DISEASES OF THE TEMPOROMANDIBULAR JOINT AND FORMULATION OF DIAGNOSIS

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DISEASES OF THE TEMPOROMANDIBULAR JOINT AND FORMULATION OF

DIAGNOSIS

Axmedova Malika Qilichovna

Asia International University.

Bukhara, Uzbekistan.

E-mail:

axmedovamalika1982@gmail.com

https://doi.org/10.5281/zenodo.14633181

Abstract. Comparatively recently, back in the 80s of the last century, differential

diagnostics of diseases of the temporomandibular joint (TMJ) was carried out between the most

common diseases of the temporomandibular joint - habitual dislocation and subluxation of the

lower jaw, arthritis and arthrosis. Later, works began to appear in which the diagnosis made, for

example, "dislocation of the meniscus of the TMJ" went beyond the international classification of

diseases (ICD), new nosological forms began to appear in the classifications, for example,

muscular-articular dysfunction.

Key words: temporomandibular joint, articular disc, arthritis, arthrosis, dislocation of the

head of the lower jaw.

ЗАБОЛЕВАНИЯ ВИСОЧНО-НИЖНЕЧЕЛЮСТНОГО СУСТАВА И

ФОРМУЛИРОВКА ДИАГНОЗА.

Аннотация. Сравнительно недавно, еще в 80-х годах прошлого века,

дифференциальная диагностика заболеваний височно-нижнечелюстного сустава (ВНЧС)

проводилась

между

наиболее

распространенными

заболеваниями

височно-

нижнечелюстного сустава — привычным вывихом и подвывихом нижней челюсти,

артритами и артрозами. Позднее стали появляться работы, в которых поставленный

диагноз, например, «вывих мениска ВНЧС» выходил за рамки международной

классификации болезней (МКБ), в классификациях стали появляться новые нозологические

формы, например, мышечно-суставная дисфункция.

Ключевые слова: височно-нижнечелюстной сустав, суставной диск, артрит,

артроз, вывих головки нижней челюсти.

The rapid further development of medical science and, in particular, the study of TMJ

pathology, was facilitated by the emergence in recent decades of highly effective technologies

such as computed tomography (CT), magnetic resonance imaging (MRI) and TMJ arthroscopy,

which significantly expanded diagnostic capabilities and revealed many previously unknown

details of structural changes in the TMJ. It became possible to visualize the soft tissue structures

of the TMJ, it was established that many pathological processes are explained or accompanied by

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a violation of these structures - the articular disc, intra-articular ligaments and capsule, and these

diseases, according to many authors, account for 70 to 80% of all cases of TMJ lesions.

Currently, the most common classification used in our country and abroad is the

classification of TMJ diseases based on ICD-10. According to this classification, joint diseases

can be classified into two classes.

Class XII. Maxillofacial anomalies (including bite anomalies), section "Diseases of the

temporomandibular joint".

• Painful dysfunction syndrome of the temporomandibular joint. • Clicking jaw.

• Dislocation and subluxation of the TMJ.

• Pain in the TMJ, not classified in other sections.

• Stiffness of the TMJ, not classified in other sections.

• Osteophytes of the temporomandibular joint.

• Other diseases of the TMJ.

• Unspecified TMJ disease.

Class XIII. Diseases of the musculoskeletal system and connective tissue. Arthropathies.

• Infectious arthropathies: pyogenic arthritis, reactive arthropathies, Reiter's disease.

• Inflammatory polyarthropathies: seropositive rheumatoid arthritis, Felty's syndrome,

other rheumatoid arthritis, juvenile arthritis.

• Traumatic arthropathies.

Arthrosis.

• Arthrosis (polyarthrosis, osteoarthrosis, primary arthrosis).

However, this classification does not take into account the issues of etiology and

pathogenesis of TMJ diseases. Most often, the diagnosis is formulated as "temporomandibular

joint pain dysfunction syndrome" (Costen syndrome), "clicking jaw" and "temporomandibular

joint osteoarthrosis".

