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Download Normal Anatomy Osseous Structures Structures
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Normal Anatomy Radiology of Temporomandibular Joint • Osseous structures • Soft tissue components Dent 5102 Osseous Structures Structures • Glenoid fossa • Articular eminence • Mandibular condyle • Post-glenoid tubercle 1 Soft Tissue Components Disk Displacement • Disk • Joint capsule • Synovia • Lateral ligament • Upper and lower joint spaces • Anterior • Anterior and lateral • Anterior and medial • Lateral • Medial • Posterior Normal Disk Position Partially Displaced Disk 2 Fully Displaced Disk Plain Films • Film and tube stationary • Shows the osseous structures • Soft tissue status • No info on disk location Plain Films in TMJ Disorders Panoramic Imaging • Transcranial • Transorbital • Submentovertex • Reverse Towne’s • Lateral oblique • Others • Shows significant erosion erosion, sclerosis sclerosis, or osteophyte • Probable fracture diagnosis • Little info on articular eminence or fossa • Good d initiall examination • Some pan machines have TMJ programs 3 Tomography • Osseous structures • Condylar position • Used along with arthrography TMJ - Tomograms Tube and film move in opposite direction direction, and rotate about a fulcrum Focal plain The level of the fulcrum is the focal plain 4 CT Scan Normal • Not for soft tissue changes • Evaluation of trauma and tumors • Perforation of alloplastic grafts into cranial fossa • Volume averaging Flattening Sclerosis 5 Flattening and sclerosis Generalized sclerosis Osteoarthrosis Osteoarthrosis 6 Osteoarthrosis Osteoarthrosis Osteoarthrosis Deviation in form 7 Cone Beam CT MRI • Disk location and displacement (~ 95% accuracy) • Osseous details poor • Soft tissue changes • Fluid or joint effusion • Protocol dependant MRI Parameters TR TE Short Short Term Effect T1 Anatomy –excellent Disk -low intensity Long Long T2 Poor anatomy Joint effusion – high intensity 8 Relative Brightness of Tissues Fat Marrow Brain Muscle Body fluid TMJ disk Cortical bone Air white gray black 9 Arthrography Arthrography: Technique • Single and double contrast • Indication – Internal derangements – Disk perforation – As a therapy? – Arthrocentesis • Contraindication • Clinical exam and history • Asepsis and anesthesia • Contrast agents • Injecting the contrast material under fluoroscope • Translation of condyle – Infection – Contrast sensitivity Scout Tomogram Contrast Material Injection • Osseous structures • Disk space • Sclerotic changes 10 Opacification of Lower Space Open Position • Translation of condyle • Reduction of disk Protruded Position Synovial chondromatosis 11 12 Trauma Condylar Fracture • Imaging for osseous structures • Panoramic • Plain films • Tomography • CT, CT in case of multiple extensive fractures Lateral Oblique Projection • • • • • • Non displaced Non-displaced Displaced Dislocated Intracapsular Extracapsular Sigmoid notch Tomograms 13 Reverse--Towne’s Reverse TMJ Transcranial TMJ-- Transorbital TMJ 14
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