Introduction

 The TMJ is a ginglymoarthrodial

joint, a term that is derived from
ginglymus, meaning a hinge joint,
allowing motion only backward and
forward in one plane, and arthrodia,
meaning a joint of which permits a
gliding motion of the surfaces.
 Peculiarity of TMJ
1. Bilateral diarthrosis – right & left function together

2. Articular surface covered by fibrocartilage

instead of hyaline cartilage

3. Only joint in human body to have a rigid endpoint

of closure that of the teeth making occlusal contact.
 Mandibular condyle

 Articular surfaces of
Temporal bone

 Capsule

 Articular disc

 Ligaments

 Muscular component
THE MANDIBULAR CONDYLE

 An ovoid process
seated atop a
narrow mandibular
neck. It’s the
articulating surface
of the mandible.
 Cranial Component
or
Articular surfaces of Temporal bone

 The articular surface of

the temporal bone is
situated on the inferior
aspect of temporal
squama anterior to
tympanic plate.
 Articular Disc
 The articular disc is the most
important anatomic structure of the
TMJ.

 It is a biconcave fibrocartilaginous
structure located between the
mandibular condyle and the temporal
bone component of the joint.

 Its functions to accommodate a

hinging action as well as the gliding
actions between the temporal and
mandibular articular bone.
 Hinging (rotation) movements
take place in the lower
compartment and gliding
(translation) movements take
place in the upper compartment.
 The disc is attached all around
the joint capsule except for the
strong straps that fix the disc
directly to the medial and
lateral condylar poles, which
ensure that the disc and
condyle move together in
protraction and retraction.
Fibrous
Capsule
 Thin sleeve of tissue completely
surrounding the joint.
 Extends from the circumference of the
cranial articular surface to the neck of
the mandible.
• This capsule is reinforced more laterally by an
external TMJ ligament, which also limits the
distraction and the posterior movement of the
condyle.
 The synovial membrane lining
the capsule covers all the intra-
articular surfaces except the
pressure-bearing fibrocartilage.
Lubrication of the Joint
 The synovial fluid comes from
two sources: first, from plasma
by dialysis, and second, by
secretion from type A and B
synoviocytes with a volume of
no more than 0.05 ml.
 Synovial fluid……
 It is clear, straw-colored viscous fluid.
 It diffuses out from the rich cappillary network of the
synovial membrane.

Contains:
 Hyaluronic acid which is highly viscous
 May also contain some free cells mostly
macrophages.

Functions:
 Lubricant for articulating surfaces.
 Carry nutrients to the avascular tissue of the joint.
 Clear the tissue debris caused by normal wear and
tear of the articulating surfaces.
TMJ disorders
Epidemiology
 Epidemiologic studies has shown that
60-70% of the general population have
functional disturbances of the
masticatory apparatus.
 Most prevalent between the ages of 20-
40 years and predominantly affects
women
Etiology
Multifactorial
 Parafunctional habits .
 Emotional stress.
 Acute trauma from blows / impacts.
 Trauma from hyperextension.
 Instability of maxillo-mandibular relationships.
 Laxity of the joints.
 Rheumatic / musculo-skeletal disorders.
 Poor general health and unhealthy lifestyle.
Classification
 Developmental anomalies
 Condylar hyperplasia.
 Condylar hypoplasia.
 Condylar Aplasia
 Osteoarthrosis
 Rheumatoid arthritis
 Inflammatory arthritis
 Infective arthritis
 Local middle ear infection
 Systemic infection (e.g. gonococcal).
 Neoplasia
 Metabolic disease (ex. Gout, chondrocalcinosis).
 Synovial disease (Ex. PVNS)
 Miscellaneous conditions (Ex: Paget’s disease of bone, acromegaly).

CD Franklin
Classification
 Intracapsular disorders of the TMJ.

