The incidence of perforations in the temporomandibular joint (TMJ) disc is estimated to be between 6% and 42% (Kim et al., 2018; Machon et al., 2017; Shen et al., 2014). Perforations are most commonly located in the posterior disc area (Liu et al., 2010). The exact causes are not fully known. In the literature, various authors have suggested that the primary cause is related to the anterior disc displacement without reduction (ADDwoR) (Cholitgul et al., 1990; Kondoh et al., 1998). However, other authors argue that the formation of perforations can be attributed to arthritic changes in the joint and not exclusively to disc displacement (Dijkgraaf et al., 1999; Roy, 2006). Perforations are observed more frequently in advanced stages of temporomandibolar disorder (TMD) and in cases of osteoarthrosis.

Disc perforations do not have specific clinical features to guide diagnosis, but they are typically observed in joints that have reached advanced stages of degeneration (Kuribayashi et al., 2008; Westesson et al., 1998). Patients in these stages usually present with chronic pain and altered jaw function (Cholitgul et al., 1990).

In cases where conservative treatment fails, surgery becomes the most appropriate treatment option in advanced stages. Patients in advanced stages, especially Wilkes stage V, and thus with disc perforation, can benefit from open TMJ surgery, either with or without discectomy (Muñoz-Guerra et al., 2012; Machon et al., 2017; Tzanidakis et al., 2013).

This surgical procedure is supported by the most scientific evidence at this stage, and has been shown to improve jaw function, reduce pain, and yield stable long-term results.

Various imaging tests are available for evaluating TMJ pathology, with the gold standard being functional MRI of the TMJ (Öǧ;ütcen-Toller et al., 2002; Orhan et al., 2017; Rao et al., 1990). There are limited publications in the literature regarding the validity and usefulness of this imaging test in detecting disc perforations. Many authors consider its diagnostic capacity to be limited due to the challenges associated with diagnosing small structures like the articular disc, and the similar signal intensity of the surrounding structures (Liu et al., 2010). Furthermore, the diagnosis of perforations using this test often requires complementary invasive techniques, such as arthrography or arthroscopy (Yang et al., 2005; Venetis et al., 2011). Therefore, it is essential to conduct studies involving patients diagnosed with TMD who have undergone TMJ arthroscopy.

The aims of our study were to: determine the usefulness of MRI in detecting disc perforations; identify the pathological findings in MRI most frequently related to the diagnosis of disc perforation in arthroscopy; and analyze which of the pathological findings in MRI were associated with the presence of disc perforation, and their magnitude.

The results will enable us to make informed decisions regarding the most suitable therapeutic approach, including open surgery in cases of disc perforation, and to avoid the need for a diagnostic arthroscopy followed by a second surgery.