TMJ Disorders – Symptoms And Causes

TMJ Disorders – Symptoms And Causes

• TMJ ankylosis: The joint is immobilized, and jaw function is affected. Hypomobility to immobility of the joint can lead to inability to open the mouth from partial to complete
• Two main factors predisposing to ankylosis are trauma and infection, in or around the joint region.

Cost Of TMJ Disorder Treatment

Read And Learn More: Maxillofacial Fractures, Disorders, and Treatments

Tmj Syndrome

Management of TMJ ankylosis

• Early surface intervention
• Aggressive resection: A gap of at least 1 to 1.5 cm should be created.
• Ipsilateral coronoidectomy and temporalis myotomy.
• Contralateral coronoidectomy and temporalis myotomy.
• The lining of the glenoid fossa region with the temporalis fascia.
• Reconstruction of the ramus with costochondral graft.
• Early mobilization and aggressive physiotherapy for at least 6 months postoperatively.
• Regular long-term follow-up.
• To carry out cosmetic surgery at a later date when the patient’s growth is complete.

TMJ Principles of Management

• Removal of the ankylosed mass of bone to mobilize the jaw.
• Reconstruction of the joint and maintenance of the vertical height of the ramus.
• Prevention of recurrence.
• Restoration of occlusion and maintaining function.
• Correction of secondary facial deformity.

TMJ Pain

Step-by-step treatment of ankylosis

• Use of basement force: Forced opening of the jaw by a mouth gag under general anesthesia. It is used in the case of fibrous ankylosis.
• Surgical lysis: Opening of the joint by preauricular approach and destroying the union of the condyle and the glenoid fossa.

“Risk Factors For Developing TMJ Disorders”

• This procedure is done in cases of fibrous or partial ankylosis where the anatomical features of the joint are not completely changed.
• The condylectomy procedure should start with the preauricular incision.
• Now, a horizontal osteotomy cut is given with the help of a bur at the level of the condylar neck.
• Section the head of the condyle to the level of the neck and separate it from the superior attachment.
• The stump of the condyle at the neck is smoothed, and the wound is closed in layers.
• As unilateral condyle leads to deviation of the mandible at the operated side on mouth opening, and in cases of bilateral ankylosis open bite is present due to loss of vertical ramus.
• So when condylectomy is done, after recontouring, an alloplastic material is used to maintain space and provide proper occlusion as well as joint movements.

Exercises For TMJ Pain Relief And Recovery

Jaw Joint Pain

• Gap arthroplasty is the procedure that involves the creation of an anatomical gap in an ankylosed segment to form an artificial joint space.
• In patients with complete bony ankylosis anatomical features of joints are very difficult to appreciate as they get covered by the bone. So, in complete bony ankylosis cases, a gap in the bone is made to separate the ramus of the mandible from the ankylosed mass in the glenoid fossa.
• Now, two horizontal bony cuts are given in the superior aspect of the ramus, and the wedge of bone between the two cuts is removed. Take care while removing the bone from the medial aspect as it is close to a maxillary artery and carotid canal.
• Remove the bone by using a large round bur till the medial bone gets thinned out completely to remove with an osteotome.
• There is a recommendation of leaving a gap of about 1 to 1.5 cm laterally and medially to prevent ankylosis.

“Early Signs Of Complications With TMJ Dysfunction“

• In cases of the gap, arthroplasty, chances of ankylosis are present if bony cuts come in contact.
• So to avoid this, an interpositional material is inserted between the two cut ends which avoids contact between them and decreases the chances of ankylosis.
• Various materials are used, which can be autogenous or alloplastic.
• Autogenous materials used for interposition are cartilaginous graft, temporal muscle, temporal fascia, fascia, and dermis, while alloplastic materials used are metallic and non-metallic.
  In metallic ones, there are tantalum plates, stainless steel, titanium, and gold, and in non-metallic ones, there are Teflon, acrylic, ceramic, and elastic.