Imaging the Temporomandibular Joint in Pediatric Pa6ents
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1 Imaging the Temporomandibular Joint in Pediatric Pa6ents Arthur B. Meyers, MD Children s Hospital of Wisconsin/ Medical College of Wisconsin, Department of Radiology
2 TMJ Pathology in Pediatrics Juvenile Idiopathic Arthri6s (JIA) ~55% TMJ pathology on clinical exam ~85% TMJ pathology detected on MRI Importance of early detec6on Other causes: Injury Facial Trauma, Iatrogenic Injury Infec6on Rarely affect the TMJ: Synovial (osteo)chondromatosis Pigmented villonodular synovi6s (PVNS) The end stage of TMJ pathology will look similar in JIA, trauma, infec6on.
3 MRI Technique Coil selec6on Dual surface coils Mul6channel Head Coil at 3T Scan planes / sequences Axial localizer Sagi[al Oblique Bilateral Coronal Combina6on of T1, T2, PD, GRE Open Mouth to assess mo6on Post Contrast Images to assess synovi6s
4 Planning the Sagi[al Oblique Plane
5 Planning the Sagi[al Oblique Plane
6 Planning the Sagi[al Oblique Plane
7 Planning the Sagi[al Oblique Plane
8 Planning the Sagi[al Oblique Plane
9 Planning the Sagi[al Oblique Plane
10 Planning the Sagi[al Oblique Plane
11 Planning the Sagi[al Oblique Plane
12 Normal Anatomy of the TMJ Osseous Anatomy Condyle Fossa Temporal Tubercle Closed Mouth
13 Normal Anatomy of the TMJ Osseous Anatomy Mandibular Condyle Mandibular Fossa Ar6cular Tubercle Closed Mouth
14 Normal Anatomy of the TMJ Osseous Anatomy Mandibular Condyle Mandibular Fossa Ar6cular Tubercle Closed Mouth
15 Normal Anatomy of the TMJ Osseous Anatomy Mandibular Condyle Mandibular Fossa Ar6cular Tubercle Closed Mouth
16 Normal Anatomy of the TMJ Soa Tissue Anatomy Disc Posterior Band Anterior Band Central Intermediate Zone A[achments Posterior bilaminar zone Normal Posi6on Normal Fibrofa[y Tissue Synovium Closed Mouth
17 Normal Anatomy of the TMJ Soa Tissue Anatomy Disc Posterior Band Anterior Band Central Intermediate Zone A[achments Posterior bilaminar zone Normal Posi6on Normal Fibrofa[y Tissue Synovium Closed Mouth
18 Normal Anatomy of the TMJ Soa Tissue Anatomy Disc Posterior Band Anterior Band Central Intermediate Zone A[achments Posterior bilaminar zone Normal Posi6on Normal Fibrofa[y Tissue Synovium Closed Mouth
19 Normal Anatomy of the TMJ Soa Tissue Anatomy Disc Posterior Band Anterior Band Central Intermediate Zone A[achments Posterior bilaminar zone Normal Posi6on Normal Fibrofa[y Tissue Synovium Closed Mouth
20 Normal Anatomy of the TMJ Soa Tissue Anatomy Disc Posterior Band Anterior Band Central Intermediate Zone A[achments Posterior bilaminar zone Normal Posi6on Normal Fibrofa[y Tissue Synovium Closed Mouth
21 Normal Anatomy of the TMJ Soa Tissue Anatomy Disc Posterior Band Anterior Band Central Intermediate Zone A[achments Posterior bilaminar zone Normal Posi6on CLOSED MOUTH Posterior Band/Bilaminar at 12 o clock Normal Fibrofa[y Tissue Synovium Closed Mouth 3
22 o clock Closed Mouth Posterior Band- Bilaminar zone junc6on 12 o clock = Normal posi6on = Borderline par6al anterior displacement >30 = Anteriorly displaced
23 Normal Mo6on of the TMJ Closed Mouth Open Mouth
24 Normal Mo6on of the TMJ Closed Mouth Open Mouth Condyle, Mandibular fossa, Ar6cular Tubercle
25 Normal Mo6on of the TMJ Closed Mouth Open Mouth
26 Normal Mo6on of the TMJ Closed Mouth Open Mouth Posterior Band, Anterior Band, Central Intermediate Zone
27 Normal Anatomy of the TMJ Soa Tissues Disc Normal Posi6on A[achments Posterior bilaminar zone Normal Fibro- fa[y Tissue Synovium Open Mouth
28 Normal Anatomy of the TMJ Soa Tissues Disc Normal Posi6on A[achments Posterior bilaminar zone Normal Fibro- fa[y Tissue Normal enhancement Synovium Open Mouth
29 Normal Anatomy of the TMJ Soa Tissues Disc Normal Posi6on A[achments Posterior bilaminar zone Normal Fibrofa[y Tissue Synovium Normal thin enhancement Open Mouth
30 Normal Anatomy of the TMJ
31 Normal Anatomy of the TMJ Mandibular fossa Disk Condyle
32 Normal Anatomy of the TMJ Synovium Normal thin enhancement
33 TMJ Pathology Synovi6s Condyle Bone marrow edema Erosions Fla[ening Decreased anterior transla6on Disc Disc A[enua6on Disc displacement Subluxa6on / Disloca6on +/- Reloca6on
34 12- year- old girl with JIA Right Lea Coronal Post- contrast
35 12- year- old girl with JIA Right Lea Synovial thickening and hyper- enhancement Normal synovial enhancement
36 12- year- old girl with JIA Right Lea Hyper- enhancement in the bone marrow corresponding to edema- like signal on T2 FS images Normal Marrow Signal
37 12- year- old girl with JIA Right Lea Normal disc posi6on Medially subluxa6on of the disc
38 Erosions 12- year- old girl with JIA 17- year- old girl with JIA Sagi[al Oblique GRE Coronal GRE
39 Erosions 17- year- old girl with JIA
40 Anterior Disc Subluxa6on 16- year- old boy with JIA
41 Anterior Disc Subluxa6on 16- year- old boy with JIA
42 Anterior Disc Subluxa6on > year- old boy with JIA
43 Anterior Disc Subluxa6on with Recapture
44 Anterior Disc Disloca6on 17- year- old girl with JIA
45 Anterior Disc Disloca6on 17- year- old girl with JIA
46 Anterior Disc Disloca6on 17- year- old girl with JIA
47 Anterior disc disloca6on without recapture Decreased anterior transla6on of the condyle
48 Anterior disc disloca6on without recapture Decreased anterior transla6on of the condyle Tearing of the bilaminar zone
49 Summary Indica6ons JIA (Trauma6c/iatrogenic injury, infec6on) Technique Sagi[al oblique and Coronal Post contrast Normal Anatomy and Mo6on Posterior band- bilaminar zone junc6on at 12 o clock >10 borderline, >30 subluxa6on Pathology Synovi6s Erosions Disc A[enua6on Subluxa6on/Disloca6on +/- Recapture
50 References Koos B, et al. Reliability of clinical symptoms in diagnosing temporomandibular joint arthri6s in juvenile idiopathic arthri6s. J Rheumatol Sep 41(9): Ringold S, Cron RQ. The temporomandibular joint in juvenile idiopathic arthri6s: frequently used and frequently arthri6c. Pediatr Rheumatol May 7:11. Aiken A, Bouloux G, Hudgins P. MR imaging of the temporomandibular joint. Magn Reson Imaging Clin N Am Aug 20(3): Meyers AB, Laor T. Magne6c resonance imaging of the temporomandibular joint in children with juvenile idiopah6c arthri6s. Pediatr Radiol Dec 43(12):
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