Source Disorder
Degenerative (non-inflammatory) Degenerative joint disease

Inflammatory Rheumatoid arthritis

Psoriatic arthritis

Infections Spread from contiguous site

Developmental Condylar hyperplasia, hypoplasia
and agenesis

Traumatic Condylar fracture, ankylosis,

dislocation and disc displacement

Burket’s
Classification of TMJ Disorders:

1. Developmental Disorders of TMJ

2. Degenerative Joint Disease
3. Inflammatory Disorders
of the Joint
4. Traumatic Disorders of TMJ
5. Metabolic Disorders
6. Neoplastic Disorders
7. TMJ Disorders Syndrome or
Myofacial Pain Dysfunction Syndrome
Classification
I. Developmental disturbances of the TMJ
 Aplasia of the mandibular condyle
 Hypoplasia of the mandibular condyle
 Hyperplasia of the mandibular condyle
II. Traumatic disturbances of the TMJ
 Luxation and subluxation (complete and incomplete dislocation)
 Ankylosis (hypomobility) Injuries of the articular disk (meniscus)
III. Fractures of the condyle
IV. Inflammatory disturbances of the TMJ
 Arthritis
 Rheumotoid arthritis
 Osteoarthritis (degenerative joint disease, hypertrophic arthritis
V. Neoplastic disturbances of the TMJ
VI. Extra-articular disturbances of the TMJ
VII. Temporomandibular joint syndrome (TMD)
 TMD secondary to myofacial pain and dysfunction (MPD)
 TMD secondary to true articular disease.
 Developmental
disturbances of the TMJ
I. Developmental disturbances of the TMJ
1. Aplasia of the mandibular condyle
 Condylar aplasia or failure of development of the mandibular
condyle – which may occur unilaterally or bilaterally.
 It is a rare condition
Clinical features:
 Associated with other anatomically related defects such as a
defective / absent external ear an under developed mandibular
ramus or macrostomia.
 Unilateral condylar aplasia - Facial asymmetry
 A shift of the mandible towards the affected side occurs during
opening
 In bilateral cases this shift is not present
Treatment
 Osteoplasty
 Orthodontic appliances
 Cosmetic surgery - in correcting facial deformity
I. Developmental disturbances of the TMJ
2. Hypoplasia of the mandibular condyle
Under development / defective formation of the mandibular
condyle
 Congenital hypoplasia
Idiopathic
Characterized by uni / bilateral under development of
the condyle
 Acquired hypoplasia
May be due to any agent which interferes with the normal
development of the condyle.
Causes:
 Forceps deliveries
 External trauma
 X-ray radiation
 Infection
Clinical features:
 Condylar hypoplasia depends upon whether the
disturbance has affected one or both condyles and upon
the degree of malformation.
 Age of the patient at the time of involvement
 The duration of the injury and its severity
 Unilateral involvement is the most common clinical type
 Limitation of lateral excursion on one side
 Mandibular midline shift during opening and closing
 The distortion of the mandible results in lack of downward
and forward growth of the body of the mandible
 Facial asymmetry

