pankaj

Rotational / hinge movement in first 20-25mm of

mouth opening
Translational movement after that when the mouth is

excessively opened.

 Translatory movement in the superior part of the joint

as the disc and the condyle traverse anteriorly along the

inclines of the anterior tubercle to provide an anterior
and inferior movement of the mandible.

Mouth closed

Mouth open

Hinge movement the inferior portion of the joint

between the head of the condyle and the lower surface of
the disc to permit opening of the mandible.

Points to remember

1.

Ligaments do not actively participate in function of

TMJ
Ligaments do not stretch
Articular surfaces must maintain constant contact

2.

3.

YOUNG CONDYLE

ADULT CONDYLE

Condylar head more

Less vascular

vascular
Neck thinner
Bone is soft & pliable
Cartilage is predominant in

the child

Neck is thicker
Bone is less pliable
Fibrous tissue

predominant

10

 Dislocation of mandible During excessive opening of the

mouth.
In operation on the joint the Seventh Nerve should be
preserve with care.
Derangement of the articular disc may result from injury
like over closure or malocclusion, this gives rise to clicking
and pain during movement of the jaw.

ETIOLOGY of dislocation
1.

Intrinsic forces
Excessive yawning
Vomiting
Singing / laughing loudly
Blowing wind instruments
Hysterical fits

2.

Extrinsic forces
Trauma to the mandible during fall or blow to the
chin, while mouth is open
Injudicious use of mouth gag during GA
Excessive pressure on mandible during Dental
extraction.

3.

Connective tissue disorders

Hyper mobility syndrome
Ehlers danlos syndrome
Marfans syndrome

4.

Psychogenic causes
Habitual dislocation.

5.

Miscellaneous causes
Internal derangement
Deceased vertical dimension
Occlusal discrepancies
Parkinsons disease
Epilepsy .

DISLOCATION
If oral openings proceeds to its maximum capacity , the condylar
heads move to the anterior slope of the articular eminences in many
cases.
Excursion of condylar heads beyond these limits
Dislocation.
Intact condylar head is displaced out of glenoid fossa, much
anteriorly beyond articular eminence but still remains within the
capsule of joint.
Incidence - 3.1 %

The dislocation can be unilateral or

bilateral.
Anterior mandibular dislocation can be :
Acute
Chronic recurrent (habitual) subluxation
Long-standing
Causes of Acute
Dislocation
Extrinsic forces /
Iatrogenic causes
Intrinsic / Self
induced forces

UNILATERAL ACUTE DISLOCATION

It is characterized by difficulty in mastication and swallowing
Speaking may be difficult.
Profuse drooling of saliva may be present at early stages
Deviation of the chin toward contra lateral side is seen
The mouth is partly open and the affected condyle cannot be

palpable.
Depression will be seen and felt in front of the tragus

Depression of preauricular area

Laterognathia

BILATERAL ACUTE DISLOCATION

It is associated with pain
Inability to close the mouth
Tense Masticatory muscles
Difficulty in speech
Excessive salivation
Protruding chin
The mandible is postured forward and movements are restricted
There is gagging of the molar teeth with the presence of anterior bite
Difficulty in swallowing and drooling of saliva is seen
Patient will complain of pain in the temporal region
The distinct hollowness can be felt in both the pre-auricular region

Posterior gag
Anterior open
bite