikura T. Severity of synovium and bone marrow abnormalities of the temporomandibular joint in early rheumatoid arthritis: role of gadolinium-enhanced fat-suppressed T1-weighted spin echo MRI. J Comput Assist Tomogr. 2000;24(3):461–5.

    Article  CAS  PubMed  Google Scholar 

  39. Kretapirom K, Okochi K, Nakamura S, Tetsumura A, Ohbayashi N, Yoshino N, Kurabayashi T. MRI characteristics of rheumatoid arthritis in the temporomandibular joint. Dentomaxillofac Radiol. 2013;42(4):31627230.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Carrasco R. Juvenile idiopathic arthritis overview and involvement of the temporomandibular joint: prevalence, systemic therapy. Oral Maxillofac Surg Clin N Am. 2015;27(1):1–10.

    Article  Google Scholar 

  41. Kuseler A, Pedersen TK, Herlin T, Gelineck J. Contrast enhanced magnetic resonance imaging as a method to diagnose early inflammatory changes in the temporomandibular joint in children with juvenile chronic arthritis. J Rheumatol. 1998;25(7):1406–12.

    CAS  PubMed  Google Scholar 

  42. Sink J, Bell B, Mesa H. Synovial chondromatosis of the temporomandibular joint: clinical, cytologic, histologic, radiologic, therapeutic aspects, and differential diagnosis of an uncommon lesion. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;117(3):e269–74.

    Article  PubMed  Google Scholar 

  43. Heffez LB. Imaging of internal derangements and synovial chondromatosis of the temporomandibular joint. Radiol Clin N Am. 1993;31(1):149–62.

    CAS  PubMed  Google Scholar 

  44. Testaverde L, Perrone A, Caporali L, Ermini A, Izzo L, D’Angeli I, Impara L, Mazza D, Izzo P, Marini M. CT and MR findings in synovial chondromatosis of the temporo-mandibular joint: our experience and review of literature. European journal of radiology. 2011;78(3):414–8.

    Article  PubMed  Google Scholar 

  45. Meng J, Guo C, Yi B, Zhao Y, Luo H, Ma X. Clinical and radiologic findings of synovial chondromatosis affecting the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109(3):441–8.

    Article  PubMed  Google Scholar 

  46. Guarda-Nardini L, Piccotti F, Ferronato G, Manfredini D. Synovial chondromatosis of the temporomandibular joint: a case description with systematic literature review. Int J Oral Maxillofac Surg. 2010;39(8):745–55.

    Article  CAS  PubMed  Google Scholar 

  47. Wang P, Tian Z, Yang J, Yu Q. Synovial chondromatosis of the temporomandibular joint: MRI findings with pathological comparison. Dentomaxillofac Radiol. 2012;41(2):110–6.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Steinbach LS. Calcium pyrophosphate dihydrate and calcium hydroxyapatite crystal deposition diseases: imaging perspectives. Radiol Clin N Am. 2004;42(1):185–205, vii.

    Article  PubMed  Google Scholar 

  49. Zweifel D, Ettlin D, Schuknecht B, Obwegeser J. Tophaceuos calcium pyrophosphate dihydrate deposition disease of the temporomandibular joint: the preferential site? J Oral Maxillofac Surg. 2012;70(1):60–7.

    Article  PubMed  Google Scholar 

  50. Takata Y, Koeda S, Inahara H, Kumamoto H, Kawamura H. Tophaceous pseudogout (tumoral calcium pyrophosphate dihydrate crystal deposition disease) of the temporomandibular joint: a case report. Asian J Oral Maxillofac Surg. 2010;22(2):108–11.

    Article  Google Scholar 

  51. Ishida T, Dorfman HD, Bullough PG. Tophaceous pseudogout (tumoral calcium pyrophosphate dihydrate crystal deposition disease). Human Pathol. 1995;26(6):587–93.

    Article  CAS  Google Scholar 

  52. Pynn BR, Weinberg S, Irish J. Calcium pyrophosphate dihydrate deposition disease of the temporomandibular joint. A case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995;79(3):278–84.

    Article  CAS  PubMed  Google Scholar 

  53. Matsumura Y, Nomura J, Nakanishi K, Yanase S, Kato H, Tagawa T. Synovial chondromatosis of the temporomandibular joint with calcium pyrophosphate dihydrate crystal deposition disease (pseudogout). Dentomaxillofac Radiol. 2012;41(8):703–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Sano T, Westesson PL, Larheim TA, Takagi R. The association of temporomandibular joint pain with abnormal bone marrow in the mandibular condyle. J Oral Maxillofac Surg. 2000;58(3):254–7.

