Week 7 :Mandible Week 8 : TMJ RT 233 Week 7 & 8 (FINAL)

Mandible 2

Mandible (Slide 3) 1.Only movable bone in the skull 2.Densest & largest facial bone 3.2 bones at birth 4.Contains mental foramina 3

Temporomandibular Joint 4

Indications

PA Mandible (rami) 1.________ or ________ 2._________________ and nose on IR 3.________& ________ perpendicular to IR 4.CR perpendicular to exit _____________ 6

7 PA Mandible (rami) Radiograph 1. Mandibular ________ 2. ________ portion of ______ are visualized 3. Entire mandible without _________ or _________ 4. _________ or __________ displacement

8 PA Mandible Rami- Diagram

PA Mandible (body) 1.________or _______ 2.____ and ____ on grid device or table – Mandibular symphysis ______with plane of IR 3.___ & ___ perpendicular to IR 4.CR perpendicular to level of ________ 9

10 PA Mandible (body) Radiograph 1.Contrast and density are sufficient to view body and rami 2.Sharp bony detail indicating no motion

11 PA Axial (rami) Mandible Positioning 1.Seated or _______ 2.Forehead and _____ on IR 3._____ & MSP perpendicular to IR 4.CR _________, centered to exit _______________

12 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

13 PA Axial (body) Mandible Positioning 1.Seated or Prone 2.____ and ____on grid device or table –mandibular symphysis ___________ with IR 3.____ & _____ perpendicular to IR 4.CR between TMJ’s, 30 ____________

14 PA Axial (body) Mandible Radiographs 1.TMJ’s just ________ to mastoid process 2.Symmetric ______ 3.Adequate contrast and density

15 Axiolateral Oblique Positioning for Ramus 1.Seated, semiprone or semisupine 2.IPL ____________ to IR 3.Mouth closed- _________ together 4.Extend neck, chin ___________forward 5.CR __ degrees _____to pass through area of interest

16 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

17 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 pt’s head _________ degrees toward IR 6.CR 25 degrees cephalic to pass through area of interest

18 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

19 Axiolateral Oblique Positioning for Mandibular Symphysis 1.Seated, semiprone or semisupine 2.IPL perpendicular to IR 3.Mouth closed- teeth together 4.Extend neck, chin jutted forward 5.Rotate pt’s head __ degrees toward IR 6.CR 25 degrees cephalic to pass through area of interest

20 Axiolateral Oblique Radiograph for Mandibular symphysis 1.No overlap of mentum by the opposite side of mandible 2.No foreshortening of the mentum region

21 SMV Mandible IOML parallel to IR Shows coronoid and condylod processes orf rami

22 SMV

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

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 24

25 Panorex Mandible Radiographs 1.Demonstrates teeth, mandible, TMJ’s 2.Density are uniform across image 3.No artifacts

Fractures and Surgical Repair

Surgical Fixation 27

28 Jaw wired shut

29

30

Temporomandibular Articulations 31

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 TMJ’s. 6.Enters approx 3” above nasion

AP Axial TMJ Radiograph 1.No rotation 2.Minimal superimposition of petrosa on condyle in closed mouth 3.Condyle and TMJ below pars petrosa in open mouth

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

Axiolateral Oblique TMJ Radiograph 1.TMJ 2.Condyle lying in mandibular fossa in closed mouth 3.Condyle lying inferior to articular tubercle in open mouth

Axiolateral Oblique Open mouth

Temporomandibular fossa condyle Coronoid

Axiolateral Oblique Closed mouth

Temporomandibular fossa coronoid condyle

Axiolateral TMJ’s CR degrees Enters ½” anterior and 2” superior to upside EAM IPL Perpendicular MSP parallel

Evaluation Criteria TMJ lying anterior to the EAM Condyle in fossa (closed mouth) Condyle inrerfior to articular tubercle (open mouthP 41

Axiolateral Closed Mouth

Axiolateral Open Mouth