(Prepared by Dr Isabel Berrocal)

            Female 24 y-o with palpable TMJ bilateral pain and painful mouth-opening, underwent in 1: Tc-99m MDP skull SPECT which showed intense osteoblastic activity in the left TMJ and mild in  the contralateral. In 2: TMJ indices vs themselves and vs skull were consistent with inflammatory findings. 3 (right) and 4 (left): TMJ – MRI showed: Anterior dislocation of both disks with chronic course in the left. Moderate medial dislocation in the right joint and significantly left lateral dislocation. Bilateral synovial inflammation more intense on left. 5: TMJ-CT showed: Figure A, B front view : Both condyle cortex with an erosion area and osteosclerosis. Right condyle (A) in central position and left condyle (B) in medial position and beyond  interarticularis space. Figure C, D side view: Both condyles in posterior position. Left condyle (D) flattened. Image suggestive of arthritis.
 

References:

1.- Byeong-Cheol Ahn, et al. New quantitative method for bone tracer uptake of temporomandibular joint using Tc-99m MDP skull SPECT. Ann Nucl Med (2009). Vol 23, Issue 7, pp: 651-656.13;
2.- Fahey Frederic H.Use of 99mTc-MDP SPECT for assessment of mandibular growth: development of normal values. Eur J Nucl Med Mol Imaging (2010) 37:1002–1010
 

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