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Tmj disorders; all what you want to know as a general dentist

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all what you need to know as a general dentist concerning TMJ

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Tmj disorders; all what you want to know as a general dentist

  1. 1. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary JMJ Disorders All What You Need To Know (A Lecture 4 GPs)
  2. 2. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Treatment Drug therapy Splint therapy Physiotherap y Occlusal adjustment Arthroscopy Arthrocentes is Disk plication Disk removal Condyle surgeries Eminectomy TMJDisorders Dislocation MPDs Arthritis Internal Derangement Examination History Clinical Ex Diagnostic Modalities Introduction Features Anatomy Blood Supply Nerve Supply Arrangement Physiology Occlusion & TMJ
  3. 3. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary INTRODUCTION
  4. 4. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary http://boxedge.org/body-measuring-yoga-anatomy
  5. 5. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  6. 6. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  7. 7. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Features of TMJ • Coordinated movements are complex • Teeth; shape and position affect the movements • Articulating surface of the TMJ is not formed of Hyaline cartilage but of a sturdy avascular fibrous layer • Only synovial joint in the human body with an articulating disc
  8. 8. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary TMJ • Synovial joint – the bones have a synovial cavity • Complex joint – Two or more articulation surfaces and an articular disc or meniscus • Diarthrosis – freely movable
  9. 9. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary ANATOMY
  10. 10. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary CRANIAL COMPONENT MANDIBULAR COMPONENT TMJ CAPSULE LIGAMENTS ARTICULAR DISC Muscles
  11. 11. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary GLENOID FOSSA LIMITS: • ANTERIORLY: ARTICULAR EMINENCE • POSTERIORLY: POST GLENOID TUBERCLE MANDIBULAR COMPONENT TMJ CAPSULE LIGAMENTS ARTICULAR DISC Muscles CRANIAL COMPONENT
  12. 12. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary GLENOID FOSSA LIMITS: • ANTERIORLY: ARTICULAR EMINENCE • POSTERIORLY: POST GLENOID TUBERCLE MANDIBULAR COMPONENT TMJ CAPSULE LIGAMENTS ARTICULAR DISC Muscles CRANIAL COMPONENT
  13. 13. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary http://dentallecnotes.blogspot.com/2012/03/note-on-pterygopalatine-fossa.html • LATERALY : LATERAL BORDER OF THE FOSSA • MEDIALY: ENTOGOLENOID PROCESS MANDIBULAR COMPONENT TMJ CAPSULE LIGAMENTS ARTICULAR DISC Muscles CRANIAL COMPONENT
  14. 14. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Mandibular condyle •SHAPE: OVOID, MAY BE FLAT, ROUND AND ANGULAR. •POLES: MEDIAL AND LATERAL. •MEDIAL IS MORE PROMINENT. CRANIAL COMPONENT MANDIBULAR COMPONENT TMJ CAPSULE LIGAMENTS ARTICULAR DISC Muscles Lateral view
  15. 15. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Mandibular condyle •SHAPE: OVOID, MAY BE FLAT, ROUND AND ANGULAR. •POLES: MEDIAL AND LATERAL. •MEDIAL IS MORE PROMINENT. CRANIAL COMPONENT MANDIBULAR COMPONENT TMJ CAPSULE LIGAMENTS ARTICULAR DISC Muscles Lateral view
  16. 16. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Mandibular condyle • OVOID, MAY BE FLAT, ROUND AND ANGULAR • POLES: MEDIAL AND LATERAL • MEDIAL IS MORE PROMINENT Anterior view Posterior view CRANIAL COMPONENT MANDIBULAR COMPONENT TMJ CAPSULE LIGAMENTS ARTICULAR DISC Muscles
  17. 17. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Mandibular condyle • OVOID, MAY BE FLAT, ROUND AND ANGULAR • POLES: MEDIAL AND LATERAL • MEDIAL IS MORE PROMINENT Anterior view Posterior view CRANIAL COMPONENT MANDIBULAR COMPONENT TMJ CAPSULE LIGAMENTS ARTICULAR DISC Muscles
  18. 18. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary http://pocketdentistry.com/1-functional-anatomy-and-biomechanics-of-the- masticatory-system/ http://www.doereport.com/generateexhibit.php?ID=1983 CRANIAL COMPONENT MANDIBULAR COMPONENT TMJ CAPSULE LIGAMENTS ARTICULAR DISC Muscles • IT IS A THIN FUNNEL SHAPED, SLEEVE FIBROUS TISSUE INVESTING JOINT COMPLETELY • INSIDE FIBROUS TISSUE CAPSULE, A SILKY SYNOVIAL MEMBRANE IS THERE
  19. 19. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary http://pocketdentistry.com/1-functional-anatomy-and-biomechanics-of-the-masticatory-system/ • IT IS A THIN FUNNEL SHAPED, SLEEVE FIBROUS TISSUE INVESTING JOINT COMPLETELY • INSIDE FIBROUS TISSUE CAPSULE, A SILKY SYNOVIAL MEMBRANE IS THERE CRANIAL COMPONENT MANDIBULAR COMPONENT TMJ CAPSULE LIGAMENTS ARTICULAR DISC Muscles
  20. 20. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary http://pocketdentistry.com/1-functional-anatomy-and-biomechanics-of- the-masticatory-system/Collateral ligaments CRANIAL COMPONENT MANDIBULAR COMPONENT TMJ CAPSULE LIGAMENTS ARTICULAR DISC Muscles Attach the disc sides to the capsule
