This document provides an overview of a seminar on temporomandibular joint anatomy. It discusses the components of the TMJ including the mandibular fossa, articular disc, condyle, synovial membrane, synovial fluid, and ligaments. It describes the development of the TMJ, surgical anatomy, movements of the joint, and applied anatomy. The seminar was guided by several professors and presented by a postgraduate student.

1. SEMINAR
ON
TEMPORO-MANDIBULAR
JOINT
ANATOMY

2. GUIDED BY –
 DR.NITIN JAGGI (PROF.& HOD)
 DR. ASHISH SINGH (PROF.)
 DR.NIKHIL PUROHIT(READER)
 DR.RANJANCHAUHAN(SR.LECTUR0
 DR.ASHISH MAHESHAWARI (SR.LEC.)
Presented by -
DR.LEENA GANGIL
PG FIRST YEAR STUDENT
2015-2018 BATCH

3. CONTENTS
• INTRODUCTION
• SYNONYM OF TMJ
• COMPONENT OF TMJ
• DEVELOPMENT OF TMJ
• SURGICAL ANATOMY OF TMJ
 MANDIBULAR FOSSA
 ARTICULAR DISC
 CONDYLE
 SYNOVIAL MEMBRANE
 SYNOVIAL FLUID
 LIGAMENTS
• MOVEMENT OF TMJ
• INNERVATIONS,VASCULARIZATION,
LYMPHATICS OF TMJ
• EXAMINATION OF TMJ
• APPLIED ANATOMY
• CONCLUSION
• REFERANCES

4. INTRODUCTION
• The Temporomandibular joint is that which connects the mandible to the skull
and regulates mandibular movement.
• The most important functions of the temporomandibular joint (TMJ) are
mastication and speech and are of great interest to maxillofacial surgeon.
• 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 arthrodial, meaning a joint of which permits a gliding motion of the
surfaces.
• It is a bicondylar joint in which the condyles, located at the two ends of the
mandible, function at the same time.

5. SYNONYMS FOR TMJ
 Craniomandibular joint -
Cranium (temporal)
Mandibular (condyle) bone
 Ginglymoarthroidal joint:-
Ginglymo  hinge movements
Arthroidal  gliding movements
• It is a synovial joint of condylar variety.
• TMJ is a compound joint ( articular disc acts as a 3rd non ossified
bone)

6. COMPONENT OF TMJ
• Bony surfaces – squamous part of Temporal bone
Mandibular condyle
• Articular disc
• Ligaments
• Capsule
• Associated muscle

8. DEVELOPMENT OF TMJ
•The TMJ develops from mesenchyme lying .
(intramembranous)
•Between the developing mandibular condyle below and the
temporal bone above.
•During the 10th week of IU life ,
•Two clefts appear in the mesenchyme –producing the upper and lower joint
cavities.
•The remaining intervening mesenchyme becomes the intra – articular disc.
The joint capsule develops from a condensation of mesenchyme surrounding
the developing joint
•Mandibular fossa is flat at birth and there is no articular eminence , this
becomes prominent only following the eruption of the decidous dentition.

10. SURGICAL ANATOMY
•The articular space of each tmj is divided into
• upper and lower compartments
because of interposition of the fibrous articular disc bt the temporal
bone and mandible.
•Glinding or translatory movements occur primarily in the upper
compartment ,
• lower compartment functions primarily as hinge or rotary joint.

11. Tmj has two articular surfaces –
UPPER ARTICULAR SURFACE : articular eminence of
temporal bone, mandibular fossa or glenoid fossa
Articular eminence( Anterior convex part )consists of thick,
dense bone & is more likely to tolerate such forces.
Posterior roof of mandibular fossa (posterior concave part)
is thin ,indicating that this area of temporal bone is not
designed to sustain heavy forces.
LOWER ARTICULAR SURFACE : head of condyle of
mandible

13. E: Articular eminence;
enp: entogolenoid
process; t:articular
tubercle; Co: condyle;
pop: postglenoid
process; lb: lateral
border of the
mandibular fossa; pep:
preglenoid
plane; Gf: glenoid fossa;
Cp: coronoid process

14. GLENOID FOSSA or MANDIBULAR FOSSA
• Its anterior wall is built by the articular eminence of the squamous temporal
bone and its posterior wall by tympanic plate of temporal bone,which also forms
the anterior wall of the external acoustic meatus.

