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Tmj findings in cbct & mri

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Review of TMJ findings observed in CBCT & MRI

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Tmj findings in cbct & mri

  1. 1. TMJ findings in CBCT & MRI Judy H. Oh, D.D.S. UCLA School of Dentistry, 1992 Preceptorship for OMFR at Rutgers School of Dental Medicine, 2016 3D Oral & Maxillofacial Imaging Center, N. Bethesda, MD 3DOMI.net
  2. 2. TMJ capsule and Adjacent structures web.duke.edu
  3. 3. TMJ capsule and Adjacent structures
  4. 4. CBCT: TMJ bone morphology 3DOMI.net Carestream 9300 Anatomage
  5. 5. CBCT: TMJ bone morphology 3DOMI.net, Carestream 9300, Anatomage
  6. 6. CBCT: Frontal, Axial & Sagittal views of TMJ 3D Oral & Maxillofacial Imaging Center, North Bethesda, MD
  7. 7. CBCT: Sagittal views of the right TMJ 3D Oral & Maxillofacial Imaging Center, North Bethesda, MD
  8. 8. CBCT: Frontal views of the right TMJ 3D Oral & Maxillofacial Imaging Center, North Bethesda, MD
  9. 9. MRI: TMJ Anatomy MRI shows soft & hard tissues of the joint Clayton A. Chan, DDS, Las Vegas, NV
  10. 10. www.drlarrywolford.com/ Dr. Larry M. Wolford, Dallas, TX MRI
  11. 11. Abnormal findings in TMJ Developmental Soft tissue related Remodeling & Arthritis Trauma Tumors
  12. 12. Abnormal findings in TMJ: Developmental Hemifacial Microsomia Condylar Aplasia Condylar Hypoplasia Condylar Hyperplasia Juvenile Arthrosis Coronoid Hyperplasia Bifid Condyle
  13. 13. Hemifacial Microsomia Underdeveloped mandible without condyle Congenital ~1 of 4000 births Possible cause: poor blood supply to face in 1st trimester Facial asymmetry Chaudhari SY. Craniofacial microsomia: A rare case report. J Oral Maxillofac Radiol 2013;1:70-4
  14. 14. Hemifacial Microsomia Chaudhari SY. Craniofacial microsomia: A rare case report. J Oral Maxillofac Radiol 2013;1:70-4
  15. 15. Hemifacial Microsomia Chaudhari SY. Craniofacial microsomia: A rare case report. J Oral Maxillofac Radiol 2013;1:70-4
  16. 16. Hemifacial Microsomia Chaudhari SY. Craniofacial microsomia: A rare case report. J Oral Maxillofac Radiol 2013;1:70-4
  17. 17. Condylar Aplasia Absence of one or both condyles; Rare Peeyush Shivhare, Lata Shankarnarayan, Usha, Mahesh Kumar, and Malliger Basavaraju Sowbhagya, “Condylar Aplasia and Hypoplasia: A Rare Case,” Case Reports in Dentistry, vol. 2013, Article ID 745602, 5 pages, 2013. doi:10.1155/2013/745602
  18. 18. Condylar Hypoplasia Micrognathia ‘Treacher Collins Syndrome’ Congenital, Developmental or Acquired(radiation, infection) Causes Degenerative Joint Disease, Osteoarthrosis Tx: Orthognathic surgery Bone graft Orthodontic therapy Differential: Degenerative Joint Disease(DJD) in older pts Juvenile Rheumatoid Arthritis if other joints involved
  19. 19. Condylar Hypoplasia HORN, Danieli de Souza Gomes et al . Hipoplasia condylar of probable otologic origin.Rev. CEFAC, São Paulo , v. 18, n. 3, p. 801-806, June 2016
  20. 20. Condylar Hyperplasia Increased cortical thickness but normal trabecular pattern Common in male, early 20’s Ipsilateral hyperplasia of mandible Ends with cessation of skeletal growth Tx: Orthodontia, Orthognathic surgery Differential: Osteoarthrosis: older pts with large osteophyte Condylar Osteoma Breaking of condyle Osteochondroma: irregular growth continues after skeletal growth
  21. 21. Condylar Hyperplasia Eurorad.org Radiopaedia.org
  22. 22. Juvenile Arthrosis, ‘Boering’s Arthrosis’ Idiopathic Condylar hypoplasia Female > Male Marked flattening & elongated A-P dimension Condylar neck is short or absent Flattening of Glenoid fossa Tx: Orthognathic surgery &/or Orthodontia Differential: Developmental condylar hypoplasia Rheumatoid arthritis DJD Condylar degeneration after surgery
