investigations of tmd
Post on 11-Apr-2017
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Investigations of TMD
Group F
Sushant Pandey
Tutor : Dr. Diksha Agrawal
Objectives To know about TMD To know the importance of history in investigation To know different types of physical examination
involved To know about different types of radiographical
examinations involved
Temporomandibular Disorder:
TMD is the collective term embracing a number of clinical problems that involve the masticatory musculature, the TMJ and associated structures or both.
TMDs are characterized by :1. Facial pain in TMJ region and/or the muscles of
mastication2. Limitation or deviation in the mandibular range of
motion3. TMJ sound during jaw movements and functions
History The purpose of history taking is to identify patients with
subclinical signs and symptoms that the patients may not be able to relate but are commonly associated with functional
disturbances of masticatory system.
The screening history consists of several questions that will help orient the clinician to any TMD.
We generally ask the patient questions regarding : Site of pain Duration of pain When is the pain worst ? Areas to which pain is radiated ? Pain while using the jaw Presence of jaw noise Past history of jaw injury or surgery
Physical ExaminationsIt includes : Inspection Palpation
Inspection
Facial asymmetry
We observe :
Facial asymmetry
Swelling
Normal opening range = 35-50 mm
Maximum mouth opening
Normal range = >7 mm
Lateral movements
Occlusion
Openbite Crowding
Examination of other joints
Palpation
Masseter Temporalis
Lateral pterygoid Medial pterygoid
Palpation of TMJ
Intraoral examination
Bruxism Scalloped tongue
OSSEOUES STRUCTURES1. Panoramic Projection2. Plain Film Imaging Modalities (Transpharyngeal, Transorbital,
Transcranial)3. Tomography
SOFT TISSSUE STRUCTURES4. Arthrography5. Magnetic Resonance Imaging (MRI)
Radiological examination
Panoramic Projections
Provides overall view of teeth and jaws and helps in comparison of left and right mandible.
Indication = Asymmetries, Fractures, Extensive erosion
Transcranial Lateral aspect of: Glenoid fossa Articular eminence Joint space Condylar head
Transpharyngeal Lateral view of: Condylar head & neck Articular eminence
Transorbital Anterior view of: Condylar head & neck Articular eminence
Tomography All aspects of: Glenoid fossa Articular eminence Joint space Condylar head
TMJ pain syndrome, Internal derangement, Clicking, mouth opening limitation
TMJ pain syndrome, Osteoarthritis, Rheumatoid Arthritis, Condylar head cyst, Fracture of neck and condyle
Trauma, Fracture
Ankylosis Neoplasms-bone involvementComplex fractures
Indication
ArthrographyIt is a technique in which an indirect image of the disk is obtained by injecting a radiopaque contrast agent into the joint spaces under fluoroscopic guidance.Indication = TMJ pain dysfunction, jaw locking
Magnetic Resonance Imaging
It uses Magnetic field and radiofrequency pulsesIt is used for viewing soft tissues.Indication = Disk displacement, internal derangements
SUMMARY
References White and Pharoah Oral Radiology Principles and Interpretation 6th Edition
Burket's Oral Medicine 11th edition
QUESTIONS ??
Special thanks to our tutor
Dr. Diksha Agrawal
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