High frequency US of the temporomandibualar joint (TMJ) - practical guide

Transcription

1 High frequency US of the temporomandibualar joint (TMJ) - practical guide Poster No.: C-2352 Congress: ECR 2014 Type: Educational Exhibit Authors: M. Lasecki, C. M. Olchowy, K. Kaczorowski, J. S#onina, W. G. Ugorski, U. Zaleska-Dorobisz; Wroclaw/PL Keywords: DOI: Anatomy, Musculoskeletal joint, Musculoskeletal soft tissue, Ultrasound, Education, Education and training /ecr2014/C-2352 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 12

2 Learning objectives The purpose of this presentation is to: 1. illustrate the normal anatomy and abnormalities of the TMJ 2. present "tricks and tips" helping to obtain highly diagnostic images. 3. make o proposal easy-to-follow check-list protocol 4. show high-resolution images, videos and anatomical schemes Background TMJ dysfunction is a common condition, leading to pain radiating to temporal bone, neck and palatine. Conventional X-ray of TMI did not reveal abnormalities In patients with mild TMI dysfunction. High frequency US may reveal typical findings and distinguish them from other similar conditions (esp. giant cell arteritis). Anatomical structures are situated superficially, therefore advantages of using the highest frequencies can be applied. Findings and procedure details There are several methods for evaluation TMDs, such as sonography, MR, CT or arthrography. Sonography has several important advantages and seems to be a very valuable method for this purpose. It is noninvasive, less expensive than any other imaging techniques mentioned above, it can be used to view the joint in movement, and - what is the most important - it can provide information about the disc displacement of the TMJ. All images presented on this poster were obtained on high-performance Toshiba Aplio 500 ultrasound machine using high frequency linear transducer ( MHz). Ultrasound examination of the TMJ consists of evaluation of its images in neutral jaw position and on open jaw, always bilaterally. There are two transducer positions for examination of each joint: 1) Horizontal position Page 2 of 12

3 The probe is positioned in a transverse direction running parallel to the Camper line which intersects the ala of the nose and the tragus of the ear. Fig. 1: TMJ. Probe position. The probe is positioned in a transverse direction running parallel to the Camper line which intersects the ala of the nose and the tragus of the ear. References: Department of Radiology, Wroclaw Medical University, University Hospital - Wroclaw/PL TIPS AND TRICKS: The transducer should be placed next to the tragus of the ear and then carefully tilted up and down to obtain optimal visualization of the lateral part of the mandibular condyle. The condyle can be clearly seen as the line nearest to the skin surface. Page 3 of 12

4 This probe position gives a transverse image of the TMJ. Fig. 2: TMJ. transverse view. References: Department of Radiology, Wroclaw Medical University, University Hospital - Wroclaw/PL The most important parameter that could be measured on this image is the distance between mandibular condyle and the articular capsule. Widening of this distance is an indirect evidence of articular disc displacement or intra - articular effusion. The capsular distension greater than 3 mm is a reliable parameter for the presence of TMJ pathology. 2) Vertical position The probe is positioned in a longitudinal direction running perpendicular to the Camper line, in front of the tragus of the ear. Page 4 of 12

5 Fig. 3: TMJ. Probe position. The probe is positioned in a longitudinal direction running perpendicular to the Camper line, in front of the tragus of the ear. References: Department of Radiology, Wroclaw Medical University, University Hospital - Wroclaw/PL TIPS AND TRICKS: It is not easy to obtain this visualization. The transducer should be placed next to the tragus of the ear and then carefully tilted back to front. The joint is visible just before masseter muscle appears. This probe position gives a coronal image of the TMJ. Page 5 of 12

6 Fig. 4: TMJ. Coronal (longitudinal) view References: Department of Radiology, Wroclaw Medical University, University Hospital - Wroclaw/PL Video loop showing how to find TMJ in longitudinal position of the probe (coronal image). Page 6 of 12

7 Fig. 5: The transducer is placed next to the tragus (as showed on fig. 3) of the ear and then carefully tilted back to front. At first temporal bone is visible. As the probe is moved to the front massive muscular structure can be seen (masseter). TMJ is is located just between those two big structures. The joint is visible just before masseter muscle appears. References: Department of Radiology, Wroclaw Medical University, University Hospital - Wroclaw/PL In this probe position it is possible to visualize chondral disc localization and its outlook, mandibular condyle and temporal bone articular surfaces. When the mouth is closed, the disc position is considered normal if the disc edge is located at approximately 11 o'clock with respect to the mandibular condyle. Page 7 of 12

8 Fig. 6: TMJ. Normal position of chondral disc. References: Department of Radiology, Wroclaw Medical University, University Hospital - Wroclaw/PL Images for this section: Page 8 of 12

9 Fig. 1: TMJ. Probe position. The probe is positioned in a transverse direction running parallel to the Camper line which intersects the ala of the nose and the tragus of the ear. Page 9 of 12

10 Fig. 2: TMJ. transverse view. Fig. 3: TMJ. Probe position. The probe is positioned in a longitudinal direction running perpendicular to the Camper line, in front of the tragus of the ear. Page 10 of 12

11 Fig. 4: TMJ. Coronal (longitudinal) view Fig. 5: The transducer is placed next to the tragus (as showed on fig. 3) of the ear and then carefully tilted back to front. At first temporal bone is visible. As the probe is moved to the front massive muscular structure can be seen (masseter). TMJ is is located just between those two big structures. The joint is visible just before masseter muscle appears. Page 11 of 12

12 Conclusion 1. High-resolution ultrasound of the TMJ is an efficient, safe, and cost-effective method in evaluation of TMJ soft tissue structures. 2. Knowledge of anatomy is essential for scanning the TMJ accurately and efficiently 3. easy-to-follow check-list protocol can be useful tool in everyday practice Personal information References References 1. Mello Junior, C. F. D., Saito, O. D. C., & Guimarães Filho, H. A. (2011). Sonographic evaluation of temporomandibular joint internal disorders. Radiologia Brasileira, 44(6), Hayashi, T., Ito, J., Koyama, J. I., & Yamada, K. (2001). The accuracy of sonography for evaluation of internal derangement of the temporomandibular joint in asymptomatic elementary school children: comparison with MR and CT. American journal of neuroradiology, 22(4), Manfredini, D., Tognini, F., Melchiorre, D., Cantini, E., & Bosco, M. (2003). The role of ultrasonography in the diagnosis of temporomandibular joint disc displacement and intraarticular effusion. Minerva stomatologica, 52(3), Pereira, L. J., Gavião, M. B. D., Bonjardim, L. R., & Castelo, P. M. (2007). Ultrasound and tomographic evaluation of temporomandibular joints in adolescents with and without signs and symptoms of temporomandibular disorders: a pilot study. Dentomaxillofacial Radiology, 36(7), Page 12 of 12