Treatment & prognosis

 Cartilage / bone transplants
 Unilateral and bilateral osteotomy to improve the
appearance of the patient with asymmetry and retrusion.
I. Developmental disturbances of the TMJ
3.Hyperplasia of the mandibular condyle
Condylar hyperplasia is a rare unilateral enlargement
of the condyle
Causes:
Sugg. Factors - Mild chronic inflammation which
stimulates the growth of the condyle or adjacent
tissue.
Clinical features: patient is usually exhibit
 A unilateral, slowly progressive elongation of the
face with deviation of the chin away from the
affected side.
 The enlarged condyle may be clinically evident
 The affected joint may or may not be painful
 A severe malocclusion is a usual sequela of the
condition
 Treatment and prognosis
 If growth is occurring condylectomy
 If growth is ceased orthognathic
surgery is performed Resection of
condyle restore normal occlusion.
I. Developmental disturbances of the TMJ
4. Bifid condyle
Double headed mandibular condyle.
They have a medial and lateral head divided by A-
P groove.
Some condyles may be divided into an anterior
and posterior head.
Etiology:
 Uncertain.
 A-P bifid condyle - traumatic in origin.
 Mediolaterally divided condyles - trauma,
abnormal muscle attachment, teratogenic agents.
Clinical features
 Unilateral
 Asymptomatic
 Pop or click of TMJ
Rx:
 Bilobed appearance of the condylar head.
Prognosis:
 Asymptomatic - no treatment necessary.
Traumatic
II. Traumatic disturbances of the TMJ
1. Luxation and subluxation (complete & incomplete
dislocation)
 Dislocation of the TMJ ↓
when the head of the condyle moves anteriorly over
the articular eminence into such a position that
cannot be returned voluntarily to its normal
position.
 Luxation of the joint is complete dislocation while
subluxation is a partial / incomplete dislocation
 Luxation may be ‘acute’, due to a sudden
traumatic injury resulting in the fracture of the
condyle.
 Yawning / having the mouth opened too widely.
Unilateral condylar dislocation
Bilateral condylar dislocation
 Luxation may be:
 Anterior
 Posterior
 Lateral
 Anterior luxation
• Most frecquent type of luxation:
• Unilateral or more often bilateral.

 .
 Etiopatogeny
Causes:
a) yawing, laughing, vomiting, rarely traumas
b) Exagerate force upon the mandible during extraction,
exagerate opening of the mouth etc).
 Bilateral luxation
 Most frequent
 The patient feels an acute pain, hears a
clicking then the impossibility of closing the
mouth.
 Clinic examen:
1. Widely opened mouth, continuous saliva
flowing
2. The distance between superior and inferior
incisors is 3-4 cm, but the molars are in
contact
3. The menton is downward and foreward, but
medial situated
4. Maseter and temporal Muscles are in tension
5. Ahead the ear there is a depresion in the
place where normally should be present the
condyle
6. The condyle`s head is situated more anterior,
under the temporozigomatic arch.
1. The mandibular angle is almost
in contact with the anterior
border of the
sternocleidomastoidian muscle.
2. By palpation, in external
auditory canal there are not felt
the condilar movements. The Simptome
Mastication act is imposible,
the swallowing hard, and the
speech is difficil.
 Unilateral luxation
 Rarely appears
Clinical exam:
1. The deviation of the condyle
is only in one side
2. Facial asimetry caused by
the menton deviation on the
healthy side
3. The soft tissues from the
healthy side are relaxated
4. The interincisival Line is
deviated on the healthy side
5. The mouth is less opened
then in bilateral luxation
6. the mandible is almost
imobile.
 Tratamentul
 Ussually ortopedic and only exceptional –
surgical
 Sometimes it may be performed anesthesia,
for killing the pain and for a good muscular
relaxation, the injection being performed in
periarticular region and in the elevating
muscles of the mandible.
Luxation & Subluxation

 Treatment:
 Relaxation of the muscles and then guiding the head
of the condyle under the articular eminence into its
normal position by an inferior and posterior pressure
of the thumbs in the mandibular molar area.
 Tehnica Nelaton
I step. push downward on the occlusal surfaces of
the molars till the condyle is situated under the
eminence
II step. Push backward the mandible by a slight
rotational movement, the menton being rised to the
maxilla. In the moment when the condyle enters in
the glenoid fossa it can be heard a click. Ussually in
this moment the mouth is sudden closed.
 Luxatiile posterioare
 Se intalnesc foarte rar si sunt insotite de obicei de fractura cu
infundarea peretelui anterior al conductului auditiv extern.
 Cauzele: se produce prin lovituri puternice sau caderi pe barbie, gura
fiind inchisa.

