口腔病理學

1. 口腔病理學 Diseases affecting Temporomandibular Joint (1) 顳 顎 關 節 疾 病 (1) 陳玉昆教授: 高雄醫學大學 口腔病理科 07-3121101~2755 yukkwa@kmu.edu.tw

2. 學 習 目 標 Understanding: 1. Vocabulary 2. Anatomy of temporomandibular joint 3. Normal joint function 4. Function of muscles of mastication

3. 參考資料 References: • Oral Pathology for the Dental Hygienist. Olga AC Ibsen, Joan Anderson Phelan, 4th edition, 2004, Chapter 10, p. 356-364 • Eric Whaites: Essentials of dental radiography & radiology 3rd edition, Chapter 29, p. 371-388 • Peggy Woodward MRI for technologists McGraw-Hill, Chapter 1 pp. 1-12 • 購網路資源：super_toolcool

4. Temporomandibular Joint Vocabulary Arthrocentesis(關節穿刺術): Surgical puncture of a joint for withdrawal of fluid. Arthrography(關節造影術):Radiography of a joint after injection of opaque contrast material. Arthroscopy(關節鏡): Method for evaluating & manipulating a joint via the insertion of a camera & instruments. Ref. 1

5. Temporomandibular Joint Vocabulary Articulation: Joint. Auscultation(聽診): Listening to sounds within the body using a stethoscope(聽筒). Crepitus(捻發音): Dry, cracking sound. Iatrogenic(醫源性): Induced inadvertently by a medical or dental care provider or by medical treatment or a diagnostic procedure. Ref. 1

6. Temporomandibular Joint Dr. Raymond Damadian built1st whole body MRI machine - 1977 Vocabulary Magnetic resonance imaging (MRI): Noninvasive diagnostic technique that uses radio waves to produce computerized images of internal body tissues. Dr Raymond Damadian & his associates, Drs Larry Minkoff & Michael Goldssmith, completed the world's 1st whole body MRI scanner. Named Indomitable to capture the spirit of its 7-year construction (now located at Smithsonian Ins, Washington, DC) The first whole body transaxial image took 4 h 45 min to produce. Made on July 3, 1977, it shows the thoracic spine of Larry Minkoff Indomitable Indomitable: 百折不撓 Ref. 3

7. Temporomandibular Joint Vocabulary Palpation: Physical examination using pressure of hand or fingers. Sign:Objective evidence of disease that can be observed by a health care provider rather than by patient. Symptom: Subjective evidence of disease or a physical disorder that is observed by patient. Trismus(牙關緊閉):Spasm of muscles of mastication. Refs. 1, 4

8. Anatomy of theTemporomandibular Joint Temporomandibular joint is articulation between condyle of mandible & glenoid fossa of temporal bone. Ref. 1

9. Anatomy of theTemporomandibular Joint Temporomandibular joint is a highly specialized joint that differs from other joints because of fibrocartilage that covers bony articulating surfaces, its ginglymoarthrodial (rotational & translational) movement. Ref. 1

10. Anatomy of theTemporomandibular Joint Temporomandibular joint depends on contralateral joint. An articular disk is interposed in the space between temporal bone & mandible. The disk divides the space into an upper (superior joint space) & a lower compartment (inferior joint space). Ref. 1

11. Anatomy of theTemporomandibular Joint Translational movements occur in upper compartment, whereas lower compartment functions primarily as hinge or rotational component. Ref. 1

12. Anatomy of theTemporomandibular Joint Superior & inferior spaces contain synovial fluid, which is produced by synovial membrane that lines the joint. Synovial fluid provides nourishment & lubrication of avascular structures. Ref. 1

13. Anatomy of theTemporomandibular Joint Articular disk is attached to lateral & medial aspects of condyle, to superior belly of lateral pterygoid muscle, & to joint capsule. • Functions of articular disk: • Shock absorption • Dissipation of synovial fluid • Facilitation of rotation & translation Ref. 1

14. Anatomy of theTemporomandibular Joint Disk & bony surfaces are avascular (without blood vessels). Joint is further surrounded & protected by fibrous connective tissue joint capsule. Ref. 1

15. Glenoid fossa Upper joint space Ext auditory meatus Disc/meniscus Lower joint space Condyle head Lateral pterygoid attachment Anatomy of theTemporomandibular Joint Basic components of TMJ include: Mandibular component: head condyle Disc Temporal component: glenoid fossa & articular eminence Capsule surrounding the joint Ref. 2

16. Anatomy of theTemporomandibular Joint Lateral Anterior Base Ref. 2

17. Function of muscles of mastication Understanding location & action of muscles of masticationis important in evaluation of disorders affecting temporomandibular joint. Ref. 1

18. Function of muscles of mastication Palpation of muscles of mastication during a clinical evaluation is used to determine whether muscle spasm or dysfunctional muscle activity is occurring. Ref. 1

19. Function of muscles of mastication Muscles of mastication include masseter, temporalis, medial pterygoid, lateral pterygoid, anterior digastric, & mylohyoid (suprahyoids). Temporalis Temporalis Lateralptyerygoid Lateralptyerygoid Masseter Medialptyerygoid Suprahyoids Masseter Ref. 1

20. Function of muscles of mastication Masseter, medial pterygoid, & temporalis, are elevator muscles that, when activated, close the mandible. Temporalis Temporalis Lateralptyerygoid Lateralptyerygoid Masseter Medialptyerygoid Suprahyoids Masseter Ref. 1

21. Function of muscles of mastication Opening, or depressor, function is accomplished mainly by lateral pterygoid muscle with some help from anterior digastric muscle. Temporalis Temporalis Lateralptyerygoid Lateralptyerygoid Masseter Medialptyerygoid Suprahyoids Masseter Ref. 1

22. Function of muscles of mastication Suprior belly of pterygoid muscle seats articular disk on eminence of articulating surface. Inferior belly is attached to mandibular condyle & functions during mouth opening. Lateralptyerygoid superior head Lateralptyerygoid inferior head Ref. 1

23. Summaries Knowing: • Vocabulary related to TMJ • Anatomy related to TMJ (glenoid fossa, disk, condyle, capsule, superior belly of lateral pterygoid muscle) 3. Function of muscles of mastication