16. • the term articular fossa refers to the particular portion
of glenoid fossa that is covered by articular tissues.
• The articular fossa is built entirely by the squamous
portion of temporal bone. The posterior part of the
articular fossa is elevated to a ridge called the
posterior articular lip.
• The posterior articular lip is higher & thicker at its
lateral end and thus visible from the side as a cone
shaped process bt the articular fossa and the tympanic
plate. This structure is the post glenoid process.

18. •In the posterior & lateral parts of the glenoid fossa, a fissure separates the
articular and non articular portions of the glenoid fossa. This fissure ,called
the tympanosqamosal fissure.
•Medial to this fissure ,a bony plate of the petrous portion of the temporal
bone, the tegmen tympani, protrudes between the tympanic & squamous
portions.
•Therefore ,instead of a tympanosquamosal fissure along the medial aspect of
glenoid fossa,an anterior petrosquamousal fissure & a posterior
petrotympanic fissure occur.
•The petrotympanic fissure is slightly widened laterally to permit passage of
chorda tympani nerve & ant tympanic blood vessels.

19. •These neurovascular structures are located within the the
glenoid fossa,but not with in the articular fossa .
•The articular eminence is the transverse bar of dense bone
that forms the posterior root of zygomatic arch & the
anterior wall of the articular fossa.
•Lateral to the articular eminence , a small bony projection
,the articular tubercle,is located. It serves as the
attachment area for portions of the temporomandibular
ligament (TML).

20. ARTICULAR DISC – BICONCAVE OVAL
STRUCTURE
•Consists of dense collagenous tissue that is avascular and devoid of nerve
tissues in the central area but has vessels and nerves in the peripheral area.
•It serve as non ossified bone that permits complex movements of the joint .
•Disc divides articular space into 2 compartments :
1. UPPER OR SUPERIOR COMPARTMENT
2. LOWER OR INFERIOR COMPARTMENT

21. Articular disc divided into 3 regions : (saggital plane)
1. Intermediate zone – thinnest
2. Ant. Band – slightly thicker
3. Post. Band – thickest
• During movement the disc is flexible to some extent and can
adapt to the functional demands of the articular surfaces.
• The disc maintains its morphology unless destructive forces or
structural changes occur in the joint.
• If these changes occur , the morphology of the disc can be
irreversibly altered producing biomechanical changes during
function.

23. ATTACHMENTS OF DISC -
• RETRODISCAL TISSUE - posterior attachment highly vascularized
 Superior retrodiscal lamina – elastic fibres
 Inferior retrodiscal lamina - collagenous fibres.
Remaining – large venous plexus which fills with blood as condyle moves
forward.
• ANTERIORLY–superior and inferior attachments of the disc– capsular
ligament
• SUPERIOR ATTACHMENT –articular surface of temporal bone
• INFERIOR ATTACHMENT – articular surface of condyle

25. • It is Composed of collagen fibres
• Between the capsular ligament attachment – superior lateral
pterygoid muscles.
• Capsular ligament attachment - medially and laterally also –
dividing joint into 2 cavities.
Superior cavity – mandibular fossa and superior surface of disc.
Inferior cavity –mandibular condyle and inferior surface of disc

26. • The internal surface of the cavities are
surrounded by specialized endothelial cells that
form a synovial lining.
• This lining along with a specialized synovial
fringe located at the anterior border of the
retrodiscal tissue produces synovial fluid which
fills both the joint cavitie.
• Medium for providing metabolic requirements to
the non vascular articular surface of the joint.