Simptome.
 In luxatia posterioara cu fractura peretelui anterior al conductului auditiv
extern, bolnavii prezinta :
 otoragie cu scaderea acuitatii auditive sau chiar surditate,
 gura intredeschisa cu distanta intre incisivii superiori si inferiori pe
aproximativ 10-20 mm
 incisivii inferiori retrudati pana la 15 mm,
 obrazi turtiti,
 miscarile mandibulare blocate,
 iar tentativa de imobilizare este foarte dureroasa.
 La palpare, conductul auditiv extern este ocupat de capul condilian iar
anterior de tragus se observa o depresiune datorita retrudarii acestuia.
Posterior luxation
 Rarely produced and are usually accompanied by fracture of
the anterior wall of the external auditory canal.
 Causes: occurs through falling on the chin, mouth being closed.

Symptoms.
 haemorrhage with decreased auditory acuity or even deafness,
 mouth half opened with distance between the upper and lower
incisors in about 10-20 mm
 retrudati lower incisors to 15 mm,
 Cheeks flatten,
 mandibular movements blocked
 and attempted restraint is very painful.
 On palpation, external auditory canal is occupied by head
condilian previously tragus and observed a depression due to
its retrudarii.
 In luxatiile fara fractura peretelui anterior al conductului auditiv, bolnavul prezinta :
 gura inchisa,
 relieful mentonier sters,
 unghiul mandibulei in contact cu marginea anterioara a muschiului
sternocleidomastoidian,
 incisivii inferiori retrudati, cu marginea incizala in contact cu fibromucoasa boltii palatine
 iar condilul mandibular se palpeaza sub conductul auditiv, imediat inaintea apofizei
mastoide.

Diagnostic.
Se precizeaza prin examenul radiografic.
Diagnosticul diferential trebuie facut cu: fracturile de cavitate glenoida a osului temporal.

Evolutie, complicatii.
 In luxatia redusa corect si urmata de un tratament bine condus, vindecarea se face fara
a lasa urme.
 In luxatiile cu infundarea peretilor conductului auditiv extern se pot produce complicatii
septice; de asemenea, incorect tratate, aceste luxatii pot fi urmate de anchiloza.
Tratament.
 Reducerea se face prinzand mandibular cu policii aplicatii in santurile vestibulare, in
imediata vecinatate a procesului alveolar si se exercita o presiune in jos urmata de o
tractiune anterioara; in acest mod se mobilizeaza condilul, readucandu-l in cavitatea
glenoida.
 Luxatii laterale
 Sunt cu totul exceptionale, deoarece luxatiile, in afara
sau inauntru sunt impiedicate de rezistenta data de
elementele anatomice ale articulatiei (radacina
longitudinala a apofizei zigomatice, fascia
interpterigoidiana, ligamentele interne etC).
 Deplasarile interne sau externe se produc in
traumatismele violente aplicate lateral pe mandibula
si sunt posibile numai in caz de fracturi ale gatului
condilului si din aceasta cauza in mod firesc va
predomina simptomatologia de fractura. Mentonul este
deviat de partea leziunii, ocluzia este incrucisata.

Tratament.
 Tratamentul tine seama de gradul de deplasare a
fragmentelor fracturate si luxate (se va efectua
tratamentul fracturilor de condil).
 2. Ankylosis
 Fusion of head of the condyle  temporal

bone.

 Etiology:

 Infection

 Traumatic injuries

 Rheumatoid arthritis
 ETIOLOGY

2/3 of ankylosis appear after infectious artritis.

Causes:
 Dental (most wisdom tooth),
 Osteomyelitis (mandibular ramus),
 Purulent parotiditis.
Traumatic injuries:
• Intraarticular fractures of the condyle;
• Bone and menisc injuries by obstretical trauma;
• Joint wounds with / without foreign bodies
Under the infection and trauma influence
(CARTILAGE, MENISC) are being destroyed

FIBROCARTILAGINOUS TISSUE

OSSEUOS TISSUE (OSSEOUS CALLUS)

