Population Covered By The Guidance
This pathway provides guidance on the imaging of adult patients with suspected temporomandibular joint disorders.
Lead Researcher: Charlotte Humphries
Experts & Contributors: Ashley Bennett (images), Eamon Koh, Michael Mason
Editorial Panel: Core membership
Link to Editorial Panel
Date reviewed: August 2013
Date Published: May 2013
Intracapsular Temporomandibular Joint Disorder
Intracapsular Temporomandibular Joint Disorder
- A term used to describe many conditions that cause pain and dysfunction of the Temporomandibular Joint (TMJ) and structures related to mastication
- Only patients with clinical evidence of significant TMJ disease or a lack of response to conservative management should have an OPG
- MRI is the modality of choice for the assessment of both soft and hard tissues of the TMJ
Date of literature search: April 2013
The search methodology is available on request. Email
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- Westesson P-L. Reliability and validity of imaging diagnosis of temporomandibular joint disorder. Adv Dent Res. 1993;7:137-51. (Review article)
- Scarfe WC. A common sense approach to TMJ and implant imaging. Ann Roy Australas Coll Dent Surg.1998;14:48-61. (Review article)
- Crow HC, Parks E, Campbell JH, Stucki DS, Daggy J. The utility of panoramic radiography in temporomandibular joint assessment. Dentomaxillofac Radiol. 2005;34:91-5. (Level III evidence)
- Epstein JB, Caldwell J, Black G. The utility of panoramic imaging of the temporomandibular joint in patients with temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92:236-9. (Review article)
- Tognini F, Mandredini D, Melchiorre D, Bosco M. Comparison of ultrasonography and magnetic resonance imaging in the evaluation of temporomandibular joint disc displacement. J Oral Rehabil. 2005;32:248-53. (Level III evidence)
- Liedberg J, Panmekiate S, Petersson A, Rohlin M. Evidence-based evaluation of three imaging methods for the temporomandibular disc. Dentomaxillofac Radiol. 1995;25:234-41. (Level II/III evidence)
- Tasaki MM, Westesson P-L. Temporomandibular joint: diagnostic accuracy with sagittal and coronal MR umaging. Radiology. 1993;186:723-9. (Level III evidence)
- Larheim RA, Westesson P-L, Sano T. Temporomandibular joint disk displacement: comparison in asymptomatic volunteers and patients. Radiology. 2001;218:428-32. (Level III evidence)
- Dixon DC. Radiographic diagnosis of temporomandibular disorders. Semin Orthod. 1995;1:207-21. (Review article)
Pathway User Guide
Yellow Boxes Denotes extra information. Some contain single or multiple white sub-boxes, click a white box to reveal detailed information in a pop-up.
White Boxes: Denotes standard pathway steps. (If inside a yellow box, they open a specific pop-up).
Zoom & Pan Controls: Use + / − or the slider to zoom. Reset returns to default. Tick Panning to drag the diagram when zoomed.
Blue “View Full Screen” Button: Opens the whole diagram in a large, full-screen pop-up window. Use Close to exit.
The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.
| SYMBOL | RRL | EFFECTIVE DOSE RANGE |
|---|---|---|
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None | 0 |
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Minimal | < 1 millisieverts |
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Low | 1-5 mSv |
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Medium | 5-10 mSv |
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High | >10 mSv |
Disclaimer
Status Of Recommendations Each pathway is designed to assist clinicians in situations when faced with a large array of possible diagnostic tests and examinations. However, it is recognised that diagnostic practice may differ from a particular pathway depending on local availability of equipment and expertise, as well as the experience of individual clinicians. Therefore each pathway is neither a rigid set of rules, nor a substitute for clinical assessment, and individual patient circumstances should always be considered.
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Panoramic Radiography (OPG)
Panoramic Radiography (OPG)
Used to detect gross osseous abnormalities and dental disease.
- Used to detect gross osseous abnormalities and dental disease
- Limited value for diagnosis of specific conditions causing temporomandibular joint dysfunction because mild degenerative disease is seen equally in symptomatic and asymptomatic people
- 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
Magnetic Resonance Imaging
Magnetic Resonance Imaging
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.
- Largely replaced arthrography as the imaging modality used to assess the location and morphology of the intra-articular disc
- 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
- 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
- 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 ,
- Correlation with symptoms is essential, as TMJ disc displacement is present in up to 35% of asymptomatic individuals
Computed Tomography
Computed Tomography
Good accuracy for diagnosing osseous abnormalities, including advanced degenerative joint disease and ankylosis. Cone-beam maxillofacial represents a radiation dose-effective alternative to conventional CT.
- Limited accuracy to detect intra-articular disc morphology and position, however studies using multi-detector CT have not been published ,
- 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
- Not recommended as a first line investigation for TMJ disorders
- Good accuracy for diagnosing osseous abnormalities, including advanced degenerative joint disease and ankylosis