What Does Giufeng Know about the TMJ

She knows that the joint consists of two distinct compartments that are divided by a disk with a dumbbell-like configuration. The disk is suspended by ventral and dorsal ligaments and translates the force from the mandibular condyle to the articular tubercle of the temporal bone. As the mouth is opened, the condyle slides out of the mandibular fossa underneath the articular tubercle. If the mouth is closed, the dorsal part of the disk stands in the 12-o'clock position a Mastoiditis b Brain abscess a Mastoiditis b Brain abscess

Mastoid Fluid Mri
Fig. 13.13a The axial T2-weighted MRI section through the mastoid shows fluid on both sides. This is indicative of mastoiditis. The patient also presented with the symptoms of middle-ear infection. As an unrelated finding the study shows a reten

tion cyst in the left maxillary sinus. b In another patient the middle-ear infection has perforated into the cranial vault. An acute and potentially lethal epidural (long arrow) and even an intracerebral abscess (short arrows) have resulted.

relative to the mandibular condyle (a); as the mouth is opened it moves to the top of the condyle (b). The mandibular condyle may be hypoplastic, the joint may show degeneration. Bear in mind the enormous forces that the small temporomandibular joint must withstand—that explains why this joint is so prone to developing problems.

^ Diagnosis: The findings are clear in our engineer's case. Both mandibular condyles show a normal configuration. Giufeng diagnoses a fixed luxation of the disk on the right side. She could not find an abnormality on the left. Now the head and neck surgeons must do what they can to give the tunnel project a real shove.

12 o'clock

Mandibular fossa Mandibular condyle Meniscus

Articular

12 o'clock

Mandibular fossa Mandibular condyle Meniscus

Giufeng reviews Mrs. Nutcracker's MRI looking separately at each side with the mouth opened and closed (Fig. 13.14).

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