INFLAMMATORY DISTURBANCES Arthritis Infectious arthritis (bacterial, viral and fungal) Rheumatoid arthritis Osteoarthritis or degenerative joint disease NEOPLASTIC DISTURBANCES Benign : osteoma, chondroma Malignant : primary, metastatic

1. DISORDERS OF
TEMPEROMANDIBULAR
JOINT - 3
D R A M I T H A G , B D S , M D S
O R A L A N D M A X I L L O F A C I A L
P A T H O L O G Y

2. ARTICULAR DISORDERS
DEVELOPMENTAL DISTURBANCES
Aplasia of the manibular condyle
Hypoplasia of mandibular condyle
Hyperplasia of manidbular condyle

3. TRAUMATIC DISTURBANCES
Internal disc derangements
Anterior disc displacement
Posterior disc displacement
Dislocations
Luxation (Complete dislocation)
Subluxation (Incomplete dislocation)
Ankylosis (hypomobility)
Injuries of Articular disck (Meniscus)
Fracture of condyle

4. INFLAMMATORY DISTURBANCES
Arthiritis
Infectious arthritis (bacterial, viral and fungal)
Rheumatoid arthiritis
Osteoarthiritis or degenerative joint disease
NEOPLASTIC DISTURBANCES
Benign : osteoma, chondroma
Malignant : primary, metastatic

5. INFLAMMATORY DISTURBANCES OF THE TMJ
ARTHIRITIS
- Or inflammation of the joint
- Most common
- Three common types of arthiritis can affect the TMJ
- Arthiritis due to infection
- Rheumatois arthiritis
- Osteoarthiritis, or degenerative joint disease
- Osteosrthiritis, or degenerative joint disease

6. ARTHRITIS DUE TO SPECIFIC INFECTION
- Incidence is low
Etiology
- Gonococci, streptococci, staphylococci, pneumococci and the tubercle bacilli can
produce polyarticular involvement, either by blood stream or lymphatic metastasis
or by direct extension from a focal infection.
- But TMJ escapes all these infections, except gonococcal.

7. Route of infection
- Direct extension of the infection into the joint as a result of an adjacent cellulitis
or osteomyelitis.
- Such an eztension may follow dental infection, infection of the parotid glan, or
even facial or ear infection.

8. Clinical features
- Patients complain of severe pain in the joint, with extreme tenderness on palapation
or manipulation over the joint area.
- Pain is of such intensity that motion is severely limited.
- Healing of this form of arthritis often result in ankylosis, either osseous or fibrous.
- Resulting in severe limitation of motion.

9. Histopathology
- Depending upon severity, variable amount of destruction of the articular cartilage
and articular disk.
- OM with destruction of the bone of the condyle may be present.
- Joint space becme obliterated in the healing phase by development of granulation
tissue and its subsequent transformation into dense scar tissue.
- In time, the disck may become completely replaced and the entire joint space may
be filled with cicatrix.

10. RHEUMATOID ARTHRITIS
- Disease of unknown etiology which commonly begins early in life
- Women > men
- Etiology – hypersensitivity reaction to bacterial toxins, specifically streptococci.
- Distribution of the joint involvement – polyarticular and frequently symmetrically
bilateral.
- Clinical efatures
- Slight fever, loss of weight and fatigability.
- Joints affected are swollen.

11. - Pain and stiffness
- Involvement of other joint lesions simultaneously
- Stiffness of the joint – results in limitation in movement and pain
- Stiffness is common in the morning and tends to diminish throughout the day with
continued use of the jaw.
- Clicking and snapping of the joint – due to alterations in the articular cartilage and
meniscus.

12. - Over a period of years – ankylosis of the joint.
- Rheumatoid arthritis in children (Still’s disease), when it involves the TMJ, may
cause malocclusion of the class II division I type with protrusion of maxillary incisors
and anterior open bite. Deformation of the mandible, characterized by shortening
of the body and reduction in height of the ramus due to failure of the growth center
in the condylar area

13. Radiograph
- Reveals flattening and stunting of the condyles and a haziness about the joint
indicative of periarticular fibrosis.
Histologic features
- Disease is characterized by the ingrowth of granulation tissue to cover the articular
surfaces, the invasion of cartilage and its replacement by granulation tissue, and
ultimate destruction of the articular cartilage.
- Eventually fibrous adhesions occur
- Meniscus becomes eroded and fibrous ankylosis
- CT can become ossified
- True bony ankylosis

14. OSTEOARTHRITIS
- Also called degenerative joint disease or hypertrophic arthiritis.
- AGE:- >40 years
- Etiology – aging process.
- Joints which bear the weight of the body kness, hips and spine  are involved
first which are subjected to continued stress and strain.
- Symptoms – clicking, snapping in the TMJ etc.. Pain is very rare.

15. NEOPLASTIC DISTURBANCES OF THE TEMPEROMANDIBULAR JOINT
- It can be
a. Benign
b. Malignant
- It can involve
a. Bone
b. Articular cartilage or
c. The joint

16. EXTRAARTICULAR JOINT DISEASES
MYOFACIAL PAIN DYSFUNCTION SYNDROME
Indicate a dysfunction of the TMJ.
It is characterized by
1. Masticatory muscle tenderness (most commonly lateral pterygoid  then
temporalis  medial pterygoid  masseter)
2. Limited opening of the mandible (<37mm)
3. Joint sounds
Females > males
Cause – spasm of the masticatory muscles (due to stress, bruxism, excessive clenching
etc).

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