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BDS3 Past Paper By Topic (05-19) > TMJ disorder > Flashcards

TMJ disorder Flashcards

1
Q

Outline the sequence of clinical examinations of TMJs (2.5)

A
  • Palpate TMJ (+press slightly medially) – ask code – 0-3 for pain
  • Palpate temporalis and masseter

• Ask patient to open and close jaw whilst
Touching temporalis, then masseter

Hear for joint sounds, noting when it occurs and its type (pop, click, crepitation)

Observe range of mandibular movement (Vertical(ard 50mm) and horizontal(9-11mm)

Observe path of opening and closing (deviations)

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2
Q

List the muscles that need to palpate for TMD patient (2.5)

A

DC/TMD: Masseter and temporalis, (no need lateral pterygoid, medial pterygoid)

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3
Q

List the alternative managements for TMD patients (2.5)

A

Counselling
(Reassurance and explain condition, Rest, self-relaxation, cognitive behavioral therapy)

Physiotherapy
(Thermal, massage (acupuncture is not conservative) )

Pharmacological therapy
(Analgesic, NSAID, muscles relaxant, antidepressant)

Occlusal splint therapy

  1. Anterior repositioning splint to eliminate clicking by guiding the mandible into a forward and downward protrusive position so displaced disc can return to a more normal therapeutic position, elasticity of disc will reposition upon time)
  2. Soft bite guard is for emergency acute TMD
  3. Localized occlusal interference splint is for breaking bruxism habit
  4. Stabilization splint is for presence of occlusal interference
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4
Q

TMJ and maxillofacial surgery
32 y.o. female, busy bank clerk, complained of left TMJ pain, patient mentioned about occasional clicking. pain on palpation of MOM, trismus, jaw deviation to the left upon opening.
Radiograph shows articulating disc of left TMJ is displaced anteriorly when the mouth is closed, but is in normal position when the mouth is opened

a. What is the diagnosis for the patient? (1)

A
  • Anterior disc displacement with reduction
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5
Q

TMJ and maxillofacial surgery
32 y.o. female, busy bank clerk, complained of left TMJ pain, patient mentioned about occasional clicking. pain on palpation of MOM, trismus, jaw deviation to the left upon opening.
Radiograph shows articulating disc of left TMJ is displaced anteriorly when the mouth is closed, but is in normal position when the mouth is opened

Name 4 components of TMJ (4)

A
  • Condyle, articular disc, temporal bone, fibrous capsule and associated ligaments and lateral pterygoid m.
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6
Q

TMJ and maxillofacial surgery
32 y.o. female, busy bank clerk, complained of left TMJ pain, patient mentioned about occasional clicking. pain on palpation of MOM, trismus, jaw deviation to the left upon opening.
Radiograph shows articulating disc of left TMJ is displaced anteriorly when the mouth is closed, but is in normal position when the mouth is opened

2 movements of the TMJ (2)

A
  • Rotation and translation
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7
Q

TMJ and maxillofacial surgery
32 y.o. female, busy bank clerk, complained of left TMJ pain, patient mentioned about occasional clicking. pain on palpation of MOM, trismus, jaw deviation to the left upon opening.
Radiograph shows articulating disc of left TMJ is displaced anteriorly when the mouth is closed, but is in normal position when the mouth is opened

Is clicking an abnormal condition? (1)

A
  • Yes. Disc is considered displaced when the inferior intermediate zone of articular disk is separated more than 2 mm from the anterior aspect of condyle
  • As translation commence, head of condyle encounter the disc in an unexpected and displaced position, bilaminar zone is stretched, friction is built up and when the tension exceed pressure exerted by condyle, the disc move backward suddenly to release energy
  • Sudden distraction of the opposing wet surface produce click
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8
Q

TMJ and maxillofacial surgery
32 y.o. female, busy bank clerk, complained of left TMJ pain, patient mentioned about occasional clicking. pain on palpation of MOM, trismus, jaw deviation to the left upon opening.
Radiograph shows articulating disc of left TMJ is displaced anteriorly when the mouth is closed, but is in normal position when the mouth is opened

What is the normal range of maximum mouth opening? (1)

A
  • Assisted range of motion: male > 40 mm, female > 35 mm (including overlap)
  • Lateral 8 mm, protrusion 6 - 8 mm
  • ***Book’s word is “Minimal / lower limit” opening
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9
Q

TMJ and maxillofacial surgery
32 y.o. female, busy bank clerk, complained of left TMJ pain, patient mentioned about occasional clicking. pain on palpation of MOM, trismus, jaw deviation to the left upon opening.
Radiograph shows articulating disc of left TMJ is displaced anteriorly when the mouth is closed, but is in normal position when the mouth is opened

3 clinical features that can accompany TMJ pain/ dysfunction (3)

A
  • Headache, arthralgia, otalgia, muscles tenderness, limited range of motion (trismus), joint sounds, deviated pathway
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10
Q

