Diagnostic Approach to Right-Sided Jaw and Ear Pain

Clinical Assessment and Imaging

• The American College of Radiology recommends evaluating for malocclusion as part of the clinical assessment for temporomandibular joint pathology 1
• The American College of Radiology suggests that MRI with gadolinium contrast is the definitive first-line modality when imaging is warranted, providing superior soft tissue contrast resolution to delineate tumors, perineural spread, and intracranial extension 3
• The American College of Radiology recommends against ordering CT head alone as the initial imaging study for suspected tumor evaluation, as it provides inadequate visualization and unnecessary radiation exposure 2

Alternative Imaging Considerations

• High-resolution CT of the temporal bone may be complementary to MRI when evaluating osseous structures of the TMJ or temporal bone, assessing for fractures or bony erosion, or characterizing middle ear pathology 1, 4