TEMPOROMANDIBULAR TEMPOROMANDIBULAR DISORDERSDISORDERS

PRESENTED BY:PRESENTED BY:

Dr. MADAANDr. MADAAN

ANATOMY OF TMJANATOMY OF TMJ Definition: It is a synovial joint of bicondylar Definition: It is a synovial joint of bicondylar

variety. variety. (CRANIOMANDIBULAR (CRANIOMANDIBULAR ARTICULATION)ARTICULATION)

Also called the Also called the GINGLYMODIARTHRODIAL GINGLYMODIARTHRODIAL JOINTJOINT..

Articular surfaces : Articular surfaces :

2 articular surfaces

upper lower

Roof: 2 parts of temporal bone

Articular eminence

Anterior part of mandibular fossa

Roof: inferior surface of disc

Floor: Articulating surface of the

mandibular condyle

Floor: superior surface of disc

ARTICULAR DISCARTICULAR DISC

It is an oval fibrous plate that divides It is an oval fibrous plate that divides the joint into an upper & lower the joint into an upper & lower compartment.compartment.

Also referred to as FIBROCARTILAGEAlso referred to as FIBROCARTILAGEConcavo-convex superior surface and Concavo-convex superior surface and

a concave inferior surface.a concave inferior surface.

LIGAMENTS

FIBROUS CAPSULE:Attachedabove to

the articulareminence & the

squamotympanic fissure below to

the neck of the condyle.

LATERAL LIGAMENT:

(temporomandibular ligament)Fibers are directed

backwards and downwards.

Attached above to the articular

tubercle & below to

the posterolateral aspect of the

neck of the mandible.

SPHENOMANDIBULAR

LIGAMENT:Attached to supine of Sphenoid &inferior to

the lingula of the mandible

STYLOMANDIBULAR

LIGAMENT:Attached above

to the Lateral surface

Of the styloid process& below to the

angle & posterior border

of ramus of

the mandible

BLOOD SUPPLYBLOOD SUPPLY

NERVE SUPPLYNERVE SUPPLY

MOVEMENTS:MOVEMENTS:

PROTRACTION OF MANDIBLE:PROTRACTION OF MANDIBLE:

The articular disc glides forwards The articular disc glides forwards over the upper articular surface, the over the upper articular surface, the head of the mandible moving with it.head of the mandible moving with it.

RETRACTION OF MANDIBLERETRACTION OF MANDIBLE : :

Reversal of protractionReversal of protraction

SLIGHT OPENING OF THE MOUTHSLIGHT OPENING OF THE MOUTH::

The head of the mandible moves on The head of the mandible moves on the undersurface of the disc like a the undersurface of the disc like a hinge.hinge.

WIDE OPENING OF THE MOUTHWIDE OPENING OF THE MOUTH : :

Hinge like movement followed by Hinge like movement followed by gliding of the disc & head of gliding of the disc & head of mandible.mandible.

LATERAL MOVEMENTSLATERAL MOVEMENTS::

Head of one side glides forwards Head of one side glides forwards along with disc but head of the along with disc but head of the opposite side merely rotates on opposite side merely rotates on vertical axis.vertical axis.

BORDER MOVEMENTSBORDER MOVEMENTS Maximum movement of mandible relative to Maximum movement of mandible relative to

a single point on mandible during all a single point on mandible during all possible extreme movementspossible extreme movements

CONTACT MOVEMENTSCONTACT MOVEMENTS Produced during gliding when maxillary & Produced during gliding when maxillary &

mandibular teeth are in contact with each mandibular teeth are in contact with each otherother

