TEMPOROMANDIBULAR DISORDERS AND PRINCIPLES OF REHABILITATION

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RADIOLOGIC EVALUATION IN TEMPOROMANDIBULAR DISORDERS

Abdullah Şükün1
Cemre Özenbaş2

1Başkent University, Faculty of Medicine, Alanya Education and Medical Research Center, Department of Radiology, Antalya, Türkiye
2Tınaztepe University, Faculty of Medicine, Department of Radiology, İzmir, Türkiye

Şükün A, Özenbaş C. Radiologic Evaluation in Temporomandibular Disorders. In: Coşar SN, Afşar Sİ editors. Temporomandibular Disorders and Principles of Rehabilitation. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.53-64.

ABSTRACT

Radiologic imaging is indispensable in the diagnosis, evaluation, and management of temporomandibular disorders (TMDs), which encompass a range of structural and functional pathologies affecting the temporomandibular joint (TMJ). This chapter provides a comprehensive overview of imaging modalities commonly used for TMJ evaluation, including magnetic resonance imaging (MRI), computed tomography (CT), and ultrasonography. MRI is highlighted as the gold standard for assessing soft tissue structures, such as the articular disc, joint effusion, and synovial membrane, due to its superior soft tissue resolution. CT is particularly effective for evaluating osseous changes, including fractures, degenerative conditions, and tumors, with 3D reconstruction capabilities offering enhanced anatomical visualization. Ultrasonography is noted for its cost-effectiveness and utility in real-time evaluations, such as detecting joint effusions and guiding therapeutic interventions. Each imaging modality is discussed in terms of its advantages, limitations, and specific clinical applications in the diagnosis and management of TMDs. Additionally, emerging technologies, such as artificial intelligence-assisted diagnostic methods, are briefly explored for their potential to revolutionize TMD imaging.

Keywords: Temporomandibular joint disorders; Physical examination; Arthralgia; Jaw Abnormalities; Facial pain

