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DMOP > Diagnostic Imaging of the Temporomandibular Joint > Flashcards

Diagnostic Imaging of the Temporomandibular Joint Flashcards

1
Q

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Diagnoses with Similar Symptoms

A

· Migraine Headache
· Tension Headache
· Temporal arteritis
· Ear infection
· Sinus infection or tumors
· Tooth infection
· Facial muscle spasm
· Jaw joint sprain
· Neuralgia
· Oral cancer
· Jaw joint tumors
· Dental malocclusion
· Jaw joint disk displacement *
· Jaw fracture

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2
Q

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Imaging Technique Selection
depends on:
(6)

A
  1. Clinical diagnosis
  2. Desire to image hard vs soft tissue
  3. Diagnostic information provided from
    the imaging technique (i.e. visualization
    of disc; or range of motion)
  4. Availability
  5. Radiation dose (aka histologic cost)
  6. $ Cost
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3
Q

Diagnostic Imaging of the
Temporomandibular Joint
(8)

A

*2D Imaging – skull radiography
*Panoramic
*CBCT
*MRI
*Arthrography
*Ultrasound
*Nuclear Medicine
*PET-CT

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4
Q

I. Imaging Techniques for Osseous Structures
* 2D skull imaging
(4)

A
  • Panoramic (has replaced 2D(skull) imaging – transcranial, transorbital, transpharyngeal, submental vertex)
  • CBCT (preferred CT technique for dentistry)
  • MDCT
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5
Q

II. Imaging Techniques for Soft Tissue Structures
(3)

A

MRI
* Arthrography
* Ultrasound

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6
Q

III. Imaging Techniques for Metabolic Activity
(2)

A
  • Nuclear Medicine
  • PET-CT
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7
Q

2D Skull Radiography
Advantages:
(3)

A
  • Readily available and accessible health care modality
  • Broad anatomic region imaged to evaluate the TMJ,
    mandible, maxilla, paranasal sinuses, and skull base in one
    radiograph.
  • Relatively low dose of ionizing radiation
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8
Q

2D Skull Radiography
Disadvantages:
(2)

A
  • Limitations include: magnification, superimposition of all
    dense skull anatomy
  • Lacks fine anatomical detail
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9
Q

PA Skull

A

Beam is 900 to sensor and
parallel to mid-sagittal skull
plane
Mid-sagittal skull plane is
900 to sensor

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10
Q

Panoramic Radiography
Advantages:
(5)

A
  • Simple and quick to perform.
  • Broad anatomic region imaged to evaluate the TMJ,
    mandible, maxilla, maxillary sinuses, teeth and
    periodontium in one radiograph.
  • Excellent for identifying fractures, gross degenerative
    changes in the TMJ, & gross pathological changes of the
    maxilla & mandible.
  • Relatively low dose of ionizing radiation.
  • Ideal for patient who cannot open his/her mouth
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11
Q

Panoramic Radiography
Disadvantages:
(3)

A
  • Limitations include: magnification, superimposition, &
    inherent distortion.
  • Lacks fine anatomical detail.
  • Ghost image artifact radiopaque shadows superimposed over
    normal anatomic structures. This results from projection of x-
    ray beam through a dense object (i.e. spinal column, hard
    palate)
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12
Q

1 day background radiation ~

A

8.5μSv

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13
Q

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Condylar Hypoplasia of traumatic origin on R condyle resulting in

A

loss of
vertical height on mandibular ramus. Hx of fracture of R condyle at age 6.

