牙科放射线学2.ppt

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1、牙科放射线学2 Still waters run deep.流静水深流静水深,人静心深人静心深 Where there is life,there is hope。有生命必有希望。有生命必有希望 Normal anatomy of TMJ Investigations available for TMJ Pathological conditions that can affect TMJ學 習 目 標1.Eric Whaites:Essentials of dental radiography&radiology 3rd edition,Chapter 29,p.371-3882.Eric

2、Whaites:Essentials of dental radiography&radiology 1st edition,Chapter 28,p.297-323.References3.Rosenberg et al,Aust Dent J 1999;44:1064.Kaohsiung Medical University,Oral Pathology Department Normal anatomy of TMJ Investigations available for TMJ Pathological conditions that can affect TMJCondyle he

3、adDisc/meniscusGlenoid fossaLateral pterygoidattachmentUpper joint spaceLower joint spaceExt.auditory meatusRef.1Basics components of the TMJ:Mandibular component:condyle head(Hard tissue)Disc(Soft tissue)Temporal component:glenoid fossa&articular eminence(Hard tissue)Capsule surround the joint(Soft

4、 tissue)Normal Anatomy LateralAnteriorBase Normal anatomy-Dry skull Ref.1RestpositionMouthclosedPrimaryrotationMouthopenedTranslationMouth openedinitiallyMouth openedwidelySecondaryrotationRef.1Investigations available for TMJ(1)The clinical indicationsHow each investigation is performed:how the pat

5、ient is positioned in relation tothe film and X-ray tubehead,and whetherthe patients mouth needs to be opened or closedInvestigations available for TMJ(2)What information from each investigationThe limitations and shortcomings of eachinvestigation Conventional radiographic projections Other techniqu

6、es and investigations Transcranial Transpharyngeal Panoramic Reverse Towns Transorbital Tomography,linearRef.1Transcranial Lateral aspect of:Glenoid fossa Articular eminence Joint space Condylar headTranspharyngeal Lateral view of:Condylar head&neck Articular eminenceDental panoramic Lateral view of

7、 tomograph both condylar headsReverse Townes Posterior view of:both condylar head&necksTransorbital Anterior view of:Condylar head&neck Articular eminenceTomography All aspects of:Glenoid fossa Articular eminence Joint space Condylar headTMJ pain dysfunction syndrome pain,clicking&mouth opening limi

8、tationTo investigate the size&position of thedisc(joint space)To investigate range of movement in thejoints Main indications Mouth openMouth closeMouth openRightMouth closeRightCentric occlusionRef.1Radiological term joint space:RL zone between condylar head&glenoid fossa,which includes discs&upper&

9、lower anatomical joint spacesDiagnostic informationClosed viewOpen viewThe size of the joint space provide indirectinformation about the position and shape ofthe discThe position of the head of the condyle withinthe fossaThe shape and conditions of the glenoid fossa&articular eminence(on the lateral

10、 aspect only)The shape of the head of the condyle&the condition of the articular surface(on the lateralaspect only)A comparison of both sidesThe range and type of movement of the condyleA comparison of the degree of movement onboth sidesMain indicationsTMJ pain dysfunction syndromeTo investigate the

11、 presence of joint disease,particularly osteoarthritis and rheumatoidarthritisTo investigate pathological conditionsaffecting the condylar head,including cysts ortumorsFractures of the neck and head of the condyleDiagnostic information The shape of the head of condyle and condition of the articular

12、surface from lateral aspect A comparison of both condylar headsRef.1Main indicationsMain indications TMJ pain dysfunction syndrome To investigate disease within the joint To investigate pathological conditions affecting the condylar heads Fractures of the condylar head or neck Condylar hypo/hyperpla

13、siaDiagnostic information The shape of the condylar head and condition of the articular surface from lateral aspect A direct comparison of both condylar heads Right closeRight openLeft openLeft closeRef.4 To investigate the articular surface of the condyles and disease within the joint Fractures of