Referanslar

  1. Maini K, Dua A. Temporomandibular Syndrome.; 2025.
  2. Choi E, Shin S, Lee K, et al. Artificial intelligence-enhanced diagnosis of degenerative joint disease using temporomandibular joint panoramic radiography and joint noise data. Sci Rep. 2025;15(1):1823. [Crossref]  [PubMed]  [PMC]
  3. Vilanova JC, Barceló J, Puig J, Remollo S, Nicolau C, Bru C. Diagnostic Imaging: Magnetic Resonance Imaging, Computed Tomography, and Ultrasound. Seminars in Ultrasound, CT and MRI. 2007;28(3):184-191. [Crossref]  [PubMed]
  4. Zaman MU, Alam MK, Alqhtani NR, et al. Effectiveness of ultrasonography in the diagnosis of temporomandibular joint disorders: A systematic review and meta-analysis. J Oral Rehabil. 2025;52(2):243-253. [Crossref]  [PubMed]  [PMC]
  5. Kundu H. Assessment of TMJ Disorders Using Ultrasonography as a Diagnostic Tool: A Review. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. Published online 2013. [Crossref]  [PubMed]  [PMC]
  6. Wojciechowska B, Szarmach A, Michcik A, Sikora M, Drogoszewska B. Is Ultrasonography an Effective Method for Diagnosing Degenerative Changes in the Temporomandibular Joint? Biomedicines. 2024;12(12). [Crossref]  [PubMed]  [PMC]
  7. Talmaceanu D, Lenghel LM, Bolog N, et al. Imaging modalities for temporomandibular joint disorders: an update. Med Pharm Rep. 2018;91(3):280-287. [Crossref]  [PubMed]  [PMC]
  8. Mafee MF, Heffez L, Campos M, et al. Temporomandibular joint: role of direct sagittal CT air-contrast arthrogram and MRI. Otolaryngol Clin North Am. 1988;21(3):575-588. [Crossref]  [PubMed]
  9. Tomas X, Pomes J, Berenguer J, et al. MR Imaging of Temporomandibular Joint Dysfunction: A Pictorial Review. RadioGraphics. 2006;26(3):765-781. [Crossref]  [PubMed]
  10. Bag AK. Imaging of the temporomandibular joint: An update. World J Radiol. 2014;6(8):567. [Crossref]  [PubMed]  [PMC]
  11. de Mello Provenzano M, Chilvarquer I, Fenyo-Pereira M. How Should the Articular Disk Position Be Analyzed? Journal of Oral and Maxillofacial Surgery. 2012;70(7):15341539. [Crossref]  [PubMed]
  12. Bas B, Yılmaz N, Gökce E, Akan H. Ultrasound assessment of increased capsular width in temporomandibular joint internal derangements: relationship with joint pain and magnetic resonance grading of joint effusion. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2011;112(1):112-117. [Crossref]  [PubMed]
  13. Okeson J. Orofacial pain : guidelines for assessment, diagnosis, and management. In: ; 1996. [Crossref]  [PubMed]
  14. Tasaki MM, Westesson PL, Isberg AM, Ren YF, Tallents RH. Classification and prevalence of temporomandibular joint disk displacement in patients and symptom-free volunteers. American Journal of Orthodontics and Dentofacial Orthopedics. 1996;109(3):249-262. [Crossref]  [PubMed]
  15. Paesani D, Westesson PL, Hatala M, Tallents RH, Kurita K. Prevalence of temporomandibular joint internal derangement in patients with craniomandibular disorders. American Journal of Orthodontics and Dentofacial Orthopedics. 1992;101(1):41-47. [Crossref]  [PubMed]
  16. Duyan Yüksel H, Orhan K, Evlice B, Kaya Ö. Evaluation of temporomandibular joint disc displacement with MRI-based radiomics analysis. Dentomaxillofac Radiol. 2025;54(1):19-27. [Crossref]
  17. Katti CG, Mohan A, Katti G, Konda P, Student PG. Posterior Disc Displacement in Temporomandibular Joint. International Journal of Research and Review (ijrrjournal.com). 2020;7(2):235.
  18. Westesson PL, Larheim TA, Tanaka H. Posterior disc displacement in the temporomandibular joint. Journal of Oral and Maxillofacial Surgery. 1998;56(11):1266-1273. [Crossref]  [PubMed]
  19. Okochi K, Ida M, Honda E, Kobayashi K, Kurabayashi T. MRI and clinical findings of posterior disk displacement in the temporomandibular joint. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2008;105(5):644-648. [Crossref]  [PubMed]
  20. Ueki K, Nakagawa K, Takatsuka S, et al. Temporomandibular joint morphology and disc position in skeletal class III patients. Journal of Cranio-Maxillofacial Surgery. 2000;28(6):362-368. [Crossref]  [PubMed]
  21. Finden SG, Enochs WS, Rao VM. Pathologic Changes of the Lateral Pterygoid Muscle in Patients with Derangement of the Temporomandibular Joint Disk: Objective Measures at MR Imaging. American Journal of Neuroradiology. 2007;28(8):1537-1539. [Crossref]  [PubMed]  [PMC]
