Radiographic examinations of the temporomandibular joint

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Radiographic examinations of the
temporomandibular joint

• Dobó-Nagy, Csaba
• Semmelweis University

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Knowledge required by clinicians

• Anatomy
• Available investigations
• Clinical indications
• How each investigation is performed
• position
• open or closed
• Limitations
• Pathological conditions

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Anatomical section of a normal TMJ
lateral pterygoid muscle
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Skull base model
A
P
R
L
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Visualization of the TMJ
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Main radiographyc projections of the TMJ
TrCran
TrOrb
TrPhar
RevTowne
SMV
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Transcranial projection
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Reverse Townes
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Transorbital
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Transpharyngeal (Parma)
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Dental panoramic tomograph
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Condylar silhouette
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Projection of panoramic tomography
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Double lateral view of TMJ
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SMV
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Corrected tomography
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Limitations of routin radiographic projections

• Soft tissue abnormalities
• Effusion
• Small and localised bony defects
• One aspect of the joint (except for tomography)

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Main pathological signs of TMJ
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Adaptive response
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Osteophyte formation
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Fracture
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osteochondroma
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Dislocaition of disk without reduction
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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)

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CT coronal view
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CT sagittal view
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CBCT imaging of a normal TMJ
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CBCT examination of arthritis
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Osteophyte
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Ankylosis
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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

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Size of TMJ space and soft tissue changes
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Diagnostic informations by modalities
Radio-grapic modalities anatomy anatomy pathology pathology adaptation adaptation
Radio-grapic modalities hard soft hard soft hard soft
panoramic
traditional
CBCT/CT
MRI

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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
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Summary of views of main projections
projection area of joint shown
Transcranial lateral aspect
Transpharyngeal lateral aspect
Dental panoramic lateral aspect
Reverse Townes posterior view
Transorbital anterior view