  23. 23. Juvenile Arthrosis, ‘Boering’s Arthrosis’ Researchgate.net 16 yr, Female
  24. 24. Juvenile Arthrosis, ‘Boering’s Arthrosis’ 3D Oral & Maxillofacial Imaging Center 21 yr, F
  25. 25. Coronoid Hyperplasia Developmental or Acquired Secondary to Ankylosis Male > Female Evident at puberty Inability to open mouth Extends >1 cm above the inferior rim of Zygomatic arch Tx: Surgical removal & physiotherapy Differential: Osteochondroma, Osteoma
  26. 26. Coronoid Hyperplasia Torenek K, Duman SB, Bayrakdar IS, Miloglu O. Clinical and radiological findings of a bilateral coronoid hyperplasia case. Eur J Dent 2015;9:149-52
  27. 27. Coronoid Hyperplasia Torenek K, Duman SB, Bayrakdar IS, Miloglu O. Clinical and radiological findings of a bilateral coronoid hyperplasia case. Eur J Dent 2015;9:149-52
  28. 28. Bifid Condyle Notch in the condylar head Possibly due to trauma to condylar growth center May cause pain or ankylosis Tx: only if it is symptomatic Differential: Vertical fracture Borahan M O, Mayil M, Pekiner F N. Using cone beam computed tomography to examine the prevalence of condylar bony changes in a Turkish subpopulation. Niger J Clin Pract 2016;19:259-66
  29. 29. Bifid Condyle Borahan M O, Mayil M, Pekiner F N. Using cone beam computed tomography to examine the prevalence of condylar bony changes in a Turkish subpopulation. Niger J Clin Pract 2016;19:259-66
  30. 30. Abnormal findings in TMJ: Soft Tissue Internal derangements with disc displacement Caused by parafunctional habits or jaw injury Disc - deformed, thickened, fibrotic, perforated Disc displaces anteriorly, anterolaterally or anteromedially *Rarely posteriorly or medially Disc displacement with reduction Disc displacement without reduction
  31. 31. Disc displacement with reduction Disc resumes to normal position during opening & click www.dentalsynergy.it
  32. 32. Disc displacement with reduction drlarrywolford.com, Dr. Larry M. Wolford, Dallas, TX Closed Open
  33. 33. Disc Displacement with Reduction occlusionconnections.com
  34. 34. Disc displacement without reduction Disc lies anteriorly to the condyle throughout movements Causes closed or open lock Alkhader, M et al. “Usefulness of Cone Beam Computed Tomography in Temporomandibular Joints with Soft Tissue Pathology.” Dentomaxillofacial Radiology 39.6 (2010): 343–348. Closed Open Osteophyte
  35. 35. Non-Reducing Disc Displacement & Arthritic Condyle www.drlarrywolford.com Dr. Larry M. Wolford, Dallas, TX
  36. 36. Abnormal findings in TMJ: Remodeling/Arthritis Remodeling Degenerative Joint Disease(DJD) Degenerative Arthritis, Osteoarthrosis Rheumatoid Arthritis Juvenile Arthritis; Chronic(Still’s Disease) or Rheumatoid Psoriatic Arthritis Septic Arthritis Synovial Chondromatosis Chondrocarcinosis(Pseudogout)
  37. 37. Remodeling Adaptive response to excessive force applied to joint Flattening Erosion Cortical thickening Subchondral sclerosis Subchondral cyst Osteophytes Precursor to Degenerative Joint Disease(DJD)
  38. 38. Remodeling A. Normal B. Flattening C. Sclerosis D. Osteophytes E. Erosion Lee DY, Kim YJ, Song YH, Lee NH, Lim YK, Kang ST, Ahn SJ.; Comparison of bony changes between panoramic radiograph and cone beam computed tomographic images in patients with temporomandibular joint disorders; Korean J Orthod. 2010 Dec;40(6):364-372. Published online 2010 December
  39. 39. Remodeling A. Normal B. Flattening C. Erosion D. Osteophytes E. Bone remodel mand. fossa ALVES, N et al. Morphological Characteristics of the Temporomandibular Joint Articular Surfaces in Patients with Temporomandibular Disorders. Int. J. Morphol. [online]. 2013, vol.31, n.4 [citado 2016-11-13], pp.1317-1321.
