Dr.

Swapnali Modak

Unique structurally and functionally. Horse-shoe shape bone that articulates with temporal bone at each end. Thus mandible has two different but connected articulations. formed by condyle of mandible inferiorly and articular eminence of temporal bone superiorly with an interposed articular disk. synovial hinge type joint. plays role in phonation,facial expression,mastication and swallowing.

Stationary segment of TM Joint is temporal bone. Condyles of mandible sits in glenoid fossa of temporal bone. Glenoid fossa is located between posterior glenoid spine and articular eminence of temporal bone. Mandible is distal or moving segment,it devides into body,two ramus with coronoid process and mandibular condyles. Mandibular condyles is having medial and lateral pole.each condyle protrudes15 to 20 mm medially from ramus. Articulatig surfaces are covered with dense, avascular collagenous tissue reffered to as fibrocartilage. To withstand repeted hgh level stress.

Articular disk is biconcave,anterior and posterior portion of disk is vascular and innervated while middle portion is avascular. Disk appears to be firmaly attched to medial and lateral pole of condyle of mandible,allows it to rotate freely on disk anteroposterior in direction. Disk attaches to joint capsule anteriorly as well as lat.ptregoid muscle,restrict post. translation of disk. Post.attach to bilaminar retrodiskal pad.

Joint is supported by short capsular fibers running from temporal bone to disk and from disk to neck of condyle. Temporomandibular ligament:2 partsouter oblique portion And inner portion of ligament. Stylomandibular lig.:band of deep cervicle fascia runs from styloid process to temporal bone to pos.border of ramus of mandible. limits protrusion of jaw. Sphenomandibular lig.:attaches to spine of sphenoid bone to middle surface of ramus of mandible.

Motion of TM Joint:1.mouth opening(mandibular depression) 2.mouth closing(elevation)3.chin forward(protrusion)4.sliding teeth to either side(lat. Deviation)

Mouth Opening:2 Phases: Rotation and glide. Ant. rotation of condyle on disk in lower joint and ant. and inferiorly translation of diskcondyle along articular eminence. Normal mouth opening -40 to 50 mm. Mandibular elevation(mouth closing):Reverse of depression.

There have been recent advances in the rehabilitation of the muscles that control the head and neck. These advances are based on evidence of specific neck muscle dysfunction in individuals with persistent head and neck pain. Traditional rehabilitation strategies have focused predominantly on muscle strength and endurance under high loads. New evidence suggests that in people with neck pain there are underlying neuromuscular problems that may require more immediate attention and may not be adequately addressed by simple strength and high-load endurance retraining.

Evidence of altered coordination between the deep and superficial neck muscles, greater neck muscle fatigue under sustained low loads, and deficits in kinaesthetic sense have been identified in symptomatic individuals. There is evidence to indicate that addressing these muscle control problems, with specific gentle exercise strategies, results in a reduction in neck pain and associated symptoms.

AII points of mandible moves forward at same amount. Protrusion: ant and inf. Mov of disk and condyle with articular eminance. Retrusion :all points moves posteriorly at same amount.

Lat. deviation to one side ,one condyle spins around vertical axis and other condyle translate forward.

Inflammatory condition: 1.capsulitis 2.synovitis Capsular fibrosis

Osseous mobility condition

Articular disk displacement Degenerative condition

Pain in area of jaw Increase or decrease active or passive rom Clicking noises Difficulties with functional activity of mandible Locking of jaw Forward head posture

Active exercise, manual mobilisation, postural training is effective Mid laser is the best than any other modality. Combination of above + relaxation is more effective. Biofeedback, emg training, proprioceptive reeducation,relaxation>placebo effect orocclusal splint.