Disorders of the temporomandibular joint and their consequences

1. Temporomandibular (articilatio temporomandibularis)

Complex, biaxial, combined.

It consists of a capsule that wraps around the joint of bone surfaces and is additionally attached to the articular disc.

Bundles:

1). Lateral (ligamentum laterale) – thickening of the lateral surface of the capsule

2). Caudal ligament (ligamentum caudale) - from the postarticular process of the temporal bone to the condylar process of the mandible.

2. Atlantooccipitalis (articulatio atlantooccipitalis)

Consists of two elliptical joints, each of which has its own capsule.

Membranes:

-dorsal atlanto-occipital - from the dorsal arch to the squama of the occipital bone

-ventral atlanto-occipital - from the ventral arch of the atlas to the body of the occipital bone.

Bundles:

1). Lateral ligament (ligamentum laterale) - from the jugular process to the craniomedial edge of the atlas wing.

3. Atlantoaxial (articulatio atlantoaxialis)

Complex cylindrical rotatory joint. Consists of a capsule, dorsal atlantoaxial membrane (connects the arches of the 1st and 2nd cervical vertebrae) and ligaments.

Bundles:

1). Dorsal and ventral atlantoaxial ligaments - from the corresponding tubercle of the atlas to the epistrophic crest.

2). Ligamentum apices dentis - from the apex of the tooth to the body of the occipital bone.

3). Longitudinal ligament of the tooth (ligamentum longitudinale dentis) - from the epistrophic tooth to the body of the occipital bone.

Long ligaments of the spinal column

1). Supraspinous ligament (ligamentum supraspinae) - from the top of the longest spinous process to the spinous processes of the sacrum and the sacral tuberosities of the ilium.

2). The nuchal ligament (ligamentum nuchae) is paired and consists of a cord and a plate.

The cord is an elastic cord, from the scales of the occipital bone to the top of the highest spinous process.

The plate is from the spinous processes of the cervical and 1st thoracic vertebrae to the cord of the nuchal ligament.

3). Dorsal longitudinal ligament - from the epistrophy to the sacrum.

4). Ventral longitudinal ligament - from the ventral surface of the 8-9 thoracic vertebrae to the promontory of the sacrum.

TMJ dysfunction - causes and consequences.

Orthodontist-dentist Nikolaeva Nadezhda Nikolaevna

The temporomandibular joint ( TMJ ) is a paired joint formed by the head of the mandible, the mandibular fossa and the articular tubercle of the temporal bone. The heads of the mandible meet at an obtuse angle at the anterior edge of the foramen magnum. The TMJ ensures the movement of the lower jaw and represents a complex activity of the body in the form of chewing, swallowing, talking, yawning. The muscles of mastication ensure precise movement of the joint in an error-free manner, unless there is dysfunction ( TMJ )
. According to WHO, about 40% of the population aged 20-50 years suffer from TMJ . But not every person seeks help from a gnathologist or osteopath with complaints about the joint, preferring to visit other doctors with headaches, fatigue, attacks of fear, pressure... Dysfunction manifests itself in the form of a neurological clinic: headache, dizziness, clicking and crunching joint, muscle tension, spasms in the head, neck, throat. Otology clinic: noise, ringing, ear congestion, hearing loss. But there are other, hidden and long-term consequences of TMJ dysfunction:

Cervical lordosis. Poor posture, when the neck is excessively straightened or, on the contrary, the head protrudes noticeably relative to the person’s body.
Curvature in the sacroiliac joint (pelvic bones) as a result, a change in the length of the limbs.

With pain and dizziness, it would seem clear: head, ear, joint. Everything is close, everything interacts. But what effect does TMJ on the entire musculoskeletal system, especially on the length of the limbs?

The TMJ is the structure of one complex - the DENTAL GNOSTIC system. The dental system is a complex of interactions between the structures and functions of the head and neck. Includes components of the bones of the skull, lower jaw, hyoid bone, clavicle and sternum, muscles and ligaments, joints, vascular, lymphatic and nervous systems, as well as soft tissues of the head and teeth. In addition, it has a connection with the sacrum and coccyx through the dura mater. Everything in the system is interconnected and depends on the normal functioning of all its parts.*

Main functions of the dental system:

Providing basic body functions: chewing, swallowing, biting, speaking, breathing.
Participation in maintaining statics: gait mechanism, cervical, vertebral and muscle balance, pelvic balance, equilibrium.
Effect on cranial (cranial) function - especially the temporal bone.
Influence on the functions of the nervous, endocrine, lymphatic systems.

Let's look at the basic functions of the body: chewing, swallowing, speaking, breathing. These basic body functions are performed through the movement of the lower jaw. The movement of the lower jaw is ensured by the movement of the head of the lower jaw in the articular fossa of the TMJ , with the help of the temporal, masticatory, pterygoid, hypoglossal and other muscles. The line of closure of the teeth - the occlusal plane, or simply the bite, should normally be parallel to the planes of the entire musculoskeletal system. The main planes of which pass through the pupils, the line of closure of the teeth, the second and third cervical vertebrae, shoulder blades, iliac crests, knees and ankles. The parallelism of the lines indicates the health of the musculoskeletal system and the dental system. A change in any of the planes leads to changes in the other planes. Therefore, a violation of the occlusal plane relative to others can cause pain and negative changes in completely unexpected parts of the body.

