Penyusun : ‡ Harris Kusnandar ‡ Deasty Elvina ‡ Jo Carolina ‡ Leonita Hartanti ‡ Inosensius Adi

Disorder of the temporomandibular joint are abnormalities that interfere with the normal form or function of the joint. Arthritides, inflammation, growth abnormalities.

Clinical Features
‡ Temporomandibular joint (TMJ) disfunction is the most common jaw disorder, 86% adults and adolescent showing >1 clinical symptoms. ‡ Signs and symptoms: pain in the TMJ or ear or both, headache, muscle tenderness, joint stiffness, clicking or other joint noises, reduced range of motion, and subluxation.

Application of Diagnostic Imaging
‡ As a supplement information, when: osseus abnormalities or infection suspected, conservative treatment failed, symptoms worsening, history of trauma, clinical signs. ‡ To evaluate: integrity and relationship of the hard and soft tissues, confirm the extent stage of progression of known disease, and evaluate the effects of treatment.

Radiographic anatomy of TMJ

‡ A bonny ellipsoid structure connected to the mandibular ramus by a narrow neck. ‡ The shape of the condyle varies considerably, and these variations may cause difficulty with radiographic interpretation, this underlines the importance of understanding the range of normal appearance.

‡ Most condyles have a pronounced ridge oriented mediolaterally on the anterior surface, marking the anterioinferior limit of the articulating area. ‡ The ridge is the upper limit of the pterygoid fovea, a small depression on the anterior surface at the junction of the condyle and neck. ‡ It is the attachment site of the superior head of the lateral pterygoid muscle and shouldn t be mistaken for an osteophyte (spur), which indicate degenerative joint disease.

‡ Fig 26-1

‡ Temporal components of TMJ are calcified by 6 months of age, complete calcification of cortical borders may not be complete until 20 years of age. ‡ Radiographs of condyles in children may so a little or no evidence of a cortical border. ‡ In the absence of disease, the cortical borders in adults are visible radographically.

Mandibular Fossa
‡ Located at the inferior aspect of the squamous part of the temporal bone, is composed of the glenoid fossa and articular eminence of the temporal bone. Covered with a thin layer of fibrocartilage. ‡ temporal component of TMJ ‡ In normal TMJ, the roof of the fossa , the posterior slope of the articular eminence, and the eminence itself form an S shape when viewed in sagital plane.

‡ Fossa depth varies, and the development of the articular eminence relies on functional stimulus from the condyle.

The mandibular fossa very flat and underdeveloped in patients with micrognathia or condylar agenesis.

‡ All aspects of the temporal component may be pneumatized with small air cells derived from the mastoid air complex. Seen in approximately in 2% of patients.

FIG 26-3

Interarticular Disk
‡ Composed of fibrous connective tissue, located between the condylar head and mandibular fossa. ‡ Diveides the joint cavity into two commpartements, inferior and superior joint spaces. Fig 26-4

‡ During mandibular opening, as the condyle rotates and translates downward and forward , the disk also moves forward and rotates so that s its thin central portion remains between the articulating convexities of the condylar head and articular eminence.

Retrodiskal Tissues
‡ Consists of a bilaminar zone of vascularized and innervated loose fibroelastic tissue. ‡ As the condyle moves forward, tissue of posterior attachment expand in volume, primarily as a result of venous distention, and as the disk move forward, tension is produced in the elastic posterior attachment.
Smooth recoil of the disk

Temporomandibular Joint Bony Relationships
‡ Radiographic joint Space ; between the condyle and temporal component. ‡ The left and right condylar position within the fossa can be determined and compared by the dimensions of the radiographic joint space viewed on collateral lateral images. ‡ Because the radiographic outline of the glenoid fossa and the condyle do not match like a smooth ball and socket joint, the joint space often varies from medial to lateral aspects of the joint.

‡ Fig 26-5

‡ Markedly eccentric condylar positioning usually represents an abnormality. ‡ Exp, inferior condylar positioning (widened joint space) maybe seen in case involving fluid or blood within the joint. ‡ Superior condylar positioning (decreased OR no joint space) may indicate loss, displacement, or perforation of intracapsular soft tissue components.

Condylar Movement
‡ The condyle typically found within a range of 2-5 mm posterior and 5-8 mm anterior in the crest of the eminence. ‡ Reduce condylar translation, has little Or no downward and forward movement and doesn t leave the mandibular fossa seen in patient who clinically have a reduced degree of mouth opening. ‡ Hypermobility : translate >5 mm anterior to the eminence.

Diagnostic Imaging of the TMJ
‡ Depends on the specific clinical problems. ‡ Both joints should be imaged during the examination, for comparison.

Osseus Structures
Panoramic Projection ‡ Provide: overall view of teeth and jaws, comparing the left and right sides of the mandible, as a screening projection to identify odontogenic diseases and other disorder that maybe the source of TMJ symptoms. ‡ Limitation : distorted view of the joints, severe image quality.

‡ Fig 26-6

‡ Gross osseus changes in the condylus, asymmetries, extensive erosions, large osteophytes, tumors, fractures. ‡ Shouldn t be used as a sole imaging modality.

Plain Film Imaging Modality ‡ Combined of: transcranial, transpharyngeal, transorbital, and submentovertex projection.

Conventional Tomography ‡ Is a radiographic technique that produces multiple thin image slices, permitting visualization of the osseus structures essentially free of superimpositions of overlapping structures. Computed Tomography ‡ Two devices available: Conventional CT and CBCT, but only conventional CT provides images of the surrounding soft tissues.

‡ CT useful for determining the presence and extent of ankylosis and neoplasms and degree of bone involvement in arthritides, imaging complex fractures, for evaluating complications from the use of polytetrafluoroethylene or silicon sheet implants.

Soft Tissue Structures
‡ Indications : TMJ pain and dysfunction, clinical finding suggest disk displacement, and symptoms unresponsive to conservative therapy.