Poster_MRT_richtige_Größe [Kompatibilitätsmodus]

Systematic of the temporomandibular MRI Diagnosis
Dr. Gerhard Polzar
Büdingen
EOS Vienna
July 2006
ZA Nikolaos Spyropoulos
Offenbach
Introduction: Systematic in MRI- Diagnostics can describe the pathology of the temporo-mandibular joint (TMJ) and will help to discover the anatomic
structures and diseases in three dimensional view. MR-Images give important information to evaluate chronical pathologic disorders of orthofunctions.
Sections layer:
Parasagittal
Paracoronal
Sections sequence
Representation as
• Main image layer
• Image perpendicularly by the condyle
axis from lat. to med.
• Image in three different lower jaw
positions
• Image layer with Video MRI's
Section sequence
Section seqence
Diagnosis of
To recognize
• Position and anatomical variation
of the caput mandibulae
• Condyle axis in the horizontal
layer
• Position and degenerative
changes of the articular discus
• Discus perforations
• TMJ compressions
• laterally or medially discus
displacements
• Condyle arthrosis
Sections layer
Transversal
Section layer
Section layer
Main layer:
Occlusal bite
therap. protrus. 2-4mm, anter. caudal
Totally ant. discus
displacement
without reposition
Totally anterior discus
displacement
submaximal anter. caudal
Totally discus displacement without reposition,
submax. Open anterior position
Dorsocranial TMJ
arthrosis with
dorsocranial TMJ
compression and
retral TMJ position
(displacement)
Anatomical structures:
MRI-Map
Temporal
lobe of the
cerebrum
m.pter.lat.inf.
m.temporalis
Findings :
Psysiol. discus
position
Strat.
sup.
bil.
Zone
Parasagittal
Partial anterior discus
displacement
Strat.
inf.
m.pter.lat.sup.
meat.acust.extern.
Discus
Zygomatic arch
Coronoid process
m.temp.
Caput
mandible
Maxillary
sinus
Subtotal anterior discus
displacement
KH
Total anter. discus
displacement with
exophyt formation
Lig.lat
A.carot.int.
Findings:
Paracoronal
Lateral discus
displacement
Apatholog. TMJ
Physiolog. joint gap with
discus
Transversal and parasagittal
Advanced condyle arthritis
with painful joint effusion
condyle arthrosis
Musc. masseter and
Musc. pterygoid
lateral displaced
discus- fragment
Fracture notch
Fracture notch
Mediocranial
condyle compression
Ligamentum lateral
with articular capsule
Dorsomedial discus
displacement
a. laterally
compressed
joint gap
partiell protrusion
The discus fragments
folded together
b. dorsomedial
positioned
discus
max. protrusion
MRI emphases:
The MRI emphases are used to represent
the different groups of tissues with
various levels of contrast. The MRimages are differented between T1-, T2-,
and proton-related images. The best
contrast for the diagnostics of the TMJ
and discus can be achieved with the
proton emphase. With iv-injection of
Gadolinum, the contrast to the well
circulated tissues is enhanced. Fat
suppressed images are excelent to point
out traumatic effusions of the joint.
T1
T2
Good for first orientation,
discus with too little contrast
Cerebral liquor with high signal,
discus too dark
Proton balanced image
Best contrast for the diagnosis of the
discus articularis
Fat suppressed T 2
For joint effusions, H2O with very high
contrast to tissue
Summary:
A systematic MRI (magnet resonance imaging) diagnosis allows a three dimensional evaluation of the anatomic structures and describe the pathology of
the temporomandibular joint (TMJ). MRIs reveal importand information about chronic pathological findings. With the increasing number of adult patients,
MRI´s are important forensically, as well as for comprehensive treatment planning.
Literatur:
1.) Polzar G, MRT Diagnostik des Kiefergelenks – Systematik, anatomisch Strukturen und häufige pathologische Befunde. Kieferorthop 19:203-126,2005, Quintessenz Verlag
2.) Bumann A, Lotzmann U: Funktionsdiagnostik und Therapieprinzipien. Farbatlanten der Zahnmedizin Bd 12. Thieme, Stuttgart, 2000,
3.) Polzar G, Toll D E, Sens M: MRT-Diagnostik des Kiefergelenkes. Selbstverlag, Freiburg, 2004
4.) Düker J: Kiefergelenkerkrankungen. Röntgendiagnostik mit der Panoramaschichtaufnahme. Hüthig, Heidelberg, 1992, pp 432-464
5.) Schächner H: Die Darstellung des kiefergelenkes mit Hilfe der Magnetischen Resonanztomographie (im Niederfeld) unter besonderer Berücksichtigung des Discus artikularis. Med Diss, Freiburg, 1998