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Tm j examination

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Tmj examination

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Tm j examination

  1. 1. Mohammad Mortazavi Mehdi Dehghan
  2. 2.  Anatomy Of Tmj  Epidemiology Of TMD  Etiology Of Tmd  Assessment  Some Temporomandibular Disorders
  3. 3. The TMJ articulation is a joint that is capable of hinge-type movements and gliding movements. The bony components are enclosed and connected by a fibrous capsule. The mandibular condyle forms the lower part of the bony joint and is generally elliptical, although variations in shape are common.The articulation is formed by the mandibular condyle occupying a hollow in the temporal bone
  4. 4. A fibrocartilage made up primarily of dense collagen of variable thickness and referred to as a disc occupies the space between the condyle and mandibular fossa
  5. 5. A mass of soft tissue occupies the space behind the disc and condyle. It is often referred to as the posterior attachment. The posterior attachment is a loosely organized system of collagen fibers, branching elastic fibers, fat, blood and lymph vessels, and nerves. Synovium covers the superior and inferior surfaces
  6. 6. • Capsular Ligament • Lateral Temporomandibular Ligament • Accessory Ligaments
  7. 7. The capsular ligament is a thin inelastic fibrous connective tissue envelope that attaches to the margins of the articular surfaces The fibers are oriented vertically and do not restrain joint movements. The medial capsule is composed of loose areolar connective tissue. The capsule and the lateral discal ligament join and attach to the lateral aspect of the neck of the condyle
  8. 8. separated from it by dissection. Its fibers pass obliquely from bone lateral to the articular tubercle in a posterior and inferior direction and insert in a narrower area below and behind the lateral pole of the condyle this ligament was identified as an oblique band from the condylar neck to the anterosuperior region on the eminence and as a horizontal band from the lateral condylar pole to an anterior attachment of the eminence.A recent study was unable to confirm a distinct structure separate from the capsule.
  9. 9. The sphenomandibular ligament arises from the sphenoid bone and inserts on the medial aspect of the mandible at the lingula. It is not considered to limit or affect mandibular movement. The stylomandibular ligament extends from the styloid process to the deep fascia of the medial pterygoid muscle. It is thought to become tense during protrusive movement of the mandible and may contribute to limiting protrusive movement.
  10. 10. Between 65 and 85% of people in the United States experience one or more symptoms of TMD during their lives. Approximately 12% experience prolonged pain or disability that results in chronic symptoms. Although the prevalence of one or more signs of mandibular pain and dysfunction is high in the population, only about 5 to 7% have symptoms severe enough to require treatment. TMD patients are similar to headache and back pain patients with respect to disability, psychosocial profile, pain intensity,hronicity, and frequency. The lower prevalence of TMD signs and symptoms in older age groups supports the probability that a significant portion of TMDs are self-limiting.
  11. 11. The lack of a clear single cause of TMDs has resulted in the proposal of a multifactorial etiology.Multiple factors come together contributing to the initiation, aggravation, and/or perpetuation: 1. Parafunctional habits (eg, nocturnal bruxing, tooth clenching, lip or cheek biting) 2. Emotional distress 3. Acute trauma to the jaw 4. Trauma from hyperextension (eg, dental procedures, oral intubations for general anesthesia, yawning, hyperextension associated with cervical trauma) 5. Instability of maxillomandibular relationships 6. Laxity of the joint 7. Comorbidity of other rheumatic or musculoskeletal disorders 8. Poor general health and an unhealthy lifestyle
  12. 12. In most cases, the correct diagnostic classification can be reached by using the history and examination findings. Diagnostic imaging is of value in selected conditions but not as a routine part of a standard assessment. Diagnostic imaging can increase accuracy in the detection of internal derangements and abnormalities of articular bone  History  Range of Mandibular Movement  Physical Examination: ◦ Palpation of the TMJ ◦ Palpation of Masticatory Muscles Palpation of Cervical Muscles  Tmj Noise  Assessment of Parafunctional Habits  Diagnostic Imaging
