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TEMPOROMANDIBULAR JOINT. ANATOMY PATHOPHYSIOLOGY SURGERY. 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. ARTHROSES. FORCES Tensile,compressive,shear and torsion.

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temporomandibular joint

TEMPOROMANDIBULAR JOINT

ANATOMY

PATHOPHYSIOLOGY

SURGERY

joints what are they
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
arthroses
ARTHROSES
  • FORCES
  • Tensile,compressive,shear and torsion
  • Concerned with differential growth, transmission of forces and with movement
types of arthroses 2
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
types of arthroses 21
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
synarthroses types
SYNARTHROSES-TYPES
  • Sutures,synostoses
  • Gomphoses (peg and socket)
  • Synchondroses (manubriosternalis)
diarthroses types
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)
the tmj

THE TMJ

Are the only synovial joints with an articular disc

tmj classification
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
tmj classification1
TMJ Classification
  • Functional classification:
    • Ginglymo - arthroidial
      • Ginglymoid: rotation - inferior joint space
      • Arthroidial: translation - superior joint space
tmj classification2
TMJ Classification
  • The mandible functions as a class III lever system
    • Load - occlusal surface
    • Fulcrum - TMJ
    • Force - muscles of mastication
slide12

Anatomy Overview

  • Temporomandibular joint…
  • -the articulation of the mandibular condylar process with the glenoid fossa/articular eminenceaspect 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.
question anatomy

QUESTION: ANATOMY

What are the six (6) components of the temporomandibular joint articulation?

slide14
Condyles
  • Articular surface of the temporal bone
  • Capsule
  • Articular disc
  • Ligaments
  • Lateral pterygoid
bony components
Bony components
  • Condyle of mandible
  • Articular tubercle of temporal bone
  • Mandibular fossa (glenoid)of temporal bone
soft tissue components
SOFT TISSUE COMPONENTS
  • Muscles and ligaments
  • Disk
  • Posterior disk attachment
  • Joint capsule
  • Synovia
ligamentous support
LIGAMENTOUS SUPPORT
  • Articular capsule-attached to temporal bone around the edges of the fossa and the articular tubercle and to neck of condyle
  • Sphenomandibular ligament-medial to the joint, runs from spine of the sphenoid bone to the lingula
ligamentous support con t
LIGAMENTOUS SUPPORT CON’T
  • Stylomandibular ligament-posterior to the joint, runs from the tip of the styloid process to the angle of the mandible
  • Temporomandibular ligament-runs from the lateral zygomatic process, anterior to the capsule, to the mandibular neck
muscles of mastication
MUSCLES OF MASTICATION
  • Masseter-completely covers the ramus, arises from zygomatic arch and inserts to lateral ramus,deep to the external lobe of parotid gland. It is an elevator of the jaw
  • Temporalis-arises from the lateral aspect of the cranium, passes deep to the zygomatic arch, and converge onto the coronoid process
muscles con t
MUSCLES CON’T
  • Temporalis-anterior and medial fascicles elevate the jaw;posterior fascicles retract the jaw
  • Lat. Pterygoid-superior head arises from the infratemporal surface of the sphenoid bone and inserts into the articular capsule and disc; the inferior head arises from the lateral pteryg. pl. and inserts into condylar process
muscles con t1
MUSCLES CON’T.
  • Action of Lat. Pteryg.-opens the jaw by pulling the condyle and the articular disc anteriorly. 1)Together, the rt. and lt. lateral pteryg. mm protrude the jaw. 2)Unilaterally, they swing the jaw to the opposite side and thus effect the grinding motion of mastication
medial pterygoid
MEDIAL PTERYGOID
  • Deep part arises from the lateral pterygoid plate and the pyramidal process of the palatine bone. The smaller superficial part arises from the tubercle of the maxillla and inserts into the periosteum of the angle of the mandible. Is a strong elevator of the mandible
movements
MOVEMENTS
  • Elevation/depression occurs in the inframeniscal compartment as the condyle rotates on the articular disc
  • Protrusion/retraction occurs in the suprameniscal compartment as the articular disc glides anteriorly and posteriorly along the temporal bone between the fossa and the articluar tubercle
temporomandibular disorders
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
historical review
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
most common tmds
MOST COMMON TMDs
  • Myofascial pain and dysfunction
  • Internal derangement
  • Osteoarthrosis
myofascial pain and dysfunction
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
internal derangement
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
wilkes classification
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
osteoarthrosis
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
epidemiology
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