The Temporo-mandibular Joint (TMJ) PDF

The Temporo-mandibular Joint (TMJ) Oral and Dental Sciences 2 GDC Learning Outcomes 1.1.5 Describe relevant and appropriate dental, oral, craniofacial and general anatomy and explain their applica8on to pa8ent management 3 Intended learni...

The Temporo-mandibular Joint (TMJ) Oral and Dental Sciences 2 GDC Learning Outcomes 1.1.5 Describe relevant and appropriate dental, oral, craniofacial and general anatomy and explain their applica8on to pa8ent management 3 Intended learning outcomes By the end of this session, you will be able to:  At the end of this session, you will be able to  List the components of the TMJ and describe their func8on  Describe the movement of the mandible  List some common problems associated with the TMJ 4  The temporomandibular joint (TMJ) is the joint that connects your mandible (lower jaw) to your skull. The joint can be found on both sides of your head in front of your ears. It allows your jaw to open and close, enabling you to speak and eat. 5 6 The temporomandibular joint  Ar8cula8on between the mandibular condyle & the inferior surface of the temporal bone.  There is bilateral ar8cula8on, both right & leG sides work as a unit.  It is the only visible and free moving ar8cula8on in the head, all others are sutures and Hxed.  Complex, co-ordinated jaw movements are controlled by reKexes  It plays an essen8al role in speech and mas8ca8on. 7 Bony landmarks of the TMJ  Mandibular (glenoid) fossa  Ar8cular eminence of the temporal bone  Mandibular condyle 8 Bones of the TMJ-mandibular (glenoid) fossa  Depression in temporal bone of skull in which mandible sits  Covered with layer of car8lage which allows smooth movement  Dense cor8cal bony surface of temporal bone, but thin at roof  Posterior to ar8cular eminence 9 Bones of the TMJ-arKcular eminence of the temporal bone  Front (anterior) of fossa  Gentle slope of bone  Covered with car8lage  Condyle moves forward over eminence of bone on wide mouth opening, side to side movement or jaw protrusion – transla8on. 10 Bones of the TMJ- mandibular condyle  Dense cor8cal bone covered with dense Hbrous connec8ve 8ssue with irregular car8lage like cells  This layer of car8lage allows for smooth mo8on within joint 11 12 Other components of the TMJ  Ar8cular capsule  Synovial 8ssue  Ar8cular disc  Ligaments 13 ArKcular Capsule  The capsule is a Hbrous membrane that surrounds the joint and aQaches to the arKcular eminence, the ar8cular disc and the neck of the mandibular condyle. 14 Synovial Kssue  is connec8ve Kssue that lines the inside of the joint capsule. 15 ArKcular disc  This is a Hbrous extension of the capsule that runs between the two arKcular surfaces of the temporomandibular joint.  It is biconcave in shape with the condyle siRng in the depression of the disc.  The disc ar8culates with the mandibular fossa of the temporal bone above and the condyle of the mandible below. 16 17 Ligaments  The ligaments give passive stability to the TMJ.  The temporomandibular ligament is the thickened lateral por8on of the capsule, and it has two parts, an outer oblique por8on and an inner horizontal por8on.  The stylomandibular ligament runs from the styloid process to the angle of the mandible.  The sphenomandibular ligament runs from spine of the sphenoid bone to the lingula of the mandible. 18 19 FuncKons of ligaments  Accessory ligaments may limit border movements of the mandible  Fibrous capsule and TMJ ligaments may limit extreme lateral movements in wide opening of mandible 20 Movement of the mandible 21 Movement of the mandible  The mandible moves in a variety of ways:  Depression and eleva8on (up and down)  Lateral devia8on (side to side)  Protrusion and retrusion (backwards and forwards) 22 23 Movements of the mandible  Ini8ally on opening, the condyle rotates within the glenoid fossa  For rota8onal movement:  Horizontal axis of rota8on (hinge axis)  Frontal (ver8cal) axis of rota8on  SagiQal axis of rota8on 24 Horizontal axis of rotaKon 25 Frontal axis of SagiRal axis of rotaKon rotaKon 26 27 The TMJ during opening 28 29  Temporomandibular Joint (TMJ) Anatomy and Disc Displacement AnimaKon - YouTube 30 Disorders of the TMJ  Today, researchers generally agree that temporomandibular disorders fall into three main categories:  Myofascial pain, the most common form of TMD, which is discomfort or pain in the muscles that control jaw func8on and the neck and shoulder muscles. Internal derangement of the joint, meaning a dislocated jaw or displaced disc, or injury to the condyle DegeneraKve joint disease, such as osteoarthri8s or rheumatoid arthri8s in the jaw joint  A person may have one or more of these condi8ons at the same 8me. 31 Symptoms of TMJ disorders  Headaches (oGen mimicking  Jaws that "get stuck," lock or go out migraines), earaches, and pain and pressure behind the eyes  Tenderness of the jaw muscles Jaws that "get stuck," lock or go out  A clicking or popping soundTenderness when you of the jaw muscles  A sudden change in the way the upper A sudden change in the way the upper and lower teeth fit together open or close your mouth Limited opening -and trismus lower teeth Ht together  Pain brought on by yawning, opening  Limited opening - trismus the mouth widely or chewing 32 Treatment for TMJ disorders  Exercises  SoG diet  Heat  GDP/ oral surgeon - biteguard/splint Jaws that "get stuck," lock or go out Tenderness of the jaw muscles  Medica8on – Apain relief, sudden muscle change  A sudden change in the way in the way the upper and lower teeth fit together the upper relaxants Limited opening -and trismus lower teeth Ht together  Botox  Surgery - arthroscopy & arthrocentesis - joint surgery - joint replacement 33 34 Dislocated Jaw 1. Pain in the face or jaw, located in front of the ear or on the a[ected side, that gets worse with movement. 2. Bite that feels "o[" or crooked. 3. Problems talking. 4. Inability to close the mouth. 5. Drooling because of inability to close the mouth. 6. Locked jaw or jaw that protrudes forward. 35 36 37 X-Ray showing a Bilateral DislocaKon of the Mandible. NoKce how open the paKent’s mouth is. 38 Jaw RelocaKon  AGer wrapping their Hngers with gauze, doctors or den8sts place their thumbs inside the mouth on the lower back teeth.  They place their other Hngers around the boQom of the lower jaw.  They press down on the back teeth and push the chin up un8l the jaw joints return to their normal loca8on. 39 40  Reducing the Dislocated Jaw - YouTube 41 Trismus  Trismus occurs when a person is unable to open their mouth more than 35 millimeters (mm).  It can occur as a result of trauma to the jaw, oral surgery, infec8on, cancer, or radia8on treatment for cancers of the head and throat.  OGen occurs aGer a long dental appointment or ID block local analgesia.  It can be permanent or temporary. 42 43 44 Treatment  Stretching exercises  SoG diet  Time…especially if temporary. 45 Trismus  (PDF) Management of trismus following radiaKon therapy by cost-e]ecKve a pproach (researchgate.net)  Trismus | HSTalks 46 Useful links  Temporomandibular joint & muscles of masKcaKon – YouTube  hRps://youtu.be/SCS4MiHJ5Xw  Temporomandibular Joint (TMJ) Anatomy (3D Anatomy Tutorial) – YouTube  Temporomandibular Joint (TMJ) Anatomy and Disc Displacement AnimaKon – You Tube  Temporomandibular joint & muscles of masKcaKon – YouTube  Home - Mr Luke Cascarini 47 The End!