Temporo-mandibular Joint

and Emergency case

Created by Group 4 :

1. Bintang Fajar Lukulo (P1337430122050)

2. Raka Shandy Dian I.
3. Renata Putri Ramadhani
4. Mohamad Risqi Maulana
5. Rifatri Cahyawati
6. Risma Sandra Aulia
7. Krisnata Bintari C.
8. Auliya Azminadya Z.
9. Andini Ratna M.
(P1337430122056)
(P1337430122059)
(P1337430122066)
(P1337430122073)
(P1337430122077)
(P1337430122082)
(P1337430122088)
(P1337430122095)

JURUSAN TEKNIK RADIODIAGNOSTIK DAN RADIOTERAPI

PROGRAM STUDI RADIOLOGI SEMARANG PROGRAM DIPLOMA III
POLTEKKES KEMENTERIAN KESEHATAN SEMARANG
TAHUN 2022 /2023
 PREFACE

Praise our gratitude to God Almighty, because for the abundance of

grace the authors can complete this paper on time without any significant
obstacles.
Our gratitude goes to the lecturers of the extremity and spine
radiography techniques course who have helped provide direction and
understanding in the preparation of this paper.
The authors realize that in the preparation of this paper there are still
many shortcomings due to our limitations. Therefore, the compiler really
hopes for criticism and suggestions to perfect this paper. Hopefully what the
compiler makes can be useful for all those who need it.

Semarang, 24 January 2023

Compiler
 TABLE OF CONTENTS
COVER i

PREFACE ii

TABLE OF CONTENTS iii

CHAPTER I INTRODUCTION 1

A. Background 1

B. Problem formulation 2

C. Research Objectives 2

D. Benefits of Research 3

CHAPTER II LITERATURE REVIEW 4

A. Theoretical Basis 4
B. Research Questions 18

CHAPTER III RESEARCH METHODOLOGY 19

3
 BAB I
INTRODUCTION

A. Background
Radiological examination is an examination that can be used to determine the
anatomy and physiology of an organ so that pathological or traumatic disorders
can help in determining the diagnosis.Temporomandibular joint (TMJ) is the only
movable joint in the head region. The tempromandibular joint connects the
mandibular to the temporal bone. The TMJ is formed by the condyle, the head of
the condyloid processus on the mandible just inside the temporomandibular fossa
on the temporal bone. The location of the TMJ is anterior and slightly superior to
the external acoustic meatus (MAE). There are two classifications of joints in the
TMJ, namely synovial joints and fibrous joints. The movement of the
temporomandibular joint is influenced by both joints. When the mouth is wide
open, the condyles move forward to the front edge of the fossa. When the mouth
closes, the condyles are inside the mandibular fossa (Bontrager, 2018).
Temporomandilbular Joint examination is a radiographic examination of the
area where the temporal bone and mandibular bone meet or connect.
Radiographic examination of the Temporomandibular Joint requires knowledge of
anatomy and function in normal and pathologic states. Radiographic examination
of the 2 Temporomandibular Joint is often performed using conventional aircraft.
Conventional radiographic techniques of the Temporomandibular Joint in clinical
situations, axiolateral projection is the projection most often used to evaluate the
Temporomandibular Joint (Yuwono, 2010). According to Bontrager's Textbook of
Radiographic Positioning and Related Anatomy Ninth Edition (2018) in
radiographic examination of the Temporomandibular Joint using conventional
aircraft, there are several projections that are generally carried out AP Axial
projection with the Towne method, Axiolateral with the Schuller method and
Axiolateral Oblique with the Law method. In axiolateral oblique projection with
Law's method and axiolateral projection with Schuller's method, radiographic
examination of the temporomandibular joint uses two positions, namely close
mouth and open mouth.Advances in science and technology in the field of
radiology are increasingly rapid. For example, the development of panoramic
aircraft used to photograph the teeth and jaw as a whole. The development of
technology makes it possible to choose various sophisticated radiographic
techniques to examine the Temporomandibular Joint. In addition to
conventional radiographs, the Temporomandibular Joint can be seen with dental
panoramic radiographs (Yuwono, 2010).
3 TMJ examination can also be done with a panoramic plane. Panoramic
planes are used to produce tomograms on curved examinations. This aircraft is
used to be able to show the entire mandible including the TMJ and all teeth on a
narrow curve film. Objects close to the axis of rotation will be clearly visible
(Merrill, 2016). In principle, the panoramic plane uses the principle of

