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TEMPOROMANDIBULAR JOINT

TEMPOROMANDIBULAR JOINT. ANATOMY PATHOPHYSIOLOGY SURGERY. JOINTS- WHAT ARE THEY?. Osseous elements which are multiple that are joined by a variety of structural elements. These co-aptations are grouped as arthroses. ARTHROSES. FORCES Tensile,compressive,shear and torsion.

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TEMPOROMANDIBULAR JOINT

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  1. TEMPOROMANDIBULAR JOINT ANATOMY PATHOPHYSIOLOGY SURGERY

  2. JOINTS- WHAT ARE THEY? • Osseous elements which are multiple that are joined by a variety of structural elements. • These co-aptations are grouped as arthroses

  3. ARTHROSES • FORCES • Tensile,compressive,shear and torsion • Concerned with differential growth, transmission of forces and with movement

  4. TYPES OF ARTHROSES-2 • 1.SYNARTHROSES: which are solid non-synovial joints. Can be fibrous or cartilaginous. • Fibrous denotes intramembranous ossification • Cartilaginous denotes endochondral ossification

  5. TYPES OF ARTHROSES-2 • 2. DIARTHROSES: which are cavitated synovial joints • Characterized by having articular surfaces covered by cartilage(hyaline or fibrocartilage) with its lubricated smooth wear resistant surface which glides over its fellow with minimal friction

  6. SYNARTHROSES-TYPES • Sutures,synostoses • Gomphoses (peg and socket) • Synchondroses (manubriosternalis)

  7. DIARTHROSES-TYPES • Can be simple(one pair of articulating , surfaces), compound(more than one pair of surfaces), or complex(with intracapsular meniscus or disc) • Surface shape:plane, spheroid(ball and socket), ellipsoid, ginglymus, bicondylar,trochoid(pivot) and sellar(saddle-shaped)

  8. THE TMJ Are the only synovial joints with an articular disc

  9. TMJ Classification • Anatomic Classification: • Diarthrodial – two joints (joint spaces) • a joint that contains the following characteristics • a freely movable joint • bony surfaces are covered with hyaline or fibrocartilage • lined by a synovial lining and contains synovial fluid

  10. TMJ Classification • Functional classification: • Ginglymo - arthroidial • Ginglymoid: rotation - inferior joint space • Arthroidial: translation - superior joint space

  11. TMJ Classification • The mandible functions as a class III lever system • Load - occlusal surface • Fulcrum - TMJ • Force - muscles of mastication

  12. Anatomy Overview • Temporomandibular joint… • -the articulation of the mandibular condylar process with the glenoid fossa/articular eminenceaspect of the temporal bone. Also includes the interposed articular disc and collateral ligamentous attachments. • -is an encapsulated, synovial joint. • -classified as a ginglymo-arthroidal joint due to its ability to function as a hinge as well as a gliding type of joint. • -functions as a Class III lever system.

  13. QUESTION: ANATOMY What are the six (6) components of the temporomandibular joint articulation?

  14. Condyles • Articular surface of the temporal bone • Capsule • Articular disc • Ligaments • Lateral pterygoid

  15. Osseous components

  16. TOMOGRAPHC SCAN OF JOINT

  17. Bony components • Condyle of mandible • Articular tubercle of temporal bone • Mandibular fossa (glenoid)of temporal bone

  18. SOFT TISSUE COMPONENTS • Muscles and ligaments • Disk • Posterior disk attachment • Joint capsule • Synovia

  19. LIGAMENTOUS SUPPORT • Articular capsule-attached to temporal bone around the edges of the fossa and the articular tubercle and to neck of condyle • Sphenomandibular ligament-medial to the joint, runs from spine of the sphenoid bone to the lingula

  20. LIGAMENTOUS SUPPORT CON’T • Stylomandibular ligament-posterior to the joint, runs from the tip of the styloid process to the angle of the mandible • Temporomandibular ligament-runs from the lateral zygomatic process, anterior to the capsule, to the mandibular neck

  21. MUSCLES OF MASTICATION • Masseter-completely covers the ramus, arises from zygomatic arch and inserts to lateral ramus,deep to the external lobe of parotid gland. It is an elevator of the jaw • Temporalis-arises from the lateral aspect of the cranium, passes deep to the zygomatic arch, and converge onto the coronoid process

  22. MUSCLES CON’T • Temporalis-anterior and medial fascicles elevate the jaw;posterior fascicles retract the jaw • Lat. Pterygoid-superior head arises from the infratemporal surface of the sphenoid bone and inserts into the articular capsule and disc; the inferior head arises from the lateral pteryg. pl. and inserts into condylar process

