TMJ Projections

Temporomandibular Joint
Projections
Introduction
The temporomandibular joint is one of the most
difficult areas to investigate radiography. The type of
imaging 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.
 Radiographic Projections
Conventional Radiographic Projections

 Transcranial view
 Transpharyngeal view
 Transorbital view
 Panoramic view
 Submentovertex view
Other Investigations

 Tomography (CT)
 MRI
 Arthrography
 Arthroscopy
 Transcranial 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
Technique

The patient is placed in the

craniotome with head rotated through 90o
so that the TMJ is touching the film and
the sagittal plane of head parallel to the
film. The X ray tube is directed
downwards 25o to the area of interest.
The procedure is performed for open and
closed mouth.
 Transpharyngeal view
Indications

 Osteo arthritis
 Rheumatic arthritis
 Fracture of neck and head of the condyle
 TMJ pain dysfunction syndrome
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 are
parallel. The X-ray beam is directed superiorly
at 5o-10o to the sigmoid notch of the opposite
side. The procedure is performed for opened
and closed mouth.
 Transorbital 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
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-ray
beam is directed from the front of the patient
through the contra lateral orbit. The procedure
is performed for opened and closed mouth.
 Panoramic view
Indications

 TMJ pain dysfunction syndrome

 Investigate disease within the joint
 # Condylar heads or necks
 Condylar abnormalities
Technique

Panoramic, images both condylar heads

and technique can be modified by raising the
X-ray tube and cassette carriage assembly to a
slightly higher level in relation to patient. But
these are limited usefulness because of the
thick image layer and the oblique distorted
view of the joint. Gross changes in the
condyle can be observed.
 Submentovetex view
Indications

 Condylar displacement
 Rotation of the mandible
 Curvature of mandible
 Displacement of the fractured zygomatic
arch
Technique

The film cassette is placed vertically in a

holding device of the craniotome. The patient
head and neck should be extended backward as
far as possible, with the vertex of the skull at he
centre of the cassette. The canthomeatal line
should extend 10o past vertical so that frankfort
line and is vertical and parallel to the film. The
central ray is directed from below the mandible
towards the vertex of the skull.
Other Investigations

Tomography

It is a radiographic technique that produce multiple thin

image slices free of superimposition of overlapping
structures. In TMJ it provides information about the three
dimensional shape and the internal structure of the osseous
components of the joints.

Advantages
 Extent of ankylosis
 Extent of neoplasm
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 into
one or both joint spaces under fluoroscopic guidance.
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.
 Summary
The search for sharp, distortion-free
imaging modalities for both hard and soft
tissue has led to to the development of
multiple conventional techniques and the
adaptation of new technologies to the TMJ
imaging. Hence the type of investigation
depends upon several factors including Pt’s
history, pt’s age, their signs and symptoms
and the facilities available.