Imaging modalities for temporomandibular joint disorders: an update

Abstract

The diagnosis and management of temporomandibular disorders (TMD) require both clinical and imaging examinations of the temporomandibular joint (TMJ). A variety of modalities can be used to image the TMJ, including magnetic resonance imaging (MRI), computed tomography (CT), cone beam CT, ultrasonography, conventional radiography. The present review outlines the indications of the most frequently used imaging techniques in TMD diagnosis.Because of the anatomic complexity of the TMJ, imaging can be difficult. Choosing the proper imaging technique is essential. Conventional radiography, nowadays, is of limited interest. The use of flat plane films for TMJ pathology is not sufficient, because this joint requires three dimensional imaging views. Osseous changes are better visualized with CT and cone beam CT. Cone beam CT provides high-resolution multiplanar reconstruction of the TMJ, with a low radiation dose, without superimposition of the bony structures. MRI is a noninvasive technique, considered to be the gold standard in imaging the soft tissue components of the TMJ. MRI is used to evaluate the articular disc in terms of location and morphology. Moreover, the early signs of TMD and the presence of joint effusion can be determined. High-resolution ultrasonography is a noninvasive, dynamic, inexpensive imaging technique, which can be useful in diagnosing TMJ disc displacements. The diagnostic value of high-resolution ultrasonography is strictly dependent on the examiner’s skills and on the equipment used.

Flattening of the articular eminence is associated with the loss of occlusal support: radiological study

“…Due to the superimposition of the base of the skull and zygomatic arch, the depiction of other than marked changes of the shape and structure of the articular eminence and glenoid fossa might not be adequate . Further, it does not reveal the functional status of the joint . Thus, OPGs are reliable only in the identification of gross osseous changes in the TMJ .…”

“…Thus, OPGs are reliable only in the identification of gross osseous changes in the TMJ . Computer tomography (CT) is characterized by higher specificity and sensitivity and it should be performed for the precise diagnostics of osseous anatomical alterations within TMJ . However, as evidenced by Gilboa et al ., the image of the sagittal inclination of the articular eminence on panoramic radiographs consistently replicates the inclination measured on human skulls.…”

“…15 Further, it does not reveal the functional status of the joint. 16 Thus, OPGs are reliable only in the identification of gross osseous changes in the TMJ. 15 Computer tomography (CT) is characterized by higher specificity and sensitivity and it should be performed for the precise diagnostics of osseous anatomical alterations within TMJ.…”

Imaging of the temporomandibular joint - contemporary clinical and radiological implications

“…Imaging of the TMJ was initially performed using methods of conventional radiography, such as panoramic, transcranial radiography, and cephalometry [10,11,12]. Conventional radiography is of limited use since the anatomy the TMJ requires three-plane imaging [13]. These methods are limited, due to distortions, superimpositions of tissues, and poor tissue contrast.…”

“…Clinical implications for the imaging of the TMJ are various, covering a broad span of possible etiologies, including developmental (hemifacial microsomia, hypoplasia, hyperplasia) [19], traumatic (fractures) [20], inflammatory (juvenile idiopathic arthritis, rheumatoid arthritis, pigmented villonodular synovitis) [13], degenerative [21,22], neoplastic (benign and malignant tumors) [23], or vascular disorders [24,25].…”