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Radiographic examinations of the temporomandibular joint

Radiographic examinations of the temporomandibular joint. Dobó-Nagy, Csaba Semmelweis University. Knowledge required by clinicians. Anatomy Available investigations Clinical indications How each investigation is performed position open or closed Limitations Pathological conditions.

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Radiographic examinations of the temporomandibular joint

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  1. Radiographic examinations of the temporomandibular joint Dobó-Nagy, Csaba Semmelweis University

  2. Knowledge required by clinicians • Anatomy • Available investigations • Clinical indications • How each investigation is performed • position • open or closed • Limitations • Pathological conditions

  3. disk Glenoid fossa tubercle (articular eminence) condyle Anatomical section of a normal TMJ lateral pterygoid muscle

  4. Skull base model A P R L

  5. Visualization of the TMJ

  6. Main radiographyc projections of the TMJ TrCran TrOrb TrPhar RevTowne SMV

  7. Transcranial projection

  8. Reverse Towne’s

  9. Transorbital

  10. Transpharyngeal (Parma)

  11. Dental panoramic tomograph

  12. Condylar silhouette

  13. Projection of panoramic tomography

  14. Double lateral view of TMJ

  15. SMV

  16. Corrected tomography

  17. Limitations of routin radiographic projections • Soft tissue abnormalities • Effusion • Small and localised bony defects • One aspect of the joint (except for tomography)

  18. A B C D E F G H I Main pathological signs of TMJ

  19. Adaptive response

  20. Osteophyte formation

  21. Fracture

  22. osteochondroma

  23. Dislocaition of disk without reduction

  24. Diagnostic informations of MR • Disk displacement • The integrity of the disk and its soft tissue attachments • Effusion (T2-weighted image) • Integrity of the articular surface • Research (gold standard)

  25. CT coronal view

  26. CT sagittal view

  27. CBCT imaging of a normal TMJ

  28. CBCT examination of arthritis

  29. Osteophyte

  30. Ankylosis

  31. Diagnostic informations of CT • The shape of the bony compartments • Information on all aspects of the joint • The condition of the articular surface • The size of the joint space • Integrity of the disk and soft tissue attachements

  32. Size of TMJ space and soft tissue changes

  33. Diagnostic informations by modalities

  34. Suggested hierarchy of imaging modalities in TMJ disease soft tissue changes panoramic MRI bone changes tomography • Primary examination: • dysfunction • organic changes • failed treatment CBCT, CT

  35. Summary of views of main projections

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