Mandible: TMJ Dysfunction
1. Introduction
TMJ dysfunction is defined as a subgroup of craniofacial pain problems (WHO). It involves not only the joint but also other masticatory structures as well as muscles of the head and neck.
2. Etiology
Its etiology is considered multifactorial but trauma plays an important role in the development of this condition.
3. Presentation
The typical presentation includes TMJ-Pain, discomfort, and clicking as well as headache, tenderness of the masticatory muscles, and functional limitation eg. mouth opening and chewing.
4. Physical examination
Physical examination should include observation of mandibular motion, measurement of mouth opening, palpation of the TMJ and masticatory muscles and oral examination with special attention to the occlusion.
5. Imaging
Imaging should include radiographs and CT-scans, however, for the evaluation of the soft-tissues (especially of the disk) an MRI is mandatory.
6. Treatment
Treatment of the TMJ dysfunction is outside the scope of the surgery reference, however, it involves a combination of procedures such as diet, physical therapy medications (analgesics, anti-inflammatories, antidepressants, muscle relaxants etz.), the use of occlusal appliances arthrocentesis, and surgery.
Occlusal appliances are removable acrylic or silicon devices meant to decrease the load on the TMJs. They will also reduce the amount of grinding and clenching and thereby reduce the neuromuscular activity.
Arthrocentesis with or without the use of an arthroscope is a minimally invasive procedure supposed to bring comfort and increase the mandibular range of motion. It is indicated to the patients in whom non-invasive forms of treatment gave unsatisfactory results. It involves the irrigation of the superior joint space with saline solution and if needed, steroids to diminish the inflammatory activity.
The surgical procedures are :
- Disk repair
- Disk repositioning
- Condylectomies
- Joint replacement
