Panoramic radiography for temporomandibular joint arthrography: A description of arthropanoramograms Kenneth Abramovitch, DDS, MS.” Robert P. Langlais, DDS, MS, FACD,b and M. Franklin Dolwick, DMD, PhD,’ Houston and San Antonio, Texas, and Gainesville, Fla. UNIVERSITY OF TEXAS DENTAL BRANCH AT HOUSTON, UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO, AND UNIVERSITY OF FLORIDA TMJ arthrograms done with panoramic radiography, i.e., arthropanoramography, can demonstrate intracapsular disk displacement and perforation pathoses. These views are very practical for inferior synowial cavity arthrograms performed in the dental operatory since panoramic radiographic machines have become common in modern dental practices. Specific advantages of arthropanoramography include the decreased financial cost and decreased radiation exposure to the patient. Arthropanoramography does not replace tomography or videofluoroscopy in TMJ arthrography. It is, however, described as a simple alternative to the more conventional forms of arthrography. (ORAL SURG ORAL MED ORAL PATHOL 1989;67:775-80) I nferior synovial cavity (ISC) arthrographic injec- tion techniques that can be performed by trained personnel, precluding the need for fluoroscopy, have been described.‘,2 A standard dental operatory radio- graphic unit used with plain film transcranial radiog- raphy is satisfactory for visualizing needle placement for the contrast injection.2 However, different radio- graphic imaging preferences exist for the interpreta- tion of the arthrograms. These preferences range from transcranial projections to linear and multidi- rectional tomography and videofluoroscopy.3*4 Because of the broad appeal and commercial avail- ability of panoramic radiography in contemporary dental practice, the purpose of this article is to describe inferior synovial cavity temporomandibular joint (TMJ) arthrograms with the use of panoramic radiography. LITERATURE REVIEW Panoramic radiographic machines are capable of producing excellent views of the temporomandibular “Department of PathoIogy and Radiology, University of Texas Dental Branch, Houston, Texas. bDepartment of Dental Diagnostic Science, Dental School, Uni- versity of Texas Health Science Center at San Antonio. ‘Oral and Maxillofacial Surgery, University of Florida, Gaines- ville, Fla. joints.5 Uemura and coworkers6 described the effec- tiveness of panoramic radiography for interpreting arthrotic joint pathoses. However, the panoramic technique has inherent distortion that projects anom- alies unique to the panoramic image. Examples of these anomalies include cupped-out anatomic depressions on the condylar surfaces and radiolucen- ties in the sigmoid notch.7 Despite these anomalies, TMJ views are still suggested for preliminary TMJ radiographic examinations.5.8 Matilla9 first described the use of panoramic radiography for TMJ arthrographic examinations. His experience, however, was extremely limited, and his equipment lacked the higher kilovoltage poten- tials necessary for clear positive contrast images. Recently these higher kilovoltage panoramic tech- niques were used during arthrographic examinations of symptomatic temporomandibular joints to demon- strate intracapsular pathoses.‘O Examples from this study will be used. DESCRIPTION OF PANORAMIC ARTHROGRAMS Arthrograms on panoramic radiographs will be referred to as arthropanoramograms. This term is derived in a manner similar to that of the term arthrotomogram, i.e., an arthrogram obtained with the use of tomography. Hence, an arthropanoramo- 775