Temporomandibular Joint Disease

TEMPOROMANDIBULAR JOINT DISEASE

TEMPOROMANDIBULAR JOINT ANATOMY

CONDYLE

GLENOID FOSSA

DISC

CAPSULE

LIGAMENT

MASTICATORY MUSCLES  Temporalis

 Geniohyoid

 Masseter

 Mylohyoid

 Medial

 Digastric

pterygoid  Lateral pterygoid

Lateral pterygoid

masseter

FUNCTIONAL ANATOMY

JAW OPENING ANATOMY

CLASSIFICATION  The

American Academy of Craniomandibular Disorders 1980,1989,1990 I Muscular Disorders II Temporomandibular Joint Disorders (Arthrogenous disorders)

CLASSIFICATION II Temporomandibular Joint Disorders (Arthrogenous disorders) A.Internal derangement 1.Deviation in form a . Frictional discincoordination b . Articular surface defects c . Disc thinning and perforation

CLASSIFICATION 2. Disc displacement a . Partial (anteromedial) disc displacement b . (Antermedial) disc displacement with reduction (1) Partial displacement (2) Complete displacement

CLASSIFICATION 3. (Antneromedial) disc displacement with intermittent locking 4. (Antneromedial) disc displacement without reduction a . Acute b . Chronic

5. (Antneromedial) disc displacement with perforation of the retrodiscal tissue 6. Adhesive disc hypomobility 7. Displacement of the disc/condyle complex a . Subluxation b . Dislocation

CLASSIFICATION B. Arthritis of the TMJ 1. Noninflammatory arthritis (osteoarthrosis) 2. Inflammatory arthritis a . Rheumatoid arthritis b . Juvenile rheumatoid arthritis c . Psoriatic arthritis d . Ankylosing spondylitis e . Lupus erythematosus

3. Infections arthritis a . Direct extension b . Systemic infection

CLASSIFICATION C. Capsulitis/synovitis D. Retrodiscitis E. Fractures of the TMJ F. Ankylosis 1. Figrous 2. Bony

CLASSIFICATION G. Developmental disturbances of the TMJ 1. Condylar hyperplasia 2. Condylar hypoplasia 3. Condylar aplasia H.Neoplasia

CLASSIFICATION  In

China 1997  TMDs 1. Masticatory muscle disorders 2. Internal derangement 3. Inflammatory disorders of TMJ 4. Osteoarthrosis

TEMPOROMANDIBULAR JOINT DISORDERS

ETIOLOGY  Mental

and society  Occlusion  Sustained overload  Immune

DIAGNOSIS CLINICAL EXAMINATION 1. History Taking Pain and sound in TMJ, dysfunction of mouth opening and mastication. 2. Physical Examination  TMJ IMAGING 

DIAGNOSING TEMPOROMANDIBULAR DISORDERS 

Physical Examination 1. General body examination 2. Facial topography 3. Temporomandibular joint 4. Masticatory and cervical muscles 5. Oral tissues 6. Dentition

DIAGNOSING TEMPOROMANDIBULAR DISORDERS

Facial topography

DIAGNOSING TEMPOROMANDIBULAR DISORDERS

Temporomandibular joint palpation

DIAGNOSING TEMPOROMANDIBULAR DISORDERS

Palpation of masticatory muscles

DIAGNOSING TEMPOROMANDIBULAR DISORDERS

Palpation of masticatory muscles

DIAGNOSING TEMPOROMANDIBULAR DISORDERS

Dentition

DIAGNOSING TEMPOROMANDIBULAR DISORDERS

Moving function of the TMJ

DIAGNOSING TEMPOROMANDIBULAR DISORDERS  TMJ

Imaging 1. Plain film radiography 2. Tomography 3. Arthrography 4. Computed tomography ( CT ) 5. Magnetic resonance imaging ( MRI )

DIAGNOSING TEMPOROMANDIBULAR DISORDERS

A: closed mouth position

B: maximal mouth opening

Plain film radiography of Normal TMJ

DIAGNOSING TEMPOROMANDIBULAR DISORDERS

Plain film radiography :Osteoarthrosis

DIAGNOSING TEMPOROMANDIBULAR DISORDERS

Arthrography

DIAGNOSING TEMPOROMANDIBULAR DISORDERS

Joint space

DIAGNOSING TEMPOROMANDIBULAR DISORDERS

Arthrography: Perforation of disc

DIAGNOSING TEMPOROMANDIBULAR DISORDERS

Arthrography:Adhesion of TMJ

DIAGNOSING TEMPOROMANDIBULAR DISORDERS

MRI:Anterior disc displacement

DIAGNOSING TEMPOROMANDIBULAR DISORDERS

MRI:osteoarthrosis

DIAGNOSING TEMPOROMANDIBULAR DISORDERS

Arthroscopy of TMJ

DIAGNOSING TEMPOROMANDIBULAR DISORDERS

DIAGNOSING TEMPOROMANDIBULAR DISORDERS

DIAGNOSING TEMPOROMANDIBULAR DISORDERS

Arthroscopy of normal TMJ

DIAGNOSING TEMPOROMANDIBULAR DISORDERS

Arthroscopy of synovitis

DIAGNOSING TEMPOROMANDIBULAR DISORDERS

Pathology of disc displacement

DIAGNOSING TEMPOROMANDIBULAR DISORDERS

Pathology of osteoarthrosis

TREATMENT  Nonsurgical

treatment  Surgical treatment

TREATMENT OF TEMPOROMANDIBULAR JOINT DISORDERS 

Nonsurgical treatment 1. Occlusal appliance therapy 2. Physical therapy 3. Medicine 4. Injections

