talking about TMJ anatomy diagnosis and screening

1. TMJFABRIKAM RESIDENCES
TMJ imaging
Adyan zahu

2. About TMJ
• Introduction
• Anatomy
• TMJ disorder
• Type of imaging
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3. FRFABRIKAM RESIDENCES

4. FR
Introduction
Tempromandibular joint is a
g in g lyoarth rod ial joint
Gin g ly mu s – a h in ge ( rotation )
A rth rod ial – slid in g movement
joint h ave an su p erior an d
inferior p art sep erated by an
artic u latin g d isc
• Synovial joint +articulating disc
• 2 or more articulating surfaces
• Freely movement
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5. Tempromandibular joint

6. FR
• Consists of
• Articular Fossa (Glenoid Fossa)
• Concave
• Articular Tubercle or (Eminence) - Convex
• Condyle of the mandible
• Articular Disc
• Joint capsule
• Ligaments
A rtic u latin g su rfac e b etween
man d ib u lar + temp oral b on e.
Anatomy
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26. FR
TMJ disorder
Company Name
• Nulla a erat eget nunc hendrerit ultrices
eu nec nulla. Donec viverra leo aliquet,
auctor quam id, convallis orci.
• Sed in molestie est. Cras ornare turpis at
ligula posuere, sit amet accumsan neque
lobortis.
• Maecenas mattis risus ligula, sed
ullamcorper nunc efficitur sed.
Competitive Service
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27. FR
extracapsular
• Myofascial p. disorder
• Referred pain
Intracapsular
• Inflammation
• Internal derangement
• Dislocation
• Arthritis
• Disc reduction
• Disc perforation
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Disorder
It depend on the problem and it’s location

28. FR
Soft tissue
• 1. Arthrography
• 2. Magnetic Resonance Imaging (MRI)
Hard tissue
• 1. Panoramic Projection
• 2. Plain Film Imaging Modalities
• 3. Conventional Tomography
• 4. Computed Tomography (CT)
A c cord in g to ty p e of d isease’s p osition & h istor y
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Disorder

30. FR
The panoramic projection is often
included as a part of examination as it
provides
1. an overall view of the teeth and the
jaws
2. provides a means of comparison
between left and right sides of
mandible
3. serves as screening projections to
identify certain odontogenic
diseases
4. certain disorders that may be source
of TMJ symptoms
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Panoramic view

32. FR
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• Panoramic machines have specific
TMJ programs which are of limited
usefulness.
• Thick image layers
• Oblique view/distorted view of the
joints
• Low image quality However this
imaging modality gives a gross
osseous change of condyle such as:-
Asymmetries
• Extensive erosions
• Large osteophytes
• Tumors
• Fractures
• For these reasons, the panoramic
view should not be considered as a
sole in imaging modality and be
supplemented.

33. Plain Film Imaging Modalities
The plain film usually consists of
combinations of following projections and
allows visualization in various planes:-
I. Transcranial Projections
II. Transpharyngeal Projections
III. Transorbital Projections
IV. Submentovertex Projections

35. FR
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Transcranial projection (lateral
oplique)
• It is a view that aids in visualizing the
sagittal view of the lateral aspects of
condyle and temporal component. It
is taken in both open and close mouth
positions
Area to be seen :
lateral aspect of glenoid fossa
Articular eminence
Joint space
Condylar head
• Indication:
• TMJ pain
• Dysfunction syndrome
• Internal derangement
• Range of movement in joint

36. FR
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• Film position:
flat against patients ear
Centered over TM joint of interest
Against facial skin parallel to sagittal
plane
• Position of patient:
head adjusted so sagittal plane is
vertical & ala tragus line parallel to floor
• View : 3 positions- open, close, rest
mouth
• Disadvantages :
• Superimposition of ipsi-lateral petrous
ridge over the condylar neck

37. Central Ray 1. the central ray is direct at
an angle of 250(+ve angulation) from the
opposite side, through the cranium and
above the petrous ridge of the temporal
bone. 2. The horizontal angulation can be
individually corrected for the condylar
long axis, or an average 200 anterior
angle may be used. Closed view- size of
joint space, position of head of condyle,
shape & condition of glenoid fossa &
articular eminence Open view- range &
type of movement Comparison of both
sides

41. FR
Area seen
• This technique provides a sagittal view
of the medial pole of the condyle. It is
taken in open mouth position.
• Lateral view :
condylar head & neck
• Articular surface
Indication
• TMJ pain d.s.
• Osteoarthritis
• Pathology of condylar head
• Fracture of c. neck & c.
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Transpharangeal view

42. Central ray- directed from opp
side cranially at angle(-5 to -10
degrees) Beneath the
zygomatic arch, through
sigmoid notch posteriorly
across pharynx at the condyle
Comparison of both condylar
heads

43. FR
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• Film placement
patient holds the cassette flat against
patients ear Centered over TM joint of
interest Against facial skin parallel to
sagittal plane ½ inch anterior to EAM
• Position of patient
Occlusal plane parallel to transverse
axis of film-soft parts are in a line with
nasopharynx and joint. Patient
instructed to inhale slowly through
nose, filling of nasopharynx with air
Open mouth-condyles move away from
base of skull and mandibular notch is
enlarged on opp side.