Ankylosis
 Clinical features:
 Occurs at any age
 Most cases
Before age of 10
M=F
 Unilateral /Bilateral
 In ability to open the jaws
 Pain, tenderness and malocclusion
Unilateral ankylosis

www.indiand
entalacadem
y.com
 Bilateral ankylosis
 Clinical features
 The unilateral ankylosis, the menton is in
retrsion and deviated to the affected side. The
mandible from the affected side is shorter, thinner,
but appears prominent, while the healthy part has a
normal length, with the mandibular angle that
appears flattened. This squash is interpreted as
atrophy.
Interincisival line is deviated to the affected side.
Bilateral anchyloses

The mental region is deleted; the chin is in retrudion

and patients have a characteristic of "bird profile".
The midline is maintained and the lower incisors are
buccaly situated, causing an anterior open bite. Due
to lack of self-cleaning teeth show massive deposits
of tartar with chronic periodontitis
 Ankylosis
Intra-articular ankylosis Extra-articular ankylosis

-Destruction of the meniscus External fibrous / osseous

-Flattening of the mandibular encapsulation.

fossa thickening of the head

of the condyle

-narrowing of the joint space

-Fibrous adhesion
www.indiand
entalacadem
y.com
Ankylosis
 R/F:
 Abnormal / irregular shape of the head of
the condyle
the dissolution of the interarticular line,
Abnormal / irregular shape of the head of the condyle

dispariția incizurii sigmoide și sinostoza dintre mandibula și

arcada temporo-zigomatică.
 Treatment:
 Surgical osteotomy / removal of
section of bone below the condyle.
 Fibrous ankylosis can be treated by
functional methods.
 TRATAMENTUL

1. Tratamentul preventiv al anchilozei temporomandibulare consta in

tratamentul corect si la timp al bolilor, care pot duce la anchiloza (artrite, fracturi
intraarticulare, osteomielite, supuratii ale partilor moi, otite etc).
 Reducerea si imobilizarea fracturilor condiliene trebuie sa fie corecta si urmata
sistematic de mecanoterapie si fizioterapie. In tratamentul tuturor starilor
patologice articulare si periarticulare se urmareste pastrarea integrala a functiei
articulatiei temporomandibulare prin metode medicale si ortopedice.
 la copii, este bine să se instituie un tratament corect al afecțiunilor traumatice și
inflamatorii care pot duce la apariția de anchiloze temporomandibulare. Orice
lovitură pe menton trebuie să fie urmată de un examen minuțios al ATM, la o
fractura condiliană imobilizarea va fi urmată în mod obligatoriu de
mecanoterapie. După accidentele infecțioase regionale să se instituie o terapie
articulară activă
 La adulți anchiloza este de obicei din cauza tratării incorecte a traumelor la
nivelul apofizei condiliene.
2. Tratamentul curativ presupune doua actiuni: interventia chirurgicala
obligatorie, pentru a inlatura obstacolul si a crea o noua articulatie, precum si o
actiune mobilizatoare, prin mecanoterapie postoperatorie.
 TRATAMENTUL CHIRURGICAL
Abordarea chirurgicala a articulatiei temporomandibulare este dificila datorita
prezentei nervului facial, care trebuie respectat obligatoriu.
 Se pot folosi cai de acces preauriculare, retroauriculare si subangulomandibulare si
numeroase traiecte de incizie.
Eliberarea mandibulei se obtine prin osteotomie, practicată la diferite nivele, astfel
osteotomia se poate face la distanta de articulatie, evitand blocul sau chiar prin insusi
blocul osos; se va urmari sa se creeze o noua articulatie cat mai aproape de locul sau
normal, prin osteotomii simple sau modelante, sau rezectii mai mult sau mai putin
intinse ale blocului osos.
Osteotomiile simple sunt urmate de recidive, iar rezectiile osoase prea intinse produc
scurtari importante ale ramului ascendent, cu agravarea tulburarilor fizionomice si
functionale.
Pentru a evita refacerea postoperatorie a anchilozei, osteotomiile s-au asociat cu diverse
interpozitii: fascicule musculare din temporal sau maseter, fascia lata, grasime,
autocartilaj costal sau cartilaj de cadavru conservat, materiale aloplastice (piese de
fildes, tantal, vitaliu sau rasini acrilice). Mentinerea succesului postoperator si
prevenirea recidivei se asigura numai printr-un tratament postoperator corect si
indelungat.
Reabilitarea pacienților
 Utilizarea aparatelor ortodontice pentru evitarea
stresului excesiv asupra grefei osoase.
 Mecanoterapie de 8-10 ori în zi timp de 3-5
minute fără forțare fizică, până la începutul
durerii sau a oboselii mușchilor
 Pentru relaxarea mușchilor se face masaj si
parafinoterapie
 Proceduri fizioterapeutice pentru îmbunătățirea
circulației sangvine și regenerarea rapidă
 Bolnavul V., 11 ani. Anchiloza ATM bilaterala.
Aspectul bolnavului pina la operatie. Hipotrofie.

