This document provides information on the temporomandibular joint (TMJ), including its definition, structure, diagnosis, and treatment of TMJ disorders. Some key points: - The TMJ is formed by the temporal bone and mandible, allowing hinging and sliding movements. It contains an articular disc that helps distribute forces. - Common TMJ disorders include myofascial pain dysfunction syndrome, osteoarthritis, dislocations, and internal derangements (abnormal disc positioning). - Diagnosis involves history, examination, and imaging like x-rays, CT, MRI. Treatment depends on the disorder but may include splint therapy, exercises, injections, or surgery.

2. * Introduction
* Anatomy
* Radiographic examination
* Myo functional pain dysfunction syndrome
* TMJ disorder
* Dx of TMJ disorder
* Rx of TMJ disorders

3. Definition :
It is the joint formed by temporal bone with the
mandible
It`s actually a sliding joint not only ball & socket
Site :
In front of
each ear

4. Structure of TMJ
1- articulating surfaces
A (bony elements)
condyle
Glinoid fossa

5. Interatricular disc
Cartilaginous disc placed between the 2 bony
elements
The disc is attached to a muscle (lateral
pterygoid) & moves with certain movement of
TMJ

7. Joint capsule
It surrounds TMJ
It is attached to glinoid
fossa margin & the neck of
condyle
*It maintain proximity of
joint parts during
function
*It limits forward
translation of the condyle

8. Synovial membrane
It is the internal
lining of external
capsule
It contains synovial
fluid for lubricating
the joint

11. Diagnosis of TMJ disorder
Comprehensive history
(onset,duration,course,pasthistory,surgical procedures,family history)
Physical examination
(palpation ,stethoscope,dentition)
Radiographic diagnosis
Lab investigations

12. Radiographic examination
To evaluate condition of teeth , bone
, surrounding hard & soft tissue
Plain x-ray (a
To see changes in bony structure only
Ex : panoramic , oblique lateral

14. Tomography
It is of a great value in dx of TMJD…
It has the property of elimination of
superimposition in plain x rays

15. Arthrography
They r taken after injecting die material into
synovial spaces to enhance intra capsular soft
tissue

16. C.T scan
It`s x-ray images in serial manner with different
levels showing hard & soft structures
v. Helpful in Dx of TMJD inspite of high dose of
exposure

17. MRI
It`s efficient in detecting changes in soft tissues
Limited accuracy in detecting bony elements
Helpful in DX of (internal derangement)

18. Arthroscopy
It allows detection of internal abnormality by
direct vision through arthroscope

19. Lab investigations
CBC
Serum calcium
Serum phosphorus & alkaline phosphatase
Serum uric acid
ESR
Serum RF

20. functional
Myofunctional pain dysfunction syndrome
Organic
Acquired (arthritis-dislocation-ankylosisinternal derangement)
Congenital (condylar hypo/hyperplasia)

21. It`s a painful condition of skeletal muscles
specially the muscles of mastication
Characterized by development of trigger points
or sensitive painful area in muscle or junction
bet muscle & facia

23. Signs & symptoms
1- Pain
-it`s the most complain
-mostly unilateral
-dull - sharp & acute
Location
Back of head & neck
Temporal area
Angle of jaw
The area in front of ear

24. 2-tenderness of muscles of mastication
Temporal muscle
is the common muscle
to produce temporal pain
Masseter : trigger points
Refer pain to : (sinus area,
Ear , above eye & even into molar region )

25. Trapezius muscle :
Pain almost referred to head & face
Medial pterygoid muscle :
Trigger points refer to ( TMJ ,
nose ,ear , lower jaw & lateral
side of neck )

26. Sternomastoid muscle:
Develops trigger points with
or
w/out TMJ problems
Cause forehead headache
(misdiagnosed with frontal sinusitis )
Also may cause pain in (ear, over &around aye
,chin & below the eye (mis diagnosed with max
sinusitis ) )

27. 3-clicking in TMJ during movement
- It is the most common symptom (it may be so
loud )
- There may be pain in joint during chewing

28. 4- limitation of mandibular
movement
5-absence of clinical or radiographic evidence
of
Organic changes in TMJ
6- No tenderness of TMJ during examination

29. Etiology of MPD
occlusal disharmony
psychological stress

30. Diagnosis of MPD
1- History.
2-Determine the range of mouth opening.
3- Radiographic examination showing
no organic changes.
4-Determine the direction & amount of mandibular deviation during
opening.
5-Examination of TMJ by palpation & auscultation & palpation of
muscles of mastication

31. Treatment of MPD
Control pain
& discomfort
Correction of
occlusal
disharmony
Removal of
psychological
stress &
tension

32. Immobilization of jaw
It produce complete rest for 2-3 weeks
Use of Boxer`s mouth guard (to separate
occlusal surfaces )

33. Correction of occlusal disharmony
1- occlusal adjustment : by selective grinding to
remove cusp interference between teeth
To maintain occlusal stability & equilibrium of
muscle during rest position

34. 2- Anterior deprogrammer :
* Suppresses clenching intensity
** Prevent occlusal wear & trauma
3-splints & occlusal bite planes :
Acrylic splints made with
simultaneous contact of
mandibular teeth in
centric occlusion
to eliminate muscular spasm

35. Thermo therapy
By heat application to activate blood circulation
of spastic muscles

36. Muscle exercise
It stimulate weak muscles & wash metabolites
so decrease spasm
Intra muscular injection of L.A :
Help in diagnosis of the syndrome & in cuts
cycle of pain