TREATMENT OF TEMPOROMANDIBULAR JOINT DISORDERS 

Occlusal appliance therapy 1. Full arch occlusal stabilization appliance (for masticatory muscle disorders, internal derangement with pain) 2. Mandibular anterior repositioning appliance (for internal derangement with clicking)

TREATMENT OF TEMPOROMANDIBULAR JOINT DISORDERS 

Physical therapy 1. Vapocoolant spray 2. Ice packs 3. Heating packs 4. Electrical stimulators 5. Ultrasound

TREATMENT OF TEMPOROMANDIBULAR JOINT DISORDERS 

Medicine (drug) 1. Nonsteroid anti-inflammatory drugs (aspirin, naproxen, ibuprofen, voltaren) 2. Anti-inflammatory drugs 3. Antalgic drugs (tramal) 4. Ataractic drugs (luminal) 5. Antidepressant 6. Muscle relaxant

TREATMENT OF TEMPOROMANDIBULAR JOINT DISORDERS  Injections 1. Anesthetic nerve and muscle blocking (procaine, lidocaine) 2. Intra-articular injection (corticosteroid, sodium hyaluronate)

Intra-articular injection

TREATMENT OF TEMPOROMANDIBULAR JOINT DISORDERS 

Surgical treatment 1. Arthroscopy 2. Arthroplasty

TREATMENT OF TEMPOROMANDIBULAR JOINT DISORDERS

arthroscopy

TREATMENT OF TEMPOROMANDIBULAR JOINT DISORDERS

arthroscopy

TREATMENT OF TEMPOROMANDIBULAR JOINT DISORDERS

TREATMENT OF TEMPOROMANDIBULAR JOINT DISORDERS 

Surgical incisions to the TMJ 1. Preauricular 2. Endaural 3. Postauricular

TREATMENT OF TEMPOROMANDIBULAR JOINT DISORDERS

Preauricular

Endaural

Postauricular

TREATMENT OF TEMPOROMANDIBULAR JOINT DISORDERS  Surgery

of TMDS

1.Disc Repositioning Procedure 2.Repair of the Perforation of the Disc 3.Discectomy

TREATMENT OF TEMPOROMANDIBULAR JOINT DISORDERS

Disc Repositioning Procedure

TREATMENT OF TEMPOROMANDIBULAR JOINT DISORDERS

Repair of the Perforation of the Disc

TREATMENT OF TEMPOROMANDIBULAR JOINT DISORDERS

Discectomy

DISLOCATION OF JAW

CLASSIFICATION  Characteristic:

acute; recurrent or chronic;

dated.  Orientation and location: forward; backward; upward; lateral.

DIAGNOSIS  CLINICAL

EXAMINATION 1. History Taking 2. Physical Examination  TMJ IMAGING 1. Plain film radiography 2. Computed tomography ( CT )

DIAGNOSIS OF MANDIBULAR DISLOCATION

Facial topography: anterior teeth open bite

DIAGNOSIS OF MANDIBULAR DISLOCATION

Dislocation of TMJ

TREATMENT  Nonsurgical

treatment  Surgical treatment

Reduction of Dislocation of the Jaw

Nonsurgical reduction

Reduction of Dislocation of the Jaw

Surgical reduction

Reduction of Dislocation of the Jaw

Facial and occlusion change between pre-operation and post-operation

TEMPOROMANDIBULAR JOINT ANKYLOSIS

ETIOLOGY  Trauma

of the TMJ, which is the most important etiologic factor, especial condylar fracture.  Septic arthritis of the TMJ, involving direct extension and systemic infection.  System disease, such as rheumatoid arthritis, Ankylosing spondylitis,and so on.

DIAGNOSIS  CLINICAL

EXAMINATION 1. History Taking 2. Physical Examination  TMJ Imaging 1. Plain film radiography 2. Tomography 3. Computed tomography ( CT )

DIAGNOSING TMJ ANKYLOSIS

DIAGNOSING TMJ ANKYLOSIS

DIAGNOSING TMJ ANKYLOSIS

Tomography

DIAGNOSING TMJ ANKYLOSIS

Computed tomography ( CT )

TREATMENT  Surgical

treatment is the mainly methods. 1. gap arthroplasty 2. interpositional arthroplasty 3. arthroreconstruction

TREATMENT OF TMJ ANKYLOSIS

Gap arthroplasty

TREATMENT OF TMJ ANKYLOSIS

interpositional arthroplasty

TREATMENT OF TMJ ANKYLOSIS

a arthroreconstruction r t h

TREATMENT OF TMJ ANKYLOSIS

Pre-operation

Post-operation one year