  40. 40. Remodeling: Flattening of the right condyle Borahan M O, Mayil M, Pekiner F N. Using cone beam computed tomography to examine the prevalence of condylar bony changes in a Turkish subpopulation. Niger J Clin Pract 2016;19:259-66
  41. 41. Remodeling: Erosion in both condyles Borahan M O, Mayil M, Pekiner F N. Using cone beam computed tomography to examine the prevalence of condylar bony changes in a Turkish subpopulation. Niger J Clin Pract 2016;19:259-66
  42. 42. Remodeling: Erosion Borahan M O, Mayil M, Pekiner F N. Using cone beam computed tomography to examine the prevalence of condylar bony changes in a Turkish subpopulation. Niger J Clin Pract 2016;19:259-66
  43. 43. Remodeling: Osteophyte Borahan M O, Mayil M, Pekiner F N. Using cone beam computed tomography to examine the prevalence of condylar bony changes in a Turkish subpopulation. Niger J Clin Pract 2016;19:259-66
  44. 44. Remodeling: Osteophyte 3D Oral & Maxillofacial Imaging Center, N. Bethesda, MD 33yr, F
  45. 45. Remodeling: Sclerosis Borahan M O, Mayil M, Pekiner F N. Using cone beam computed tomography to examine the prevalence of condylar bony changes in a Turkish subpopulation. Niger J Clin Pract 2016;19:259-66
  46. 46. Remodeling: Subchondral cyst, ‘Ely cyst’ Borahan M O, Mayil M, Pekiner F N. Using cone beam computed tomography to examine the prevalence of condylar bony changes in a Turkish subpopulation. Niger J Clin Pract 2016;19:259-66
  47. 47. Remodeling: Subchondral cyst ALVES, N et al. Morphological Characteristics of the Temporomandibular Joint Articular Surfaces in Patients with Temporomandibular Disorders. Int. J. Morphol. [online]. 2013, vol.31, n.4 [citado 2016-11-13], pp.1317-1321.
  48. 48. Remodeling: Osteophyte with ‘joint mice’ ALVES, N et al. Morphological Characteristics of the Temporomandibular Joint Articular Surfaces in Patients with Temporomandibular Disorders. Int. J. Morphol. [online]. 2013, vol.31, n.4 [citado 2016-11-13], pp.1317-1321.
  49. 49. Degenerative Joint Disease(DJD) Etiology: Acute trauma Hypermobility of joint Parafunction Internal disc derangement Not inflammatory Female>Male Adolescent Internal Condylar Resorption (AICR): Female:Male(8:1) Tx: Splint therapy, anti-inflammatory and/or physiotherapy Differential: Erosive- Rheumatoid arthritis with severe erosion; Proliferative - osteochondroma, osteoma
  50. 50. Degenerative Joint Disease(DJD) Deterioration of articular cartilage Flattening Surface erosion Cortical thickening or thinning Osteophyte Osteophyte with loose joint bodies: ‘Joint mice’ Sclerosis of articular surface Subchondral sclerosis Subchondral cyst(Ely cyst) Reduced joint space Long-term non-reducing disc displacement Anterior open bite
  51. 51. TMJ: Perforation drlarrywolford.com, Dr. Larry M. Wolford, Dallas, TX
  52. 52. Sagittal T1 MRI images of resorbed condyles and anteriorly displaced discs AICR: 19 yr old female, onset at 14 yr www.drlarrywolford.com/ Dr. Larry M. Wolford, Dallas, TX
  53. 53. CBCT showing advanced arthritis with severe condylar resorption www.drlarrywolford.com/ Dr. Larry M. Wolford, Dallas, TX AICR: 22 yr Female, Onset at 14 yr
  54. 54. MRI showing the arthritic changes in the joints and the severely degenerated articular discs www.drlarrywolford.com/ Dr. Larry M. Wolford, Dallas, TX AICR: 22 yr Female Onset at 14 yr