FREE MOVEMENTSFREE MOVEMENTS In this teeth do not come into contact with In this teeth do not come into contact with

each othereach other

PROTRUSION PROTRUSION Forward movement Forward movement

of mandibleof mandible Muscles involved:- Muscles involved:-

1. Lateral 1. Lateral pterygoidpterygoid

2. medial 2. medial pterygoidpterygoid

Muscle Muscle involvement is involvement is bilateralbilateral

RETRACTIONRETRACTION

Backward Backward movement of movement of mandiblemandible

Muscles involved:- Muscles involved:-

1. Temporalis 1. Temporalis (post. fibres) (post. fibres) 2. Digastric 2. Digastric (post. belly)(post. belly)

Bilateral Bilateral involvementinvolvement

DEPRESSIONDEPRESSION

Downward movement Downward movement of mandible of mandible

Causes opening of Causes opening of mouthmouth

Muscles involved:-Muscles involved:-

1.Lateral pterygoid 1.Lateral pterygoid

2.Digastric(ant.belly)2.Digastric(ant.belly)

3.Geniohyoid 3.Geniohyoid

4.Mylohyoid 4.Mylohyoid Muscle involvement Muscle involvement

is bilateralis bilateral

ELEVATIONELEVATION Upward movement Upward movement

of mandibleof mandible Causes closing of Causes closing of

mouthmouth Muscles involved:- Muscles involved:- 1. Masseter1. Masseter 2. Temporalis2. Temporalis 3. Medial pterygoid3. Medial pterygoid During this closure During this closure

movement, head is movement, head is retracted before retracted before elevationelevation

TEMPORALIS

LATERALPTERYGOID

MASSETERMEDIAL PTERYGOID

MYLOHYOID

DIGASTRICGENIOHYOID

ELEVATION

RETRACTION

PROTRUSION

DEPRESSION

TMJ DISORDERSTMJ DISORDERS

ETIOLOGYETIOLOGY :Some factors proposed are: :Some factors proposed are:1.1. Parafunctional habitsParafunctional habits2.2. Emotional distressEmotional distress3.3. Acute trauma from blows or impartsAcute trauma from blows or imparts4.4. Trauma from hyperextensionTrauma from hyperextension5.5. Instability of maxillomandibular Instability of maxillomandibular

relationshipsrelationships6.6. Laxity of the jointsLaxity of the joints7.7. Comorbidity of other rheumatic or Comorbidity of other rheumatic or

musculoskeletal disorders.musculoskeletal disorders.8.8. Poor general health and unhealthy Poor general health and unhealthy

lifestyle.lifestyle.

DIAGNOSTIC CLASSIFICATION DIAGNOSTIC CLASSIFICATION

Diagnostic category Diagnostic category

Cranial bones Cranial bones (including the (including the mandible ) mandible )

Diagnosis Diagnosis

Congenital and Congenital and developmentaldevelopmental disordersdisorders: aplasia, : aplasia, hyperplasia, hyperplasia, hypoplasia,and hypoplasia,and dysplasiadysplasia

Acquired disordersAcquired disorders : :(neoplasia, fracture)(neoplasia, fracture)

DIAGNOSTIC CLASSIFICATIONDIAGNOSTIC CLASSIFICATIONDiagnostic category Diagnostic category

Temporomandibular Temporomandibular joint disordersjoint disorders

Diagnosis Diagnosis Deviation in formDeviation in formDisk displacementDisk displacement with with reduction , without reduction , without reduction)reduction)DislocationDislocation Inflammatory Inflammatory conditionsconditions (synovitis,capsulitis)(synovitis,capsulitis)Arthritides Arthritides (osteoartheritis, (osteoartheritis, osteoarthrosis)osteoarthrosis) Ankylosis &Ankylosis & NeoplasiaNeoplasia

DIAGNOSTIC CLASSIFICATIONDIAGNOSTIC CLASSIFICATIONDiagnostic category Diagnostic category

Masticatory muscle Masticatory muscle disorderdisorder

Diagnosis Diagnosis

Myofacial painMyofacial painMyostitisMyostitisSpasmSpasmProtective splintingProtective splintingContractureContracture

ASSESSMENTASSESSMENT

Diagnostic assessment can be done using Diagnostic assessment can be done using the following aids:the following aids:

