Clinico-radiological correlation of MRI findings in patients with temporomandibular joint disc perforation

This study was performed to investigate the clinical and magnetic resonance imaging (MRI) correlates of temporomandibular joint (TMJ) disc perforation, focusing on internal derangement patterns, disc configuration, joint effusion, condylar morphology, condylar bone marrow signal changes, and pain severity. A total of 282 patients (564 TMJs) who underwent bilateral TMJ MRI for temporomandibular disorder-related symptoms were included in this retrospective study. Disc perforation, disc position and configuration, condylar morphology, joint effusion, and condylar bone marrow signal patterns were evaluated on MRI. Pain intensity was recorded using a visual analogue scale (VAS). Associations were analysed using non-parametric tests and generalized estimating equations. Disc perforation was detected in 129 TMJs (22.9%). Patients with disc perforation were older (P = 0.004); however, there was no association with sex (P = 0.74). Most joints with perforated discs (79.1%) showed a normal disc position, whereas disc displacement with or without reduction predominated in those with non-perforated discs (P < 0.001). Disc configuration and condylar morphology differed significantly according to perforation status (P < 0.001). Joint effusion and bone marrow signal patterns were not significantly associated with disc perforation (P = 0.78 and P = 0.68, respectively). Mean VAS pain scores were lower in joints with perforated discs than in those with non-perforated discs (P = 0.043). MRI-confirmed TMJ disc perforation may not represent an inherently painful or clinically active stage, underscoring the need for integrated clinical interpretation.