27. CONDYLE
Barrel shape – measuring – 20mm – mediolateral , 10mm –
anteroposterior
• Perpendicular to ascending ramus of the mandible
• Oriented 10 – 30 degrees with frontal plane.
Medial pole more prominent than lateral pole
Articular surface of Posterior aspect > anterior aspect
p
A

28. • In the frontal view – articular eminence often is concave and
fits roughly to superior surface of condyle .
•Bony surface of condyle and articular part of the temporal
bone – covered with dense fibrous connective tissues with
irregular cartilage like cells.
•The number of cells increases with age and stress
on the joint.

29. SYNOVIAL MEMBRANE
• lines TMJ cavity internally
• Outer flattened endothelial like cells resting on
vascular connective tissue.
• Connective tissue show mainly two types of cells
- fibroblast like ( B cells) --rich in RER
- macrophage like( A cells)-- rich in Golgi

30. SYNOVIAL FLUID
Having proteoglycans and some mucin which act as lubricant.
Volume-- 1 ml in inf joint space ,Slight more in upper joint space
Viscosity is higher than blood
synovial fluid ( a mechanism to provide nutrition to avascular discal tissue)
Lubricant between articular surfaces during function.
The two mechanisms by which synovial fluid lubricates are -
• Boundary lubrication
• Weeping lubrication

31. BOUNDARY LUBRICATION
• Occurs when joint is moved and synovial fluid is
forced from one area of cavity into another.
• The synovial fluid located in the border or recess areas
is forced on the articular surface thus providing
lubrication.

32. WEEPING LUBRICATION
• Refers to the ability of articular surfaces to absorb a small amount of
synovial fluid.
• During function of a joint , forces are created between the articular
surfaces
• These forces drive a small amount of synovial fluid in and out of
articular tissues.
• This is the mechanism by which metabolic exchange occurs.
• Under compressive forces therefore, a small amount of synovial
fluid is released.

33. • This synovial fluid acts as a lubricant between articular tissues
to prevent sticking.
• Weeping lubrication helps eliminate friction in compressed but
not a moving joint.
• Only a small amount of friction is eliminated by weeping
lubrication.

34. LIGAMENTS
•Ligaments play an important role in protecting the structures.
•The ligaments of the joints are made up of collagenous connective
tissue,which do not stretch.
•They do not enter actively into joint function but instead act as a passive
restraining devices to limit and restrict border movements.

35. THREE FUNTCIONAL LIGAMENTS support the
TMJ :
•COLLATERAL LIGAMENTS
• CAPSULAR LIGAMENT
•TM LIGAMENT
TWO ACCESSORY LIGAMENTS
• SPHENOMANDIBULAR LIGAMENT
• STYLOMANDIBULAR LIGAMENT

37. COLLATERAL (DISCAL) LIGAMENTS
• Attach the medial and lateral borders of the articular disc to the
poles of the condyle
• Commonely called as discal ligaments – medial and laterlal
• Medial discal ligament – attaches the medial edge of the disc to
the medial pole of the condyle.
• Lateral discal ligament – attaches the lateral edge of the disc to
the lateral pole of the condyle,
• These ligaments are responsible for dividing the joint
mediolaterally into the superior and inferior joint cavities.

38. • The discal ligaments are true ligaments ,composed of collagenous
connective tissue fibres , therefore they do not stretch.
• They allow the disc to move passively with the condyle as it glides
anteriorly and posteriorly on the articular surface of the condyle

39. • Thus these ligaments are responsible for the hinging movement of
the TMJ , which occurs between the condyle and the articular disc.
• These ligaments have a vascular supply and are innervated .
• Strain on these ligaments produces pain.

40. CAPSULAR LIGAMENT
• The entire TMJ is surrounded and encompassed by the capsular
ligament .
• The fibres of the capsular ligament are attached superiorly to the
temporal bone along the borders of the articular surface of the
mandibular fossa and articular eminence .
• Inferiorly the fibers of the capsular ligament attach to the neck
of the condyle.

41. • The capsular ligament -resist any medial, lateral or inferior
forces that tend to separate or dislocate the articular surfaces.
• One significant function – to encompass the joint thus
retaining the synovial fluid.
• Capsular ligament is well innervated and provides
proprioceptive feedback regarding position and movement
of joint .