  22. Hegab AF, Al Hameed HIa, Karam KS. Classification of temporomandibular joint internal derangement based on magnetic resonance imaging and clinical findings of 435 patients contributing to a nonsurgical treatment protocol. Sci Rep. 2021;11(1):20917. [Crossref]  [PubMed]  [PMC]
  23. Whyte A, Boeddinghaus R, Bartley A, Vijeyaendra R. Imaging of the temporomandibular joint. Clin Radiol. 2021;76(1):76.e21-76.e35. [Crossref]  [PubMed]
  24. Rowe NL. Ankylosis of the temporomandibular joint. J R Coll Surg Edinb. 1982;27(2):67-79. [Crossref]
  25. Xia L, An J, He Y, et al. Association between the clinical features of and types of temporomandibular joint ankylosis based on a modified classification system. Sci Rep. 2019;9(1):10493. [Crossref]  [PubMed]  [PMC]
  26. Tanaka E, Detamore MS, Mercuri LG. Degenerative Disorders of the Temporomandibular Joint: Etiology, Diagnosis, and Treatment. J Dent Res. 2008;87(4):296-307. [Crossref]  [PubMed]
  27. Wiberg B, Wänman A. Signs of osteoarthrosis of the temporomandibular joints in young patients. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 1998;86(2):158-164. [Crossref]  [PubMed]
  28. Moraes MB de, Costa NCQ, Silva GYS da, Costa FC, Raldi FV, Lopes SLP de C. Unveiling degenerative bone changes in the condyle: a texture analysis approach using cone-beam computed tomography. Acta Cir Bras. 2025;40:e401325. [Crossref]  [PubMed]  [PMC]
  29. Massilla Mani F, Sivasubramanian SS. A study of temporomandibular joint osteoarthritis using computed tomographic imaging. Biomed J. 2016;39(3):201-206. [Crossref]  [PubMed]  [PMC]
  30. Nozawa M, Fukuda M, Kotaki S, et al. Evaluation of temporomandibular joint osteoarthritis using a new FRACTURE sequence of 3.0T MRI. Dentomaxillofac Radiol. 2025;54(1):64-69. [Crossref]  [PubMed]
  31. Covert L, Mater H Van, Hechler BL. Comprehensive Management of Rheumatic Diseases Affecting the Temporomandibular Joint. Diagnostics. 2021;11(3):409. [Crossref]  [PubMed]  [PMC]
  32. Smith HJ, Larheim TA, Aspestrand F. Rheumatic and nonrheumatic disease in the temporomandibular joint: gadolinium-enhanced MR imaging. Radiology. 1992;185(1):229-234. [Crossref]  [PubMed]
  33. Arvidsson LZ, Smith HJ, Flatø B, Larheim TA. Temporomandibular Joint Findings in Adults with Long-standing Juvenile Idiopathic Arthritis: CT and MR Imaging Assessment. Radiology. 2010;256(1):191-200. [Crossref]  [PubMed]
  34. Barry F, Schlund M, Guignardat JF, et al. Temporomandibular joint septic arthritis: a report of thirteen cases and a systematic review of the literature. Rheumatol Int. 2025;45(1):28. [Crossref]  [PubMed]
  35. Cai XY, Yang C, Zhang ZY, Qiu WL, Chen MJ, Zhang SY. Septic Arthritis of the Temporomandibular Joint: A Retrospective Review of 40 Cases. Journal of Oral and Maxillofacial Surgery. 2010;68(4):731-738. [Crossref]  [PubMed]
  36. Salamon NM, Casselman JW. Temporomandibular Joint Disorders: A Pictorial Review. Semin Musculoskelet Radiol. 2020;24(05):591-607. [Crossref]  [PubMed]
  37. Yibulayin F, Yu C xi, Feng L, et al. Malignant tumours of temporomandibular joint. BMC Cancer. 2020;20(1):967. [Crossref]  [PubMed]  [PMC]
  38. Kruse ALD, Luebbers HT, Obwegeser JA, Edelmann L, Graetz KW. Temporomandibular disorders associated with metastases to the temporomandibular joint: a review of the literature and 3 additional cases. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2010;110(2):e21-e28. [Crossref]  [PubMed]
  39. Holmlund AB, Eriksson L, Reinholt FP. Synovial chondromatosis of the temporomandibular joint. Int J Oral Maxillofac Surg. 2003;32(2):143-147. [Crossref]  [PubMed]
  40. Tang T, Han FG. Calcium pyrophosphate deposition disease of the temporomandibular joint invading the middle cranial fossa: Two case reports. World J Clin Cases. 2021;9(11):2662-2670. [Crossref]  [PubMed]  [PMC]
  41. Kim KA, Koh KJ. Recurrent simple bone cyst of the mandibular condyle: a case report. Imaging Sci Dent. 2013;43(1):49. [Crossref]  [PubMed]  [PMC]
  42. Zadik Y, Aktaş A, Drucker S, Nitzan DW. Aneurysmal bone cyst of mandibular condyle: A case report and review of the literature. Journal of Cranio-Maxillofacial Surgery. 2012;40(8):e243-e248. [Crossref]  [PubMed]