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Cross-sectional and Functional Imaging of the Temporomandibular Joint: Radiology, Pathology, and Basic Biomechanics of the Jaw¹

¹ From the Department of Radiology (O.J.S., M.S.) and Institute of Oral and Maxillofacial Surgery and Dentistry (W.M.), Hospital Lainz, Wolkersbergenstrasse 1, Vienna, Austria 1130; Institute of Anatomy, University Innsbruck, Austria (F.A., H.F.); and the Department of Radiology, University Hospital Innsbruck, Austria (A.R., H.G.). Presented as an educational exhibit at the 2002 RSNA scientific assembly. Received March 14, 2003, revision requested May 13, revision received and accepted July 8. Address correspondence to O.J.S. (e-mail: oliver.sommer@wienkav.at).

View larger version (59K): [in a new window]   Figure 1.  Axial MR scout images (400/20). Parasagittal and paracoronal section blocks are angulated perpendicular and parallel to the axis of the mandibular condyle.

View larger version (18K): [in a new window]   Figure 2.  Schematic of the temporomandibular disk in a sagittal projection. 1, Anterior band; 2, posterior band; 3, intermediate zone (inconstant central water signal intensity); 4, anterior attachment; 5, posterior attachment, or bilaminar zone.

View larger version (57K): [in a new window]   Figure 3a.  (a) Schematic of the TMJ in a closed mouth position and sagittal projection and (b) sagittal thin section of a closed jaw. 1, Mandibular head; 2, articular eminence; 3, disk (3a, anterior band; 3b, intermediate zone; 3c, posterior band); 4, bilaminar zone; 5, lateral pterygoid muscle with interposed fat tissue (yellow in schematic) (5a, superior head; 5b, inferior head); 6, superior joint space; 7, inferior joint space.

View larger version (164K): [in a new window]   Figure 3b.  (a) Schematic of the TMJ in a closed mouth position and sagittal projection and (b) sagittal thin section of a closed jaw. 1, Mandibular head; 2, articular eminence; 3, disk (3a, anterior band; 3b, intermediate zone; 3c, posterior band); 4, bilaminar zone; 5, lateral pterygoid muscle with interposed fat tissue (yellow in schematic) (5a, superior head; 5b, inferior head); 6, superior joint space; 7, inferior joint space.

View larger version (62K): [in a new window]   Figure 4a.  (a) Schematic of the TMJ in a closed mouth position and coronal projection and (b) coronal thin section of a closed jaw. 1, Mandibular head; 2, articular fossa; 3, disk; 4, medial attachment; 5, lateral attachment; 6, superior joint space; 7, inferior joint space; 8, lateral pterygoid muscle.

View larger version (139K): [in a new window]   Figure 4b.  (a) Schematic of the TMJ in a closed mouth position and coronal projection and (b) coronal thin section of a closed jaw. 1, Mandibular head; 2, articular fossa; 3, disk; 4, medial attachment; 5, lateral attachment; 6, superior joint space; 7, inferior joint space; 8, lateral pterygoid muscle.

View larger version (134K): [in a new window]   Figure 5.  a, Sagittal and b, coronal MR images (770/27) of a normal TMJ with jaw in closed position. 1, Mandibular head; 2, articular fossa; 3, disk (3a, anterior band; 3b, intermediate zone; 3c, posterior band); 4, bilaminar zone; 5, lateral pterygoid muscle.

View larger version (47K): [in a new window]   Figure 6.  Schematic of the TMJ in a closed mouth position and sagittal projection. The posterior band of the disk lies within 10° of the 12 o'clock position.

View larger version (71K): [in a new window]   Figure 7.  Schematic of the TMJ in an open mouth position and sagittal projection. 1, Mandibular head; 2, articular eminence; 3, superior joint space; 4, inferior joint space; 5, disk (5a, anterior band; 5b, intermediate zone; 5c, posterior band); 6, bilaminar zone; 7, lateral pterygoid muscle with interposed fat tissue (yellow).

View larger version (143K): [in a new window]   Figure 8.  a, Sagittal and b, coronal MR images (770/27) of a normal TMJ with the jaw in an open position. Note the bow-tie shape of the disk in the sagittal projection. 1, Mandibular head; 2, articular eminence; 3, disk (3a, anterior band; 3b, intermediate zone; 3c, posterior band) ; 4, bilaminar zone; 5, lateral pterygoid muscle.

View larger version (95K): [in a new window]   Figure 9.  Photographs of anatomic TMJ specimens show (a) a lateral view in the closed position and (b) an anteroinferior view in the open position. The capsule is dissected laterally in a and anteriorly in b. The capsular attachments and their relationship to the disk can be appreciated. 1, Mandibular head; 2, articular eminence; 3, disk; 4, superior joint space; 5, joint capsule (5a, lateral; 5b, anterior; 5c, medial fibers).