42. TEMPOROMANDIBULAR LIGAMENT
The lateral aspect of the capsular ligament
is reinforced by strong , tight fibres – lateral
ligament or TM ligament.
TM ligament has 2 parts
• Outer oblique portion
• Inner horizontal portion

43. • Outer portion – extends from outer surface of the articular tubercle and
zygomatic process postero-inferiorly to the outer surface of the condylar
neck.
• Inner horizontal portion – extends from the outer surface of the articular
tubercle and zygomatic process posteriorly and horizontally to the lateral
pole of the condyle and posterior part of articular disc.

44. • Function of outer oblique portion – resists excessive drooping of the
condyle – limiting the extent of mouth opening.
• During the initial phase of opening ,the condyle can rotate around a
fixed point until the TM ligament becomes tight as its point of
insertion on the neck of the condyle is rotated posteriorly.
• When the ligament is taut, the neck of the condyle cannot rotate
further .
• If mouth were to be opened wider- the condyle has to move
downward and forward across the articular eminence.

45. • Clinically tested by – closing the mouth and applying mild posterior
force to the chin-jaw easily rotates until teeth are 20 – 25mm apart after
which a resistance is felt when the jaw is opened wider.
• This resistance is brought about by the tightening of TM ligament.
This unique feature of TM ligament which limitsrotational
opening is found only in humans.

47. • The inner horizontal portion of TM ligament limits posterior movement
of condyle and disc.
• When force applied to the mandible it displaces the condyle posteriorly
, this portion of ligament becomes tight and prevents the condyle from
moving further into the posterior region of the mandibular fossa.
• Hence it protects the retrodiscal tissues from trauma created by posterior
displacement of the condyle.
• Also protects the lateral pterygoid muscle from overextension or
overlengthening.
• The effectiveness of TM ligament is demonstrated during cases of
extreme trauma to the mandible.

49. SPHENOMANDIBULAR LIGAMENT
• Accesory ligament of the TMJ
• Arises from the spine of the sphenoid bone and extends
downwards to a small bone prominence on the medial
surface of the ramus of the mandible called the lingula.
• It does not have any significant limiting effects on
mandibular movement.

50. STYLOMANDIBULAR LIGAMENT
• It arises from the styloid process and extends downwards and
forward to the angle and posterior border of the ramus of the
mandible.
• It becomes taut when the mandible is protruded but is most
relaxed when the mandible is opened.
• The stylomandibular ligament therefore limits the excessive
protrusive movements of the mandible.

51. MOVEMENTS OF TMJ
Movements
• Rotational / hinge movement in first 20-25mm of mouth
opening
• Translational movement after that when the mouth is
excessively opened.

52. • 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.

53. Muscle producing movements
•DEPRESSION –
Lateral pterygoid
Diagastric
Geniohyoid
Mylohyoid
•ELEVATION –
Masseter
Temporalis
Medial pterygoid

54. Posterior fibers of diagastric
SIDE TO SIDE MOVEMENT –
Turning the chin to the left side produced by the left
lateral pterygoid & right medial pterygoid & vice versa.
•PROTRUSION –
Lateral pterygoid
Medial pterygoid
•RETRUSION –
Posterior fibers of temporalis

55. Anteriorly -
Mandibular notch
Lateral pterygoid
Masstric nerve and vessels
• A careful dissection of 16 intact human cadaveric head specimens revealed The
location of the masseteric artery was then determined in relation to 3 points
process:
1) the anterior-superior aspect of the condylar neck = 10.3 mm;
2) the most inferior aspect of the articular tubercle = 11.4 mm;
3) the inferior aspect of the sigmoid notch = 3 mm

56. LATERALY
•Skin and fascia
•Parotid gland
•Temporal branch of
facial nerve

57. POSTERIORLY -
Parotid gland
Superficial temporal vessels
Auriculotemporal nerve

58. Medially –
• Tympanic plate (separates from ICA)
• spine of sphenoid
• Auriculotemporal & chorda tympani nerve
• middle meningeal artery

59. SUPERIORLY –
middle cranial fossa
middle meningeal vessels
Inferiorly –
maxillary artery & vein

60. •Most innervation is provided by the auriculotemporal
nerve as it leaves the mandibular nerve behind the
joint and ascends laterally and superiorly to wrap
around the posterior region of the joint
• Additional innervations by – deep temporal
and massetric nerve.

