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Temporomandibular joint disorders - (TMJ)
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Temporomandibular joint disorders - (TMJ)

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Temporomandibular joint disorder - anatomy, diagnosis, therapy

American Family Physician,  July, 1992  by Brendan C. Stack, Jr.,  Brendan C. Stack, Sr.

Temporomandibular joint disorder is a common clinical entity with diverse etiologies and symptoms. The hallmarks on physical examination are reduced or dysfunctional mandibular range of motion, malocclusion, and joint or preauricular tenderness. The diagnosis is made when a history of craniofacial symptoms or headache is linked with temporomandibular joint dysfunction. Temporomandibular joint disorders usually respond to medical treatment with anti-inflammatory medications, soft diet and occlusal therapy, without the need for surgical intervention. These disorders must be considered in the differential diagnosis of chronic headache, facial pain and compromised mandibular movement.

The dental literature reports that temporomandibular joint disorders are frequently underdiagnosed by physicians.[1-3] These disorders are responsible for many common craniofacial signs and symptoms. Temporomandibular joint disorders are often associated with complaints of chronic muscular headaches or craniofacial pain. A basic familiarity with these disorders will help the primary care physician in diagnosis and management. Many of these disorders produce symptoms that mimic more serious medical problems, such as intracranial aneurysms, migraine or neoplasms of the head and neck. These diagnoses should be considered before beginning treatment for presumed temporomandibular joint disorder.

History

It was not until the 1950s that temporomandibular joint disorders were frequently reported in the dental literature as specific clinical entities.[1] Despite the medical nature of these disorders and an estimated prevalence of up to 30 percent among the general population, treatment has tended to be overlooked by the medical profession.[1,3] With today's litigious society and the frequency of temporomandibular joint disorder among motor vehicle accident victims, a knowledge of these disorders is increasingly important for the primary care physician. Due in part to the proximity and relationship of the temporomandibular joint to the oral cavity, the dental profession has taken the lead in research of these disorders and has created specialty groups dedicated to their study and treatment.

It is important to note the frequent interchange of the terms "temporomandibular joint dysfunction syndrome" and "myofascial pain disorder." The former is a dated term that refers to the intra-articular dysfunction of the joint and resultant signs and symptoms. The term "temporomandibular joint disorders" is currently used and indicates a spectrum of joint disease and associated Symptoms.[4,5] Myofascial pain disorder, also known as fibromyalgia, refers to primary craniofacial pain and dysfunction due to myofascial trigger points and is distinct from temporomandibular joint disorder.[2,6]

Anatomy

The temporomandibular joint is diarthrodial (a gliding hinge). The joint represents the point of articulation between the condyle of the mandible and the glenoid fossa of the temporal bone (Figure 1). The condyle and fossa are separated by a dense fibrous biconcave articular meniscus, which divides the joint space into superior and inferior compartments.[7] The confines of the joint are defined by a nonenervated, synovial-lined fibrous capsule, which is stabilized laterally and medially by ligaments.[8]

Near the temporomandibular joint are many neural and vascular structures that may be compromised, producing various symptom complexes when the joint is dysfunctional.[9] The posterior wall of the glenoid fossa can be a thin bony or dehiscent septum between the joint and the middle ear space. This anatomic proximity as well as common innervations provides the potential for symptoms to be referred to the ear.[10] Muscles that work with the joint include the masseter, temporalis and lateral and medial pterygoids.

The normal temporomandibular joint acts as a hinge during early mouth opening, up to 25 mm (Figure 2). As the mouth is opened further, the condyle/meniscus assembly glides anteriorly and inferiorly over the posterior slope of the articular eminence. This second component of motion is responsible for the final 20 to 25 mm of mandibular opening.[1]

 

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