TMJ ankylosis

Conservative and minimally invasive treatment

Treatment of internal TMJ derangements requires a multidisciplinary approach involving prosthodontists, orthodontists, and maxillofacial surgeons. At initial stages, conservative therapy shows high efficacy. It includes rational prosthetics, bite correction, and the use of occlusal splints and therapeutic mouthguards.

When synovitis develops, drug therapy is prescribed (NSAIDs, such as diclofenac sodium or nimesulide), and after inflammation subsides — physical therapy and medical gymnastics. For recurrent articular disc dislocation with joint locking, blocks of the motor branches of the trigeminal nerve are used, and for muscle spasm — transcutaneous electrical nerve stimulation (TENS). Even if the disc cannot be reduced due to adhesions or changes in its shape (which is confirmed by MRI), adequate treatment relieves the pain syndrome and improves joint function.

If conservative measures fail, the patient is transferred to a hospital for minimally invasive procedures:

• TMJ lavage: puncture under local anesthesia with joint irrigation to break down adhesions and widen the joint space.
• Arthroscopy: an endoscopic method that allows simultaneous diagnosis and elimination of intra-articular adhesions.
• Surgical reduction: indicated when the clinical picture of irreducible displacement and disc deformation persists.

TMJ osteoarthritis

Osteoarthritis is a degenerative-dystrophic disease primarily affecting the articular cartilage, and secondarily — the underlying bone tissue. Unlike arthritis, reactive synovitis here is secondary in nature, while the inflammatory component is mild and occurs episodically.

The disease is divided into primary (damage to initially healthy cartilage) and secondary (against the background of trauma, arthritis, endocrine disorders). TMJ osteoarthritis is more common than inflammatory pathologies, and its local causes include muscle hypertonus, occlusion disorders, and joint trauma.

Clinical forms of osteoarthritis:

1. Sclerosing: characterized by subchondral sclerosis (bone compaction). It proceeds with a minimal number of complaints and mild pain.
2. Deforming: accompanied by enlargement of articular surfaces, formation of osteophytes (bone spurs), and deformation of the mandibular condyle. Patients complain of stiffness, crepitus, and constant pain aggravated by movement.

Radiological signs include compaction of bone margins, subchondral sclerosis, narrowing of the joint space, and limitation of condylar movements. Treatment aims to eliminate the cause (rational prosthetics), pharmacological support (NSAIDs, chondroprotectors), physical therapy, and, in severe cases, surgical remodeling of the mandibular condyle.

Temporomandibular joint pain dysfunction syndrome

Painful dysfunction syndrome is one of the most difficult pain syndromes to diagnose in the maxillofacial region. According to ICD-10, it belongs to maxillofacial anomalies, but in clinical practice, it is considered a TMJ disease since pain is directly related to mandibular movements.

The pathology has a pronounced gender specificity: over 70% of patients are women. This is due to steroid imbalance, metabolic disorders, and a tendency toward joint hypermobility. In the vast majority of cases, the syndrome arises from iatrogenic disorders in the dentition system (errors in prosthetics, filling) or neuromuscular disorders against the background of stress.

Clinical picture:

• Pain radiating to the neck, head, and jaws.
• Limitation of mouth opening.
• S-shaped movement of the mandible when opening the mouth.
• Clicking or crepitus in the joints.
• Tenderness of isolated masticatory muscles upon palpation.

To confirm the diagnosis and relieve muscle spasm, diagnostic blocks (according to Bersh–Dubov or Egorov) are used. Administration of a 0.5–1.0% lidocaine solution makes it possible to distinguish muscle pain from joint pain: if the pain disappears after injection and the mouth opens wider, the diagnosis of pain dysfunction syndrome is considered confirmed. The course of treatment usually includes 4–6 blocks.

Class and exam questions

What else to study on this topic

• Methodology for performing blocks of the motor branches of the trigeminal nerve (according to Bersh–Dubov and Egorov).
• Principles of rational prosthetics and the use of occlusal splints in TMJ pathologies.
• Radiological and MRI diagnosis of articular disc deformations.
• Physiotherapeutic methods: magnetotherapy and ultraphonophoresis with hydrocortisone.

Other topics in "Chapter 13. Temporomandibular Joint Disorders (V.V. Bekreev)"

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