Temporomandibular joint: MR assessment of rotational and sideways disk displacements

The accuracy of coronal and sagittal magnetic resonance (MR) imaging was examined in the assessment of rotational and sideways displacements of the temporomandibular joint (TMJ) disk. Rotational disk displacement implies a combination of anterior and medial or lateral displacements, whereas sideways displacement implies pure medial or lateral displacement without an anterior component. Multiple 3-mm-thick coronal and sagittal MR images were obtained of 18 fresh TMJ autopsy specimens and compared with the observations in corresponding coronal cryosections. MR imaging correctly delineated the mediolateral position of the disk in 15 joints (83%) and incorrectly delineated it in three joints (17%). Osseous anatomy was correctly assessed in 17 joints (94%). On cryosections, six joints (33%) showed medial disk displacement and two joints (11%) showed lateral displacement. In five of these eight joints the medial or lateral displacement occurred in conjunction with an anterior displacement, that is, rotational displacement. Clinical MR imaging in 37 patients (61 joints with coronal images) showed medial or lateral disk displacement in 16 joints (26%). This study suggests that rotational and sideways displacements of the TMJ disk are an important aspect of internal derangement. The multiplanar capabilities of MR are suitable for an assessment of these abnormalities.