  23. MUSCLES CON’T. • Action of Lat. Pteryg.-opens the jaw by pulling the condyle and the articular disc anteriorly. 1)Together, the rt. and lt. lateral pteryg. mm protrude the jaw. 2)Unilaterally, they swing the jaw to the opposite side and thus effect the grinding motion of mastication

  24. MEDIAL PTERYGOID • Deep part arises from the lateral pterygoid plate and the pyramidal process of the palatine bone. The smaller superficial part arises from the tubercle of the maxillla and inserts into the periosteum of the angle of the mandible. Is a strong elevator of the mandible

  25. DISC POSITION

  26. MOVEMENTS • Elevation/depression occurs in the inframeniscal compartment as the condyle rotates on the articular disc • Protrusion/retraction occurs in the suprameniscal compartment as the articular disc glides anteriorly and posteriorly along the temporal bone between the fossa and the articluar tubercle

  27. Anatomy Overview

  28. TEMPOROMANDIBULAR DISORDERS • A collective term used to describe a number of related conditions that involve the TMJ’s, masticatory muscles, and associated structures; these conditions may present with facial pain, joint noises, limited jaw function, and other symptoms-ear ache, headache, tinnitus, neck/shoulder pain

  29. HISTORICAL REVIEW • Costen syndrome 1934 • Temporomandibular joint pain dysfunction syndrome 1955 • Myofascial pain and dysfunction 1969 • Facial arthromyalgia 1974 • Temporomandibular disorders 1983 • Craniomandibular disorders 1993

  30. MOST COMMON TMDs • Myofascial pain and dysfunction • Internal derangement • Osteoarthrosis

  31. MYOFASCIAL PAIN AND DYSFUNCTION • Refers to a group of poorly defined muscle disorders (eg, fibromyalgia) characterized by diffuse facial pain and episodic limited jaw opening • May result from parafunctional habits and significant relationship to psychophysiologic disorders such as stress or depression

  32. INTERNAL DERANGEMENT • Abnormal relationship of the articular disc to the mandibular condyle, fossa,and articular eminence, interfering with the smooth action of the joint (Dolwick 1983) • Is a localized mechanical fault within the joint • Synonymous with disc displacement

  33. WILKES CLASSIFICATION • STAGE I: TMJ clicking/no pain/no radiographic DJD • STAGE II: +Jt sounds/pain with intermittent locking but no x-ray DJD • STAGE III: As II, but with x-ray DJD • STAGE IV:ADD without reduction/DJD • STAGE V: Disc perf./Advanced DJD

  34. OSTEOARTHROSIS • Is a nanpainful, localized degenerative joint disease that mainly affects bone and articular cartilage. • It is often idiopathic, but predisposing factors such as old age, repetitive trauma (bruxism), abnormal joint posturing, or multiple surgical procedures may be involved. If painful,then referred to as osteoarthritis

  35. DEGENERATIVE CHANGES IN CONDYLE

  36. EPIDEMIOLOGY • About 60-70% of the population have features of TMDs • About 20-30% report symptoms of TMDs • About 5% of people with TMD symptoms actually seek treatment • The female:male ranges from 3:1 to 9:1

  37. TMJ SURGERY • Indicated for a subset of temporomandibular disorders: 1.Internal derangment; 2.Degenerative joint disease; 3. Rheumatoid arthritis; 4. Infectious arthritis; 5.Mandibular dislocation; 6.Ankylosis; 7.Condylar hyper/hypoplasia

  38. CONTRALATERAL PAIN SUGGESTS ARTICULAR DISEASE

  39. INTERNAL DERANGEMENT

  40. SURGERIES OF THE JOINT • Arthrocentesis • Arthroscopy • Arthrotomy • Disc repositioning • Condylotomy • Partial and total joint replacement

  41. HOLMLUND-HELMSING LINE

  42. ARTHROSCOPY

  43. PREAURICULAR INCISION

  44. SUPERIOR JOINT SPACE

  45. SURGICAL EXPOSURE OF THE DISC

  46. DISC REPOSITIONING • Attempt tp relocate the disc so that it’s posterior band can be returned t the normal condyle-disc-fossa relationship • Accomplish by plication; full thickness excision or partial thickness excision

  47. EXPOSURE OF INFERIOR JOINT SPACE

  48. ANKYLOSIS

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