GOOD MORNING

TEMPOROMANDIBULAR JOINT ARTHROGRAPHY

Presentor:Reman Dhakal

Roll no. 13

Contents

• Normal anatomy of TMJ• Introduction of Arthrography• Types of Arthrography• Advantages of Arthrography• Procedure• Limitation and complication• Conclusion• Refrences

Anatomy of TMJ

Introduction

• 1947 - Dr. Fleming Norgaard , 1970s - Wilkes

• Arthrography involves injection of a radiopaque contrast material into the joint spaces. The space occupied by the disc can then be visualised lying between the layers of contrast material

TYPES OF ARTHROGRAPHY

SINGLE CONTRAST

ARTHROGRAPHY

•Injection of contrast material into the lower joint spaces

DOUBLE CONTRAST

RADIOGRAPHY

•Injecting contrast material into both the spaces and viewing the configuration and position of the disc as contrast material in both spaces

Uses 1. Information regarding the soft tissue

components.2. Presence of adhesions, perforations and

discontinuities in the capsule 3. Correct pre-operative diagnosis of loose bodies

(joint mice)4. Distinguish the synovial changes of an

inflammatory arthritis from an internal derangement resulting from meniscal dysfunction

ProcedurePatient’s position : lateral recumbent with head tilted.Condylar identification : posterosuperior aspectLocal anesthesia : superficial skinFilling of contrast media in tube : no air bubble Introduction of needle containing contrast media :

jaw closed positionWhen condyle is encountered : slight opening of

mouth Injection of contrast media : 0.4 – 0.5 mlWithdrawn of needle and fluoroscopic videotape

image are recorded

LIMITATIONS

1. Direct medial or lateral displacements are difficult to interpret.

2. Cannot be used when the disc is severely de-formed

3. Contraindicated in acute joint infection.

Disadvantages

• pain• Allergic reaction to iodine or contrast media• Iodine may bring about fibrosis.• Very strict asepsis has to be maintain.• Capsule may rupture if too much contrast media is injected.• Parotitis has been reported.• Intravasation of contrast material infrequently occurs ---

Epinephrine in a dose of 0.03 ml (1:1000) per 3ml of contrast material is recommended.

• Rarely transient facial paralysis– rapid injection of lidocaine.

SUMMARY

• Temporomandibular joint arthrography has gained acceptance for the diagnosis of internal derangements of the temporo-mandibular joint. Arthrography is highly accurate in depicting internal derangements of the joint and in aiding differential diagnosis. TMJ arthrography will likely remain a diagnostic procedure inspite of the recent developments with MRI .

• The dynamics meniscal derangements especially in the clicking jaw, remains an invaluable aspect of this modality in contrast to the static images obtained with CT and MRI

REFRENCES Text book of ORAL MEDICINE, ORAL DIAGNOSIS AND ORAL RADIOLOGY -By Ravikiran Ongole 2ND edition.

Single air contrast arthrography for temporomandibular joint disorder using limited cone beam computed tomography for dental use ( K Honda*1, K Matumoto1, M Kashima1, Y Takano1, S Kawashima1, and Y Arai2

TEMPOROMANDIBULAR JOINT ARTHROGRAPHY AN OVERVIEW *RAVIKIRAN ONGOLE, **NAVJYOT PANJRATH, ***AUSWAF AHSAN & ****KEERTHILATHA M. PAI

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