Violations of occlusion as a result of tooth wear, congenital malocclusion, and more often, inadequate dental treatment or prosthetics, inept use of braces, illegal removal of healthy teeth, lead to response disorders in the cervical spine and spasm of the muscles of the back of the neck. Prolonged spasm causes structural changes in the muscle, shortening it and causing it to lose its ability to contract and relax. Muscle spasm leads to spasm of the chewing and facial muscles. Thus, for the body, muscle spasm on one side is a pathological process that leads to spasm in another area. For example, the temporal muscle is involved in supporting statics; the masticatory muscles are its synergist. These muscles contain a large number of proprioceptors (sensory fibers). A constant flow of nerve impulses from proprioceptors is involved in the regulation of the vertical position of the body. Violation of occlusion (bite) leads to unbalanced movement of the lower jaw and maxillofacial muscles, incl. masticatory and temporal muscles. A change in the flow of nerve impulses, due to dysfunction of the TMJ , causes curvature of the spine in the cervical region and sacroiliac joint, which leads to twisting of the pelvis and changes in the length of the limbs.

An imbalance in the TMJ sends a negative stimulus to the nervous system 24 hours a day, 7 days a week. Any malocclusion changes the direction of force in the skull. For example, premature contact on the lateral teeth causes uncoordinated muscle movement and distortion of nerve impulse transmission to the brain. Uncoordinated muscle movements often cause tension in the fascia of the neck. The nodes of the sympathetic trunk of the autonomic nervous system lie anterior to the prevertebral fascia of the neck. Thus, dysfunction of the TMJ , causing tension in the fascia of the neck, can irritate cervical sympathetic communications, provoking a reflex spasm of the vessels of the head. Spasm of the blood vessels in the head causes a disturbance in the blood supply to the cerebellum, which is manifested by a lack of coordination, dizziness - as a result of anxiety. TMJ dysfunction causes torsion (torsio; Latin “rotation, twisting”) of the temporal bone, in which the labyrinth with the vestibular apparatus is located. Changes in the vestibular system lead to imbalance and dizziness. Nasal congestion may also be associated with TMJ . Due to the shortening of the fascia of the neck muscles, there is a violation of lymphatic drainage and the outflow of venous blood from the head. This may manifest itself in the form of tissue edema in the area of the nasal passages, since this area is rich in blood vessels. Diseases of the temporomandibular joint have the following causes :

Malocclusion (occlusion) is a closure of the teeth, which disrupts the shape and function of the dental system. This manifests itself in the form of deformation of the occlusal surface of the teeth with blockade of the movement of the lower jaw. Which can lead to pathological wear of teeth, functional overload of the TMJ and chewing muscles. The most common TMJ problem is a decrease in bite height. This is due to several factors: impaired teething, bruxism, premature loss of milk or permanent teeth, congenital absence of a group of teeth, microdontia (small teeth), pathological abrasion of enamel, violation of the vertical size of teeth due to the work of the dentist. Changes in the position of the TMJ due to illiterate orthodontic treatment, illegal or forced removal, tooth decay.
Stress (overexertion, strong clenching of teeth).
Jaw trauma (fractures of facial bones and jaw).
Endocrine, metabolic disorders, infectious diseases.
Excessive physical activity.
Bad habits (biting nails, holding the phone incorrectly, etc.)

Symptoms of temporomandibular joint diseases:

Headache, spasms in the facial muscles and jaw area.
Clicking, crunching, grinding when the jaw moves.
Pain, congestion and ringing in the ears.
Enlarged submandibular lymph nodes.
Dizziness.

TMJ diseases on human health is far from being studied, in contrast to the methods of diagnosis, treatment and restoration of TMJ by a doctor. In most cases, a transparent corrective aligner is enough to save yourself from many present and future health problems.

How is your neck structured?

It almost always starts with pain or discomfort in the neck area. However, when collecting anamnesis in patients with cerebral pectoral or brachial vertebrogenic syndromes, it is not often possible to hear about this. However, if you carefully question the patient, he will definitely tell you about neck pain in the past. The latter may occur in paroxysms. In this case, they are called cervical lumbago. These are acute pains. Acutely occurring pain and long-lasting pain are called cervicalgia. Cervical lumbago can be very intense - “piercing”, “like an electric shock”; cervicalgia is a boring pain, sometimes dull, in the depths of the neck, arising and intensifying with strictly defined movements for each patient. The pain appears more often in the morning, especially after sleeping on an uncomfortable pillow, and is accompanied by a feeling of stiffness in the neck. They are especially intensified during active efforts, both static and dynamic: getting out of bed, working at a desk, driving a car on the freeway, but more so in the area of a populated area, near a stationary object and on a conveyor belt. Thus, active activity of the neck muscles during periods of exacerbation of osteochondrosis increases pain. However, even during these periods, not every muscle activity leads to pathology. We will dwell on what muscle activity at this stage does not worsen the condition, but, on the contrary, prevents such deterioration by providing local myofixation, when discussing issues of prevention and treatment of the pathology under consideration.

