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TEMPOROMANDIBULAR JOINT DISORDERS

TEMPOROMANDIBULAR JOINT DISORDERS. TMJ D/O. The chief symptoms and dysfunctions are associated with altered condyle -disc relationship and function.

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TEMPOROMANDIBULAR JOINT DISORDERS

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  1. TEMPOROMANDIBULAR JOINT DISORDERS

  2. TMJ D/O • The chief symptoms and dysfunctions are associated with altered condyle-disc relationship and function. • Dysfunction and arthralgia common. Dysfunction is associated with clicking and catching of the joint. The clicking anfd catching is usually constant, repeatable, and may be progressive.

  3. TMJ DISORDERS 3 MAJOR CATEGORIES • 1. DERANGEMENTS OF THE CONDYLE-DISC COMPLEX • 2. STRUCTURAL INCOMPATIBILITIES OF THE ARTICULAR SURFACES • 3.INFLAMMATORY D/O OF THE JOINT

  4. DERANGMENTS OF THE CONDYLE-DISC COMPLEX • CAUSE: breakdown of the normal rotational function of the disc on the condyle. The movement loss is secondary to elongation of the discal collateral ligaments. Disc attachments include:posteriorly-retrodiscal tissue(posterior attachment) and superior retrodiscal lamina attaches to the tympanic plate and the inferior retrodiscal lamina to the posterior margin of the articular surface of condyle

  5. DERANGEMENTS OF COND-DISC. • Disc attachments con’t.: anterior region of disc include both superior and inferior attachment site via the capsular ligament. Also the superior attachment is to the articular surface of the temporal bone. The inferior attachment is to the articular surface of the condyle. Anteriorly, between the attachments of the capsular ligament, disc is also attached to superior lateral pterygoid muscle

  6. DISC ATTACHMENTS CON’T • Medial and lateral attachments of disc also occur. The joint cavity is divided into superior and inferior joint space. Synovium lines the joint spaces and secretes synovial fluid. Lubrication by this fluid occurs by two mechanisms: 1. boundary lubrication which is fluid movement between spaces and 2. weeping lubrication which is synovial fluid absorbtion during compressive function

  7. MOST COMMON FACTOR ASSD WITH BREAKDOWN OF CONDYLE-DISC RELASTIONSHIP TRAUMA!!!!! macrotrauma or microtrauma

  8. TYPES OF DERANGMENTS OF THE CONDYLE –DISC COMPLEX (3) • DISC DISPLACEMENT • DISC DISLOCATION WITH REDUCTION • DISC DISLOCATION WITHOUT REDUCTION • Disc displacement-internal derangement and is the relationship between condyle and disc when the teeth are in occlusion.

  9. NORMAL CONDYLE-DISC

  10. ANTERIOR DISPLACEMENT Posterior disc border thinned with elongation lamina

  11. DISC DISPLACEMENTS • Proceeds from incoordination phase (pt state that their jaw “catches” but no joint noise and indicates early increase in frictional properties of jt. Next category: ADDwr-- disc is forward and clicking/popping heard. Sound production is from condyle passing over posterior band. The disc is generally displaced anteromedial because of pull of lateral pterygoid. A second click upon closing is referred to as a reciprocal click.

  12. ADDwr Resting closed position Disc recaptures with opening

  13. DISC DISPLACEMENTS CON’T • After incoordination, ADDwr, then the next progresssive phase is ADDwor. The intra-articular disc is further forward and the condyle is unable to pass over the posterior band on attempted mouth opening, with resultant locking rather than clicking. Only condyle rotation but without translation. Lastly, limitation of mouth opening is not caused by disc displacement but by adhesion of disc to articular eminence.

  14. Permanent adhesion between disc and superior aspect of fossa

  15. ADDwor • Clinical characteristics will show a decreased ROM and is usually with a MIO of 25-30mm. The mandible may deflect to the involved jt side. The maximum opening reveals a hard end feel (apply pressure to lower incisors and no further increase in opening). Laterotrusive movements (excursions) are normal on ipsilateral but restricted on contralateral side

  16. STRUCTURAL INCOMPATIBILITIES • Occur when normally smooth sliding surfaces are altered and frictional pattern becomes prominent. Like with trauma-blow to chin with teeth together will cause macrotrauma and lead to joint surface alteration. Also, trauma may result in hemarthrosis. Blood may induce fibrosis/scar formation • Deviation in form, subluxation, and spontaneous dislocation are examples

  17. Osteophyte on condyle with probable impingment on posterior band

  18. Structural incompatibility Osteophyte on medial pole Disc with central perforation

  19. SUBLUXATION-HYPERMOBILITY • Occurs in the absence of pathology. Anatomic features with joint movement like a steep eminence allows rotation and with further movement the condyle translates out of the fossa. The pt states that “my jaw goes out with side opening like yawning • Remember down and back

  20. SPONTANEOUS DISLOCATIONOPEN LOCK • Represents a hyperextension of the TMJ, that fixes the joint in the open position and prevents translation • It is called an open lock because the pt cannot close the mouth • It occurs most often with joints with anatomical features that produce subluxation • Muscle dystonias-may cause like jaw-opening oromandibulardystonia

  21. INFLAMMATORY D/O • Characterized by continous deep pain, accentuated by function. Continous pain can produce secondary central excitatory effects • Inflammatory conditions are classified by structures involved:synovitis, capsulitis, retrodiscitis, and the arthritides

  22. Synovitis and capsulitis • High association with trauma. History may include a traumatic or abusive movement. • The capsular ligament can be palpated over the lateral pole of the condyle • Pain caused by this manuever indicates capsulitis

  23. RETRODISCITIS • Association with trauma like a blow to chin. Pain is constant, function makes worse, and may progress to secondary central excitatory effects. • Will feel a soft end unless disc dislocation. May see an acute malocclusion with disocclusion of ipsilateral posterior teeth and heavy contact of contralateral anterior teeth.

  24. ARTHRITIDES • Osteorthritis represents a destructive process by which the bony surfaces of condyle and eminence/fossa become altered. Subchondral cyst may be seen • Is often painful, worse with jaw movement. Crepitation(grinding) common • Association with disc displacement and perforation • Adaptive changes and pt without pain referred as osteoarthrosis

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