Saturday, March 3, 2018

Anatomy of Temporomandibular Joint (TMJ)


"Temporomandibular joint forms the craniomandibular articulation"
·  Two synovial joints (right and left) connected with a single bone “the Mandible” makes the joint unique. Further coordinated movements of both joints facilitates the mandibular movements.
·         Boney components
1.      Contyle of mandible
2.      Squamous temporal bone of the skull

·         TMJ is a Complex joint – by function and by structure


·         Also it is a “Ginglymoarthoridal” jt
                                    Hinging movement – Ginglymoid movement
                                    Gliding movement – Arthroidal movement
·         Another classification of joints classify TMJ as a Compound Jt

-          By definition compound jt is joint composed of 3 or more bones
-    TMJ is composed of 2 bones , but considered compound jt  because articular discis is considered functionally non ossified bone
-         TMJ differs from other diarthoidal joints of the body
  I.  TMJ forms bilateral diarthrosis – functioning both Lt  Rt joints together
 II.Articular surfaces are covered by fibrocartilage instend of hyaline cartilage
III.TMJ is the only joint which has argitend point of closure, because when the mouth is closed the teeth come into occlusal contact

The Disc
·         Dense fibrous tissue
·         Devoid of blood vessels and nerves. Therefore it does not manifest marked inflammation in trauma.
·         Four Regions
1.       Anterior
2.       Intermediated – sits along articular eminence
3.       Posterior – Thickest – 12 ‘o clock on contyle
4.       Bilaminar region (Contains Blood vessels)
Collagen type I – Mainly
1.       Superficial layers – Parallel to anterior-posterior direction
2.       Central – Oriented random fashion
This arrangement provide ability with stand forces
 
Structure of Temporomandibluar joint
Anteriorly Disc divides into two lamellae
1.       Superior Lamella – Fuse with capsule  the periosteum of the anterior slope of articular eminence
2.       Inferior Lamella – anterior surface of the neck of the condyle
3.       Mid – with fibers of lateral pterygoid muscle

Muscles of Mastication
Although they are called muscles of mastication, they always function with other groups of the face, tongue, soft palate & hyoid bone

Masseter                                        

Superficial Part
Arises from lower border of Zygomatic arch                                                                           
Fibers directed downward back wards
Insert along the angle of the mandible
Insertion-  Lower 1/3 of the posterior border of the ramus and along lower boarder of the mandible to the 8 tooth

Deep Part                                                    
           Inserts above superficial masseter along the ramus of the mandible                              -

Function
1.       Elevation of the mandible
Nerve Supple


                      V Nerve      >    Mandibular branch          >       Masseteric Nerve


                                              
Temporalis
-                                                        Fan shaped muscle
-                                                        Attachment of large muscle extend to 
                                 I.                     Small portion of parietal bon- extends above
                               II.                    Greater Portion of the savamous portion of the temporal bone
                             III.                    Temporal surface of the frontal bove
                             IV.                    Temporal surface of greater wing of the sphenoid bove
                                                                      



·         Temporal Fascia attaches to supra temporal in border of the zygomatic arch.
·         Temporal Fascia
o   Thickens When passing downwards.
o   Splits in to two layers.
o   Superficial layer blends periosteum of the lateral Surface of the Zygomatic arch.
o   Deep Portion blunts T medial Surface.
o   Many of the muscle fibers original from the medial surface of the temporal fascia.
·         Insertion of temporalis.
o   Coronoid   Process
o   Antero medial Surface of the ramus of the mandible.
·         Function
o   Elevates the mandible.
·         Innervation
o   Deep temporal branches arising from the mandibular division of   V

Medial Pterygoid
                2. Heads 
  • Superficial Head
  • Deep head

Deep head- Originates from medial Surface of lateral Pterygoid plate a Pyarmydal Process of the Palatine bone.
Inserted in to Roughened medial  Surface of the mandible near the angle of the mandible.
Superficial Head-Originals from Tuberosity of the maxilla adjacent Pyramidal process of the Palatine bone.
Joins with deep head to in sear in to mandible.
Runs-  Downwards
         -  Backwards
         -  Laterally

Innervated by – Nerve to medial Pterygoid.
                       _ Branch of the mandibular.
                       _ Division of the Trigeminal Nerve.


Lateral Pterygoid
Two heads
·         Superior head
·         Inferior head

v  Superior head – Originals from infra temporal Surface of the grater wing of sphenoid.

Runs backwards, laterally, almost horizontally and insert to the disk capsule of the TMJ the condyle.

Function – Stabilizer the mandibular condyle against the reticular eminence during mastication.

v  Inferior head - Originals from lateral Surface of lateral Pterygoid plate.
Fibers extend Back wads, Upwads Out wads to insert in to neck of the condyle.

Function
Protrusion
Lateral excursion

Innervation
Branch of buccal nerve- From mandible division of  V


Other muscles
1.       Digastrics
2.       Mylohyoid
3.       Geniohyoid
4.       Platysma



Wednesday, July 5, 2017

Guess What ????

63 year old male patient presented to the X clinic complaining of burning sensation in left side floor of the mouth for 2 weeks. Past medical history revealed no significant findings. Patient is a known betel chewer for 25-30 years (5-6 quids per day with all ingredients). Also patient is a occasional smoker and consuming alcohol. Extra oral examination revealed no palpable lymph nodes on  both sides neck. Intra orally patient had a white patch on the floor of the mouth in elation to 34, 35, 36 region and it didn't removed when tired to rub off with gauze. Diagnosis???


