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TMJ Presentation Transcript

  • 1. * Introduction * Anatomy * Radiographic examination * Myo functional pain dysfunction syndrome * TMJ disorder * Dx of TMJ disorder * Rx of TMJ disorders
  • 2. Definition : It is the joint formed by temporal bone with the mandible It`s actually a sliding joint not only ball & socket Site : In front of each ear
  • 3. Structure of TMJ 1- articulating surfaces A (bony elements) condyle Glinoid fossa
  • 4. Interatricular disc Cartilaginous disc placed between the 2 bony elements The disc is attached to a muscle (lateral pterygoid) & moves with certain movement of TMJ
  • 5. Joint capsule It surrounds TMJ It is attached to glinoid fossa margin & the neck of condyle *It maintain proximity of joint parts during function *It limits forward translation of the condyle
  • 6. Synovial membrane It is the internal lining of external capsule It contains synovial fluid for lubricating the joint
  • 7. Diagnosis of TMJ disorder Comprehensive history (onset,duration,course,pasthistory,surgical procedures,family history) Physical examination (palpation ,stethoscope,dentition) Radiographic diagnosis Lab investigations
  • 8. Radiographic examination To evaluate condition of teeth , bone , surrounding hard & soft tissue Plain x-ray (a To see changes in bony structure only Ex : panoramic , oblique lateral
  • 9. Tomography It is of a great value in dx of TMJD… It has the property of elimination of superimposition in plain x rays
  • 10. Arthrography They r taken after injecting die material into synovial spaces to enhance intra capsular soft tissue
  • 11. C.T scan It`s x-ray images in serial manner with different levels showing hard & soft structures v. Helpful in Dx of TMJD inspite of high dose of exposure
  • 12. MRI It`s efficient in detecting changes in soft tissues Limited accuracy in detecting bony elements Helpful in DX of (internal derangement)
  • 13. Arthroscopy It allows detection of internal abnormality by direct vision through arthroscope
  • 14. Lab investigations CBC Serum calcium Serum phosphorus & alkaline phosphatase Serum uric acid ESR Serum RF
  • 15. functional Myofunctional pain dysfunction syndrome Organic Acquired (arthritis-dislocation-ankylosisinternal derangement) Congenital (condylar hypo/hyperplasia)
  • 16. It`s a painful condition of skeletal muscles specially the muscles of mastication Characterized by development of trigger points or sensitive painful area in muscle or junction bet muscle & facia
  • 17. Signs & symptoms 1- Pain -it`s the most complain -mostly unilateral -dull - sharp & acute Location Back of head & neck Temporal area Angle of jaw The area in front of ear
  • 18. 2-tenderness of muscles of mastication Temporal muscle is the common muscle to produce temporal pain Masseter : trigger points Refer pain to : (sinus area, Ear , above eye & even into molar region )
  • 19. Trapezius muscle : Pain almost referred to head & face Medial pterygoid muscle : Trigger points refer to ( TMJ , nose ,ear , lower jaw & lateral side of neck )
  • 20. Sternomastoid muscle: Develops trigger points with or w/out TMJ problems Cause forehead headache (misdiagnosed with frontal sinusitis ) Also may cause pain in (ear, over &around aye ,chin & below the eye (mis diagnosed with max sinusitis ) )
  • 21. 3-clicking in TMJ during movement - It is the most common symptom (it may be so loud ) - There may be pain in joint during chewing
  • 22. 4- limitation of mandibular movement 5-absence of clinical or radiographic evidence of Organic changes in TMJ 6- No tenderness of TMJ during examination
  • 23. Etiology of MPD occlusal disharmony psychological stress
  • 24. Diagnosis of MPD 1- History. 2-Determine the range of mouth opening. 3- Radiographic examination showing no organic changes. 4-Determine the direction & amount of mandibular deviation during opening. 5-Examination of TMJ by palpation & auscultation & palpation of muscles of mastication
  • 25. Treatment of MPD Control pain & discomfort Correction of occlusal disharmony Removal of psychological stress & tension
  • 26. Immobilization of jaw It produce complete rest for 2-3 weeks Use of Boxer`s mouth guard (to separate occlusal surfaces )
  • 27. Correction of occlusal disharmony 1- occlusal adjustment : by selective grinding to remove cusp interference between teeth To maintain occlusal stability & equilibrium of muscle during rest position
  • 28. 2- Anterior deprogrammer : * Suppresses clenching intensity ** Prevent occlusal wear & trauma 3-splints & occlusal bite planes : Acrylic splints made with simultaneous contact of mandibular teeth in centric occlusion to eliminate muscular spasm
  • 29. Thermo therapy By heat application to activate blood circulation of spastic muscles
  • 30. Muscle exercise It stimulate weak muscles & wash metabolites so decrease spasm Intra muscular injection of L.A : Help in diagnosis of the syndrome & in cuts cycle of pain
  • 31. Psychological therapy Emotional stress stimulate vascular dynamics (contraction & dilatation ) so increasing muscular tone leading to spasm Administration of muscle relaxant
  • 32. Acquired organic disorders of TMJ 1- Inflammatory. 2- Degenerative. 3- Infectious. 4- Traumatic.