View larger version (135K): [in a new window]   Figure 10a.  (a, b) Photographs of anatomic TMJ specimens. (a) The joint capsule with the laterally reinforcing lateral ligament (1) and lateral pterygoid muscle (2) are shown in the lateral projection. The superior belly of the lateral pterygoid muscle inserts on the disk and the capsule (2A); the inferior part inserts on the mandibular neck (2B). (b) In the medial aspect, the mandibular ramus (1), the lateral pterygoid muscle (2), and the medial pterygoid muscle (3) are shown. (c) Coronal MR image (400/15) of the pterygoid muscles. The mandibular ramus (1), lateral pterygoid muscle (2), and medial pterygoid muscle (3) are shown.

View larger version (113K): [in a new window]   Figure 10b.  (a, b) Photographs of anatomic TMJ specimens. (a) The joint capsule with the laterally reinforcing lateral ligament (1) and lateral pterygoid muscle (2) are shown in the lateral projection. The superior belly of the lateral pterygoid muscle inserts on the disk and the capsule (2A); the inferior part inserts on the mandibular neck (2B). (b) In the medial aspect, the mandibular ramus (1), the lateral pterygoid muscle (2), and the medial pterygoid muscle (3) are shown. (c) Coronal MR image (400/15) of the pterygoid muscles. The mandibular ramus (1), lateral pterygoid muscle (2), and medial pterygoid muscle (3) are shown.

View larger version (149K): [in a new window]   Figure 10c.  (a, b) Photographs of anatomic TMJ specimens. (a) The joint capsule with the laterally reinforcing lateral ligament (1) and lateral pterygoid muscle (2) are shown in the lateral projection. The superior belly of the lateral pterygoid muscle inserts on the disk and the capsule (2A); the inferior part inserts on the mandibular neck (2B). (b) In the medial aspect, the mandibular ramus (1), the lateral pterygoid muscle (2), and the medial pterygoid muscle (3) are shown. (c) Coronal MR image (400/15) of the pterygoid muscles. The mandibular ramus (1), lateral pterygoid muscle (2), and medial pterygoid muscle (3) are shown.

View larger version (140K): [in a new window]   Figure 11.  Partial anterior disk displacement. Sagittal MR image (2,800/15) of TMJ with the jaw closed shows the posterior band (arrow), which is at the 10 o'clock position.

View larger version (127K): [in a new window]   Figure 12.  Unidirectional complete anterior disk displacement. Sagittal MR image (2,800/15) of the TMJ with the jaw closed shows the disk deformity (arrow). Deformity of the condyle is also noted, due to osteoarthritic changes in the joint.

View larger version (100K): [in a new window]   Figure 13.  Coronal MR images (2,800/15) of closed jaws. A slight medial disk displacement (arrow) is noted on the right side; a slight lateral displacement (arrow) is seen on the left side.

View larger version (146K): [in a new window]   Figure 14a.  Aneterolateral disk displacement. (a) Sagittal and (b) coronal MR images (2,800/15) of a pathologic TMJ with the jaw closed. In a, anterior displacement and deformity of the disk are noted. The arrow indicates the completely dislocated and deformed disk. For the whole sequence of images from medial to lateral, see Movie 4. In b, the lateral component of the anterolateral disk displacement can be easily identified. The disk (arrow) bulges laterally beyond the lateral condylar contour (indicated by the line). For the whole sequence of images, see Movie 5.

View larger version (149K): [in a new window]   Figure 14b.  Aneterolateral disk displacement. (a) Sagittal and (b) coronal MR images (2,800/15) of a pathologic TMJ with the jaw closed. In a, anterior displacement and deformity of the disk are noted. The arrow indicates the completely dislocated and deformed disk. For the whole sequence of images from medial to lateral, see Movie 4. In b, the lateral component of the anterolateral disk displacement can be easily identified. The disk (arrow) bulges laterally beyond the lateral condylar contour (indicated by the line). For the whole sequence of images, see Movie 5.

View larger version (133K): [in a new window]   Figure 15.  Unidirectional anterior disk displacement without recapture. Sagittal MR image (2,800/15) of a pathologic TMJ with the jaw open (same patient as Fig 12) shows that the anteriorly displaced disk (arrow) does not relocate. Deformity of the disk is noted.

View larger version (109K): [in a new window]   Figure 16a.  Anterolateral disk displacement with complete recapture. (a) Coronal (left) and sagittal MR images (2,800/15) of a pathologic TMJ with the jaw in the closed position. The coronal image depicts the lateral bulging of the disk (arrow) beyond the condylar contour. The disk (arrow) is also depicted in the sagittal image.(b) MR image (2,800/15) of the same TMJ with the jaw in the open position. The disk (arrows) is in a normal position.