37. Psychological therapy
Emotional stress stimulate vascular dynamics
(contraction & dilatation ) so increasing
muscular tone leading to spasm
Administration of muscle relaxant

38. Acquired organic disorders of TMJ
1- Inflammatory.
2- Degenerative.
3- Infectious.
4- Traumatic.

39. Rheumatoid arthritis
It`s a systemic inflammatory
disease that produce destructive
changes to the joints (may affect
more than one joint )
c/p:
Pain , joint noise ,limitation of
movement , malocclusion )
Juvenile RA : impairment of jaw
growth & may lead to ankylosis

40. Diagnosis of R.A
Clinically : multiple joint involvement
Lab investigations : RH factor
Radiographic examination : (lack of joint space d.t condylar
destruction )
- Condyle is eroded ,flattened & rarefied
- Glinoid fossa is shallow

41. Treatment
*application of moist heat
*anti inflammatory drugs
*immunosuppressive drugs
*Gold salts
*steroids (oral – joint injection)

42. Degenerative arthritis (osteoarthritis)
Non inflammatory focal degenerative disorder that affect
primarily articular cartilage and sub condylar bone (initiated
by deterioration of articular soft tissue cover & exposure of
bone )
Cause : long term functional abuse

43. C/P :
*Crepitation sound from joints
*Restricted or normal mouth opening
*With or w/out pain
*Occasionally may joints show inflammatory signs
*Women > Men
*Tenderness of muscles of mastication
*Limitation of mandibular movement & deviation
to the affected side
*Tenderness over condyle

44. Diagnosis
Based on clinical & radiographic examination
(irregularity of condylar surface & radiolucency
in substance of condyle )

45. Treatment
Analgesics
Anti inflammatory
drugs
Muscle relaxant
Surgery (condylar
shaving or high
condylectomy )

46. Infectious arthritis
It is the consequence of direct extension from
middle ear , parotid gland & posterior areas of
mandible
it is also happened after trauma followed by
infection from septseamia
Leads to inflammation of synovial tissues
Leads to destruction of fibro cartilage & bone
leading to ankylosis

48. Treatment
Administration of
antibiotics
Drainage of source of
infection
Rest
analgesics

49. Occurs d.t trauma to the joint
There is muscular tear ,
ligamentous injury
Hemarthrosis may be present
Mechanical damage to
surrounding structure may be
present

50. Diagnosis
History of severe trauma with pain , swelling , &
dysfunction
Only the affected joint showing inflammation
Presence of normal joint function before trauma
Treatment : Rest ,
Administration of analgesics , anti inflammatory
drugs

51. Congenital condylar disorders
Condylar hypoplasia
Condylar hyperplasia
Others

52. Benign tumors
1- synovial chondromatosis :
Benign tumor characterized by cartilaginous
metaplasia of synovial membrane producing
small nodules which separate form membrane
to become loose bodies that may ossify

54. 2- osteochondroma
Benign tumor characterized by normal bone &
cartilage near growth zones

55. Osteoma
Osteoma is a benign tumour consisting
of mature bone tissue.
It is a slow growing, asymptomatic

56. Anterior (to
eminence)
Lateral (in
temporal
fossa)
Dislocation
of TMJ
Posterior (in
fracture of
base of skull
)
Superior
(into medial
cranial
fossa)

59. Signs & symptoms of dislocation
- Mandible fixed in open position
- Protrusion of chin
- Deviation to the normal side
By palpation depression is noticed in
front of the ear
- Limitation of movement
- Pain
-

60. Treatment of dislocation
Acute dislocation :
Manual reduction under sedation or even under
G.A with muscle relaxant
Then immobilization for several days ..

61. Chronic dislocation
- Manual reduction with L.A or G.A & muscle
relaxant
- Surgical exposure of joint & direct reduction
- Condylectomy
- Condylotomy

62. 3- Recurrent dislocation
Conservative RX : immobilization for several days
Injection of sclerozing material around capsule to
produce fibrosis
Surgical RX : re-situation of capsule & ligament
Ligation of condyle
Removal of eminence
Removal of activating muscle

63. TMJ ankylosis
It is fibrous or bony
union between joint
components
It is unilateral or bilateral
Partial or complete
True or false (When the
structures outside the joint
are affected)

64. False ankylosis
Muscular trismus
Muscular atrophy or fibrosis
Myositis ossificans
Tetanus
Neurogenic closure of mouth

65. Etiology
Birth trauma
Heamarthrosis
Suppurative arthritis
Rheumatoid arthritis
Osteomyelitis
Fracture condyle

66. Clinical findings
- Inability to open
mouth
- Gradual
development of jaw
immobilization
- Slight opening mouth
in unilateral affection

67. - Bird face ,micrognathia, mal occlusion &
impacted teeth
- Deviation of mandible to the affected side

68. Treatment
* If fibrous ankylosis :
Open the mandible
manually under G.A

69. * Condylectomy
* Osteoarthrotomy
* Repalcement
of condyle

70. Abnormal relationship between articular disc to
condyle & eminence

71. Symptoms
Pain during function
Joint clicking or noise
Earache or headache
Facial pain

72. Ant. Displacement of the
disc (with
reduction)(clicking)
Ant. dislocation of the disc
(w/out reduction) (locked
joint).

73. Treatment
Conservative treatment
Surgical treatment
Occlusal therapy :Selective grinding.
Construction of splints.
Relocation of disc:
meniscoplasty
Condylotomy.
Capsular rearrangement of
the meniscus.
High condylectomy
Physiotherapy :Soft diet , muscular
exercises.
Muscle relaxants.