MRI of the temporomandibular joint

MRI of the temporomandibular joint is a promising method for diagnosing disorders of the motor function of the cranial bones. It allows you to quickly, without violating the integrity of soft tissues, assess the anatomical features and possible damage to the bones of the joint, its innervation, the state of the facial muscles, providing the doctor with important information for making an accurate diagnosis.

Indications for the procedure

As we know from human anatomy, the lower jaw is the only movable bone of the facial skeleton, thanks to which we can take and grind food, providing the body's needs for nutrients. The mobility of the lower jaw is due to the temporomandibular joint, which is considered one of the most complex in the entire skeleton.

This joint is paired, and the movement of both of its joints must be synchronous and coordinated. But this movement is not simple, but combined, combining the sliding of the surfaces of the joint and their rotation around the floating center.

Sometimes, for various reasons, the well-coordinated work of the joint is disrupted, and in order to identify the cause of the violations, doctors prescribe MRI of the temporomandibular joint, as one of the most informative methods.

Such an examination is prescribed during a medical appointment, where the patient can apply with various complaints. The indications for an MRI are:

• discomfort and pain in the temples, cheeks, severe headaches,
• muscle tension in the lower jaw and cheekbones, neck, head,
• violation of the sensitivity of the skin in the area of the joint,
• the appearance of a clicking sound (crunch) when moving the jaw,
• limited movements of the lower jaw, the inability to open the mouth normally, speech and bite disorders,
• involuntary fixation of the jaw in one position, the inability to move it, open or close the mouth,
• chewing difficulties, discomfort while eating,
• rapid fatigue of the facial muscles,
• facial asymmetry,
• sore teeth after sleeping
• pain that pierces the jaw, neck and gives to the shoulder,
• swelling of the face, not associated with lack of sleep, heart or kidney disease, unilateral swelling of the face.

It is clear that an MRI may be ordered if a dislocation or fracture of the jaw near the joint is suspected. The study is necessary both for diagnosis and for the development of a treatment regimen.

MRI diagnostics is prescribed for suspected inflammatory processes in the joint (arthritis), rupture or perforation of the articular disc, osteoarthritis, osteomyelitis, synovitis, tumor processes in hard and soft tissues near the joint.

MRI of the temporomandibular joint is a preliminary (diagnostic) stage of orthodontic treatment and dental prosthetics.

Since MRI allows you to see those details that are not available to other diagnostic methods (X-ray, orthopanthogram, computer scan), it is prescribed when the study cannot detect the cause of the onset of clinical symptoms. [1]

Preparation

Magnetic resonance imaging is a generally safe diagnostic method that allows you to get a lot of information about the internal structures of the skeleton of the skull without harm to the patient's health. Such an examination does not require special preparation and can be carried out immediately after arrival at the medical center.

Since an MRI of the temporomandibular joint is prescribed by a doctor, the consultation itself with a specialist can be considered as preparation for the procedure. The doctor explains to the patient how safe the examination is, how it goes, what not to take with you into the device, how to behave while the equipment is in operation, so that the images are reliable and of high quality, what are the contraindications for MRI.

If the hospital doctor does not provide this information, the patient will learn all the information from the center staff who will carry out the procedure.

If a person has a fear of closed space, he will be recommended options that will help to calm down and endure the procedure to the end. This may be taking sedatives or listening to music, for which special equipment is provided. In case of severe pain, painkillers are administered.

There are no restrictions on food, drinking water or medications. If the study is planned to be carried out with contrast, which is rare, the patient will be told in advance how to prepare for it.

Technique MRI of the temporomandibular joint

The procedure for MRI of the temporomandibular joint is extremely simple. The patient is asked to remove outer clothing. You can take care of comfortable clothes in advance or use the one offered in the center. If you stay in your clothes, you will have to take off everything that contains metal parts (belts, buttons, buttons, cufflinks, dentures, etc.). Together with outerwear, you will have to leave all items that can interact with the magnetic field: watches, mobile phones, keys, payment cards, metal jewelry, etc.

In the room where the MRI equipment is located, the patient lies on his back on a movable table, which will subsequently move in a magnetic circuit. At this time, the device takes several series of pictures. The patient's head is fixed with rollers, because immobility is the main condition for obtaining clear images, and not everyone is able to lie still for 5-15 minutes.

