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Ankylosis of temporomandibular joint: etiology, pathogenesis, classification, clinical features, diagnosis and treatment of ankylosis. Contracture of the mandible: etiology, classification, clinical features, differential diagnosis, treatment, prevention. Dislocations mandible: etiology, symptoms, diagnosis, treatment.
(TMJ), an essential joint of the face, required for speech andnutrition; a synovial joint formed by the mandibular fossa of the temporal bone and the head of the condyle of the mandible with an intervening articular disc. The joint surface is completely covered by a thick fibrous capsule that allows for range of movements.
Ankylosis (joint stiffness)
is the pathological fusion of parts of a joint resulting in restricted movement across the joint
Ankylosis of the Temporomandibular joint, an arthrogenic disorder of the TMJ, refers to restricted mandibular movements (hypomobility) with deviation to the affected side on opening of the mouth.
Affects all age group but more in the first decade of life (0 – 10 years)
There’s equal male and female distribution
Almost all cases are unilateral.
Extravasation of blood into the joint space
Calcificatiion and obliteration of the joint space
There’s destruction of the meniscus and flattening of the temporal fossa
thickening and flattening of the condylar head and a narrowing of the joint space.
Opposing surfaces then develop fibrous adhesions that inhibit normal movements and finally, may become ossified.
Inability to open the jaws
In unilateral ankylosis, the lower jaws shifts towards the affected side on opening of the mouth
In severe cases, there is complete immobilization
There may be Abnormal forward protrusion of the mandible as the excess tissues occupies the space
Others are related to the underlying cause of the ankylosis
Other bones and joints deformities
Facial growth distortion
Poor oral hygiene
Multiple carious and impacted teeth
Non surgical management
Aims and Objectives of surgery
To release ankylosed mass and creation of a gap to mobilize the joint
Creation of functional joint (improve patient’s oral hygiene, nutrition and good speech)
To reconstruct the joint and restore the vertical height of the ramus
To prevent re-occurrence
To restore normal facial growth pattern
To improve esthetic appearance of the face (cosmetic reason)
MATERIALS USED IN INTERPOSITIONAL ARTHROPLASTY
Advantages of this procedure (interpositional arthroplasty)
Non-Odontogenic- Peritonsillar abscess
Complications of Radiotherapy:
Complications of Chemotherapy:
Lock-jaw caused due to muscle rigidity.
Dislocation is a complete separation of the articular surfaces with fixation in an abnormal position.
Anterior dislocation of the condyle in which the normal anatomic relationships within the joint have been completely disrupted occurs with the condyle displaced and fixed anterior to the articular eminence.
To move the condyle back into the correct position, a doctor or dentist will pull the lower jaw downward and tip the chin upward to free the condyle .