_section of a normal tmj semmelweis egyetem一个正常的颞下颌关节解剖断面semmelweis 课件

Radiographic examinations of the temporomandibular joint Dob-Nagy, Csaba Semmelweis University Knowledge required by clinicians nAnatomy nAvailable investigations nClinical indications nHow each investigation is performed nposition nopen or closed nLimitations nPathological conditions Anatomical section of a normal TMJ condyle disk GlenoidGlenoid fossa fossa tubercletubercle ( (articulararticular eminenceeminence) ) lateral pterygoid muscle Skull base model A A P P L L R R Visualization of the TMJ Main radiographyc projections of the TMJ TrCran TrPhar TrOrb SMV RevTowne Transcranial projection Reverse Townes Transorbital Transpharyngeal (Parma) Dental panoramic tomograph Condylar silhouette Projection of panoramic tomography Double lateral view of TMJ SMV Corrected tomography Limitations of routin radiographic projections nSoft tissue abnormalities nEffusion nSmall and localised bony defects nOne aspect of the joint (except for tomography) Main pathological signs of TMJ A A B B C C D D E E F F G G HH I I Adaptive response Osteophyte formation Fracture osteochondroma Dislocaition of disk without reduction Diagnostic informations of MR nDisk displacement nThe integrity of the disk and its soft tissue attachments nEffusion (T2-weighted image) nIntegrity of the articular surface nResearch (gold standard) CT coronal view CT sagittal view CBCT imaging of a normal TMJ CBCT examination of arthritis Osteophyte Ankylosis Diagnostic informations of CT nThe shape of the bony compartments nInformation on all aspects of the joint nThe condition of the articular surface nThe size of the joint space nIntegrity of the disk and soft tissue attachements Size of TMJ space and soft tissue changes Diagnostic informations by modalities Radio- grapic modalities anatomypathologyadaptation hardsofthardsofthardsoft panoramic traditional CBCT/CT MRI Suggested hierarchy of imaging modalities in TMJ disease panoramicMRI tomography CBCT, CT soft tissue changes bone changes Primary examination: dysfunction organic changes failed treatment Summary of views of main projections projectionarea of joint shown Transcraniallateral aspect Tran