    Article  CAS  PubMed  Google Scholar 

  55. Wolford LM. Idiopathic condylar resorption of the temporomandibular joint in teenage girls (cheerleaders syndrome). Proc (Bayl Univ Med Cent). 2001;14(3):246–52.

    CAS  Google Scholar 

  56. Wolford LM, Goncalves JR. Condylar resorption of the temporomandibular joint: how do we treat it? Oral Maxillofac Surg Clin N Am. 2015;27(1):47–67.

    Article  Google Scholar 

  57. Som PM, Curtin HD. Head and neck imaging. 5th ed. St. Louis: Mosby Elsevier; 2011.

    Google Scholar 

  58. Bittar GT, Bibb CA, Pullinger AG. Histologic characteristics of the lateral pterygoid muscle insertion to the temporomandibular joint. J Orofac Pain. 1994;8(3):243–9.

    CAS  PubMed  Google Scholar 

  59. 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;26(3):765–81.

    Article  PubMed  Google Scholar 

  60. D’Ippolito SM, Borri Wolosker AM, D’Ippolito G, Herbert de Souza B, Fenyo-Pereira M. Evaluation of the lateral pterygoid muscle using magnetic resonance imaging. Dentomaxillofac Radiol. 2010;39(8):494–500.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Finden SG, Enochs WS, Rao VM. Pathologic changes of the lateral pterygoid muscle in patients with derangement of the temporomandibular joint disk: objective measures at MR imaging. AJNR Am J Neuroradiol. 2007;28(8):1537–9.

    Article  CAS  PubMed  Google Scholar 

  62. Fernandes T, Lobo JC, Castro R, Oliveira MI, Som PM. Anatomy and pathology of the masticator space. Insights Imaging. 2013;4(5):605–16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Ahmad M, Hollender L, Anderson Q, Kartha K, Ohrbach R, Truelove EL, John MT, Schiffman EL. Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107(6):844–60.

    Article  PubMed  PubMed Central  Google Scholar 

  64. De Leeuw R, Klasser G. American Academy of Orofacial Pain. Orofacial Pain: Guidelines for assessment, diagnosis, and management. 5th ed. Chicago: Quintessence Publ.; 2013.

    Google Scholar 

  65. Dolwick MF. Temporomandibular joint surgery for internal derangement. Dent Clin N Am. 2007;51(1):195–208, vii–viii.

    Article  PubMed  Google Scholar 

  66. Goncalves JR, Cassano DS, Rezende L, Wolford LM. Disc repositioning: does it really work? Oral Maxillofac Surg Clin N Am. 2015;27(1):85–107.

    Article  Google Scholar 

  67. McCain JP, Hossameldin RH, Srouji S, Maher A. Arthroscopic discopexy is effective in managing temporomandibular joint internal derangement in patients with Wilkes stage II and III. J Oral Maxillofac Surg. 2015;73(3):391–401.

    Article  PubMed  Google Scholar 

  68. Aiken A, Bouloux G, Hudgins P. MR imaging of the temporomandibular joint. Magn Reson Imaging Clin N Am. 2012;20(3):397–412.

    Article  PubMed  Google Scholar 

  69. da Silva PA, Lopes MT, Freire FS. A prospective study of 138 arthroscopies of the temporomandibular joint. Braz J Otorhinolaryngol. 2015;81(4):352–7.

    Article  PubMed  Google Scholar 

  70. Al-Moraissi EA. Open versus arthroscopic surgery for the management of internal derangement of the temporomandibular joint: a meta-analysis of the literature. Int J Oral Maxillofac Surg. 2015;44(6):763–70.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thanks Dr. Angelo Rutty, Perea Hospital-Puerto Rico, for his contribution with superb anatomic drawings. Many thanks as well to Dr. Mary Mahoney, University of Cincinnati, for her invaluable suggestions at the early stages of this manuscript.

Conflict of Interest

The authors declare no conflicts of interests relevant to this submitted manuscript.

Author information

Authors and Affiliations

  1. Section of Neuroradiology, Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, 45267-0761, Cincinnati, OH, USA

    H. Morales

  2. University of Cincinnati Medical Center, Cincinnati, USA

    R. Cornelius

Authors
  1. H. Morales
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Cornelius
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. Morales.

Additional information

Previously presented Scientific Exhibit at: Annual Meeting of the American Society of Neuroradiology, April 21–26, 2012; New York, NY.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Morales, H., Cornelius, R. Imaging Approach to Temporomandibular Joint Disorders. Clin Neuroradiol 26, 5–22 (2016). https://doi.org/10.1007/s00062-015-0465-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00062-015-0465-0

Keywords

Search

Navigation