Magnetic resonance imaging (MRI) can be helpful in assessment of the temporomandibular joint in a variety of inflammatory conditions. Lochbuhler et al reported a classification for changes seen in the images. The authors are from University Children’s Hospital Zurich.
Patient selection: disorder of the temporomandibular joint
Classification:
(1) inflammatory activity
(2) osseous deformity
(3) corticosteroid injection (CSI)
Inflammatory Activity on MRI
Descriptor
Grade
little if any joint fluid, enhancement confined to joint fluid
normal
0
enhancement exceeds visible joint fluid, variable bone marrow edema
mild
1
intense enhancement involving the entire joint space, variable enhancing joint effusion, variable bone marrow edema
moderate
2
intense enhancement involving the entire joint space, visible synovial thickening, intermediate signal intensity on T2-weighted image
severe
3
Osseous Deformity
Flattening of Condyle
Flattening of Articular Eminence, Glenoid Fossa
Erosions
Descriptor
Grade
normal
none
NA
normal
0
mild
mild
NA
mild
1
moderate
moderate
small
moderate
2
severe with loss of height
flat
large with or without fragmentation
severe
3
where:
• The normal condyle has an S-shaped articular eminence and glenoid fossa. The condyle is round in young patients and more square in older patients.
Corticosteroid Injection on MRI
Grade
no fluid in joint space (all injected fluid extra-articular)
0
small amount of fluid in joint space
1
moderate amount of fluid in joint space
2
large amount of fluid in joint space (all inected fluid intra-articular)
3
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