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Week 7 :Mandible Week 8 : TMJ RT 233 Week 7 & 8 (FINAL) Mandible 2 Mandible (Slide 3) 1. Only movable bone in the skull 2. Densest & largest facial bone 3. 2 bones at birth 4. Contains mental foramina 3 Temporomandibular Joint 4 Indications 1 2 3 PA Mandible (rami) 1. ________ or ________ 2. _________________ and nose on IR 3. ________& ________ perpendicular to IR 4. CR perpendicular to exit _____________ 6 PA Mandible (rami) Radiograph 1. Mandibular ________ 2. ________ portion of ______ are visualized 3. Entire mandible without _________ or _________ 4. _________ or __________ displacement 7 PA Mandible Rami- Diagram 8 PA Mandible (body) 1. ________or _______ 2. ____ and ____ on grid device or table – Mandibular symphysis ______with plane of IR 3. ___ & ___ perpendicular to IR 4. CR perpendicular to level of ________ 9 PA Mandible (body) Radiograph 1. Contrast and density are sufficient to view body and rami 2. Sharp bony detail indicating no motion 10 PA Axial (rami) Mandible Positioning 1. Seated or _______ 2. Forehead and _____ on IR 3. _____ & MSP perpendicular to IR 4. CR 20- 25 _________, centered to exit _______________ 11 PA Axial (rami) Mandible Radiographs 1. Heads of ________ are visible through ______ processes. 2. Condyloid processes are slightly _________. 3. Proper density 12 4. No rotation or tilt PA Axial (body) Mandible Positioning 1. Seated or Prone 2. ____ and ____on grid device or table – mandibular symphysis ___________ with IR 3. ____ & _____ perpendicular to IR 4. CR between TMJ’s, 30 ____________ 13 PA Axial (body) Mandible Radiographs 1. TMJ’s just ________ to mastoid process 2. Symmetric ______ 3. Adequate contrast and density 14 Axiolateral Oblique Positioning for Ramus 1. Seated, semiprone or semisupine 2. IPL ____________ to IR 3. Mouth closed- _________ together 4. Extend neck, chin ___________forward 5. CR __ degrees _____to pass through area of interest 15 Axiolateral Oblique Radiograph for Ramus 1. No overlap of ramus by opposite side of mandible 2. No elongation or foreshortening of ramus 3. No superimposition of ramus by c-spine 16 Axiolateral Oblique Positioning for Body 1. Seated, semiprone or semisupine 2. IPL perpendicular to IR 3. Mouth closed- teeth together 4. Extend neck, chin jutted forward 5. Rotate pt’s head _________ degrees toward IR 6. CR 25 degrees cephalic to pass through area of interest 17 Axiolateral Oblique Radiograph for Body 1. No overlap of body by opposite side of mandible 2. No elongation or foreshortening of body 3. No superimposition of body by c-spine 18 Axiolateral Oblique Positioning for Mandibular Symphysis 1. Seated, semiprone or semisupine 2. IPL perpendicular to IR 3. Mouth closed- teeth together 4. Extend neck, chin jutted forward 5. Rotate pt’s head __ degrees toward IR 6. CR 25 degrees cephalic to pass through area of interest 19 Axiolateral Oblique Radiograph for Mandibular symphysis 1. No overlap of mentum by the opposite side of mandible 2. No foreshortening of the mentum region 20 SMV Mandible • IOML parallel to IR • Shows coronoid and condylod processes orf rami 21 SMV 22 SMV Radiograph • Condyles anterior to pars petrosae • Symphysis extended almost past border of face • Equal distance from condyles to lateral margin of skull 23 Panorex Mandible 1. Explain how tube/image receptor move 2. IOML perpendicular 3. Stand straight, not jutting chin forward 4. Instruct pt to keep lips together and tongue on roof of mouth 24 Panorex Mandible Radiographs 1. Demonstrates teeth, mandible, TMJ’s 2. Density are uniform across image 3. No artifacts 25 Fractures and Surgical Repair Surgical Fixation 27 Jaw wired shut 28 29 30 Temporomandibular Articulations 31 1. Supine or seated upright 2. Posterior teeth closed and in contact 3. For open mouth- wide as possible without chin jutted forward 4. OML perp to IR 5. CR 35 caudad, centered midway between TMJ’s. 6. Enters approx 3” above nasion AP Axial TMJ AP Axial TMJ Radiograph 1. No rotation 2. Minimal superimposition of petrosa on condyle in closed mouth 3. Condyle and TMJ below pars petrosa in open mouth 1. Semiprone or seated 2. Center ½” anterior to EAM 3. Rest cheek on grid device 4. Rotate MSP approx 15 degrees toward IR 5. IPL perpendicular 6. CR 15 caudad exiting through TMJ closest to IR about 1 ½ “ superior to upside EAM Axiolateral Oblique TMJ Axiolateral Oblique TMJ Radiograph 1. TMJ 2. Condyle lying in mandibular fossa in closed mouth 3. Condyle lying inferior to articular tubercle in open mouth Axiolateral Oblique Open mouth Axiolateral Oblique Open mouth Temporomandibular fossa condyle Coronoid Axiolateral Oblique Closed mouth Axiolateral Oblique Closed mouth Temporomandibular fossa condyle coronoid Axiolateral TMJ’s • CR 25-30 degrees • Enters ½” anterior and 2” superior to upside EAM • IPL Perpendicular • MSP parallel Evaluation Criteria • TMJ lying anterior to the EAM • Condyle in fossa (closed mouth) • Condyle inrerfior to articular tubercle (open mouthP 41 Axiolateral Closed Mouth Axiolateral Open Mouth