By:

Nour-Eldin A. Nour-Eldin Mohammed

Normal Anatomy
Mandibular condyle
(head)
Glenoid fossa
Articular tubercle
(eminence)

Posterior band of articular disc

Anterior band of articular disc

Mandibular condyle (head)

Lateral pterygoid muscle raphe

Lower head of lateral pterygoid muscle

Posterior disc attachmen

Mandibular condyle (head)

Articular disc

MRI and autopsy

sections: upper row
oblique sagittal MRI,
asymptomatic
volunteer: left lateral,
middle medial, right
opened mouth

Internal Derangements
General orthopedic term implying a

mechanical fault that interferes with the

smooth action of a joint
The most common internal derangement is
disc displacement
Clinical Features
Clicking sounds from joint(s)
Restricted or normal mouth opening capacity
Deviation on opening
Pain

Internal Derangements
Imaging Features
Anterior disc displacement: posterior
band of the disc located anterior to the
superior portion of the condyle at closed
mouth on oblique sagittal images
Disc may have normal (biconcave) or
deformed morphology
In opened mouth position disc may be in
a normal position (with reduction) or
continue to be displaced (without
reduction)

Partial anterior disc displacement at bas

lateral sections

central sections

open-mouth

Complete anterior disc displacement

medial section

Autopsy

Open-mouth
MRI

Lateral disc displacement and

normal bone

Medial disc displacement

coronal MRI

Oblique coronal MRI

Posterior disc displacement

Osteoarthritis
Definition
Non-inflammatory focal degenerative disorder
of synovial joints, primarily affecting articular
cartilage and sub-condylar bone; initiated by
deterioration of articular soft-tissue cover and
exposure of bone.
Clinical Features
Crepitation sounds from joint(s)
Restricted or normal mouth opening capacity
Pain or no pain from joint areas and/or of
mastication muscles
Occasionally, joints may show inflammatory
signs
Women more frequent than men

anteriorly displaced and deformed, degenerated disc

and irregular cortical outline with osteophytosis and
sclerosis of condyle .

Advanced osteoarthritis and anterior

disc displacement, with joint effusion

Bone Marrow
Abnormalities
Definition
Bone marrow edema: serum proteins
within marrow interstitium
surrounded by normal hematopoietic
marrow.
Osteonecrosis: complete loss of
hematopoietic marrow.

Imaging Features
Abnormal signal on T2-weighted
image from
condyle marrow: increased signal
indicates marrow edema; reduced
signal indicates marrow sclerosis or
fibrosis
Combination of marrow edema signal
and marrow sclerosis signal in condyle
most reliable sign for histologic
diagnosis of osteonecrosis
Marrow sclerosis signal may indicate
advanced
osteoarthritis without osteonecrosis, or
osteonecrosis

Arthritides
Definition
Inflammation of synovial membrane
characterized by edema, cellular accumulation,
and synovial proliferation (villous formation).
Clinical Features
Swelling of joint area, not frequently seen in TMJ
Pain (in active disease) from joints
Restricted mouth opening capacity
Morning stiffness, in particular stiff neck
Dental occlusion problems; my bite doesnt fit
Crepitation due to secondary osteoarthritis

Rheumatoid arthritis.

After 1 year

Rheumatoid arthritis. A MRI shows completely destroyed

disc, replaced by fibrous or vascular pannus and cortical
punched-out erosion (arrow) with sclerosis in condyle.

Psoriatic arthropathy. Oblique coronal and

oblique sagittal CT images show punched-out
erosion in lateral part of condyle (arrow).

Psoriatic arthropathy. MRI shows contrast enhancement

within bone erosion and in joint space, consistent with thickened
synovium/pannus formation. Openmouth
MRI shows reduced condylar translation but normally
located disc (and normal bone in this section)

Inflammatory arthritis

Ankyloses
Definition
Fibrous or bony union between
joint components.

Growth Disturbances
(Anomalies)
Definition
Abnormal growth of mandibular condyle; overgrowth,
undergrowth, or bifid appearance.

Condylar hypoplasia
and facial asymmetry

Condylar
Hypoplasia

Normal TMJ

Bifid condyle.

Inflammatory or Tumor-like
Conditions
Calcium Pyrophosphate
Dehydrate Crystal
Deposition Disease
(Pseudogout)

Benign Tumors
Synovial Chondromatosis
Benign tumor characterized by cartilaginous

metaplasia of synovial membrane, usually in knee,

producing small nodules of cartilage, which
essentially separate from membrane to become
loose bodies that may ossify.

Synovial Chondromato

Osteochondroma
Definition
Benign tumor characterized by normal bone
and cartilage, near growth zones.

Osteoma

Malignant Tumors

Osteosarcoma mandible; 18-yearold

Malignant tumor, mandible; 70- yearold male with metastasis from lung
cancer

Thank
you