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The Tempromandibular Joint (TMJ)

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Title: The Tempromandibular Joint (TMJ) Created Date: 8/16/2006 12:00:00 AM Document presentation format: On-screen Show (4:3) Other titles: Corbel Arial Consolas ... – PowerPoint PPT presentation

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Title: The Tempromandibular Joint (TMJ)


1
The Tempromandibular Joint(TMJ)
  • By
  • Nour-Eldin A. Nour-Eldin Mohammed

2
Normal Anatomy
Mandibular condyle (head)
Glenoid fossa
Articular tubercle (eminence)
3
Posterior band of articular disc
Anterior band of articular disc
Mandibular condyle (head)
Lateral pterygoid muscle raphe
Lower head of lateral pterygoid muscle
Posterior disc attachment
4
Mandibular condyle (head)
Articular disc
5
MRI and autopsy sections upper row oblique
sagittal MRI, asymptomatic volunteer left
lateral, middle medial, right opened mouth
6
Internal Derangements
  • General orthopedic term implying a mechanical
    fault that interferes with the smooth action of a
    joint
  • The most common internal derangement is disc
    displacement
  • Clinical Features
  • Clicking sounds from joint(s)
  • Restricted or normal mouth opening capacity
  • Deviation on opening
  • Pain

7
Internal Derangements
  • Imaging Features
  • Anterior disc displacement posterior band of the
    disc located anterior to the superior portion of
    the condyle at closed mouth on oblique sagittal
    images
  • Disc may have normal (biconcave) or deformed
    morphology
  • In opened mouth position disc may be in a normal
    position (with reduction) or continue to be
    displaced (without reduction)

8
Partial anterior disc displacement at baseline
lateral sections
central sections
open-mouth
9
Complete anterior disc displacement
Open-mouth MRI
medial section
Autopsy
10
Lateral disc displacement and normal bone
11
Medial disc displacement
Oblique coronal MRI
coronal MRI
12
Posterior disc displacement
13
Osteoarthritis
  • Definition
  • Non-inflammatory focal degenerative disorder of
    synovial joints, primarily affecting articular
    cartilage and sub-condylar bone initiated by
    deterioration of articular soft-tissue cover and
    exposure of bone.
  • Clinical Features
  • Crepitation sounds from joint(s)
  • Restricted or normal mouth opening capacity
  • Pain or no pain from joint areas and/or of
    mastication muscles
  • Occasionally, joints may show inflammatory signs
  • Women more frequent than men

14
anteriorly displaced and deformed, degenerated
disc and irregular cortical outline with
osteophytosis and sclerosis of condyle .
15
Advanced osteoarthritis and anterior disc
displacement, with joint effusion
16
Bone Marrow Abnormalities
  • Definition
  • Bone marrow edema serum proteins within marrow
    interstitium surrounded by normal hematopoietic
    marrow.
  • Osteonecrosis complete loss of hematopoietic
    marrow.

17
  • Imaging Features
  • Abnormal signal on T2-weighted image from
  • condyle marrow increased signal indicates marrow
    edema reduced signal indicates marrow sclerosis
    or fibrosis
  • Combination of marrow edema signal and marrow
    sclerosis signal in condyle most reliable sign
    for histologic diagnosis of osteonecrosis
  • Marrow sclerosis signal may indicate advanced
  • osteoarthritis without osteonecrosis, or
    osteonecrosis

18
Arthritides
  • Definition
  • Inflammation of synovial membrane characterized
    by edema, cellular accumulation, and synovial
    proliferation (villous formation).
  • Clinical Features
  • Swelling of joint area, not frequently seen in
    TMJ
  • Pain (in active disease) from joints
  • Restricted mouth opening capacity
  • Morning stiffness, in particular stiff neck
  • Dental occlusion problems my bite doesnt fit
  • Crepitation due to secondary osteoarthritis

19
Rheumatoid arthritis.
After 1 year
20
Rheumatoid arthritis. A MRI shows completely
destroyed disc, replaced by fibrous or vascular
pannus and cortical punched-out erosion (arrow)
with sclerosis in condyle.
21
Psoriatic arthropathy. Oblique coronal and
oblique sagittal CT images show punched-out
erosion in lateral part of condyle (arrow).
Psoriatic arthropathy. MRI shows contrast
enhancement within bone erosion and in joint
space, consistent with thickened synovium/pannus
formation. Openmouth MRI shows reduced condylar
translation but normally located disc (and normal
bone in this section)
22
Inflammatory arthritis
23
Ankyloses
Definition Fibrous or bony union between joint
components.
24
Growth Disturbances (Anomalies)
Definition Abnormal growth of mandibular condyle
overgrowth, undergrowth, or bifid appearance.
25
Condylar hypoplasia and facial asymmetry
Condylar Hypoplasia
Normal TMJ
26
Bifid condyle.
27
Inflammatory or Tumor-like Conditions
Calcium Pyrophosphate Dehydrate
Crystal Deposition Disease (Pseudogout)
28
Benign Tumors
  • Synovial Chondromatosis
  • Benign tumor characterized by cartilaginous
    metaplasia of synovial membrane, usually in knee,
    producing small nodules of cartilage, which
    essentially separate from membrane to become
    loose bodies that may ossify.

29
Synovial Chondromatosis
30
Osteochondroma
Definition Benign tumor characterized by normal
bone and cartilage, near growth zones.
31
Osteoma
32
Malignant Tumors
Osteosarcoma mandible 18-yearold female
33
Malignant tumor, mandible 70- year-old male with
metastasis from lung cancer
34
Thank you
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