Answer : Leukoplakia (Leukoplakia is a clinicall white patch that cannot be classified clinically or hitopathologically in to any other disease entity.) There are two types of leukoplakias namely homogenous and non-homogenous.

Further reading : Click here for Leukoplakia

Friday, August 5, 2016

Circulatory system physiology Multiple choice questions(MCQ) with Answers

   

     1.     Blood volume
    
a.     Can be measured by a dilution technique using inulin
b.     Is approximately 7% of the body weight of an adult
c.      Relative to the body weight in an infant is less than in an adult
d.     Is decreased by long residence at high altitude
e.     Is increased in pregnancy

     2.     With knowledge of the packed cell volume following can be used to measure the blood volume
a.     Chromium labelled red blood cells
b.     Inulin
c.      Sodium thiocyanate
d.     Evans blue
e.     Iodinated human serum albumin

     3.     Cytotoxic killer cells
a.     Kill by releasing perforins into the target cells
b.     Formation is stimulated by helper T cells
c.      Do not play a role in the development of autoimmunity
d.     Are increased in transplant recipients
e.     Stimulate humoral immunity

     4.     Eosinophilia occurs in
a.     Asthma
b.     Acute bacterial infection
c.      Helminthic infestation
d.     Military TB
e.     Hepatic cirrhosis

     5.     Increased eosinophils are found in
a.     TB
b.     Syphilis
c.      Acute adenitis
d.     Hodgkin’s disease
e.     Lymphosarcoma

     6.     Plasma cells
a.     Are strongly phagocytic
b.     Are normally present in bone marrow
c.      Contains large amount of RNA
d.     Synthesizes proteins
e.     Produces immunoglobulins

     7.     Lymphocytes
                a.     Are found only in the lymph nodes
                b.     Have a shorter life than neutrophils
                c.      Can be transformed into blast cells
                d.     Stimulated to multiply by corticosteroids
                e.     Are particularly sensitive to radiation

     8.     T lymphocytes
                a.     Do not participate in humoral immunity
                b.     Are responsible for the production of lymphokines
                c.      Are transformed into plasma cells
                d.     Are activated by interleukins
                e.     Are significantly depleted in the AIDS complex

     9.     Red blood cells
a.     Haemolyse in hypertonic saline
b.     Disintegrate to release erythropoietin
c.      Are relatively inelastic
d.     Are smaller than normal in foliate deficiency
e.     Are smaller than normal in iron deficiency

     10.Haemoglobin
a.     Contains ferric irons
b.     May be oxidized to methaemoglobin
c.      Combines with carbon dioxide
d.     Is a stronger acid when oxygenated
e.     Has the same molecular structure as myoglobin

     11.Haemoglobin
a.     Has a greater affinity for carbon monoxide than for oxygen
b.     Is not filtered at the renal glomeruli
c.      Has the same molecular weight as myoglobin
d.     Is formed in the healthy adult at a rate of about 6g/day
e.     Concentration in red cells rises in macrocytic anaemia

     12. Fetal haemoglobin
a.     Has one iron atom per molecule
b.     Has a different amino acid composition in globin as compared with adult haemoglobin
c.      Has an O2 dissociation curve shifted to the right as compared to adult haemoglobin
d.     Is present in the blood in sickle cell disease
e.     Oxygen uptake is not affected by chances in the pCO2

     13.Diagnostic features of homozygous thalassaemia include
a.     Hypochromia
b.     Reduction in HbA2
c.      Increase in HbF
d.     Normal or high serum iron
e.     Megaloblasts in the bone marrow

     14.Following are frequently seen in sickle cell disease in the adult
a.     Splenomegaly
b.     Jaundice
c.      Dysphagia
d.     Aseptic necrosis of bone
e.     Leg ulcers

     15.The age of 70 years red cell formation is found in the bone marrow of
a.     Femur
b.     Tibia
c.      Vertebrae
d.     Sternum
e.     Ribs

     16.Erythropoiesis
a.     In the fetus takes place in liver and spleen
b.     Is stimulated by hypoxia
c.      Is increased in hypothyroidism
d.     Is decreased in myeloid leukaemia
e.     Stimulated by aldosterone

     17.Erythropoietin
a.     Cases a rise in the reticulocyte percentage
b.     Level in blood is reduced after bilateral nephrectomy
c.      Is essential for the synthesis of haemoglobin
d.     Is a glycoprotein
e.     Is secreted by cells in the bone marrow

     18.Erythropoietin
a.     Is secreted by cells of the liver
b.     Secretion is increased in cyanotic congenital heart disease
c.      Level in plasma is increased during residence in high altitude
d.     Increases the number of red cell precursors in bone marrow
e.     Has an immediate action in increasing the circulating red cells

     19.Red cell breakdown products increase
a.     Plasma bilirubin
b.     Porphyrins in the urine
c.      Haemosiderin depositon
d.     Plasma alkaline phosphate
e.     Blood uric acid concentration

     20.Bilirubin
a.     Is mainly produced in the liver
b.     In the unconjugated state is moderately soluble in water
c.      Is conjugated with glucoronic acid in the liver
d.     Is converted to urobillinogen in the liver
e.     Is found in the urine in haemolytic anaemia



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