1. Radiographic examinations of the temporomandibular joint
Dobó-Nagy, Csaba
Semmelweis University

2. Knowledge required by clinicians
Anatomy
Available investigations
Clinical indications
How each investigation is performed
position
open or closed
Limitations
Pathological conditions

3. Anatomical section of a normal TMJ
condyle
disk
Glenoid fossa
tubercle (articular eminence)
lateral pterygoid muscle

4. Skull base model A P L R

5. Visualization of the TMJ

6. Main radiographyc projections of the TMJ
TrCran
TrOrb
TrPhar
RevTowne
SMV

7. Transcranial projection

8. Reverse Towne’s

9. Transorbital

10. Transpharyngeal (Parma)

11. Dental panoramic tomograph

12. Condylar silhouette

13. Projection of panoramic tomography

14. Double lateral view of TMJ

15. SMV

16. Corrected tomography

17. Limitations of routin radiographic projections
Soft tissue abnormalities
Effusion
Small and localised bony defects
One aspect of the joint (except for tomography)

18. Main pathological signs of TMJB C D E F G H I

19. Adaptive response

20. Osteophyte formation

21. Fracture

22. osteochondroma

23. Dislocaition of disk without reduction

24. Diagnostic informations of MR
Disk displacement
The integrity of the disk and its soft tissue attachments
Effusion (T2-weighted image)
Integrity of the articular surface
Research (gold standard)

25. CT coronal view

26. CT sagittal view

27. CBCT imaging of a normal TMJ

28. CBCT examination of arthritis

29. Osteophyte

30. Ankylosis

31. Diagnostic informations of CT
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

32. Size of TMJ space and soft tissue changes

33. Diagnostic informations by modalities
Radio-grapic modalities
anatomy
pathology
adaptation
hard
soft
panoramic
traditional
CBCT/CT
MRI

34. Suggested hierarchy of imaging modalities in TMJ disease
soft tissue changes
panoramic
MRI
bone changes
tomography
Primary examination:
dysfunction
organic changes
failed treatment
CBCT, CT

35. Summary of views of main projections
area of joint shown
Transcranial
lateral aspect
Transpharyngeal
Dental panoramic
Reverse Towne’s
posterior view
Transorbital
anterior view