Some joints of the musculoskeletal system perform thousands of movements every day, while remaining completely invisible from the outside. These include the temporomandibular joint (TMJ), which connects the bone formations of the same name just in front of the auricle. Although its external contours are inaccessible for inspection, the general anatomy of the joint is of interest - it is no longer possible to find both a complex and a combined joint in the body.
Although its numerous components are aimed at implementing a single, physiologically significant movement - opening and closing the mouth. But thanks to it, a person can perform several actions at once - from banal chewing to voice functions. Therefore, the structure of the temporomandibular joint is characterized by the complexity necessary to perform a number of tasks at once.
And the articulation is located on a fairly dense area in terms of anatomical formations - the base of the skull. Because of this, its structures are formed compactly enough so as not to disrupt the functioning of nearby vessels, nerves and hearing organs. Although the temporomandibular joint itself is not simple - it is surrounded by a large amount of its own soft tissue. All of them are designed to carry out the many functions that the connection is assigned to perform.
When describing the temporomandibular joint, both symmetrical joints are considered simultaneously, since their work occurs simultaneously. They have absolutely identical characteristics, consisting of several provisions:
The external contours of the joint are hidden mainly due to the powerful fibers of the masticatory muscle, which carries out the main movement in it - opening and closing the mouth.
This formation in the articulation is mobile, that is, it makes movements relative to another bone - the temporal bone. From an anatomical point of view, the lower jaw, like the rest of the skull, has a rather non-standard structure. Therefore, some of its features should be described:
When the lower jaw is fractured, simultaneous damage to the joint located on the other side often occurs, which is due to the combined work of both joints.
This formation is already directly part of the skull, and with the help of sutures it is connected to the surrounding bones. Therefore, it is motionless - all movements are carried out only relative to its surface. To fully understand the anatomy of the temporal bone, its main parts should be listed:
Due to the intra-articular disc, the temporomandibular joint acquires the properties of a block-like joint, in which movements are carried out predominantly along one axis.
Considering the complex structure of the articulation, its capsule also has small features associated with the division of the cavity by a cartilaginous disc. Therefore, it is customary to divide the joint cavity together with the membranes into two anatomical levels:
The articular cavity of the temporomandibular joint is not large in size, since its main part is occupied by a fibrous cartilaginous plate.
Since the joint is small, the tendons that strengthen it also do not represent large anatomical structures. But even their classification implies division into large and small entities:
Despite the significant number of tendons, they play virtually no supporting role - the main load is taken by the muscles that move the joint.
Since the cartilaginous plate is located inside the articular cavity, its structure can only be judged indirectly. Although it is similar in structure and purpose to the menisci of the knee joint, it still has some distinctive features:
In general, the disc is necessary to create additional axes of mobility, which are realized during the contraction of individual muscles located nearby.
Thanks to the large number of vascular plexuses located in the area of the base of the skull, the joint receives nutrition from several sources at once. Arteries in large numbers approach its capsule, supplying it with oxygen and nutrients. In order of importance they are arranged in the following order:
The venous outflow from the joint is formed much more simply - individual small vessels flow into a large plexus located just below and in front of the joint. Then only one large formation emerges from it - the mandibular vein.
Of all the structures that make up the formation, nerve fibers fit only to its membranes. Therefore, the innervation is only sensitive in nature - the receptors are irritated only in response to mechanical irritation and stretching of the capsule. Since there are many nerves in the area of the base of the skull, sensitivity is provided by several of them at once:
The trigeminal nerve also includes motor branches that ensure the coordinated work of the masticatory muscles, which provide mobility in the joint.
Based on its structure and shape, it is assumed that the temporomandibular joint should not have more than two axes of movement. But the special structure of the ligamentous and muscular apparatus, as well as the cartilaginous disc present inside, completely refutes this position:
The listed functions are just an ideal example - in reality, there is a combination of two or three mobility options at once. Such a load on the joint would inevitably lead to its rapid destruction under the influence of continuous work. But, thanks to good blood supply and the absence of support functions, it manages to fully recover from its continuous work.
Pain in the jaw joint is one of the most common. Patients often complain of pain when chewing and moving the jaw. There are many reasons for the appearance of these symptoms. To help the patient, you need to correctly diagnose and find out the cause of the pain.
