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1、Unit Nine Diseases of the Temporo - mandibular Joint,The common diseases of the temporo - mandibular joint are subluxation,dislocation and ankylosis.The infection of this joint is rare.,Subluxation半脱位 Dislocation脱位 Ankylosis关节强直,Subluxation. Subluxation refers to a selfreducing derangement between t
2、he components of a joint.,Selfreduce自行使复位 Derangement紊乱,When referring to the temporo- mandibular joint, the term frequently is used to describle the situation when the condyle moves anterior to the articular eminence during opening excursion. The main symptoms are crackle, pain and limitation of ja
3、w. The treatment is very complex.,Condyle髁状突 Articular关节的 Eminence隆凸,隆起 Excursion移动 Crackle弹响,Dislocation of the temporo - mandibular joint. The temporo - mandibular joint may become dislocated as a result of external trauma, sudden or prolonged wide opening.,Trauma创伤,Predisposing to dislocation is
4、usually extreme capsular laxity, such as that associated with chronic subluxation, a wide opening can pull the condyle overforward to become located in front of the articular eminence, and then it can not return to the glenoid fossa.,Predispose使易罹患 Laxity松驰 Glenoid关节窝的,Ankylosis of the temporo - man
5、dibular joint.Ankylosis can be divided into two categories: falseankylosis and true ankylosis.,False ankylosis: False ankylosis may be due to trauma, such as gunshot wounds, with or without involvement of jaw bone, in healing of which there has been considerable formation of scar tissue either in th
6、e muscle or in the soft tissues anywhere between the upper and lower jaws.,Scar tissu瘢痕组织,Inflammation in this area may be followed by organization of exudate and formation of fibrous tissue. False ankylosis may be due to scars following extensive intraoral ulceration,Exudate渗出物 Ulceration溃疡,the res
7、ult of noma, scarlet fever or other acute exanthemas. It is frequently seen after treatment of malignant growth of the mouth by cautery, X - my and radium.,Noma坏疽性口炎 Scarlet fever猩红热 Exanthemas疹 Cautery烧灼术,In false ankylosis, there still nearly always be some movement present. The cause of the limit
8、ation will usually be evident on examination. The amount of resistance encountered to attempt to separate the jaws should be tested by means of wedge mouth gag inserted between the teeth.,By means of藉 Wedge楔 Mouth gag开口器,In mild cases, this re-sistance may be slight and easily overcome by the mouth
9、gag. In others, it may be impossible to produce any separation beyond a certain millimeters.,The scar may be seen in the mucosa,skin or both of the cheek. In the gunshot and noma cases,there may be some tissue defect on the lip and cheek, the teeth are exposed to sight. If the scar is located betwee
10、n the maxillary tuberosity and mandibular ramus, it can not be seen or palpated.,Mucosa粘膜 Defect缺损 Maxillary tuberosity上颌结节 Mandibular ramus 下颌升支 Palpate触诊,The extensive scar may involve the entire mucosa of the cheek; in this condition, the separation of the mandible is impossible.,Treatment. The s
11、car bands should be cut or dissected out. The raw surface must be covered with split skin grafts, because simply cutting dense adhesion leaves a broad raw surface to granulate.,Dissect解剖,切开 Graft移植物 Adhesion粘连 Granulate生肉芽,When the wound heals, it produces more scars and will contract, and the condi
12、tion will not be in the least improved. If the scar extents from the cheek to the face or there is some tissue defect,Contract收缩,the cheek and face must be repaired by a skin flap or a skin tube that were planned before the operation.,Skin flap皮瓣 Skin tube皮管,True ankylosis. True ankylosis may follow
13、 any of the suppurative conditions of the joint, resulting either from extension of infection from local structures, such as the middle ear or from metastatic septic arthritis.,Suppurative化脓性的 Metastatic转移性的 Septic脓毒性的 Arthritis关节炎,Bony union of the joint surfaces and surrounding parts may also occu
14、r after severe traumatism, such as blow or fall on the chin, in which the main part of the force is received in the region of the condyle.,Severe严重的 Blow打击 Chin颏 Force力,Deformity. After prolonged ankylosis, especially when dating back to early childhood before full development of the mandible, a cha
15、racteristic deformity may be present. The condyloid process is shortened.,Deformity畸形 Date back起至 Development发育 Condyloid process 髁状突,This causes an apparent elongation of the coronoid process. The angle of the mandible is elongated, so that it forms a point projecting downwards, and the base of the
16、 bone under the mental foramen is thickened.,Elongation伸长 Coronoid process Mental foramen颏孔,The mental process is much diminished in size, causing an apparent recession. The base of the bone, between the angle and a point vertically under the canine region, is deeply concave in outline.,Recession后退,
17、凹处 Canine region Concave凹的,The cause of these changes lies in the activity of the muscles that depress the jaw. The muscles of mastication, i. E, those which elevate the lower jaw are inactive, while those which assist in depressing the mandible become more and more active in an endeavor to overcome the fixation of the articulation.,
