Ankylosis of TMJ

Arthritis of TMJ

• Infectious arthritis

• Rheumatoid arthritis

• Degenerative arthritis

• Traumatic arthritis

退行性変化の X線所見

Radiological　 changes of R.A.

• Reduced mobility• Reduction of joint space• Erosion• Flattening• Osteophyte formation• Osteosclerosis• Osteoporosis• Deformation,total loss of condyle

Clinical features of R.A.

• Pain,swelling,limitation of jaw movement,crepitation.

• Changes in the occlusion of the teeth

• (advanced case )progressive opening of the bite.

• Total ankylosis(rare)

MRI image of TMJ with jaw in closed position,sagittal plane,A- Normal MRI of TMJ,coronal plane of image,jaw close

d,arc-shaped disk-A

B-Normal MRI image,jaw open position,sagittal plane, relatively high signal noted in post.band of disk, is attached to neck of condyle via firm capsular attachment(arr

owheads) T-tubercle C-condyleArrowheads-attachment of sup.belly of lat.pterygoid m.to the ant.band of disk

Normal MRI of TMJ,coronal plane of image,jaw closed,arc-shaped disk

Internal derangementanterior displacement of the disk

Normal TMJ

Internal TMJ derangementThe early click

Severe disk derangementclosed lock

Normal TMJ arthrogram

Change in relationship of disk to osseous structures with mouth opening when the condyle articulates

with the intermediate zone of the disk1post.band C condyle 2 smaller ant.band e eminence

Normal relationship of the disk to the condyle and fosssa(mouth closed)

post.band(1) directly above the condyle(c)smaller ant.band(2)immmediattely below the eminence,ant.band of normally positioned disk can cause a small conca

ve defect on the ant.recess(arrow)

Bifid condyle(duplication of

condyle)

Panoramic radiogram,chondrosarcoma

Indications for radiography of TMJ• １） Pain• ２） Systemic disease• ３） Noise,clicking sounds during moveme

nt• ４） Masticatory 　 muscle pain• 5)trismus, limitation of mouth opening• 6) trauma• 7)asymmetrical face• 8)morphological abnormalities

Diagnostic values between several techniques

• TLOP ＞ TMP>TPP• TLOP ： ostephyte on anterior aspect of condyle,flattening

of post.slope and crest of articular eminence.

• TMP: erosion on condyle.flattening of later.parts of articular eminence or most laterally situated osteophyte.

TLOP and TMP complement each other, if they are used in conjunction,more

structural changes are demonstrated. (Pertersson)

Principles of radiographic examination of TMJ

• Ideal examination should result in three-dimensional topography of the shape,size,and the structure of joint components.

• 1)Avoiding the superimposition of cranial structures.

• 2)Direct the X-Ray beam perpendicular to the cassette.

• 3)Put the film as close as possible to the joint under examination.

• 4)Reproducibility of the radiographic procedure.

Radiographic technique of TMJthree dimensional topography of the joint

components

A.Conventional methods 1)Lateral views TLOP( transcranial lateral oblique projection,Schuller’s modification) TPP(transpharyngealprojection,Parma,Toller,Lewis ） 2)Anteroposterior views Ante ｒ oposterior projection(Towne’s proj.) ORP(orbitao-ramus projection,Grant-Lanting proj.) TMP(transmaxillary projection ） 3)Axial view Base projection,Submento-vertical Projection)

4)Panoramic radiography

B.Special methods

• 1)Tomography

• 2)cinefluorography

• 3)Arthrography

• 4)Nuclear Medicine Imaging (scintigraphy)

• 5)Computed tomography

• 6)MRI(magnetic resonance Imaging)

Arthrography of TMJ

• Arthrography of the tmj

• Double Contrast Arthrography

• Digital Subtraction Arthrography

TMJ arthrography

• An accurate and effective means of diagnosing Internal derangements and other abnormalities.

• Shows perforated disk which no other diagnostic method can demonstrate with reliability.

• Allows evaluation of the dynamics of the joint with mouth opening and closing.

• Helpful in patients with clicking from other than a displaced disk (i.e. a prominent articular eminence).

• Cost-efficeint

Arthrography Double contrast

• An alternative arthrographic tehnique

• Injections of contrast medium and air into both upper and lower joint spaces followed by tomography.

• Can demonstrate the soft tissues of the joint with greater detail than single contrast technique.

Nuclear Medicine Imaging

• Radionuclide bone scintigraphy offers a sensitive method for detecting the presence of tmj pathology and serving as an economical screening technique.

• For determination of the presence of significant organic tmj disease.

• Small remodeling changes in bony structures,or Inflammation in the surrounding tissues can be detected long before than other conventional radiographs.

TLOP,shows only lat.third of joint

Transmaxillary proj.McCabe(oblique infraorbital proj.)

TPP(transpharyngeal proj.)

LOTP vs.Axial tomo.Osteophyte,narrow ant. Js,sclerotic tubercle