The Temperomandibular Joint Disorder
The temperomandibular joint is the articulation of the mandibular condyle into the mandibular fossa of the temporal bone. The temperomandibular joint is the only movable joint of the skull. It is basically a synovial joint composed of two articulating surfaces. It has a fibrous capsule and a synovial membrane filled with synovial fluid.
It develops by 10th week of gestation from 2 separate blastemas for the temporal bone and condyle respectively.
The TMJ disorders may be due to dislocation of the discs due to over bite, trauma and several other factors. Usually a physical examination is done which involves inspection, palpation and auscultation to ascertain that an abnormality or dysfunction is present. Facial asymmetry, deviation, occlusal derangement, open bite and swellings should be noted.
Trauma to the TMJ can cause a variety of primary and secondary problems. Depending on the intensity of the force and the age of the patient can cause simple derangements to complex ankylotic sequelae.any traumatic incident involving the TMJ may lead to acute arthritis, site of inflammation being the capsule. Chronic trauma to the joint due to trauma from the occusion is also responsible for arthritis.
The disorder is characterized by tenderness of the affected joint and restriction of movement, which cause the mandible to swing to the affected side on the opening. There may be edema around the joint and restriction of mouth opening due to pain.
The abnormal immobility of the temperomandibular joint is called as ankylosis.this often results from trauma, infection, auto immune diseases or failed surgery. Chronic pain and limitation of the movements may occur.
it may sometimes lead to arrest of condylar growth. There are different types of ankylosis such as false, fibrous and true ankylosis.Dislocation of the TMJ occurs when the mandibular condyle is displaced anteriorly behind the articular eminence.subluxation is the displacement of the condyle out of the glenoid fossa and anterosuperior to the articular eminence, which can be reduced by the patient. it can be unilateral or bilateral.
True dislocation is a one in which the patient cannot reduce it by himself and requires expert assistance for reduction.habitual or recurrent dislocation refers to frequent and repeated episodes of recurrent dislocation which can be manipulated back to form.
Joint over extension predisposing to dislocation may be caused by yawning, wide jaw opening or vomiting. Extrinsic trauma may also result in dislocation with injury to capsule and ligaments.
The treatment for acute dislocation can be done with or without the use of local anaesthesia.the sensory reflex mechanism of the joint is blocked when local anesthesia is used to overcome muscle spasm. The use of sedatives and tranquilizers prior to manipulation may help in facilitating reduction.IMF for few days after reduction is necessary to prevent inflammation and oedema.
| 