1
 tomography. In the TMJ examination with a panoramic plane using the
infraorbitameatal line object position parallel to the floor and the occlusal plane
inclined 10 ° from posterior to anterior, the position of the bite block between the
patient's front teeth and the patient is asked to place the lips in the same position
and place the tongue on the palate (Bontrager, 2018). Based on the author's
experience during Field Work Practice III at the Radiology Installation of Sleman
Yogyakarta Hospital, the examination of temporomandibular joint radiographs
with cases of patients with temporomandibular joint disorders is carried out using
a panoramic aircraft with the patient's position open mouth and close mouth on the
right temporomandibular joint and left temporomandibular joint which are printed
on one sheet of radiograph results. And there are also cases examined using
conventional aircraft with schuller open mouth and close mouth projections on
temporomandibular joint radiographic examinations.
From the examination procedures performed by the radiographers, the author
underlies to further study the specific reasons for the use of panoramic aircraft and
conventional aircraft schuller method used to diagnose temporomandibular joint
in radiographic examination of temporomandibular joint and present it in the form
of Scientific Paper entitled "TECHNIQUE OF RADIOGRAPHICAL
EXAMINATION OF TEMPOROMANDIBULAR JOINT INSTALLATION
RADIOLOGY SLEMAN HOSPITAL YOGYAKARTA.

B. Problem Formulation
Based on the background of the problem, the author formulates the following
problems:
1. How is the technique of radiographic examination of Temporomandibular
Joint using panoramic method and schuller method at Radiology Installation of
Sleman Yogyakarta Hospital?
2. Why is the technique of radiographic examination of Temporomandibular
Joint at Radiology Installation of Sleman Yogyakarta Hospital using
panoramic method and schuller method?
3. How is the anatomical information obtained in the technique of radiographic
examination of Temporomandibular Joint at Radiology Installation of Sleman
Yogyakarta Hospital using panoramic method with schuller method?

C. Research Objectives
1. To know the technique of radiographic examination of Temporomandibular
Joint at Radiology Installation of Sleman Yogyakarta Hospital.
2. To know the reasons and reviews why the panoramic method and schuller
method are used in radiographic examination of TMJ at Sleman Yogyakarta
Hospital.
3. Can find out the anatomical information obtained in the Temporomandibular
Joint radiographic examination technique at the Radiology Installation of
Sleman Yogyakarta Hospital using panoramic using the schuller method.

2
D. Benefits of Research
1. Adding to the knowledge and insight of researchers and readers about
temporomandibular joint radiographic examination techniques using
panoramic aircraft.
2. Providing input to radiographers and related parties at the Radiology
Installation of Sleman Yogyakarta Hospital in conducting
temporomandibular joint radiographic examinations using appropriate and
correct examination procedures so as to produce clear radiograph
information.
3. Provide a clear picture in radiology about the comparison of anatomical
information produced in the radiographic examination of the
Temporomandibular Joint using the panoramic method using the schuller
method.

3
 CHAPTER II
LITERATURE REVIEW

A. Theoretical Basis
1. Anatomy and Physiology of the Temporomandibular Joint
Temporomandibular Joint (TMJ), is the only one movable joints in the head.
Temporomandibular Joint (TMJ) is formed by the mandibular condyloid process
with the fossa temporomandibular joint on the temporal bone. Temporomandibular
joint (TMJ) is located anterior and slightly superior to the MAE (Meatus External
Acoustics). The TMJ is classified as a synovial joint which is separated into the
upper and lower synovial cavities by a fibrous articular disc (Bontrager, 2018).

