GOOD AFTERNOON

A VEIW ON TEMPOROMANDIBULAR

JOINT

GUIDED BY:DR. R. N. PODDAR,HOD, ORAL & MAXILLOFACIAL SURGERY,DR. R. AHMED DENTAL COLLEGE & HOSPITAL, KOLKATA

DR. MANIMAY BANERJEE,ASSOCIATE PROFESSOR, DEPT. OF ORAL & MAXILLOFACIAL SURGERY,RADCH,KOLKATA

WHAT IS TEMPOROMANDIBULAR JOINT ?

• IT IS THE AREA WHERE THE MANDIBLE ARTICULATES WITH THE CRANIUM.

• IT IS DESCRIBED AS A COMPLEX, MULTIAXIAL, SYNOVIAL, BICONDYLAR AND GINGLIMOARTHROIDAL JOINT.

• TMJ IS ALSO KNOWN AS CRANIO MANDIBULAR JOINT/ ARTICULATION.

WHY SHALL WE KNOW TMJ ?

PATIENTS FREQUENTLY CONSULT A DENTIST BECAUSE OF PAIN AND DYSFUNCTION IN TEMPORO MANDIBULAR REGION.

TMDs(TEMPOROMANDIBULAR DISORDERS) INCLUDE MYOFACIAL PAIN , INTERNAL DEARRANGEMENT, INFLAMMATION, DILOCATION, ANKYLOSIS, NEOPLASIA ETC.

NOTHING IS MORE FUNDAMENTAL TO TREATING PATIENTS THAN KNOWING THE ANATOMY.

SO TO TREAT THE TMDs WE SHOULD KNOW WELL THE ANATOMY AND PHYSIOLOGY OF THE WHOLE ARTICULATORY SYSTEM OF TEMPOROMANDIBULAR REGION.

TEMPOROMANDIBULAR

ARTICULATORY SYSTEM

MASTICATORY &

ACCESSORY MUSCLES

TEMPORO MANDIBULA

R JOINT

OCCLUSION OF TEETH

TEMPOROMANDIBULAR JOINT

CRANIAL COMPONENT

MANDIBULAR COMPONENT

TMJ CAPSULE

LIGAMENTS

ARTICULAR DISC

CRANIAL COMPONENT

• IT IS ALSO KNOWN AS MANDIBULAR/GLENOID FOSSA.

• LIMITS: ANTERIORLY ARTICULAR EMINENCE, POSTERIORLY POST GLENOID TUBERCLE.

MANDIBULAR COMPONENT

• THE ARTICULAR PART OF THE MANDIBLE IS AN OVOID CONDYLAR PROCESS.

• SHAPE: NORMALLY OVOID. MAY BE FLAT, ROUND AND ANGULAR.

• POLES: MEDIAL AND LATERAL. • MEDIAL IS MORE PROMINENT.

• DIAMETER: MESIOLATERAL- 13 TO 25 MM ANTERO POSTERIOR- 5.5 TO 16 MM

TMJ CAPSULE

IT IS A THIN SLEEVE FIBROUS TISSUE INVESTING JOINT COMPLETELY.

FUNNEL SHAPED

INSIDE FIBROUS TISSUE CAPSULE, A SILKY SYNOVIAL MEMBRANE IS THERE.

LIGAMENTS

TRUE FALSE

• COLLATERAL SPHENO MANDIBULAR

• CAPSULAR STYLOMANDIBULAR

• TEMPOROMANDIBULAR

ARTICULAR DISCIT IS AN INTERVENING DISC WHICH DIVIDES THE ARTICULAR SPACE INTO TWO COMPARTMENTS. 1. INFERIOR/ CONDYLODISCAL COMPARTMENT. 2. SUPERIOR OR CONDYLODISCAL COMPARTMENT.

ANTERIORLY IT IS ATTACHED WITH ARTICULAR EMINENCE.POSTERIORLY IT IS DIVIDED INTO TWO LAMINA.1. SUPERIOR RETRODISCAL LAMINA2. INFERIOR RETRODISCAL LAMINAWITHIN THESE LAMINA THERE IS RETRODISCAL

TISSUE SPACE.PARTS OF MENISCUS: ANTERIOR , INTERMEDIATE

AND POSTERIOR ZONE.

LUBRICATION MECHANISMTHE LUBRICATION MECHANISM OF TMJ IS CONTROLLED BY THE SYNOVIAL FLUID, PRESENT IN THE JOINT CAVITY.TWO TYPES OF LUBRICATION IS SEEN MAINLY.

• OCCURS WHEN THE JOINT IS MOVED NORMALLY.

• PREVENTS FRICTION

BOUNDARY LUBRICATIO

N• OCCURS DURING FORCES ARE CREATED

BETWEEN THE ARTICULAR SURFACES• ELIMINATE FRICTION IN THE

COMPRESSED BUT NOT MOVING JOINT

WEEPING LUBRICATIO

N

NEURO VASCULAR SUPPLYBLOOD SUPPLY: SUPERFICIAL TEMPORAL ARTERY FROM POSTERIORMIDDLE MENINGEAL ARTERY FROM ANTERIOR INTERNAL MAXILLARY ARTERY FROM INFERIOROTHER IMPORTANT ARTERIES ARE- DEEP AURICULAR,

ANTERIOR TYMPANIC AND ASCENDING PHARYNGEAL.CONDYLE GETS A LITTLE BIT FROM INFERIOR ALVEOLAR.