TMJ and maxillofacial surgery
32 y.o. female, busy bank clerk, complained of left TMJ pain, patient mentioned about occasional clicking. pain on palpation of MOM, trismus, jaw deviation to the left upon opening.
Radiograph shows articulating disc of left TMJ is displaced anteriorly when the mouth is closed, but is in normal position when the mouth is opened

What are the 2 types of internal derangement? (2)

A
  • Disc displacement with and without reduction
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11
Q

TMJ and maxillofacial surgery
32 y.o. female, busy bank clerk, complained of left TMJ pain, patient mentioned about occasional clicking. pain on palpation of MOM, trismus, jaw deviation to the left upon opening.
Radiograph shows articulating disc of left TMJ is displaced anteriorly when the mouth is closed, but is in normal position when the mouth is opened

What can be observed on plain radiograph if the px has internal derangement?(1)

A
  • Nothing as it doesn’t show the disk (fibrocartilage)
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12
Q

TMJ and maxillofacial surgery
32 y.o. female, busy bank clerk, complained of left TMJ pain, patient mentioned about occasional clicking. pain on palpation of MOM, trismus, jaw deviation to the left upon opening.
Radiograph shows articulating disc of left TMJ is displaced anteriorly when the mouth is closed, but is in normal position when the mouth is opened

Arthroscopy is used for imaging and diagnosis. Which joint space (upper/lower) can be visualized? Choose the adequate answer. (1)

A

Upper

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13
Q

TMJ and maxillofacial surgery
32 y.o. female, busy bank clerk, complained of left TMJ pain, patient mentioned about occasional clicking. pain on palpation of MOM, trismus, jaw deviation to the left upon opening.
Radiograph shows articulating disc of left TMJ is displaced anteriorly when the mouth is closed, but is in normal position when the mouth is opened

2 imaging techniques for investigating the condylar disc(2)

A

CT MRI

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14
Q

TMJ and maxillofacial surgery
32 y.o. female, busy bank clerk, complained of left TMJ pain, patient mentioned about occasional clicking. pain on palpation of MOM, trismus, jaw deviation to the left upon opening.
Radiograph shows articulating disc of left TMJ is displaced anteriorly when the mouth is closed, but is in normal position when the mouth is opened

3 conditions that will affect TMJ (3)

A
  • Rheumatoid arthritis, systemic joint laxity (hypermobile joint syndrome), hormonal change (elevated estrogen during menstrual cycle), osteoporosis
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15
Q

TMJ and maxillofacial surgery
32 y.o. female, busy bank clerk, complained of left TMJ pain, patient mentioned about occasional clicking. pain on palpation of MOM, trismus, jaw deviation to the left upon opening.
Radiograph shows articulating disc of left TMJ is displaced anteriorly when the mouth is closed, but is in normal position when the mouth is opened

Is TMD a kind of clinical manifestation of mental disorders? (1)

A
  • Yes. TMD may occur secondary to stress induce involuntary clenching
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16
Q

What is the aetiology of TMJ clicking and limited mouth opening? (4)

A

TMJ clicking – because disc is displaced anteriorly, so when the condyle slides forward, the disc pops back onto the head of the condyle, creating a click. During closing, a smaller (reciprocal) sound can be heard, as the condyle slips over the posterior rim of the disk and the disk slips forward.

Limited mouth opening can happen with patients who experience TMJ clicking, because the disc may sometimes NOT reduce at opening. (so cannot have clicking with limited mouth opening, only one or the other)

17
Q

What is your working diagnosis of joint problem (clicking and limited mouth opening) (2)

A

Disc displacement with reduction
Disc displacement with reduction with intermittent locking
Disc displacement without reduction with limited opening
Disc displacement without reduction without limited opening (maybe disc is displaced way too anteriorly)

18
Q

What are the treatment goals of therapy for TMJ problem(3)

A 
Control pain (if pain)
If no pain, reassure patient about it – explain to patient why they have the TMJ problem
Relaxation techniques (if caused by clenching, bruxism)
Monitor – TMJ may become bone joint disease in the future
19
Q

What is the diagnostic approach of TMD (2)

A

Panoramic – to see the shape of the condyle. Is good for bone diesease. CT scan (assess bone abnormalities) and MRI (see soft tissues) is much better.

20
Q

Possible etiology of TMD if joint problem (4)

A
  • Degenerative joint disease: Osteoarthrosis, osteoarthritis (The most important pathophysiological factor for degeneration of the joint is the mechanical stress leading to progressive cartilage wear and damage.)
  • Systemic arthritis
  • Condylysis/idiopathic condylar resorption
  • Osteochondritis dissecans
  • Osteonecrosis
  • Neoplasm
  • Synovial chondromatosis
21
Q

Goal of treatment of joint problem (4)

A

Goal:
Suppress the active inflammatory process, preserve function, prevent further deformity and relieve pain

Treatment choices:
physical therapy, pulsed electrical stimulation, pharmacological, topical ointments, supplements, steroid injections, hyaluronic acid (HA) injections, acupuncture

BDS3 Past Paper By Topic (05-19) (24 decks)

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