Surgical Options for TMJ Diseases Flashcards
Give examples of different TMJ diseases?
- TMD
- Jaw dislocation
- Osteoarthritis
- Rheumatoid arthritis
- Chondromatosis
- Foreign body granuloma
- Infection
- Trauma/radiation damage
- Ankylosis
- Tumour
What are the different components of TMJ diseases?
- Muscular issues (most common)
- Mechanical TMJ dysfunction
- Psychological underlying cause
- Trauma
What psychological causes can lead to TMJ disease?
- bruxism
- clenching
- grinding
- having teeth in occlusion all the time
- lack of FWS
What occlusal factors may lead to TMD?
- deep overbite
- occlusal disharmony (eg high filling)
- lack of teeth leads to overclosing
- class II jaw relation
What symptoms are associated with TMD?
- reduced opening
- clicking
- locking
- deviation
What important anatomical considerations are involved in TMD?
- glenoid fossa
- condylar head
- articular disc
- lateral ligament
- inner surface of capsule
- synovial membrane
What is found in the superior compartment of the TMJ?
- superior part of articulating disc
- inferior surface of the glenoid fossa
What is found in the inferior compartment of the TMJ?
- superior surface of condyle
- inferior surface of articulating disc
What is involved in anterior disc displacement without reduction TMD?
- exceeds elasticity of fibre (bilaminar zone)
- disc cannot be pulled back
- mechanically blocked
How will a patient with TMD (anterior disc displacement without reduction) present?
- limited mouth opening
- unable to move jaw back
- jaw propped open
How can TMD be managed conservatively?
- counselling (most important)
- pain management = analgesics & muscle relaxation
- joint rest = supported mandible during yawning, appropriate diet, avoid parafunction
- physical therapy
- restoration of occlusal stability (lower any high fillings etc)
What special investigations can be done to assess TMD?
- OPT including condyles
- Arthrogram
- MRI
What are examples of surgical procedures that can be used to treat TMD?
- DISC PLICATION = recapturing dislocated disc & relocated into anatomical position
- EMINECTOMY = remove articular eminence, increase gap to allow spontaneous recapturing
- HIGH CONDYLAR SHAVE
- CONDYLECTOMY = remove condyle usually due to tumour or ankylosis
- MENISCECTOMY = removal of disc, usually due to fibrosis
- RECONSTRUCTIVE SURGERY = remove joint & replace
What important structure is at risk of being damaged during TMD surgery?
Facial nerve
What type of surgery investigation can be done to the TMJ?
Arthroscopy