  21. 21. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary CRANIAL COMPONENT MANDIBULAR COMPONENT TMJ CAPSULE ARTICULAR DISC LIGAMENTS Muscles MENISCUS: Divide the joint into 2 compartments Superior compartment (large) – TRANSLATION MOVEMENT Inferior Compartment (small) – ROTATION MOVEMENT
  22. 22. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary CRANIAL COMPONENT MANDIBULAR COMPONENT TMJ CAPSULE ARTICULAR DISC LIGAMENTS Muscles PARTS OF MENISCUS: ANTERIOR , INTERMEDIATE AND POSTERIOR ZONE
  23. 23. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary  ANTERIORLY  ATTACHED WITH ARTICULAR EMINENCE  ATTACHED TO THE LATERAL PTERYGOID MUSCLE  POSTERIORLY IT IS DIVIDED INTO TWO LAMINA • SUPERIOR RETRODISCAL LAMINA • INFERIOR RETRODISCAL LAMINA WITHIN THESE LAMINA THERE IS RETRODISCAL TISSUE SPACE CRANIAL COMPONENT MANDIBULAR COMPONENT TMJ CAPSULE ARTICULAR DISC LIGAMENTS Muscles
  24. 24. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary  ANTERIORLY  ATTACHED WITH ARTICULAR EMINENCE  ATTACHED TO THE LATERAL PTERYGOID MUSCLE  POSTERIORLY IT IS DIVIDED INTO TWO LAMINA • SUPERIOR RETRODISCAL LAMINA • INFERIOR RETRODISCAL LAMINA WITHIN THESE LAMINA THERE IS RETRODISCAL TISSUE SPACE CRANIAL COMPONENT MANDIBULAR COMPONENT TMJ CAPSULE ARTICULAR DISC LIGAMENTS Muscles
  25. 25. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary True Capsular ligament Temporomandibular ligament http://what-when-how.com/dental-anatomy-physiology-and-occlusion/the-temporomandibular- joints-teeth-and-muscles-and-their-functions-dental-anatomy-physiology-and-occlusion-part-1/ LIGAMENTS ARTICULAR DISC Muscles CRANIAL COMPONENT MANDIBULAR COMPONENT TMJ CAPSULE
  26. 26. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary True False Capsular ligament Temporomandibular ligament Sphenomandibular ligament Stylomandibular ligament http://what-when-how.com/dental-anatomy-physiology-and-occlusion/the-temporomandibular- joints-teeth-and-muscles-and-their-functions-dental-anatomy-physiology-and-occlusion-part-1/ LIGAMENTS ARTICULAR DISC Muscles CRANIAL COMPONENT MANDIBULAR COMPONENT TMJ CAPSULE
  27. 27. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary LIGAMENTS Muscles ARTICULAR DISC CRANIAL COMPONENT MANDIBULAR COMPONENT TMJ CAPSULE
  28. 28. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary LIGAMENTS Muscles ARTICULAR DISC CRANIAL COMPONENT MANDIBULAR COMPONENT TMJ CAPSULE
  29. 29. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Sagittal section
  30. 30. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Frontal section
  31. 31. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Keep In Mind Occlusion & TMJ • Maximum support to the muscles and joint Stable Occlusiion • Malfunction damage to the joint Poor Occlusion • Increases the pressure on the joint, causing damage and degeneration Instable Occlusion
  32. 32. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary BLOOD SUPPLY
  33. 33. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary • Branches of External Carotid Artery • The Blood supply to TMJ is only Superficial • There is no blood supply inside the capsule • TMJ takes its nourishment from Synovial fluid • IA shares in the blood supply of the condyles
  34. 34. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary NERVE SUPPLY
  35. 35. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary  MANDIBULAR NERVE • AURICULOTEMPORAL FOR POSTERIOR • MASSETERIC for MEDIAL AND LATERAL ASPECTS • DEEP TEMPORAL NERVE
  36. 36. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary http://dentallecnotes.blogspot.com/2011/08/anatomy-of-temporomandibular-jointwith.html Masseteric Auriculotemporal Auriculotemporal Temporal
  37. 37. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary NORMAL ARRANGEMENT
  38. 38. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  39. 39. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  40. 40. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary • The condyle is present in the middle of the glenoid fossa • The posterior portion of the disc is considered normal between 12 and 1 o'clock
  41. 41. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary http://www.claytonchandds.com/anatomyofthetmj.html
  42. 42. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary http://www.claytonchandds.com/anatomyofthetmj.html
  43. 43. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary http://www.claytonchandds.com/anatomyofthetmj.html
  44. 44. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary TMJ Syndrome - Morphopedics.html
  45. 45. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary PHYSIOLOGY - MOVEMENTS
  46. 46. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary • It opens and closes like a hinge • It slides forward and backward • Side to side during its function • Hinge • Translation • Lateral • protrusive http://www.georgia-clinic.com/blog/2014/06/treatment-with-a-tmj-specialist-in-augusta-ga/
