Normal movement of TMJ

 Rotation takes place between head of condyle and

inferior surface of disc, referred to as condyle-disc
complex structure (inferior joint)
 Sliding movement occurs in the superior joint
between condyle-disc complex and glenoid fossa
Scheme of normal movement of TMJ
 INTERNAL DERANGEMENT

 ADHESION

 ALTERATION

 CONDYLE DISLOCATION

 FRACTURE OF CONDYLE

 ANKYLOSIS
internal derangement

 Disc Displacements
 Disc Dislocation with Reduction
 Disc Dislocation without Reduction
A. Normal position of the disc relative to head of condyle in closed position
B. Functional displacement of the disc.
Disc Displacements
Occurs when:
 Posterior surface of disc becomes thinned, and

inferior retrodiscal lamina and lateral discal

collateral ligament become elongated.
 These cause the disc to move anteriorly (and

medially) to the articular surface of the condyle.

Disc Displacement

Reciprocal click
Disc Dislocation with Reduction
Occurs when:
 The thinning of the disc and elongation of the ligaments worsen

 Disc moves more anteriorly

 On mouth opening the head of condyle has to be jumping over

the disc to achieve its normal position, producing click sound
 During further sliding movement, the disc assumes its normal
position
 In disc dislocation with reduction the condyle is usually located in
retrodiscal tissue which have a large number of nerve and blood
supply, this is the reason why this condition may occasionaly cause
pain
Disc Dislocation with Reduction
Disc Dislocation without Reduction

 Occurs when:
 The elasticity of superior retrodiscal lamina has lost
leading to difficulty of the disc in returning into its
normal position
 Signs:
 Restricted mouth opening (closed lock)
 No clicking sound
Disc Dislocation without Reduction
Structural Incompatibility of the Articular
Surface
1. Adhesion
 Stiffness of the joints surfaces, may be found in

superior or inferior joint spaces

 Adhesion may occur, in certain individuals, as

temporary stiffness usually as a result of long static

position (e.g. on morning wake up)
 Permanent adhesion may develop secondary to
trauma or disc derangements.
A.Adhesion in superior joint space. B. The presence of the
adhesion limits the joint to only rotation. C. If the adhesion is
freed, normal translation can occur.
Posterior dislocation of the disc.
A, Permanen adhesion between the disc and fossa. B, Continued
movement of condyle causes elongation of the discal and
anterior capsular ligament permiting the condyle to move onto
ant border of the disc. C,posterior disloctn of the disc
2. ALTERATION
alteration of the shape of condylar head
Terjadi
Adanya spasme otot sehingga mengunci pada satu atau kedua kondilus keanterior
melewati tuberkulum artikularis
 SYMPTOMS

 Unable to close the

mouth
 Pseudo-prognathism
 Complain of pain in TMJ
region
 High incidence rate of 25% -
35%
 May cause:
• malocclusion (open bite)
• disturbance of TMJ functions
• Ankylosis
• mandibular growth disturbance
 18 year old female patient, involved in road
traffic accident, fell from motor bike, sustained
wound in the chin, unable to chew and open
mouth wide
 Anterior and posterior open bite
 X-ray: bilateral fracture of condyle and left
mandibular symphisis
 25 year old male patient, fell from motor bike,
sustained injury of chin
 Crown fracture of anterior teeth
 Good occlusion
 X-ray: undisplaced fracture of left condyle
ANKYLOSIS
1. Fibrous Ankylosis/partial ankylosis
fibrotic change in TMJ structure secondary to prolonged
non functioning of TMJ
2. Bony ankylosis
union (fusion) between head of condyle and glenoid fossa
CASE
Radiograph

 Panoramic: left TMJ showing fusion of head of condyle to glenoid

fossa indicating bony ankylosis
CT Scan (3-dimension)