Inflammatory diorder of Tmj

INFLAMMATORY DISORDER OF TEMPOROMANDIBULAR JOINT(TMJ). : 

INFLAMMATORY DISORDER OF TEMPOROMANDIBULAR JOINT(TMJ). SYEDA TOOBA ZAIDI DEPTT OF ORAL PATHOLOGY

CONTENTS : 

CONTENTS INTRODUCTION. ANATOMY. DISORDER OF TMJ CLASSIFICATION RADIOGRAPHS.

ANATOMY : 

ANATOMY Temporomandibular joint. A true synovial joint capable of gliding, sliding and slight rotation. Tmj complex Condyle of mandible. Mandibular fossa. Articular tubercle of the temporal bone Articular disk (meniscus) Two synovial membrane: superior/ inferior. Condylar process which is lined by fibrous tissues, primarily hyaline cartilage. Coronoid process. insertion for portions of temporalis and messeter

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1. Disc 6. Inferior joint cavity 2. Condyle 7. Superior joint cavity 3. Fibrocartilage 8. Superior belly of lateral pterygoid 4. Capsular ligament muscle 5. Retrodiscal tissue 9. Inferior belly of lateral pterygoid muscle HISTOLOGICAL PICTURES OF TMJ

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LIGAMENTS. The extrinsic ligaments The lateral ligament The stylomandibular ligament The sphenomandibular ligament

DISORDER OF TMJ : 

DISORDER OF TMJ Temporomandibular joint disorder (TMJD orTMD), or TMJ syndrome, is an umbrella term covering acute or chronic inflammation of the temporomandibular joint, which connects the mandible to the skull. The temporomandibular joint is susceptible to many of the conditions that affect other joints in the body, including ankylosis, arthritis, trauma, dislocations, developmental anomalies, and neoplasia.

Signs and symptoms : 

Signs and symptoms Signs and symptoms of temporomandibular joint disorder vary in their presentation and can be very complex. On average the symptoms will involve more than one of the numerous TMJ components: muscles, nerves, tendons, ligaments, bones, connective tissue, and the teeth. Ear pain associated with the swelling of surrounding tissue is a symptom of temporomandibular joint disorder. Symptoms associated with TMJ disorders may be: Biting or chewing difficulty or discomfort Clicking, popping, or grating sound when opening or closing the mouth Dull, aching pain in the face Earache Headache Jaw pain or tenderness of the jaw Reduced ability to open or close the mouth Tinnitus

SYNOVITIS & CAPSULITIS : 

SYNOVITIS & CAPSULITIS DEFINITION An inflammation of the synovial tissues and of the capsule. Differentiated by arthroscopy. Etiology: Trauma to the tissue. Wide open mouth procedures or abusive movements. Inflammation which has spreaded from adjacent structures. Clinical features. Tenderness over the affected joint. Capsular ligament can be palpated.

INFLAMMATORY DISORDER : 

INFLAMMATORY DISORDER 1) TRAUMATIC ARTHRITIS. 2) INFECTIVE ARTHRITIS. 3)RHEUMATOID ARTHRITIS.

INFECTIOUS ARTHRITIS : 

INFECTIOUS ARTHRITIS Is infection and inflammation of the joint. Rare. Infection may invade the TMJ. Aetiology. ROUTES OF INFECTION: Direct spread of organisms. Direct extension of osteomyelitis of mandible. Hematogenous spread- common. Infection from the middle ear. Staphylococcus aureas is the most common organism.

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Clinical features Any age, no gender predilection. Redness and swelling over the joint. Trismus, severe pain on opening mouth. unilateral. Inability to occlude the teeth, large, tender cervical nodes. Fever, malaise, mandible deviated to unaffected side

Radiographic features : 

Radiographic features Early stages of disease- no radiographic signs may be present. Space b/w condyle and mandibular fossa widened. Evident bony changes- 7-10 days after clinical symptoms.

This figure show decalcified parafiin process section of infected bone was stained by modified gram stain. Gram +ve bacteria (blue). Embeded deep in the bone(red) : 

This figure show decalcified parafiin process section of infected bone was stained by modified gram stain. Gram +ve bacteria (blue). Embeded deep in the bone(red) HISTOPATHOLOGICAL PICTURE

TRAUMATIC ARTHRITIS : 

TRAUMATIC ARTHRITIS Damage to the condyle or to the ligaments and capsule of the joint following acute trauma may lead to traumatic arthritis or haemarthrosis. Example of acute trauma include. Condylar fracture Hyperextension sprains. Effusion which is an influx of fluid into the joint,usually as a result of trauma ( haemorrage) or inflamation(exudate). Clinical features Swelling over the affected joint. Pain in TMJ, preauricular region, or ear. Difficulty occluding the posterior teeth.

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.  Bilateral low condylar neck factures; nondisplaced fracture on the right, laterally displaced fracture on the left (arrows). Panoramic radiographs

RHEUMATOID ARTHRITIS : 

RHEUMATOID ARTHRITIS This is the non organ specific autoimmune systemic disorder. Involve Multiple joints of the body. Inflammation of the synovial membranes. In severe cases osseous tissues are resorbed. More commonly associated with joint of hands , wrist. Also occur in tmj, always bilateral Condylar support lost- malocclusion

Clinical features : 

Clinical features Incidence higher in females, increases with age. Small joints of hand, wrist, feet, knees, affected in bilateral symmetric fashion. Tmj involement- swelling, pain, tenderness, stiffness on opening mouth, limited range of motion and crepitus. Radiographic features. Generalized osteopenia of condyle & temporal bone component. Erosion of the anterior and posterior condylar surfaces

Examples of TMJ erosions for the 4 grades. A, very slight erosion in condyle B, erosion of top of condyle . C, half of condyle eroded. D, condyle completely eroded : 

Examples of TMJ erosions for the 4 grades. A, very slight erosion in condyle B, erosion of top of condyle . C, half of condyle eroded. D, condyle completely eroded

RHEMUTOID ARTHRITIS (CONT) : 

RHEMUTOID ARTHRITIS (CONT) 24 yr old man with rhemutoid arthritis show irregularity and erosive changes of the mandible condyle (black arrow) and articular eminence( white arrows)

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Commonest variant of rheumatoid arthritis. Juvenile rheumatoid arthritis(stills disease) Is a chronic inflammatory disease that appears before age of 16 yrs. Chronic intermittent synovial inflammation, Joint effusion, swollen and painful joint. As the disease progresses cartilage and bone are destroyed. Clinical features : Patient has pain, tenderness in affected joint. Disease can be asymptomatic

Juvenile rheumatoid arthritis : 

Juvenile rheumatoid arthritis Chronic changes in mandible condyle, such as flattening and beaking. (radiological pic)

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