Anathomy Temporomandibular Joint

A diarthrosis (synovial) joint is a joint with movement free. The surface of the
joint is covered by a thin layer of hyaline cartilage separated joint cavity, arrangement
in which allows the joint to move freely. The joint cavity is bounded by the synovial
membrane extends from the edge of one joint surface to another joint surface
(Syaifuddin, 2009). The TMJ has two synovial membranes, viz the superior synovial
membrane lining the fibrous capsule in the articular disc superiorly, and the synovial
4
membrane lining it inferiorly capsule fibrous layer in the inferior articular disc
(Moore, 2014). At the temporomandibular joint there is an articular disc is an oval-
shaped fibrocartilaginous disc that divides the sender into the upper and lower
cavities. Discs stick around capsule, and in front it is attached to the tendon of the
pterygoid muscle lateral and on the head of the mandible by fibrous bands. This
ribbon ensure that the discs move forward and backward together mandibular head
During mandibular protraction and reconstruction movements. The function of the
disc is to allow the upper gliding movement joint and lower hinge movement of the
joint (Snell, 2012).
The thick portion of the sending capsule forms the lateral ligament
(temporomandibular ligament), which strengthens the TMJ laterally, and with the
postglenodale tubercle, working to prevent posterior joint dislocation. The two outer
ligaments and the lateral ligament connect lower with skull.
Ligamens stylomandibulare, which is actually a thickening of the capsule parotid
gland fibrosa, running from the styloid process to angular mandible. The ligaments
are significantly absent strengthening joints. The sphenomandibular ligament runs
from the spine sphenoid bone to the mandibular lingua. The ligament is mandibular
primary passive support, despite masticatory muscle tone usually bears the weight of
the mandible. However, ligaments play a roleas a "swinging hinge" for the mandible,
which acts as fulcrum and lacertus musculi recti lateralis for mandibular movement on
the TMJ (Moore, 2014).

Articulatio Temporomandibularis looks laterally and medial. (Netters, 2011)

An articular disc completely divides the articulation temporomandibular

becomes two separate jaws (joints dithalamic):
a. The lower jaw allows opening and closing movements mandible like a hinge.
b. The maxilla allows the mandibular head to shift inward anterior to the articular
tubercle (protus). This is especially require lateral pterygoid work. Move back to
mandibular fossa is called retraction (rektur). (Paulsen, 2015).
5
 Independent movement at one temporomandibular joint no possible Happen because
Second articulation the temporomandibular joint is connected by an arch Bone
mandible. Temporomandibular articulation can do The two main functions during
chewing are elevation (adduction) and mandibular depression (abduction) and
grinding movements. Besides adduction and abduction movements, forward and
backward movements (retrusion) and grind (side-shift laterotrusion and
mediotrusive)is a pattern articulation movement temporomandibular. The muscles of
mastication play a role in various ways of moving this joint (Paulsen, 2015).
Movement-Movement of the TMJ is mainly elicited by the matication muscles. The
four muscles are m. temporalis, masseter, m.pterygoideus lateral and medial (Moore,
2014).

Articulatio Temporomandibularis Mouth action

2. Disorders of the Temporomandibular Joint

According to the American Dental Association (ADA) has determined term
TMD (Temporo Mandibular Disorder) or joint disorders temporomandibular as all
functional disorders in the system mastication. Disorders of the temporomandibular
joint can felt as pain and disturbance of function normal chewing system (Kartika
and Himawan, 2007).
The causes of temporomandibular joint disorders are: complex and
multifactorial. The main factor causing the disturbance one of the
temporomandibular joints is trauma. every trauma which affect the condyle will
affect the development of function normal TMJ and growth of facial structures. This
change will influences mandibular development and structure related to. There are
two possible causes of deficiency growth after trauma to the condyle, i.e. loss of
stimulation normal growth, and growth deficiency due to presence mechanical
resistance caused by the movement of the send that is too fast (Kartika and
Himawan, 2007).
When there is trauma to the mandible, the temporo joint region mandible will
experience disturbances which can be hemarthrosis, dislocations, fractures of the
condylar processes and subcondylar processes, and dislocation due to fracture of the
condylar process. Condyle fracture is wrong fracture involving the joint
temporomandibular which can cause joint disorders temporomandibular.
Complications that often occur due to fractures condyles are ankylosis and

