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Referral details

Case 114026

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Referral category

Temporomandibular joints (TMJ)

Region of interest

R + L TMJ and Maxilla + Mandible

Referral reason

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3 Files Info

Canaray 114026

Volume rendering of right TMJ in the closed position

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Normal left TMJ in mandibular closed position

In the mandibular closed position, the left condylar head is relatively centrally positioned in the glenoid fossa. The osseous structures of the left temporomandibular joint appear normal.

1. Osteochondroma in right temporomandibular joint

A large irregularly-shaped increase in the size of the right condylar head has occurred. The enlargement is confined to the anterior superior surface of the right condylar head, and is continuous with the underlying trabecular bone. The temporal component of the right temporomandibular joint exhibits sclerosis and remodelling. This radiographic appearance is pathognomonic for an osteochondroma. Surgical removal of the entity is indicated. The right condylar head is anteriorly and inferiorly positioned in the right temporomandibular joint due to the alteration of its shape and the presence of a large joint mouse in the region posterior to the condylar head.

2. No translation of right condylar head in mandibular open position

The right condylar head does not exhibit any translation in the mandibular open position. The left condylar head translates to the crest of the articular eminence in the mandibular open position.

Sagittal views of right TMJ in mandibular closed position

These sagittal cross-sectional images demonstrate the large joint mouse that has formed in the region distal to the right condylar head. In addition, the irregularly shaped osteochondroma that has formed on the anterior surface of the condylar head is evident in these images. The continuity of the osteochondroma with the underlying trabecular bone of the condylar head is supportive of the diagnosis. Note the sclerotic appearance and the irregular shape of the articular eminence.

Coronal views of right condylar head

These coronal cross-sectional images demonstrate the irregularly shaped superior surface of the osteochondroma, as well as the inferior displacement of the condylar head by the progressively enlarging osteochondroma.

Axial views of right condylar head

These axial cross-sectional images demonstrate the growth of the osteochondroma on the anterior superior surface of the right condylar head.

3. Severe bone loss around tooth 37D

Tooth 37 exhibits severe periodontal bone loss around its distal root. This may represent a combined endodontic/periodontal lesion. No unobturated canals are visible in tooth 37. The mesial root of the tooth appears normal.

Mandibular asymmetry secondary to osteochondroma formation in right condylar head

These orthogonal images demonstrate the deviation of the mandible to the left due to the formation of the osteochondroma in the right temporomandibular joint.

4. Left posterior crossbite

The canines, premolars, and molars in the second and third quadrants are in crossbite.