OMFS

1. TMJ DISORDERS
Dr. Junaid Shakeel
REGISTRAR (SIR SYED DENTAL COLLEGE)
FCPS-II (THEORY)
B.D.S (DOW)

2. CLASSIFICATION
• MYOFACIAL PAIN / TMPDS
• DISC DISPLACEMENT DISORDERS
• DEGENERATIVE JOINT DISEASES
• TMJ DISLOCATION
• ANKYLOSIS
• FRACTURE

3. TMPDS
• MOST COMMON CAUSE OF MYOFACIAL PAIN
AND LIMITED FUNCTION.
• SOURCE OF PAIN IS MUSCULAR, WHICH
ALMOST ALWAYS CAUSES MUSCLE
TENDERNESS & HYPERACTIVITY.
• FREQUENTLY ASSOCIATED WITH CLENCHING &
BRUXISM, RESULTING FROM STRESS.

4. • SOMETIMES MAY BE ASSOCIATED WITH DISC
DISORDERS OR DEGENRATIVE JOINT DISEASES.

5. SYMPTOMS OF TMPDS
• MUSCLE TENDERNESS.
• USUALLY NO TMJ PAIN OR JOINT CLICK.
• RANGE OF MOTION MAY BE DECREASED & MAY
BE ASSOCIATED WITH DEVIATION TOWARDS THE
AFFECTED SIDE.
• WEAR FACETS ON TEETH.

6. RADIOGRAPHIC FINDINGS IN TMPDS
• USUALLY ABSENT.

7. TREATMENT
• COUNSELLING.
• MUSCLE RELAXANTS.
• ANTI DEPRESSANTS.

8. DISC DISPLACEMENT DISORDERS
• ANTERIOR DISC DISPLACEMENT WITH
REDUCTION .
• ANTERIOR DISC DISPLACEMENT WITHOUT
REDUCTION.

9. NORMAL JOINT

10. ANTERIOR DISC DISPLACEMENT
(WITH REDUCTION)

11. ANTERIOR DISC DISPLACEMENT
(WITH REDUCTION)

12. ANTERIOR DISC DISPLACEMENT
(WITH REDUCTION)
• DISC HAS MOVED ANTERIOR AND MEDIAL TO
CONDYLE IN CLOSED POSITION.
• DURING OPENING , CONDYLE MOVES OVER THE
POSTERIOR BAND OF DISC AND REST ON
RETRODISCAL TISSUE. THIS PRODUCES THE CLICK
SOUND.
• A RECIPROCAL CLICK MAY BE PRODUCED WHILE
CLOSING THE MOUTH.

13. EXAMINATION FINDINGS
• JOINT TENDERNESS, MUSCLE TENDERNESS
MAY ALSO EXIST.
• OPENING CLICK IS COMMON.
• IN SOME CASES, RECIPROCAL CLICK MAY BE
PRESENT.
• MAXIMAL OPENING MAY BE SLIGHTLY
REDUCED.

14. DIAGNOSIS
• HISTORY
• CLINICAL
• MRI
• ARTHROSCOPY
• ARTHROGRAPHY

15. TREATMENT
• PATIENT COUNSELLING.
• MEDICATION.
• PHYSICAL THERAPY.
• SPLINT THERAPY.
• IMF OR INTRA-ARTICULAR INJECTIONS
• ARTHROCENTESIS AND LAVAGE.
• ARTHROSCOPY.
• DISKECTOMY OR DISKOPLASTY.

16. PATIENT COUNSELLING
• TREATABLE.
• MEDICAL OPTIONS ARE PREFERRABLE.
• BEHAVIOUR MODIFICATION.
• COMPLIANCE OF PATIENT IS MANDATORY.
• LONG SPAN OF TREATMENT.

17. MEDICATIONS
• NSAIDS
• MUSCLE RELAXANTS.
• ANTI DEPRESSANTS.
• ANXIOLYTICS.

18. PHYSICAL THERAPY
• TO RELAX THE MUSCLES OF MASTICATION.

19. SPLINT THERAPY
• ANTERIOR REPOSITIONING SPLINT
• AUTO REPOSITIONING SPLINT

20. IMF

21. Intra lesional injections
• Steroids.
• Local anesthesia.

22. Arthrocentesis & lavage
• Minimally invasive technique that involves lavage
of joint space and release adhesions.
• 2 entry points or ports are created in upper joint
space, for injecting ringers lactate in joint.
• At the conclusion of procedure, a mixture of local
anesthesia and steroid, to reduce post operative
discomfort.

23. Arthrocentesis & lavage

24. arthroscopy
• Allow direct visualization of joint space .
• Endoscopic intervention.
• Bands can be released and biopsy samples can
be attained.

25. arthroscopy

26. Diskotomy / diskoplasty
• Removal of a wedge shape part of
interarticular disk and then repositioning it
over the condyle, laterally and posteriorly.

27. diskectomy
• Removal of interarticular disc.

28. Anterior disk displacement
(without reduction)
• Patient is unable to open the mouth
completely
• The disk is unable to slide over the condylar
surface and buckles up, preventing opening of
the mouth.

29. Anterior disk displacement
(without reduction)

30. Ankylosis

31. Ankylosis

32. Ankylosis
• Classicfication of tmj ankylosis
1. bony
2. fibrous
1. true ankylosis
2. false ankylosis
1. unilateral
2. bilateral

33. Ankylosis
• History of trauma or fall in childhood.
• Gradual reduction in mouth opening.
• Symptoms :
unilateral – asymmetry and deviation of jaw.
Shortening of jaw on affected side.
Bilateral – bird face appearance.
Limited mouth opening in both cases.

34. Diagnosis of ankylosis

35. Treatment of ankylosis
• Growth centre transplantation.

36. Treatment of ankylosis

37. Treatment of ankylosis