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Structural Aspects Developmental Disorders Inflammatory Disorders Osteoarthrosis Functional Disorders Loose Bodies Neoplasms Age Changes in the Jaws & TMJ Trismus & Dislocation
Self-limiting.
Unknown cause.
Facial asymmetry and deviation of mandible to opposite side and malocclusion. Becomes apparent during 2nd decade of life.
Generally unilateral.
Trismus.
Deviation on opening. Signs of acute infection.
When symptomatic, TMJ involvement presents as: Limitation of opening. Stiffness. Crepitus. Referred pain. Tenderness on biting. Severe disability is unusual.
Articular surfaces may become very irregular and fibrous ankylosis may result, either in the lower joint compartment or with total destruction of articular disc and complete ankylosis.
Osteoarthrosis (Osteoarthritis)
A degenerative disease which mainly affects weight-bearing joints. In the TMJ it differs from other joints probably because: 1. It is not a weight-bearing joint. 2. The articular surface is covered with fibrous tissue rather than hyaline cartilage. It is rare in TMJ before 5th decade of life, but after that it increases proportionately with age.
Osteoarthrosis
Clinical features: Pain. Crepitus. Limitation of jaw movement.
Deviation on opening.
Many cases are clinically silent.
Osteoarthrosis
Clinical features: Clinical studies suggest a relationship in some cases between later development of osteoarthrosis and: a. untreated myofascial pain-dysfunction syndrome, b. loss of molar support, c. disc displacement.
Osteoarthrosis
Histological changes: Early changes consist of uneven distribution of cells in articular covering of condyle +/- some osteoclastic resorption of subarticular bone. Vertical splits (fibrillation) develop in articular layer.
Followed by fragmentation and loss of articular surface with eventual denudation of underlying bone.
Osteoarthrosis
Histological changes:
Reactive changes in exposed bone lead to thickening of trabeculae and formation of a dense surface layereburnation (bony sclerosis ). Osteophytic lipping on anterior surface may occur.
Osteophytes: peripheral bone formation
Osteoarthrosis
Radiographic changes:
Osteoarthrosis
Loose Bodies
Radiopaque bodies apparently lying free within the joint space are common in major joints but rare in TMJ. They may cause discomfort, crepitus, and limitation of movement. The main causes in TMJ are: 1. Intracapsular fractures. 2. Fractured osteophytes in osteoarthrosis. 3. Synovial chondromatosis.
Loose Bodies
Synovial Chondromatosis: disease of unknown etiology characterized by formation of multiple nodules of cartilage which may calcify and ossify, scattered throughout the synovium. They may be released in the joint space and appear as loose bodies.
Neoplsams
Primary neoplasms of the TMJ are rare. Benign tumors such as chondromas and osteomas are more frequent than sarcomas arising from bone or synovial tissues.
There may be perforation of the disc, particularly of its posterior attachment with progressive joint damage and osteoarthrosis.