DEPARTMENT OF ORAL MEDICINE DIAGNOSISDEPARTMENT OF ORAL MEDICINE DIAGNOSIS
ANDAND
RADIOLOGYRADIOLOGY
TEJAS KHAIRE IV/ITE...
 
www.indiandentalacademy.com
The Temporomandibular joint (TMJ) is the jaw joint.
As the term temporomandibular indicates, this joint
includes the tempo...
The transcranial provides a sagittal view of lateral
aspects of the condyle and temporal component.
It is used to evaluate...
 
www.indiandentalacademy.com
 
www.indiandentalacademy.com
HEAD POSITION
The patients head is adjusted so that the sagittal plane is vertical.
The ala tragus line is parallel to the...
It provides a sagittal view of medial pole of condyle and usually taken in open
mouth positon
FILM PLACEMENT
The cassette ...
 
www.indiandentalacademy.com
 
The patient is instructed to slowly inhale through nose during exposure,
so as to ensure filling of nasopharynx with air...
It provides anterior view of TMJ, perpendicular to transcranial and
transpharyngeal projections.
FILM PLACEMENT
The film i...
www.indiandentalacademy.com
 The point of entry may be taken at:
 1. Pupil of same eye, asking the patient to look
straight ahead
 2. Medial canthu...
 
This view is primarily meant for viewing
The condylar neck and head
High fractures of the TMJ
Quality of articular surfa...
HEAD POSITION
The patients head is tilted downwards so that the
canthomeatul line forms a 25 to 30 degree angle with
casse...
 
www.indiandentalacademy.com
Xeroradiography provide a finer and clearer image of TMJ
because of wide latitude and edge enhancement inherent
characteri...
 
The purpose of submentovertex view is to identify the position of
condyles, demonstrate the base of skull, evaluate frac...
 
www.indiandentalacademy.com
Panoramic radiography used to be considered a good imaging
method for evaluating TMJ since information about the teeth and...
 
www.indiandentalacademy.com
.
 
The soft tissue imaging can be imaged with magnetic resonance imaging
(MRI) or arthrography
ARTHROGRAPHY
The technique...
Several studies have shown that arthrography is an accurate imaging
method for evaluating anterior disc displacement.
The ...
MRI uses a magnetic field and radio frequency pulses rather than ionizing
radiation to produce multiple digital image slic...
Tomography of TMJ is generated through the synchronous movement of the x-
ray tube and film cassette through an imaginary ...
 
                                                                                                                        ...
Thank you
For more details please visit
www.indiandentalacademy.com
www.indiandentalacademy.com
Upcoming SlideShare
Loading in …5
×

Temporomandibular joint imaging 2 /certified fixed orthodontic courses by Indian dental academy

1,409 views

Published on


The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

Published in: Health & Medicine, Business
0 Comments
7 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,409
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
0
Comments
0
Likes
7
Embeds 0
No embeds

No notes for slide

Temporomandibular joint imaging 2 /certified fixed orthodontic courses by Indian dental academy

