3. Upper articular surface - part of temporal bone
1.Articular tubercular
2.Anterior part of mandibular fossa
3.Tympanic plate
Inferior articular surface - head of mandible
4.
5.
6. FIBROUS CAPSULE
loose above the intra articular disc and tight below it
Synovial membrane lines it
Lateral temporomandibular ligament
reinforces the capsular ligament
Sphenomandibular ligament
Remnant of merkel’s cartilage
Stylomandibular ligament
Thickened part of deep cervical fascia
Separates parotid and submandibular gland
7.
8. Divides the joint into upper and lower
compartment
Upper compartment- gliding
Lower compartment-rotation and gliding
Periphery of disc attached to fibrous capsule
Represents primitive insertion of lateral pterygoid
Prevents friction b/w articular surface
Proprioceptive fibre present
9.
10.
11. Ankylosis (joint stiffness) is the pathological fusion of parts of
a joint resulting in restricted movement across the joint.
Ankylosis of the Temporomandibular joint, an arthrogenic
disorder of the TMJ, refers to restricted mandibular
movements (hypomobility) with deviation to the affected side
on opening of the mouth.
12. Affects all age group but more in the first decade of life (0 –
10 years).
Equal male and female distribution.
More common in Asian subcontinent.
13. Bilateral or Unilateral ankylosis
Fibrous ankylosis or Bony ankylosis
Intra-articular or Extra-articular ankylosis
Complete or Partial ankylosis
True or false ankylosis
14. Trauma
-At birth (with forceps)
-Blow to the chin (causing
haemarthrosis)
-Condylar fracture
Infections and Inflammatory
-Rheumatoid Arthritis
-Septic arthritis
-Otitis media
-Mastoditis
-Parotitis
-Osteoarthritis
Others
-Malignancies
-Post radiology
-Post surgery
-Prolonged trismus
Systemic disease
-Small pox
-Ankylosing spondylitis
-Syphilis
-Typhoid fever
-Scarlet fever
15. Extra-articular ankylosis may be due to enlargement of the
muscles of mastication, the facial nerve, or the coronoid
process.
Intra-articular ankylosis causes are trauma, infection, and
juvenile rheumatoid arthritis.
16. TRAUMA
Extravasation of blood into the joint space
Haemarthrosis
Calcificatiion and obliteration of the joint space
Intra-capsular ankylosis Extra-capsular ankylosis
17. Facial deformity
Deviation of chin towards affected side
Inability to open the jaws, absent
condylar movements on affected side
In unilateral ankylosis, the lower jaws
shifts towards the affected side on
opening of the mouth
Flatness or fullness on affected side
Cross bite on ipsilateral side
Class II malocclusion on affected side
18.
19. Fusion of joint
Loss of joint space
Prominent antigonial notch
Coronoid hyperplasia
23. Aims and Objectives of surgery
To release ankylosed mass and creation of a gap
Creation of functional joint (improve patient’s oral
hygiene, nutrition and good speech)
To reconstruct the joint and restore the vertical height of
the ramus
To prevent recurrence
To restore normal facial growth pattern
25. For patients with early ankylosis
Fibrous ankylosis
Pre-auricular incision is made
Cut at the level of the condylar neck
The head (condyle) should be separated from
the superior attachment carefully
The wound is then sutured in layers
The usual complication of this procedure is an
ipsilateral deviation to the affected side and
anterior open bite if the procedure was
bilaterally.
26. Extensive bony ankylosis.
The section here consists of two
horizontal osteotomy cuts
Removal of bony wedges for
creation of a gap between the
roof of the glenoid fossa and the
ramus of the mandible.
This gap permits mobility
The minimum gap should be 1cm
to avoid re-ankylosis.
There is high recurrence and open
bite deformity.
27. This is actually an improvement/modification on gap
arthroplasty.
Currently the surgical protocol of choice.
Materials are used to interpose between the ramus of the
mandible and base of the skull to avoid re-ankylosis.
The procedure involves the creation of gap, but in addition, a
barrier is inserted between the two surfaces to avoid
reoccurrence and to maintain the vertical height of the ramus.
28. In patients with severe disease, placement of alloplastic or
autogenous materials after resection of the condyle is the
favored surgical approach.
The interposition of materials is used to maintain vertical
height and to restore a functional joint.
A commonly used alloplast has been silicone rubber to
produce a pseudoarticulation.
29. Autogenous replacement materials includes dermis, fat, fascia
lata, and muscle.
The costochondral graft harvested from the contralateral sixth
rib is the optimal approach.
Autologous condylar reconstruction is preferred in the
growing patient and young adult, in whom a prosthetic implant
will probably wear out at some point and need to be replaced.
The patient needs aggressive physical therapy to maintain
motion of the reconstructed joint space.
30.
31. Total TMJ reconstruction has
proved safe and effective in
long-term management of
selected patients.
The prosthesis should be
custom fitted; computer-
aided design and
manufactured.