  47. 47. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Axis of Movements • Hinge – transverse movement – Movement • Opening & Closure – Place • Superior compartment – Fulcrum • Condyle twists – Center of rotation • It takes place in sagital plane – Action • Condyle twists vertically https://www.slideshare.net/pramodchahar9/tmj-and- prosthodontic-implications
  48. 48. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Axis of Movements • Vertical Axis – Movement • Lateral movements – Place • In inferior disc space – Fulcrum • Condyle twists laterally and backward – Center of rotation • In horizontal plane – Action • Condyle twists https://www.slideshare.net/pramodchahar9/tmj-and- prosthodontic-implications
  49. 49. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Axis of Movements • Sagital (antroposterior) Axis – Movement • Lateral movements – Place • In inferior disc space – Fulcrum • Condyle twists – Center of rotation • Frontal plane – Action • Condyle twists https://www.slideshare.net/pramodchahar9/tmj-and- prosthodontic-implications
  50. 50. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary • Hinge movement – Slight opening – IIO 20-25mm • Translational movement – Superior joint space – after that when the mouth is excessively opened • Rotation movement – Inferior joint space – Mouth excessively opened
  51. 51. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  52. 52. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  53. 53. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  54. 54. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary • Depression Of Mandible – Gravity – Lateral pterygoid – Digrastric – Geniohyoid – Mylohyoid • Elevation of Mandible – Temporalis – Masseter – Medial Pterygoids • Protrusion of Mandible – Lateral Pterygoids – Medial Pterygoids • Retraction of Mandible – Posterior fibers of Temporalis
  55. 55. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary EXAMINATION
  56. 56. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Examination History Clinical examination Diagnostic Modalities
  57. 57. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Examination History Family history Medical history Chief Compain Habits Clinical examination Diagnostic Modalities
  58. 58. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Examination History Clinical examination Inspection Palpation Auscultation Diagnostic Modalities
  59. 59. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Examination History Clinical examination Inspection Mouth opening IIO MIO Shift Teeth & occlusion Bite Palpation Auscultation Diagnostic Modalities
  60. 60. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Examination History Clinical examination Inspection Palpation Muscles of mastication Auscultation Diagnostic Modalities
  61. 61. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Temporalis Muscle
  62. 62. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Superficial Masseter
  63. 63. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Deep Massetter
  64. 64. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Mylohyoid Muscle
  65. 65. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Examination History Clinical examination Inspection Palpation Auscultation Diagnostic Modalities
  66. 66. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Doppler
  67. 67. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  68. 68. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Examination History Clinical examination Diagnostic Modalities Plain radiography Tomograms Plain/ tomograms + contrast CT scans / CBCT MRI Ultrasonography EMG
  69. 69. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Panoramic View
  70. 70. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Double TMJ View
  71. 71. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary CT Scans
  72. 72. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  73. 73. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary CBCT Scans
  74. 74. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary https://www.sciencedirect.com/science/article/pii/S1073874615000158 MRI
  75. 75. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  76. 76. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  77. 77. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  78. 78. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  79. 79. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  80. 80. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  81. 81. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  82. 82. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  83. 83. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary DISORDERS
  84. 84. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary TMJ Disorders Extracapsular Myofascial pain dysfunction Referred pain Intracapsular Inflammation Internal Derangement Dislocation Arthritis
  85. 85. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary TMJDisorders Muscles Related Myofascial Pain Syndrome Dislocation Internal derangement Anterior disc displacement with reduction Anterior disc displacement without reduction Disc perforation Bone Related Arthritis Dislocation
