MRI of Temporomandibular Joint Disorders

Edwin Y. Wang, MD; Kenneth A. Fleisher, DDS

Appl Radiol. 2008;37(9):17-25.

Introduction

Approximately 10 million individuals in the United States are affected by temporomandibular joint (TMJ) abnormalities (National Institutes of Health data, National Institute of Dental and Craniofacial Research).^[1] The highest prevalence of temporomandibular disorders (TMD) is in women aged 20 to 40 years, with women representing 80% of patients being treated for TMD.^[2,3] Magnetic resonance imaging (MRI) plays an important role in the evaluation of TMD, as it allows for a noninvasive depiction of the joint that is not otherwise available. Moreover, clinical diagnosis of TMJ abnormalities can be challenging, particularly given the psychosocial factors that can be involved in pain disorders. The diagnostic accuracy of the clinical examination is variable, ranging from 54% to 90%.^[4]

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Table 1. MRI Protocol for Evaluation of the Temporomandibular Joint
Sequence	Notes
Scout imaging	Planning for following sequences
Proton-density sagittal oblique closed-mouth imaging	Oriented perpendicular to the long axis of the condylar head on axial imaging
Short tau inversion recovery (STIR) sagittal oblique closed-mouth imaging	Assessment for joint effusion, marrow edema, and retrodiscal soft tissue edema
T1-weighted coronal oblique closed-mouth imaging	Assessment for mediolateral disc displacement
Proton-density sagittal oblique open-mouth imaging	30-mL syringe used as a static bite block
Dynamic sagittal half-Fourier acquisition single-shot turbo spino-echo (HASTE) imaging	35-second dynamic assessment of range of motion and joint components

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