Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Jul;91(3):280-287.
doi: 10.15386/cjmed-970. Epub 2018 Jul 31.

Imaging modalities for temporomandibular joint disorders: an update

Daniel Talmaceanu  1 , Lavinia Manuela Lenghel  2 , Nicolae Bolog  3 , Mihaela Hedesiu  2 , Smaranda Buduru  4 , Horatiu Rotar  1 , Mihaela Baciut  1 , Grigore Baciut  1
Affiliations
Review

Imaging modalities for temporomandibular joint disorders: an update

Daniel Talmaceanu et al. Clujul Med. 2018 Jul.

Abstract

The diagnosis and management of temporomandibular disorders (TMD) require both clinical and imaging examinations of the temporomandibular joint (TMJ). A variety of modalities can be used to image the TMJ, including magnetic resonance imaging (MRI), computed tomography (CT), cone beam CT, ultrasonography, conventional radiography. The present review outlines the indications of the most frequently used imaging techniques in TMD diagnosis. Because of the anatomic complexity of the TMJ, imaging can be difficult. Choosing the proper imaging technique is essential. Conventional radiography, nowadays, is of limited interest. The use of flat plane films for TMJ pathology is not sufficient, because this joint requires three dimensional imaging views. Osseous changes are better visualized with CT and cone beam CT. Cone beam CT provides high-resolution multiplanar reconstruction of the TMJ, with a low radiation dose, without superimposition of the bony structures. MRI is a noninvasive technique, considered to be the gold standard in imaging the soft tissue components of the TMJ. MRI is used to evaluate the articular disc in terms of location and morphology. Moreover, the early signs of TMD and the presence of joint effusion can be determined. High-resolution ultrasonography is a noninvasive, dynamic, inexpensive imaging technique, which can be useful in diagnosing TMJ disc displacements. The diagnostic value of high-resolution ultrasonography is strictly dependent on the examiner's skills and on the equipment used.

Keywords: computed tomography; magnetic resonance imaging; temporomandibular disorders; temporomandibular joint; ultrasonography.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Temporomandibular joint anatomy: GF - glenoid fossa; C - mandibular condyle; D - articular disc; RT - retrodiscal tissue; LPM - lateral pterygoid muscle.
Figure 2
Figure 2
Panoramic radiography: important asymmetry between right and left mandibular condyle.
Figure 3
Figure 3
Comparative TMJ views obtained with a panoramic equipment: mouth-closed (a), (d) and mouth-opened (b), (c).
Figure 4
Figure 4
Contact technique (Parma incidence) of imaging the TMJ: mouth-closed (a), mouth-opened (b).
Figure 5
Figure 5
CT scan of an intracapsular fracture of the right TMJ. Sagittal plane (a), coronal plane (b).
Figure 6
Figure 6
Cone beam CT of the right TMJ: flattening and erosions of the mandibular condyle. Sagittal plane (a), coronal plane (b).
Figure 7
Figure 7
Cone beam CT of TMJ: left condyle hyperplasia (arrow). Coronal plane (a), axial plane (b).
Figure 8
Figure 8
Sagittal, proton density, MRI of a normal TMJ: mouth-closed (a), mouth-opened (b). The disc (arrow) is in a correct position.
Figure 9
Figure 9
Sagittal, proton density, MRI of an anterior disc displacement with reduction: mouth-closed (a), mouth-opened (b). The displaced disc (arrow) returns to its normal position at maximal mouth opening.
Figure 10
Figure 10
Sagittal, T2 weighted, MRI of a TMJ effusion.
Figure 11
Figure 11
High-resolution US of an anterior disc displacement with reduction: mouth-closed (a), mouth-opened (b). The arrow shows the displaced disc.
Figure 12
Figure 12
High-resolution US of an anterior disc displacement without reduction: mouth-closed (a), mouth-opened (b). 1 - articular eminence; 2 – articular disc; 3 - mandibular condyle.
See this image and copyright information in PMC

References

    1. Okeson JP. Management of temporomandibular disorders and occlusion. 6th ed. St. Louis: Mosby; 2008. pp. 5–21.
    1. Shaffer SM, Brismée JM, Sizer PS, Courtney CA. Temporomandibular disorders. Part 1: anatomy and examination/diagnosis. J Man Manip Ther. 2014;22:2–12. - PMC - PubMed
    1. Slavicek R. The masticatory organ: functions and dysfunctions. Gamma Meidizinisch-wissenschaftliche Forbildungs- GmbH; Klostenburg: 2006. pp. 60–66.
    1. Alomar X, Medrano J, Cabratosa J, Clavero JA, Lorente M, Serra I, et al. Anatomy of the temporomandibular joint. Semin Ultrasound CT MR. 2007;28(3):170–183. - PubMed
    1. De Leeuw R, Klasser G. Orofacial Pain: Guidelines for assessement, diagnosis and management. 5th ed. Chicago: Quintessence Publishing Co., Inc; 2013. pp. 127–137.

LinkOut - more resources