The Temporomandibular joint of the facial skeleton.ppt

The Temporomandibular joint of the facial skeleton

1. TMJ disorders &itsTMJ disorders &its
managementmanagement
Dr.B.R.PrasadDr.B.R.Prasad
HOD & Vice PrincipalHOD & Vice Principal
Dept of OMFS Dept of OMFS
ABSMIDSABSMIDS

2. ClassificationClassification
1.Masticatory muscle disorders
Muscle Splinting
Masticatory Muscle spasm
Muscle Inflamation

3. 2.Disk Interference Disorders2.Disk Interference Disorders

Class-1 Interference(during max. Class-1 Interference(during max.
intercuspation)intercuspation)
Class-2 Interference(followingmax. Class-2 Interference(followingmax.
intercuspation)intercuspation)

Class-3 Interference(During normal Class-3 Interference(During normal
translatory cycle)translatory cycle)

Class-4 Interference(Joint hypermobility)Class-4 Interference(Joint hypermobility)
Class-5 Interference(Spontaneous Class-5 Interference(Spontaneous
Dislocation)Dislocation)

4. 3.Inflammatory Disorders of the 3.Inflammatory Disorders of the
JointJoint

Sinovitis and CapsulitisSinovitis and Capsulitis

RetrodiscitisRetrodiscitis

Inflammatory ArthritisInflammatory Arthritis

5. 4.Chronic Mandibular 4.Chronic Mandibular
HypomobilityHypomobility

Elevator Muscle ContractureElevator Muscle Contracture

Capsular FibrosisCapsular Fibrosis

AnkylosisAnkylosis

6. 5.Growth Disorders of the 5.Growth Disorders of the
JointJoint

Aberration of DevelopmentAberration of Development

Acquired Change in Joint StructureAcquired Change in Joint Structure

NeoplasiaNeoplasia

7. Subluxation v/s DislocationSubluxation v/s Dislocation

Incomplete Incomplete
displacement of the displacement of the
condylar head condylar head
anterior to the anterior to the
articular eminence; articular eminence;
usually self usually self
reducing. reducing.

Condyle is shiffted Condyle is shiffted
from the glenoid from the glenoid
fossa which fossa which requires requires
manual reduction.manual reduction.

8. Myofacial Pain Dysfunction Myofacial Pain Dysfunction
SyndromeSyndrome

ClickingClicking

CrepitusCrepitus

DeviationDeviation

LimitationLimitation

Pain –on opening -on closingPain –on opening -on closing

9. Transient TrismusTransient Trismus

LIMITED MOUTH OPENING COMMON LIMITED MOUTH OPENING COMMON
FOLLOWING TRAUMA AND POST OPERATIVE FOLLOWING TRAUMA AND POST OPERATIVE
PERIOD IN THE MANDIBULAR /MASTICATORY PERIOD IN THE MANDIBULAR /MASTICATORY
MUSCLE REGION MUSCLE REGION

10. Deviation and rotation of the Deviation and rotation of the
condylecondyle

Following mandibular resectionFollowing mandibular resection the the
condyle relationship to the fossa is condyle relationship to the fossa is
disturbed leading to muscle imbalance disturbed leading to muscle imbalance
and strain on ligaments associated with and strain on ligaments associated with
the TMJ. the TMJ.

11. Internal DerangementInternal Derangement

Disturbance in the normal anatomic Disturbance in the normal anatomic
relation of the condyle and the disc that relation of the condyle and the disc that
interferes with smooth movement of interferes with smooth movement of
the joint and causes momentary the joint and causes momentary
catching, clicking, popping or lockingcatching, clicking, popping or locking

12. Wilke’s Classification:Wilke’s Classification:

STG-1 – Early reducingSTG-1 – Early reducing

STG-2 – Late reducingSTG-2 – Late reducing

STG-3 –Non reducing acute/subacuteSTG-3 –Non reducing acute/subacute

STG-4 - Non reducing chronicSTG-4 - Non reducing chronic

STG-5 - Non reducing chronic with STG-5 - Non reducing chronic with
osteoarthrosisosteoarthrosis

