Shika Hoshasen

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Purpose: Panoramic TMJ projection is one of the alternative methods of conventional radiography, such as transcranial projection, for diagnosing temporomandibular joint disorder. There have been a few reports describing the diagnostic ability of this method. We evaluated the diagnostic accuracy of detecting bone change with panoramic TMJ projection.
Materials and Methods: Fifty TMJs in 25 patients were examined. All TMJs were examined by panoramic TMJ projection (Hyper XF) and limited cone-beam CT (3D Accuitomo FPD; 3DX). Two observers evaluated the presence of bone change in the TMJ region using panoramic TMJ projection. One other observer evaluated the limited cone-beam CT for the presence and the pattern of bone changes in the TMJ region as the gold standard. Panoramic TMJ findings were evaluated with regard to sensitivity, specificity, and accuracy.
Results and conclusions: Sensitivity, specificity and accuracy of the panoramic TMJ projection were 0.86, 0.76, and 0.82, respectively. These results and those of previous reports on other radiographic methods for TMJ suggest that panoramic TMJ projection is a useful method of screening for bone change due to TMJ disorder.

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The present paper reports a case of radicular cyst in the mandible which shows atypical radiographic findings. The patient was a 33-year-old male, complaining of paresthesia of the left lower lip. Radiographically, a cystic lesion was seen in the root apex of the mandibular left first molar. The lesion showed a well defined margin and without osteosclerotic change in the surrounding bone. CT images revealed a marked buccolingual cortical bone resorption which looked like so-called “punched-out” appearance. In this case, panoramic radiograph showed cystic lesion whereas CT findings suggested tumorous lesion.

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