  55. 55. Degenerative Arthritis, Osteoarthrosis Age related; avg age 35, most prominent 40’s, 50’s Female:Male(7:1) Unilateral Pain, Dysfunction, Disability Non-inflammatory Etiology: Parafunction, Occlusion, Psychosocial Macrotrauma, Genetics Yount, K, Osteoarthritis of TMJ, Practical Pain Management Dec, 2011
  56. 56. Degenerative Arthritis: etiology Parafunction: clenching increases intra-articular pressure destroys lubricant27(phospholipids, hyaluronic acid) causes stickiness, pulling, tearing of elastin & lateral ligament Occlusion: lack of anterior guidance, class II occlusion lateral interference on posterior teeth, cross bite loss of posterior teeth, bite discrepancy Yount, K, Osteoarthritis of TMJ, Practical Pain Management Dec, 2011
  57. 57. Degenerative Arthritis: etiology cont’d Psychosocial: poor sleep, stress, anxiety, depression Macrotrauma: stretching & tears of the lateral ligament & elastin caused by jaw bracing during impact muscle tension from stress or clenching hypercontraction of the lateral pterygoid Genetic: hypermobility of joint increases damage to ligaments & elastin Yount, K, Osteoarthritis of TMJ, Practical Pain Management Dec, 2011
  58. 58. Degenerative Arthritis: clinical & radiographic Pain/Tenderness in joint & masticatory muscles Reduced range of motion or deviation Crepitus during mandibular movements Flattening of condyle Irregular cortical outlines Erosions Resorption of condylar head, mandibular fossa Subchondral cyst Osteophyte Reduced joint space Sclerosis
  59. 59. Remodeling: Erosion of the left condyle Prasannasrinivas Deshpande et al. Diagnostic Imaging in TMJ Osteoarthritis: A Case Report and Overview. International Journal of Dental Sciences and Research, 2015, Vol. 3, No. 3, 56-59. doi:10.12691/ijdsr-3-3-4 70 yr Female
  60. 60. Remodeling: Reduced joint space, Erosion, Osteophyte, Sclerosis of AE, Ely’s Cyst Prasannasrinivas Deshpande et al. Diagnostic Imaging in TMJ Osteoarthritis: A Case Report and Overview. International Journal of Dental Sciences and Research, 2015, Vol. 3, No. 3, 56-59. doi:10.12691/ijdsr-3-3-4 70 yr Female
  61. 61. Remodeling: Right TMJ Flattening Reduced joint space Osteophyte with ‘joint mice’ Sclerosis of condylar head Remodeling: Left TMJ Flattening of the lateral pole 3D Oral & Maxillofacial Imaging Center, North Bethesda, MD
  62. 62. Remodeling: ‘Joint Mice’ Prasannasrinivas Deshpande et al. Diagnostic Imaging in TMJ Osteoarthritis: A Case Report and Overview. International Journal of Dental Sciences and Research, 2015, Vol. 3, No. 3, 56-59. doi:10.12691/ijdsr-3-3-4 70 yr Female
  63. 63. Rheumatoid Arthritis Chronic inflammation, Autoimmune disease, 40-60 yr(F>M) Affects hands & feet: 70% involves TMJ (Synovial membrane, Tendon sheaths, Ligaments) Bitemporal headache/pain, Hypomobility, Crepitus Anterior open bite, Ankylosis Flattening, Erosion, Resorption, Sclerosis Reduced joint space, Osteophyte Shortened posterior ramus causing premature posterior occlusion & anterior open bite
  64. 64. Rheumatoid Arthritis: 22 yr. Female: Pain in the left TMJ Limited mouth opening Joint space narrowing Coronal view of open mouth a. Normal b. Narrowing of articular space & Erosion R L Sodhi A, Naik S, Pai A, Anuradha A. Rheumatoid arthritis affecting temporomandibular joint. Contemporary Clinical Dentistry. 2015;6(1):124-127. doi:10.4103/0976-237X.149308.