View larger version (129K): [in a new window]   Figure 16b.  Anterolateral disk displacement with complete recapture. (a) Coronal (left) and sagittal MR images (2,800/15) of a pathologic TMJ with the jaw in the closed position. The coronal image depicts the lateral bulging of the disk (arrow) beyond the condylar contour. The disk (arrow) is also depicted in the sagittal image.(b) MR image (2,800/15) of the same TMJ with the jaw in the open position. The disk (arrows) is in a normal position.

View larger version (139K): [in a new window]   Figure 17.  Anterior disk displacement with osteoarthritis. (a, b) Sagittal and (c, d) coronal STIR images (4,240/30, 150-msec inversion time) of a TMJ with the jaw in the closed position, in two different positions in the respective plane. Joint space narrowing, contour irregularity, and subchondral cyst are best depicted in the coronal images; bone marrow edema and synovial fluid are best seen in the sagittal images. 1, Condyle with areas of bone edema; 2, articular fossa; 3, displaced disk; 4, effusion; 5, cyst.

View larger version (125K): [in a new window]   Figure 18.  Classification of condylar process fractures. Sites of low (L), medium (M), and high (H) condylar neck fractures and extracapsular and intracapsular condylar head fractures.

View larger version (121K): [in a new window]   Figure 19a.  Bilateral medially displaced fractures of the mandibular head with contraction. (a) Magnification of a lateral radiograph of the head. Fracture of the mandibular neck is noted (arrow). (b) Axial multisection CT (1.25-mm section thickness, table feed of 3.75 mm/sec, 25-cm FOV) provides an excellent overview of the fractures (arrows). For the whole sequence, see Movie 10. (c) Coronal reconstruction (2-mm reconstruction interval) of axial CT sections provides another excellent overview of fractures (arrows) and shows small fragments on the right. For the whole sequence, see Movie 11.

View larger version (131K): [in a new window]   Figure 19b.  Bilateral medially displaced fractures of the mandibular head with contraction. (a) Magnification of a lateral radiograph of the head. Fracture of the mandibular neck is noted (arrow). (b) Axial multisection CT (1.25-mm section thickness, table feed of 3.75 mm/sec, 25-cm FOV) provides an excellent overview of the fractures (arrows). For the whole sequence, see Movie 10. (c) Coronal reconstruction (2-mm reconstruction interval) of axial CT sections provides another excellent overview of fractures (arrows) and shows small fragments on the right. For the whole sequence, see Movie 11.

View larger version (125K): [in a new window]   Figure 19c.  Bilateral medially displaced fractures of the mandibular head with contraction. (a) Magnification of a lateral radiograph of the head. Fracture of the mandibular neck is noted (arrow). (b) Axial multisection CT (1.25-mm section thickness, table feed of 3.75 mm/sec, 25-cm FOV) provides an excellent overview of the fractures (arrows). For the whole sequence, see Movie 10. (c) Coronal reconstruction (2-mm reconstruction interval) of axial CT sections provides another excellent overview of fractures (arrows) and shows small fragments on the right. For the whole sequence, see Movie 11.

View larger version (106K): [in a new window]   Figure 20.  Coronal reconstruction of axial multisection CT scans (1.25-mm section thickness, table feed of 3.75 mm/sec, 25-cm FOV, 2-mm reconstruction interval). Nondisplaced fracture of the right zygomatic process (1), vertical condylar head fracture on the right (2) and comminuted, displaced condylar head fracture (3) on the left. For the whole sequence, see Movie 12.

View larger version (82K): [in a new window]   Figure 21a.  Bilateral low condylar neck factures; nondisplaced fracture on the right, laterally displaced fracture on the left (arrows). Panoramic radiographs (a) before and (b) after osteosynthesis with plates.

View larger version (90K): [in a new window]   Figure 21b.  Bilateral low condylar neck factures; nondisplaced fracture on the right, laterally displaced fracture on the left (arrows). Panoramic radiographs (a) before and (b) after osteosynthesis with plates.

View larger version (76K): [in a new window]   Figure 22.  Inflamed TMJ in rheumatoid arthritis. Sagittal T1-weighted (400/15) spin-echo MR images a, before and b, after intravenous contrast material infusion show slight enhancement of the bilaminar zone (arrow).

View larger version (154K): [in a new window]   Figure 23.  Sagittal STIR image (4,240/30, 150-msec inversion time) of an inflamed TMJ in patient with rheumatoid arthritis. The synovitis and inflammation of the surrounding tissue can be easily detected because of the increased water content (1). A small volume of intracapsular fluid in the superior joint space is visible (2). In this patient, the partial anterior disk displacement (3) did not cause any symptoms. For the whole sequence from medial to lateral, see Movie 13.