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Radiology > TMJ Abnormalities > Flashcards

TMJ Abnormalities Flashcards

1
Q

describe mandibular condyle

A

cylindrical

2cm mediolateral

variable shape

angled 15-33 degrees with sagittal plane

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2
Q

temporal component of TMJ - implication for?

A

formed by squamous portion

posterior – glenoid / madnibualr fossa

anterior - articular emninence and tubercle
- WHERE YOU WILL MOST LIKELY SEE OSTEOARTHRITIS

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3
Q

where will you see artheroarthritis in TMJ?

A

anterior portion at the articular eminence and tubercle

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4
Q

interarticular disc - describe

A

avascular fibrous connective tissue

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5
Q

which part is thicker in the disc

A

thicker anterior band

thinner in middle and VERYT HICK POSTERIOR BAND
- also thicker medially than laterally

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6
Q

displacement in what direction?

A

medio-anterior

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7
Q

where does interarticular disc (meniscus) attach?

A

to the condylar poles both medially and laterally

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8
Q

Retrodiscal tissues aka

A

posterior disc attachment

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9
Q

Retrodiscal tissue describe

A

well-innervated and may be the cause of paon in the case of anterior disc displacement

VASCULAR
- expands in volume via venous distension

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10
Q

superior vs inferior aspects of Retrodiscal tissues

A

sueprior - very flexible

inferior - not as flexible

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11
Q

when to image the TMJ?

A
  1. supplements clinical inforamtion
    - osseous abnormalities
    - conservative tx has failed
    - symptoms are worsening
    - history of significant trama, dysfunctin, alteration in ROM, nerve abnormalities, changes in occlusion
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12
Q

TMJ imaging modalities

A
  1. PANO
  2. CBCT
  3. MDCT
  4. MRI
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13
Q

MDCT and TMJ imaging?

A

see soft tissue – but CANOT VISUALIZE THE DISC

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14
Q

MRI of disc?

A

FLUID IS MORE NOTICEABLE

- provides contrast for disc and other SOFT TISSUE structures

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15
Q

MRI of disc?

A

FLUID IS MORE NOTICEABLE

- provides contrast for disc and other SOFT TISSUE structures

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16
Q

condylar hyperplasia

A

developmental abnormality that results in ENLARGED and occasionally deformed condylar head
- possible enlarged glneoid fossa, condylar neck, ramus and body

female >male

age less than 20

self-limiting

mandibular assymetry

normal cortical thickness and trabecular pattern – condylar head and neck may bend forward or lateral

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17
Q

differential diagnosis with condylar hyperplasia

A

tumor – more irregular like osteochondroma

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18
Q

coronoid hyperplasia presents as

A

elongated coronoid process, extending at least 10mm above the inferior rim of the zygomatic arch

male > female

often bilateral and can contact the posterio surface of zygomatic arch, restricting condylar translation

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19
Q

bifid condlye is what?

A

anatomical VARIANT

  • developmental depression or notch in teh superior condylar surface
  • more of an anomoly and cannot say pathiology
  • usually incidental finding
  • occasionally TMD symptoms
  • more often unilateral and can be anterio-posterior or mediolateral
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20
Q

bifid condlye is what?

A

anatomical VARIANT

  • developmental depression or notch in teh superior condylar surface
  • more of an anomoly and cannot say pathiology
  • usually incidental finding
  • occasionally TMD symptoms
  • more often unilateral and can be anterio-posterior or mediolateral
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21
Q

describe disc displacement

direction most likely to occur?

A

abnormally positioned disc relative to the condylar and temporal components of the TMJ

MOST COMMONLY ANTERIOR
- but can be antero-medially, medially, or anterior-laterally displaced

can interfere with function, cause pain, or be asympotmatic

  • POPPING, CLICKING,
  • crepitus (sign of degeneration)
  • decreased ROM
  • may be locking
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22
Q

normal appearance of the disc usually look?

A

liek a bow-ties

at 11 or 12 o-clock

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23
Q

disc deformities and perforatin

A

long-term displacement leads to loss of normal shape

  • may be impossible to identify
  • perforations occur most commonly in retrodiscal tissue
  • not reliable on MRI
  • bone to bone contact of osseous componenets is suggestive of perforation or displacement
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24
Q

DJD aka

inflammatory?

A

osteoarthritis

not considered inflammatory but signs are kind of liekt hat

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25
Q

describe DJD

A

breakdown of articulating fibrocartilage leading to deterioration of teh osseouos structures

non-inflammatory

bone erosion as well as new bone formation (osteophytes and sclerosis)
- incidence increases with age and females more likely than males

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26
Q

DJD occurs where?

A

most likely where things are occluding

- anterior glenoid fossa- posterior articualr eminence

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27
Q

6 signs of DJD

A
  1. flattening?
    - some people jsut have that though
  2. reduced joint space
  3. sclerosis
    - formation
  4. osteophyte
    - formation of bone
  5. subchondral cyst
    - usually small / round / W-D
  6. erosion
    - right on the surface of the joint
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28
Q

what may be first sifgn of DJD

A

flattening

29
Q

symptoms of osteoarthritis is usually?

