 Hello everyone, my name is Dr. Shubham Karev, junior resident at Sir Jeje Hospital, Mumbai. I am before you presenting a case study under the title of MR Assessment of Internal Rearrangement of Emporomandibular Joint, then under the guidance of Dr. Mayor Buriwer, an assistant professor at Sir Jeje Group of Hospitals, Mumbai. Let's go with the introduction. The TMJ Joint is a gingivo-arthrial joint which allows the motion only in a backward and a forward direction and permits a gliding motion. Emporomandibular Joint, the main function is of the mastication and the speech and hence is of great interest to the podontologists, clinicians and the radiologists. The internal rearrangement of TMJ is defined as an abnormal, positional and functional relationship between the disc and the articular surface. Pre-sized localization of the disc is very important in the diagnosis of the TMJ internal rearrangement. Hence, an MRI imaging is required for the interpretation of these abnormalities. The aims and objectives of our study are to study the various internal rearrangements of the TMJ joint using an MRI. By trial and method, we have studied 15 patients referred to us with a pain in the pre-oricular region or pain during the jaw movements or clicking sensation. All the scans were done in a 3-tas-lise GED-scovered 750-metre MRI. The following sequences were used, going for the axial PD, sagittal PD, PD-fat sag, sag and the coronal PD-fat sag. The scans were reported by two readers. The results and the observations has been observed, have been obtained by observing 30 emporomandibular joints of 15 patients which were referred to our department. Based upon our study we have concluded that the anterior displacement with the reduction was the most common internal rearrangement found in our study. This is a graphical, this is an eye chart of the derangements which we have obtained by studying the patients in our study. Coming to the discussion, the discussion goes for the emporomandibular joint is a gingerly arterial joint. The articular surface of the TMJ joint is formed by the inferiorly by the mandibular condyle and superiorly by the glenoid fossa and the articular eminence of the temporal bone. The articular disc is round or oval by concave or vascular between the condyle and the glenoid. The disc itself is oriented into three zones, an entry band intermediate and the posterior. The posterior band is thick one measuring approximately 3 mm, a bilimolar zone. The intermediate zone is a thin central zone of approximately 1 mm. It prevents the articular damage through a continuous interposition between the condyle and the temporal surface during our mouth opening and closing. In a closed mode, the posterior band of the disc is directly above the condyle near the vertical line through the apex of the condyle or curvature in such a template. The junction of the posterior band and the bilimolar zone should fall within 10 degree of this vertical line to be evaluated as a normal. In an open mouth, the junction between the enter band and the intermediate zone should be interposed between the condyle and the articular eminence. The muscles of mastication in addition to the other axis helps in opening and closing the mouth. If this is not present as we see on the picture on our right side, there is disruption of that joint and there is displacement of this location of the joint. On an MRR, the marrow fat in the condyle as a T1 high signal, the disc is otherwise emotionally hypoint and spike on the disc. The bilimolar zone is visible as an intermediate zone in a closed mouth position. The junction of the posterior band and the posterior attachment lies above the condyle nearly at 12 o'clock position. In an open mouth position, it lies between the condyle and the articular eminence and the posterior band is against the posterior surface of the condyle. The superior belly of the lateral teregoid attaches to the anterior band of the disc. The inferior belly of the lateral teregoid attaches to the anterior surface of the condyle or neck with a thin linear hypointense fibrous band. The internal derangements. The opening of the mouth requires a perfect synchronization. The term internal derangement refers to the mechanical defect that interferes with the harmonic position. On that basis, we have anterior displacement of the disc with reduction to the normal position with mouth opening. Without reduction, the entire displacement with perforation, the sideway displacement is medial and lateral, the rotational, antrimedial or antrolateral and the posterior displacement. That is displacement with reduction. The articular disc may dislodge in several directions anterior, medial, lateral, antrimedial, antrolateral and the posterior. This means that the disc is displaced from the mesaline and the condyle when the mouth is closed. In case of reduction, the disc returns back to its anatomical position on opening the mouth spontaneously. The disc remains in the position as long as the mouth is closed. Once the mouth is opened, it gets dislodged. Like the shoddy in the figure, this is an anterior displacement of the disc on a closed mouth. The disc is repositioned when the mouth is open, as you can see here. This has been displaced and this gets repositioned on opening the mouth. That is displacement without reduction. In this event, after closing the mouth, it doesn't get spontaneously to its anatomical position. Like you can see, it is displaced here and same, it remains displaced even during opening. Now, there is displacement with the perforation of the tear. The disc is less likely to reduce to a normal position as a bio-LMLR zone becomes progressively dysfunction. The disc perforation can occur or the disc might become thickened and fibrotic. Like in the figure 3, the sagged PD of a left impermanence shows the anterior displacement of the disc on a closed mouth. In figure 3, we see that the posterior zone is thickened and shows a high signal, most likely a tear. As you can see here, this might be a tear of the disc. Now, the medial displacement. This goes into the side-to-side displacement which we have in the medial and the lateral. The medial displacement, we have shown the medial displacement. The figure 5 is in the coronal section where we see the disc between the clenoid fossa and the mandibular condyne but on the right side. The conclusion of a study goes by that the imaging of the TMS joint is performed by the case series depending upon the clinical science and symptoms. The MRI is the modality of choice for the evaluation of the disc position and the internal arrangements of the joint. These are my references. Thank you.