45. FR
Indication
• Truma
• Fracture
Area of joint seen
• Ant. View of TMJ
• Medial displasment of fractured
condylar
• Fracture of neck of condylar
I t i s t a k e n i n t h e o p e n o r p r o t r u d e d p o s i t i o n a n d d e p i c t s t h e
e n t i r e m e d i a l l a t e r a l a s p e c t o f c o n d y l e i n f r o n t a l p l a n e .
Tr a n s o r b i t a l P r o j e c t i o n s
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Transorbital Projections (ZIMMER
PROJECTION)

48. FR
p rovid es a view of sku ll b ase an d con d y les in a h orizontal p lan e. It is often
u sed to d etermin e th e an g u lation s of th e lon g axis of th e con d y lar h ead so
for correc ted tomog rap hy.
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Submentovertex Projections(water’s
view)

49. FR
pr ovides mor e infor mation about the 3 -
D imens ional s hapes and inter nal s tr uc tures of
the os s eous c omponents of joints by pr oviding
detailed image s lic es and 3D images .
Tw o types of C T ar e available :-
1. C onventional C T
2 . C BC T
Both modalities c an give exc ellent image of
os s eous s tr uc tures ,
but only c onventional C T c an give images of
s ur r ounding s oft tis s ues .
However convention al tomog rap hy is g rad u ally
b ein g rep lac ed by CO NE -BEA M CO MPUTE D
TO MO GR A PHY.
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Conventional Tomography

51. FR
• Three-dimensional shape and internal
structure of the osseous components
• Surrounding soft tissue
• Both axial & coronal images
• Reformat images in sagittal plane
• Not diagnostic for disk …
• Conventional and CBCT can not produce
accurate images of the articular disk.
the recent technology developed for angiography in 1982
and subsequently applied to maxillofacial imaging. CBCT
has the advantage of reduced patient overdose compared
to medial CT and is likely to replace Conventional
Tomography. In CBCT the patient is scanned in closed
position and low resolution scan done in open or other
positions
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CBCT

52. FR
Indications:
• Extent of ankylosis
• neoplasms-bone involvement
• Complex fractures
• Complications -polytetrafluoroethylene
or silicon sheet implants -erosions into
the middle cranial fossa
• Heterotopic bone growth
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55. FR
in d icated wh en th e TMJ p ain an d d ysfu n c tion are
p resent an d wh en c lin ical fin d in g s su g gest d isk
d isp lac ement alon g with sy mptoms th at arte
u n resp on sive to con ser vative th erapy.
Imag in g sh ou ld b e p resc rib ed on ly wh en th e
antic ip ated resu lts are exp ec ted to influ en c e th e
treatment p lan .
Th e imag in g mod alities for soft tissu es are :
1 . A rth rog rap hy
2. Magnetic Resonance Imaging ( MRI)
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Soft Tissue Structures Imaging

56. FR
Indication
• Indications: Position and function of disk
-pain and dysfunction-long standing
History of locking-persistent Perforations
of the disk and retrodiskal tissue. Joint
dynamics Disc displacement-
ant/anteromedial
• Contraindications:
• Infections in the preauricular region.
• Patients allergic to contrast media.
• Patients with bleeding disorders and on
anticoagulant therapy
It is a technique in which an indirect image of the disk is
obtained by injecting a radiopaque contrast agent into the
joint spaces under fluoroscopic guidance. However MRI has
replaced Arthrography in todays context and is now the
imaging technique of choice for soft tissues.
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Arthrography

58. FR
• Disk is of low signal intensity (dark grey
or black) and can be distinguished from
surrounding tissue that has high signal
intensity. Posterior disk attachment
(PDA) shows higher than the disk and
the junction between the posterior band
of the disk and PDA is distinct. Medial
disk displacements-best seen
U s es Magnetic field and r adiofr equenc y puls es
Tis s ue with greater water c ontent emit a higher s ignal
Bilater al dual s ur fac e c oils - 0.5 to 2 tes la - Impr ove image
r es olution
MR I pr oduc es exc ellent image qualities s o is the pr inc iple
imaging c hoic e for s oft tis s ue.
Oblique s a g itta l/o b liq u e c o r o n a l s c a n s w ith t1 , t2
C los ed mo u th , p a r tia lly o p e n a n d fu lly o p e n p o s itio n s
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MAGNETIC RESONANCE IMAGING
(MRI)

62. ‫هيج‬ ‫يعني‬..

63. AZ Thank You.
Adyan Z. faleeh
07700566561
alzubaydyadyan@gmail.com