61. VASCULARIZATION OF TMJ
Predominant vessels are
• Superficial temporal artery - from the posterior
• Middle meningeal artery - from the anterior
• Internal maxillary artery – from the inferior
•Other important arteries are – the deep auricular , anterior tympanic
and ascending pharyngeal arteries.
• The condyle – through marrow spaces by way of the inferior
alveolar artery .

64. LYMPHATICS OF TMJ
MainlyintoPAROTID LYMPH NODES
Also drain into:-
• Preauricular lymphnodes
• Submandibularlymphnodes

66. Radiographic techniques
- OPG
- Transcranial view
- transpharyngeal view
- A.P View
- C.T
- M.R.I

67. FUNCTIONAL EXAMINATIONA OF TMJ
•Objectives
To asses severity of clicking pain and dysfunction, which are characterized by
pathological symptoms.
Clinical examination
• Auscultation
• Palpation
1.Auscultation –
When auscultation is carried out with stethoscopes
clicking & cripitus in the joint may be diagnosed
during anteroposterior & eccentric movement of
mandible.
2. Palpaltion –
Palpation of tmj during opening and closing which
reveals possible pain on pressure of condylar area.

68. Methods of palpation –
1) Pretragus (lateral palpation of tmj)
Exert slight pressure on the condyle of mandible with index
fingers.Palpate both side simultaneously .
Register any tenderness to palpation of joints & irregularities in
condylar movement during opening & closing

69. PALPATION OF MASTICATORY MUSCLES:
• An accepted method of determining muscle tenderness or pain is to
use the fingers tips of the middle & index finger to palpate specific
anatomic sites.
• It has been proposed that 2 lb of digital pressure on extraoral
muscles & 1lb of pressure on intraoral areas held for 3 to 5 seconds
are appropriate.

70. TEMPORALIS –
Palpated by placing thumb behind
the eye , 1st finger on the middle
belly and 2nd finger near the
coronoid process in front of meatus.

71. MASSETER –
Palpated by asking the
patient to close the mouth
forcefully , anterior fibers
are then visible .
Deep fibers can be
palpated deep to the
zygomatic bone.

72. LATERAL PTERYGOID
• Superior fibers are palpated by placing finger near the lateral poles of condyle
and lower fibers are palpated by running the finger buccally and behind the
maxillary tuberosity.

73. MEDIAL PTERYGOID
Palpated by placing the finger near the lower part
of medial surface of ramus of mandible.

74. AGE CHANGES OF THE TMJ:
• Condyle:
– Becomes more flattened
– Fibrous capsule becomes thicker.
– Osteoporosis of underlying bone.
– Thinning or absence of cartilaginous zone.
• Disk:
– Becomes thinner.
– Shows hyalinization and chondroid changes.

75. • Synovial fluid:
Become fibrotic with thick basement
membrane.
• Blood vessels and nerves:
Walls of blood vessels thickened.
• Nerves decrease in number

76. • These age changes lead to:
 -Decrease in the synovial fluid formation
 -Impairment of motion due to decrease in the disc and capsule
extensibility
 -Decrease the resilience during mastication due to chondroid changes into
collagenous elements
 -Dysfunction in older people

77. APPLIED ANATOMY –
Temporomandibular disorders (TMD)
•These are a class of degenerative musculoskeletal
conditions associated with morphologic and functional
deformities.
•The joint may not only involved in the inflammatory
pathologies,but also involved secondary to the stress and
psychological disorders due to mandibular parafunction.

