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TEMPOROMANDIBULAR JOINT ANATOMY PATHOPHYSIOLOGY SURGERY
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JOINTS- WHAT ARE THEY? Osseous elements which are multiple that are joined by a variety of structural elements. These co-aptations are grouped as arthroses
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ARTHROSES Concerned with differential growth, transmission of forces and with movement FORCES Tensile,compres sive,shear and torsion
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TYPES OF ARTHROSES-2 1.SYNARTHROSES: which are solid non-synovial joints. Can be fibrous or cartilaginous. Fibrous denotes intramembranous ossification Cartilaginous denotes endochondral ossification
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TYPES OF ARTHROSES-2 2. DIARTHROSES: which are cavitated synovial joints Characterized by having articular surfaces covered by cartilage(hyaline or fibrocartilage) with its lubricated smooth wear resistant surface which glides over its fellow with minimal friction
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SYNARTHROSES-TYPES Sutures,synostoses Gomphoses (peg and socket) Synchondroses (manubriosternalis)
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DIARTHROSES-TYPES Can be simple(one pair of articulating, surfaces), compound(more than one pair of surfaces), or complex(with intracapsular meniscus or disc) Surface shape:plane, spheroid(ball and socket), ellipsoid, ginglymus, bicondylar,trochoid(pivot) and sellar(saddle-shaped)
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THE TMJ Are the only synovial joints with an articular disc
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TMJ Classification Anatomic Classification: Diarthrodial – two joints (joint spaces) a joint that contains the following characteristics a freely movable joint bony surfaces are covered with hyaline or fibrocartilage lined by a synovial lining and contains synovial fluid
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TMJ Classification Functional classification: Ginglymo - arthroidial Ginglymoid: rotation - inferior joint space Arthroidial: translation - superior joint space
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TMJ Classification The mandible functions as a class III lever system Load - occlusal surface Fulcrum - TMJ Force - muscles of mastication
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Anatomy Overview Temporomandibular joint… - the articulation of the mandibular condylar process with the glenoid fossa/articular eminence aspect of the temporal bone. Also includes the interposed articular disc and collateral ligamentous attachments. -is an encapsulated, synovial joint. -classified as a ginglymo-arthroidal joint due to its ability to function as a hinge as well as a gliding type of joint. -functions as a Class III lever system.
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QUESTION: ANATOMY What are the six (6) components of the temporomandibular joint articulation?
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Condyles Articular surface of the temporal bone Capsule Articular disc Ligaments Lateral pterygoid
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Osseous components
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TOMOGRAPHC SCAN OF JOINT
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SOFT TISSUE COMPONENTS Muscles and ligaments Disk Posterior disk attachment Joint capsule Synovia
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DISC POSITION
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Anatomy Overview
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TEMPOROMANDIBULAR DISORDERS A collective term used to describe a number of related conditions that involve the TMJ’s, masticatory muscles, and associated structures; these conditions may present with facial pain, joint noises, limited jaw function, and other symptoms-ear ache, headache, tinnitus, neck/shoulder pain
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HISTORICAL REVIEW Costen syndrome 1934 Temporomandibular joint pain dysfunction syndrome 1955 Myofascial pain and dysfunction 1969 Facial arthromyalgia 1974 Temporomandibular disorders 1983 Craniomandibular disorders 1993
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MOST COMMON TMDs Myofascial pain and dysfunction Internal derangement Osteoarthrosis
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MYOFASCIAL PAIN AND DYSFUNCTION Refers to a group of poorly defined muscle disorders (eg, fibromyalgia) characterized by diffuse facial pain and episodic limited jaw opening May result from parafunctional habits and significant relationship to psychophysiologic disorders such as stress or depression
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INTERNAL DERANGEMENT Abnormal relationship of the articular disc to the mandibular condyle, fossa,and articular eminence, interfering with the smooth action of the joint (Dolwick 1983) Is a localized mechanical fault within the joint Synonymous with disc displacement
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WILKES CLASSIFICATION STAGE I: TMJ clicking/no pain/no radiographic DJD STAGE II: +Jt sounds/pain with intermittent locking but no x-ray DJD STAGE III: As II, but with x-ray DJD STAGE IV:ADD without reduction/DJD STAGE V: Disc perf./Advanced DJD
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OSTEOARTHROSIS Is a nanpainful, localized degenerative joint disease that mainly affects bone and articular cartilage. It is often idiopathic, but predisposing factors such as old age, repetitive trauma (bruxism), abnormal joint posturing, or multiple surgical procedures may be involved. If painful,then referred to as osteoarthritis
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DEGENERATIVE CHANGES IN CONDYLE
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EPIDEMIOLOGY About 60-70% of the population have features of TMDs About 20-30% report symptoms of TMDs About 5% of people with TMD symptoms actually seek treatment The female:male ranges from 3:1 to 9:1
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TMJ SURGERY Indicated for a subset of temporomandibular disorders: 1.Internal derangment; 2.Degenerative joint disease; 3. Rheumatoid arthritis; 4. Infectious arthritis; 5.Mandibular dislocation; 6.Ankylosis; 7.Condylar hyper/hypoplasia
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CONTRALATERAL PAIN SUGGESTS ARTICULAR DISEASE
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INTERNAL DERANGEMENT
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SURGERIES OF THE JOINT Discectomy Disc repositioning Condylotomy Arthrocentesis Arthroscopy Partial and total joint replacement
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HOLMLUND- HELMSING LINE
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ARTHROSCOPY
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ANKYLOSIS
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TOTAL JOINT REPLACEMENT
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PHYSICAL THERAPY
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