ANKYLOSIS OF TMJ AND

SUBLUXATION
 AIMS AND OBJECTIVES

It aims to provide and overview of ankylosis

of tmj and subluxation there etiology clinical
features and about management .
TMJ ankylosis is a pathologic condition
where the mandible is fused to the fossa by
bony or fibrotic tissues.
 CONTENTS
•ANKYLOSIS OF TMJ
DEFINATION
CLASSIFICATION
ETIOLOGY
ETIOPATHOGENESIS
CLINICAL FEATURES
MANAGEMENT
•SUBLUXATION
•CONCLUSION
•FREQUENTLY ASKED QUESTIONS
ANKYLOSIS

 Ankylosis of the Temporomandibular joint, an

arthrogenic disorder of the TMJ, refers to restricted
mandibular movements (hypomobility) with deviation to
the affected side on opening of the mouth.
 CLASSIFICATION

• Bilateral or Unilateral ankylosis

• Fibrous ankylosis or Bony ankylosis

• Intra-articular or Extra-articular ankylosis

• Complete or Partial ankylosis

• True or false ankylosis

True ankylosis
Intra-capsular condition - fusion of the bony False ankylosis
surfaces of the jaw - the condyle and gleniod Damage to the tissues
fossa.
directly adjacent to
Pseudo-ankylosis the joint from trauma,
Mechanical interference - joint hypomobility infection or radiation.
and the joint is normal.
Fibrous ankylosis, coronoid hyperplasia or
fusion of coronoid process with the tuberosity
of maxilla or zygoma are examples.
ETIOLOGY
 ETIOPATHOGENESIS
Microtrauma

Trauma Local Infections Systemic Infections

Hemarthrosis

Drop in O2 Tension & PH

Promotes Osteosynthesis

Ankylotic Mass
 CLINICAL
FEATURES
•Obvious facial deformit
•Deviation of chin towards affected side
•Inability to open the jaws, absent condylar movements
on affected side

•In unilateral ankylosis, the lower jaws

shifts towards the affected side on opening
of the mouth
•Flatness or fullness on affected side
•Cross bite on ipsilateral side
•Class II malocclusion on affected side
BILATERAL ANKYLOSIS

 Inability to open the mouth

 Mandible symmetrical but micrognathic
 Bird face deformity
 Antigonial notch well defined bilaterally
 Upper incisors protrusive with ant open bite
 Multiple carious teeth with bad PDL health
 Severe malocclusion , crowding .
 Multiple Impacted teeth may be found on radiograph
 RADIOGRAPHIC FEATURES

 Fusion of joint
 Loss of joint space
 Prominent antegonial notch
 Coronoid hyperplasia

Antegonial notch prominent

TREATMENT DECISION MAKING
SUBLUXATION
 SUBLUXATION (HYPERMOBILITY)

 variation in anatomic form of the fossa

Clinical description of condyle as it moves anterior to crest of articular
eminence.
Cause: result of anatomic form of fossa; steep short posterior slope of
eminence- longer flat anterior slope.
Results when disc is maximally rotated on condyle before full translation.
History :
 Patient reports locking sensation on opening few too
wide and difficulty in returning mouth to closed
position.

 Clinical cosiderations:

 During the final stage of maximal mouth opening

there is sudden jump of condyle forward with a
‘thud’ sensation.

 Definitive Treatment – Eminectomy- reducing

steepness of eminence.
SPONTANEOUS DISLOCATION /OPEN LOCK

causes :
 forcing it open beyond normal restrictions causes disc to be
trapped in an ant position.
History :
 - associated with wide open mouth procedures such as long
dental appointment or extended yawning that does not
allow patient to close the mouth.
C/C :
 patient remains in wide open mouth condition
 pain is commonly present secondary to the patients attempts
to close the mouth
 Definitive treatment  manual manipulation for reduction
 CONCLUSION

o THE TEMPOROMANDIBULAR JOINT IS A COMPLEX JOINT, BOTH

MORPHOLOGICALLY AND FUNCTIONALLY.
o SO MANAGEMENT FOR TEMPEROMANDIBULAR DISORDERS, CONSERVATIVE
TREATMENTS OR NON-INVASIVE AND REVERSIBLE TECHNIQUES ARE
CONSIDERED TO BE THE FIRST TREATMENT CHOICES FOR TMD.
 FREQUENTLY ASKED QUESTIONS

-Describe in detail about ANKYLOSIS

OF TMJ
And write its management?
-Write in detail about subluxation?