A

pain within the joint and crepitits

30
Q

DD with DJD

A
  1. inflammatory arthritis (rheumatoid) - more erosice

2. benign tumor - more scleortic (osteoma or osteochondroma)

31
Q

rheumatoid arthritis

A

synovial membrane inflammation in several joints

affects TMJ in half of patients

32
Q

RA looks?

A

jigaw pattern?
- fribrous ankylosis

generalized osteopenia of the TMJ with synovial inflammation

very erosive
can occur from secondary DJD

33
Q

fibrous anklylosis occurs with ?

A

RA

34
Q

RA DD importance of what ?

A

medical history

35
Q

Juvenile arthrosis aka?

A

idiopathic condylar resorption

or

cheerleader syndrome

36
Q

idiopathic condylar resorption looks? who usually gets it ?

A

“toad-stool” appearance

females – younger

37
Q

treatment for juvenile arthrosis? (ICR)

A

surgery

- to fix disc and correct plane of occlusion

38
Q

juvenile idopathic arthritis looks? who gets it

A

even younger than IRC –

“bird-face” and open bite

39
Q

major things to note about septic arthritis

A
  1. unilateral
  2. redness and swelling
    3.
40
Q

defintion of effusion

A

influx of fluid into the joint

may be associated with trauma (hemarthrosis) disc displacement or arthritis

typical TMD symptoms and fluid in the ear, tinnitus, hearing difficulties, difficulty occluding post teeth

41
Q

condylar disloction presents as?

A

usually locked open

- condyle

42
Q

fracture look for

A

discontiuity in cortical outlines or overlapping

43
Q

ankylosis two types

A

fibrous or osseous / bony

fibrous - jigsaw

44
Q

fibrous ankylosis

A

irregular, narrow oint space and jigsaw puzzle

45
Q

bony ankylosis

A

joint space is obliterated by osseous bridge

- degenerative changes

46
Q

most common benign tumor

A

osteochondroma

- radio-opaque

47
Q

loss of cortex on condyle in younger?

A

not a pathological sign for anything – they take longer to develop

48
Q

Pano and CBCT and MT for TMJ?

A

Pano - gross disease

CT - hard tissue (ossseeous changes)

MCT- hard tissue plus soft tissues

**MRI FOR DISC AND FLUID (EFFUSION)

49
Q

developmental hyperplasia of condyle DD?

A

osteochondroma (most common benign tumor in jaw)

but developmental will STOP after puberty and is usually more unilateral and ‘regular enlargment’

50
Q

pronounced antegonial notch seen in?

A

condylar HYPO-plasia

51
Q

downward bowing of the inferior border?

A

HYPER- plasia of condylar

52
Q

hypo and hyperplasia of condyle tend to be?

A

unilateral – whereas coronoid hyperplasia (10mm above the inferior rim of zygomatic arch) may be bilateral

53
Q

effusion / fluid in the joint is early sign of?

A

DJD – degenerative joint disease

54
Q

DJD AKA

A

osteoarthritis

55
Q

sign of eroding condyles?

A

anterior OPEN bite

– like seen in RA which is more likely to cause erosion than DJD

56
Q

sign of fibrous ankylosis?

A

jig saw looking of the condylar and eminence – with erosion

vs osseous ankylosis – bone on bone

57
Q

RA vs osteoarthritis

A

multiple joints involved and severe erosions think RA

58
Q

severe erosion in young patient (before age 16) think

A

Juvenile idiopathic arthritis

  • bird face appearance
59
Q

sign of juvenile arthrosis

A

“toad-stool appearance” of condylar head and flattened

60
Q

septic arthritis signs?

A

unilateral and from infection / inflammation

with PERIOSTEAL REACTION - like double contour

redness, lymphadonopathy, fevere malaise

61
Q

synovial chondromatosis looks? what is it?

A

little pebbles within the synovial membrane

BENIGN tumor – one of most common affecting the TMJ

62
Q

chondromatosis vs chondroCALCINOIS

A

CALCIONIS – finer more evenly distributed tadio-opacities

63
Q

condylar dislocation usually?

A

way anterior to the eminence

64
Q

most common benign tumor of jaw

A

osteochondroma

- mixed appearance

65
Q

location of osteochondrom

A

almost looks like a large osteophyte

  • Radio-opaque
66
Q

chondrosarcoma is

location?

A

malignant

condyle

anterior mandible

mandibular symphysisi

67
Q

malignant tumors more likely to be intrinisc or extrinisic?

A

EXTRINSIC
- Like they metastisize here

  • look for PATHOLOGICAL FRACTURES
68
Q

‘common’ malignant tumors that metastisize to the jaw

A

breast, lung, kidney, thyroid, prostate, colon, multiple myeloma

salivary gland tumors

Radiology (26 decks)

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