78. 1.TMJ ANKYLOSIS –
Ankylosis is a greek terminology meaning “ stiff joint”.
Tmj ankylosis is the pathological fusion between the glenoid
fossa of temporal bone and the condylar process of the mandible.
Etiology of ankylosis -
1.Trauma –
a)Fall on the chin leading to indirect injuries to tmj like
hemarthosis, contusion .
b) intra capsular & extra capsular fracture of condyle
c) birth trauma – application of forceps during labor

79. 2. Infections -
• Middle ear infections
• Septic fractures of condyle, zygomatic arch
• Osteomyelitis of condyle
• Mastoiditis
• Hematogenous infections
• Specific infections – tuberculosis, syphilis, actinomycosis
etc.
3. Inflammatory joint pathologies –
• Osteoarthritis
• Rheumatoid arthritis
• Rheumatic arthritis

80. classification – According to kazanjian
TRUE ANKYLOSIS OR INTRA ARTICULAR ANKYLOSIS
• Fibrous
• Bony
FALSE OR EXTRA ARTICULAR ANKYLOSIS
• Fusion of coronoid process with zygomatic arch
OTHER REASON OF FALSE ANKYLOSIS
•Muscle fibrosis
•myositis ossificans
•oral submucous fibrosis
•neurogenic ( tetnus,tetany)
•malignancy ,
•Depressed zygomatic fracture etc

81. UNILATERAL ANKYLOSIS –
• Deviation of the mandible &chin on affected side .
• Roundness or fullness of face on affected side,flatness or
elongation of face on the unaffected side.
• Well defined antegoinal notch on affected side.
• Cross bite & some amount of incisal opening may be possible
• A bony thickening is often felt in the preauricular area of the
affected TMJ.
CLINICAL FEATURES-

82. BILATERAL ANKYLOSIS
• The mandible is symmetrical but micrognathic.
• Pt has typical bird face deformity with receded chin.
• The neck chin angle may be reduced or almost completely absent.
• Antegonial notch is well defined bilaterally
• Cl II malocclusion ,upper incisors are proclined with anterior open bite .
• Oral opening will be less than 5 mm or nil oral opening
• Multiple carious teeth ,periodontally compromised,malocclusion,multiple
impacted teeth.

83. TREATMENT MODALITIES
• Brisement force
• Condylectomy
• Gap arthoplasty
• Interpositional arthoplasty with reconstruction of the
joint

84. SURGICALAPPROACHES TO
TMJ

85. •POST/ RETRO AURICULAR

86. •SUBMANDIBULAR or RISDON’S APPROACH

87. HEMICORONAL INCISION

88. •ENDAURAL

89. POSTRAMAL / HIND’S INCISION
.

90. • PREAURICULAR
THOMA’S ANGULATED INCISION

91. PREAURICULAR
DINGMAN’S INCISION

92. BLAIR’S INVERTED HOCKYSTICK

93. ALKAYA- BRAMLEY’S INCISION
INVERTED QUESTION MARK INCISION

94. •A question mark shaped skin incision which avoids main vessels and nerves
•About 2 cm above the malar arch, the temporalis fascia splits into 2 parts, which can
be easily identified by fat globules between 2 layers which form an important
landmark.
•In this, temporal facia and superficial temporal artery are reflected with skin flap.
Later helps in better healing of the flap.
•Under no circumstances should the inferior end of the skin incision be extended below
the lobe of the ear as it increases the risk of damage to main trunk of facial nerve.
• It is particularly important in children where it may be quite superficial.

95. • INTRA ORAL APPROACH: it was described by
sear (1972) for removal of hyperplastic condyles.
• The incision commences at the level of upper occlusal plane and
passes downwards and forwards between the internal and external
oblique ridges of mandible and then forwards as necessary along
mandibular body.
• Upper end should not be extended beyond the level of upper molar
teeth, otherwise buccal pad of fat is encountered and prolapses in
the wound decreasing the visibility .