6
 temporomandibular joint disorders. Every patient with a fracture of the mandibular
condyle has opening limitations. Nonetheless the condyle fracture true mandible or
associated fracture fascia produces abnormal mandibular movement.

Condyle Fracture

Classification of condyle fractures according to several factors, namely: (1)

the anatomical location of the fracture, (2) the relation of the condylar segments to
the mandibular segment, (3) the relationship of the head of the condyle to the fossa
glenoideus. This classification system requires radiographic imaging obtained at
least two images from the correct angle.
a. Condylar head. Although it is very difficult to define with exactly the head of the
condyle radiographically, but very it is easy to see narrowing of the condylar neck
and head the condyle rests on it. Condyle fracture, view by definition, it is an
intracapsular fracture due to an adherent capsule on the condylar neck. These
fractures may be classed as vertical fracture.
b. Neck condyle. Condyle neck is area narrowing thin under the head of the condyle.
this fracture an extracapsular fracture.
c. Subcondyle. This region is located below the neck of the condyle and extends
fromthe deepest point of the sigmoid notch anterior to deepest point of the
posterior concave aspect of the mandibular ramus. Based on the location of the
fracture, this fracture is often referred to as "high" or "low" subcondyle fractures.
The mandibular head can slide over the articular tubercle when the mouth is
opened, it is called a TMJ dislocation. This can caused by heavy yawning or blows to
the mandible open. When a joint gets dislocated, the mandible becomes locked in the
forward position and can no longer be closed. The condition is easily diagnosed
clinically and reduced by pressing the lower row of teeth (Schuenke, 2015).

7
Picture description :
a. Mandibular Fossa
b. M. Ptergoideus Lateral
c. Mandibular condyle process
Sometimes during gaping or forceful biting, excessive contraction of the M.
ptergoideus lateralis can cause the head the mandible is dislocated anteriorly
(anteriorly articular tubercle). In this position, the mandible remains open wide and
the person is unable to close it. The most frequently sideways blow to the chin when
the mouth is open causes dislocation of the TMJ on the side that received the blow.
TMJ dislocation as well may accompany mandibular fractures. Posterior dislocations
are rare held in place by the postglenoidal tubercle and lateral ligaments strong
intrinsic. Usually when a fall or when the chin is hit directly, the mandibular neck
fractures before it occurs dislocation (Moore, 2013).
a. Etiology and Risk Factors
Dislocation of the temporomandibular joint is a detachment condyle from its
normal position. The glenoid fossa is located in the squamous-temporal base of the
skull. This can happen partial (subluxation) or complete (luxation), bilateral or
unilateral, acute, or prolonged chronic. Additionally, dislocations may occur in the
anterior-medial, superior, medial, lateral or dislocated area posterior and the cause can
be spontaneous or induced by trauma, forcefully opened mouth from endotracheal
intubation by larungal mask or tracheal tube, ENT or dental procedure, endoscopy,
excessive mouth opening when yawning, laughing and vomiting. Changes to
structural components such as loose capsule, ligament, and small or short condyle
atrophy, articular atrophy, elongated articular, arch hypoplasia zygomatic, less
notched glenoid fossa can be the cause dislocation occurs. Predisposing factors
include epilepsy, vomiting severe, Ehlers-Danlos syndrome and Marfan and
movement syndromes dystonic from neuroleptic in neuropsychiatric disease.
(Septadina.
b. Pathophysiology

