TEMPROMANDIBULAR

JOINT

TMJ: is a bilateral joint permits

the mandible to move as a unit
with two functional patterns:
Hinge (inferior portion)
Translation (superior portion)
(ginglymoarthroidal
joint) (compound joint)
it has four anatomical parts:
1- condyle
2- articular fossa
3- articular disc
4- articular capsule

The Synovial fluid:

Consist of small amounts of a clear, straw-colored viscus
fluid. It is an infiltrate of the blood diffused out from the
rich capillary network of the synovial membrane.
Function:
1- lubrication by two mechanisms: boundry lubrication
weeping lubrication
2- nutrition.
3- clear the tissue debris.

Ligaments :
1-collateral(discal)
2-capsular
3-tempromandibular
4-sphenomandibular
5-stylomandibular

Muscles of mastication:
1- masseter: superficial & deep
2- temporalis
3- medial pterygoid
4- lateral pterygoid: superior & inferior
- Digastric muscles is not a muscle of
mastication but it play an important role in
mandibular function.

Nerve supply: the mandibular division of the

trigeminal nerve.
Vascular supply:
superficial temporal artery--- post
middle meningeal artery--- ant
internal max.artery---- inf
deep auricular
Anterior tympanic
Ascending pharengeal arteries

Age changes of theTMJ:

1- Flattened condyle
2- osteoporosis of the condyle bone.
3- Thickning of the fibrous covering of the condyle.
4- Thinning of the cartilagenous zone of condyle.
5- Thinning of the disc
6- Fibrotic synovial folds
7- Thickening of the b.v. walls
8- Decrease the number of nerves

These age changes lead to:

-Decrease in the synovial fluid formation
-Impairment of motion due to decrease in
the disc and capsule extensibility
-Decrease the resilience during mastication
due to chondroid changes into
collagenous elements
-Dysfunction in older people

Disorders
of TMJ

Disorders of the TMJ:

1- limitation of movement:
- temporary
- permanent
2- dislocation
3- pain
4- hyperplasia
5- neoplasm

2-Dislocation: due to:

-blow on the jaw
-forceful extraction
-while yawning
-epileptic pt
recurrent dislocation is a typical feature of
ehler-danlos & marfans syndrome or
there may be no systemic disorder.

Types of displacement:
1-anterior disc displacement with reduction:
Joint noise, pain, clicking and full range of movements
2-acute anterior disc displacement without reduction:
Acute onset of limitation of opening with pain & deviation to
the affected side, history of clicking
3-chronic anterior disc displacement without reduction:
Limitation of opening for variable period,history of clicking

3-Pain in or around the joint: due to:

injury
infection & inflammation
vascular disease e.g: cranial arteritis
muscle spasm e.g: pain dysfunction syndrome
rheumatoid & other arthritis
salivary gland disease e.g: parotid neoplasm
ear disease e.g: otitis media, externa

4-Hyperplasia:
Is rare unilateral overgrowth of the condyle.
It causes: facial asymmetry, deviation of the jaw to
the unaffected side on opening and crossbite.
Treated by:
-If it is stabilized at the end of puberty --- corrective
osteotomies to restore occlusion & facial
asymmetry
-If it is still active --- intracapsular condylectomy

5-Neoplasms: (rare):
osteochondroma
osteoma
chondroma

Management:
Goals:
- decreased pain
- decreased loading
- restored function
- restored daily activities

Management options:
1-Pt.education & palliative home care:yawning
2-Behaviour modifications: habits
3-Drug therapy: e.g: NSAID, analgesics
4-Exercise therapy
5-Splint therapy
6-Occlusal therapy
7-mobilization
8-Physical agents: heat,cold,muscle relaxation
9-Other therapy: joint surgery, orthodontics.

Thank you