The temporomandibular joint (TMJ) is considered one of the most used and mobile joints in the human body. It is responsible for opening and closing the jaw, so it almost always works when people talk, chew, yawn, etc.
Diseases associated with damage to the jaw joint are very common. A huge number of patients suffer from pain when moving their jaw; according to statistics, about 40% of the population have at least once experienced discomfort in the TMJ area . However, not everyone seeks medical help; people do not attach serious importance to pain in the temporomandibular joint and usually self-medicate.
Pain in the jaw joint is considered the most common dental pathology after caries and pulpitis.
There are many reasons for joint pain, the most common are:
If your temporomandibular joint hurts, you should consult a doctor immediately. There are many causes of pain, and pain can be a signal of the development of a serious disease, such as osteomyelitis or arthritis.
When the maxillofacial joint hurts, depending on the cause of the disease, the following symptoms may additionally be observed:
Important! When the jaw joint hurts near the ear, this may be a signal of the development of a complication of a dental disease (the development of arthritis, arthrosis, etc.).
With TMJ diseases, patients are concerned not only with pain in the jaw; a common symptom of inflammation is ear pain
Pain in the temporomandibular joint indicates the development of some disease or pathology, the most common cases:
Important! Sometimes the temporomandibular joint hurts after having dentures installed. Pain in this condition is considered normal, since the joint is simply not accustomed to the presence of a “foreign” object in the mouth. If discomfort does not go away for a long time, you should consult a doctor.
Patients with pain in the jaw joint are examined by several doctors to determine the cause of the pathology. Usually the patient goes to see a family doctor, who gives a referral to an appropriate specialist.
If your jaw joint hurts, you should seek medical help. In the process of diagnosing and treating the disease, depending on its cause, various specialists can participate - dentists, orthopedists, rheumatologists, infectious disease specialists, neurologists, otolaryngologists, etc.
If there is acute pain in the jaw joint, you need to apply a cold compress
To determine the cause of pain in the temporomandibular joint, the patient is interviewed, his condition is assessed, and anamnesis is collected. Diagnostics includes the following studies:
If the pain is a complication of a dental disease, the patient is treated by a dentist. Caries is a common cause of infection and inflammatory diseases.
Often, diseases of the jaw joint occur in an acute form, so providing the patient with emergency medical care is the first step to recovery. Patients with acute pain in the TMJ are advised to rest completely, immobilize the affected joint, and apply cold.
Drug treatment depends on the cause of the pain, for example, for inflammation of the jaw joint, the patient is prescribed non-steroidal anti-inflammatory drugs and painkillers (Nimesil, Diclofenac, Ibuprofen, etc.). In case of an infectious lesion of the joint, antibiotics are prescribed, psychological relaxation drugs are prescribed to relieve tension in the muscles, and special dentures and acrylic devices are prescribed to correct the bite.
Physiotherapy effectively combats diseases of the jaw joints; patients are prescribed a course of electrophoresis, UHF, diadynamic currents, etc.
Important! Patients with TMJ inflammation and other joint diseases should not open their mouths wide and eat solid foods. To immobilize the damaged joint, doctors recommend wearing a chin sling or parietal-mental bandage, using dental splints, etc.
If the cause of the pain cannot be determined after laboratory tests, the patient is referred to a CT and MRI of the temporomandibular joint
If conservative therapy does not help, surgical treatment is resorted to. Most often, operations are performed after serious joint injuries or for purulent mandibular arthritis.
Whatever the cause of pain in the TMJ, be sure to see a doctor. Self-medication for this pathology is ineffective and threatens the development of complications.
The temporomandibular joint (TMJ) is a paired joint projected in the area of the front of the ears, located at the place where the skull and lower jaw connect.
The anatomical structural elements of the joint are: the articular head; glenoid cavity; intra-articular disc dividing the joint cavity into the upper and lower floors, the articular capsule and the ligamentous apparatus.
TMJ pathologies include:
Muscular-articular dysfunction of the TMJ can cause disturbances in the functioning of such muscle groups as mastication, facial expression, and cervical muscles; or cause intra-articular disturbances in the movement and position of the disc and (or) ligamentous apparatus.
Degenerative changes in the TMJ are most often described by radiation diagnosticians and manifest themselves in the form of narrowing of the joint space on CT or MRI studies, which is a symptom of other TMJ diseases.