13. Treatment
Medical Non-surgical Surgical

14. MedicalMedical

Patient Counselling and MotivationPatient Counselling and Motivation

BiofeedbackBiofeedback

DrugsDrugs

15. Non-SurgicalNon-Surgical

Non-invasive- Exercises, Physical Non-invasive- Exercises, Physical
Therapy, Electric nerve stimulation, heat Therapy, Electric nerve stimulation, heat
therapy, UStherapy, US

Splints to reposition the condyle and Splints to reposition the condyle and
recapture the disc recapture the disc

Occlusal rehabilitationOcclusal rehabilitation

16. Surgical ProceduresSurgical Procedures

ARTHROCENTESIS AND LAVAGEARTHROCENTESIS AND LAVAGE

ARTHROSCOPYARTHROSCOPY

ARTHROTOMY AND DISK REPAIR (a)Plication (b)Bilamellar Flap ARTHROTOMY AND DISK REPAIR (a)Plication (b)Bilamellar Flap
repairrepair

ARTHROTOMY WITH DISKECTOMYARTHROTOMY WITH DISKECTOMY

ARTHROTOMY WITH DISKECTOMY AND AUTOLOGUS GRAFT ARTHROTOMY WITH DISKECTOMY AND AUTOLOGUS GRAFT
DISC REPLACEMENTDISC REPLACEMENT

ARTHROTOMY WITH DISKECTOMY AND AUTOLOGUS FLAP ARTHROTOMY WITH DISKECTOMY AND AUTOLOGUS FLAP
RECONSTRUCTIONRECONSTRUCTION

ARTHROTOMY WITH DISKECTOMY AND ALLOPLASTIC DISK ARTHROTOMY WITH DISKECTOMY AND ALLOPLASTIC DISK
REPLACEMENTREPLACEMENT

CONDYLOTOMYCONDYLOTOMY

EMINECTOMYEMINECTOMY

CONDYLECTOMY (a) Gap Arthropalasty (b) Interpositional CONDYLECTOMY (a) Gap Arthropalasty (b) Interpositional
ArthroplastyArthroplasty

17. Arthrocentesis & LavageArthrocentesis & Lavage

18. Surgical approaches to the Surgical approaches to the
TMJTMJ

19. Entering the CapsuleEntering the Capsule

20. DiscoplastyDiscoplasty

21. Releasing the disc and closureReleasing the disc and closure

22. Gap & Interpositional Gap & Interpositional
ArthroplastyArthroplasty

23. Condylar repositioningCondylar repositioning

24. Arthrotomy and disk repairArthrotomy and disk repair

25. EminectomyEminectomy

26. Discectomy & Autologous Disc Discectomy & Autologous Disc
RepairRepair

27. Graft in placeGraft in place

28. High condylectomy and High condylectomy and
CondyloplastyCondyloplasty

29. Alloplastic ImplantsAlloplastic Implants

30. Occlusal repositional SplintOcclusal repositional Splint

31. Arthroscopic view of TMJArthroscopic view of TMJ
Normal v/s Pathologic Normal v/s Pathologic

32. TMJ ArthroscopeTMJ Arthroscope

33. Procedure to release Procedure to release
adhesionsadhesions

34. Disc PlicationDisc Plication

36. TMJ AnkylosisTMJ Ankylosis

37. Costochondral Autologous Costochondral Autologous
graftgraft

38. Graft in place & post op Graft in place & post op
openingopening

39. Alloplastic ImplantsAlloplastic Implants

40. Conchal cartilage for disc Conchal cartilage for disc
replacementreplacement

41. Pre op mouth opening in Ankylosis
Some clinical cases

42. Post operative view
A Smiling Patient

43. Pre op
Post op

44. Pre op view

45. Post op

46. Radiographic view of
Ankylosis

47. CT Scan

50. Intra operative view

51. Interpositional Arthroplasty

52. Closure
Mouth opening intra op

53. Thank youThank you