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