Temporomandibular Joint Disorders

ct

Computed Tomography

• Limited accuracy to detect intra-articular disc morphology and position, however studies using multi-detector CT have not been published 1,9
• For anterior displacement of the intra-articular disc CT has a sensitivity and specificity of 66% and 68% respectively. For sideways and rotational disc displacement the sensitivity and specificity is 64% and 83% respectively 6
• Not recommended as a first line investigation for TMJ disorders 9
• Good accuracy for diagnosing osseous abnormalities, including advanced degenerative joint disease and ankylosis 9

mri

Magnetic Resonance Imaging

• Largely replaced arthrography as the imaging modality used to assess the location and morphology of the intra-articular disc 1
• Superior to radiography and computed tomography for soft tissue definition, and considered the modality of choice for assessing both soft and hard tissues of the TMJ 5
• MRI can detect anterior displacement of the intra-articular disc with a sensitivity and specificity of 86% and 63% respectively. For sideways and rotational disc displacement the sensitivity and specificity is 81% and 87% respectively 6
• Most studies are limited because surgery is not optimal as a gold standard due to the small surgical incision, and difficulties in observing medial and lateral disc displacement. A study of the accuracy of MRI for TMJ autopsy specimens revealed an accuracy of 95% for disc morphology and position, and 93% for osseous conditions 1,7
• Correlation with symptoms is essential, as TMJ disc displacement is present in up to 35% of asymptomatic individuals 8

opg

Panoramic Radiography (OPG)

• Used to detect gross osseous abnormalities and dental disease 2
• Limited value for diagnosis of specific conditions causing temporomandibular joint dysfunction because mild degenerative disease is seen equally in symptomatic and asymptomatic people 3
• Not recommended as a routine investigation in all patients who present with TMJ symptoms. Only patients with clinical evidence of significant TMJ disease or a lack of response to conservative management should have an OPG 4

tmj

Temporomandibular Joint Disorder (TMJ)

• TMJ disorder is an umbrella term used to describe many conditions with differing aetiologies that cause pain and dysfunction of the TMJ and structures related to mastication 1
• It can be broadly categorised into 2 groups
  • Intracapsular disorders: synovitis, osteoarthritis, inflammatory arthritides, and displacement of the articular disc
  • Extracapsular disorders: myofascial pain involving the muscles of mastication, trigeminal neuralgia

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