  1. 1.   DEPARTMENT OF ORAL MEDICINE DIAGNOSISDEPARTMENT OF ORAL MEDICINE DIAGNOSIS ANDAND RADIOLOGYRADIOLOGY TEJAS KHAIRE IV/ITEJAS KHAIRE IV/I www.indiandentalacademy.com INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
  2. 2.   www.indiandentalacademy.com
  3. 3. The Temporomandibular joint (TMJ) is the jaw joint. As the term temporomandibular indicates, this joint includes the temporal bone and mandible. The glenoid fossa and articular eminence of the temporal bone, the condyle of mandible, and the articular disk between bones make up TMJ area. This area can be very difficult to examine radiographically because of multiple adjacent bony structures. Specialized imaging techniques must be used for TMJ   www.indiandentalacademy.com
  4. 4. The transcranial provides a sagittal view of lateral aspects of the condyle and temporal component. It is used to evaluate the superior surface of condyle and articular eminence. INDICATIONS For identifying gross osseous changes on lateral aspect Displaced Condylar fractures Osteoarthritis Rheumatoid Arthritis Outline of articular disc Translatory movement of condyle in relation to glenoid fossa.   FILM PLACEMENT The cassette is placed flat against the patient’s ear and centered over the TM joint of interest, against the facial skin parallel to the sagittal plane.   www.indiandentalacademy.com
  5. 5.   www.indiandentalacademy.com
  6. 6.   www.indiandentalacademy.com
  7. 7. HEAD POSITION The patients head is adjusted so that the sagittal plane is vertical. The ala tragus line is parallel to the floor. This view is taken with the patients mouth in different positions Open mouth and closed mouth . BEAM ALIGNMENT The point of entry is different according to the technique used. A. Post auricular or Lindblom technique Point of entry of central ray is 0.5 inch behind and 2 inch above the auditory meatus. The beam is directed downward(+25degrees) and forward(20 degrees) and is centered on the TMJ being examined B. Grewcock approach The central ray enters through a point 2 inch above the external auditory meatus. C. Gill’s approach The central ray enters through a point ½” inch anterior and 2” above external auditory meatus.   In all three techniques the central ray is directed caudally at an angle of +20 to +25 degree Exposure parameters Kvp-70 mA-07 Seconds-1.5   Vwww.indiandentalacademy.com
  8. 8. It provides a sagittal view of medial pole of condyle and usually taken in open mouth positon FILM PLACEMENT The cassette is placed flat against the patient’s ear and centered to a point 0.5i nch anterior to external auditory meatus, over the TM joint of interest, against the facial skin parallel to the sagittal plane. HEAD POSITION The patients head is adjusted so that the sagittal plane is vertical and parallel to the film, with the TM joint of interest adjacent to the film. The film is centered to a point ½” anterior to the external auditory meatus The occlusal plane should be parallel to the transverse axis of the film so that the soft parts of nasopharynx are in one line with TMJ.   P www.indiandentalacademy.com
  9. 9.   www.indiandentalacademy.com
  10. 10.   The patient is instructed to slowly inhale through nose during exposure, so as to ensure filling of nasopharynx with air during exposure The patient should open his mouth so that the condyles move away from the base of skull and the mandibular notch of opposite side is enlarged . BEAM ALIGNMENT. Point of entry of central ray is directed from opposite side cranially , at an angle of -5 to -10 degrees posteriorly It is directed through the mandibular notch, that is a window between the coronoid, condyle and the zygomatic arch, to the side below the base of skull to the TM joint of interest EXPOSURE PARAMETERS Kvp-70 mA-07 www.indiandentalacademy.com
  11. 11. It provides anterior view of TMJ, perpendicular to transcranial and transpharyngeal projections. FILM PLACEMENT The film is positioned behind the patients head at an angle of 45degree to sagittal plane. HEAD POSITION The patients head is positioned so that the sagittal plane is vertical. The canthomeatul line should be 10 degree to the horizontal, with the head tipped downwards. The mouth should be wide open.   BEAM ALIGNMENT The tube head is placed in front of patients face The central ray is directed to the joint of interest, at an angle of +20degree, to strike the cassette at right angles.   P www.indiandentalacademy.com
  12. 12. www.indiandentalacademy.com
  13. 13.  The point of entry may be taken at:  1. Pupil of same eye, asking the patient to look straight ahead  2. Medial canthus of same eye.  3. Medial canthus of opposite eye  EXPOSURE PARAMETERS  Kvp-70  mA-07  Seconds-0.8  Here the entire mediolateral dimension of the articular eminence, condylar head, and condylar neck is visible, which makes this view particularly useful for visualizing condylar neck fractures. www.indiandentalacademy.com
  14. 14.   This view is primarily meant for viewing The condylar neck and head High fractures of the TMJ Quality of articular surfaces Condylar hypoplasia or hypertrophy. FILM PLACEMENT The cassette is placed perpendicular to the floor in a cassette holding device.The long-axis of cassette is placed vertically. www.indiandentalacademy.com
  15. 15. HEAD POSITION The patients head is tilted downwards so that the canthomeatul line forms a 25 to 30 degree angle with cassette. The film is adjusted so that the lips are centered to the film. Only patients forehead and tip of nose should touch the film The patient here is asked to keep his/her mouth wideopen. BEAM ALIGNMENT It is directed through the mid-sagittal plane at the level of mandible and perpendicular to the film. EXPOSURE PARAMETERS Kvp-65 mA-10 Seconds 2-3   Lwww.indiandentalacademy.com
  16. 16.   www.indiandentalacademy.com
  17. 17. Xeroradiography provide a finer and clearer image of TMJ because of wide latitude and edge enhancement inherent characteristic of this modality. Greater bony detail and additional information, particularly in areas of overlap. A serious drawback of this technique is unavoidable higher dose of radiation at skin surface which is 2.4 to 16.2 times higher than with conventional techniques. Therefore it is not a practical method for routine TMJ examination.   D www.indiandentalacademy.com
