TEMPOROMANDIBULAR JOINT

1
TEMPOROMANDIBULAR JOINT

• ANATOMY
• PATHOPHYSIOLOGY
• SURGERY

2
JOINTS- WHAT ARE THEY?

• Osseous elements which are multiple that are
  joined by a variety of structural elements.
• These co-aptations are grouped as arthroses

3
ARTHROSES

• FORCES
• Tensile,compressive,shear and torsion

• Concerned with differential growth, transmission
  of forces and with movement

4
TYPES OF ARTHROSES-2

• 1.SYNARTHROSES which are solid non-synovial
  joints. Can be fibrous or cartilaginous.
• Fibrous denotes intramembranous ossification
• Cartilaginous denotes endochondral ossification

5
TYPES OF ARTHROSES-2

• 2. DIARTHROSES which are cavitated synovial
  joints
• Characterized by having articular surfaces
  covered by cartilage(hyaline or fibrocartilage)
  with its lubricated smooth wear resistant surface
  which glides over its fellow with minimal friction

6
SYNARTHROSES-TYPES

• Sutures,synostoses
• Gomphoses (peg and socket)
• Synchondroses (manubriosternalis)

7
DIARTHROSES-TYPES

• Can be simple(one pair of articulating ,
  surfaces), compound(more than one pair of
  surfaces), or complex(with intracapsular meniscus
  or disc)
• Surface shapeplane, spheroid(ball and socket),
  ellipsoid, ginglymus, bicondylar,trochoid(pivot)
  and sellar(saddle-shaped)

8
THE TMJ

• Are the only synovial joints with an articular
  disc

9
TMJ Classification

• Anatomic Classification
• Diarthrodial two joints (joint spaces)
• a joint that contains the following
  characteristics
• a freely movable joint
• bony surfaces are covered with hyaline or
  fibrocartilage
• lined by a synovial lining and contains synovial
  fluid

10
TMJ Classification

• Functional classification
• Ginglymo - arthroidial
• Ginglymoid rotation - inferior joint space
• Arthroidial translation - superior joint space

11
TMJ Classification

• The mandible functions as a class III lever
  system
• Load - occlusal surface
• Fulcrum - TMJ
• Force - muscles of mastication

12
Anatomy Overview

• Temporomandibular joint
• -the articulation of the mandibular condylar
  process with the glenoid fossa/articular eminence
  aspect of the temporal bone. Also includes the
  interposed articular disc and collateral
  ligamentous attachments.
• -is an encapsulated, synovial joint.
• -classified as a ginglymo-arthroidal joint due to
  its ability to function as a hinge as well as a
  gliding type of joint.
• -functions as a Class III lever system.

13
QUESTION ANATOMY

• What are the six (6) components of the
  temporomandibular joint articulation?

14

• Condyles
• Articular surface of the temporal bone
• Capsule
• Articular disc
• Ligaments
• Lateral pterygoid

15
Osseous components
16
TOMOGRAPHC SCAN OF JOINT
17
SOFT TISSUE COMPONENTS

• Muscles and ligaments
• Disk
• Posterior disk attachment
• Joint capsule
• Synovia

18
DISC POSITION
19
Anatomy Overview
20
TEMPOROMANDIBULAR DISORDERS

• A collective term used to describe a number of
  related conditions that involve the TMJs,
  masticatory muscles, and associated structures
  these conditions may present with facial pain,
  joint noises, limited jaw function, and other
  symptoms-ear ache, headache, tinnitus,
  neck/shoulder pain

21
HISTORICAL REVIEW

• Costen syndrome 1934
• Temporomandibular joint pain dysfunction syndrome
  1955
• Myofascial pain and dysfunction 1969
• Facial arthromyalgia 1974
• Temporomandibular disorders 1983
• Craniomandibular disorders 1993

22
MOST COMMON TMDs

• Myofascial pain and dysfunction
• Internal derangement
• Osteoarthrosis

23
MYOFASCIAL PAIN AND DYSFUNCTION

• Refers to a group of poorly defined muscle
  disorders (eg, fibromyalgia) characterized by
  diffuse facial pain and episodic limited jaw
  opening
• May result from parafunctional habits and
  significant relationship to psychophysiologic
  disorders such as stress or depression

24
INTERNAL DERANGEMENT

• Abnormal relationship of the articular disc to
  the mandibular condyle, fossa,and articular
  eminence, interfering with the smooth action of
  the joint (Dolwick 1983)
• Is a localized mechanical fault within the joint
• Synonymous with disc displacement

25
(No Transcript)
26
WILKES CLASSIFICATION

• STAGE I TMJ clicking/no pain/no radiographic DJD
• STAGE II Jt sounds/pain with intermittent
  locking but no x-ray DJD
• STAGE III As II, but with x-ray DJD
• STAGE IVADD without reduction/DJD
• STAGE V Disc perf./Advanced DJD

27
OSTEOARTHROSIS

• Is a nanpainful, localized degenerative joint
  disease that mainly affects bone and articular
  cartilage.
• It is often idiopathic, but predisposing factors
  such as old age, repetitive trauma (bruxism),
  abnormal joint posturing, or multiple surgical
  procedures may be involved. If painful,then
  referred to as osteoarthritis

28
DEGENERATIVE CHANGES IN CONDYLE
29
EPIDEMIOLOGY

• About 60-70 of the population have features of
  TMDs
• About 20-30 report symptoms of TMDs
• About 5 of people with TMD symptoms actually
  seek treatment
• The femalemale ranges from 31 to 91

30
TMJ SURGERY

• Indicated for a subset of temporomandibular
  disorders
• 1.Internal derangment 2.Degenerative joint
  disease 3. Rheumatoid arthritis 4.
  Infectious arthritis 5.Mandibular dislocation
  6.Ankylosis 7.Condylar hyper/hypoplasia

31
CONTRALATERAL PAIN SUGGESTS ARTICULAR DISEASE
32
INTERNAL DERANGEMENT
33
SURGERIES OF THE JOINT

• Discectomy
• Disc repositioning
• Condylotomy
• Arthrocentesis
• Arthroscopy
• Partial and total joint replacement

34
(No Transcript)
35
HOLMLUND-HELMSING LINE
36
ARTHROSCOPY
37
ANKYLOSIS
38
TOTAL JOINT REPLACEMENT
39
(No Transcript)
40
PHYSICAL THERAPY