14、the condylar heads and necks Condylar hypo/hyperplasiaMain indicationsMouth openRef.1Diagnostic information The shape of the condylar heads and condition of the articular surfaces from the posterior aspect A direct comparsion of both condylesRef.1 To investigate the articular surface of the condyle

15、and disease within the joint High fractures of the condylar neck to show medio-lateral displacement This view is rarely used due tothe risk of damage to the lens ofeye from radiationHowever,it provides an AP view ofthe condylar head-an aspect notshown by other radiographsMouth openRef.2Main indicati

16、onsRef.2 The shape of the condylar head and neck from the anterior aspect The condition of the articular surface from the anterior aspectDiagnostic informationMain indications Full assessment of the whole of the joint to determine the presence and site of any bone disease or abnormality To investiga

17、te the condyle and articular fossa when the patient is unable to open the mouth Assessment of fractures of the articular fossa and intracapsular fracturesLateralAnterior15o20o25o30oRef.1Diagnostic information The size of the joint space The position of the head of the condyle within the fossa The sh

18、ape of the head of the condyle and condition of the articular surface including the medial and lateral aspects The shape and condition of the articular fossa and eminence Information on all aspects of the joints The positions and orientation of the fracture fragments Arthrography Computed tomography

19、 Magnetic resonance imaging ArtheroscopyMain indicationsDiagnostic information下列何者是下列何者是AP view為：為：A.Panoramic radiographyB.Transcranial projectionC.TransorbitalD.Modified Towns viewMain indications Longstanding TMJ pain dysfunction unresponsive to simple treatments Persistent history of locking Lim

20、ited opening of unknown etiologyMain contraindications Acute joint infection Allergy to iodine or contrast mediumDiagnostic information Dynamic information on the position of the joint components and disc as they move in relation to one another Static images of the joint components with the mouth cl

21、osed and with the mouth open.Any anterior or anteromedial displacement of the disc can be observed The integrity of the disc,i.e.any perforationsNote:Outline the lower joint space usually provides more useful information on the discRef.1Main indicationsDiagnostic information The shape of the condyle

22、 and the condition of the articular surface The condition of the glenoid fossa and eminence The position and shape of the disc The integrity of the disc and its soft tissue attachments The nature of any condylar head disease It provides sectional or slice images of the joint It can produce images of

23、 the hard and soft tissues in the joint,including the disc,in different planes Ref.4Condylar headAnteriordisplaceddiscMain indications When diagnosis of internal derangements is in doubt As a preoperative assessment before disc surgeryRef.4 It gives direct visualization of the TMJ and allows certain

24、 interventional procedures to be performed,including Washing out the joint with saline Introduction of steroids directly into the joint Division of adhesions Removal of loose bodies from within the jointArthroscopy is considered as the last line of investigation before full surgical exploration ofth

25、e joint is carriedMain indications1.Upper joint space2.Lower joint space3.Disc4.Prolene suture5.Yeates drain6.External auditory meatusRef.3Fibrillation(顫動顫動)DiscAdhesionDiscRef.4 Main pathological conditions affecting the TMJTMJ pain dysfunction syndromeInternal derangementsOsteoarthritisJuvenile rh

26、eumatoid arthritis(Stills disease)AnkylosisTumorsFracturesDevelopmental anomalies(史迪爾氏症史迪爾氏症)Main pathological conditions affecting the TMJ最可能的診斷為：最可能的診斷為：A.AmeloblastomaB.Squamous cell carcinomaC.HemangiomaD.Central giant cell granuloma(A)A multilocular radiolucency;(B),(C)Surgical specimen;(D)Costochondral graft;(E)Histological examination:bony trabeculae entrapped by multiple blood vessels Knowing:Normal anatomy of TMJ What investigations are available for TMJ Main pathological conditions that can affect TMJSummariesSummaries