Presentation
Persistent left-side jaw pain and partial dislocation after wisdom teeth extraction four years ago.
Patient Data
On the open mouth sequence the left temporomandibular joint shows anterior displacement of the articular disc (moderate subluxation). The retrodiscal tissue's paucity suggests disruption of the area.
Dynamic imaging of the temporomandibular joint shows the difference in articular disc position between the left temporomandibular joint (left side of image) and right temporomandibular joint (right side of image) of the patient during the opening and closing of the jaw. Through the range of motion of the jaw, the articular disc displaces on the symptomatic left side further anteriorly compared with the opposite normal right side. On jaw closure, there is recapture of the articular disc on the left.
Circle annotates the difference in anterior displacement of the temporomandibular joint articular disc.
Case Discussion
The patient presented with left jaw pain, other presentations include a click or pop sound while using the masticatory muscles and mandibular movement limitation. The articular disc is still seen to be anteriorly displaced while open, indicating disruption of the retrodiscal capsular ligament attachment. As the disc appears to be seated correctly during a closed jaw, the clicking noise would not be present in the patient and intermittent locking was not a problem 1.
MRI is the preferred method of imaging TMJ syndrome as it is able to accurately depict the disc displacement, joint effusion and surrounding soft tissues 2. Disc displacement is seen on the PD images, noting that anterior and posterior displacement are signs of the syndrome, while novel techniques such as the dynamic imaging sequence can be used to clearly identify the difference in displacement between the two sides of the jaw 3,4.
Case Courtesy of Dr Zane Sherif and Mr Ben Kennedy.
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