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TMJ APPLIED ANATOMY
- 2. Anatomy and applied aspect of the Temporomandibu lar Joint Dr. Yarva Pranathi Reddy 1st year Post Graduate trainee Moderater: Dr. K Anoosha Asst. Professor
- 3. Contents Introduction Embryology Components of TMJ Ligaments Relations Innervation Vascular supply Biomechanics Layers and approaches to TMJ Conclusion References
- 4. Introduction Synovial, bilateral, diarthroidal, ginglymoid Four movements Common to other joints by Differs by
- 5. Embryology 8th week Functions as a jaw joint 10th week 2 clefts develop forming 2 joint cavities New born Flat mandibular fossa and no articular tubercle 71/2 weeks Articular disc starts to appear [Craniofacial development - Sperber]
- 6. Applied Aspect TMJ ankylosis Disc perforation Hemifacial microsomia - Type 1 Type 2 Type 3 Bilateral 1st and 2nd pharyngeal arch defects: - Treacher Collins Syndrome - Bilateral Craniofacial Microsomia
- 7. Bony components Superiorly: Mandibular fossa Articular eminence Inferiorly: Condyle
- 8. Mandibular Fossa Boundaries Rims Relations Not a load bearing area
- 9. [Anatomical Examination of Mandibular Condyle Protrusion Into the Middle Cranial Fossa: Cadaveric Dissection(J Craniofac Surg 2018;00: 00–00)] Thinnest portion of mandibular fossa is the bony roof (0.9mm) mean thickness. Condyle in children - rounded with underdeveloped medial and lateral poles. In adolescents - condylar neck is thicker leading to its added strength.
- 10. Articular Eminence Tilted at an angle Of 25 degrees to occlusion plane. 3 parts Covered by fibrous tissue Subjected to load during function. [Grays anatomy - 39th edition]
- 11. Applied Aspect [Recurrent Mandibular Dislocation Treated by Eminectomy The Journal of Craniofacial Surgery & Volume 23, Number 5, September 2012] [Temporomandibular joint eminence augmentation by down fracture and inter-positional cartilage graft J. Oral Maxillofac. Surg. 1991," 20." 357-359.]
- 12. Condyle Parts Attachments Condylar axis Articular surface covering Reserve cell layer Excess loading
- 13. [Anatomical Variations in Condylar Shape and Symmetry: Study of 100 Patients (International Journal of Science and Research (IJSR)Volume 4 Issue 12, December 2015)]
- 14. [BIFID MANDIBULAR CONDYLE: A VERY RARE ENTITY Pakistan Oral & Dental Journal Vol 31, No. 1 (June 2011)]
- 15. Applied Aspect Dislocation: Anterior Posterior Lateral Superior Fracture: • Based on level • Relationship to mandible Tumors: Chondroblastoma Chondroma Giant cell tumor Hemangioma Langerhans cell disease Osteochondroma/osteosarcoma
- 16. [Osteochondroma of the mandibular condyle cured by conservative resection Journal of Dental Sciences (2014) 9, 91e95]
- 20. Applied Aspect [Two cases of posterior open bite caused by the thickness of retrodiscal tissue in the temporomandibular joint. J Oral Maxillofac. Surg. 2014] [A clinical evaluation of temporomandibular joint disk plication surgery(AM J ORTHOD DENTOFAC ORTHOP 1991;100:156-62.)]
- 21. [The Role of a Temporalis Fascia and Muscle Flap inTemporomandibular Joint Surgery J Oral Maxillofac Surg 1990] The flap is well organised Obtained through same incision Protects facial nerve from injury Morbidity at donor site is minimal
- 23. Applied Aspect Synovitis Synovial chondromatosis Synovial sarcoma [Synovial sarcoma of the temporomandibular joint and infratemporal fossa Auris Nasus [Innovative Surgical Management of the Synovial Chondromatosis of Temporo- Mandibular Joints: Highly Conservative Surgical Technique(J Craniofac Surg 2016;27: 1197–1201)]
- 25. • Horizontal incision above lateral rim of glenoid fossa • Horizontal incision below lateral rim of glenoid fossa • Horizontal incisions above and below • L shape • T shape • Cross hair • Open sky • Vertical Capsular Incisions [Peterson’s principles of oral and maxillofacial surgery - 2nd edition]
- 26. Extracapsular ligaments Lateral TM ligament Sphenomandibular ligament Stylomandibular ligament
- 27. Relations
- 28. [Atlas of temporomandibular joint surgery Peter D Quinn]
- 30. Vascular supply
- 31. Classification of TMJ in relation to Maxillary Artery Class I: normal relation Class II: normal relation with ankylosis Class III: artery runs closer to/within the ankylosed mass Class IV: ankylosed mass fused to the base of the skull and there is extensive bone formation [Imaging of temporomandibular joint ankylosis. A new radiographic classification Dentomaxillofacial Radiology (2002) 31, 19±23]
- 32. Biomechanics Divided into 2 systems Joint stability & interarticular pressure Rotation of the disc Translation of the disc Unilateral chewing
- 34. Neuromuscular adaptation: early and short term Skeletal adaptation: superior movement of ramus Dental adaptation: extrusion of teeth [MASTICATORY FUNCTION FOLLOWING FRACTURES OF THE MANDIBULAR CONDYLE January 10, 1994]
- 35. Layers to TMJ Temporoparietal fascia Subgaleal fascia Temporalis fascia
- 36. Approaches to TMJ Preauricular approach Popowich and crane incision Dingmans incision Thoma’s angulated incision Endural approach Postauricular approach Alkayat-Bramley approach Retromandibular approach Rhytidectomy
- 41. Conclusion The temporomandibular joint is a simple yet complex structure. Knowing the anatomy and its normal functions is essential for an ORAL AND MAXILLOFACIAL SURGEON to identify the abnormal from the normal for appropriate management.
- 42. References Grays Anatomy - 39th edition BD Chaurasia’s Human Anatomy Vol 3 - 5th edition Craniofacial Development - Sperber Temporomandibular Disorders(Vol 4) - RJ Fonseca Management of Temporomandibular Disorders - Okeson Surgical Approaches to Facial Skeleton - Edward Ellis