TMJ ( Temporomandibular Joints )

Temporomandibular Disorders

The temporomandibular joints (TMJ) are the joints that connects the lower jaw and skull. This joint helps us in opening and closing the mouth. In this joint there are few ligaments, muscles, discs apart from bones. If this entire unit functions in one piece, then there no trouble. But when there is a non synchronized function there might be a temporomandibular dysfunction/disorder.(TMD).

Are there any specific reasons for TMD?

In most of the cases there are no particular causes for this condition. But most of the time its due to wrong positioning of jaw continuous grinding of teeth, some habits like biting nails or opening bottles in front teeth In all these actions unknowingly the affected person gets his lower jaw in front, which is ideally a wrong position for the jaw (i.e) the jaw is stretched to a forward position. Over time there is disturbances like disc displacement,bony resorptions etc. These are believed to be the causes and reasons behind TMD.

How do I know if I have TMD?
Most common features that an affected person might have:

  • Swelling over face usually lower one third of face
  • Pain in front of the ear
  • Difficulty to open mouth widely
  • Some clicking or grating sounds while opening or closing the jaws
  • Headaches can spread to neck and back
  • Inability to close jaws
  • Restricted movements of jaw
  • These symptoms can be a differential diagnosis for many other conditions. it is better to consult with the doctor if it is persistent.

What are the treatment option for this condition?
His based on vastus aspects. It is not the same for every individual. It varies from person to person, at what stage he/she comes to us, is he having any other correlating conditions like rheumatoid arthritis, is there

These patients can fall into two categories for treatment

  • Conservative/medical therapy
  • Surgical therapy
  • Conservative therapy includes the patients with mild symptoms which can be corrected with stopping the habit like night grinding of teeth or biting nails etc some of the might need relaxation therapy where they will go through stress management, medita ditation Mostly a soft bland diet is advised. ed. Jaw stre rengthening exercises are taught to relieve the stress Hot/cold water fermentation is also also relieving!led jaw(leg bone) is connected with the blood vessels of face. This surgery is performed under general anaesthesia and a minimum of 3 weeks stay is needed Following this lost teeth can also be replaced with derital implants over a period of time Surgical treatment like arthrocentesis arthroscopy, disc plication eminectomy, condylectomy, discectomy joint replacement are available. Arthrocentesis is a simple day care procedure wherein two needles are inserted into the joint space and flushed with sterile fluids and medicaments to lyse the adhesions. Through one needle the fluids are flushed in under pressure the fluid along with adhesions are flushed out through the other needle.
  • Arthroscopy is a procedure where the joint is viewed through a camera inserted through the key hole made. Procedures can be done through arthroscopy like plication or cuttuing or even flushing out the joint. This procedure will need general anaesthesia and a few days of stay in hospital.
  • Disc plication is a procedure where the disc of the joint is exposed under general anesthesia. In some conditions the disc might get displaced to a wrong and unfavorable place. The corrective procedure is to get back the disc and to tighten the Tigaments to help stay in the preferred zone.
  • In case of recurrent dislocations we might proceed with a procedure called eminectomy where the articular eminence of the bone is cut and removed to enhance the free movement of the condylar head. This is also done under general anaesthesia.
  • Condylectomy is done in cases with degenerative diseases of the joint recurrent dislocations or lock jaw, ankylosis where the can be bony or fibrous adhesions around the joint not allowing movement to happen. Here the condyle is removed either partially or in toto.
  • Joint replacement is a procedure where the entire joint is replaced with two components including the cranial component and the lower jaw component. This allows free movement of the joint enhancing mouth opening and chewing. This treatment is done in cases of severe ankylosis.

What will be done at the hospital?

Initially a thorough evaluation will be done and a set of radiographs including an orthopantamogram or a paranasal view will be done according to the suspected area of swelling we might need a computed tomogram (CT) for clearer details. After the radiographic evaluation is done we will be able to come to have an idea what is the condition to confirm a biopsy will be taken. After we receive the biopsy report a final treatment plan will be made.

Treatment options:
Surgical options
Removal of the cyst in one piece-if it is small in size Removal of the cyst over a period of time-if it is too big we allow it to shrink and then remove on the whole.

Removal +Reconstruction:
Here we remove the tumor on the whole which usually may be half of the lower or upper jaw. Following removal of the jaw the patients may not be able to chew food or have difficulty hence we have reconstruction options to aid in bringing back the patients life to near normal. We can reconstruct the jaw with bones from the leg. After a thorough evaluation a portion of the bone from the calf region is taken along with its blood supply. This bone is cut into shape of the jaw bone and fixed there with plates and screws. Then the blood vessels from the remodified jaw(leg bone) is connected with the blood vessels of face. This surgery is performed under general anaesthesia and a minimum of 3 weeks stay is needed.Following this lost teeth can also be replaced with dental implants over a period of time.