Temporomandibular joint trauma
Work plan:
I – Contusion and joint sprain
1-Definitions
2-Etiology:
3-Clinic:
4-Radiology:
5-Treatment:
6-Evolution:
II-Joint fractures ,
III-Dislocations
1-Definition:
2-Etiology:
3-Classification:
A-Anterior dislocation:
B-Posterior dislocation
C-Lateral dislocation
D-Upper dislocation
Conclusion
I – Contusion and joint sprain
1-Definitions
Contusion:
Damage to the joint equipment without bone damage.
Sprain:
Traumatic injury to the joint with elongation or tearing of the ligaments without displacement of the articular surfaces.
2-Etiology :
- Traumatic etiology:
- A direct shock to the ATM region.
- An indirect shock: on the angle, horizontal branch, symphysis or due to an exaggerated movement of the mandible.
3-Clinic :
- Limitation of mouth opening.
- Spontaneous pain, pain on movement and pressure.
- Painful deviation of the mandible towards the affected side when opening the mouth.
4-Radiology : Shows bone integrity; sometimes a widening of the joint space.
- The MRI and the scanner will provide maximum information.
5-Treatment :
- Analgesics, anti-inflammatories.
- Resting the joint.
6-Evolution :
- Healing without after-effects in a few days.
- In severe trauma, cracking and residual pain may persist.
II-Joint fractures ,
- Fractures of the articular condylar region are numerous and may be of interest to:
-The lower mobile bony segment of the joint.
-The upper segment fixed.
III-Dislocations
1-Definition :
Permanent loss of normal relationships of articular surfaces: temporal eminence and mandibular condyle »
2-Etiology:
- Permanent loss of normal relationships of articular surfaces: temporal eminence and mandibular condyle »
- Ligament hyperlaxity and bone dysmorphism.
3-Classification:
- Anterior dislocation
- Posterior dislocation
- Lateral dislocation
- Superior dislocation
A-Anterior dislocation:
A-1-Definition :
“It is the exaggeration of the movement of the mandibular condyle forward, the condylar head passes in front of the temporal eminence and cannot return to the glenoid cavity”
A-2. Etiology :
| Triggering causes | Contributing causes |
| Forced mouth openingShock on the chin | Meniscocondylar asynchronism. Ligamentous hyperlaxity. Abnormalities of the bony extremities. Uncompensated posterior edentulation. |
A-3-Clinic:
- Bilateral form
– Mouth open blocked 3 to 4 cm.
-Abundant salivation (inability to swallow)
-Dry throat
-Chin down, projected forward
-Hollow cheeks
-Palpation of the pre-tragal regions reveals emptiness of the glenoid cavities.
- One-sided form
-The anterior gap is less significant.
-The chin is deviated to the healthy side.
-The cheek on the dislocated side is flattened and tense, hollowed on the healthy side.
-Condylar protrusion and periauricular depression do not exist on the healthy side.
A-4-X-ray
:
Figure 1
- A dental panoramic scan confirms the position of the mandibular condyle in front of the temporal eminence.
- MRI shows that the disc is located anterior to the temporal eminence. Figure 1
A-4-Treatment:
- Treatment of recent blocked dislocation (figure 2)
Temporomandibular joint trauma
Figure 2: Nelaton maneuver
-Treatment of irreducible dislocation
It is surgical;
The obstacle to reduction is located at the level of the external lateral ligament , its section allows reduction.
-Treatment of recurrent dislocations
Occlusal treatment: necessary from the first consultation.
-Treatment of old neglected dislocations
-For a long time, the treatment was a condylectomy, which allowed for a setback, but led to disorders of mandibular function.
– Reduction can usually be achieved after eminecectomy.
B-Posterior dislocation
B-1-Clinic :
- Rare, they occur after a horizontal shock to the chin.
- The condyle in a posterior position, depressing the tympanic membrane.
- Accompanied by otorrhagia, sometimes by hearing loss.
- Limited mouth opening, molar gap.
- On palpation, mandibular condyles inside the EAC.
B-2-Radio:
- CT scan confirms the tympanic membrane fracture.
B-3-Treatment:
- A brief immobilization of the mandible
- Reduction, followed by treatment of the CAE
C-Lateral dislocation
- Exceptional.
- We note an ascension of the mandible on the dislocated side + laterodeviation with malocclusion and trismus.
- At the dental level, we note a lateral crossbite.
C -1-Treatment :
Orthopedic, aimed at achieving molar elevation and elastic traction.
D-Upper dislocation
- Exceptional and very serious, following a violent vertical shock.
- Mouth open, condyle sunk into the middle cerebral fossa.
- The CT scan shows intracranial displacement of the condyle.
- The association of a neurological syndrome may delay the diagnosis.
Temporomandibular joint trauma
D-1-Processing :
After removing the vital risk, the reduction is orthopedic, rarely surgical.
Conclusion
Joint trauma is relatively common and is a recognized cause of ADAM. Early and effective management would prevent a number of reversible and irreversible complications.
Good oral hygiene Regular scaling at the dentist Dental implant placement Dental x-rays Teeth whitening A visit to the dentist The dentist uses local anesthesia to minimize pain