17 - Surgical options in TMD Flashcards
What diseases affect the TMJ?
- TMD
- jaw dislocation
- osteoarthritis
- rheumatoid arthritis
- chondromatosis
- foreign body granuloma
- infection
- traumatic damage
- radiation damage
- ankylosis
- tumours
What are the different components of TMJ dysfunction?
- muscular “initiation”
- mechanical “TMJ dysfunction”
- psychological “underlying cause:
- trauma “aetiology”
What types of trauma can affect the MTJ?
- physical injury (macrotrauma)
- chronic joint overloading (microtrauma, bruxism)
- occlusal factors (deep bite, disharmony, lack of posterior support)
- anatomical features including class II jaw relationship
What symptoms might a pain complain of in relation to their TMJ?
- muscular
- capsular
- intra-capsular “disc”
- reduced mobility
- clicking, crepitus or locking
What are the anatomical components of the TMJ?
- glenoid fossa
- condylar head
- articular disc
- lateral ligament
- inner surface of capsule
- synovial membrane
What is the function of the upper compartment?
Translation
What is the function of the lower compartment?
Rotation
What makes up the articular cartilage?
- chondrocytes
- collagen fibres in proteoglycan matrix
How does inflammatory disease affect the articular cartilage?
Inflammatory disease produces proteases which degrade proteoglycans
What structures are innervated in the TMJ?
- capsule
- synovial tissue
- subchondral bone
What degenerative changes can affect the TMJ?
- cartilage degernation
- disc perforation
- multiple adhesions/adhesive capsulitis
- osteophytes
- flattening fo condyle and eminence
- subcentral cysts
What are conservation management options for TMD?
- counselling
- pain management
- joint rest
- physical therapy
- restoration of occlusal stability (eg splint)
What are the functions of a bite appliance?
- eliminates occlusal interferences
- prevents joint head from rotating so far posteriorly in glenoid fossa
- reduces loading on TMJ
What investigations can be used for TMD?
- radiographic investigations
- arthrogram
- MRI
- arthroscopy
What procedures are can be done arthroscopically?
- diagnosis
- biopsy
- lysis and lavage
- disc reduction
- removal of loose bodies
- eminectomy
