Radiographic examinations of the temporomandibular joint DobNagy Csaba
Radiographic examinations of the temporomandibular joint Dobó-Nagy, Csaba Semmelweis University
Knowledge required by clinicians n n Anatomy Available investigations n n Clinical indications How each investigation is performed n n position open or closed Limitations Pathological conditions
Anatomical section of a normal TMJ disk Glenoid fossa tubercle (articular eminence) condyle lateral pterygoid muscle
Skull base model A L P R
Visualization of the TMJ
Main radiographyc projections of the TMJ Tr. Cran Tr. Orb Tr. Phar Rev. Towne SMV
Transcranial projection
Reverse Towne’s
Transorbital
Transpharyngeal (Parma)
Dental panoramic tomograph
Condylar silhouette
Projection of panoramic tomography
Double lateral view of TMJ
SMV
Corrected tomography
Limitations of routin radiographic projections n n Soft tissue abnormalities Effusion Small and localised bony defects One aspect of the joint (except for tomography)
Main pathological signs of TMJ A B C D E F G H I
Adaptive response
Osteophyte formation
Fracture
osteochondroma
Dislocaition of disk without reduction
Diagnostic informations of MR n n n Disk displacement The integrity of the disk and its soft tissue attachments Effusion (T 2 -weighted image) Integrity of the articular surface Research (gold standard)
CT coronal view
CT sagittal view
CBCT imaging of a normal TMJ
CBCT examination of arthritis
Osteophyte
Ankylosis
Diagnostic informations of CT n n n The shape of the bony compartments Information on all aspects of the joint The condition of the articular surface The size of the joint space Integrity of the disk and soft tissue attachements
Size of TMJ space and soft tissue changes
Diagnostic informations by modalities Radiograpic modalities panoramic traditional CBCT/CT MRI anatomy hard soft pathology hard soft adaptation hard soft
Suggested hierarchy of imaging modalities in TMJ disease soft tissue changes panoramic MRI bone changes tomography Primary examination: • dysfunction • organic changes CBCT, CT • failed treatment
Summary of views of main projections projection area of joint shown Transcranial lateral aspect Transpharyngeal lateral aspect Dental panoramic lateral aspect Reverse Towne’s posterior view Transorbital anterior view
- Slides: 35