  65. 65. Rheumatoid Arthritis: 22 yr. Female: Pain in the left TMJ, Limited mouth opening Sagittal view of open mouth a. Normal b. Narrowing of articular space & Erosion Sodhi A, Naik S, Pai A, Anuradha A. Rheumatoid arthritis affecting temporomandibular joint. Contemporary Clinical Dentistry. 2015;6(1):124-127. doi:10.4103/0976-237X.149308. R L
  66. 66. Connective Tissue, Auto-Immune Disease www.drlarrywolford.com/ Dr. Larry M. Wolford, Dallas, TX
  67. 67. Juvenile Arthritis; Chronic(Still’s Disease) or Rheumatoid Chronic inflammation <16 yrs, 40% involves TMJ Synovial hypertrophy, Joint effusion, Swollen & Painful joints Affects Cartilage & Bone Micrognathia(bird face), Anterior open bite Osteopenia, Impaired mandibular growth, Erosions Flattening, Abnormal disc Small condyle, Fibrous ankylosis Deepening of antegonial notch
  68. 68. Psoriatic Arthritis Skin lesions, 7% involves TMJ Radiographic similarity to rheumatoid arthritis
  69. 69. Septic Arthritis Rare infection & inflammation Cause: Parotid, Otic, Mastoid Osteomyelitis; Middle ear infection Common in Rheumatoid arthritis, Diabetes, Immunosuppressed Children after blunt trauma with hematoma; Unilateral mandibular deviation to unaffected side due to joint effusion Joint space widened with erosion & thinning of cortex Osteopenia, Sequestra formation Osseous ankylosis Inhibited mandibular growth
  70. 70. Septic Arthritis 24 yr. male presents with Periauricular(L) swelling & pain Erythema Fever Myalgia Joint pain, generalized, for 2-3 wks Limited mouth opening, deviation to R Treated with antibiotics MRI: left TMJ joint with effusion circled 2ml of turbid fluid withdrawn via needle aspiration & cultured Al-Khalisy HM, Nikiforov I, Mansoora Q, Goldman J, Cheriyath P. Septic Arthritis in the Temporomandibular Joint. North American Journal of Medical Sciences. 2015;7(10):480-482. doi:10.4103/1947-2714.168678.
  71. 71. Synovial Chondromatosis Chondrometaplasia, Osteochontromatosis Rare in TMJ, mostly affects large joints Benign synovial metaplasia: cartilaginous nodules Female:Male(4:1) Mainly affects superior joint space Fragments of cartilage, Loose bodies in synovial membrane Joint swelling/pain, Clicking/Crepitus, Limited joint movement Multiple, loose calcified nodules in joint space Sclerosis of mandibular fossa & condylar head Widened joint space Irregularity of osseous cortical surface
  72. 72. Synovial Chondromatosis http://roentgenrayreader.blogspot.com/2011/07/synovial-chondromatosis-of.html
  73. 73. Synovial Chondromatosis 49 yr. Male: Pain in the R joint for several years Swelling Clicking Limited opening Panoramic: Calcified nodular lesions (arrows) Lim SW, Jeon SJ, Choi SS, Choi KH. Synovial chondromatosis in the temporomandibular joint: a case with typical imaging features and pathological findings. The British Journal of Radiology. 2011;84(1007):e215-e218. doi:10.1259/bjr/69067316.
  74. 74. Synovial Chondromatosis (a)Axial CT: multifocal calcified loose bodies (arrow) (b) Coronal CT image: loose bodies (arrow). bony erosion of glenoid fossa (arrowhead), widening of joint space but no extra-articular extension (c) Follow-up CT obtained after 10 months: complete removal of intra- articular mass and calcifications and the absence of recurrence. Lim SW, Jeon SJ, Choi SS, Choi KH. Synovial chondromatosis in the temporomandibular joint: a case with typical imaging features and pathological findings. The British Journal of Radiology. 2011;84(1007):e215-e218. doi:10.1259/bjr/69067316.
  75. 75. Synovial Chondromatosis MRI: multiple loose bodies in soft tissue mass(a) soft tissue mass expanding with thickened synovium(b) Lim SW, Jeon SJ, Choi SS, Choi KH. Synovial chondromatosis in the temporomandibular joint: a case with typical imaging features and pathological findings. The British Journal of Radiology. 2011;84(1007):e215-e218. doi:10.1259/bjr/69067316.
