Week 7 :Mandible Week 8 : TMJ

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Week 7 Mandible Week 8 TMJ

• RT 233 Week 7 8
• (FINAL)

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Mandible
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Mandible (Slide 3)

1. Only movable bone in the skull
2. Densest largest facial bone
3. 2 bones at birth
4. Contains mental foramina

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Temporomandibular Joint
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Indications

• 1
• 2
• 3

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PA Mandible (rami)

1. ________ or ________
2. _________________ and nose on IR
3. ________ ________ perpendicular to IR
4. CR perpendicular to exit _____________

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PA Mandible (rami) Radiograph

• 1. Mandibular ________
• 2. ________ portion of ______ are visualized
• 3. Entire mandible without _________ or _________
• 4. _________ or __________ displacement

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PA Mandible Rami- Diagram
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PA Mandible (body)

• ________or _______
• ____ and ____ on grid device or table
• Mandibular symphysis ______with plane of IR
• ___ ___ perpendicular to IR
• CR perpendicular to level of ________

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PA Mandible (body) Radiograph

• Contrast and density are sufficient to view body
  and rami
• Sharp bony detail indicating no motion

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PA Axial (rami)Mandible Positioning

• Seated or _______
• Forehead and _____ on IR
• _____ MSP perpendicular to IR
• CR 20- 25 _________, centered to exit
  _______________

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PA Axial (rami)Mandible Radiographs

1. Heads of ________ are visible through ______
   processes.
2. Condyloid processes are slightly _________.
3. Proper density
4. No rotation or tilt

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PA Axial (body)Mandible Positioning

• Seated or Prone
• ____ and ____on grid device or table
• mandibular symphysis ___________ with IR
• ____ _____ perpendicular to IR
• CR between TMJs, 30 ____________

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PA Axial (body)Mandible Radiographs

• TMJs just ________ to mastoid process
• Symmetric ______
• Adequate contrast and density

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Axiolateral Oblique Positioning for Ramus

• Seated, semiprone or semisupine
• IPL ____________ to IR
• Mouth closed- _________ together
• Extend neck, chin ___________forward
• CR __ degrees _____to pass through area of
  interest

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Axiolateral Oblique Radiograph for Ramus

1. No overlap of ramus by opposite side of mandible
2. No elongation or foreshortening of ramus
3. No superimposition of ramus by c-spine

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Axiolateral Oblique Positioning for Body

1. Seated, semiprone or semisupine
2. IPL perpendicular to IR
3. Mouth closed- teeth together
4. Extend neck, chin jutted forward
5. Rotate pts head _________ degrees toward IR
6. CR 25 degrees cephalic to pass through area of
   interest

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Axiolateral Oblique Radiograph for Body

1. No overlap of body by opposite side of mandible
2. No elongation or foreshortening of body
3. No superimposition of body by c-spine

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Axiolateral Oblique Positioning for Mandibular
Symphysis

• Seated, semiprone or semisupine
• IPL perpendicular to IR
• Mouth closed- teeth together
• Extend neck, chin jutted forward
• Rotate pts head __ degrees toward IR
• CR 25 degrees cephalic to pass through area of
  interest

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Axiolateral Oblique Radiograph for Mandibular
symphysis

• No overlap of mentum by the opposite side of
  mandible
• No foreshortening of the mentum region

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SMV Mandible

• IOML parallel to IR
• Shows coronoid and condylod processes orf rami

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SMV
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SMV Radiograph

• Condyles anterior to pars petrosae
• Symphysis extended almost past border of face
• Equal distance from condyles to lateral margin of
  skull

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Panorex Mandible

1. Explain how tube/image receptor move
2. IOML perpendicular
3. Stand straight, not jutting chin forward
4. Instruct pt to keep lips together and tongue on
   roof of mouth

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Panorex Mandible Radiographs

• Demonstrates teeth, mandible, TMJs
• Density are uniform across image
• No artifacts

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Fractures and Surgical Repair
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Surgical Fixation
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Jaw wired shut
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(No Transcript)
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(No Transcript)
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Temporomandibular Articulations
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AP Axial TMJ

1. Supine or seated upright
2. Posterior teeth closed and in contact
3. For open mouth- wide as possible without chin
   jutted forward
4. OML perp to IR
5. CR 35 caudad, centered midway between TMJs.
6. Enters approx 3 above nasion

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AP Axial TMJ Radiograph

• No rotation
• Minimal superimposition of petrosa on condyle in
  closed mouth
• Condyle and TMJ below pars petrosa in open mouth

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Axiolateral Oblique TMJ

1. Semiprone or seated
2. Center ½ anterior to EAM
3. Rest cheek on grid device
4. Rotate MSP approx 15 degrees toward IR
5. IPL perpendicular
6. CR 15 caudad exiting through TMJ closest to IR
   about 1 ½ superior to upside EAM

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Axiolateral Oblique TMJ Radiograph

• TMJ
• Condyle lying in mandibular fossa in closed mouth
  
• Condyle lying inferior to articular tubercle in
  open mouth

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Axiolateral Oblique Open mouth
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Axiolateral Oblique Open mouth
Temporomandibular fossa
condyle
Coronoid
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Axiolateral ObliqueClosed mouth
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Axiolateral ObliqueClosed mouth
Temporomandibular fossa
condyle
coronoid
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Axiolateral TMJs

• CR 25-30 degrees
• Enters ½ anterior and 2 superior to upside EAM
• IPL Perpendicular
• MSP parallel

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Evaluation Criteria

• TMJ lying anterior to the EAM
• Condyle in fossa (closed mouth)
• Condyle inrerfior to articular tubercle (open
  mouthP

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Axiolateral Closed Mouth
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Axiolateral Open Mouth