Some patients complain of a feeling of a foreign object in the neck, such as a “cola” or “extra bone”. Others talk about the “glands”, “balls”, “bones” they feel under the skin and in the depths of the neck. It is curious that the impression of the presence of such substrates is not unfounded. These compactions, granules, really exist. A doctor can also palpate them. But these “tumor” lumps, palpable by the patient, were always there. It’s just common for a person to constantly knead, massage, and knead the sore spot during periods of pain. Detected or supposedly “new” formations usually turn out to be small muscles, ligaments, and compactions of the fat layer, which can be painful in dystrophic syndromes. With repeated cervicalgia, a person sometimes complains of a cracking sound in the cervical vertebrae. Sometimes this sound is very intense - and the patient thinks that the crackling sound is heard by others. Sometimes the pain radiates to the cervicothoracic spine or to the interscapular region. Such circumstances disorient an inexperienced doctor who hastily diagnoses “thoracic osteochondrosis.”

What are the mechanisms of occurrence of cervical lumbago and their varied pain pattern? To answer this question, we should return to the problem of dystrophic pathology of the cervical region.

As previously reported, intervertebral discs receive less nutrition than other tissues. Existing only through osmosis and diffusion, they are the first to age, losing their elasticity and strength. The fibrous ring begins to stretch, and then the nucleus pulposus falls out - a herniated disc. It affects surrounding tissues and irritates their receptors. It should be noted here that the tissues surrounding the disc (and primarily the posterior longitudinal ligament) are extremely abundantly supplied with receptors that perceive nocicent stimuli. From the receptors, pain impulses follow through the recurrent sinuvertebral nerve of Luschka into the spinal cord, from where they reach the thalamus and the posterior central gyrus through the spinothalamic tract - the patient feels pain in the depths of the neck. However, the source of pain (etiological factor) can also be pathology of the intervertebral joints. The fact is that the capsule surrounding the intervertebral joint, as it were, protrudes into the articular intervertebral space; its outer sections are made of a kind of ring of collagen-cartilaginous structure. Since this ring in its structure and function resembles the meniscus of the knee joint, it is called meniscoid. The pressure inside the joint capsule and, accordingly, in the ring area is negative. What is the possible role of meniscoids in the occurrence of lumbago? It turns out that damage in the meniscus area occurs especially easily in conditions of unexpected (unpredicted) movements. Thus, lumbago often occurs when there is an unexpected change in position, for example in icy conditions. When performing any motor act, the central nervous system at the subcortical level ensures its coordinating regulation according to a predicted program. There is also probable prediction at the cortical level. This is, for example, preparation for lifting weights. Both in the first case and in the second, an unexpected action (a push from behind, a jerk of a suitcase, a barbell) due to discoordination, disruption of the programmed movement pattern as a result of insufficient local myofixation produces excessive displacement in the intervertebral joint, its subluxation, the joint space increases, the microstructure of the meniscoid changes and capsules. Due to the negative pressure in the intervertebral space, the meniscoid is pulled into the joint cavity, followed by the capsule.

The periarticular tissues are supplied with a large number of pain endings. They send a discharge of impulses along the radicular dendrites to the spinothalamic pathway, to the ansor cortex - pain sensations appear in the neck area. Cervicalgia, quite acute, due to excessive and awkward movements of the head can be caused by a chronic degenerative process in the joints and membranes. All these manifestations in the area of intervertebral joints and their capsules (periarticular tissues) constitute the essence of cervicospondyloperiarthrosis syndrome. It is manifested by stiffness in the neck, pain and tenderness of the intervertebral joint capsule. Both in response to protrusion of the nucleus pulposus and in response to subluxation or degeneration of the intervertebral joints and their capsules, a reflex defence of the paravertebral muscles occurs.

There is also a rational protective mechanism in this - local myofixation is formed. A tense muscle corset protects this part of the spine from hypermobility. However, this tension simultaneously leads to a further increase in the load on the affected disc (static compression), to further “squeezing out” the hernia. The subsequent increase in hernia pressure leads to increased defence. Thus, the mechanism of a vicious circle unfolds. Since reflex muscle tension occurs in response to an inadequate, unpredictable stimulus, the muscle response is chaotic, and muscles of the most diverse function and strength are involved. Hence the forced position of the head, and torticollis, and sclerotomy pain in the thoracic region. Due to pathology in the osseous-ligamentous apparatus of the spine, the discharge of impulses also reaches the muscles of the shoulder joint. The bombardment of pathological impulses, addressed to various muscles of the neck, also reaches the anterior scalene muscle. This leads to torticollis and pain - the asymmetrical tension of these muscles does not so much fix the neck as deform it.

Author: V.I. Dikul