Temporomandibular Joint

Disorder Part I
CHIPPY AHWIL

Dept of Otorhinolaryngology HNS

Hasan Sadikin General Hospital
Bandung - 2004

Introduction
Medical,

dental, & surgical concepts:

proper diagnosis
TMJ syndr, Constens syndr, or myofascial pain
dysfunction syndr no longer used

TMJ disorder acute or chronic pain

Physical & emotional components of pain

Anatomy Trigeminal Nerve

Sensory
Motor

(mandibular nerve)

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

Anatomy - TMJ
Articulation

of the mandible with the skull base

True synovial

hinging
gliding

Mandibular

fossa
Fibrocartilage (not hyaline cartilage)
Articular disc
Vascular superior lamina : A-V shunt
Discal ligaments (vascularized & innervated)
25

26

27

28

29

30

Mandibular Movements
Opening
Closing
Protrusion

& Retrusion
Lateral Excursions

31

32

Muscular Disorder
Myogenic

Organic

pain normal TMJ

Hemifacial hypertrophy, atrophy

True spasm (CNS)

Functional
Pain
Strains injury hyperfunction / overuse /
improper use

33

Muscular Disorder
Muscle

pain, patient could be:

Nocturnal/diurnal bruxism
Clinical evidence of the behavior (attrition)
No history or signs of masticatory strain

Fibromyalgia

Women
Musculoskeletal pain
No arthritis or myositis
34

Muscular Disorder
Dental

Occlusion

Malocclusion
Treatment protecting dentition &
periodontium from the effect of misuse
(bruxism)

35

TMJ Disorders
Internal
All

derangements:

abnormal process confines of joint capsule

Internal

derangements of the TMJ = other

joints
The same articular disease
Internal derangement = disc displacement

36

TMJ Disorders
DISC DISPLACEMENT
Disruption of ligamentous attachment of
the disc to the condyle & pull of the lateral
pterygoid muscle
Causes:

structural weakness
blunt facial trauma
mandibular hyperextension
systemic joint hypermobility
37

Disc Displacement with reduction

38

Disc Displacement without reduction

39

TMJ Disorders

estrogen receptor primate TMJ ligaments

female >>
generalized joint hypermobility

Vector

of displacement:

anteromedial (most common) due to lateral

pterygoid orientation

Degree

of displacement clinical
symptoms
Type of displacement
40

41

TMJ Disorders
Cause

of pain:

Mechanical

(stretch, compressed)
Chemical (NO released)
Types:

clinical progression of the stages in

chronic disc derangement
Best prognosis:
Non-painful

click, occurs early in the opening

motion
42

TMJ Disorders
DEGENGERATIVE JOINT DISEASE
Loss of articular tissues
Partial or total loss
Articular

fibrocartilage
Metaplastic or destructive changes in the disc &
its attachments
=

osteoarthritis
Still controversy ostearthritis prior to
osteoarthrosis OR otherwise
43

TMJ Disorders
CONGENITAL & DEVELOPMENTAL
INTERNAL DERANGEMENTS
Manifest as facial asymmetries & dental
malocclusions
Branchial arch syndr, hemifacial
microsomia, isolated condylar aplasia, etc

44

TMJ Disorders
ANKYLOSIS
Fibrous type
Due

Bony

to chronic inflammation or disuse

type

Partial

ossification of the joint complex

Complete fusion of the mandible to the
temporal bone

45

Complete Ankylosis

46

Partial Ankylosis

47

Imaging
Arthrography
Tomography
Videofluoroscopy
MRI

48

49

50

51

52

References

Donlon WC. Temporomandibular Joint Disorders in:

Bailey BJ. Head & Neck Surger-Otolaryngology vol 1. 2nd
ed.Lippincott-Raven. Philadelphia. 1998
Netter. Human Anatomy. Ciba-Geigy CD-Rom.
Perters RA, Gross SG. Clinical Management of
Temporomandibular Disorders and Orofacial Pain.
Quintessence Publishing Co, Inc. Chicago. 1995
Grays Anatomy, 1995
Crossman AR, Neary D. Neuroanatomy an illustrated
colour text. 2nd ed. Churchill-Livingstone. Edinburgh.
2000
53