8
 In 60 percent of cases caused by trauma from a fall, traffic accidents, domestic
accidents, violence, and other causes such as excessive opening of the mouth when
yawn, laugh, sing, open mouth prolonged oforal and ENT procedures, opening the
mouth forcefully from the procedure anesthesia and endoscopy contribute about 40
percent. (Septadina, 2015). Dislocation of the temporomandibular joint is divided
into 5 classifications namely:
1) Anterior Dislocation
Anterior dislocations are the most common and occur due to displacement
from the condyle anterior to the articular temporal bone eminence. Usually anterior
dislocation adjunct in the normal sequence of muscle action when the mouth is closed
from extreme opening. Masseter muscle and temporalis muscle elevating the
mandible before the lateral ptergoid to Relax so that the mandibular condyle is pulled
out of the fossa glenoid and anterior to the crest of the bone. muscle spasms masseter,
temporalis and ptergoid muscles cause trismus and holds the condyle back into the
glenoid fossa.
2) Posterior Dislocation
Posterior dislocations usually occur due to a blow straight to the chin. The
mandibular condyle is pushed posteriorly towards the mastoids. Injury to the external
auditory canal of the condylar crest can occur from any type of injury.
3) Superior Dislocation
Superior dislocations, also called central dislocations, can occur from a direct
blow to the half-open mouth. Corner mandible in this position becomes small and
round one
predeposing factor is the upward migration of the condylar head margins condyle.
This can result in a glenoid fossa fracture and dislocation of the mandibular condyle
to the middle skull base. A further injury from this type of dislocation can be injury
facial nerve, intracranial hematoma, brain contusion, leakcerebrospinal fluid, and
damage to the cranial nerves the eighth resulted in deafness. Medial dislocation both
anterior dislocations. Avrahami et la document 11 cases of medial dislocation and
stated that it was Occurs due to sustained traction of the pterygoid muscles lateral to
the condyle of the affected side.
4) Lateral Dislocation
Lateral dislocations are usually associated with fractures mandible. This case
can occur in type I (subluxation) or type II (luxation). Type II is subclassified into
three form, depending on duration and management performed. The condylar heads
migrate laterally and superiorly and frequently palpable in the temporal space. Acute
dislocation comes within 2 weeks and it is easily reduced by the Hippocratic
maneuver. After 2 weeks, spasms and shortening of the temporalis and masseter
9
muscle occurs and reduction becomes difficult to achieve Manually. This causes the
start of the dislocation protracted chronic. Eminence articular lengthening can prevent
backward shift in the normal position on glenoid fossa, in this case, a prolonged
chronic dislocation with the formation of new pseudojoints to varying degrees
movement and such patients have problems with difficulty in closing the mouth (open
lock) and malocclusion where there is mandibular prognathism with anterior bite.
5) Chronic Dislokation
Recurrent chronic dislocations occur in people with the habit of opening the
mouth wide usually occurs spontaneously spontaneous and reduced depending on the
degree of change temporomandibular joint morphology and its structure nearby.
When the articular eminence is elongated, it is dislocated hard to reduce. This occurs
usually in patients with eminence hypoplasia, narrow fossa, loose capsule,collagen
disorders, small condyles, hypermobility syndrome,oromandibular dystonias and use
of neuroleptic drugs plain view of the TMJ especially in the transcranio-oblique,
contrast CT scan, i-CAT scan and MRI, and digital linear tomography plain rotation,
joint arthroscopy is useful for assessing position condyle head and meniscus in
relation to the fossa glenoid, mastoid process, tympanic plate and articular eminence.
New tools include the Dolphin system which imports facial photos 2D (face wrap) 3D
stereographic images are used for improve treatment simulation.

