A VEIW ON TEMPOROMANDIBULAR JOINT

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A VEIW ON TEMPOROMANDIBULAR JOINT,tmj,TEMPOROMANDIBULAR JOINT,anatomy of TEMPOROMANDIBULAR JOINT,pathology of TEMPOROMANDIBULAR JOIN

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A VEIW ON TEMPOROMANDIBULAR JOINT

  1. 1. GOOD AFTERNOON<br />
  2. 2. A VEIW ON TEMPOROMANDIBULAR JOINT<br />GUIDED BY:<br />DR. R. N. PODDAR,<br />HOD, <br />ORAL & MAXILLOFACIAL SURGERY,<br />DR. R. AHMED DENTAL COLLEGE & HOSPITAL, KOLKATA<br />DR. MANIMAY BANERJEE,<br />ASSOCIATE PROFESSOR, <br />DEPT. OF ORAL & MAXILLOFACIAL SURGERY,<br />RADCH,KOLKATA<br />
  3. 3. WHAT IS TEMPOROMANDIBULAR JOINT ?<br /><ul><li>IT IS THE AREA WHERE THE MANDIBLE ARTICULATES WITH THE CRANIUM.
  4. 4. IT IS DESCRIBED AS A COMPLEX, MULTIAXIAL, SYNOVIAL, BICONDYLAR AND GINGLIMOARTHROIDAL JOINT.
  5. 5. TMJ IS ALSO KNOWN AS CRANIO MANDIBULAR JOINT/ ARTICULATION. </li></li></ul><li>WHY SHALL WE KNOW TMJ ?<br /><ul><li>PATIENTS FREQUENTLY CONSULT A DENTIST BECAUSE OF PAIN AND DYSFUNCTION IN TEMPORO MANDIBULAR REGION.
  6. 6. TMDs(TEMPOROMANDIBULAR DISORDERS) INCLUDE MYOFACIAL PAIN , INTERNAL DEARRANGEMENT, INFLAMMATION, DILOCATION, ANKYLOSIS, NEOPLASIA ETC.
  7. 7. NOTHING IS MORE FUNDAMENTAL TO TREATING PATIENTS THAN KNOWING THE ANATOMY.
  8. 8. SO TO TREAT THE TMDs WE SHOULD KNOW WELL THE ANATOMY AND PHYSIOLOGY OF THE WHOLE ARTICULATORY SYSTEM OF TEMPOROMANDIBULAR REGION.</li></li></ul><li>
  9. 9. TEMPOROMANDIBULAR JOINT<br />
  10. 10. CRANIAL COMPONENT<br /><ul><li>IT IS ALSO KNOWN AS MANDIBULAR/GLENOID FOSSA.
  11. 11. LIMITS: ANTERIORLY ARTICULAR EMINENCE, POSTERIORLY POST GLENOID TUBERCLE.</li></ul>MANDIBULAR COMPONENT<br /><ul><li>THE ARTICULAR PART OF THE MANDIBLE IS AN OVOID CONDYLAR PROCESS.
  12. 12. SHAPE: NORMALLY OVOID. MAY BE FLAT, ROUND AND ANGULAR.
  13. 13. POLES: MEDIAL AND LATERAL.
  14. 14. MEDIAL IS MORE PROMINENT.
  15. 15. DIAMETER: MESIOLATERAL- 13 TO 25 MM</li></ul> ANTERO POSTERIOR- 5.5 TO 16 MM<br />
  16. 16. TMJ CAPSULE<br /><ul><li>IT IS A THIN SLEEVE FIBROUS TISSUE INVESTING JOINT COMPLETELY.
  17. 17. FUNNEL SHAPED
  18. 18. INSIDE FIBROUS TISSUE CAPSULE, A SILKY SYNOVIAL MEMBRANE IS THERE.</li></ul>LIGAMENTS<br />TRUE FALSE<br /><ul><li>COLLATERAL SPHENO MANDIBULAR
  19. 19. CAPSULAR STYLOMANDIBULAR
  20. 20. TEMPOROMANDIBULAR</li></li></ul><li>ARTICULAR DISC<br />IT IS AN INTERVENING DISC WHICH DIVIDES THE ARTICULAR SPACE INTO TWO COMPARTMENTS.<br />1. INFERIOR/ CONDYLODISCAL COMPARTMENT.<br /> 2. SUPERIOR OR CONDYLODISCAL COMPARTMENT.<br />ANTERIORLY IT IS ATTACHED WITH ARTICULAR EMINENCE.POSTERIORLY IT IS DIVIDED INTO TWO LAMINA.<br />SUPERIOR RETRODISCAL LAMINA<br />INFERIOR RETRODISCAL LAMINA<br />WITHIN THESE LAMINA THERE IS RETRODISCAL TISSUE SPACE.<br />PARTS OF MENISCUS: ANTERIOR , INTERMEDIATE AND POSTERIOR ZONE.<br />
  21. 21. LUBRICATION MECHANISM<br />THE LUBRICATION MECHANISM OF TMJ IS CONTROLLED BY THE SYNOVIAL FLUID, PRESENT IN THE JOINT CAVITY.<br />TWO TYPES OF LUBRICATION IS SEEN MAINLY. <br />
  22. 22. NEURO VASCULAR SUPPLY<br />BLOOD SUPPLY: <br /><ul><li>SUPERFICIAL TEMPORAL ARTERY FROM POSTERIOR
  23. 23. MIDDLE MENINGEAL ARTERY FROM ANTERIOR
  24. 24. INTERNAL MAXILLARY ARTERY FROM INFERIOR
  25. 25. OTHER IMPORTANT ARTERIES ARE- DEEP AURICULAR, ANTERIOR TYMPANIC AND ASCENDING PHARYNGEAL.