  13. 13. QUESTIONS TO BE ASKED:  Do you have pain in the face,front of ear and the temple area?  Do you get headaches , earaches , neckache , or cheek pain?  When is the pain at its worst ?  Do you experience pain when using the jaw?  Do you experience pain in the teeth?  Do you experience joint noises when moving your jaw or chewing?  Does your jaw ever lock or get stuck?  Does your jaw motion feel restricted?  Have you had any jaw injury?  Have you had treatment for jaw symptoms? if so , what was the effect?  Do you have any other muscle , bone , or joint problem such as arthritis?
  14. 14. The maximum opening distance between the incisal edges of upper and lower incisor is measured using scale , Boley gauge or ruler Normal opening – 40 to 55 mm Normal opening can also be estimated by patient’s own finger Normal : three finger end on end Two finger opening reveals reduction in opening but not necessarily reduction in function One finger opening indicates reduced function
  15. 15. Normal lateral range of movement is >7mm Measurements are made with teeth slightly seperated,measuring the displacement of lower midline from maxillary midline. Any condition (tumor, muscle spasm, fracture, ankylosis, displaced meniscus) that prevents the normal translation of one condyle will not prevent the contralateral condyle from sliding forward normally . The result is deviation of the chin toward the affected side .
  16. 16. Palpation of the pretragus area; the lateral aspect of the temporomandibular joint (TMJ). Intra-auricular palpation; the posterior aspect of the TMJ
  17. 17. Palpation of the masseter muscles Bimanual palpation of the masseter muscle
  18. 18. Palpation of the lateral pterygoid muscle Palpation of the medial pterygoid muscle
  19. 19. Palpation of the temporalis muscle Palpation of the sternocleidomastoid muscle.
  20. 20. It is difficult to determine the presence of active oral habits, and only indirect means are generally available. Patients are often unaware of tooth clenching or other behaviors contributing to jaw hyperactivity while awake. Self-report, monitoring daytime jaw activity and tooth position, and reports by sleeping partners of tooth-grinding noises are helpful. Assessing tooth wear, soft tissue changes (lip or cheek chewing, an accentuated occlusal line, and scalloped tongue borders), and hypertrophic jaw-closing muscles may suggest hyperactivity.
  21. 21. TMJs can be examined by using plain-film radiography, tomography, arthrography, CT, MRI, single-photon emission computed tomography, and radioisotope scanning MRI has become the imaging method of choice to assess disc form and position.
  22. 22. Disc displacement with reduction  Symptoms Clicking or popping noise in TMJ May feel “catching” in TMJ  Signs Reciprocal click May have deviation in active vertical mandibular range of motion and/or in protrusion No restriction in active vertical mandibular range motion
  23. 23. With Reduction Tmj Noise:  Reciprocal click  opening click
  24. 24. Disc displacement without reduction (Closedlock)  Symptoms History of clicking or popping noise in TMJ Limited mandibular range of motion Signs  Signs No TMJ sounds Restriction in active vertical mandibular range motion and laterotrusion May have deflection in active vertical mandibular range of motion and/or in protrusion
  25. 25. Without Reduction Tmj Nosie:  No click  Possibly crepitus
  26. 26. Myalgia  Symptoms Pain in localized area of one masticatory muscle (usually masseter or temporalis) Fatigue with chewing  Signs Tender muscles upon palpation Sometimes limited active vertical range of mandibular motion
  27. 27. Subluxation/dislocation (Open lock)  Symptoms Jaw “catches” open when yawning or opening mouth wide (if gets stuck open then dislocation) Pain in TMJ when jaw gets stuck Loud pop when opening wide  Signs Excessive active mandibular vertical range of motion Eminence pop Residual tenderness in TMJ upon palpation if recent episode
  28. 28. Capsulitis/arthritis  Symptoms Pain in TMJ or in front of ear Pain exacerbated by jaw function May have limited mandibular function secondary to pain  Signs TMJ tender to palpation TMJ pain worsened upon clenching Limited active mandibular range of motion, laterotrusion,protrusion

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