A Brief description of the causes and clinical manifestations of the internal derangement of the temporomandibular joint , with particular emphasis on Disc Displacements .
The presentation deals with the basics required for studying TMJ ankylosis. The text has been simplified and presented. It is well supported with illustrations.
Suggestions and feedback will be well appreciated. :)
The presentation deals with the basics required for studying TMJ ankylosis. The text has been simplified and presented. It is well supported with illustrations.
Suggestions and feedback will be well appreciated. :)
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Mandibular angle fractures account for 23% to 42% of all facial fractures. Fracture of mandibular angle can be classified as (A) Vertical favorable or unfavorable, (B) Horizontally favorable of unfavorable. Traditionally, mandibular angle fractures have been treated with either closed reduction and inter-maxillary fixation or open reduction and internal fixation with or without inter-maxillary fixation. Patients treated with inter-maxillary fixation have a restricted airway and loose excess weight. Rigid internal fixation and early return to function have eliminated the use of wire osteosenthysis and prolonged use of inter-maxillary fixation. The principal of rigid fixation, however, have inherent set of disadvantages including damage to the inferior alveolar nerve and the marginal mandibular branch of facial nerve. Postoperative malocclusion rates are also high. With the introduction of semi-rigid technique fracture of the mandibular angle could be treated according to Champy’s Ideal lines of osteosenthysis. The technique involves placement of a single monocortial miniplate on the superior border of the mandible. However, some studies suggested using a second miniplate along the inferior border. Wether one or two miniplates should be used is still debatable. The application of 3D plates may provide additional stability in 3 dimension and good resistance against torque forces.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Mandibular angle fractures account for 23% to 42% of all facial fractures. Fracture of mandibular angle can be classified as (A) Vertical favorable or unfavorable, (B) Horizontally favorable of unfavorable. Traditionally, mandibular angle fractures have been treated with either closed reduction and inter-maxillary fixation or open reduction and internal fixation with or without inter-maxillary fixation. Patients treated with inter-maxillary fixation have a restricted airway and loose excess weight. Rigid internal fixation and early return to function have eliminated the use of wire osteosenthysis and prolonged use of inter-maxillary fixation. The principal of rigid fixation, however, have inherent set of disadvantages including damage to the inferior alveolar nerve and the marginal mandibular branch of facial nerve. Postoperative malocclusion rates are also high. With the introduction of semi-rigid technique fracture of the mandibular angle could be treated according to Champy’s Ideal lines of osteosenthysis. The technique involves placement of a single monocortial miniplate on the superior border of the mandible. However, some studies suggested using a second miniplate along the inferior border. Wether one or two miniplates should be used is still debatable. The application of 3D plates may provide additional stability in 3 dimension and good resistance against torque forces.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Arthrocentesis of the temporomandibular jointAhmed Adawy
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Arthrocentesis of the temporomandibular joint refers to lavage of the upper joint space, hydraulic pressure and manipulation to release adhesions of the “anchored disc phenomenon” and improve motion. The technique of arthrocentesis is discussed together with the indications and contraindications of the procedure. Further, the presentation includes modifications of the standard technique.
Conservative management of temporomandibular disorders Marwan Mouakeh
this presentation addresses the TM Joint disorders focusing on the conservative and no-surgical methods of treatment , with special emphasis on the effective role of occlusal splints .
Anoverview of TMD'S categories and main types of interocclusal appliances( occlusal splints ) used during the management of these musculoskeletal disorders .
Temporomandibular Disorders & Its Management. Detailed Presentation from the main book "Okeson". Post Graduate Level Presentation With proper management of the temporomandibular disorders of all types of management. Supportive and Definitive Therapy and Surgical Management & Myofacial pain dysfunction Syndrome
Temparo mandibular joint disorders /certified fixed orthodontic courses by In...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
This presentation gives some basic information regarding the definition , etiology and pathophysiology of " obstructive sleep apnea" which is a serious sleep disorder .Treatment methods are briefly reviewed with special emphasis on the role of the oral surgeon and orthodontist in the management of this medical condition .
This presentation is intended to give the GP dentists as well as specialists some essential information regarding " white spot lesions" ,which can be considered as one of the most common side effect of orthodontic treatment with fixed appliances.
This presentation gives a brief description of the clinical features and causes of gummy smile conditions , their clinical and differential dignosis , as well as the different treatment methods that may be used to correct these problems .
