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  • B-Normal MRI image,jaw open position,sagittal plane, relatively high signal noted in of disk,disk is attached to neck of condyle via firm capsular attachment(arrowheads) T-tubercle C-condyle
    Arrowheads-attachment of sup.bellyof lat.pterygoid the of disk
  • Normal MRI of TMJ,coronal plane of image,jaw closed,arc-shaped disk
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    1. 1. Ankylosis of TMJ
    2. 2. Arthritis of TMJ • Infectious arthritis • Rheumatoid arthritis • Degenerative arthritis • Traumatic arthritis
    3. 3. 退行性変化の X 線所見
    4. 4. Radiological   changes of R.A. • Reduced mobility • Reduction of joint space • Erosion • Flattening • Osteophyte formation • Osteosclerosis • Osteoporosis • Deformation,total loss of condyle
    5. 5. Clinical features of R.A. • Pain,swelling,limitation of jaw movement,crepitation. • Changes in the occlusion of the teeth • (advanced case )progressive opening of the bite. • Total ankylosis(rare)
    6. 6. MRI image of TMJ with jaw in closed position,sagittal plane,A- Normal MRI of TMJ,coronal plane of image,jaw closed,arc-shaped disk-A B-Normal MRI image,jaw open position,sagittal plane, relatively high signal noted in of disk, is attached to neck of condyle via firm capsular attachment(arrowheads) T- tubercle C-condyle Arrowheads-attachment of sup.belly of lat.pterygoid the of disk
    7. 7. Normal MRI of TMJ,coronal plane of image,jaw closed,arc-shaped disk
    8. 8. Internal derangement anterior displacement of the disk
    9. 9. Normal TMJ
    10. 10. Internal TMJ derangement The early click
    11. 11. Severe disk derangement closed lock
    12. 12. Normal TMJ arthrogram
    13. 13. Change in relationship of disk to osseous structures with mouth opening when the condyle articulates with the intermediate zone of the disk C condyle 2 smaller e eminence
    14. 14. Normal relationship of the disk to the condyle and fosssa(mouth closed) directly above the condyle(c)smaller below the eminence, of normally positioned disk can cause a small concave defect on the ant.recess(arrow)
    15. 15. Bifid condyle (duplication of condyle)
    16. 16. Panoramic radiogram, chondrosarcoma
    17. 17. Indications for radiography of TMJ • 1) Pain • 2) Systemic disease • 3) Noise,clicking sounds during movement • 4) Masticatory   muscle pain • 5)trismus, limitation of mouth opening • 6) trauma • 7)asymmetrical face • 8)morphological abnormalities
    18. 18. Diagnostic values between several techniques • TLOP > TMP>TPP • TLOP : ostephyte on anterior aspect of condyle,flattening of post.slope and crest of articular eminence. • TMP:erosion on condyle.flattening of of articular eminence or most laterally situated osteophyte. TLOP and TMP complement each other, if they are used in conjunction,more structural changes are demonstrated. (Pertersson)
    19. 19. Principles of radiographic examination of TMJ • Ideal examination should result in three- dimensional topography of the shape,size,and the structure of joint components. • 1)Avoiding the superimposition of cranial structures. • 2)Direct the X-Ray beam perpendicular to the cassette. • 3)Put the film as close as possible to the joint under examination. • 4)Reproducibility of the radiographic procedure.
    20. 20. Radiographic technique of TMJ three dimensional topography of the joint components A.Conventional methods 1)Lateral views TLOP( transcranial lateral oblique projection,Schuller’s modification) TPP(transpharyngealprojection,Parma,Toller,Lewis ) 2)Anteroposterior views Ante r oposterior projection(Towne’s proj.) ORP(orbitao-ramus projection,Grant-Lanting proj.) TMP(transmaxillary projection ) 3)Axial view Base projection,Submento-vertical Projection) 4)Panoramic radiography
    21. 21. B.Special methods • 1)Tomography • 2)cinefluorography • 3)Arthrography • 4)Nuclear Medicine Imaging (scintigraphy) • 5)Computed tomography • 6)MRI(magnetic resonance Imaging)
    22. 22. Arthrography of TMJ • Arthrography of the tmj • Double Contrast Arthrography • Digital Subtraction Arthrography
    23. 23. TMJ arthrography • An accurate and effective means of diagnosing Internal derangements and other abnormalities. • Shows perforated disk which no other diagnostic method can demonstrate with reliability. • Allows evaluation of the dynamics of the joint with mouth opening and closing. • Helpful in patients with clicking from other than a displaced disk (i.e. a prominent articular eminence). • Cost-efficeint
    24. 24. Arthrography Double contrast • An alternative arthrographic tehnique • Injections of contrast medium and air into both upper and lower joint spaces followed by tomography. • Can demonstrate the soft tissues of the joint with greater detail than single contrast technique.
    25. 25. Nuclear Medicine Imaging • Radionuclide bone scintigraphy offers a sensitive method for detecting the presence of tmj pathology and serving as an economical screening technique. • For determination of the presence of significant organic tmj disease. • Small remodeling changes in bony structures,or Inflammation in the surrounding tissues can be detected long before than other conventional radiographs.
    26. 26. TLOP,shows only lat.third of joint
    27. 27. Transmaxillary proj. McCabe(oblique infraorbital proj.)
    28. 28. TPP(transpharyngeal proj.)
    29. 29. LOTP vs.Axial tomo. Osteophyte,narrow ant. Js,sclerotic tubercle