  • 33. Rheumatoid arthritis It`s a systemic inflammatory disease that produce destructive changes to the joints (may affect more than one joint ) c/p: Pain , joint noise ,limitation of movement , malocclusion ) Juvenile RA : impairment of jaw growth & may lead to ankylosis
  • 34. Diagnosis of R.A Clinically : multiple joint involvement Lab investigations : RH factor Radiographic examination : (lack of joint space d.t condylar destruction ) - Condyle is eroded ,flattened & rarefied - Glinoid fossa is shallow
  • 35. Treatment *application of moist heat *anti inflammatory drugs *immunosuppressive drugs *Gold salts *steroids (oral – joint injection)
  • 36. Degenerative arthritis (osteoarthritis) Non inflammatory focal degenerative disorder that affect primarily articular cartilage and sub condylar bone (initiated by deterioration of articular soft tissue cover & exposure of bone ) Cause : long term functional abuse
  • 37. C/P : *Crepitation sound from joints *Restricted or normal mouth opening *With or w/out pain *Occasionally may joints show inflammatory signs *Women > Men *Tenderness of muscles of mastication *Limitation of mandibular movement & deviation to the affected side *Tenderness over condyle
  • 38. Diagnosis Based on clinical & radiographic examination (irregularity of condylar surface & radiolucency in substance of condyle )
  • 39. Treatment Analgesics Anti inflammatory drugs Muscle relaxant Surgery (condylar shaving or high condylectomy )
  • 40. Infectious arthritis It is the consequence of direct extension from middle ear , parotid gland & posterior areas of mandible it is also happened after trauma followed by infection from septseamia Leads to inflammation of synovial tissues Leads to destruction of fibro cartilage & bone leading to ankylosis
  • 41. Treatment Administration of antibiotics Drainage of source of infection Rest analgesics
  • 42. Occurs d.t trauma to the joint There is muscular tear , ligamentous injury Hemarthrosis may be present Mechanical damage to surrounding structure may be present
  • 43. Diagnosis History of severe trauma with pain , swelling , & dysfunction Only the affected joint showing inflammation Presence of normal joint function before trauma Treatment : Rest , Administration of analgesics , anti inflammatory drugs
  • 44. Congenital condylar disorders Condylar hypoplasia Condylar hyperplasia Others
  • 45. Benign tumors 1- synovial chondromatosis : Benign tumor characterized by cartilaginous metaplasia of synovial membrane producing small nodules which separate form membrane to become loose bodies that may ossify
  • 46. 2- osteochondroma Benign tumor characterized by normal bone & cartilage near growth zones
  • 47. Osteoma Osteoma is a benign tumour consisting of mature bone tissue. It is a slow growing, asymptomatic
  • 48. Anterior (to eminence) Lateral (in temporal fossa) Dislocation of TMJ Posterior (in fracture of base of skull ) Superior (into medial cranial fossa)
  • 49. Signs & symptoms of dislocation - Mandible fixed in open position - Protrusion of chin - Deviation to the normal side By palpation depression is noticed in front of the ear - Limitation of movement - Pain -
  • 50. Treatment of dislocation Acute dislocation : Manual reduction under sedation or even under G.A with muscle relaxant Then immobilization for several days ..
  • 51. Chronic dislocation - Manual reduction with L.A or G.A & muscle relaxant - Surgical exposure of joint & direct reduction - Condylectomy - Condylotomy
  • 52. 3- Recurrent dislocation Conservative RX : immobilization for several days Injection of sclerozing material around capsule to produce fibrosis Surgical RX : re-situation of capsule & ligament Ligation of condyle Removal of eminence Removal of activating muscle
  • 53. TMJ ankylosis It is fibrous or bony union between joint components It is unilateral or bilateral Partial or complete True or false (When the structures outside the joint are affected)
  • 54. False ankylosis Muscular trismus Muscular atrophy or fibrosis Myositis ossificans Tetanus Neurogenic closure of mouth
  • 55. Etiology Birth trauma Heamarthrosis Suppurative arthritis Rheumatoid arthritis Osteomyelitis Fracture condyle
  • 56. Clinical findings - Inability to open mouth - Gradual development of jaw immobilization - Slight opening mouth in unilateral affection
  • 57. - Bird face ,micrognathia, mal occlusion & impacted teeth - Deviation of mandible to the affected side
  • 58. Treatment * If fibrous ankylosis : Open the mandible manually under G.A
  • 59. * Condylectomy * Osteoarthrotomy * Repalcement of condyle
  • 60. Abnormal relationship between articular disc to condyle & eminence
  • 61. Symptoms Pain during function Joint clicking or noise Earache or headache Facial pain
  • 62. Ant. Displacement of the disc (with reduction)(clicking) Ant. dislocation of the disc (w/out reduction) (locked joint).
  • 63. Treatment Conservative treatment Surgical treatment Occlusal therapy :Selective grinding. Construction of splints. Relocation of disc: meniscoplasty Condylotomy. Capsular rearrangement of the meniscus. High condylectomy Physiotherapy :Soft diet , muscular exercises. Muscle relaxants.