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TMJ overview
- 1. KIMS DENTAL DEPARTMENT presents CMEPROGRAM A brief insight into ORPHAN JOINT
- 2. MODERATOR DR. SRINIVAS SAKAMURI MDS HEADOF THE DEPARTMENT PRESENTER DR G. GURU KARTHIK MDS ORAL AND MAXILLOFACIAL SURGEON
- 3. List of contents •Introduction • Peculiarities of TM Joint. • Applied anatomy. • Normal movements. • Evaluation of patient. • Signs and symptoms • Classification of TMJ disorders. • A brief insight into MPDS. Internal derangements. Dislocations, subluxation. Ankylosis.
- 4. Treatment: • Conservative management •Surgical management Minimally invasive Invasive
- 5. Introduction All the bonesin the skull are attached with fibrous joint and are immovable expect for temporomandibular joint. • The temporomandibular joint( TMJ ) is a bilateral synovial articulation between the mandible and temporal bone. The name of the joint is derived from the two bones which form the joint: the upper temporal bone which is part of the cranium (skull), and the lower jawbone or mandible. • The most important functions of the temporomandibular joint (TMJ) are mastication and speech. 1/7/2018 SEMINAR ON APPLIED ANATOMY OF TMJ, G.Guru Karthik/91 5
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- 9. Arterial & Nervesupply
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- 11. INNERVATION OF TMJ •Auriculotemporal nerve • Masseteric nerve • Deep temporal nerve • Mechanoceptors • Nociceptors
- 12. Peculiarities of TMJ 1.Bilateral diarthrosis – right & left function together 2. Articular surface covered by fibrocartilage instead of hyaline cartilage. 3. Only joint in human body to have a rigid endpoint of closure i.e. occlusal contact through teeth.
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- 16. EVALUATION OF THEPATIENT 1. Case history 2. Physical examination 3. Radiographic evaluation a. Transcranial views b. OPG c. Tomograms d. Arthrography e. CT scans f. MRI 4. Psychologic evaluation
- 17. 1. History oftrauma. 2. History of rheumatoid arthiritis. 3. History of osteoarthritis. 4. History of long standing otitis media. 5. Long standing cervical spondylitis. 6. History of extraction of posterior teeth. 7. Bruxism. 8. History of psychological issues. 9. History of unfinished orthodontic treatment.
- 18. • Gait- associatedwith osteo/rheumatoid arthiritis. • Tmj examination. • Masticatory muscles examination.
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- 22. CLASSIFICATION OF TMJDISORDERS 1. Myofascial pain and dysfunction (MPD) 2. Disk displacement disorders 3. Degenerative joint disease 4. Systemic arthritic conditions 5. Chronic recurrent dislocation 6. Ankylosis 7. Neoplasia 8. Infections
- 23. MYOFASCIAL PAIN &DYSFUNCTON •MPD is the most common cause of masticatory pain and limited function for which patients seek dental consultation and treatment. •The source of the pain and dysfunction is muscular, with masticatory muscles developing tenderness and pain as a result of abnormal muscular function or hyperactivity.
- 24. MYOFASCIAL PAIN &DYSFUNCTON CAUSES : • Daytime clenching • Bruxism • Malocclusion • Disk displacement disorders • Degenerative joint disease
- 25. Associated symptoms ofMPDS Neurologic Tingling Numbness Blurred vision Twitches Lacrimation Otologic Tinnitus Ear pain Dizziness Vertigo Diminished hearing Gastrointestinal tract Nausea Vomiting Diarrhea Constipation Dry mouth Musculoskeletal Fatigue Tension Tiredness Weakness Joint pain
- 26. MYOFASCIAL PAIN &DYSFUNCTON SIGNS : • Diffuse tenderness of the masticatory muscles • The range of the mandibular movements is decreased • Deviation of the mandible to the affected side • The teeth frequently have wear facets • Joint noises may be present • Trismus. • Radiographs of the TMJs are usually normal
- 27. 2. DISC DISPLACEMENTDISORDERS Disk displacement with reduction Disk displacement without reduction
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- 29. Conservative management Diet modifications. Occlusalcorrections if any Muscle reprogramming exercises. Splints. Orthodontic treatment if required. Muscle relaxants Anti-anxiolytics. PRILIMINARY TREATMENT
- 30. NON INVASIVE TREATMENT THERMALAPPLICATION THERAPAUTIC ULTRASOUND BIOSTIMULATION
- 31. • Jaw restrainingdevices. • Biofeedback mechanics.
- 32. PERMANENT OCCLUSAL MODIFICATION •Occlusal equilibration •Prosthetic restoration • Orthodontics • Orthognathic surgery
- 33. TMJ SURGERY •Arthrocentesis •Arthroscopy •Disk-Repositioning Surgery •DiskRepair or Removal •Condylotomy •Total Joint Replacement •Arthroplasty for Ankylosis
- 34. ARTHROCENTESIS • L.A. withintravenous sedation • Needles into the superior joint space • Ringer’s solution • Steroids, L.A • NSAIDs • Very effective in anterior disk displacement without reduction • Stretching of capsule, decrease in pain mediators, release of adhesions, elimination of negative pressure
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- 38. DISK REPOSITIONING SURGERY •Indicated in anterior disk displacement with or without reduction • Removing a wedge of tissue from posterior attachment • Suturing the disk back to the correct anatomical position • May be combined with recontouring of the disk,articular eminence,and condyle • Jaw exercises
- 39. DISK REPAIR ORREMOVAL • Disk repair with dermal grafts or fascial tissue • Diskectomy without replacement • Disk replacement with autogenous grafts or alloplastic implants
- 40. MANAGEMENT OF RECURRENT DISLOCATION 1.Capsule tightening procedures (capsulorrhaphy,reinforcement of capsule) 2. Creating mechanical obstacle (osteotomy of eminence,placement of graft,silastic block,Dautry’s procedure, use of pins or screws) 3. Direct restrain of condyle 4. Creation of new muscle balance 5. Removal of mechanical obstacles
- 41. Osseous Surgery ofTMJ - Condyloplasty
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- 45. Autogenous or allogenousimplants
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- 55. 1/7/2018 case presentation/ jaya lakshmi / 12 55
- 56. 1/7/2018 case presentation/ jaya lakshmi / 12 56
- 57. 1/7/2018 case presentation/ jaya lakshmi / 12 57
- 59. OUR TEAM Dr. SrinivasSakamuri MDS Endodontist Dr Sahana Mallineni MDS Periodeontist Dr. Venkatesh Nettam MDS Orthodontist Dr. Kalyani Ch. BDS EHS Coordinator Dr. Chandana BDS Budding Dentist Dr. G. Guru Karthik MDS Oral and Maxillofacial Surgeon