96. MYOFASCIAL PAIN DYSFUNCTION
SYNDROME
•Myofascial pain dysfunction (MPD) syndrome is a
psychophysiologic disease that primarily involves the muscles of
mastication ( laskin 1969).
•The condition is characterized by poorly
localized,dull,aching,radiating pain that may become acute during use
of the jaw ,and mandibular dysfunction that usually involves a
limitation of opening.
•M:f – 1:5

97. MANAGEMENT –
Pharmacological modalities
Intra- articular injections
Occlusal splints
Physiotherapeutic modalities
Stress management
Psychologic modalities
Surgical management

98. ARTHITIS
Arthritis is the most frequent pathologic condition affecting the tmj.
TRAUMATIC ARTHRITIS ,(HEMARTHOSIS)
 The tmj is often subjected to indirect trauma.
 The fall on the chin thrusts the mandible backward and upward and the
intervening soft tissues like the capsule , meniscus and synovial
membrane get contused and undergo inflammation.
 The inflammatory reaction makes the joint painful and hypomobile. the
effusion of the joint space by the inflammatory exudates and or blood
takes place, because of which the condyle gets pushed downwards &
produces open bite on the involed side.

99. DEGENERATIVE ARTHRITIS ( OSTEOARTHRITIS)
•Osteoarthritis is a non inflammatory disorder characterized by joint deterioration &
proliferation.
•It is associated with aging .
•clinical sign & symptoms are remarkably absent .
•patient may complain of pain on palpation & movements,which is associated with
muscle spasm.
•Radiographic features – when the patient is in maximum intercuspation ,the joint
space may be narrow or absent.
•flattening of condylar head may be evident.

100. •Loss of cortex or erosion of articulating surfaces of the condyle or
temporal component are characteristic of this disease.
•“Ely cysts” small round radiolucent areas with irregular margins
surrounded by increased density, are visible.
•In advanced stage bony proliferation occurs at the periphery of the
articulating surface area.
•This new bone which is formed is known as osteophyte.
• The broken osteophytes lie with in the joint space, known as “joint
mice”.

101. RHEUMATOID ARTHRITIS
 Rheumoid arthritis is an autoimmune inflammatory condition in
which the inflamed &hypertropic synovial membrane grows onto
the articulating surfaces.
 It is more common in females with increasing age.
 There is usually bilateral pain,tenderness & swelling & limitation
of jaw motion.
 TREATMENT FOR ARTHRITIS -
• Pain relief analgesics , NSAIDS
corticostroides,physiotherapy,high codylotomy or joint
replacement.

102. DISC CONDYLE INCOORDINATION
1. Hypermobility
2. Subluxation
3. Dislocation

103. HYPERMOBILITY -
In hypermobility , the jaw opens more than normal,the
fibres in the bilaminar zone gets stretched & becomes
inflamed , producing pain.
Management include restraining the excessive jaw
movements by advising the patient not to open the mouth
wide or support the lower jaw at chin ,while yawning.
 In severe cases ,elastics can be used to restrain the jaw.

104. SUBLUXATION -
Later manifestation of hypermobility ,the head of condyle moves ahead of the
articular eminence when the patient is able to reduce the condyle in its normal
position ,it is known as subluxation.
DISLOCATION –
It is also a step ahead of hypermobility. When the patient is unable to reduce
the condyle in its normal position himself ,the condition is described as
dislocation.

105. In acute cases -Management include jaw reduction by moving the
mandible slightly anterior ,downward and then backwards ,upwards by
holding with thumb on molars .
In chronic dislocation fibrous adhesion develop ,which prevent the
reduction,in such cases surgical treatment like eminectomy or
condylectomy may be required.

106.  It is impossible to treatment of jaw movement without an in depth
awareness of the anatomy ,physiology ,and biomechanics of the TMJ.
 The first requirement for successful movement of jaw is stable,
comfortable TMJ.
 The jaw joints must be able to accept maximum loading by the elevator
muscles with no signs of discomfort.
 It is only through an understanding of how the normal, healthy TMJ
functions that we can make sense out of what is wrong when it isn't
functioning comfortably.
 This understanding of TMJ is foundational to diagnosis and treatment.

108. THANK YOU