3. Temporomandibular Joint Radiographic Examination Technique

a. Indications for Temporomandibular Joint Radiographic Examination
Indications for examining the TMJ according to Bontrager (2018), namely
fracture and abnormal relationship or movement of the fossa temporomandibular and
condyle. You can't open your mouth performed for patients with possible fractures.
b. Patient Preparation
Patient preparation according to Bontrager (2018) is to let gometal or plastic
objects around the head and neck.
c. Preparation of Tools and Materials
1) X-ray machine

10
2) Imaging receptors measuring 18 × 24 cm
3) Grids
4) Marker R or L
5) Lead shielding
d. Temporomandibular Joint Radiography Technique In the temporomandibular joint
radiographic examination there are several projections used, including the AP
projection Axial (Towne Method), Axiolateral Oblique (Method Law), and the
Axiolateral projection (Schuller Method) was performed with open mouth and close
mouth
(Bontrager Ninth Edition,2018).
1) AP Axial Projection (Towne Method)

AP axial CR 42° for IOML (close mouth position).

(Bontrager, 2018)

a) Patient Position
The patient's position is standing in front of the bucky stand or lying down on on
the examination table.
b) Object Position
The patient's head is set on the examination table or upright on the surface of the
cassette. Chin lowered s(Orbito Meatal Line) perpendicular to the examination
table or cassette or IOML (Infra Orbito Meatal Line) perpendicularly examination
table or cassette by increasing the directional angle beam axis by 7°. Adjust MSP
(Mid Sagittal Plane) the head is perpendicular to the line of the examination table
or bucky stand to prevent head rotation or crooked.
c) Direction of the beam axis (Central ray)
The direction of the beam axis (central ray) is 35° to the caudad if OML
perpendicular to film or 42° caudad if IOML perpendicular to the film.
d) Shooting point (Central point)
The aiming point (central point) is centered on 3 inches above nation

11
e) Focus Film Distance (FFD)
Checking FFD by 40 inches (102 cm)
f) Collimation
Collimation is set as wide as the object of examination
g) Exposure
Exposure is done one than breath
h) Radiation Protection
Protects sensitive tissue against outside radiation
inspection object.

TMJ proyeksi AP projection radiograph

Picture description :
a. Temporomandibular fossa
b. Condyloid process
c. Cervical Vertebrae

TMJ radiograph criteria according to Bontrager 2018:

Mandibular condyloid process and fossa visualized temporomandibular. No
rotation characterized by a symmetrical condyloid process on the lateral side of the
cervical vertebrae. TMJ looks bare superposition. Collimation includes the entire
object (object uncut). Contrast and density (brightness) is sufficient to show the
condylar processes and fossae temporomandibular. Boundaries between bones are
clear indicates no movement.
2) Oblique Axiolateral Projection (Law Method)

12
 (Bontrager, 2018)

(Bontrager, 2018)

a) Position of the patient

Position the patient standing or semi-prone. Adjust the lateral side head on
examination table or upright on cassette surface.
b) Object Position
Adjust so that the IPL (Inter Pupillary Line) is perpendicular with tape or film and
MSP parallel to tape or film. The IOML is perpendicular to the leading edge of the
cassette. From the head position laterally, head tilted 15° toward cassette.
c) Direction of the Ray Axis (Central ray)
The direction of the central ray is 15° to the caudad.
d) Central point
The aiming point (central point) is centered at 1.5 inches (4 cm) above the MAE
(Meatus Acustikus Eksterna).
e) Focus Film Distance (FFD)
The FFD of the examination is 40 inches (102 cm).
f) Collimation
Collimation is set as wide as the examination object.
g) Exposure
Exposure is performed one breath at a time.
h) Radiation Protection

13
Protect radiation-sensitive tissues outside the
examination.
i) Radiograph Criteria

TMJ radiograph criteria according to Bontrager 2018:

The TMJ near the cassette is visualized. The mandibular condylar processes
are in the fossa mandible when the mouth is closed and the condylar processes the
mandible is anterior to the mandibular fossa at the mouth open. The TMJ near the
cassette is visualized without superposition with the other TMJ (15° rotation prevent
superposition). TMJ is not superposed with cervical vertebrae. Collimation covers the
whole object (the object is not truncated). Contrast and density (brightness) sufficient
to expose the condylar processes and fossa temporomandibular. Boundaries between
bones are clear indicates no movement.
2) Axiolateral Projection (Schuller Method)