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
2. Internal Derangements
General orthopedic term implying a mechanical
fault that interferes with the smooth action of a
joint
The most common internal derangement is
Disc Displacement
5. Temporo-Mandibular Joint (TMJ)
A compound synovial joint ,
connecting the mandible to the
temporal bone
Diarthrodial Paired Joint
6. • a Biconcave oval structure dividing
the joint cavity into 2 distinct
compartments
• Nonvascular and Noninnervated
dense fibrous connective tissue
instead of the hyaline cartilage found
in other body joints
• The Articular Disc ( Meniscus )
Temporo-Mandibular Joint (TMJ)
7. Divides the joint cavity into
2 separate compartments
Insures stability of the TMJ
during function
Absorbs forces acting on the
joint during function
Temporo-Mandibular Joint (TMJ)
• The Articular Disc ( Meniscus )
8. Temporo-Mandibular Joint (TMJ)
• The Articular Disc ( Meniscus )
- 2 types of joint movements
occur in separate compartments of
this joint :
• sliding or translation in the
upper compartment
• hinge or rotation in the lower
compartment
10. •The lower condylar
lamina : Non-Elastic
•The upper temporal
lamina : Elastic
(Retrodiscal Tissue or Bilaminar Zone):
a highly vascularized and well-innervated
tissue
• Posterior Attachment
11. Physiologic Position of the Articular Disc
1
2
3
The absence of blood vessels & nerves in the Intermediate Zone
enables this part of the disc to act as a Pressure-bearing area .
12. •12 O’clock position
The posterior band ends, in healthy TMJ , at the apex of the
condyle when teeth are in occlusion
13. Collateral Discal Ligaments : short and non-elastic
• Frontal View
The Articular Disc
Medial
Distal
19. • a Disorder characterized by an abnormal relationship
between the articular disc , mandibular condyle, and
articular eminence .
• The disc is most often
displaced anteriorly or
antero-medially
Disc Displacement
20. Disc Displacements
• The most frequent abnormality found in patients
presenting with signs and symptoms of
temporomandibular disorders ( TMDs)
• The main cause of TMJ internal derangement
• Using the MRI techniques, the prevalence of disc
displacements in patients suffering from TMDs
symptoms was about %84 .
32. Functional Classification
• Disc Displacement With Reduction
• Disc Displacement Without Reduction -Acute Phase -
• Disc Displacement Without Reduction -Chronic Phase -
of TMJ Disc DisplacementsClassifications
33. Closed Partially Open Fully Open
• The displaced disc recaptures its normal relationship with
the mandibular condyle during mouth opening
• Disc Displacement With Reduction
35. Disc Displacement Without Reduction
• Displacement of the articular disc on closing , and failure to
reduce or recapture the normal relationship with the condyle
upon opening
38. Disc Displacement Without Reduction
Closed
Open
• Contact is lost between the condyle , disc, and articular
eminence
• Articular space collapsed trapping the disc in front of the
condyle
40. Normal TMJ Function is dependant on :
Disc morphology
Disc attachments ( post. / collat. )
Lateral Pterygoid ( functional) coordination
Etiopathology of TMJ Internal Derangements
41. Disc morphology : Loss of self-seating property
Disc attachments ( post. / collat. )
Lateral Pterygoid ( functional) coordination
Etiopathology of TMJ Internal Derangements
42. Disc morphology : Loss of self-seating property
Disc attachments ( post. / collat. ) : Loosening or tearing
Lateral Pterygoid : ( functional) Incoordination
Etiopathology of TMJ Internal Derangements
43. Etiopathology of TMJ Internal Derangements
Disc morphology : Loss of self-seating property
Disc attachments ( post. / collat. ) : Loosening or tearing
Lateral Pterygoid : ( functional) Incoordination
44. 1 – Thickening of the posterior
band of the disc
2 - Elongation or loosening of the
disc’s collateral or posterior
attachments
3 – Change in the shape of the disc
from biconcave to biconvex
4 – Incoordination of the two
heads of the lateral pterygoid
muscle .
Etiopathology of Disc Displacements
45. Etiopathology of Disc Displacements
Posterior positioning of the
mandibular condyle relative to the
articular disc
The codylar head loads against the
posterior part of the disc
Progressive alteration in the form
of the posterior band
The disc looses its “ self-seating”
property and aggravation of the
anterior displacement of the disc
46. • Alteration of the normal
disc / condyle relation
• The condyle will load on
the richly vascularized
and well innervated
posterior part of the disc
• Pain in the TMJ and
Dysfunction
Development of Disc Displacements
47. Evolution of TMJ Disc Displacements
Disc Displacement With Reduction
Disc Displacement Without Reduction
Disc Perforations
Degenerative Joint Disease
Complete
Partial
Acute
Chronic
48. •Anteriorly displaced and deformed, degenerated disc and irregular
cortical outline with osteophytosis and sclerosis of condyle .
Evolution of TMJ Disc Displacements
49. Advanced osteoarthritis and anterior disc
displacement, with joint effusion
Evolution of TMJ Disc Displacements
52. What causes TMJ disorders?
The Exact Causes Are Not Clear Yet …
- Trauma to the jaw or TMJ :
> Macrotrauma
> Microtrauma
- Malocclusion (Bad Bite)
- A possible link between Female Hormones and
TMJ disorders ?