Inflammatory disease of the TMJ, the causes of which can be specific (tuberculosis, syphilis) or nonspecific infectious agents; and autoimmune and connective tissue diseases.
Acquired or congenital disorder of TMJ mobility. It may be a consequence of hematogenous osteomyelitis as a result of umbilical sepsis, rheumatoid disease, trauma and is characterized by heterotopic bone formation and fusion of articular surfaces.
Treatment for TMJ can range from conservative dental and medical treatments to complex surgical procedures. Depending on the diagnosis, treatment may include a short course of anti-inflammatory, painkillers and drugs aimed at muscle relaxation, special mouthguards/plates/splint therapy, consultation with medical specialists on psychological problems and stress.
If non-surgical treatment is unsuccessful or if there is obvious joint damage, surgery may be recommended. Surgery may involve arthroscopy and arthrolavage (a technique identical to orthopedic procedures used to examine and treat large joints such as the knee) or removing damaged tissue and replacing it with implants.
After diagnosing and making the correct diagnosis for problems with the temporomandibular joint, our specialists will provide the appropriate treatment necessary for a particular case.
Every day our joints perform thousands of movements that are very difficult to notice from the outside. One of these is considered to be the temporomandibular joint, which unites formations of the same name. Although its contours cannot be seen from the outside, the structure of this joint is of great interest - there is no other joint in the body that is both complex and combined.
The interaction of all components of the joint is aimed at carrying out physiologically significant movements - opening and closing the mouth. Thanks to this, a person can perform a large number of actions: from chewing to vocal functions. Therefore, the temporomandibular joint, the anatomy of which is highly complex, has such a strong impact on a person’s quality of life.
This joint is located at the base of the skull, where a large number of other anatomical structures are located. Therefore, its structures are quite compact and do not interfere with the functioning of numerous vessels, nerves and the organ of hearing. The joint itself cannot be called simple, since it is surrounded by soft tissues responsible for certain functions.
The structure of the temporomandibular joint is always considered from both sides, since the joints work simultaneously.
Their main characteristics:
Summary table of the main parameters of the temporomandibular joint:
Important! The anatomy of the temporomandibular joint is externally hidden due to the powerful fibers of the masticatory muscle, which carries out the main joint movements - opening and closing the mouth.
The mandible, its anatomy and the temporomandibular joint are very closely related. It is the mobile component that makes all types of movements relative to the temporal bone.
In this regard, it is necessary to know a number of bone features:
Important! In case of injuries and fractures of the lower jaw, both joints suffer, as they are combined with each other.
The temporal bone is part of the skull and is connected to the surrounding bones through sutures. It is a stationary component of the joint - all movements are carried out relative to its surface.
Main characteristics of the temporal bone:
Important! Due to the presence of an articular disc in the joint cavity, movements can become block-like in nature and are carried out only along one axis.
The temporomandibular joint, the structure of which is complex, consists of an articular cavity and a capsule, which also has its own characteristics.
They are associated with the division into 2 anatomical floors through a cartilaginous disc:
Important! The articular cavity of the joint is not significant in size, since the disc occupies its main part.
The temporomandibular joint is small, so its tendons are not large.
But, despite this, they are divided into large and small entities:
Important! A large number of tendons are practically not involved in supporting the articular joint. This function is performed by the muscles that set it in motion.
The cartilaginous plate is located inside the joint cavity, so it is difficult to judge its structure for sure.
In its structure and function, the disc resembles the menisci of the knee joint, although there are still some features:
A large number of vessels that are located in the base of the skull supply the temporomandibular joint from various sources. The arteries closely fit the capsule and supply the formation with oxygen and nutrients.
By value they can be ranked as follows:
Outflow is somewhat simpler. Individual small veins form a larger venous trunk, located below and anterior to the articulation. Next comes one formation - the mandibular vein.
Nerve fibers only approach the sheath, so the innervation is extremely sensitive. In other words, the receptors are irritated only when a mechanical effect occurs on the capsule.
The main nerve trunks that provide this sensitivity are the following:
Important! The trigeminal nerve also has motor branches. They are responsible for the work of the chewing muscles, which provide mobility in the joint.
The structure and functions of the temporomandibular joint are closely related. Based on its structure and shape, it is assumed that movement can only occur in two axes.