  86. 86. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Dislocation
  87. 87. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary • Displacement of the condyle out of the glenoid fossa but within the capsule of the joint • Etiology: 1. Extreme trauma specially to the chin when the mouth is open 2. Sudden wide mandibular opening e.g. yawing 3. Prolonged wide opening 4. injudicious use of mouth gag during GA 5. forceful luxation of mandibular teeth during extraction 6. Capsular laxity as in chronic subluxation
  88. 88. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  89. 89. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Classifications of Dislocation of the mandible I. According to the direction of the dislocated condyle: 1. Anterior dislocation 2. Posterior dislocation 3. Medially 4. Laterally 5. upwards II. According to the site: 1. Unilateral 2. Bilateral
  90. 90. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Classifications of Dislocation of the mandible Cont. III. According to the choronicity: 1. Acute Dislocation Occurs after sudden stretching of the masticatory muscles 2. Recurrent dislocation Dislocation occurs several times with inability of the patient to reduce it by himself 3. Subluxation Self reducible dislocation
  91. 91. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  92. 92. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  93. 93. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  94. 94. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  95. 95. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  96. 96. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  97. 97. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  98. 98. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Recurrentdislocation Conservative Minimally invasive Surgical treatment
  99. 99. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Recurrentdislocation Conservative IMF Decrease mouth activity Minimally invasive Surgical treatment
  100. 100. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  101. 101. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Recurrentdislocation Conservative Minimally invasive Injection of scleroting agent Injection of Botox Injection of autologous blood intracapsular Surgical treatment
  102. 102. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  103. 103. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  104. 104. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Recurrentdislocation Conservative Minimally invasive Surgical treatment (eminence surgeries) Decrease the eminence Increase the eminence
  105. 105. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Recurrentdislocation Conservative Minimally invasive Surgical treatment Decrease the eminence Eminectomy Increase the eminence
  106. 106. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  107. 107. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  108. 108. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  109. 109. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Recurrentdislocation Conservative Minimally invasive Surgical treatment Decrease the eminence Increase the eminence Onlay grafting Screw fixation Down Fracturing of the zygomatic arch
  110. 110. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  111. 111. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  112. 112. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  113. 113. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  114. 114. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  115. 115. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Myofascial pain Syndrome TMDs
  116. 116. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary • TMD is a collective term representing a broad spectrum of clinical joint and muscle problems in the oro-facial area • It characterized by – Pain – Joint sounds – Irregular or limited jaw function
  117. 117. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary • MPS is a common painful condition associated with tender points in muscle • It can affects any skeletal muscles in the body involving mostly the masticatory muscles and muscles of the neck and shoulders • It is responsible for many cases of chronic musculoskeletal pain
  118. 118. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary • The cardinal clinical manifestations of MPS include – Pain • Dull aching • Aggravated by chewing and other jaw functions • Localized or radiated – Tenderness over the masticatory muscles – Limitation or deviation of mandibular movement – Joint sounds – headache – Development of TrP
  119. 119. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  120. 120. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Causes 1. Trauma 2. Malocclusion 3. Arthritis 4. Developmental abnormalities 5. Hypermobility 6. Internal joint derangement 7. Psychogenic causes