NERVE SUPPLY:FOR ANTERIOR ASPECTS. MANDIBULAR NERVE AFTER

INNERVATING THE JAW JOINT GIVES 3 BRANCHES-1. AURICULOTEMPORAL FOR POSTERIOR,

MEDIAL AND LATERAL ASPECTS.2. MASSETERIC AND3. A BRANCH FROM POSTERIOR DEEP TEMPORAL NERVE

MOVEMENTS

MOVEMENTS OF CONDYLE AT THE JOINT SPACE

• ROTATION

• TRANSLATION

MOVEMENTS OF MANDIBLE PROPER

• SAGITTAL PLANE BORDER AND FUNCTIONAL

• HORIZOTAL PLANE BORDER AND FUNCTIONAL

• VERTICAL PLANE BORDER AND FUNTIONAL

MOVEMENTS

SAGITTAL PLANE BORDER AND FUNTIONAL MOVEMENTS

FOUR DISTINCT MOVEMENTS COMPNENTS BELONG TO THIS GROUP.

1. POSTERIIOR OPENING BORDER2. ANTERIOR OPENING BORDER3. SUPERIOR CONTACT BORDER4. FUNCTIONAL

HORIZONTAL PLANE BORDER AND FUNCTIONAL MOVEMENTS

IN THE HORIZONTAL PLANE, A RHOMBOID SHAPED PATTERN IS SEEN THAT HAS FOUR DISTINCT MOVEMENT COMPONENTS WITH A FUNCTIONAL COMPONENT.1. LEFT LATERAL BORDER2. COTINUED LEFT LATERAL BORDER

WITH PROTRUTION.3. RIGHT LATERAL BORDER4. CONTINUED RIGHT LATERAL BORDER

WITH PROTRUSION.

VERTICAL BORDER AND FUNTIONAL MOVEMENTS

WHEN MANDIBULAR MOTION IS VIEWED IN THE FRONTAL PLANE, A SHIELD SHAPED PATTERN CAN BE SEEN; THE COMPONENTS OF IT ARE:1. LEFT LATERAL SUPERIOR BORDER2. LEFT LATERAL OPENING BORDER3. RIGHT LATERAL SUPERIOR BORDER4. RIGHT LATERAL OPENING BORDER

EXAMINATION THE EVALUATION OF A PATIENT WITH PROBLEM IN

TEMPOROMANDIBULAR REGION INCLUDE THOROUGH HISTORY, PHYSICAL EXAMINATION OF MASTICATORY SYSTEM AND PROBLEM FOCUSSED TMJ RADIOGRAPHY.

GENERAL EXAMINATION OF TMJ MAINLY GO THROUGH THE PALPATION AND AUSCULTATION METHOD .

• SYSTEMIC EVALUATION OF MASTICATORY MUSCLE.

• EVALUATION OF TMJ FOR TENDERNESS• MEASUREMENT OF RANGE OF JAW MOTION.

PALPATION:

AUSCULTATION: IN SOME TMDs, JOINT NOISE IS HEARD WHICH CAN BE EASILY DETECTED DURING PALPATION OR WITH THE HELP OF STETHOSCOPE.MOST COMMON JOINT SOUNDS ARE:1. CLICKING 2. CREPITUS

SYSTEMIC EVALUATION OF MUSCLES OF MASTICATION

1. PALPATION OF MASSETER

2. PALPATION OF TEMPORALIS

3. PALPATION OF TEMPORALIS TENDON

EVALUATION OF TMJ

A. CLOSED MOUTH POSITION

B. OPEN MOUTH POSITION

MEASUREMENT OF RANGE OF JAW MOTION

A. MAXIMUM VOLUNTARY VERTICAL OPENING (NORMALLY UP TO 45 MM)

B. EVALUATION OF LATERAL EXTRUSIVE MOVEMENT (10 MM APPROX)

DIAGNOSTIC AIDS USED TO EVALUATE TMJ

PANOROMIC RADIOGRAPHY

TOMOGRAMS

TEMPOROMANDIBULAR ARTHROGRAPHY

COMPUTED TOMOGRAPHY

MAGNETIC RESONANCE IMAGING

MRI CT

TOMOGRAM PANOROGRAPH

CONCLUSIONNature has blessed us with a marvelously dynamic masticatory system , allowing us to function and therefore exist.Articulatory system is an important part of the masticatory system of our body.So as a dental care provider to treat the patients of TMDs before knowing the pathology, this is essential to know the normal anatomy and physiology of TMJ.

THANK YOU…

SPECIAL THANKS TO:DR. NUPUR BANERJEE, DEPT. OF ORAL &MAXILLOFACIAL SURGERY,R.A.D.C.H.,KOLDR. DEBOBRATA MONDAL,DEPT. OF ORAL &MAXILLOFACIAL SURGERY,R.A.D.C.H., KOLMR. ARINDAM MONDALALL OF MY TEACHERS, SENIORS, JUNIORS AND BATCHMATES.