SEMINAR ON

DIGNOSTIC IMAGING OF TMJ

SUBMITTED BY HEMLATA DUBEY B.D.S. FINAL YEAR

DEPARTMENT OF ORAL MEDICINE & RADIOLOGEY

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DIGNOSTIC IMAGING OF THE TMJ

TMJ is broadly divided into 2 categories. a) Osseous structures b) Soft issue structure Selection of type imaging technique depends on following factors . Specific clinical problems . Whether hard or soft tissue imaging is desired. . Amount of diagnostic information available from the particular Imaging modality. . Cost of examination. . Radiation dose. Note: Both the joints should be imaged during the examination for comparison.

Diagnostic Imaging of TMJ Osseous structure Soft tissue structure Osseous structure Panoramic projection Plain film imaging modality Conventional tomography Computed tomography Soft tissue structure Anthrography MRI

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A. Osseous structure imaging

Panoramic projection- It provides :-

1- Overall view of teeth & jaws. 2- A means for comparing RT & LT sides of mandible. 3- Identify odontogenic disease and other disorders that may be
source of TMJ symptoms.

fig.a- Panoramic images that revealed right condylar hyperplasia. fig.b- Destruction of the condole by malignant tumor.

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- Panoramic machines with specific TMJ programs are not used because of thick image layer and distorted oblique view of the joint they provide which limit image quality. - Only gross osseous changes of condyle is identified as Asymmetries, extensive erosion, large osteophytes tumours & Fractures. - Condylar position and functions not dictated. - Mild osseous changes not seen due to superimposition by the skull base & zygomatic arch. . For this reason panoramic view is not used alone.

B. Plain film imaging modality:It consists of A- Transcranial view. B- Transorbital view. C- Transpharyngeal view. D- Submentovertex view.

A - Transcranial view :- It is take in closed & open mouth position. - It provides lateral views of TMJ.

Uses:1- In case of displaced candylar fracture. 2- Any degenerative changes but not minor changes. 3- Range of motion.

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Fig. [a&b] - Transcranial projection providing a profile of the lateral aspects of condylar head.(arrow). In the closed view and the degree of translatory movement(arrow) in the open view.

B - Transorbital view :- Also known as ZIMMER PROJECTION. - It provide imaging of interior aspect (mediolateral aspect in frontal plane) of TMJ. - It is taken in open or protruded position. - Beam is passed through the ipsilateral orbit and head is slightly tilted with film placed slightly posterior.

Uses:1- As an adjunct to transcranial & transpharyngeal xray view. 2- Condyler neck fracture. 3- In case of limited range of motion only neck is visible not the head.

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Fig. Transorbital projection showing a view of the condyle.the lateral pole is indicated with an arrow.

C - Transpharyngeal view :-

Also known as - Parma projection. - MC queen projection. - Infra axial projection. - It is taken in the mouth opened position only. - It provides imaging of medial aspects of TMJ.

Uses:1- Medially displaced fractures. 2- Subtle changes in TMJ (Minute).

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Fig. Transpharyngeal projection showing a medial profile of the condyle.

D - Submentovertex view :It provide a view of skull base & Condyle in horizontal plane.

Uses:-

1- To determine the angulation of the long axes of condyler head For connected tomography.

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Fig. Submentovertex projection showing the Measurement of the angle of the long axis of the condyler head used for tomography.

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