Radiographic Considerations in TMD Flashcards
1
Q
What are the different imaging when can you for TMJ diagnostics?
A
- Pan
- CBCT
- Multidetector computed tomography (MDCT)
- MRI
2
Q
PAN
A
- Broad overview of TMJ
- Detect Gross osseous changes (FAN LEEO)
- asymmetries
- extensive erosion
- large osteophytes
- neoplasms
- fractures
- No info about condyle position or function
3
Q
CBCT
A
- Low radiation dose
- acquired with mouth closed and teeth in MI
- Detect Osseous changes (DJD FAN)
- Degenerative joint disease
- Ankylosis
- Neoplasms
- Fractures
- Cannot see soft tissue lesions (Discs)
4
Q
MDCT
A
- provides same info as CBCT but
- Limited view of soft tissues
- Higher radiation dose
5
Q
MRI
A
- Soft Tissue Pathology
- Mouth is closed and opened when taken
- contraindication:
- Pacemakers
- Intracranial vascular clips
- Metal Particles in vital structures
- Stainless steel crowns and ortho=image artifacts
6
Q
TMJ Developmental Abnormalities:
A
- Condylar hyperplasia
- Condylar hypoplasia
- Coronoid hyperplasia
- Bifid condyle
7
Q
TMJ Soft Tissue Abnormalities
A
- Disc displacement (reduction vs non-reduction)
- Deformities and perforation
- Fibrous Adhesion and Effusion
8
Q
TMJ Remodeling and Arthritic Conditioning
A
- Remodeling
- Degenerative joint diseaes
- Rheumatoid Athritis
- Juvenile idiopathic arthritis
- Septic arthritis
9
Q
TMJ Articular Loose bodies
A
- Synovial Chondromatosis
- Chondrocalcinosis
10
Q
TMJ Trauma abnormalities
A
- Effusion
- Condylar dislocation
- Fracture
- Neonatal Fractures
- Ankylosis
11
Q
TMJ Neoplasia Abnormalities
A
- Benign Neoplasia
- osteochondromas
- osteomas
- osteoblastomas
- chondroblastomas
- Malignant Neoplasia
- Primary:
- Chondrosarcoma
- Osteosarcoma
- Synovial Sarcoma
- Metastatic
- Salivary gland
- breast
- kidney
- lung
- colon
- prostate
- thyroid gland
- Primary:
12
Q
Degenerative Joint Disease
Clinical Features
Image Features
A
- Noninflammatory
- articulating fibrocartilage is broken down
- due to excessive loading
- Clinical Features
- Asympatomatic
- Pain
- Join noise (Crepitus)
- Limited ROM
- Image Features:
- Erosion
- Osteophyte
- reduced joint space
- subcondral sclerosis
- subcentral cyst (ely cyst)
13
Q
Rheumatoid Arthritis:
Clinical Features
Image features
A
- Synovial membrane inflammation
- Clinical features
- swelling, pain, tenderness, stiffness
- Limited ROM
- Crepitus
- Anterior open bite
- Imaging Features: (ER SOS GO BF)
- Generalized osteopenia
- Erosion (“Sharped pencil”)
- osteophyte
- reduced joint space
- Subcondral cyst
- subchondral sclerosis
- Fibrous ankylosis
- Bony ankylosis
- Osteopenia & Severe erosion of articular eminence=More characteristic of RA
14
Q
Disc Displacement:
Normal vs Anterior Displacement w/reduction vs Anterior Displacement w/or reduction
A
- Anterior displacement in closed position= most common disc displacement
- Normal:
- Close
- posterior band b/w condyle and mandibular fossa
- Open
- intermediate band b/w condyle and articular eminence
- Close
- Anterior displacement w/reduction
- Close:
- disc is anterior displaced
- posterior band anterior to condyle
- Open: (Reduces to normal)
- Disc is in normal position
- Close:
- Anterior Displacement w/o reduction
- Close:
- disc is anteriorly displace
- Open:
- disc still anterior to condyle
- Close:
15
Q
Disc displacement: Reduction vs non reduction
A
- Reduction
- Anterior displaced disc resumes normal position when mouth opens
- Audible Click
- Non-reduction
- Disc remains anterior displaced when opened
- Disc bent or deformed
16
Q
TMJ Fracture
A
- Condylar neck fractures→ most common
- unilateral
- parasymphyseal or mandibular body fracture on contralateral side
- Condyle head displacement in anterior and medial direction
17
Q
TMJ Ankylosis
A
- Restricted condyle movement
- due to intraarticular or extraarticular causes
- Intraarticular causes
- fibrous ankylosis
- fibrous connection of joint components
- Bony ankylosis
- Bone bridge connects joint components
- fibrous ankylosis
18
Q
Eagle Syndrome
A
- CN impingement due to:
- elongated soloed process
- ossified sylohyoid ligament
- Related to recent neck trauma
- tonsilectomy
- Symptoms:
- Vague, nagging to intense pain when:
- speaking
- chewing
- swallowing
- turning head
- open mouth wide
- Foreign body sensation in throat when swallowing
- feels like something is in your throat when swallowing
- Very LITTLE correlation b/w extent of ossification & intensity of symptoms
- Vague, nagging to intense pain when:
- Treatment:
- Vague symptoms=conservative
- steroid or lidocaine injection in tonsillar fossa
- Persistent or intense symptoms
- amputate stylohyoid process (Stylohyoidectomy)
- Vague symptoms=conservative