- Stress
53. Causes of TMJ Disc Displacements
Extrinsic FactorsIntrinsic Factors
54. Causes of TMJ Disc Displacements
Extrinsic Factors ( Macrotrauma) :
Direct : sudden blow following traffic
accidents or violent sports
Indirect : Whiplash
55. Acute Trauma to the Neck : Whiplash
Macrotrauma: Blow, Traumatic extraction , Intubation…
Causes of TMJ Disc Displacements : Extrinsic Factors
56. Causes of TMJ Disc Displacements
Intrinsic Factors (Microtrauma) :
Bruxism
Excessive mouth opening : prolonged
dental treatment – 3rd molars extraction
( traumatic) - intaoral intubation during
general anesthesia
Hard foods
58. Stress: Emotional & Physical
Stress frequently leads to unreleased nervous energy. It is very
common for people under stress to release this nervous energy by
grinding and clenching their teeth.
Causes of TMJ Disc Displacements
59. Specific Forms of Malocclusion
Causes of TMJ Disc Displacements
Anterior Open Bite Occlusal Interferences
with mandibular shift
60. Causes of TMJ Disc Displacements
Posterior Crossbite
with mandibular shift
Class II-division2 Malocclusion
Specific Forms of Malocclusion
61. Causes of TMJ Disc Displacements
Other Possible Causes
• Loss of posterior occlusal support
( missing > 5 posterior teeth ) and TMJ
overloading
• Generalized Hyperlaxity of
body joints
63. • Disc Displacement With Reduction
Clinical Signs & Symptoms
• Clicking or popping sounds during mandibular
opening and closing – Reciprocal Clicking –
• Deviation of the mandibular midline to the
affected side early on opening
• Pain resulting from the strained discal ligaments
or condylar pressure against posterior
attachment
• Limited mouth opening ( only in case of secondary
muscle splinting )
64. • Disc Displacement With Reduction
• The main sign of DD With Reduction
• The first click occurs early during mouth opening ,indicating
recapture of the displaced disc
• The second click occurs during mouth closure, indicating
displacement of the disc anteriorly .
• Reciprocal Click
66. • Disc Displacement With Reduction
to the side of the displaced disc
indicative of interference during
movement
midline returns to the centered
position after reduction of disc
displacement
Deviation of the mandibular midline
67. • Disc Displacement With Reduction
Articular Pain ( Arthralgia)
Resulting from strained discal
ligaments or,
Codylar pressure against posterior
attachments
68. Arthralgia (Articular Pain)
Localized in the TMJ Region
Increased with mandibular
movement.
Origin of pain :
posterior attachment - collateral
ligaments -articular capsule.
69. Myalgia ( Muscular Pain)
Dull , Deep , and Diffuse pain
Depressing
Felt in the morning when
related to Nocturnal Bruxism
Influenced by functional
demands ( chewing…)
70. Acute Disc Displacement Without Reduction
Clinical Signs and Symptoms
1- Severely restricted opening ( < 25-30 mm)
2- Mandibular midline Deflection
3- Limitation of protrusive excursion (accompanied by
deflection to the ipsilateral side )
4- Restriction of the lateral movement to the
contralateral side
71. Disc Displacement Without Reduction
• Clinical Signs & Symptoms
Sudden absence of joint clicking associated with
severe restricted opening ( closed lock )
Mandibular midline deflection towards the
affected side
Limitation in protrusive and lateral ( to the affected
side ) mandibular movements
Severe articular pain
Acute Phase
72. Disc Displacement Without Reduction
Sudden absence of joint
clicking associated with
severe restricted opening
( mechanical interference)
Closed Lock
73. Disc Displacement Without Reduction
Closed Lock :
Severe limited mandibular
movement (20 -25 mm) due to
abnormal positioning of the
articular disc in front of the
condyle
75. - Continuous displacement
of mandibular midline along
the whole opening movement
- A common sign of ADD
Without Reduction
Midline Deviation ,vs , Midline Deflection
- The mandible returns to the
centered position on opening
- Indicative of interference
during condyle movement
- A prominent sign of ADD
With Reduction
DeflectionDeviation
77. Chronic ADD without Reduction
and SymptomsClinical Signs
- Slight limitation in mandibular opening
- Slight deflection to the affected side
- Joint Sounds “ Crepitus “
78. Disc Displacement Without Reduction
• Progressive improvement of opening due to elongation
of posterior attachment and discal ligaments
• Moderate articular pain
• Joint Crepitation indicative of degenerative changes in
the articular surfaces
Chronic Phase
79. Pseudo-disc
Disc Displacement Without Reduction
Chronic Phase
Formation of “ pseudo-disc” as an
extension of the posterior band
this structure can withstand the
condylar pressure because it is
deprived of innervation and
vascularization