1.1. HistoryHistory2.2. Physical examinationPhysical examination3.3. Range of mandibular movementRange of mandibular movement4.4. Palpation of masticatory movementsPalpation of masticatory movements5.5. Palpation of cervical musclesPalpation of cervical muscles6.6. Palpation of TMJPalpation of TMJ7.7. Assessment of parafuntional habitsAssessment of parafuntional habits

8. Diagnostic imaging8. Diagnostic imaging

9. Diagnostic LA nerve blocks9. Diagnostic LA nerve blocks

MYOFASCIAL PAIN OF MYOFASCIAL PAIN OF MASTICATORY MUSCLESMASTICATORY MUSCLES

Also called,Also called, Masticatory myalgesia syndromeMasticatory myalgesia syndrome TMJ pain dysfunction syndromeTMJ pain dysfunction syndromeEtiology:Etiology: Masticatory muscle spasmMasticatory muscle spasm Muscle spasm is because of :Muscle spasm is because of :

- Muscular Overextension - Muscular Overextension - Muscular Over contraction- Muscular Over contraction - Muscle Fatigue- Muscle Fatigue

Chronic oral habits e.g. : grinding or clenching Chronic oral habits e.g. : grinding or clenching of teethof teeth

Clinical featuresClinical features

Age : usually below 40 yearsAge : usually below 40 years Sex : females more than malesSex : females more than males Cardinal signs and symptoms :Cardinal signs and symptoms :

1.1. PainPain

2.2. Muscle tendernessMuscle tenderness

3.3. Clicking noise in TMJClicking noise in TMJ

4.4. Limitation of jaw motion with Limitation of jaw motion with deviation on deviation on

openingopening

TRIGGER POINT THERAPYTRIGGER POINT THERAPY

It has used two modalities :It has used two modalities :

The cooling of skin over the involved The cooling of skin over the involved muscle and stretchingmuscle and stretching

The direct injection of LA into the The direct injection of LA into the muscle.muscle.

INTRACAPSULAR DISORDERS :INTRACAPSULAR DISORDERS :ARTICULAR DISK DISORDERARTICULAR DISK DISORDER

DEFINATION :DEFINATION :Articular disk Articular disk displacement (ADD) is an abnormal displacement (ADD) is an abnormal relationship between the :relationship between the :

-the disk-the disk -the mandibular condyle-the mandibular condyle -and articular eminence, -and articular eminence, resulting from the stretching or tearing resulting from the stretching or tearing

of the attachment of the disk of the of the attachment of the disk of the condyle and the glenoid fossa.condyle and the glenoid fossa.

ETIOLOGYETIOLOGY

Trauma Trauma Bruxism Bruxism

Clinical featuresClinical features

ADD is divided into stages on the ADD is divided into stages on the basis of signs and symptoms basis of signs and symptoms combined with the results of combined with the results of imaging studies :imaging studies :

1.1. Anterior disk displacement with Anterior disk displacement with reductionreduction

2.2. ADD with intermittent lockingADD with intermittent locking

3.3. ADD without reduction (closed lock)ADD without reduction (closed lock)

ADD WITH REDUCTION ADD WITH REDUCTION ((CLICKING JOINT)CLICKING JOINT)

Due to loosening of articular disk Due to loosening of articular disk because of : because of :

Elongation or tearing of restraining Elongation or tearing of restraining ligaments & has moved from its normal ligaments & has moved from its normal position on the top of the condyle.position on the top of the condyle.

Chief complaintChief complaint : :

Pain during mandibular movement. Pain is Pain during mandibular movement. Pain is most noticeable at the time of a click. most noticeable at the time of a click.

ADD WITHOUT REDUCTION ADD WITHOUT REDUCTION ((CLOSED LOCK)CLOSED LOCK)

Detected more frequently in patients Detected more frequently in patients with clicking joints that progress to with clicking joints that progress to intermittent brief locking and then intermittent brief locking and then permanent locking.permanent locking.

The limited mandibular opening The limited mandibular opening occurs when disk interferes with the occurs when disk interferes with the normal translation of the condyle normal translation of the condyle along the glenoid fossa.along the glenoid fossa.

