Disorders In The Temperomandibular Joint
The tempromandibular joint is the synovial joint of the condylar variety. It has articular disc, ligaments and a fibrous capsule. It acts a cushion and withstands the compressive forces. The possible movements are protraction, retraction, elevation, depression and side to side movement. These movements are brought together by the co-ordination of later & medial pterygoid, masseter, temprolis, and mylohyoid and digastric muscles.
Excessive opening of the mouth or during convulsion, the head of the mandible may slip into the infratemporalfossa; as a result there is an inability to close the mouth. Forward dislocation is the commonest form of dislocation. The deep fibres of masseter spasm hold the dislocated jaw open. The spasm is relieved first before anterior dislocation is reduced. Reduction is done by depressing the jaw with the thumbs placing on the last molar teeth and at the same time elevating the chin.
Symptoms such as head ache, dizziness, and nausea and ear pain are indicators of temperomandibular disorders. This is often misunderstood with ear pain. This is a commonest disorder which is been cured with a help of a oral and maxillofacial surgeon. Usually an x-ray is taken to access the level of the dislocation of the joint. Then the treatment plan is done.
The main causes for anterior dislocation may be drooping of chin, excessive opening of the mouth, convulsion and fracture of the mandible that dearranges the articular ends. During extraction of teeth the mandible is depressed excessively. It may cause anterior dislocation.
Derangement of the articular disc may result from injury like over closure or malocclusion. This gives rise to clicking and pain during movements of the jaw. Fracture of the mandible may be accompanied by dislocation of the temperomandibular joints.
In this condition care should be taken to protect the facial nerve and auricotemporal nerve. Injury to the auricular branches of the auriculotemporal nerve supplying the tempromandibular joint leads to joint laxity and instability of the joint. Subluxation can occur due to relaxed ligament or loose intra articular disc.
The tubercle, ligaments, muscles and position of the mandible may have an influence over the stability of the temperomandibular joint. The articular and glenoid tubercle prevent forward and backward displacement of the joint. Occlusal position of the mandible increases the stability of the joint.
The temperomandibular joint I a peculiar joint in the face. There are several reasons for it. The articular surfaces are covered by fibro cartilage instead of hyaline cartilage. This joint develops very late. When all the joints of the body are fully developed, the temperomandibular joint will be incomplete. Only by twelfth year it is fully developed. Moreover the joint of two sides move together so that the movements are restricted.
In operations of the temperomandibular joint, care should be taken so that the seventh nerve is preserved
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