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