Radiographic examinations of the temporomandibular joint

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Presentation transcript:

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

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

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

Skull base model A P L R

Visualization of the TMJ

Main radiographyc projections of the TMJ TrCran TrOrb TrPhar RevTowne 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 Soft tissue abnormalities Effusion Small and localised bony defects One aspect of the joint (except for tomography)

Main pathological signs of TMJ B C D E F G H I

Adaptive response

Osteophyte formation

Fracture

osteochondroma

Dislocaition of disk without reduction

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)

CT coronal view

CT sagittal view

CBCT imaging of a normal TMJ

CBCT examination of arthritis

Osteophyte

Ankylosis

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

Size of TMJ space and soft tissue changes

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

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

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