But the characteristics of the ligaments and muscles, the articular disc refute this statement:
The temporomandibular joint is a rather complex structure. The photos and videos in this article only confirm its features.
Of the variety of examination methods, it is worth highlighting the most significant and relevant today.
These methods include:
Using radiography you can determine:
Table 1. Distinctive signs of arthrosis and arthritis of the temporomandibular joint:
An orthopantomogram shows both joints at once, this is its advantage.
On a computed tomogram, it is possible to identify structural changes in the bones in more detail, layer by layer and in detail. The possibilities of MRI of the temporomandibular joint are quite wide. You can see the correct implementation of this method in the photo below.
The reasons for conducting magnetic resonance imaging may be signs that were not identified using previously indicated methods, as well as if it is necessary to see the condition of the soft tissues in this area.
Contraindications to MRI are:
The advantage of using this method is that this method avoids radiation exposure to the body and makes it possible to evaluate:
Using ultrasound of the temporomandibular joint, you can visualize the head, disc, ligaments, and muscles of the joint. The relative echogenicity of tissues is determined, similar signs of a pair of joints are compared, and the performance of functions is observed.
Of course, the choice of diagnostic method and technique remains with your doctor, because only he is competent in what signs and by what criteria he needs to evaluate in order to identify or exclude joint pathology.
Pathology of the temporomandibular joint is currently common and is in third position after caries and gum disease. From 40 to 70 percent of Russians suffer to some extent from diseases of the jaw joints. Let's look at some diseases separately.
Arthritis of the temporomandibular joint makes up the bulk of all diseases in this area. We use this particular pair of our joints very often every day, while eating, talking; when laughing, smiling, yawning. Therefore, all problems and pain in the TMJ cause significant discomfort.
Early consultation with a doctor is the main key to success in treatment and serves to prevent chronicity of the process. Myofascial syndrome of the temporomandibular joint is a special case of myofascial syndrome of the face.
This syndrome is characterized by the following:
The strength and tone of the affected muscle decrease, restriction appears when opening the mouth and clicking in the joint itself.
Dysfunction of the temporomandibular joint is observed with painful dysfunction of the TMJ. This pathology is manifested by a constant aching pain in the area in front of the ear canal. The pain can radiate to the cheek, ear, neck, submandibular space, temple, and back of the head. The pain intensifies with wide opening of the mouth and chewing.
It often becomes difficult to open your mouth fully. There may be clicking and crunching in the joint. Palpation of the muscles of the masticatory group is painful, especially the lateral pterygoid muscle. Asymmetry can be detected in the activity of the masticatory muscles using electromyography.
For a complete diagnosis, computed tomography and magnetic resonance imaging are used. For differential diagnosis, consultations with several specialists are prescribed, including a dentist, ENT doctor, and neurologist.
In this case, post-isometric muscle relaxation is very helpful for the treatment of the temporomandibular joint. This technique is usually used by dentists, chiropractors, and physical therapists.
I would like to note that it is with dysfunction that relief is often brought by blockades with local anesthetics such as mandibular anesthesia. To carry out such a blockade, there are certain bone landmarks that are known to any practicing dental surgeon, one of which is the temporal crest of the mandible.
Ankylosis of the temporomandibular joint is observed as a complication of inflammation and/or trauma, including birth. This lesion of the temporomandibular joint occurs twice as often in men and develops mainly in childhood and adolescence. Ankylosis may be accompanied by insufficient development of the lower jaw, dysfunction of the joint itself, and an external defect on the affected side.
In severe cases, this disease requires complex, step-by-step, comprehensive treatment with the participation of a surgeon, orthodontist, and pediatric dentist. The help of a traumatologist, pediatrician, otolaryngologist, psychotherapist, and plastic surgeon is often necessary.
Without timely and proper treatment, this is a very difficult condition, especially considering the young age of the patients, many of whom suffer from an aesthetic defect much more severely than adults.
Modern principles of treatment of the temporomandibular joint consist of several main approaches:
Thus, we can summarize that the treatment of TMJ diseases is a rather complex and diverse task, and therefore requires highly qualified medical personnel, literacy and full awareness of modern diagnostic and treatment methods.