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14
Q

Panoramic TMJ Projections
(2)

A
  • A special module
    available on most
    contemporary TMJ
    units
  • Panoramic TMJ
    projections can be
    taken in closed,
    protruded and open
    positions
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15
Q

Cone Beam Computed Tomography
(4)

A
  • Introduced in oral &
    maxillofacial
    imaging in 2001
  • Utilizes relatively
    low ionization
    radiation
  • Multiplane (3D)
    visualization of hard
    tissues
  • no visualization of
    soft tissues
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16
Q

Cone Beam Computed Tomography
(4)

A
  • Introduced in oral & maxillofacial imaging in 2001
  • Utilizes relatively low ionization radiation
  • Multiplane (3D) visualization of hard tissues
  • no visualization of soft tissues
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17
Q

CBCT Advantages
(6)

A
  • Controlled
    magnification
  • Lack of
    superimposition
  • Absence of
    geometric distortion
  • Multiplanar & 3D display
  • Ease in data acquisition,
    reconstruction & display
  • Improved structure
    visualization &
    diagnostic efficacy
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18
Q

TMJ Articular Disorders

A
  • Non-Inflammatory (DJD, OA)
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19
Q

Early Remodeling Changes
(5)

A
  • temporal fossa and condylar
    process demonstrate intact
    cortices with physiologic thickness.
  • trabecular patterns are within
    physiologic limits
  • Right - mild flattening of the
    condylar articular cortex
  • Left – mild flattening of medial side
    of condylar articular cortex
  • condylar processes are slightly
    posteriorly displaced in the
    temporal fossa in the closed
    mandibular position. The posterior
    positioning increases the joint
    spaces.
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20
Q

On the open view, the condylar processes translate to
positions just posterior to the crest of the articular eminence
* this indicates

A

slight limitation to the range of condylar
translation

21
Q

Impression:
Bilateral physiologic remodeling with evidence of
degenerative joint disease. The lack of consistent cortication in the
left TMJ is indicative of active —.

A

osteoarthritis

22
Q

Multi-Detector Computed Tomography
(MDCT)
a.k.a.
(4)

A
  • Multislice CT (MSCT)
  • Multidetector Helical CT
  • Multirow CT
  • Multirow Helical CT
23
Q

Images constructed in the anatomic
planes of imaging;
(3)

A
  1. Coronal (frontal)
  2. Axial (transverse)
  3. Sagittal
24
Q

MDCT
(4)

A
  • X-ray tube & detector revolve around patient
    and data is stored in computer
  • Similar hard tissue pathology in sinuses, TMJ,
    head and neck as CBCT
  • Not useful in evaluation of disc displacement
    due to poor reliability of imaging the disc and
    superiority of MRI
  • Pt receives higher dose of radiation
    compared to dental CBCT due to larger Field
    of view (FOV)
25
Q

Computed Tomography (CT)
* ADVANTAGES
(4)

A
  • Eliminates superimposition of images of structures
    superficial/deep to area of interest
  • Differentiates between tissues easily due to high-
    contrast resolution and “windowing” ability
  • Stored images are reconstructed in axial, coronal &
    sagittal planes from a single imaging procedure
  • Better insurance benefits (maybe)
26
Q

Disadvantages of C.T.
(3)

A

1) High dose of ionizing radiation
2) Expensive and not as readily available as
conventional imaging
3) Sensitive to artifacts from metallic
restorations and patient movement

27
Q

Magnetic Resonance Imaging
(MRI)
* One of the most important advantages MR
has is the ability to

A

separate tissues with
extracellular water from cellular tissues
with intracellular water

28
Q

Components of
Magnetic Resonance Imaging
(MRI)
(3)

A
  1. Magnets
  2. Resonant energy
  3. Imaging
29
Q

MRI System
(2)

A

Image Capture
Image Processing

30
Q

Experiences for the Patient
(3)

A
  • Confined space
  • “Clanging” noise
  • Mild vibration and movement
31
Q

skipped
TMJ Articular Disorders
* Disc Derangements
(6)

A

1 - No evidence of Internal Derangement (NID)
Normal
2 - Meniscal (Disk) Displacement with Reduction
3 - Meniscal (Disk) Displacement without
Reduction
4 - Meniscal (Disk) Displacement without
Reduction Associated with Perforation
5 - Meniscal (Disk) Displacement without
Reduction and Perforation and Degenerative
Joint Disease
6 - Ankylosis

32
Q

Magnetic Resonance Imaging
Advantages of the M.R.I.
(3)