Bolnavul V., I,5 ani dupa operatie.

Bolnavul M., 4 ani. Anchiloza ATM pe dreapta.
Aspectul bolnavei pina la operatie.

Bolnava M., dupa 4 ani .

 Bolnavul C., 12 ani.
Anchiloza ATM
forma osoasa pe stinga.
Hipodezvoltarea
mandibulei pe stinga.
 Bolnavul C.,
6 luni dupa operatie.
Cavitatea orala se
deschide 3,5 cm.
Bolnava G., 10 ani. Anchiloza ATM forma fibroasa, hipodezvoltarea
mandibulei pe stinga.

fig(а, b). Aspectul bolnavei la

internare. Cavitatea bucala se
deschide 0,5 см.

Ortopantomograma pina la
operatie.
(a) – endoproteza;
(b) – endoproteza fixata de ramul mandibulei.
 Bolnava G., la 1 luna dupa operatie.

а – aspectul bolnavei la 1 luna

dupa operatie;
b– cavitatea bucala se deschide
3 см.

Ortopantomograma la 7 zile
dupa operatie.
3.Injuries of the articular disk
 Malocclusion

 Loss of adaptation of the disk to the

condyle.

 Precipitating factors

○ Blow / fall

○ Rheumatoid arthritis
 Clinical features:
 Females

 Young adults  frequently affected.

 Pain, snapping or clicking and crepitation.

 Transient / prolonged locking of the jaw

may occur.
Injuries of the articular disk

Normal disc position Anterior disc

displacement
Injuries of the articular disk
Injuries of the articular disk

 Rx:
 No positive findings
 Treatment:
 Immobilization
 Menisectomy / surgical removal of
the disk.
www.indiand
entalacadem
y.com
Fractures
 Condylar fracture:

 Traumatic injury

 Limitation of motion

 Pain and swelling

 Displaced anteriorly and medially into the

infratemporal region

Surgical reduction
Unilateral

Bilateral
INFLAMMATORY DISTURBANCES

www.indiand
entalacadem
y.com
 Arthritis.
3 types :

1. Arthritis due to a specific infection.

2. Rheumatoid arthritis.

3. Osteoarthritis / degenerative joint

disease.
www.indiand
entalacadem
y.com
Uncommon
Neisseria gonorrhea, Str, Staph. Pneumococci,
tubercle bacilli, H. influenzae
 Direct spread of a local infection or blood stream
/ lymphatic metastasis.
C/F:
- Severe pain in the joint.
 Extreme tenderness
 Healing  results in ankylosis.

www.indiand
entalacadem
y.com
HistoPathogenesis
Destruction  articular cartilage and articular disc.
 Obliteration of joint space  by the development
of granulation tissue
 Transforms into scar tissue.
Rx:
 Antibiotics – in the acute phase
 Meniscetomy / condylectomy is advocated in the
advanced cases.
www.indiand
entalacadem
y.com
Rheumatoid arthritis
 Chronic autoimmune disorder

 non-suppurative inflammatory destruction of the

joints.

