‫سورة البقرة األية ‪32‬‬

MRI OF THE T.M.J.

ANATOMY
THE TMJ IS FORMED BY
ARTICLATION BETWEEN THE
MANDIBULAR CONDYLE AND
THE TEMPORAL BONE
THE MANDIBULAR CONDYLE
 THE ARTICULAR DISK

This small fibrocartilage cushion

is interposed between the
mandibular condyle and the
condylar fossa, separating the
joint into distinct upper and
lower compartment
 THE ARTICULAR DISK

 IT DIVIDES THE JOINT INTO:

1. TEMPRO-DISCAL.
2. DISCO-CONDYLAR.

WHAT IS THE
IMPORTANCE?????
 THE ARTICULAR DISK
Morphological components:

1. The anterior band(2-3mm)

2. The posterior band(4-5mm).
3. Thin intermediate
zone(1mm).
THE ARTICULAR DISK
 THE ARTICULAR DISK
 The disk assumes BOW TIE
appearance .
 Owing to fibrous element it exhibits
low signal in different pulse
sequences.
 It has no vascular or nerve supply.
 Collateral ligaments secure the disk to
the condyle
 THE ARTICULAR DISK
 INCLOSED MOUTH
POSITION IT IS ANTERO-
SUPERIOR TO THE
MANDIBULAR CONDYLE
IN 11 O'CLOCK POSITION
ON THE LEFT SIDE AND 1
O'CLOCK ON THE RIGHT.
 THE ARTICULAR DISK
 IN OPEN MOUTH POSITION
THE MANDIBULAR CONDYLE
THE DISC AND THE
MANDIBUALR EMINENCE ARE
ALIGNED IN 12 O'CLOCK
POSITION
THE ARTICULAR DISK AND THE
MANDIULAR HEAD COMPLEX
 MRI ANATOMY
 Thebone of the condylar fossa is
thin and typically does not
contain a large amount of fat.

 The articular surfaces of the

condyle and fossa are covered
with dense fibrous connective
tissue rather than the chondral
cartilage that lines most other
joints
 MRI ANATOMY
 The dense
cortical bone
of the condyle
and condylar
fossa displays
very low
signal on MR
images
 PERFORATED DISK

 NOT MRI DIAGNOSIS.

 ARTHROGRAPHIC DIAGNOSIS.

 EQUALS SURGERY.
TECHNIQUE
 MRI EXAMINATION
 Coil : Dual TMJ surface coil
 Small FOV 8 to 10 cm.
 Gradient-echo or the T2 spin-echo (SE)
sequences in sagittal oblique plane in both
closed and open mouth positions are
mandatory .
 Coronal images are routinely obtained
because they provide information about
mediolateral relationships at the TMJ.
 T1WI is advocated at inflammatory and
neoplastic conditions.
 Sagittal images
are assigned
from the axial
scout in an
oblique plane
corresponding
to the axis of
the condyle
and body of the
mandible.
 Slice thickness is 2-3 mm and
interslice gap is 0-1mm.

 Range of motion is 6 cm (12 in

Baboons) cine imaging is
obtained by multiple slices in
dead sagittal 1-5 mm open mouth
gap. Guarded by incremental
mouth opening device .
INDICATIONS
 PAIN.
 CLCKING
 LIMITATION OF MOVEMENT and /or
dislocation.
 TRAUMA.
 SKULL BASE MASSES,INFLAMMATORY
STATES.
 COLLAGEN DISEASES e.g. Rheumatoid
Arthritis.
 SYNOVIAL NEOPLASMS (Sarcoma).
TO INTERPRET AN MRI EXAMINATION
FOR THE TMJ COMMENT THE FOLLWING:

1. CLOSED ,THE SITE AND SHAPE OF

THE DISK.

2. OPEN ,SITE , SHAPE OF THE DISK,

AND HORIZONTAL TRANSLATION
MOVEMENT.

3. EFFUSION.
 PATHOLOGICAL
CONSIDERATIONS
 Internal
Derangements
 Internal Derangements
 The intraarticular disk has been the focus of
much attention in TMJ imaging.
 C.T and Arthrography were the mean of
diagnosis.
 The diagnosis of internal derangement centers
on abnormal disk position or function.
 The abnormally positioned disk is usually
found anterior to the condyle
 ANTERIOR DISPLACEMENT

It is classified according to (shape):

1. Degeneration of the posterior band and

buckling of the anterior band thus
assuming triangular .

2. Resorption of the disk .

POSTERIOR DISPLACEMENT
 ACCORDING TO POSITION AND REDUCTION

 MILD :The disk is anteriorly dislocated

with reduction in closed position
(Return to normal position in OMP).
 Moderate: The disc is anteriorly
dislocated (DISPLACED)
(NO REDUCTION IN OMP) .
 Severe: The disc is disfigured,
anteriorly dislocated with no reduction
 MANDIBULAR DISLOCATION

MEANS THAT THE MANDIBULAR CONDYLE

UNDERWENT ANTERIOR DISPLACEMENT BEYOND
THE TEMPORAL EMINENCE (HYPERMOBILE
MANDIBLE):

1. CONDYLE.

2. CONDYLE /DISC COMPLEX.

 MANDIBULAR DISLOCATION

 EARLY:HOLDS THE DISC IN PLACE

LEADING TO DISPLACED CONDYLE
(SURGICAL).

 LATE:
HOLDS THE DISC/CONDYLE
COMPLEX (LOCK JAW).
 ADHESIONS

THE POSTERIOR ATTACHMENT

MAY UNDERGO FIBROSIS??????
 Articular Disease:
 Osteoarthritis .
 Giant cell reaction
 GOUT .
 Rheumatoid arthritis .
 Synovial chondromatosis .
 Synovial sarcoma.
 TRAUMA

MANDIBULAR FRACTURES.
CONDYLAR FRACTURES.