14
a) Patient Position
Position the patient standing or semi-prone. Sore side stick with tape.
b) Object Position
Sets the Repala in the true lateral position and tilts the patient as comfortably as
possible. Set the IPL (Inter Pupillary Line) perpendicular to the tape or film and MSP
head parallel to tape or film. IOML is straight on the leading edge of the cassette.
c) Direction of the Ray Axis (Central ray)
The direction of the beam axis (central ray) is 25° - 30° to the direction caudad.
d) Shooting point (Central point)
Aim point (central point) centered at ½ inch (1.3 cm) forward then 2 inches (5 cm)
above the MAE.
e) Focus Film Distance (FFD)
Checking FFD is 40 inches (102 cm).
f) Collimation
Collimation is set as wide as the object of inspection.
g) Exposure
Exposure is done during breath hold respiration.
h) Radiation Protection
Protects sensitive tissue from outside radiation
examiner object.
i) Radiograph criteria

15
TMJ radiograph results axiolateral projection of the lid and
open your mouth. (Bontrager, 2018)

TMJ radiograph criteria according to Bontrager 2018:

The TMJ near the cassette is visualized. The mandibular condylar processes
are in the fossa mandible when the mouth is closed and the condylar processes the
mandible is anterior to the mandibular fossa at the mouth open. TMJ visualized
without rotation marked by superposition of lateral boundaries. Collimation includes
the entire object (object not truncated). Contrast and density (brightness) enough to
show processes condyle and fossa temporomandibular. Between boundaries bone
clear, indicates no movement.
4. Panoramic Tomography Mandibular Examination Technique
Mandibular panoramic radiographic examination techniques can also be used
showing the temporomandibular joint including patient preparation, preparation of
tools, and inspection procedures. (Bontrager, 2018)
1) Patient Preparation
There are no special preparations to be made. Patient only asked to A take off
the objects that can be interfere with the radiographic image. In addition, patients are
also given an explanation of the inspection procedure to run with smoothly and there
is no repetition of photos.
2) Preparation of Tools and Materials
On panoramic mandibular radiographic examination, exposing the
temporomandibular joint requires a plane panoramic X-ray with kV range 70-80,
cassette with size 23 x 30 cm, non-grid curve cassette. Before the patient is positioned
set the cassette on the plane panoramic. Then position the X-ray tube and cassette on
initial position and position the chin rest at the level of the patient's chin.
3) Panoramic Radiography Examination
A panoramic mandibular radiographic examination was performed by using
the I position, if the part to be inspected is the temporomandibular joint, so it uses 2
positions namely open mouth and close mouth positions. At the time of open moth

16
position, Mouth should be opened wide but done as much as possible Because this is
dangerous if the mandible is not in place. At the time of the closed mouth position, the
teeth on the posterior part must be in contact. Occlusion of the mandibular incisors is
in an indented position and the condyle is in the fossa mandible, On examination of
the temporomandibular joint with a plane panoramic, the patient's position is standing
with both hands clasped on hand grips or sitting upright in a seat on an airplane that
has mounted with a straight back. Then the position of the object is set in order to get
the maximum picture of information in a way set the infraorbital line parallel to the
floor (plane occlusal turn 10° from posterior to anterior, midsagittal plane the head is
aligned with the vertical midline at the chin rest or a larger bite block between the
patient's front teeth Then the patient is asked to press the lips together and placing the
tongue on the roof of the mouth. The direction of the beam is direct and slightly
cephalic for projecting the anatomical structure and collimation used little vertical
gap. After the first exposure is over, continue second exposure by changing the film
and panoramic plane in initial position. For the second exposure the patient was asked
to open mouth.

4) Radiograph criteria
Radiographic criteria obtained from mandibular examination
by using a panoramic plane is no rotation
or displacement of the mandible, the temporomandibular joint is located
in the same horizontal plane, there is magnification of the ramus mandibular and
posterior teeth, cervical portion is visible with no superposition of the
temporomandibular joint (Bontrager, 2018).

