TÀI LIỆU HỘI NGHỊ KỸ THUẬT ĐIỆN QUANG VÀ Y HỌC HẠT NHÂN VIỆT NAM LẦN 7 (2019) Nguồn: https://hinhanhykhoa.com/

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Magnetic Resonance Imaging Techniques
Findings of the Temporomandibular Joint
Internal Derangement
Bachelor Nguyen Quang Trung
Bachelor Nguyen Thi Hoa
MD Hoang Dinh Au
Radiology Departmen HaNoi Medical University
H it l
Overview
 Dysfunction of Temporomandibular Joint is a group of disorders in the
temporal jaw joints, muscles and related structures
 The function of the temporomandibular joint is a group of diseases including
many of the most common is the syndrome of endocrine disorders.
 Base on the research: temporomandibular joint dysfunction accounts for
over 28% of the world population. In Vietnam according to the study of more
than 1020 workers found temporomandibular joint dysfunction up to 60.5%

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Diagnostic methods
Clinical examination( Experience)
 Radiology:
Schuller‘s
Ultrasound
CT scanner
 MRI
Advantage MRI
 Fully evaluated, the anatomy of the shape, signal and position of the
joint disk both closed and closed,
 Evaluate the ligament, joint and surrounding muscle mass systems that
support joint activity.
 Evaluation of early signal changes in the convex surface, irregularities of
protrusion, lower jaw bone.
 The only non-invasive diagnostic method that can assess in detail the
internal structure of the joint.
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TMJfunction
https://www.alilamedicalmedia.com
Anatomy
Anatomy of TMJ

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Anatomy
Anatomy of TMJ on Sagital Close mouth
Anatomy
Anatomy of TMJ on Sagital open mouth

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Techniques
 The patient has an MRI scan with a clinical diagnosis
Patient preparation
 The patient has an MRI scan with a clinical diagnosis
 There were previous examination results: ultrasound, Xquang ...
 Explain to patients for good coordination
 Examination of patient history of safety related to magnetic fields
 Write commit before inject gadonilium

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 Signa HDxt 1.5tesla ( GE)
 Coil Flex 3 ind ( Head coil)
Equipment preparation
Coil Flex 3 ind ( Head coil)
 Xilanh
 Head first supine
 Center of laser beam localiser over the glabella
Patient position
Center of laser beam localiser over the glabella
 Instruct patients to keep their mouths closed and open

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PROTOCOL
 Localize
 Calibration Calibration
 T2 FSE Axial
 PD FS Cor R, L
 T2 Sag close R, L
 T1 Sag close R, L
 PD FS Sag close R, L
 PD FS Sag open R, Lg p
 Dynamic
Sequence Possiton Plane TR/TE FOV Thick Spacing Matrix
Parametter
T2 SE Close Axial 3640/90 230x230 2,5 mm 1 mm 224x320
T1 SE Close Sagittal 420/10 100x100 3 mm 1 mm 192x256
T2 SE Close Sagittal 1640/80 100x100 3 mm 1 mm 192x256
PD FS Close Sagittal 1500/30 100x100 3 mm 1 mm 192x256
PD FS Close Coronal 1500/30 100x100 3 mm 1 mm 192x256
PD FS Open Sagittal 1500/30 100x100 3 mm 1 mm 192x256

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Localizer
Planning
Sagital Coronal Axial
Calibration
Planning

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Planning
• On Sagital plane: the position block parallel to the hard palateg p p p p
• On Coronal plane: the position block perpendicular to the cervical spine
• The slices must cover whole TMJ (from copus collasum to the line of
angle of jaw)
T2 FSE Axial
Result T2 FSE Axial

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Planning
• On sagital plane: the position block parallel to the line along ramus and
mandibular condyle
• On Axial plane: the position block parallel to the condyle of the mandible
• The slices must cover TMJ (from articular eminence up to the line of the
internal auditory meatus)
Coronal PDFS
Result T2 PDFS Coronal
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Planning
• On Axial plane: the position block parallel to the left condyle of the
mandible
• On Coronal plane: the position block parallel to the line along RT
temporal bone and ramus of mandible
• The slices must cover whole TMJ (from TMJ from side to side)
Sagital Close
Result T1 FSE Sagital

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Result T2 FSE Sagital
Result T2 PDFS Sagital
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Planning
Sagital PDFS Open the same Sagital PDFS Close Planning
Result T2 PDFS Sagital Open

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DYNAMIC
Some clinical cases
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Case 1Case 1
BN : male 27Y
Clinical diagnosis :Clinically the joint cries when opening your mouth
MRI: displacement of disc joints with recovery

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Case 2Case 2
BN : male 23Y
Clinical diagnosis :Clinically the joint cries when opening your mouth and pain
MRI: dislocated joint disc does not recover, disk deformity and jammed joints
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Case 3Case 3
BN : female 54Y
Clinical diagnosis :Joint jaw joint pain and limited open mouth
CASE
THÌ NGẬM MIỆNGTHÌ NGẬM MIỆNG THÌ HÁ MIỆNGTHÌ HÁ MIỆNG
ĐĨA KHỚPĐĨA KHỚP ĐĨA KHỚPĐĨA KHỚP
MRI: perforation of articulated disc with early degenerative lesions

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Conclude
Understand the basic anatomy
Guide patients to cooperate
Closed mouth and open mouth
References
1. S. J. Scrivani, D. A. Keith và L. B. Kaban (2008). Temporomandibular
disorders. New England Journal of Medicine, 359 (25), 2693-2705.
2. W. Guralnick, L. B. Kaban và R. G. Merrill (1978). Temporomandibular-joint
afflictions. New England Journal of Medicine, 299 (3), 123-129.
3. H. T. D. Thảo và H. T. Hùng (2003). Rối loạn thái dương hàm. Tạp chí Y học
Hồ Chín Minh, tập 8 (số 4), 23-30.
4. A. Rudisch, K. Innerhofer, S. Bertram và cộng sự (2001). Magnetic resonance
imaging findings of internal derangement and effusion in patients with unilateralimaging findings of internal derangement and effusion in patients with unilateral
temporomandibular joint pain. Oral Surgery, Oral Medicine, Oral Pathology, Oral
Radiology, and Endodontology, 92 (5), 566-571.
5. https://mrimaster.com/
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