Limited lateral movementLimited lateral movementPain Pain

POSTERIOR DISK POSTERIOR DISK DISPLACEMENTDISPLACEMENT

Described as the condyle slipping over the Described as the condyle slipping over the anterior rim of the disk during opening with anterior rim of the disk during opening with the disk being caught and brought back ward the disk being caught and brought back ward in an abnormal relation to the condyle when in an abnormal relation to the condyle when the mouth is closed.the mouth is closed.

c/f : 1. sudden inability to bring the upper c/f : 1. sudden inability to bring the upper and lower teeth together in maximal and lower teeth together in maximal occlusion,occlusion,

2. Pain 2. Pain 3. Displacement forward of the mandible on the 3. Displacement forward of the mandible on the

affected side.affected side.4. Restricted lateral movements on affected side4. Restricted lateral movements on affected side5. No restriction of mouth opening5. No restriction of mouth opening

MANAGEMENTMANAGEMENT

Recommended treatments for symptomatic Recommended treatments for symptomatic ADD include ADD include

- splint therapy- splint therapy -Manual manipulation & other forms of -Manual manipulation & other forms of

physical physical therapytherapy

-Anti-inflammatory drugs-Anti-inflammatory drugs -Arthrocentesis -Arthrocentesis -Arthroscopic lysis & lavage-Arthroscopic lysis & lavage -Arthroplasty -Arthroplasty -Vertical ramus osteotomy-Vertical ramus osteotomy

ADD WITH REDUCTION ADD WITH REDUCTION ((CLICKING JOINT)CLICKING JOINT)

Flat plane stabilization splintsFlat plane stabilization splints

Anterior repositioning splintAnterior repositioning splint

ADD WITHOUT REDUCTION ADD WITHOUT REDUCTION ((CLOSED LOCK)CLOSED LOCK)

Nonsurgical and surgicalNonsurgical and surgical Nonsurgical Nonsurgical :: 1.1. Manual manipulationManual manipulation2.2. Exercise programExercise program3.3. Flat plane occlusal stabalization Flat plane occlusal stabalization

applianceappliance4.4. Anti-inflammatory drugsAnti-inflammatory drugs Surgical Surgical ::1.1. Arthrocentesis Arthrocentesis 2.2. ArthroscopyArthroscopy

DEGENERATIVE JOINT DISEAES DEGENERATIVE JOINT DISEAES ((OSTEOARTHRITIS)OSTEOARTHRITIS)

It is primarily a disorder of articular It is primarily a disorder of articular cartilage and subchondral bone, with cartilage and subchondral bone, with secondary inflammation of the synovial secondary inflammation of the synovial membrane. membrane.

CLINICAL FEATURESCLINICAL FEATURES Incidence increases with ageIncidence increases with age Inflammation and joint effusionsInflammation and joint effusionsClicking, snapping or unilateral pain over Clicking, snapping or unilateral pain over

the condyle occursthe condyle occursCrepitusCrepitusLimitation of openingLimitation of openingDestruction of disc may also occur.Destruction of disc may also occur.

Narrowing of the joint space, Narrowing of the joint space, irregular joint space, irregular joint space, flattening of the articular surfaces,flattening of the articular surfaces,osteophytic formation, osteophytic formation, anterior lipping of the condyle,anterior lipping of the condyle,and the presence of Ely’s cysts. and the presence of Ely’s cysts.