17
Panoramic radiograph results
(Bontrager, 2018)

5. Temporomandibular Joint Panoramic Examination Technique (Manual Book X-

mind Panoramic X-Ray Series)
a. Patient position for examination of the temporomandibular joint ie fixing the chin
using a chin rest. Then The patient is asked to press the upper lip on the chin rest with
mouth closed.
b. Position the Mid Sagittal Plane (MSP) of the patient's head must be symmetrical
with vertical lines of collimator lamps. The patient must stare at there should be no
movement or shift of the patient's head in front one of the positions.
c. The position of the focus lamp must be in the center of focus, with a width of 10
mm from the front. The roots of the incisor teeth must be parallel to the line focus.
1. The elevation of the Frantort area must be horizontal.
e. After the TMJ closed mouth position has been exposed, the patient
asked to open his mouth to do the exposure second.

B. Research Questions
1. Procedure for examining the temporomandibular joint in the Radiology Installation
Yogyakarta Sleman General Hospital.
a. How to prepare the patient before undergoing the examination
radiography of the temporomandibular joint in the Radiology Installation of the
Hospital
Yogyakarta.
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b. How to prepare tools and materials for radiographic examination
temporomandibular joint in the Radiology Installation of Sleman Hospital
c. How is the temporomandibular joint radiographic examination technique
using the panoramic method and the Schuller method in the installation Radiology at
Sleman Yogyakarta Hospital.
2. Reasons for using the temporomandibular joint examination panoramic method and
schuller method in the Hospital Radiology Installation Yogyakarta
a. Why do you use temporomandibular joint examination? panoramic method?
b. Why do you use temporomandibular joint examination?schüller method?
3. What are the criteria for images of the temporomandibular joint with
using the panoramic method? 4. What are the criteria for images of the
temporomandibular joint with use the schuller method?

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 CHAPTER III
RESEARCH METHODOLOGY

A.Type of Research
This type of research in scientific writing is research qualitative with a case study
approach.
B. Time and Location of Data Collection Data
collection for the preparation of this scientific paper carried out from March 2018 to
May 2018 at the installation Radiology RSUD at Sleman Yogyakarta Hospital
C. Research Subjects
Research subjects in scientific papers conducted at The Radiology Installation of
Sleman Yogyakarta Hospital is a radiologist, the sending doctor, and the radiographer
of the Sleman Yogyakarta Regional Hospital who had SEMARANG Examination of
the temporomandibular joint using panoramic dental.
D. Data Collection Methods
1. Observation Method
The author directly observes the inspection procedure temporomandibular joint in the
Radiology Installation of Sleman Hospital Yogyakarta.
2. Interview Method
The author conducted an interview with a radiographer Examine the
temporomandibular joint with using dental panoramic, radiologist and sending doctor.
3. Documentation
The author retrieves the data from the required documents in making this scientific
paper, such as a letter of request x-rays, radiograph results, results of patient
radiograph readings and PROTAPCASE KNIC radiographic examination of the
temporomandibular joint in the Radiology Installation Yogyakarta Sleman General
Hospital.
E. Research Instruments
Equipment used for data collection are:
1. Observation guidelines
2. Gudelines interview guide
3. Documentation guidelines
F. Data Processing and Data Analysis
The data analysis used in this study is an analytical model
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Interactive includes:
1. Data Collection
The data obtained from the results of interviews, observations and documentation is
then recorded and collected for the stage next.
2. Data reduction
With reduction, the researcher summarizes, retrieves the data urgent. In reducing data,
researchers will refer to the objectives to be achieved.
3. Presentation of data After the data is reduced, open coding is then made makes it
easy to quote. By presenting data, it will makes it easy to understand what's going on.
4. Drawing conclusions
The data that has been reduced and presented is then compared with the existing
theory so that a conclusion can be drawn.

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