temporo mandibular projections

7/28/2019 Temporo Mandibular Projections

1/23

TMJ ProjectionsTMJ Projections


2/23

Temporomandibular JointTemporomandibular Joint

ProjectionsProjectionsIntroduction

The temporomandibular joint is one of the most

difficult areas to investigate radiography. The type ofimaging technique depends on the specific clinical problem

whether imaging of order soft issue. The imaging modalities

is used to evaluate the anatomy of TMJ, osseous contours,

condyle and range of motion. The soft issue imaging is

indicated to know the information about the disk position, to

image the abnormalities of muscles and surrounding tissues.


3/23

Radiographic ProjectionsRadiographic Projections

Conventional Radiographic Projections

Transcranial view Transpharyngeal view

Transorbital view

Panoramic view

Submentovertex view


4/23

Other Investigations

Tomography (CT)

MRI

Arthrography Arthroscopy


5/23

Transcranial ViewTranscranial View

Indications

TMJ Pain dysfunction syndrome

Size and position of disk

Range of movement of joints

Advantage

Simplicity

Cheap and effective method

Radiation exposure low


6/23

Technique

The patient is placed in thecraniotome with head rotated through 90o

so that the TMJ is touching the film andthe sagittal plane of head parallel to thefilm. The X ray tube is directeddownwards 25o to the area of interest.The procedure is performed for open andclosed mouth.


7/23


8/23

Transpharyngeal viewTranspharyngeal view

Indications

Osteo arthritis

Rheumatic arthritis

Fracture of neck and head of the condyle TMJ pain dysfunction syndrome


9/23

Technique

The patient holds the cassette against the

side of the face over the TMJ area of interest.

The film and the sagittal plane of the head areparallel. The X-ray beam is directed superiorly

at 5o-10o to the sigmoid notch of the opposite

side. The procedure is performed for openedand closed mouth.


10/23


11/23

Transorbital viewTransorbital view

Indications

Investigate the articular surface of condyle

and disease within the joint

Fracture of the condylar neck and to show

its medio-lateral displacement


12/23

Technique

The patient holds the cassette behind the

ear and the head is tilted down 10o so that the

canthomeatal line is horizontal. The X-raybeam is directed from the front of the patient

through the contra lateral orbit. The procedure

is performed for opened and closed mouth.


13/23


14/23

Panoramic viewPanoramic view

Indications

TMJ pain dysfunction syndrome

Investigate disease within the joint

# Condylar heads or necks Condylar abnormalities


15/23

Technique

Panoramic, images both condylar heads

and technique can be modified by raising the

X-ray tube and cassette carriage assembly to aslightly higher level in relation to patient. But

these are limited usefulness because of the

thick image layer and the oblique distortedview of the joint. Gross changes in the

condyle can be observed.


16/23


17/23

Submentovetex viewSubmentovetex view

Indications

Condylar displacement

Rotation of the mandible

Curvature of mandible Displacement of the fractured zygomatic

arch


18/23

Technique

The film cassette is placed vertically in aholding device of the craniotome. The patienthead and neck should be extended backward asfar as possible, with the vertex of the skull at hecentre of the cassette. The canthomeatal lineshould extend 10o past vertical so that frankfortline and is vertical and parallel to the film. Thecentral ray is directed from below the mandibletowards the vertex of the skull.


19/23


20/23

Other Investigations

Tomography

It is a radiographic technique that produce multiple thinimage slices free of superimposition of overlappingstructures. In TMJ it provides information about the three

dimensional shape and the internal structure of the osseouscomponents of the joints.

Advantages

Extent of ankylosis Extent of neoplasm


21/23

MRI

It is a non-invasive technique producing high resolution

images. MRI is mostly applied in diagnosis of internal

derangements.

Arthrography

It is a technique in which an indirect image of the disk is

obtained by injecting a radio opaque contrast agent intoone or both joint spaces under fluoroscopic guidance.


22/23

Arthroscopy

It is a newly advanced technique which

gives a direct visualisation of the TMJ which

is considered to be the last line of procedure.


23/23

SummarySummary

The search for sharp, distortion-freeimaging modalities for both hard and soft

tissue has led to to the development ofmultiple conventional techniques and theadaptation of new technologies to the TMJimaging. Hence the type of investigation

depends upon several factors including Ptshistory, pts age, their signs and symptomsand the facilities available.

temporo mandibular projections

Documents