Title: Week 7 :Mandible Week 8 : TMJ
1Week 7 Mandible Week 8 TMJ
2Mandible
3Mandible (Slide 3)
- Only movable bone in the skull
- Densest largest facial bone
- 2 bones at birth
- Contains mental foramina
4Temporomandibular Joint
5Indications
6PA Mandible (rami)
- ________ or ________
- _________________ and nose on IR
- ________ ________ perpendicular to IR
- CR perpendicular to exit _____________
7PA Mandible (rami) Radiograph
- 1. Mandibular ________
- 2. ________ portion of ______ are visualized
- 3. Entire mandible without _________ or _________
- 4. _________ or __________ displacement
8PA Mandible Rami- Diagram
9PA Mandible (body)
- ________or _______
- ____ and ____ on grid device or table
- Mandibular symphysis ______with plane of IR
- ___ ___ perpendicular to IR
- CR perpendicular to level of ________
10PA Mandible (body) Radiograph
- Contrast and density are sufficient to view body
and rami - Sharp bony detail indicating no motion
11PA Axial (rami)Mandible Positioning
- Seated or _______
- Forehead and _____ on IR
- _____ MSP perpendicular to IR
- CR 20- 25 _________, centered to exit
_______________
12PA Axial (rami)Mandible Radiographs
- Heads of ________ are visible through ______
processes. - Condyloid processes are slightly _________.
- Proper density
- No rotation or tilt
13PA Axial (body)Mandible Positioning
- Seated or Prone
- ____ and ____on grid device or table
- mandibular symphysis ___________ with IR
- ____ _____ perpendicular to IR
- CR between TMJs, 30 ____________
14PA Axial (body)Mandible Radiographs
- TMJs just ________ to mastoid process
- Symmetric ______
- Adequate contrast and density
15Axiolateral Oblique Positioning for Ramus
- Seated, semiprone or semisupine
- IPL ____________ to IR
- Mouth closed- _________ together
- Extend neck, chin ___________forward
- CR __ degrees _____to pass through area of
interest
16Axiolateral Oblique Radiograph for Ramus
- No overlap of ramus by opposite side of mandible
- No elongation or foreshortening of ramus
- No superimposition of ramus by c-spine
17Axiolateral Oblique Positioning for Body
- Seated, semiprone or semisupine
- IPL perpendicular to IR
- Mouth closed- teeth together
- Extend neck, chin jutted forward
- Rotate pts head _________ degrees toward IR
- CR 25 degrees cephalic to pass through area of
interest
18Axiolateral Oblique Radiograph for Body
- No overlap of body by opposite side of mandible
- No elongation or foreshortening of body
- No superimposition of body by c-spine
19Axiolateral Oblique Positioning for Mandibular
Symphysis
- Seated, semiprone or semisupine
- IPL perpendicular to IR
- Mouth closed- teeth together
- Extend neck, chin jutted forward
- Rotate pts head __ degrees toward IR
- CR 25 degrees cephalic to pass through area of
interest
20Axiolateral Oblique Radiograph for Mandibular
symphysis
- No overlap of mentum by the opposite side of
mandible - No foreshortening of the mentum region
21SMV Mandible
- IOML parallel to IR
- Shows coronoid and condylod processes orf rami
22SMV
23SMV Radiograph
- Condyles anterior to pars petrosae
- Symphysis extended almost past border of face
- Equal distance from condyles to lateral margin of
skull
24Panorex Mandible
- Explain how tube/image receptor move
- IOML perpendicular
- Stand straight, not jutting chin forward
- Instruct pt to keep lips together and tongue on
roof of mouth
25Panorex Mandible Radiographs
- Demonstrates teeth, mandible, TMJs
- Density are uniform across image
- No artifacts
26Fractures and Surgical Repair
27Surgical Fixation
28Jaw wired shut
29(No Transcript)
30(No Transcript)
31Temporomandibular Articulations
32AP Axial TMJ
- Supine or seated upright
- Posterior teeth closed and in contact
- For open mouth- wide as possible without chin
jutted forward - OML perp to IR
- CR 35 caudad, centered midway between TMJs.
- Enters approx 3 above nasion
33AP Axial TMJ Radiograph
- No rotation
- Minimal superimposition of petrosa on condyle in
closed mouth - Condyle and TMJ below pars petrosa in open mouth
34Axiolateral Oblique TMJ
- Semiprone or seated
- Center ½ anterior to EAM
- Rest cheek on grid device
- Rotate MSP approx 15 degrees toward IR
- IPL perpendicular
- CR 15 caudad exiting through TMJ closest to IR
about 1 ½ superior to upside EAM
35Axiolateral Oblique TMJ Radiograph
- TMJ
- Condyle lying in mandibular fossa in closed mouth
- Condyle lying inferior to articular tubercle in
open mouth
36Axiolateral Oblique Open mouth
37Axiolateral Oblique Open mouth
Temporomandibular fossa
condyle
Coronoid
38Axiolateral ObliqueClosed mouth
39Axiolateral ObliqueClosed mouth
Temporomandibular fossa
condyle
coronoid
40Axiolateral TMJs
- CR 25-30 degrees
- Enters ½ anterior and 2 superior to upside EAM
- IPL Perpendicular
- MSP parallel
41Evaluation Criteria
- TMJ lying anterior to the EAM
- Condyle in fossa (closed mouth)
- Condyle inrerfior to articular tubercle (open
mouthP
42Axiolateral Closed Mouth
43Axiolateral Open Mouth