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Patologia dell’articolazione temporo-mandibolare Temporomandibular Joint Disease

G. Michelozzi, M.Y. Mourou, S. Schiavoni, N. Gandolfo, F. Calabrò


Key words: temporomandibular joint, diagnosis, CT, MR

RIASSUNTO – RM e TC permettono la valutazione di tutta la patologia dell’articolazione temporo-mandibolare (ATM) e in particolare delle dislocazioni discali senza e con riduzione, delle osteopatie necrotiche (specie osteocondrite dissecante e necrosi vascolare asettica), della patologia sinoviale e delle artriti (artrite reumatoide, condromatosi sinoviale, sinovite villonodulare, cisti sinoviali), dei corpi liberi intra-articolari, della patologia neoplastica primitiva e secondaria, dei traumi e naturalmente delle malformazioni. Le affezioni patologiche intra- e extracapsulari della ATM sono per lo più responsabili di una limitata apertura della bocca associata in genere a dolore locale. Anche la rara patologia del processo coronoideo (iperplasia coronoidea, osteocondroma e esiti traumatici) rappresenta un’altra causa di alterata funzionalità della ATM che è caratterizzata da una limitata apertura della bocca in genere non dolorosa: lo studio sistematico del coronoide deve pertanto essere considerato estensione obbligatoria di quello dell’ATM. SUMMARY – Neuroradiological investigation of the temporomandibular joint is an integral part of basal skull examination. The current techniques of choice are CT, which has replaced traditional x-ray, and the systematic use of MR which has replaced arthrography with the sole exception of disc perforations. Spiral CT allows rapid assessment of bony structures in the temporomandibular joint in the axial plane, reconstructed planes and the 3D technique with closed mouth and preferably open mouth. MR allows investigation of bony structures and especially all the components in and outside the temporomandibular joint, particularly the disc-capsule compartment. T2 and T1 weighted sequences are used in condylo-choroidal oblique sagittal and condylar oblique coronal planes preferably using a dedicated double coil with closed mouth and various degrees of open mouth. Administration of contrast medium is usually confined to arthritic disease and tumours. Bone scintigraphy and angiography by catherization are seldom used. Thanks to MR, diagnosis is possible in all temporomandibular joint diseases, offering a detailed neuroradiological investigation of the disc displacements with and without reduction, necrotic osteopathy (especially osteochondritis dissecans and aseptic vascular necrosis), synovial disease and arthitis (especially rheumatoid arthritis, synovial chondromatosis, villous synovitis, synovial cysts) of the intra-articular free bodies, primary and secondary tumours, trauma and malformations. Diseases inside and outside the temporomandibular joint are mainly responsible for limited mouth opening usually accompanied by local pain. Rare diseases of the coronoid process (coronoid hyperplasia, osteochondroma and the outcome of trauma) are another cause of impaired temporomandibular joint function characterised by limited mouth opening, usually painless. Systematic investigation should therefore follow examination of the temporomandibular joint.

3 June

Create date: 09/04/2013 | Last update: 09/04/2013