The temporomandibular joint

Andy Moores

doi:10.22233/9781910443286.25

British Small Animal Veterinary Association , 472 (2018); https://doi.org/10.22233/9781910443286.25

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The temporomandibular joint

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Author: Andy Moores
From: BSAVA Manual of Canine and Feline Musculoskeletal Disorders
Item: Chapter 25, pp 472 - 482
DOI: 10.22233/9781910443286.25
Copyright: © 2018 British Small Animal Veterinary Association
Publication Date: November 2018

Abstract

The temporomandibular joint is a synovial condylar (hinge) joint formed between the condyloid process of the mandible and the mandibular fossa of the temporal bone. This chapter covers clinical and surgical anatomy, clinical examination, diagnostic imaging, luxation, fractures, ankylosis and dysplasia/locking jaw syndrome. Quick Reference Guide to Imaging Techniques by Thomas W. Maddox. Operative Techniques: Approach to the temporomandibular joint; Zygomatic arch resection.

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Figures

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25.1

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25.1 Dorsoventral radiograph of a cat with a unilateral (left) temporomandibular joint (TMJ) luxation (arrowed).

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25.2

CT 3D reconstructions from a cat with a left rostrodorsal temporomandibular joint (TMJ) luxation. (a) Oblique lateral view of the normal right side. (b) Ventrodorsal and (c) oblique lateral views of the luxated left side. © 2018 British Small Animal Veterinary Association

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25.2 CT 3D reconstructions from a cat with a left rostrodorsal temporomandibular joint (TMJ) luxation. (a) Oblique lateral view of the normal right side. (b) Ventrodorsal and (c) oblique lateral views of the luxated left side.

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25.3

Diagrams showing technique for the closed reduction of a temporomandibular joint (TMJ) luxation. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association

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25.3 Diagrams showing technique for the closed reduction of a temporomandibular joint (TMJ) luxation. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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25.4

CT 3D reconstruction from a cat with a laterally displaced coronoid process associated with a traumatic lateral temporomandibular joint (TMJ) subluxation. © 2018 British Small Animal Veterinary Association

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25.4 CT 3D reconstruction from a cat with a laterally displaced coronoid process associated with a traumatic lateral temporomandibular joint (TMJ) subluxation.

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25.5

Transverse CT images of a cat with a left condyloid process fracture (arrowed). (a) Preoperative and (b) after 4 weeks of maxillomandibular fixation with an external skeletal fixator, showing bone healing. (Reproduced from Moores, 2011 with permission from The Journal of Small Animal Practice) © 2018 British Small Animal Veterinary Association

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25.5 Transverse CT images of a cat with a left condyloid process fracture (arrowed). (a) Preoperative and (b) after 4 weeks of maxillomandibular fixation with an external skeletal fixator, showing bone healing. (Reproduced from Moores, 2011 with permission from The Journal of Small Animal Practice)

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25.6

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25.6 A tape muzzle fashioned from strips of inelastic adhesive tape.

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25.7

Pharyngotomy endotracheal intubation. (a) A stab incision is made caudal to the mandible using a finger in the pharynx as a guide. (b) Forceps are used to create a tunnel into the pharynx and to retrieve the cuff tube. (c) The endotracheal tube is disconnected and retrieved in the same way as the cuff tube. (d) The tube is secured with a finger-trap suture. © 2018 British Small Animal Veterinary Association

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25.7 Pharyngotomy endotracheal intubation. (a) A stab incision is made caudal to the mandible using a finger in the pharynx as a guide. (b) Forceps are used to create a tunnel into the pharynx and to retrieve the cuff tube. (c) The endotracheal tube is disconnected and retrieved in the same way as the cuff tube. (d) The tube is secured with a finger-trap suture.

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25.8

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25.8 Cat with a maxillomandibular external skeletal fixator in place.

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25.9

CT 3D reconstructions from a cat with a right zygomatic arch osteoma causing complete extracapsular ankylosis of the right TMJ. Mandibular symphysiotomy was performed to allow endotracheal intubation. (a–b) Preoperative scans. (c) Postoperative scan demonstrating complete resection of the zygomatic arch and the coronoid process of the mandible. © 2018 British Small Animal Veterinary Association

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25.9 CT 3D reconstructions from a cat with a right zygomatic arch osteoma causing complete extracapsular ankylosis of the right TMJ. Mandibular symphysiotomy was performed to allow endotracheal intubation. (a–b) Preoperative scans. (c) Postoperative scan demonstrating complete resection of the zygomatic arch and the coronoid process of the mandible.

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25.10

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25.10 A dog with a locked open jaw due to coronoid process–zygomatic arch impingement.

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25.11

CT 3D reconstructions from a Boxer with a locked jaw. (a) Preoperative scan with the jaw in a locked position. (b) Postoperative scan showing partial resection of the zygomatic arch. The locking was bilateral and a similar resection was performed on the right side. © 2018 British Small Animal Veterinary Association

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25.11 CT 3D reconstructions from a Boxer with a locked jaw. (a) Preoperative scan with the jaw in a locked position. (b) Postoperative scan showing partial resection of the zygomatic arch. The locking was bilateral and a similar resection was performed on the right side.

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25.12

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25.12 Patient positioning for a dorsoventral view of the skull including the temporomandibular joints.

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25.13

Patient positioning for a sagittal oblique view of the temporomandibular joint. The joint projected rostrally is the dependent one (i.e. the one nearest the cassette). Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association

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25.13 Patient positioning for a sagittal oblique view of the temporomandibular joint. The joint projected rostrally is the dependent one (i.e. the one nearest the cassette). Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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25.14

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25.14 (a) Dorsal, (b) sagittal and (c) transverse multiplanar reconstructed images of the temporomandibular joint of a dog.

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25.15

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25.15 Local anatomy of the temporomandibular joint (TMJ). Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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25.16

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25.16 Surgical approach to the temporomandibular joint (TMJ). Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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25.17

Excision arthroplasty. The crescent-shaped line of the osteotomy is depicted. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association

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25.17 Excision arthroplasty. The crescent-shaped line of the osteotomy is depicted. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.