Therefore, do not try to cure yourself! This way you can lose that precious time during which you can already be healthy and smile at the new day without interference or obstacles. The instructions that the doctor follows when working with this education are very complex, since the cost of an error is high. Any deviation, even not the most significant one, can lead to a deterioration in the standard of living.
TMJ arthritis is an inflammation of the main joint used in chewing, that is, opening and closing the mouth. Needless to say, the disease is extremely unpleasant, because it significantly complicates the process of eating and speaking.
A long-term disease can lead to arthrosis and damage the joint of the same name on the opposite side. After all, the temporomandibular joint is a combined joint, which means that it works together with its “twin brother” on the opposite side. Therefore, if one (for example, the left) joint suffers for a long time, this will eventually damage the other (respectively, the right) joint.
To prevent this from happening, you need to know the reasons and prevent the disease in time. If arthritis does occur, you need to correctly identify it and prescribe productive treatment. To better understand the basic principles of diagnosis and subsequent treatment of TMJ, you need to know approximately its anatomy and principles of operation.
The described joint is unique in its own way, and according to several criteria. No wonder it can be so difficult to define.
It is formed by two bones:
The head of the mandible fits into the fossa of the temporal bone. This joint is covered by an articular capsule and is additionally strengthened by many ligaments.
The peculiarity is that the resulting articular cavity is divided into two parts by intra-articular cartilage - the disc. This disc significantly increases joint mobility. When damaged during arthritis, it completely fails to perform its function, which leads to a sharp limitation of movements in the joint. This property makes the joint complex.
In addition, the peculiarity of the functioning of the lower jaw is such that when it moves, both temporomandibular joints are necessarily involved: left and right. This is also very important to take into account, since a complication of damage to one of them is subsequent damage to the opposite one.
In order to prevent either a sharp restriction of movements or subsequent damage to the opposite joint, you need to know the causes of the disease and, if possible, reduce their severity to a minimum.
Arthritis of the temporomandibular joint (not to be confused with the maxillary joint - there is no such thing at all!) is a fairly rare disease. Due to the current circumstances, this disease has not been studied very well, in particular there are many gaps in knowledge about the causes of the disease.
Today, there are several types of temporomandibular joint arthritis based on their cause:
There are many causes for non-infectious arthritis. For example, inflammation in the temporomandibular joint often occurs due to injury. Unlike the direct infectious type, inflammation does not arise due to microbes that have entered the joint cavity from the outside, but due to its own tissues, damaged and rejected by the body.
The arthritis in question can occur some time (at least a month) after the infection. According to the modern hypothesis, during an infectious disease, a cross-reaction of the immune system occurs to the proteins of microorganisms and the proteins of the body that make up the body, including the joints. As a result, the body “turns up against itself” and after some time begins to attack its own joints (in particular the temporomandibular joints).
Often the temporomandibular joint becomes inflamed with rheumatoid arthritis. Then the damage to the joints will be extensive, with the so-called polyarthritis. The small joints of the hands, knees, elbows, and ankles are especially often involved in the process.
A more rare cause of TMJ arthritis is rheumatism. It is characterized by the “volatile” nature of inflammation of the joints and accompanying heart defects.
This truly huge variety of causes in relation to arthritis of the temporomandibular joint is manifested by fairly typical symptoms. Although, of course, there are nuances for each of them (both in the case of symptoms and treatment).
The symptoms of TMJ arthritis are not very difficult to define. Especially when it comes to acute arthritis or exacerbation of the disease. The following symptoms are described below.
The first thing a patient with temporomandibular joint arthritis complains about is, of course, pain. This pain is sharp, occurs suddenly and is immediately intense. If such a symptom occurs, diagnosis and treatment should be started immediately.
It is characterized by intensification when trying to open or close the mouth, move the chin forward and with other movements of the lower jaw. The pain is well localized - the joint “hurts” clearly in its own projection, without spreading over a large area.
At the same time, irradiation of pain to neighboring parts of the body is possible. The most common targets of such irradiation are:
However, other directions of pain irradiation are also possible.
During an exacerbation of chronic arthritis of the temporomandibular joint, as well as in the acute form of the disease, a sharp restriction of the movement of the lower jaw is observed. There are often cases when the patient cannot open his mouth wider than half a centimeter!
Any movements in the joint, albeit scanty, are accompanied by increased pain, which further limits the mobility of the joint, but not physically, but psychologically - not every person will want to endure such high-intensity pain again.