  76. 76. Synovial Chondromatosis (a) Numerous small calcified nodules (b) Histopathological (×40) analysis: small, metaplastic cartilaginous nodules of varying size with calcifications. Lim SW, Jeon SJ, Choi SS, Choi KH. Synovial chondromatosis in the temporomandibular joint: a case with typical imaging features and pathological findings. The British Journal of Radiology. 2011;84(1007):e215-e218. doi:10.1259/bjr/69067316.
  77. 77. Chondrocarcinosis(Pseudogout) Acute or Chronic Synovitis Deposition of Calcium Pyrophosphate Dehydrate Rare in TMJ Unilateral Male>Female Fine radiopacities with uniform distribution in joint space Bone erosion with increased condylar bone density Swelling & edema of muscles
  78. 78. Chondrocarcinosis(Pseudogout) Calcified mass in the glenoid fossa, bulging into the epitympanum & middle cranial fossa floor. E. Gatti, I. Montermini, A. Marconi, E. Botturi, R. Maroldi. Department of Radiology, University of Brescia, Brescia, Italy., ECR 2009-CASE OF THE DAY
  79. 79. Abnormal findings in TMJ: Trauma Effusion Dislocation Fractures Neofractures Ankylosis
  80. 80. Effusion Influx of fluid into a joint due to hemorrhage or inflammation Causes: internal derangement trauma arthritis rheumatic disease Symptoms: Swelling, Pain Limited opening Hearing difficulties Difficulty occluding posterior teeth due to fluid in joint
  81. 81. Effusion Closed: ( ) deformed, anteriorly displaced disc ( )Temporal posterior attachment Alkhader, M et al. “Usefulness of Cone Beam Computed Tomography in Temporomandibular Joints with Soft Tissue Pathology.” Dentomaxillofacial Radiology 39.6 (2010): 343–348. Reduced on open Superior joint space Effusion CBCT: no osseous abnormality
  82. 82. Dislocation Condyle outside the mandibular fossa but inside the capsule Bilateral Displaced condyle anteriorly & superiorly Condylar fracture may be a cause Inability to close the mouth with pain Muscle spasm
  83. 83. Dislocation Exodontia.info blogs.brown.edu
  84. 84. Dislocation Bilateral TMJ dislocation blogs.brown.edu
  85. 85. Fractures Condylar fracture: intra- or extra-capsular Condylar neck fracture: dislocation of condylar head to forward-medial direction Irregular cortical outline Unilateral Look for parasymphyseal or body fracture of opposite Ankylosis, Radiolucent or radiopaque lines, Step defects Condylar head fracture with vertical or compressive patterns Remodeling: Flattening, DJD, Hemarthrosis
  86. 86. Fractures Radiopaedia.org High neck fracture
  87. 87. Fractures Guardsman fracture: a tripartite fracture of the parasymphyseal region and both condylar necks Radiopaedia.org High neck fracture
  88. 88. Neofractures Forcep injury causing condylar fracture Severe mandibular hypoplasia Lack of development of Glenoid fossa/eminence
  89. 89. Ankylosis Fibrous or Bony in the joint Unilateral: Trauma or Infection Bilateral: Rheumatoid arthritis Fibrous: Irregular erosions on articular surfaces Reduced joint space, Jigsaw puzzle appearance Bony: Osseous bridges Large bony masses Differential: muscle spasm myositis ossificans coronoid process hyperplasia
  90. 90. Ankylosis Bilateral TMJ ankylosis: bony fusion of mandibular condyle to the glenoid fossa on the left side. AO Surgery Reference
  91. 91. Ankylosis Unilateral bony ankylosis causing Hypoplastic mandible Facial asymmetry Hegde RJ, Devrukhkar VN, Khare SS, Saraf TA. Temporomandibular joint ankylosis in child: A case report. J Indian Soc Pedod Prev Dent 2015;33:166-9