  121. 121. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary 1. Acute trauma (macrotrauma) a. Punch to the jaw b. Fist blow c. Accident 2. Chronic trauma (microtrauma) a. Bruxism b. Clinching c. Grinding 3. Iatrogenic a. Extraction molar teeth specially impacted ones b. Tonsillectomy c. Endoscopy d. Opening the jaw too widely during laughing ,yawning or biting into a thick something e.g. sandwich Trauma
  122. 122. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary • The effect of this factor varies from mild to severe • It results from missing of various teeth pushing to abnormal habits in chewing and putting strain on the jaw muscles Malocclusion
  123. 123. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary 1. Hypoplastic condyles 2. Hyperplastic condyles Developmental abnormalities
  124. 124. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary • Results when the ligaments that hold the joint together become stretched • It usually occur by trying to open the mouth too wide Hypermobility
  125. 125. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Treatment Removal of the cause Conservative TTT Minimally invasive Splint therapy Combination
  126. 126. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Treatment Removal of the cause Conservative TTT Occlusal adjustment Drug therapy Splint therapy Physiotherapy Minimally invasive Splint therapy Combination
  127. 127. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Treatment Removal of the cause Conservative TTT Occlusal adjustment Minimally invasive Splint therapy Combination
  128. 128. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Treatment Removal of the cause Conservative TTT Occlusal adjustment Minimally invasive Splint therapy Combination
  129. 129. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Treatment Removal of the cause Conservative TTT Drug therapy Minimally invasive Splint therapy Combination Muscle relaxants NSAIDs Tricyclic drugs
  130. 130. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Treatment Removal of the cause Conservative TTT Splint therapy Minimally invasive Splint therapy Combination • Habit breaking devices • Soft night guard • Hard night guard • Muscle deprograming splints Other splints Used for ID
  131. 131. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Treatment Removal of the cause Conservative TTT Splint therapy Minimally invasive Splint therapy Combination • Habit breaking devices • Soft night guard • Hard night guard • Muscle deprograming splints
  132. 132. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Treatment Removal of the cause Conservative TTT Physiotherapy Minimally invasive Splint therapy Combination • Exercise • Hydrotherapy • Short wave and Ultrasound • TENS
  133. 133. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Treatment Removal of the cause Conservative TTT Physiotherapy Minimally invasive Splint therapy Combination • Exercise • Hydrotherapy • Short wave and Ultrasound • TENS
  134. 134. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Treatment Removal of the cause Conservative TTT Physiotherapy Minimally invasive Splint therapy Combination • Exercise • Hydrotherapy • Short wave and Ultrasound • TENS
  135. 135. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Treatment Removal of the cause Conservative TTT Physiotherapy Minimally invasive Splint therapy Combination • Exercise • Hydrotherapy • Short wave and Ultrasound • TENS
  136. 136. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Treatment Removal of the cause Conservative TTT Physiotherapy Minimally invasive Splint therapy Combination • Exercise • Hydrotherapy • Short wave and Ultrasound • TENS
  137. 137. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Treatment Removal of the cause Conservative TTT Physiotherapy Minimally invasive Splint therapy Combination • Exercise • Hydrotherapy • Short wave and Ultrasound • TENS
  138. 138. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Treatment Removal of the cause Conservative TTT Physiotherapy Minimally invasive Splint therapy Combination • Exercise • Hydrotherapy • Short wave and Ultrasound • TENS
  139. 139. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Treatment Removal of the cause Conservative TTT Physiotherapy Minimally invasive Splint therapy Combination • Exercise • Hydrotherapy • Short wave and Ultrasound • TENS
  140. 140. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Treatment Removal of the cause Conservative TTT Minimally invasive TP injection LA anesthesia Saline Distilled water Acupuncture Soft Laser Therapy Splint therapy Combination
  141. 141. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary http://collegevilledentistry.com/
  142. 142. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary http://collegevilledentistry.com/
  143. 143. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary http://collegevilledentistry.com/
  144. 144. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  145. 145. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  146. 146. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Treatment Removal of the cause Conservative TTT Minimally invasive TP injection Soft Laser Therapy Splint therapy Combination