When a patient with arthritis opens their mouth, their lower jaw “shifts” toward the affected joint. This happens because the opposite joint is not damaged, and the volume of movement in it remains the same, that is, greater.
Inflammation of the temporomandibular joint gives typical manifestations of inflammation. Namely:
All these signs are pathognomonic for typical arthritis of the temporomandibular joint. However, with certain forms, nuances are possible.
If the arthritis has become purulent, then symptoms corresponding to purulent inflammation arise:
If you notice such symptoms, you should immediately seek medical help. After all, delay in this case is fraught with serious complications.
When rheumatoid arthritis occurs, then, in addition to the temporomandibular joint itself, many others are affected: small joints of the hands, knee, elbow, and ankle joints. Arthritis caused by this disease is characterized by the so-called “morning stiffness” - the inability to move the joint in the morning, which gradually disappears by lunchtime. A biochemical blood test reveals rheumatoid factor.
The symptoms of rheumatism are somewhat similar. It also affects other joints, which, unlike rheumatoid arthritis, is accompanied by fever and heart defects. A biochemical study determines markers of acute inflammation, for example, CRP. It should be mentioned that these symptoms are more typical during an exacerbation - the so-called. rheumatic fever.
In the case of arthritis of a traumatic nature, the main role is given to the anamnesis. The patient must clearly remember the moment of injury in the lower jaw or area under the ear. Trismus often occurs, which is why arthritis can be confused with manifestations of meningitis, brain lesions, or trigeminal nerve syndrome. Traumatic arthritis requires immediate consultation with a specialist, since often without medical help it develops into ankylosis of the joint - permanent absolute immobility of the lower jaw with the inability to open the mouth.
The discovery of a large number of the symptoms described above speaks in favor of TMJ arthritis. However, for a more accurate diagnosis, it is recommended to use modern instrumental methods.
A diverse arsenal of tools is used today to diagnose TMJ arthritis. However, not all of them are super effective in diagnosing the disease. Here are the most common methods:
Quite an old and far from the most effective method for diagnosing arthritis. The x-ray does not clearly show soft tissues, but they are responsible for the manifestations of arthritis. Therefore, x-rays are not very good in diagnosing this disease, which can only be judged by indirect and not very reliable signs such as increased joint space or swelling of surrounding tissues.
The method also imperfectly visualizes damaged soft tissue, but has higher resolution and better tissue differentiation. This provides more information and allows you to identify arthritis with greater confidence.
However, this method is still more suitable for arthrosis - long-term complications of chronic arthritis, than for the arthritis itself, especially at an early stage.
Ultrasound perfectly “sees” the fluid in the joint. This is exactly what you need. After all, arthritis is characterized by swelling of the joint, which means excessive accumulation of fluid. However, the method does not visualize the soft tissue structure very well. And in the case of the temporomandibular joint, it is often difficult to place the sensor in such a way as to see some of the details of interest.
The most expensive, slowest, most high-tech method. It allows you to thoroughly study both soft tissue and the amount of fluid in the joint cavity. This allows arthritis to be detected at the earliest stages with a high degree of reliability.
Treatment should be aimed at both the symptoms of the disease and its underlying cause.
At the very beginning of treatment, the lower jaw is immobilized. This is done using a special sling-shaped bandage. Recommended duration is three days. If arthritis is traumatic in nature, then in parallel with this it is necessary to apply cold compresses.
The next step is to remove the pain symptom. This is most often done by taking NSAIDs, which, in addition to relieving pain, reduce the severity of inflammation.
If the infectious nature of arthritis is identified, then antibiotics are indicated as treatment. In the case of a purulent form, drainage of the joint is required to remove pus from its cavity.
Next, a course of physiotherapy is recommended. It also relieves pain, reduces the severity of inflammation and increases the regenerative potential of tissues. In addition to this, it is recommended to take special medications that promote better regeneration and restoration of damaged tissues - chondroprotectors.
When it comes to diseases such as rheumatism, rheumatoid fever, gout and others, it is necessary, in addition to the procedures described above, to take measures to treat the underlying disease.
Perhaps the most important thing in the treatment of TMJ arthritis is that it should be done by a specialist. An irresponsible approach in this case is fraught with serious complications: ankylosis of the TMJ, hearing loss, etc.