  92. 92. Ankylosis Alkhader, M et al. “Usefulness of Cone Beam Computed Tomography in Temporomandibular Joints with Soft Tissue Pathology.” Dentomaxillofacial Radiology 39.6 (2010): 343–348. Closed: Deformed articular disc Anteriorly displaced Temporal posterior attachment( ) Open: not reduced No sign of joint effusion CBCT: Ankylosis
  93. 93. Abnormal findings in TMJ: Tumors Benign: Osteochondroma Osteocartilaginous Exostosis Malignant: Osteosarcomas Chondrosarcomas Metastatic tumors
  94. 94. Benign Tumors Osteochondroma, Osteocartilaginous exostosis Affects 20-30 yr old Limited mouth opening, jaw deviation to contralateral side Facial asymmetry, Malocclusion CBCT - Enlarged condyle with irregular outline Abnormal pedunculated mass attached to condyle Altered trabecular pattern Radiopacity, Radiolucency Less common: Osteoma, Osteoblastoma, Chondroblastoma Fibromyxoma, Giant Cell lesions Aneurysmal bone cysts Langerhans cell histiocytosis
  95. 95. Benign Tumors: Osteochondroma 62 yr. Male complains of snoring. No pain, no dysfunction, no hx of jaw fracture or trauma Rheumatology Network
  96. 96. Benign Tumors: Giant Cell Tumor Marius Bredella, et al, Tenosynovial, Diffuse Type Giant Cell Tumor of the Temporomandibular Joint, Diagnosis and Management of a Rare Tumor, Journal of Clinical Medicine Research, Vol. 7, No. 4, Apr 2015
  97. 97. Malignant Tumors Osteosarcomas, Chondrosarcomas, Metastatic tumors Pain, Unilateral swelling in preauricular region Reduced joint mobility Mandibular deviation CBCT: Bone destruction with poorly defined borders Irregular margins Erosion of cortical plates Minimal expansion Pathologic calcification Condylar deformity Less common: Synovial sarcoma, Fibrosarcoma Parotid salivary gland tumor, Rhabdomyosarcoma
  98. 98. Malignant Tumors: Osteosarcoma SlideShare: Nour-Eldin A. Nour-Eldin Mohammed
  99. 99. References: 1. Chaudhari SY. Craniofacial microsomia: A rare case report. J Oral Maxillofac Radiol 2013;1:70-4 2. HORN, Danieli de Souza Gomes et al . Hipoplasia condylar of probable otologic origin.Rev. CEFAC, São Paulo , v. 18, n. 3, p. 801-806, June 2016 3. Peeyush Shivhare, Lata Shankarnarayan, Usha, Mahesh Kumar, and Malliger Basavaraju Sowbhagya, “Condylar Aplasia and Hypoplasia: A Rare Case,” Case Reports in Dentistry, vol. 2013, Article ID 745602, 5 pages, 2013. doi:10.1155/2013/745602 4. Shawneen Gonzalez, DDS, MS; Interpretation Basics of CBCT, 5. Pande SP, Kumbhare SP, Parate AR. Incidental findings on cone beam computed tomography: Relate and relay. J Indian Acad Oral Med Radiol 2015;27:48-54 6. 3D Oral & Maxillofacial Imaging Center, North Bethesda, MD 7. drlarrywolford.com/ Dr. Larry M. Wolford, Dallas, TX 8. Dentalsynergy.it 9. Occlusionconnections.com 10. Eurorad.org 11. Radiopaedia.org 12. Researchgate.net 13. Torenek K, Duman SB, Bayrakdar IS, Miloglu O. Clinical and radiological findings of a bilateral coronoid hyperplasia case. Eur J Dent 2015;9:149-52 14. Borahan M O, Mayil M, Pekiner F N. Using cone beam computed tomography to examine the prevalence of condylar bony changes in a Turkish subpopulation. Niger J Clin Pract 2016;19:259-66 15. Hu, Y.K. et al. Changes in disc status in the reducing and nonreducing anterior disc displacement of temporomandibular joint: a longitudinal retrospective study. Sci. Rep. 6, 34253; doi: 10.1038/ srep34253 (2016).
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  101. 101. with gratitude for your generous support! Dr. S. Singer Dr. A. Creanga Dr. M. Strickland Oral & Maxillofacial Radiology Department Rutgers School of Dental Medicine

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