MRI and arthrography in the evaluation of TMJ disorders

Arthrosis of the temporomandibular joint (TMJ) is a noninfectious, noninflammatory condition characterized by joint pain, noise (clicking) and abnormal motion. It contains various disease processes, such as abnormalities in the menisci or masticating muscles, subluxation of the condyle and degenerative joint disease. Analysis of the morphology and dynamics of TMJ by means of imaging modalities has become highly advanced since the development of arthrography in the late 1970s. Magnetic resonance imaging (MRI) has become the modality of choice in the evaluation of TMJ owing to the development of surface coils. We retrospectively studied MRI and inferior joint compartment arthrography in the evaluation of TMJ disorders. Nineteen joints of 14 patients included 15 with internal derangement, two with osteoarthrosis and two normal joints. Sagittal MR images were routinely obtained in a resting position and in positions with the mouth half open, and also with the mouth fully open on balanced images. Although perforation of the menisci was difficult to evaluate, MRI and arthrography were equally useful in identifying the shape and position of the meniscus. However, MRI was more reliable in depicting TMJ abnormalities than arthrography. MR is considered to be the modality of choice in screening arthrosis of TMJ, making the definitive diagnosis of internal derangement and monitoring conservative therapy for arthrosis.