Temporomandibular joint disorders (TJDs) are problems that affect the joint between the lower jaw and the base of the skull. A TJD is not usually a serious condition, but symptoms can impact significantly on quality of life (NHS Choices).

This book is a practical guide to diagnostic aids for temporomandibular joint disorders, to help trainees and practitioners select appropriate treatment plans.

Beginning with an introduction to the anatomy of the temporomandibular joint (TMJ) and classification of associated disorders, the following chapters describe different diagnostic techniques including computed tomography (CT), plain film imaging, arthrography (injection of contrast material into the joint followed by X-Ray, MRI or CT), and nuclear medicine imaging.

The final chapters examine special cases such as imaging of the TMJ in rheumatic disease and in juvenile rheumatoid arthritis.
Key points

Practical guide to diagnostic aids for temporomandibular joint disorders
Covers different imaging techniques
Covers TMJ imaging in special cases
Includes more than 100 images

1. Introduction 1
2. Gross Anatomy of the TMJ 3
Condyle 3
Mandibular Fossa 4
Interarticular Disk 6
Posterior Attachment (Retrodiscal Tissues) 6
TMJ Bony Relationships 6
3. Classification of Temporomandibular Joint Disorders 9
4. Abnormalities of the TMJ 11
Developmental Abnormalities 11
Soft Tissue Abnormalities 17
Remodeling and Arthritic Conditions 21
Degenerative Joint Disease 22
Rheumatoid Arthritis 26
Juvenile Chronic Arthritis 27
Psoriatic Arthritis and Ankylosing Spondylitis 28
Septic Arthritis 29
Synovial Chondromatosis 30
Chondrocalcinosis 31
Trauma 31
Dislocation 32
Fracture 33
Ankylosis 34
Tumors 35
5. Diagnostic Imaging of the TMJ 38
Hard Tissue Imaging 38
Conventional Tomography 43
Soft Tissue Imaging 45
Magnetic Resonance Imaging 45
6. Plain Film Imaging and Tomography 48
Submentovertical (Axial) Projection 48
Lateral Projections 49
Transpharyngeal Projection 51
Frontal Projections 52
Panoramic Views 53
Tomography 54
Prelims.indd 13 19-03-2014 12:42:04xiv Diagnostic Aids in Temporomandibular Joint Disorders
Interpretation of Findings 55
Radiation Dosimetry 57
Selection of Radiographic Technique 57
7. Computed Tomography 58
CT Scanning (Technical Considerations) 58
TMJ CT Scanning (Rationale) 61
CT Number Highlighting (Blink Mode) 62
Minimizing Adverse Effects of Highlighting 64
Edge Response Function (ERF) 64
Minimizing Adverse Effects of ERF 65
Intradiscal Inhomogeneities 65
Minimizing Adverse Effects of Intradiscal Inhomogeneities 65
Three-dimensional CT Reconstructions 65
8. Arthrography of the Inferior Joint Space of the
Temporomandibular Joint 67
Indications for Arthrography 67
Technique of TMJ Arthrography 68
Post-Arthrography Complications 70
Contrast Material 71
Interpreting the Arthrogram 71
Internal Derangements 72
Miscellaneous Uses of TMJ Arthrography 75
9. Double Contrast Arthrography 77
Development of Technique 77
Equipment and Technique 77
Local Anesthetic and Joint Puncture 78
Arthrographic Findings 83
Post-treatment Imaging 91
Complications of Double Contrast Arthrography 92
Comparison between Double and Single Contrast Arthrography 93
10. Digital Subtraction Arthrography 95
Digital Imaging 95
Equipment for Digital Radiography 96
Technique for Digital Subtraction Arthrography and
Task-Oriented Digital Imaging 98
Internal Derangements 99
Inflammatory Disease 100
Degenerative Disease 100
Advantages of Digital Subtraction Arthrography 101
Prelims.indd 14 19-03-2014 12:42:04Contents xv
11. Magnetic Resonance Imaging 103
Physical Principles 103
Imaging Technology 105
Instrumentation 106
Magnetic Resonance Imaging of the TMJ Techniques 108
Normal Magnetic Resonance Image Anatomy of TMJ 111
Magnetic Resonance Imaging of Internal Derangement 113
MRI Characteristics of Disk Displacement 113
Future Perspectives 118
12. Nuclear Medicine Imaging 119
Radiopharmaceutical 119
Instrumentation 120
Imaging of the TMJ 120
Image Interpretation 121
Image Correlation 123
13. Selection of Imaging Modalities for Patients
Presenting with Symptoms of Internal Derangement 126
Screening Modalities 127
Imaging Diagnosis of Internal Derangement 128
Arthroscopy 129
14. Imaging of the Temporomandibular Joint in
Rheumatic Disease 130
Rheumatoid Arthritis 130
Involvement of TMJ 131
Plain Film and Panoramic Radiography 132
Tomography 133
Computed Tomography 135
Arthrography 136
Magnetic Resonance Imaging (MRI) 137
Scintigraphy 139
15. Imaging of the Temporomandibular Joint in
Juvenile Rheumatoid Arthritis 145
Juvenile Rheumatoid Arthritis 145
Involvement of TMJ and Jaw Skeleton 147
Bibliograpy