The Wilkes classification, Research Diagnostic Criteria (RDC) and the classification of the

American Academy of Orofacial Pain (AAOFP) are widely used in foreign literature.

The most common classification used by maxillofacial surgeons in other countries is the

Wilkes classification. But this classification does not include all TMJ diseases. The use of the RDC

classification requires a large number of complex calculations and calculations, which limits their

use in practical dentistry. In 1997, Russian scientists created a new classification of diseases and

injuries of the temporomandibular joint, which was adapted to modern diagnostic capabilities and

recognized by leading experts as the most successful:

Articular diseases:

1. Inflammatory (arthritis). 2.

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2. Non-inflammatory.

2.1. Internal disorders.

2.2. Osteoarthrosis:

- not associated with internal disorders of the TMJ, primary or generalized;

- associated with internal disorders of the TMJ (secondary).

2.3. Ankylosis.

2.4. Congenital anomalies.

2.5. Tumors.

Non-articular diseases:

1. Bruxism.

2. Pain syndrome of TMJ dysfunction.

3. Contractures of the masticatory muscles.

One of the main features of this classification is the presence of a section on internal

disorders.

Internal TMJ disorders.

The collective term "internal TMJ disorders" includes conditions

in which there is pathology of the soft tissue elements of the joint (articular disc, intra-articular

ligaments, capsule), changes in their anatomical and functional relationships. According to literary

data, they make up 70-80% of patients who have sought medical attention for TMJ pathology. The

most common cause of this type of pathology is long-term changes in the dental system that form

forced occlusion. In the absence of occlusal pathology, the cause of internal TMJ disorders may

be a change in the state of the muscles involved in chewing. In many cases, the leading etiological

factor in the appearance of these disorders is overstretching of the ligamentous apparatus of the

TMJ. It should be noted that the onset and progression of internal TMJ disorders is often associated

with the initial state of the soft tissue structures that make it up. Patients with connective tissue

dysplasia are characterized by a high degree of predisposition to diseases of the musculoskeletal

system.

There are 9 clinical forms of internal TMJ disorders.

The main clinical forms, syndromes and clinical manifestations are presented in Table 1.

Table 1 - Main clinical forms of internal TMJ disorders, syndromes and clinical

manifestations

Clinical forms

Syndromes

Main clinical

manifestations

Chronic dislocation

of the head of the mandible

Dislocation of the

head of the lower jaw without

displacement of the articular

disc

Dislocation of the head

of the lower jaw, not requiring

reduction, without clicking

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Subluxation of the

articular disc

Anterior early

reducible displacement

No dislocation of the

head of the lower jaw, clicking

within the glenoid fossa

Chronic dislocation

of the head of the lower jaw

with subluxation of the

articular disc

Dislocation of the

head of the lower jaw,

anterior early irreducible

displacement of the articular

disc

Dislocation of the head

of the lower jaw, not requiring

reduction, clicking within the

glenoid fossa

Chronic TMJ

dislocation

Dislocation of the

head of the lower jaw,

anterior late reducible

displacement of the articular

disc

Dislocation of the head

of the lower jaw, not requiring

reduction, clicking sound

during dislocation

Habitual dislocation

of the TMJ

Same

Dislocation of the head

of the lower jaw requiring

reduction, clicking sound

during dislocation

Recurrent

dislocation of the articular

disc

Intermittent anterior

non-reducible displacement

of the articular disc

Transient blocking of

the TMJ with different options

for disc position during

reduction

Chronic dislocation

of the articular disc

Permanent anterior

non-reducible displacement

of the articular disc

Permanent blocking of

the TMJ

Chronic dislocation

of the articular disc,

osteoarthritis (secondary)

Anterior permanent

irreducible displacement of

the articular disc, its

adhesion, violation of the

integrity of the cartilaginous

covering of the head of the

lower jaw, etc. R-logical

signs of osteoarthritis

Permanent blocking of

the TMJ

Chronic posterior

dislocation of the articular

disc

Posterior permanent

irreducible displacement of

the articular disc

Pain, disturbance of

teeth occlusion on the affected

side

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