A

1) No ionizing radiation
2) Best soft tissue imaging;
suspected articular disc disorders, particularly
disc displacement, edema, perforation, soft
tissue adhesions, & tumors
3) Physically painless

33
Q

Disadvantages of MRI
(5)

A

1) Sensitive to motion artifacts
2) Expensive financial and temporal demands
3) Claustrophobia
4) Psychologically difficult to tolerate
5) Disc displacement is over diagnosed with
15 -35% false- positive findings

34
Q

MRI Concluding Comments
* Best modality to study soft tissue disease; — most common imaging sequences to evaluate
change in soft tissue structures
* Functional studies of …
* Poor reliability in depicting —
* MRI accuracy is no greater than clinical
examination for detecting —

A

T1 and T2
fluid dynamics in vascular
channels
disc perforation
disc displacement
without reduction

35
Q

Arthrography Tray Armamentarium
Arthrography of TMJ Synovial
Spaces is best imaging for

A

meniscal perforation

36
Q

Arthrography
* What is it
* TMJ uses are 3
* Functioning of condyle/disc relationship can
be assessed with use of 2

r

A

radiographic contrast medium is injected into
the inferior/superior joint synovial space(s)
and the fill pattern is evaluated
radiographically; primarily with tomography

disc position, meniscal/disk
perforation and fibrosis

fluoroscopy and
videotaping.

37
Q

Arthrography
Limited use at present due to wide
availability of
* Use on selected patient cases when
dynamic imaging results will alter the
course of treatment or when indicated
prior to —
* Most reliable method for identification of
—

A

MRI and patient
discomfort
joint lavage
perforation in the articular disc.

38
Q

Arthrography
Disadvantages
(4)

A
  • Invasive
  • Ionizing radiation
  • Discomfort due to injection of contrast medium
  • Possible hypersensitivity to contrast agent
39
Q

Ultrasound of Normal TMJ
(4)

A
  • Low financial cost
  • Less invasive
  • Detects fluid in the joint space
  • Can be evaluated in open and closed
    jaw positions
    Ultrasound of Normal TMJ
40
Q

Nuclear Medicine Bone Scan
(4)

A
  • Imaging technique where bone binds a
    radioisotope Tc99
  • Gamma camera takes images of where the
    radioisotope has collected
  • Metabolic activity determines degree of
    radioisotope binding
  • Binding determines the signal strentgth
41
Q

Nuclear Medicine Bone Scan
Advantages
(1)

A

1) Radioactive isotope concentrates in areas
of rapid bone turnover and gives positive
response with 10% increase of osteoblastic
activity

42
Q

Nuclear Medicine Bone Scan
Disadvantages
(3)

A

1) Expensive and invasive
2) Morphologic changes not imaged
3) Findings not specific to any disease process

43
Q

PET CT
(2)

A
  • Combination of PET and CT is referred to as hybrid
    or fusion imaging
  • Superior to plain nuclear medicine alone
44
Q

PET CT
Useful for:
(3)

A
  • location of a tumor
  • followup of chemotherapy or surgery
  • staging dementia, evaluate stroke
45
Q

PET - CT FDG Overview
Positron Emission Tomography-
Computed Tomography
(2)

A

» Fluorine-18 (18F) is a positron-
emitting radioactive isotope that
is used with a glucose analogue
for quantitative imaging i
» Computed tomography (CT) is
fused or co-registered with the
PET scan to aid in interpretation

46
Q

Increased FDG uptake is evident as

A

increased brightness in left
condyle laterally and superiorly. Comparison of left and right
condyles joints illustrates difference in FDG uptake.

47
Q

PET SCAN
Advantages
(2)

A
  • Allows functional study of a metabolic
    process
  • Provides a visual image that
    corresponds with patient anatomy
48
Q

PET SCAN
Disadvantages
(3)

A
  • Higher dosimetry
  • High finances
  • Slow imaging; not capable for time
    sequences > 30 seconds

DMOP (15 decks)

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