Temporomandibular joint (axiolateral view)
The axiolateral temporomandibular view allows for visualisation of the articular tubercle, mandibular condyle and fossa and is thus useful to identify structural changes and displaced fractures, as well as assess excursion and joint spaces.
Clinical indications include trauma, the presence of joint noises, trismus and occlusal alterations 1.
- the patient is seated upright with the side of interest closest to the detector.
- the head is placed in a true lateral position
- inter-Pupillary Line (IPL) perpendicular and Mid-Sagittal Plane parallel to the detector
- oblique the body to assist in patient positioning and reduce the object to image receptor distance
- depending on the projection (open or closed mouth) instruct the patient to open their mouth side and keep it there or keep it shut
- left and right lateral and open and closed mouth
- central ray 25º-30º caudad, centred 5cm superior and 1 cm anterior to the EAM
- no more than 10x10 cm with TMJ of interest is in the middle of the image
- 18 cm X 24 cm
- 70-75 kVp
- 16-25 mAs
- 100 cm
Image technical evaluation
- the TMJ closest to the image receptor should be clearly demonstrated without the superimposition of the opposite TMJ.
- joint is central on the radiograph
- a radiolucent support such as a sponge can be used to help the head maintain position
- this projection can be performed prone, in patients that cannot stand unsupported this will increase patient stability
- 1. Ferreira LA, Grossmann E, Januzzi E, Paula MVQd, Carvalho ACP. Diagnosis of temporomandibular joint disorders: indication of imaging exams. Brazilian Journal of Otorhinolaryngology. 2016;82:341-52.