Radiographic examinations of the temporomandibular joint Dobó-Nagy, Csaba Semmelweis University Knowledge required by clinicians   Anatomy Available investigations   Clinical indications How each investigation is performed     position open or closed Limitations Pathological conditions Anatomical section of a normal TMJ disk Glenoid fossa tubercle (articular eminence) condyle lateral pterygoid muscle Skull base model A L P R Visualization of the TMJ Main radiographyc projections of the TMJ TrCran TrOrb TrPhar RevTowne SMV Transcranial projection Reverse Towne’s Transorbital Transpharyngeal (Parma) Dental panoramic tomograph Condylar silhouette Projection of panoramic tomography Double lateral view of TMJ SMV Corrected tomography Limitations of routin radiographic projections     Soft tissue abnormalities Effusion Small and localised bony defects One aspect of the joint (except for tomography) Main pathological signs of TMJ A B C D E F G H I Adaptive response Osteophyte formation Fracture osteochondroma Dislocaition of disk without reduction Diagnostic informations of MR      Disk displacement The integrity of the disk and its soft tissue attachments Effusion (T2-weighted image) Integrity of the articular surface Research (gold standard) CT coronal view CT sagittal view CBCT imaging of a normal TMJ CBCT examination of arthritis Osteophyte Ankylosis Diagnostic informations of CT      The shape of the bony compartments Information on all aspects of the joint The condition of the articular surface The size of the joint space Integrity of the disk and soft tissue attachements Size of TMJ space and soft tissue changes Diagnostic informations by modalities Radiograpic modalities panoramic traditional CBCT/CT MRI anatomy hard soft pathology hard soft adaptation hard soft Suggested hierarchy of imaging modalities in TMJ disease soft tissue changes panoramic MRI bone changes tomography Primary examination: •dysfunction •organic changes CBCT, CT •failed treatment Summary of views of main projections projection area of joint shown Transcranial lateral aspect Transpharyngeal lateral aspect Dental panoramic lateral aspect Reverse Towne’s posterior view Transorbital anterior view