Indications for radiography of TMJ

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Ankylosis of TMJ
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Arthritis of TMJ

• Infectious arthritis
• Rheumatoid arthritis
• Degenerative arthritis
• Traumatic arthritis

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Radiological changes of R.A.

• Reduced mobility
• Reduction of joint space
• Erosion
• Flattening
• Osteophyte formation
• Osteosclerosis
• Osteoporosis
• Deformation,total loss of condyle

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Clinical features of R.A.

• Pain,swelling,limitation of jaw
  movement,crepitation.
• Changes in the occlusion of the teeth
• (advanced case )progressive opening of the bite.
• Total ankylosis(rare)

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B-Normal MRI image,jaw open position,sagittal
plane, relatively high signal noted in post.band
of disk, is attached to neck of condyle via firm
capsular attachment(arrowheads) T-tubercle
C-condyle Arrowheads-attachment of sup.belly of
lat.pterygoid m.to the ant.band of disk
MRI image of TMJ with jaw in closed
position,sagittal plane,A- Normal MRI of
TMJ,coronal plane of image,jaw closed,arc-shaped
disk-A
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Normal MRI of TMJ,coronal plane of image,jaw
closed,arc-shaped disk
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Internal derangementanterior displacement of the
disk
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Normal TMJ
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Internal TMJ derangementThe early click
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Severe disk derangementclosed lock
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Normal TMJ arthrogram
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Change in relationship of disk to osseous
structures with mouth opening when the condyle
articulates with the intermediate zone of the disk

• 1post.band C condyle 2 smaller ant.band e eminence

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Normal relationship of the disk to the condyle
and fosssa(mouth closed)post.band(1) directly
above the condyle(c)smaller ant.band(2)immmediatte
ly below the eminence,ant.band of normally
positioned disk can cause a small concave defect
on the ant.recess(arrow)
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Bifid condyle(duplication of condyle)
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Panoramic radiogram,chondrosarcoma
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Indications for radiography of TMJ

• 1)Pain
• 2)Systemic disease
• 3)Noise,clicking sounds during movement
• 4)Masticatory muscle pain
• 5)trismus, limitation of mouth opening
• 6) trauma
• 7)asymmetrical face
• 8)morphological abnormalities

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Diagnostic values between several techniques

• TLOPgtTMPgtTPP
• TLOPostephyte on anterior aspect of
  condyle,flattening of post.slope and crest of
  articular eminence.
• TMP erosion on condyle.flattening of later.parts
  of articular eminence or most laterally situated
  osteophyte.
• TLOP and TMP complement each other, if they
  are used in conjunction,more
• structural changes are demonstrated.
• (Pertersson)

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Principles of radiographic examination of TMJ

• Ideal examination should result in
  three-dimensional topography of the
  shape,size,and the structure of joint components.
• 1)Avoiding the superimposition of cranial
  structures.
• 2)Direct the X-Ray beam perpendicular to the
  cassette.
• 3)Put the film as close as possible to the joint
  under examination.
• 4)Reproducibility of the radiographic procedure.

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Radiographic technique of TMJthree dimensional
topography of the joint components

• A.Conventional methods
• 1)Lateral views
• TLOP( transcranial lateral oblique
  projection,Schullers modification)
• TPP(transpharyngealprojection,Parma,Toller,Lewi
  s )
• 2)Anteroposterior views
• Anteroposterior projection(Townes proj.)
• ORP(orbitao-ramus projection,Grant-Lanting
  proj.)
• TMP(transmaxillary projection)
• 3)Axial view
• Base projection,Submento-vertical Projection)
• 4)Panoramic radiography

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B.Special methods

• 1)Tomography
• 2)cinefluorography
• 3)Arthrography
• 4)Nuclear Medicine Imaging (scintigraphy)
• 5)Computed tomography
• 6)MRI(magnetic resonance Imaging)

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Arthrography of TMJ

• Arthrography of the tmj
• Double Contrast Arthrography
• Digital Subtraction Arthrography

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TMJ arthrography

• An accurate and effective means of diagnosing
  Internal derangements and other abnormalities.
• Shows perforated disk which no other diagnostic
  method can demonstrate with reliability.
• Allows evaluation of the dynamics of the joint
  with mouth opening and closing.
• Helpful in patients with clicking from other than
  a displaced disk (i.e. a prominent articular
  eminence).
• Cost-efficeint

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Arthrography Double contrast

• An alternative arthrographic tehnique
• Injections of contrast medium and air into both
  upper and lower joint spaces followed by
  tomography.
• Can demonstrate the soft tissues of the joint
  with greater detail than single contrast
  technique.

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Nuclear Medicine Imaging

• Radionuclide bone scintigraphy offers a sensitive
  method for detecting the presence of tmj
  pathology and serving as an economical screening
  technique.
• For determination of the presence of significant
  organic tmj disease.
• Small remodeling changes in bony structures,or
  Inflammation in the surrounding tissues can be
  detected long before than other conventional
  radiographs.

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TLOP,shows only lat.third of joint
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Transmaxillary proj.McCabe(oblique infraorbital
proj.)
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TPP(transpharyngeal proj.)
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LOTP vs.Axial tomo.Osteophyte,narrow ant.
Js,sclerotic tubercle
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