《牙科放射线学》PPT课件.ppt

牙科放射線學(2),陳玉昆教授:高雄醫學大學 口腔病理科 07-31211012755,Temporomandibular Joint Radiography,顳顎關節放射線攝影術,Normal anatomy of TMJ Investigations available for TMJ Pathological conditions that can affect TMJ,學 習 目 標,1.Eric Whaites:Essentials of dental radiography&radiology 3rd edition,Chapter 29,p.371-388,2.Eric Whaites:Essentials of dental radiography&radiology 1st edition,Chapter 28,p.297-323.,References,3.Rosenberg et al,Aust Dent J 1999;44:106,4.Kaohsiung Medical University,Oral Pathology Department,Normal anatomy of TMJ Investigations available for TMJ Pathological conditions that can affect TMJ,Subtopics,Ref.1,Basics components of the TMJ:Mandibular component:condyle head(Hard tissue)Disc(Soft tissue)Temporal component:glenoid fossa&articular eminence(Hard tissue)Capsule surround the joint(Soft tissue),Normal Anatomy,Lateral,Anterior,Base,Normal anatomy-Dry skull,Ref.1,Rotatory and translatory movements of condyle during normal mouth opening,Ref.1,Conventional radiographic projections Other techniques and investigations,Investigations,Transcranial Transpharyngeal Panoramic Reverse Towns Transorbital Tomography,linear,Summary of different parts of TMJshown by the conventional projections,Ref.1,Transcranial Lateral aspect of:Glenoid fossa Articular eminence Joint space Condylar headTranspharyngeal Lateral view of:Condylar head&neck Articular eminenceDental panoramic Lateral view of tomograph both condylar heads,Reverse Townes Posterior view of:both condylar head&necksTransorbital Anterior view of:Condylar head&neck Articular eminenceTomography All aspects of:Glenoid fossa Articular eminence Joint space Condylar head,Transcranial,Mouth close,Transcranial,Centric occlusion,Ref.1,Radiological term joint space:RL zone between condylar head&glenoid fossa,which includes discs&upper&lower anatomical joint spaces,Diagnostic information,Closed view,Open view,Transcranial,Main indications,Transpharyngeal,TMJ pain dysfunction syndromeTo investigate the presence of joint disease,particularly osteoarthritis and rheumatoidarthritisTo investigate pathological conditionsaffecting the condylar head,including cysts ortumorsFractures of the neck and head of the condyle,Diagnostic information,The shape of the head of condyle and condition of the articular surface from lateral aspect A comparison of both condylar heads,Transpharyngeal,Ref.1,Dental panoramic tomograph,Main indications,Main indications,TMJ pain dysfunction syndrome To investigate disease within the joint To investigate pathological conditions affecting the condylar heads Fractures of the condylar head or neck Condylar hypo/hyperplasia,Diagnostic information,The shape of the condylar head and condition of the articular surface from lateral aspect A direct comparison of both condylar heads,Dental panoramic tomograph,Transcranialview taken frompanoramicmachine,Ref.4,Reverse Townes,Mouth open,Ref.1,Diagnostic information,The shape of the condylar heads and condition of the articular surfaces from the posterior aspect A direct comparsion of both condyles,Reverse Townes,Ref.1,Transorbital(Zimmers view),To investigate the articular surface of the condyle and disease within the joint High fractures of the condylar neck to show medio-lateral displacement,This view is rarely used due tothe risk of damage to the lens ofeye from radiationHowever,it provides an AP view ofthe condylar head-an aspect notshown by other radiographs,Mouth open,Ref.2,Main indications,Transorbital,Ref.2,The shape of the condylar head and neck from the anterior aspect The condition of the articular surface from the anterior aspect,Diagnostic information,Tomography,Tomography,Ref.1,Diagnostic information,The size of the joint space The position of the head of the condyle within the fossa The shape of the head of the condyle and condition of the articular surface including the medial and lateral aspects The shape and condition of the articular fossa and eminence Information on all aspects of the joints The positions and orientation of the fracture fragments,Tomography,Other techniques&investigations,下列何者是AP view為：A.Panoramic radiographyB.Transcranial projectionC.TransorbitalD.Modified Towns view,Arthrography,Main indications,Longstanding TMJ pain dysfunction unresponsive to simple treatments Persistent history of locking Limited opening of unknown etiology,Main contraindications,Acute joint infection Allergy to iodine or contrast medium,Diagnostic information,Dynamic information on the position of the joint components and disc as they move in relation to one another Static images of the joint components with the mouth closed and with the mouth open.Any anterior or anteromedial displacement of the disc can be observed The integrity of the disc,i.e.any perforations,Note:Outline the lower joint space usually provides more useful information on the disc,Arthrography,Ref.1,Computed tomography,Main indications,Diagnostic information,The shape of the condyle and the condition of the articular surface The condition of the glenoid fossa and eminence The position and shape of the disc The integrity of the disc and its soft tissue attachments The nature of any condylar head disease,It provides sectional or slice images of the joint It can produce images of the hard and soft tissues in the joint,including the disc,in different planes,Computed tomography,Ref.4,Magnetic resonance imaging,Condylar head,Anteriordisplaceddisc,Main indications,When diagnosis of internal derangements is in doubt As a preoperative assessment before disc surgery,Ref.4,Arthroscopy,It gives direct visualization of the TMJ and allows certain interventional procedures to be performed,including Washing out the joint with saline Introduction of steroids directly into the joint Division of adhesions Removal of loose bodies from within the joint,Arthroscopy is considered as the last line of investigation before full surgical exploration ofthe joint is carried,Main indications,Upper joint spaceLower joint spaceDiscProlene sutureYeates drainExternal auditory meatus,Arthroscopy,Ref.3,Fibrillation(顫動),Arthroscopy,Ref.4,Main pathological conditions affecting the TMJ,TMJ pain dysfunction syndromeInternal derangementsOsteoarthritisJuvenile rheumatoid arthritis(Stills disease)AnkylosisTumorsFracturesDevelopmental anomalies,(史迪爾氏症),Main pathological conditions affecting the TMJ,最可能的診斷為：A.AmeloblastomaB.Squamous cell carcinomaC.HemangiomaD.Central giant cell granuloma,A multilocular radiolucency;(B),(C)Surgical specimen;(D)Costochondral graft;(E)Histological examination:bony trabeculae entrapped by multiple blood vessels,Knowing:Normal anatomy of TMJ What investigations are available for TMJ Main pathological conditions that can affect TMJ,Summaries,What are the key pointsof this lecture?,Have you alreadyremember these three points(red,yellow&green)?,Revision,The End,