 Etiology:
 Unknown

 Cross reaction of antibody against microorganisms

deposited in the synovial membrane.

www.indiand
entalacadem
y.com
 A reactive macrophage – laden fibroblastic
proliferation from the synovium creeps onto
the joint surface.
↓
Releases collagenases & proteases
↓
Destroys the cartilage & bone
 TMJ involvement  20%

www.indiand
entalacadem
y.com
 Rheumatoid arthritis
C/F:

 M:F = 1:3

 M = 25-30 yrs; F = 35-45 yrs

 Early stages manifests

www.indiand
entalacadem
y.com
 Pain, swelling and stiffness joint

 Clenching the teeth on one side produces pain

of contra lateral joint.

 Destruction of condylar head  receding chin &

malocclusion

www.indiand
entalacadem
y.com
R/F:

 Flattened condylar head

 An irregular surface of temporal fossa

 Anterior displacement of the condyle

 High resolution CT  erosions of the condyle &

glenoid fossae.

www.indiand
entalacadem
y.com
H-P :

 Hyperplasia of synovial lining cells

 Hyperemia, edema and inflammation of the

synovial tissues

 diffuse infiltration of chronic inflammatory cells into

the articular architecture.

www.indiand
entalacadem
y.com
 destruction of articular surface of the condyle.

 Invasion of the cartilage and its replacement by

granulation tissue.

 Perforation of meniscus

www.indiand
entalacadem
y.com
www.indiand
entalacadem
y.com
Lab findings:
 80% of patients  ↑rheumatoid factor
ANA detected in 50%
↑ESR
Mild anemia

www.indiand
entalacadem
y.com
Rx & Prognosis:

 Anti-inflammatory drugs

 Corticosteoids.

 Surgical intervention

www.indiand
entalacadem
y.com
Osteoarthritis

Disorder of articular cartilage, subcondral bone

with secondary inflammation of the synovial
membrane
Etiology: unknown.
 Genetic
 Aging process.
 Chronic microtrauma
 Primary  above 50 yrs & asymptomatic
 Secondary  due to trauma, metabolic disease

www.indiand
entalacadem
y.com
C/F:
 Unilateral pain over the condyle & over muscles
of mastication
 Limitation of mandibular opening
 Crepitus and stiffness
 Deviation of mandible towards painful side

www.indiand
entalacadem
y.com
R / F:
 Obliteration of the joint space
 Surface irregularities and protruberances
 Flattening of the articular surface.
 Radiolucent subchondral cysts
 Ossification within the synovial membrane

www.indiand
entalacadem
y.com
H-P /F:

 Degeneration of cartilage cells

 infiltration of chronic inflammatory cells

 Loss of osteocytes

 fatty degeneration & necrosis of the marrow

 Large degenerative space beneath the articular

cartilage (Subchondral cysts)

www.indiand
entalacadem
y.com
www.indiand
entalacadem
y.com
Rx:
 NSAIDs, heat, soft diet, rest and
occlusal splints
 Arthroplasty
 Orofacial physiotherapy.

www.indiand
entalacadem
y.com
NEOPLASTIC

www.indiand
entalacadem
y.com
 Neoplasms and tumor-like growths, benign and
malignant, may involve the TMJ.
Etiology: Unknown
 From embryonic mesenchymal remnants of
synovium.
 That become metaplastic, calcify, break off into
the joint space
 Chondromas, osteomas and osteochondromas
are common benign tumors.

www.indiand
entalacadem
y.com
www.indiand
entalacadem
y.com
Osteochondroma – bone capped with cartilage
www.indiand

and dense collagenous tissue entalacadem

y.com
 CT scan and arthroscopy is necessary
for accurate diagnosis.
Rx:
 Conservative and surgical removal of
involved synovium and articular disk.

