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DISORDERS OF
THE TEMPORO-
MANDIBULAR
JOINT
LECTURE OBJECTIVES
By the end of this lecture you should
be able to know the following :
1 ) Radiographic Anatomy of the TMJ
2 ) TMJ Bony Relationships
3 ) Diagnostic Imaging of the TMJ
4 ) Radiographic Abnormalities of the
TMJ
 Radiographic anatomy of
the TMJ
• Understanding of the
radiographic anatomy of the
TMJ is essential so that a
normal variant is not mistaken
for an abnormality.
 Condyle
• Radiographs of condyles
in children may show
little or no evidence of a
cortical border.
• In the absence of disease
(normal), the cortical borders in
adults are visible
radiographically.
• A layer of fibrocartilage covers
the condyle but is not visible
radiographically.
 Inter-articular Disk
• The inter-articular disk
(meniscus), composed of
fibrous connective tissue, is
located between the
condylar head and
mandibular fossa.
• The disk divides the joint
cavity into two compartments,
called the inferior (lower) and
superior (upper) joint spaces.
• The disk and posterior
attachment are collectively
called the soft tissue
component of the TMJ.
TMJ Anatomy : Lateral view
TMJ Anatomy : Coronal view
 TMJ bony relationships
• Radiographic joint space is a
general term used to describe the
radiolucent area between the
condyle and temporal component.
• It contains the soft tissue
components of the joint.
• A condyle is positioned
concentrically when the
anterior and posterior
aspects of the radiolucent
joint space are uniform in
width.
• The condyle is retruded when
the posterior joint space width
is less than the anterior.
• And protruded when the
posterior joint space is wider
than the anterior.
Lateral (sagittal)
tomograms
A, Closed view.
B, Closed view with
the condyle retruded.
C, Open view.
• In most individuals, at
maximal opening the
condyle moves to the
summit of the articular
eminence or slightly
anterior to it.
• The condyle typically is found
within a range of 5 to 8 mm
anterior to the crest of the
eminence.
• Hypermobility of the joint may be
suspected if the condyle translates
more than 5 to 8 mm anterior to
the eminence.
 Diagnostic imaging of
the TMJ
• In most cases the
imaging protocol
begins with hard
tissue imaging.
• Soft tissue imaging is
indicated when
information about disk is
needed or to image
abnormalities in the
muscles or surrounding
tissues.
Soft Tissue Imaging
• The soft tissues of the
joint can be imaged
with MRI or
arthrography.
 Arthrography
• It is a technique in which an indirect
image of the disk is obtained by
injecting a radiopaque contrast agent
into joint spaces.
• The risks of this procedure include
allergic reaction to the nonionic iodine
contrast agent and infection.
• Lower joint space arthrograms of a normal TMJ.
• A, closed view. B, open view.
Radiographic
abnormalities
of the TMJ
 Disk Displacement
• Partial or full anterior disk
displacement is indicated by
anterior location of the posterior
band of the disk from the normal
position, which is directly superior
to the condylar head.
• If the disk remains
anteriorly displaced
(nonreduction) on
opening, it may bend or
deform as the condyle
pushes against it .
• Position and
movement of
the disk during
jaw opening.
• Normal position
(left).
• Partially
displaced
anteriorly
(with reduction,
middle).
• Fully displaced
anteriorly
(without
reduction, right).
• Lower joint space arthrograms of a
nonreducing, anteriorly displaced disk. A,
closed view. B, open view.