TMJ radiographic techniques

Techniques:
plain radiography- 1
2- panoramic radiography
3- Tomography
4- Arthrography
5- Computed tomography (CT)
6- Magnetic resonance imaging (MRI)

Plain radiography :*
Plain films of TMJ are made with a stationary
x-ray source and film. In order to avoid
superimposition of adjacent anatomic bony
structures making visualization of all parts of
TMJ, different projections of transcranial
films :have been applied, which include
lateral transcranial view
transmaxillary view
submental-vertex view
transpharyngeal view
-

lateral transcranial-

Transmaxillary-

Submental vertex-

Transpharyngeal view-

Panoramic radiography*
Its a good imaging method for evaluating TMJ
since information about the teeth and other
parts of the jaws were also shown on the image

However, the relationship between the condyle

and glenoid fossa cannot be evaluated in the
panoramic film because the fossa cannot be seen
with superimposition of the base of the skull and
zygomatic arch.
The morphology of the condyle becomes wider
than the anatomic structure of the condyle

Tomography*
Tomography of TMJ is generated through the
synchronous movement of the x-ray tube and
film cassette through an imaginary fulcrum
located in the center of the desired imaging
plane. Linear tomography and complex
tomography are involved

tomography is a good method for depicting the

osseous changes with arthrosis in TMJ
For evaluation of condyle position in glenoid fossa
of TMJ, tomography has been reported to be
more reliable than plain film and panoramic
radiography
On the other hand, the relationship between the
condyle position and disc displacement is
uncertain. The condyle position is not reliable in
estimating the disc displacement of TMJ and
related symptoms

The major disadvantage of tomography is the lack

of visualization of the soft tissue of TMJ, a
.problem shared with plain film radiography

:Arthrography *
A 25 or 23 gauge needle is placed into the inferior
joint space immediately posterior to the condyle.
Small amounts of iodinated contrast are injected
under fluoroscopy. The contrast tracks along the
posterior, superior and anterior portions of the
condyle. The anterior collection of contrast,
called the anterior recess, normally has a
. smooth, tear-drop shape

If the meniscus is perforated, contrast flows into

both the superior and inferior joint recesses.
However, the arthrographic needle can
inadvertently puncture the meniscus and cause
.iatrogenic filling of both joint spaces

:computed tomography (CT)*

Computed tomography (CT) can be used to
diagnose internal derangement and other
.disorders of the TMJ
The patient is scanned in either the transverse or
direct sagittal plane using thin sections (1-2 mm)
.and a soft tissue technique

If transverse sections are obtained, sagittal

reconstructions are made through the condyle.
The meniscus can be visualized on CT since it is
slightly higher in density than the surrounding
muscle and soft
. tissue

Normally, there is only a small amount of

increased soft tissue density anterior to the
condyle on CT. In internal derangement, the
anteriorly displaced meniscus results in
abnormally increased soft tissue density anterior
.to the condyle

Magnetic resonance imaging (MRI)*

Magnetic resonance (MR) can also be used to diagnose
.internal derangement and other disorders of the TMJ
The patient is scanned in the sagittal plane using a
surface coil and a high resolution technique
The low intensity cortex of the condyle surrounds the
high signal fat in the marrow. The meniscus is a low
intensity structure which is attached posteriorly by the
.intermediate intensity bilaminar zone

Normally, the anterior band lies immediately in

front of the condyle. The junction of the
bilaminar zone and the meniscus normally lies at
.the superior aspect of the condyle

In internal derangement, the meniscus is

.abnormally positioned anterior to the condyle