During the procedure, the patient has the opportunity to contact the doctor, who is in the next room. Two-way communication allows you to report discomfort and hear instructions from the doctor (for example, hold your breath if necessary) in different rooms.

If the patient complains of limited mobility of the lower jaw, up to its jamming, an MRI of the left and right temporomandibular joints is performed, for which separate round-shaped radiofrequency coils are applied to them. Since the joint is paired, there is a need to examine both of its departments, otherwise it is difficult to determine which side the problem lies on if the patient himself cannot indicate the localization of unpleasant sensations.

When clinical symptoms appear associated with the movement of the jaw (during chewing, talking, opening the mouth, etc.), an MRI of the temporomandibular joint with functional tests is prescribed. The biphasic study includes an open and closed mouth scan. Scanning with an open mouth is carried out for 5 minutes to make it easier for the patient to fix the jaw, he is offered to squeeze some object between his teeth (most often a tube of toothpaste).

What does an MRI of the mandibular joint show? On the images obtained with the help of magnetic resonance imaging, you can see microscopic structures with the possibility of examining them in different projections, assess the condition of the movable bone, articular disc, facial muscles and ligaments.

The tomogram makes it possible to examine various anatomical structures and changes in them, to identify foreign inclusions, tumor processes, congenital defects of the jaw and joint, and traumatic disorders. The doctor has the opportunity to assess the state of the vessels of the study area, differentiate functional disorders and degenerative processes, identify malocclusion and the causes that cause it. [2]

Contraindications to the procedure

MRI is considered one of the safest diagnostic methods, so it does not have a large list of contraindications that many other body examination methods have. Even the existing contraindications are associated only with the possibility of interaction between the magnetic field and ferromagnets used in the manufacture of various devices. This interaction can damage the device and introduce distortion into the images obtained by the tonometer.

There are very few absolute contraindications for MRI of the temporomandibular joint. This includes situations where a person, for medical reasons or for other reasons, cannot part with the device or metal objects in his body, i.e. Availability

• pacemakers and defibrillators,
• inner ear implants (if they contain ferromagnets or the material of the device is unknown),
• vascular steel clips on the aneurysm,

• any fragments of metal, bullets in the human body, including small metal chips inside the eye orbit (professional reason requiring a preliminary X-ray of the skull of the worker).

Relative are contraindications associated with the patient's condition and the presence of instruments and devices that should not change their properties under the influence of a magnetic field or somehow affect it. These include artificial joints, neurostimulators, insulin pumps, pacemakers, hemostatic clips and vascular stents, non-ferromagnetic implants. Questions may also arise about dentures, steel plates and wires used in orthopedic treatment, permanent makeup, tattoos, where ferromagnetic materials can be used.

In all of the above cases, the doctor must be informed in advance, if possible, indicating what metal the device is made of, what makeup and tattoo paints were used, i.e. Any information that will help secure the procedure and make its results as reliable as possible.

MRI of the temporomandibular joint is not performed with severe claustrophobia and the patient's serious condition, when life support procedures are required. During pregnancy, the possible risks will need to be discussed with the doctor, although in general they are small, given the safety of a magnetic field of such strength for a person and the remoteness of the fetus from the examined area of the body (head). [3]

Care after the procedure

Considering the safety of the magnetic field and the tomograph itself, no consequences after the procedure can be expected. Therefore, MRI diagnostics has gained such popularity because, in the absence of side effects during and after the procedure, it allows you to identify pathologies that are inaccessible to other diagnostic methods. The only unpleasant consequence may be a series of low-quality images if the patient did not remain still or hid the presence of metal objects in the body.

Complications after the procedure are also possible only if the patient does not heed the doctor's warnings. There are few contraindications to the examination, but they must be taken into account. The magnetic field can destroy the device, which may support the functionality of individual organs. For example, if a pacemaker malfunctions, the work of the heart is disrupted, which can lead to a serious condition and even death of the patient.

On the other hand, any piece of a ferromagnet can affect the magnetic field, distorting the results of research. If the doctor will rely on them, there is a risk of incorrect diagnosis and treatment that does not correspond to the situation.

Specific care after the MRI procedure of the temporomandibular joint is not required. The main thing is that the results of the study help to identify the problem, and subsequently return the person to health and the joy of existence.