Post on 03-Apr-2018
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TMJ ProjectionsTMJ Projections
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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.
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Radiographic ProjectionsRadiographic Projections
Conventional Radiographic Projections
Transcranial view Transpharyngeal view
Transorbital view
Panoramic view
Submentovertex view
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Other Investigations
Tomography (CT)
MRI
Arthrography Arthroscopy
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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
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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.
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Transpharyngeal viewTranspharyngeal view
Indications
Osteo arthritis
Rheumatic arthritis
Fracture of neck and head of the condyle TMJ pain dysfunction syndrome
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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.
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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
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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.
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Panoramic viewPanoramic view
Indications
TMJ pain dysfunction syndrome
Investigate disease within the joint
# Condylar heads or necks Condylar abnormalities
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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.
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Submentovetex viewSubmentovetex view
Indications
Condylar displacement
Rotation of the mandible
Curvature of mandible Displacement of the fractured zygomatic
arch
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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.
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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
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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.
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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.
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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.