TMJ

Question 0

What is para function?

Answer 0

Purposeless oro mandibular movements

Question 1

What is the stomatoghnathic system?

Answer 1

TMJ
Muscle
Occlusion

Question 2

What are examples of para function?

Answer 2

Bruxism,
Check biting
Nail biting

Question 3

Bruxism can be…

Answer 3

Day or night

Question 4

Most people brux during?

Answer 4

The day 30%

Night time 7-10%

Question 5

What is the aetiology of bruxism?

Answer 5

Habit
Concentration
Stress
Sleep disorder

Question 6

What are the TMJ disorders?

Answer 6

Growth and development 
Trauma
Neoplasm
Arthritis
Degenerative
TMD
Dislocation 
Ankylosis 
Internal derangement

Question 7

What is an example of a grower abnormality of TMJ?

Answer 7

Condylar hyperplasia
Condylar aplasia
Condylar Hypoplasia

Question 8

What is an example of a traumatic injury to TMJ?

Answer 8

Fracture of condyles
Guards man
Fracture of body
Fracture of ramus

Question 9

Why us an example of a condylar neoplasm?

Answer 9

Benign or malignant but are rare
Primary tumours of TMJ are less than 1% of head and neck tumours usually metasteses from 5B’s

Osteoma
Chondroma
Chondrosarcoma
Metastatic

Question 10

Give an example of a degenerative diseases of TMJ

Answer 10

Osteoarthritis
RA
JA

Question 11

Give an example of an inflammatory disease of TMJ

Answer 11

Inflammatory arthritis

Question 12

What are the features of osteoarthitis? And symptoms

Answer 12

Beaking : oesophytes
Flattening: of condylar head
Cysts: subchondral Ely cysts

SSE
Sclerosis of glenoid fossa
Subchondral sclerosis (eburnatjkn)
Erosion of articular surface of condylar head

Chronic pain, crepitus, difficulty in chewing

Question 13

How does RA of TMJ present?

Answer 13

Flattening of condylar head
Erosion and destruction of condylar surface
Occasional oesophytes 
Hollowing of gelonoid fossa
Reduced range of movement 
Usually bilateral and symmetrical

Question 14

What is TMD?

Answer 14

A narrow spectrum of relatively non specific disorders that affect the TMJ and or MOM

Question 15

What are the primary symptoms of TMJ?

Answer 15

Pain and muscle or joing
Click
Limitation
Grinding
Pain from joint capsule, restrodiscsl tissues muscles 
Locking

Question 16

What are the secondary symptoms of TMJ?

Answer 16

Otalgia
Vertigo
Headache
Low grade tinnitus

Question 17

What is the prevalence of TMD?

Answer 17

Affects all ages
M and f same
Most commonly in young adults peak 20-40
20-75%of people have symptoms but only 2-4% have treatment

Question 18

What is the aetiology of TMD?

Answer 18

Trauma
Bruxism
Occlusion
Stress
Idiopathic

BIOPSYCHOSOCIAL: biological, psycho and social

Question 19

What is the diff diagnosis of TMD?

Answer 19

Related structure pathology eg teeth, patoid ENT
Neuralgia
Intra cranial lesions
Cervical pain
Vascular eg temporal arterits 
Somatic presentation of psychiatric 
Diseases of salivary gland 
Headaches

Question 20

What is the treatment for TMD?

Answer 20

Physical: massage, heat compress, yoga, homeopathy, US, acupuncture
Drugs: NSAIDS, anxiolytics, muscle relaxants, anti depressant
Occlusal splint
Psychological
Surgery
Acupuncture
Placebo

Question 21

What should the normal painless Maximal opening be?

Answer 21

40-55mm

Question 22

What can happen in patients with TMJ when they open their mouth?

Answer 22

Deviation p

Question 23

What is internal derangement?

Answer 23

Localised mechanical fault innTMJ which interferes with its smooth action

Question 24

What sign may indicate risk of internal dereangemtn?

Answer 24

Clicking | This is because the disk may become abnormally shaped and displaced and may act as a door stop

Question 25

What are the symptoms of ineffective arthritis?

Answer 25

``` Pyrexia Systemic upset Swelling Erythema Suppuration Very restricted mouth opening ```

Question 26

What is ankylosis ?

Answer 26

Abnormal,al union across a joint space

Question 27

What type of tissue may form the union in ankylosis?

Answer 27

Fibrous or bony

Question 28

What are the two groups of ankylosis ?

Answer 28

Extracapsular and intra capsular

Question 29

What are the causes of extra capsular ankylosis?

Answer 29

1. Trauma eg laceration leading to peri articular fibrosis 2. Chronic interested infection next to the joint 3. Tumours fibro sarcoma and chondrosarclma 4. Peri articular fibrosis: irradiation or prolonged immobilisation of the jaw

Question 30

Why are the causes of intrscapsular ankylosis ?

Answer 30

Trauma: intra capsular, condylar fracture, penetrating wound and forceps delivery at birth Infection: otitis media, mastoiditis, osteomyelitis, pyogenic arthritis Tumour: osteoma, chondroma, osteosarcoma, sarcoma, fibro sarcoma, synovial sarcoma, Misc: synovial chondromatosis

Question 31

What are the surgical options for TMJ ?

Answer 31

Arthroscopy and arthocentesis High condylar shave Eminectomy Joint replacement

Question 32

What is arthocentesis?

Answer 32

Lavage of the joint

Question 33

What is an eminectomy?

Answer 33

Cut of: to enable joint to slide freely | Build up: stops translational movement

Question 34

What are the signs which would make you suspicious of a tumour?

Answer 34

``` New signs of TMD in patient more than 60 Lymph involvemtn Cranial nerve dysfunction Trismus Anosmia Objective ipsilateral hearing loss ```

Question 35

What are the imagine options for TMJ?

Answer 35

``` DPT PA CT MRI NM ```

Question 36

When would we do a DPT?

Answer 36

Patient present with trimsus and take open and closed view

Question 37

When would we take a PA jaws?

Answer 37

``` Fracture Cysts Tumour Mandib hypo and hyperplasia Maxillofackal deformations ```

Question 38

When would we do a CT?

Answer 38

Looks at hard and soft tissue Shape and condition of condyle, fossa and articular eminence Position shape and integrity of disk Nature of condylar head disease

Question 39

When would we do an MRI?

Answer 39

Assessment of soft tisse Good when looking at position and from of disk in open and closed views and when diagnosis of internal dereangemtn possible and pre op before disc sugery

Question 41

When would we take a radiosotope ?

Answer 41

Use technetium 99mTc and will get into areas of active bone growth as well as salivary glands, thyroid, blood liver, lung and heart,

Question 42

WHere does the manidble deviate towards the side of when there is a problem?

Answer 42

it will deviate towards the side of derangment eg the side that has the problem