Dislocation, ankylosis and fracture of the TMJ

Dislocation of the TMJ

 

¨ Displacement of one component of the joint beyond its normal limits, without spontaneous return to its normal position

¨ For many patients repeated episodes of dislocation occur, despite great care, may be managed entirely conservatively, but for some the frequency or difficulty in reduction may warrant active surgery

 

Surgical techniques include:

¨ Prevention of forward condylar movement by placement of a block on the articular

             eminence

¨ Prevention of condylar movement by tightening the constraints of the capsule

¨ Limitation of the forward pull of the lat pterygoid (by section)

¨ Reducing height of the eminence to allow easier reduction

 

 

Ankylosis of the TMJ

 

¨ Ankylosis may be caused by trauma (especially intracapsular fractures), infection or a systemic arthropathy such as juvenile rheumatoid or reactive arthritis

¨ Severe restriction of mouth opening, may be slowly progressive

¨ Treatment is directed either at mobilising the existing joint and attempting to prevent reformation of the ankylosis or at forming a false joint lower down in the mandible

 

 

Fracture dislocation of the condylar neck

 

¨ In the event of bilateral fracture dislocations of the condylar necks, the elevator muscles pull the mandible up posteriorly and create an anterior open bite

¨ Open reduction and internal fixation reduces the morbidity considerably

¨ Fractures within the capsule of the joint are more likely to result in ankylosis, but are not amenable to ORIF

 

                                                                                                                    

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Tumours of the TMJ