RADIOGRAPHIC FEATURESRADIOGRAPHIC FEATURES

Conservative therapy includes Conservative therapy includes Nonsteroidal anti-inflammatory Nonsteroidal anti-inflammatory

medications;medications;Heat ; Heat ; soft diet;soft diet; rest ; and occlusal splintsrest ; and occlusal splints treat myofascial pain or meniscal treat myofascial pain or meniscal

defects.defects. Intra-articular steroids Intra-articular steroids

TreatmentTreatment

Synovial ChondromatosisSynovial ChondromatosisCHONDROMETAPLASIACHONDROMETAPLASIA

Synovial chondromatosis (SC) is an Synovial chondromatosis (SC) is an uncommon benign disorder characterized uncommon benign disorder characterized by the presence of multiple cartilagenous by the presence of multiple cartilagenous nodules of the synovial membrane that nodules of the synovial membrane that break, off resulting in clusters of free-break, off resulting in clusters of free-floating loose calcified bodies in the joint. It floating loose calcified bodies in the joint. It is theorized that SC originates from is theorized that SC originates from embryonic mesenchymal remnants of the embryonic mesenchymal remnants of the subintimal layer of the synovium that subintimal layer of the synovium that become metaplastic, calcify, and break off become metaplastic, calcify, and break off into the joint space into the joint space

Slow progressive swelling in the Slow progressive swelling in the pretragus region,pretragus region,

Pain , and limitation of mandibular Pain , and limitation of mandibular movement movement

TMJ clicking, locking, crepitus, and TMJ clicking, locking, crepitus, and occlusal changesocclusal changes

Intracranial extension may lead to Intracranial extension may lead to neurologic deficits such as facial neurologic deficits such as facial nerve paralysis. nerve paralysis.

CLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS

TREATMENTTREATMENT

Treatment should be conservative Treatment should be conservative and consist of removal of the mass of and consist of removal of the mass of loose bodies.loose bodies.

This may be done arthroscopically This may be done arthroscopically when only a small lesion is present, when only a small lesion is present, but arthrotomy is required for larger but arthrotomy is required for larger lesions. lesions.

Rheumatoid ArthritisRheumatoid Arthritis

The disease process starts as a The disease process starts as a vasculitis of the synovial membrane. vasculitis of the synovial membrane. It progresses to chronic inflammation It progresses to chronic inflammation marked by an intense round cell marked by an intense round cell infiltrate and subsequent formation infiltrate and subsequent formation of granulation tissue. The cellular of granulation tissue. The cellular infiltrate spreads from the articular infiltrate spreads from the articular surfaces eventually to cause an surfaces eventually to cause an erosion of the underlying bone.erosion of the underlying bone.

CLINICAL CLINICAL MANIFESTATIONSMANIFESTATIONS

The TMJs are usually bilaterally involved in RA. The TMJs are usually bilaterally involved in RA. limitation of mandibular opening and joint pain. limitation of mandibular opening and joint pain. Pain is usually associated with the early acutePain is usually associated with the early acute

phases of the disease but is not a common phases of the disease but is not a common complaint in later stages. complaint in later stages.

Other symptoms often noted include Other symptoms often noted include morning stiffness, joint sounds, and tenderness morning stiffness, joint sounds, and tenderness

and swelling over the joint area. and swelling over the joint area.

TREATMENTTREATMENT Flat plane occlusal applianceFlat plane occlusal appliance may be helpful, may be helpful,

particularly ifparticularly if parafunctional habits are exacerbating the symptoms. parafunctional habits are exacerbating the symptoms.

An exercise program to increase mandibular movement An exercise program to increase mandibular movement should be instituted as soon as possible after the acute should be instituted as soon as possible after the acute symptoms subside. When patients have severe symptoms subside. When patients have severe symptoms, the use of intra-articular steroids should be symptoms, the use of intra-articular steroids should be considered. considered.

Surgical treatmentSurgical treatment of the joints including placement of of the joints including placement of

prosthetic joints, is indicated in patients who have prosthetic joints, is indicated in patients who have severesevere

functional impairment or intractable pain not functional impairment or intractable pain not successfullysuccessfully

managed by other means.managed by other means.

Psoriatic ArthritisPsoriatic Arthritis

Psoriatic arthritis (PA) is an erosive Psoriatic arthritis (PA) is an erosive polyarthritis occurring in patients polyarthritis occurring in patients with a negative rheumatoid factor with a negative rheumatoid factor who have psoriatic skin lesions.251 who have psoriatic skin lesions.251 The skin lesions precede the joint The skin lesions precede the joint involvement by several years. involvement by several years.

CLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS

The symptoms of PA of the TMJ are The symptoms of PA of the TMJ are similar to those noted in RA similar to those noted in RA

Radiographic findings:Radiographic findings:show erosion of the condyle and show erosion of the condyle and

glenoid fossae rather than glenoid fossae rather than proliferation. proliferation.

TreatmentTreatment

physical therapy and NSAIDS physical therapy and NSAIDS Immunosuppressive drugs,Immunosuppressive drugs, Only when there is intractable TMJ Only when there is intractable TMJ

pain or disabling limitation of pain or disabling limitation of mandibular movement is mandibular movement is surgerysurgery indicated.indicated.

Arthroplasty or condylectomy with Arthroplasty or condylectomy with placement of costochondral grafts has placement of costochondral grafts has been performed successfully. been performed successfully.

Septic ArthritisSeptic Arthritis

Septic arthritis of the TMJ most commonly Septic arthritis of the TMJ most commonly occurs in patients with previously existing occurs in patients with previously existing joint disease such as rheumatoid arthritis, or joint disease such as rheumatoid arthritis, or underlying medical disorders (particularly underlying medical disorders (particularly diabetes).diabetes).

Patients receiving immunosuppressive drugs Patients receiving immunosuppressive drugs or long term corticosteroids also have an or long term corticosteroids also have an increased incidence of septic arthritis.increased incidence of septic arthritis.

Gonococci are the primary blood borne Gonococci are the primary blood borne agents causing septic arthritis in a previously agents causing septic arthritis in a previously normal TMJ while normal TMJ while Staphylococcus aureus Staphylococcus aureus is the is the most common organism involved in previously most common organism involved in previously arthritic joints arthritic joints

CLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS Trismus Trismus Deviation of the mandible to the affected side, Deviation of the mandible to the affected side, Severe pain on movement,Severe pain on movement, An inability to occlude the teeth, owingAn inability to occlude the teeth, owing to the presence of inflammation in the joint space.to the presence of inflammation in the joint space. Examination reveals redness and swelling in the region Examination reveals redness and swelling in the region

ofof the involved joint. the involved joint. The swelling may be fluctuantThe swelling may be fluctuant and extend beyond the region of the joint.and extend beyond the region of the joint. Large tender cervical lymph nodes are frequently Large tender cervical lymph nodes are frequently

observed on theobserved on the side of the infection;side of the infection;TREATMENTTREATMENTTreatment of septic arthritis of the TMJ consists of surgicalTreatment of septic arthritis of the TMJ consists of surgicaldrainage, joint irrigation, and 4 to 6 weeks of antibiotics.drainage, joint irrigation, and 4 to 6 weeks of antibiotics.

DEVELOPMENTAL DISTURBANCES DEVELOPMENTAL DISTURBANCES IncludeInclude

a) aplasia of mandibular condylea) aplasia of mandibular condyle

b) hypoplasia of mandibular condyleb) hypoplasia of mandibular condyle

c) hyperplasia of mand condylec) hyperplasia of mand condyle

APLASIAAPLASIAMandibular condyle fails to developMandibular condyle fails to developUnilateral or bilateral diseaseUnilateral or bilateral disease

Clinical featuresClinical featuresDefective or absent external earDefective or absent external earUnderdeveloped mand ramus or Underdeveloped mand ramus or

macrostomiamacrostomia In unilateral aplasia In unilateral aplasia

-Facial asymmetry occurs-Facial asymmetry occurs

-Both occlusion & mastication -Both occlusion & mastication alteredaltered

-Mand. shift towards affected -Mand. shift towards affected sideside

In bilateral cases mand. shift is not In bilateral cases mand. shift is not present present

TREATMENTTREATMENT

OsteoplastyOsteoplastyMalocclusion corrected by Malocclusion corrected by

orthodontic appliancesorthodontic appliancesCosmetic surgery( for facial Cosmetic surgery( for facial

deformity) deformity)

