This document discusses investigations for temporomandibular disorders (TMD). It defines TMD as clinical problems involving the jaw joint (TMJ) and muscles of mastication, characterized by facial pain and limited jaw movement. A thorough history and physical exam are important, including inspection of asymmetry and range of motion, and palpation of muscles and joints. Radiographic exams include panoramic x-rays to view teeth and bones, and MRI to view soft tissues like discs. Arthrography involves injecting dye into joints under fluoroscopy. Different imaging modalities provide views of bony and soft tissue structures to aid in diagnosing TMD issues like internal derangements, fractures, or cysts.

1. Investigations of TMD
Group F
Sushant
Pandey
Tutor : Dr. Diksha Agrawal

2. Objectives
 To know about TMD
 To know the importance of history in investigation
 To know different types of physical examination involved
 To know about different types of radiographical
examinations involved

3. Temporomandibular Disorder:
TMD is the collective term embracing a number of clinical
problems that involve the masticatory musculature, the TMJ
and associated structures or both.
TMDs are characterized by :
1. Facial pain in TMJ region and/or the muscles of
mastication
2. Limitation or deviation in the mandibular range of motion
3. TMJ sound during jaw movements and functions

4. History
The purpose of history taking is to identify patients with subclinical signs
and symptoms that the patients may not be able to relate but are
commonly associated with functional disturbances of masticatory system.
The screening history consists of several questions that will help orient the
clinician to any TMD.

5. We generally ask the patient questions regarding :
 Site of pain
 Duration of pain
 When is the pain worst ?
 Areas to which pain is radiated ?
 Pain while using the jaw
 Presence of jaw noise
 Past history of jaw injury or surgery

6. Physical Examinations
It includes :
 Inspection
 Palpation

7. Inspection
Facial asymmetry
We observe :
Facial asymmetry

8. Swelling

9. Normal opening range = 35-50 mm
Maximum mouth opening

10. Normal range = >7 mm
Lateral movements

12. Occlusion

13. Openbite Crowding

14. Examination of other joints

15. Palpation
Masseter Temporalis

16. Lateral pterygoid Medial pterygoid

17. Palpation of TMJ

18. Intraoral examination
Bruxism Scalloped tongue

19. OSSEOUES STRUCTURES
1. Panoramic Projection
2. Plain Film Imaging Modalities (Transpharyngeal, Transorbital, Transcranial)
3. Tomography
SOFT TISSSUE STRUCTURES
1. Arthrography
2. Magnetic Resonance Imaging (MRI)
Radiological examination

20. Panoramic Projections
Provides overall view of teeth and
jaws and helps in comparison of left
and right mandible.
Indication = Asymmetries, Fractures,
Extensive erosion

21. Transcranial Lateral aspect of:
Glenoid fossa
Articular eminence
Joint space
Condylar head
Transpharyngeal Lateral view of:
Condylar head & neck
Articular eminence
Transorbital Anterior view of:
Condylar head & neck
Articular eminence
Tomography All aspects of:
Glenoid fossa
Articular eminence
Joint space
Condylar head
TMJ pain syndrome, Internal derangement,
Clicking, mouth opening limitation
TMJ pain syndrome, Osteoarthritis,
Rheumatoid Arthritis, Condylar head cyst,
Fracture of neck and condyle
Trauma, Fracture
Ankylosis
Neoplasms-bone involvement
Complex fractures
Indication

25. Arthrography
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.
Indication = TMJ pain dysfunction, jaw locking

26. Magnetic Resonance Imaging
It uses Magnetic field and radiofrequency pulses
It is used for viewing soft tissues.
Indication = Disk displacement, internal derangements

27. SUMMARY

29. References
White and Pharoah Oral Radiology Principles and Interpretation 6th Edition
Burket's Oral Medicine 11th edition

30. QUESTIONS ??

31. Special thanks to our tutor
Dr. Diksha Agrawal