  147. 147. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  148. 148. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Treatment Removal of the cause Conservative TTT Minimally invasive Splint therapy Muscle deprograming splint Habit breaking device Combination
  149. 149. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary http://www.is.wayne.edu/MNISSANI/BRUXNET/advice.htm
  150. 150. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  151. 151. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  152. 152. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  153. 153. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Arthritis
  154. 154. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary 1. Osteoarthritis – Occurs with missing or perforated disc 2. Rheumatoid arthritis – Bilateral affecting the two joints – Usually affects other joints of the body
  155. 155. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Treatmentaccordingtothecause Disc perforation Disc plication Minesectomy Interpositional grafting Joint replacement Total joint replacement Patrial joint replacement
  156. 156. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  157. 157. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  158. 158. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Internal Derangement
  159. 159. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Internalderangement Anterior disc displacement with reduction Anterior disc displacement without reduction Disc perforations
  160. 160. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Anterior disc displacement with reduction
  161. 161. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary • Anterior disk displacement with reduction – Presented by clicking or popping sound in the joint when the mouth opens wide or the jaw shifts from side to side – This is usually the only symptom
  162. 162. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  163. 163. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  164. 164. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary ANTERIOR DISC DISPLACEMENT WITHOUT REDUCTION
  165. 165. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary • Anterior displacement without reduction – pain is a common symptom – with some limitation of jaw opening – No clicking
  166. 166. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  167. 167. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  168. 168. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary DISC PERFORATIONS
  169. 169. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary • Disk perforation • This is the most serious condition • Pain is usually persistent and increase with any joint movement • Crepitus
  170. 170. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  171. 171. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  172. 172. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary TREATMENT
  173. 173. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Treatment Conservative TTT Drug therapy Splint therapy Physiotherapy Occlusal adjustment Minimally invasive Arthroscopy Arthrocentesis Surgical TTT Disk plication Disk removal (menisectomy) Condyle surgeries Eminence surgeries Orthognathic surgery
  174. 174. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Splints • Superior repositioning splint SRS • Anterior repositioning splint ARS
  175. 175. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  176. 176. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  177. 177. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  178. 178. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  179. 179. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Arthrocentesis • Two point entry • Lysis and lavage • Installation of drugs – Steriods – Hyaluronates
  180. 180. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  181. 181. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  182. 182. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary arthroscopy • Two points joint entry • Inflow canula and lens • Outflow canula • Mainly diagnostic • Limited surgical intervention
  183. 183. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  184. 184. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Open Arthrotomy • Last resort • Only 5% of cases would need surgery • disadvantages – Recurrence of the symptoms – External scar – Facial nerve affection – Adhesions – Major occlusal changes in some procedures
  185. 185. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Disk Plication (repositioning)
  186. 186. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  187. 187. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  188. 188. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
  189. 189. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Menisectomy (disk removal)
  190. 190. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary condylotomy
  191. 191. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary Thank you

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