TMJ : TMJ TEMPORO MANDIBULAR JOINT
Slide 2 : MANDIBULAR CONDYLE LAT. PTERYGOID ARTICULAR FOSSA CONDYLE Articular eminence Articulating
disc
TMJ consists of : TMJ consists of The condyle is the portion of the mandible that articulates with the cranium around which movement occurs.
The articulating surface is quite convex antero - posteriorly.
Each condyle articulates with articular disc which is interposed between it and temporal bone condyle Articulating
disc Articular eminence Fossa
TEMPOROMANDIBULAR FOSSA : TEMPOROMANDIBULAR FOSSA The area where the condyle articulates with squamous portion of the temporal bone called temporomandibular fossa or glenoid fossa. 4 ARTICULAR
EMINENCE TEMPORAL FOSSA
ARTICULAR DISC : ARTICULAR DISC 3 Regions
Posterior
Anterior
Intermediate 5 ANTERIOR REGION POSTERIOR
REGION INTERMEDIATE
REGION BILAMINAR
ZONE
BLOOD SUPPLY : BLOOD SUPPLY Deep temporal artery
Maseteric artery
Superficial temporal artery 6
NERVE SUPPLY : NERVE SUPPLY Auriculotemporal nerve
Masseteric nerve 7
CLINICAL FEATURES OF TMJ ANKYLOSIS : CLINICAL FEATURES OF TMJ ANKYLOSIS
UNILATERAL ANKYLOSIS : UNILATERAL ANKYLOSIS 1: Facial assymetry
2: Deviation of mandible & chin to the affected side
3: Chin is receded with hypolplastic mandible on the affected side
4: Roundness & fullness of face on the affected side
5: Appearance of the flatness & elongation on the unaffected side
Slide 10 : ANTIGONIAL NOTCH ANKYLOSED MASS
Slide 11 : 6:The lower border of the mandible on the affected side has a concavity that ends in well defined anti-gonial notch
7: Some amount of oral opening may be possible. Inter incisal opening will vary depending on whether it is fibrous or bony ankylosis
8: Cross bite may be seen
9: unilateral posterior cross bite on the
ipsilateral side
10: Condylar movements are absent on
the affected site
BILATERAL ANKYLOSIS : BILATERAL ANKYLOSIS 1: Inability to open the mouth
2: Mandible is micrognathic.
patient develops typical bird face deformity with receding chin.
3: The neck chin angle may be reduced/ almost completely absent
4: Anti-gonial notch well defined bilaterally
Slide 13 : 5: Anterior open bite
6: carious teeth
7:poor periodontal health
8: multiple impacted teeth
9: Severe malocclusion
10: crowding
INVESTIGATIONS : INVESTIGATIONS
Slide 15 : 1 : OPG
2: LATERAL OBLIQUE VIEW
3: PA VIEW
4: CEPHELOMETRIC
5: LATERAL TRANSCRANIAL VIEW
Slide 16 : COMPUTED TOMOGRAPHY
Slide 17 : 3D CT SCAN
ANKYLOSIS : ANKYLOSIS MANAGEMENT
OF
AIMS & OBJECTIVES : AIMS & OBJECTIVES 1: Release of ankylosed mass & creation of gap to mobilize the joint
2: To reconstruct the joint & to restore the
vertical height of the mandible
3: To prevent recurrance
4: To restore normal facial growth pattern
5: To improve esthetics
SURGICAL APPROACHES : SURGICAL APPROACHES Pre auricular
modifications – Blairs
Thomas
Alkayat & bramleys
popwich”s modification of alkayat & bramleys
Post auricular
Endural
Submandibular
Retromandibular
Coronal
PRE AURICULAR BLAIR & IVY : PRE AURICULAR BLAIR & IVY
THOMA : THOMA ALKAYAT & BRAMLEYS
SUB MANDIBULAR : SUB MANDIBULAR RETRO MANDIBULAR
Slide 24 : 1: CONDYLECTOMY TREATMENT MODALITIES
Slide 25 : 3: INTERPOSITIONAL ARTHROPLASTY
Slide 26 :
Slide 27 :
Slide 28 :
INTERPOSITIONAL GRAFTS USED IN TMJ ANKYLOSIS : INTERPOSITIONAL GRAFTS USED IN TMJ ANKYLOSIS Autogenous
Meniscus e.g., disk repositioning
Muscle e.g., temporalis,
pterygo-masseteric sling
Fascia e.g., temporalis, fascia lata, dura
Skin e.g., dermis, full thickness
Cartilage e.g., ear, rib, sternum
Fat e.g., groin, buttocks
Combined e.g., muscle-fascia
Slide 30 : Allogeneic (cryopreserved, freeze-dried or lyophilized)
Cartilage
Dura
Alloplastic
Sialastic
Acrylic
Silicone
Xenograft (bovine)
Collagen
Cartilage
COMPLICATIONS : COMPLICATIONS 1: Damage to facial nerve
2: Damage to auriculotemporal nerve
3: Bleeding from maxillary artery
4: Damage to the middle ear
5: Rupture of glenoid fossa
6: Recurrance