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The Craniomandibular Complex: Changes through the Lifespan

Dennis Langton, PT, CCTT

September 10, 2013

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Question

Are there any bony changes to the craniomandibular complex that you can expect as a patient ages?  Are there any differences in children?

Answer

Yes, you do see a lot of bony changes particularly as people begin to lose their teeth.  We see a lot of edentulous patients that we have had to work on. Those people have much flatter superior aspects of the condyle. Their joint spaces are a lot smaller, and there is a much more arthritic appearance on the eminence and on the anterior third of the condyle.  As I said, the condyle also shrinks, and the lateral pulley erodes more.  You might also see, with the big clenchers, an increased growth in the coronoid process as well as an extended girth in the ascending ramus of the mandible.  

 

Children are interesting because we need to remember that we are not born with a temporomandibular joint.  We actually create it. As a child initially grows and suckles, the sucking movement, which is kind of an oval movement and more vertical in appearance, creates the depth of the fossa itself.  As a child then begins to chew, we get a lot more anterior movements as well as vertical movements, so the fossa continues to develop, but the ascending ramus of the mandible begins to move vertically and begins to appear.  If you look at a newborn baby in the face, from the eyes up is half of the face and from the eyes below is the other half of the face. It is two parts. If you look at an adult, you have forehead to eyes, eyes to the upper lip, and lip to chin; in otherwise a three-part face.  This is because in an adult, the ascending ramus of the mandible has actually grown as has the condyle.  

 

The thing to remember is kind of where your patients are in their lifespan.  This is why (if you have attended some of Rocky’s courses) you should only let your children suck their thumbs or suck on pacifiers for 18 months and no longer.  What you have to remember in children is that the formation is growing as they move through those first few years.  When you work on temporomandibular joint activity with younger children, you want to work more vertically, which is the same as with adults, but less anteriorly as you do with adults.  That is really the only difference.  Once we get into the adolescent years and once they have acquired the three-part face, the bony structures are the same and you can proceed the same way. Before that, you want to take care of those things I just mentioned.

 


dennis langton

Dennis Langton, PT, CCTT

Dennis Langton PT, CCTT is a 1973 graduate of the University of Utah in Salt Lake City Utah.  Dennis began work in both treating and research in Craniomandibular disorders in 1982. He has over 500 hours of advanced training in CMD, has presented over 30 clinical and research papers and taught over 75 post-graduate professional courses in Craniomandibular Disorders both nationally and internationally.  He has participated in more than 175 fresh cadavor dissections of the head, neck and cervical spine and is co-author of a functional anatomy text on the head, neck and temporomandibular joint and contributing author on two textbooks on evaluation and treatment of CMD.


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