HYPOPLASIAHYPOPLASIA

Underdeveloped or defective Underdeveloped or defective formation of condyleformation of condyle

It may be congenital or acquiredIt may be congenital or acquired

CLINICAL FEATURES:-CLINICAL FEATURES:-Facial asymmetry in unilateral cases Facial asymmetry in unilateral cases In mild disturbance there is slight In mild disturbance there is slight

mandibular shifting from midlinemandibular shifting from midline

TREATMENTTREATMENT

Cartilage or bone transplants Cartilage or bone transplants preceded by osteotomypreceded by osteotomy

HYPERPLASIAHYPERPLASIAUnilateral enlargement of condyle.Unilateral enlargement of condyle.

ETIOLOGYETIOLOGYMild chronic inflammation Mild chronic inflammation

CLINICAL FEATURESCLINICAL FEATURESUnilateral slowly Unilateral slowly

progressive progressive elongation of face.elongation of face.

Deviation of chin Deviation of chin away from affected away from affected side.side.

Severe Severe Malocclusion occursMalocclusion occurs

TREATMENTTREATMENTResection of condyleResection of condyle

TRAUMATIC DISTURBANCES TRAUMATIC DISTURBANCES Include Include a)a) Luxation & Luxation &

subluxationsubluxationb)b) AnkylosisAnkylosisc) Fractures of condylec) Fractures of condyle

LUXATION & LUXATION & SUBLUXATIONSUBLUXATION

Dislocation occurs Dislocation occurs when head of condyle when head of condyle moves anteriorly into moves anteriorly into such a position that it such a position that it cannot be returned cannot be returned voluntarily to its voluntarily to its normal position.normal position.

ETIOLOGYETIOLOGY Traumatic injuryTraumatic injury Yawning or opening the Yawning or opening the

mouth too widelymouth too widely

CLINICAL FEATURESCLINICAL FEATURES Sudden locking & Sudden locking &

immobilization of jaws immobilization of jaws when mouth is opened.when mouth is opened.

Mouth cannot be closedMouth cannot be closed

TREATMENTTREATMENT Relaxation of musclesRelaxation of muscles Moving the mandible to its position by exerting Moving the mandible to its position by exerting

inferior & post. pressure of thumbs in inferior & post. pressure of thumbs in mandibular molar areas.mandibular molar areas.

FRACTURES OF FRACTURES OF CONDYLECONDYLE

ETIOLOGYETIOLOGY Traumatic injuryTraumatic injury

CLINICAL FEATURESCLINICAL FEATURES Limitation of motionLimitation of motion Pain & swelling over Pain & swelling over

involved condyleinvolved condyle

TREATMENTTREATMENT

ANKYLOSISANKYLOSISHypomobilityHypomobilityETIOLOGYETIOLOGYTraumatic injuryTraumatic injury Infections in & about the jointsInfections in & about the joints

CLINICAL FEATURESCLINICAL FEATURESPatients may not able to open the mouth Patients may not able to open the mouth

to appreciable extent.to appreciable extent.Facial deformity occursFacial deformity occurs

TREATMENTTREATMENTSurgical Surgical OsteotomyOsteotomy

NEOPLASTIC DISTURBANCESNEOPLASTIC DISTURBANCES Neoplasms or tumor like growths benign or Neoplasms or tumor like growths benign or

malignant may involved TMJ.malignant may involved TMJ. Some tumors may originate from condyle or Some tumors may originate from condyle or

from joint capsule.from joint capsule. Metastatic tumors have also been reported to Metastatic tumors have also been reported to

involve TMJ.involve TMJ.

EXTRAARTICULAR DISTURBANCESEXTRAARTICULAR DISTURBANCES Sinusitis & middle ear disease often caused Sinusitis & middle ear disease often caused

pain in joint.pain in joint. Other conditions like cellulitis, odontalgia, Other conditions like cellulitis, odontalgia,

neuritis of trigeminal n. also causes pain in neuritis of trigeminal n. also causes pain in joint.joint.