  18. 18.   The purpose of submentovertex view is to identify the position of condyles, demonstrate the base of skull, evaluate fractures of zygomatic arch. FILM PLACEMENT The cassette is placed perpendicular to the floor in a cassette holding device. The long axis of the cassette is placed vertically. HEAD POSITION The patient’s head and neck are tipped back as far as possible; the vertex (top) of the skull touches the cassette .Both the midsagittal and Frankfort plane are positioned perpendicular to floor .The head is centered on cassette. BEAM ALIGNMENT The central ray is directed through the centre of head and perpendicular to the cassette. www.indiandentalacademy.com
  19. 19.   www.indiandentalacademy.com
  20. 20. Panoramic radiography used to be considered a good imaging method for evaluating TMJ since information about the teeth and other parts of the jaws were also shown on the image. However, the relationship between the condyle and glenoid fossa cannot be evaluated in the panoramic film because the fossa cannot be seen with superimposition of the base of the skull and zygomatic arch. The morphology of the condyle becomes wider than the anatomic structure of the condyle Panoramic radiography has also been used in evaluating condyle fractures .   www.indiandentalacademy.com
  21. 21.   www.indiandentalacademy.com
  22. 22. .   The soft tissue imaging can be imaged with magnetic resonance imaging (MRI) or arthrography ARTHROGRAPHY The technique of TMJ arthrography was introduced in the 1940s but it was not extensively used until the late 1970s There are two technical methods for arthrography of TMJ. In single- contrast arthrography, radiopaque material is injected into either the lower or upper joint space, or into both compartments .In double-contrast arthrography, a small amount of air is injected into the joint space after the injection of contrast materials . A comparative study reported that there was no statistically significant difference in the diagnostic accuracy between these two techniques                                                                                                                                                                                                                                                                       Lwww.indiandentalacademy.com
  23. 23. Several studies have shown that arthrography is an accurate imaging method for evaluating anterior disc displacement. The accuracy for diagnosing the position of the disc ranged from 84% to 100%. Perforation and adhesion of the disc can also be shown by this technique .These studies have given important evidence for diagnosis and identification of TMJ internal derangement Arthrography is based on plain film and tomography . A recent study reported that using the arthrography technique might improve the accuracy of diagnosing perforations and adhesions of the disc in magnetic resonance imaging of TMJ (Toyama et al. 2000). There are some advantages of this technique. Arthrography is a method that depends upon more technical training and experience in the observation of images.                                                                                                                                                                                                                                                                      www.indiandentalacademy.com
  24. 24. MRI uses a magnetic field and radio frequency pulses rather than ionizing radiation to produce multiple digital image slices MRI with surface coil was Introduced applied to TMJ imaging in the 1980s Several studies have compared MRI of TMJ with arthrography and CT). The accuracy of MRI in evaluating osseous changes in TMJ was 60% to100% and the accuracy in evaluating disc displacement was 73% to 95% . Studies showed that MRI was the best method of imaging both the hard and soft tissues of the TMJ. Several studies have confirmed that disc displacement In MRI showed close associations with clicking, pain and other dysfunction symptoms of TMJ . MRI was considered as a golden standard to evaluate the disc position The results of some reports have shown that MRI is not only an accurate method to detect the disc position but also a potential technique to evaluate the pathological changes of the masticatory muscles in TMD.                                                                                                                                                                                                                                                                        www.indiandentalacademy.com
  25. 25. Tomography of TMJ is generated through the synchronous movement of the x- ray tube and film cassette through an imaginary fulcrum located in the center of the desired imaging plane. Linear tomography and complex tomography are involved Osseous changes : Arthrography is a good method for depicting the osseous changes with arthrosis in TMJ In studies of TMJ specimens obtained at autopsy, tomography has been shown to represent the anatomic structures better than transcranial radiography Condyle position. For evaluation of condyle position in glenoid fossa of TMJ, tomography has been reported to be more reliable than plain film and panoramic radiography in a study comparing the three methods. Tomography has been used for evaluating the condyle position and joint space. Clinically, condyle position is still an important aspect in orthognathic surgery and orthodontic studies .The major disadvantage of tomography is the lack of visualization of the soft tissue of TMJ, a problem shared with plain film radiography.                                                                                                                                                                                                                                                                       www.indiandentalacademy.com
  26. 26.                                                                                                                                                                                                                                                                    1  .  ORAL  RADIOLOGY   PRINCIPLES  AND  INTERPRETATION  5TH  EDITION WHITE.PHAROAH 2.DENTAL  RADIOLOGRAPHY PRINCIPLES AND TECHNIQUES 3RD  EDITION LAURA.JOEN. 3.DENTAL  AND  MAXILLOFACIAL RADIOLOGY  KARJODKAR www.indiandentalacademy.com
  27. 27. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

×