  26. 26. CONDYLE GETS A LITTLE BIT FROM INFERIOR ALVEOLAR.</li></ul>NERVE SUPPLY:<br /><ul><li>FOR ANTERIOR ASPECTS. MANDIBULAR NERVE AFTER INNERVATING THE JAW JOINT GIVES 3 BRANCHES-</li></ul>AURICULOTEMPORAL FOR POSTERIOR, MEDIAL AND LATERAL ASPECTS.<br />2. MASSETERIC AND<br />3. A BRANCH FROM POSTERIOR DEEP TEMPORAL NERVE <br />
  27. 27. MOVEMENTS<br />MOVEMENTS OF CONDYLE AT THE JOINT SPACE<br /><ul><li>ROTATION
  28. 28. TRANSLATION</li></ul>MOVEMENTS OF MANDIBLE PROPER<br /><ul><li>SAGITTAL PLANE BORDER AND FUNCTIONAL
  29. 29. HORIZOTAL PLANE BORDER AND FUNCTIONAL
  30. 30. VERTICAL PLANE BORDER AND FUNTIONAL</li></li></ul><li>
  31. 31. MOVEMENTS<br />
  32. 32. SAGITTAL PLANE BORDER AND FUNTIONAL MOVEMENTS<br />FOUR DISTINCT MOVEMENTS COMPNENTS BELONG TO THIS GROUP.<br />POSTERIIOR OPENING BORDER<br />ANTERIOR OPENING BORDER<br />SUPERIOR CONTACT BORDER<br />FUNCTIONAL<br />
  33. 33. Horizontal plane border and functional movements<br />IN THE HORIZONTAL PLANE, A RHOMBOID SHAPED PATTERN IS SEEN THAT HAS FOUR DISTINCT MOVEMENT COMPONENTS WITH A FUNCTIONAL COMPONENT.<br />LEFT LATERAL BORDER<br />COTINUED LEFT LATERAL BORDER WITH PROTRUTION.<br />RIGHT LATERAL BORDER<br />CONTINUED RIGHT LATERAL BORDER WITH PROTRUSION.<br />
  34. 34. VERTICAL BORDER AND FUNTIONAL MOVEMENTS<br />WHEN MANDIBULAR MOTION IS VIEWED IN THE FRONTAL PLANE, A SHIELD SHAPED PATTERN CAN BE SEEN; THE COMPONENTS OF IT ARE:<br />LEFT LATERAL SUPERIOR BORDER<br />LEFT LATERAL OPENING BORDER<br />RIGHT LATERAL SUPERIOR BORDER<br />RIGHT LATERAL OPENING BORDER<br />
  35. 35. EXAMINATION<br /><ul><li>THE EVALUATION OF A PATIENT WITH PROBLEM IN TEMPOROMANDIBULAR REGION INCLUDE THOROUGH HISTORY, PHYSICAL EXAMINATION OF MASTICATORY SYSTEM AND PROBLEM FOCUSSED TMJ RADIOGRAPHY.
  36. 36. GENERAL EXAMINATION OF TMJ MAINLY GO THROUGH THE PALPATION AND AUSCULTATION METHOD .</li></ul>PALPATION:<br />AUSCULTATION:<br /><ul><li>SYSTEMIC EVALUATION OF MASTICATORY MUSCLE.
  37. 37. EVALUATION OF TMJ FOR TENDERNESS
  38. 38. MEASUREMENT OF RANGE OF JAW MOTION.</li></ul>IN SOME TMDs, JOINT NOISE IS HEARD WHICH CAN BE EASILY DETECTED DURING PALPATION OR WITH THE HELP OF STETHOSCOPE.<br />MOST COMMON JOINT SOUNDS ARE:<br />1. CLICKING 2. CREPITUS<br />
  39. 39. SYSTEMIC EVALUATION OF MUSCLES OF MASTICATION<br />3. PALPATION OF TEMPORALIS TENDON<br />1. PALPATION OF MASSETER<br />2. PALPATION OF TEMPORALIS<br />
  40. 40. EVALUATION OF TMJ<br />A. CLOSED MOUTH POSITION<br />B. OPEN MOUTH POSITION<br />
  41. 41. MEASUREMENT OF RANGE OF JAW MOTION<br />MAXIMUM VOLUNTARY VERTICAL OPENING (NORMALLY UP TO 45 MM)<br />EVALUATION OF LATERAL EXTRUSIVE MOVEMENT (10 MM APPROX)<br />
  42. 42. DIAGNOSTIC AIDS USED TO EVALUATE TMJ<br />
  43. 43. MRI<br />CT<br />PANOROGRAPH<br />TOMOGRAM<br />
  44. 44. CONCLUSION<br />Nature has blessed us with a marvelously dynamic masticatory system , allowing us to function and therefore exist.<br />Articulatory system is an important part of the masticatory system of our body.<br />So as a dental care provider to treat the patients of TMDs before knowing the pathology, this is essential to know the normal anatomy and physiology of TMJ.<br />
  45. 45. Thank you…<br />
  46. 46. SPECIAL THANKS TO:<br />DR. NUPUR BANERJEE, <br />DEPT. OF ORAL &MAXILLOFACIAL SURGERY,<br />R.A.D.C.H.,KOL<br />DR. DEBOBRATA MONDAL,<br />DEPT. OF ORAL &MAXILLOFACIAL SURGERY,<br />R.A.D.C.H., KOL<br />MR. ARINDAM MONDAL<br />ALL OF MY TEACHERS, SENIORS, JUNIORS AND BATCHMATES.<br />

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