www.indiand
entalacadem
y.com
EXTRA-ARTICULAR

www.indiand
entalacadem
y.com
 A variety of extraarticular disturbances may
manifest themselves clinically as TMJ
problems.
 Impacted molar teeth
 Sinusitis & Middle ear disease
 Infratemporal cellulitis
 Neuritis of the 3rd division of the trigeminal nerve.
 Odontolgia.
 Overclosure of the mandible due to severe dental
attrition.
 Costen’s syndrome.
www.indiand
entalacadem
y.com
TEMPORO MANDIBULAR JOINT
SYNDROME

www.indiand
entalacadem
y.com
 Most common cause of facial pain after
toothache.

 TMD can be classified broadly as:

 TMD secondary to myofacial pain and

dysfunction (MPD).

 TMD secondary to true articular disease

www.indiand
entalacadem
y.com
Etiology:

 Tissue injury

 Physical stress  Bruxism and day time jaw

clenching in a stressed and anxious person.

 Psychological & behavioural abnormalities

 Poor nutritional status

 Genetic predisposition

www.indiand
entalacadem
y.com
DIGAMMATIC RERESENTATION OF
ETIOLOGY OF MPDS
PSYCHOPHYSIOLOGIC THEORY OF MPDS
(Modified by LASKIN in 1969)

www.indiand
entalacadem
y.com
C /F:
 Constant diffuse unilateral pain
 Severe in the morning and worsens as day
progresses
 Radiates to cervical region, shoulders and back
 Limitation of jaw movement
 Deviation to the affected site

www.indiand
entalacadem
y.com
VII. TEMPOROMANDIBULAR JOINT SYNDROME
(TM disorder)

Cl / Ft:

 Tenderness in MM

 Angle of mandible

 Anterior temporal region & coronoid

aspect
www.indiand
entalacadem
y.com
Rx:

 Physiotherapy  moist heat, TENS,

Aucpressure, Acupuncture.

 Behavioural and relaxation techniques

 Occlusal splint therapy

 NSAIDs, Muscle relaxants

www.indiand
entalacadem
y.com
2. True intra-articular disease :
 Disk displacement disorder.

 Chronic recurrent dislocations.

 Degenerative joint disorders.

 Ankylosis.

 Infection

www.indiand
entalacadem
y.com
 Etiology:

 Malocclusion.

 Jaw clenching.

 Bruxism.

 Personality disorders

 Increased pain sensitivity.

 Stress and anxiety.

www.indiand
entalacadem
y.com
C/F:

 Affects young woman aged 20-40 yrs.

 M:F – 1:4.

 In TMD pain is unilateral associated with clicking,

popping and snapping sounds.

 Limited jaw opening due to pain / disk

displacement.

 Associated with chewing and may radiate to head.

www.indiand
entalacadem
y.com
 Treatment & Prognosis:
1. Self limiting.
2. Conservative treatment involving self
care practices.
 Rehabilitation aimed at eliminating
muscle spasms.
3. NSAIDs
 Prognosis is good.

www.indiand
entalacadem
y.com
Investigations  TMJ
 TMJ imaging
 Panoramic radiographs
 Transcranial view
 Transpharyngeal view
 Transorbital view
 Reverse Towne’s view
 Submento-vertex (SMV) view
 Conventional tomography
 Arthrography www.indiand
entalacadem
y.com
 Computed tomography (CT)

 Magnetic resonance imaging (MRI)

 Arthroscopy

 Bone scan

www.indiand
entalacadem
y.com
References
 Shafer’s Textbook of Oral Pathology. 5th
edition.
 Neville: Oral & Maxillofacial Pathology. 2nd
edition.
 Jaffery P. Okeson – Management of
Temporomandibular disorders and
occlusion.
 Martin S. Greenberg, Michael Glick –
www.indiand

Burkit’s oral medicine and diagnosis. entalacadem

y.com
www.indiand
entalacadem
y.com