By Hassanien Riyadh

TEMPOROMANDIBUL
AR DISORDERS
 Functional Anatomy

Bony structures
•The temporal bone
-Articular (mandibular) fossa
-Articular eminence
•the mandibular condyles
 Articular disk

-It is ovale in shape.

-Its nonvascularized and
noninnervated (allow the disk to
resist pressure).
-Posteriorly, the disk blends with a
highly vascular, highly innervated
structure (retrodiskal tissue or
bilaminar zone).
 Ligaments

1-Capsular Ligament
2-Collateral (Diskal)
3-Lateral Temporomandibular
Ligament
4-Acc essory Ligaments
-Stylomandibular ligament
-Sphenomandibular Ligament
 Musculature

Msseter-
Medial pterygoid-
Lateral pterygoid -
Temporalis-
 Nerve supply

Sensory innervation of the

temporomandibular joint is derived
from the auriculotemporal and
masseteric branches of V3
Evaluation of TMJ
1. Chief complaint
2. Histoy of present illness HPI
3. Medical and dental history Hx.
4. Clinical examination:
palpation

Systematic evaluation of muscles of mastication. A, Palpation of masseter muscle. B, Palpation

of temporalis muscle. C, Palpation of lateral pterygoid muscle D, Palpation of Medial pterygoid
muscle
Evaluation of temporomandibular joint for tenderness and noise. Joint is palpated -
.laterally in closed position (A) and open position (B)
auscultation
 by stethoscop for joint sounds for
presence and timing of clicks and
crepitus and their correlation to jaw
movement
measurement of mandibular range of motion (40_55mm)
*evaluation of mandibular gait (lateral is 1:4 of opening)
5. Radiological findings

-OPG
Tomography

Temporomandibular joint tomogram displaying flattening

of the condylar head in degenerative joint disease.
CT: provide the most accurate radiographic-
assessment of the bony components of the joint
MRI-

C = condyle, D = disc, F = fossa, E = eminence

-Cone beam computerized tomography
(CBCT)
INTERNAL DERANGEMENTS OF THE TMJ

Anterior Disc displacement

 with reduction.
 with reduction with intermittent locking.
 without reduction with limited opening.
 without reduction without limited opening.
Temporomandibular Joint Arthritis
 osteoarthrities.
 rheumatoid arthritis.
 infection arthritis.
 traumatic arthritis.
Ankylosis

Ankylosis of the temporomandibular joint

(TMJ) most often results from trauma or
infection, but it may be congenital or a
result of rheumatoid arthritis. Chronic,
painless limitation of motion occurs.
When ankylosis leads to arrest of
condylar growth, facial asymmetry is
common
Treatment of the TMJ

 Nonpharmacologic Management
- Behavioral (soft diet, avoid chewing
gum)
Physical therapy
 Passive
 Acitve
Occlusal splint
Pharmacological
-analgesics(non opiate/opiod)
-anti-inflammatory (NSAI, steroids)
-muscle relaxants (centrally
acting/peripherally)
-anxiolytics (diazepam)
-antntidepressents (TCA/MAOIs)   
-Local anesthesia: for diagnosis to block
intraarticular or intramuscular/pain
relief/increase range of motion
the surgical tretment of the TMJ

 Minimally invasive (arthrocentesis,

arthroscopy)
Thank you for listening