Imaging Of Temporomandibular Joint

Imaging Of Temporomandibular Joint

Name the techniques used for temporomandibular joint radiography. Describe the technique of transcranial projection including its exposure parameters. Mention its indications.
Answer. Following are the techniques used for temporomandibular joint radiography:

• Transcranial projection
• Trans pharyngeal projection
• Trans orbital projection
• Reverse Towne’s projection

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TMJ imaging

Transcranial Projection

Technique

Film Position

Cassette is placed flat against the patient’s ear and centered to TMJ against the facial skin parallel to sagittal plane.

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Position of Patient

• Patient’s head should be adjusted so that sagittal plane is vertical.
• Ala tragus is parallel to the flor.
• View is taken with the patient’s mouth in three positions, i.e.
  • Mouth in open position
  • Mouth in rest position
  • Mouth in closed position

TMJ radiographs

Central Ray

Point of entry is different according to the technique used.

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Postauricular or Lindblom technique

Technique

Point of entry of the central ray is 1/2 “behind and 2” above the auditory meatus.

According to Lindblom, the central ray should be directed from posteriorly so that it passes along long axis of condyle and the medial pole of condyle is more posterior to lateral pole.

Grewiock Approach

The central ray enters through a point 2” above the external auditory meatus.

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Gill’s Approach

Central ray enters through a point 1/2” anterior and 2” above the external auditory meatus.

In all the three techniques, the central ray is directed caudally at an angle of + 20° to + 25°.

Point of exit is through TMJ of interest.

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Exposure Parameters

Intra oral X-ray machine

kVp: 70

mA: 07

Seconds: 1.5

TMJ dysfunction imaging

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Indications

• This view is very useful in detecting the articulating surface changes which are caused by the various forms of arthritis.
• Relationship of condyle to the articulating surface of the joint is viewed in this radiograph.
• Transcranial view shows the lateral oblique view of condylar head as well as articular fossa. It also shows very minute, subtle bony irregularities on the lateral bony surfaces.