Mandible, T M J

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Mandible, T M J

  1. 1. Mandible, TMJ Radiographs & Diagrams 2009
  2. 2. Mandible PA   PA Axial  Axiolateral Oblique  Towne Method (AP Axial)  Modified Waters  SMV  Panorex
  3. 3. TMJ Towne Method   Schuller  Law  Panorex
  4. 4. PA Mandible Rest pt’s forehead & nose  against bucky Tuck in chin to bring OML  & MSP perp to IR 40” SID  CR perp to IR to exit @  junction of lips Collimate to area of  mandible Shows mandibular rami &  lateral portion of body Rami s/b symmetrical  Mentum superimposed on  C-spine
  5. 5. Lateral Facial Bones Coronoid process a. Mandibular fossa b. Neck of condyloid c. process Mandibular notch d. Gonion e.
  6. 6. Axiolateral Oblique- Mentum 45° Place pt in a true lateral w/  SOI against IR Mouth closed, neck extended  To visualize mentum, oblique  head 45° towards IR Angle CR 25° cephalic to exit  area of interest CR will skim under the closest  side of mandible to project the opposite side (area of interest) free of superimposition
  7. 7. Axiolateral Oblique – Body 30° Start from true lateral  Oblique head 30°  towards IR 25° CR angle  CR will exit body on  opposite side of mandible Collimate to mandible  on all sides
  8. 8. Axiolateral Oblique- General Survey 10° - 15° Oblique head 10°-  15° towards IR  CR angled 25° cephalad  Area of interest should be demonstrated w/minimal superimposition & foreshortening
  9. 9. Axiolateral Oblique- Labeling Alveolar process 1. 2. Gonion 3. Ramus 4. Condyloid process
  10. 10. Panorex (Eagle’s Syndrome) Note extra styloid  processes lateral to gonions
  11. 11. Law - TMJ Head in true lateral  IPL perp & MSP parallel to IR  IOML perp to front edge of IR  SOI against IR  Rotate head 15° towards IR  Angle CR 15° caudad  Enters 1 ½ “ ↑ to upside EAM  Exits downside TMJ  SHOWS: TMJ Closed IR  Closed mouth: Condyle in TM  fossa Open mouth: Condyle @  anterior margin of TM fossa
  12. 12. Panorex Pt is seated w/IOML  parallel to floor & MSP perp to IR Teeth on bite piece,  chin in bite block Fixed CR & SID  Shows: Flat image of  entire mandible; teeth, TMJ’s, body, rami, angles, symphysis, condyles & coronoid processes
  13. 13. Schuller - TMJ Pt’s head in true lateral  (body obliqued as needed for comfort) IPL perp to IR, MSP  parallel Angle CR 25°-30° caudad  Center ½ in anterior & 2 in  superior to upside EAM Center IR to projected TMJ  Collimate on all sides to  aprox 4 in square Closed mouth & open  mouth Shows TMJ closest to IR 
  14. 14. Law Method- TMJ SOI closest to IR  Head lateral body obliqued as  necessary for comfort IPL perp to IR to avoid tilt  From lateral, rotate face 15°  towards IR Angle CR 15° caudad  centered to 1 ½ in ↑ to upside EAM Center IR to projected CR  Collimate on all sides to aprox  4 in square Shows TMJ closest to IR 
  15. 15. Law vs Schuller’s-how do you tell? Look for the hook   Condyloid process appears as a hook on Law Method radiographs.  Appears to hook around towards the mouth
  16. 16. PA Mandible (Bad) Taken on phantom  (no C-spine)  OML is not perpendicular
  17. 17. Law - TMJ Law- look for the hook  Condyle appears to  hook towards the face This one could use  more collimation
  18. 18. Modified Townes (Mandible) OML & MSP perp to IR  CR angle 35°-40° caudad  Enter glabella (to pass  through EAM’s & B/T gonions @ MSP) Shows: condyloid  processes, TMJ fossae, Mandibular rami free from superimposition
  19. 19. SMV- Mandible • IOML parallel to IR CR enters ½ way B/T  gonions or 1 ½-2 in ↓ to mandibular symphysis Shows mandible,  coronoid & condyloid processes Mandibular condyles  anterior to petrosae Mandibular symphysis  superimposed on frontal bone
  20. 20. Modified Townes (Mandible) Note necklace in  anatomy
  21. 21. Panorex – Open/Closed
  22. 22. Townes - TMJ OML & MSP perp to IR  CR angle 35° caudad to  pass 1” anterior to TMJ level (Angle 42° caudad if IOML  perp) *Additional 5 ° may show  TM fossae & joint best Shows: Condyloid process  & TMJ fossae (do 1 closed & 1 open view)
  23. 23. Review- Skull Landmarks Mentum 1. Acanthion 2. Nasion 3. Glabella 4. Vertex 5. Head 6. Outer canthus 7. Inion 8. Tragus 9. mandible 10.
  24. 24. Review- Positioning Lines EAM 1. GML 2. OML 3. IOML 4. AML 5. MML 6. 8° a. 7° b. 10° c. 20° d.
  25. 25. Nasal bone 1. Frontal process of maxilla 2. Lacrimal bone 3. Superior nasal conchae 4. Inferior nasal conchae 5. Vomer 6. Alveolar process 7. Mandible 8. Maxilla 9. Zygomatic process of 10. maxilla Zygoma 11. Perpendicular plate of 12. ethmoid
  26. 26. 13. Temporal bone 14. Frontal portion of maxilla 15. sphenoid 16. Parietal bone 17. Frontal bone
  27. 27. Skull- Lateral View Vertex 1. Inion 2. Temporal bone 3. Mastoid process 4. Squamous portion of 5. temporal bone 5a. Styloid process of temporal bone Mandible 6. Maxilla 7. Zygomatic arch 8. Anterior nasal spine 9.
  28. 28. Lateral Skull (Contd.) 10. Sphenoid bone 11. Lacrimal bone 12. Nasal bone 13. Zygoma 14. Sphenoid 15. Frontal bone 16. Coronal suture 17. Squamosal suture 18. Lambdoidal suture
  29. 29. Maxillae & Palatine Bones Palatine Process A. of Maxilla B. Palatine Bones C. Pterygoid process of Sphenoid
  30. 30. Sinuses- Anterior View Frontal Sinuses 1. 2. Ethmoid & sphenoid Sinuses 3. Maxillary Sinuses
  31. 31. Sinuses – Lateral View Frontal Sinuses 1. 2. Ethmoid Sinuses 3. Sphenoid Sinuses 4. Maxillary Sinuses
  32. 32. Mandible – Lateral View Coronoid Process A. Manbidular Notch B. Neck of condyloid C. process Head of condyloid D. process Condyloid process E. Ramus F. Gonion G. Body H. Mentum I. Alveolar Process J.

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