TMJ imagenologia
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Imagenología de la ATMImagenología de la ATM
Sergio UribeProfesor Asociado
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TMJ• Superficies articulares
– Cóndilos mandibulares– Cóndilo y cavidad glenoídea del temporal
• Medios de unión– Frenos– Refuerzo– Ligamentos a distancia
• Esfenomaxilar• Pterigonmaxilar• Timpanomaxilar• Estilomaxilar
• Medio de adaptación– Menisco
• Medio de deslizamiento– Sinovial
• Movimientos
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Objetivo examen imagenológico Objetivo examen imagenológico de la TMJde la TMJ
1. Evaluar la integridad de las estructuras
2. Confirmar la extensión de una patología conocida
3. Determinar la progresión de una patología conocida
4. Evaluar los efectos de un tto
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Métodos de diagnósticoMétodos de diagnóstico• Artrografía• Radiográficos
– Planares– Tomográficas
• Convencionales• Computarizadas (CT)
• Artroscopía• Medicina nuclear
– Cintigrafía / SPECT– RMN
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PlanasPlanas
• Transcraneal
• Transfaríngea
• Transmaxilar
• SMV
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Que posición condilar representa mejor Que posición condilar representa mejor una población asintomática?una población asintomática?
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“existe insuficiente evidencia que apoye el diagnóstico de una disfunción mandibular en base a una posición condilar radiográfica”
ADA, 1982
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“existe la tentación de omitir la Rx convencional y proceder directamente con la imaginología avanzada, negando cualquier beneficio del conocimiento acumulado en los últimos 45 años con el uso de la Rx convencional”
Pharoah
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PanorámicaPanorámica
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• Superposición de estructuras articulares
• Solo cóndilo
• Similar a Transfaríngea
• Acuerdo con tomografía = 60 a 70%
• Detecta cambios grandes en– Forma y estructura– Erosiones, esclerosis
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1. En la vista de perfil el cóndilo mandibular se observa mas angosto y curvo que en la vista lateral
2. El espacio y las superficies articulares se ven mas definidas en la vista oblicua
3. La relación entre el cóndilo, la fosa y la eminencia se ven solo en las imágenes laterales
4. En la imagen lateral las estructuras mediales de la ATM se proyectan sobre las estructuras laterales en ambas vistas
5. La separación horizontal entre el cóndilo y la eminencia se reduce en la vista lateral
Chomenko AG, J Prosthet Dent 1982 (48)3:332-335
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http://emedicine.medscape.com/article/870075-overview
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http://emedicine.medscape.com/article/870075-overview
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Tomografía convencionalTomografía convencional
• Fuente de rayos y película móvil• Permite obtener secciones finas• Disminuye la superposición• Tipos:
– Lineal – Circular– Espiral– hipocicloidal (Littleton: Sectional imaging methods: a comparison)
• Equipamiento mas caro
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Tomografía Tomografía
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• Evaluar posición condilar
• Complementar detalles de la estructura ósea
• Proporciona vista lateral real de la ATM
• Proporciona información acerca del espacio articular
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ArtrografíaArtrografía
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ARTROGRAFIAARTROGRAFIA
• Inyección de un líquido de contraste
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Indicaciones ArtrografíaIndicaciones Artrografía
• Información de tejidos blandos
• Forma y posición del disco
• Presencia de– Adherencias– Perforaciones– Discontinuidades
• Estudio de movimientos
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y Contraindicacionesy Contraindicaciones
• No identifica movimientos mediales
• Forma del disco solo si esta deformación es extensa
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Ultrasonografía
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Tomografía computarizada (TAC)Tomografía computarizada (TAC)
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RMNRMN
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Medicina NuclearMedicina Nuclear
• Aumento anormal en la formación de hueso
• Tumor óseo, infección, enf ósea degenerativa
• Presencia o ausencia de crecimiento en hiperplasia condilar
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SPECTSPECT
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SPECTSPECT
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Panorámica
Transcraneal
PA-AP Tomografía Artrografía CT RM Nuclear Ultrasonido
Anquilosis
Ósea 0 0 0 ++ 0 +++ + 0 0
Fibrosa 0 0 0 0 0 ++ +++ 0 0
Artritis + + 0 ++ 0 ++ +++ ++ 0
Anomalías + + + ++ 0 +++ ++ 0 0
Posición de disco
0 0 0 0 ++ + +++ 0 0
Fracturas ++ + ++ ++ 0 +++ ++ + 0
Implantes + 0 + ++ 0 +++ +++ ++ 0
Inflamación
0 0 0 + ++ + +++ +++ 0
neoplasia + + + + 0 +++ +++ ++ 0
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• Ribeiro-Rotta RF et al. Do computed tomography and magnetic resonance imaging add to temporomandibular joint disorder treatment? A systematic review of diagnostic efficacy. J Oral Rehabil. 2010
• Limchaichana N et al. The efficacy of magnetic resonance imaging in the diagnosis of degenerative and inflammatory temporomandibular joint disorders: a systematic literature review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Oct;102(4):521-36.
• Tomas X et al. MR imaging of temporomandibular joint dysfunction: a pictorial review. Radiographics. 2006 May-Jun;26(3):765-81.
• Styles C, Whyte A. MRI in the assessment of internal derangement and pain within the temporomandibular joint: a pictorial essay. Br J Oral Maxillofac Surg. 2002 Jun;40(3):220-8.
• Westesson PL. Reliability and validity of imaging diagnosis of temporomandibular joint disorder. Adv Dent Res. 1993 Aug;7(2):137-51.
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