TMD Flashcards
what is the intra-articular disc
-name the 2 joint spaces
biconcave sheet of avascular CT,
superior and inferior joint spaces
- blood supply to TMJ
- Nerve supply to TMJ
Bl - deep auricular artery
N - auriculotemporal/masseteric branch/posterior temporal branches
what is the capsule of the TMJ
Thin fibrous CT attached to rim of fossa and neck of condyle
name another name for TMD
myofacial pain dysfunction
Costen’s syndrome
causes of TMD
- myofacial pain
- disc displacement
- degenerative disease - osteoarthritis/rh arthritis
- chronic recurrent dislocation
- ankylosis
- hyperplasia
- neoplasia
- infection
pathogenesis of TMD
- inflammation of MoM
- trauma
- stress
- psychogenic
important aspects of history
- pain
- E/O exam - MoM hypertrophy/click/crepitus/Tender to palpation/jaw movement/asymmetry
- I/O -tongue scalloping/wear facets/linea alba/NCTSL,
special inv
- Plain Rg - OPT
- CBCT
- MRI
- arthrography
- ultrasound
diff diagnosis of TMD
sinusitis/odintogenic pain/earache/headache/referred neck pain/angina/trigeminal neuralgia
treatment of TMD
- Reassurance
- Conservative Advice including limiting jaw movements- soft diet, masticate bilaterally, no wide opening, no chewing gum, don’t incise foods, cut food into small pieces, stop parafunctional habits, support mouth on opening, replace missing teeth
- Stress management- relaxation, massage, lifestyle alteration, counseling.
- Physiotherapy- acupuncture, TENS, short wave diathermy, muscle manipulation
- Pharmacotherapy- NSAIDS diazepam, antidepressants
- Splint Therapy
- Botox
- Intra-articular steroids- rare, may damage joint
- Manipulation under GA- can help to determine cause of trismus
- Surgery- Arthrocentesis (flushing out joint to break down adhesions), Arthroscopy (visualises joint- can simultaneously remove adhesions).
theory of splint therapy
Theoretically, splints stabilize the occlusion, improve the function of the masticatory muscles and thereby decreasing abnormal activity and protect the teeth in cases of tooth grinding. Despite the lack of evidence, many clinicians feel that due to their relative inexpense, non-invasive nature and historical benefit to a significant number of patients, the use of splints is justified.
what is anterior disc displacement with reduction
-symps
- cause of tmj clicking
- lack of coordination between articular disc andcondyle - ie the condyle displaces the disc and it has to snap back into place
- asymp/jaw stiffness/mandible displaced to affected site
treament of interal derangement
- limit mouth opening
- support jaw when yawning
- biteraising appliance
- asymp - no treatment
