Diagnostic Oral Radiology

8/9/2019 Diagnostic Oral Radiology

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Penyusun :

Harris Kusnandar

Deasty Elvina Jo Carolina

Leonita Hartanti

Inosensius Adi


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Disorder of the temporomandibular joint are

abnormalities that interfere with the normalform or function of the joint.

Arthritides, inflammation, growthabnormalities.


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Clinical Features

Temporomandibular joint (TMJ) disfunction is

the most common jaw disorder, 86% adults

and adolescent showing >1 clinical symptoms.

Signs and symptoms: pain in the TMJ or ear or

both, headache, muscle tenderness, joint

stiffness, clicking or other joint noises,

reduced range of motion, and subluxation.


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Application of Diagnostic

Imaging As a supplement information, when: osseus

abnormalities or infection suspected,

conservative treatment failed, symptoms

worsening, history of trauma, clinical signs.

To evaluate: integrity and relationship of the

hard and soft tissues, confirm the extent stage

of progression of known disease, and evaluatethe effects of treatment.


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Radiographic anatomy of TMJ


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Condyle

A bonny ellipsoid structure connected to the

mandibular ramus by a narrow neck.

The shape of the condyle varies considerably,and these variations may cause difficulty with

radiographic interpretation, this underlines

the importance of understanding the range of

normal appearance.


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Most condyles have a pronounced ridge

oriented mediolaterally on the anteriorsurface, marking the anterioinferior limit ofthe articulating area.

The ridge is the upper limit of the pterygoid

fovea, a small depression on the anteriorsurface at the junction of the condyle andneck.

It is the attachment site of the superior head

of the lateral pterygoid muscle and shouldntbe mistaken for an osteophyte (spur), whichindicate degenerative joint disease.


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Fig 26-1


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Temporal components ofTMJ are calcified by

6 months of age, complete calcification ofcortical borders may not be complete until 20

years of age.

Radiographs of condyles in children may so a

little or no evidence of a cortical border.

In the absence of disease, the cortical borders

in adults are visible radographically.


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Mandibular Fossa

Located at the inferior aspect of the squamous

part of the temporal bone, is composed of the

glenoid fossa and articular eminence of the

temporal bone. Covered with a thin layer of

fibrocartilage.

temporal component ofTMJ

In normal TMJ, the roof of the fossa , the

posterior slope of the articular eminence, and

the eminence itself form an S shape when

viewed in sagital plane.


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Fossa depth varies, and the development of

the articular eminence relies on functionalstimulus from the condyle.

The mandibular fossa very flat andunderdeveloped in patients with micrognathia

or condylar agenesis.


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All aspects of the temporal component may

be pneumatized with small air cells derived

from the mastoid air complex. Seen in

approximately in 2% of patients.

FIG 26-3


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During mandibular opening, as the condyle

rotates and translates downward and forward, the disk also moves forward and rotates so

thats its thin central portion remains between

the articulating convexities of the condylar

head and articular eminence.


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Retrodiskal Tissues

Consists of a bilaminar zone of vascularized

and innervated loose fibroelastic tissue.

As the condyle moves forward, tissue ofposterior attachment expand in volume,

primarily as a result of venous distention, and

as the disk move forward, tension is produced

in the elastic posterior attachment.Smooth recoil of the disk


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Temporomandibular Joint Bony

Relationships

Radiographic joint Space; between the

condyle and temporal component.

The left and right condylar position within the

fossa can be determined and compared by thedimensions of the radiographic joint space

viewed on collateral lateral images.

Because the radiographic outline of theglenoid fossa and the condyle do not match

like a smooth ball and socket joint, the joint

space often varies from medial to lateral

aspects of the joint.


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Fig 26-5


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Markedly eccentric condylar positioning

usually represents an abnormality.

Exp, inferior condylar positioning (widened

joint space) maybe seen in case involving fluid

or blood within the joint. Superior condylar positioning (decreased OR

no joint space) may indicate loss,

displacement, or perforation of intracapsular

soft tissue components.


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Condylar Movement

The condyle typically found within a range of

2-5 mm posterior and 5-8 mm anterior in the

crest of the eminence.

Reduce condylar translation, has little Or nodownward and forward movement and

doesnt leave the mandibular fossa seen in

patient who clinically have a reduced degree

of mouth opening.

Hypermobility : translate >5 mm anterior to

the eminence.


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Diagnostic Imaging of the

TMJ Depends on the specific clinical problems.

Both joints should be imaged during the

examination, for comparison.


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Osseus Structures

Panoramic Projection

Provide: overall view of teeth and jaws,

comparing the left and right sides of themandible, as a screening projection to identify

odontogenic diseases and other disorder that

maybe the source ofTMJ symptoms.

Limitation : distorted view of the joints,

severe image quality.


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Fig 26-6


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Gross osseus changes in the condylus,

asymmetries, extensive erosions, largeosteophytes, tumors, fractures.

Shouldnt be used as a sole imaging modality.

Plain Film Imaging Modality

Combined of: transcranial, transpharyngeal,

transorbital, and submentovertex projection.


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Conventional Tomography

Is a radiographic technique that producesmultiple thin image slices, permitting

visualization of the osseus structures

essentially free of superimpositions of

overlapping structures.

Computed Tomography

Two devices available: Conventional CT and

CBCT, but only conventional CT provides

images of the surrounding soft tissues.


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CT useful for determining the presence and

extent of ankylosis and neoplasms and degreeof bone involvement in arthritides, imaging

complex fractures, for evaluating

complications from the use of

polytetrafluoroethylene or silicon sheet

implants.


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Soft Tissue Structures

Indications : TMJ pain and dysfunction, clinical

finding suggest disk displacement, and

symptoms unresponsive to conservative

therapy.

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Diagnostic Oral Radiology