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TMJ Flashcards

1
Q

unlike oteher joints TMJ enclosed with

A

fibrous tissue

articular disk that is biconcave

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2
Q

bones with TMJ

A

mandible and cranium bone

portion of mandible = condylar process– bulbous and elongated m-d and flattened a-p

cranial bone = temporal bone

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3
Q

help in diangosis / evaluation

A

history

clinical exam

imaging studies

arthroscopy - joint exam

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4
Q

___ may be the most important part of evaluation

A

history - interview

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5
Q

disroders include

A

myofacial pain and dysfunction (MPD)

internal derangements

degenerative joint disease

systemic arthritic conditions

chronic recurrent dislocation

ankylosis

neoplasm

trauma

infections

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6
Q

physical exam

A

evaluation of the masticatory system (asymmetry, hypertrophy, clenching)

muscles palpated for tenderness, fasiciculations, spasm, trigger points

note any tenderness and noise

  • note the range of opening

dental evaluation?
- wear? occlusion?

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7
Q

mandibular range of motion

A

normal is 45 mm vertically and 10 mm protrusive and laterally

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8
Q

dental evalutiaon

A

wear facets, occlusal relationships, CR/CO relationship

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9
Q

internal derangements diagnostic toolls

A

IMAGING

  • transcranial
  • panoramic
  • tomogram
  • arthrography
  • CT scan
  • MRI
  • nuclear imaging
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10
Q

panoramic use

A

one of the best radiographs for overall screening evaluaiton of the TMJ’s

visualization of both TMJ’s on same film

provides good assessment of the bony anatomy of the articulating surfaces of the mandibular condyle and glenoud fossae, and other areas

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11
Q

tomograms

A

allows radiographic sectioning at different levels of the condyle and fossa complex,

provides individual view visualizing the joint in SLICES from the medial to the lateral pole

eliminates bony superimposition and overlap

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12
Q

which gives a clearer picture of the bony anatomy

A

TOMOGRAMS

Can see degenerative condylar changes

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13
Q

TMJ arthrography

A

first imaging techniue available to visualize the intraarticular disk

injection of contrast material into the inferior or superior spaces of the joint

demonstrates the presence of perforations and adhesions of the disk or its attachments

RARELY used today

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14
Q

computed tomography

A

combination of tomographic views of the joint, combined with computer enhancement of hard and soft tissue images

CT images provide the MOST ACCURATE radiographc assessment of the BONY components of the joint

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15
Q

most accurate radio assessment

A

Computed Tomography

CT

example - diagnosis of fibro-osseous ankylosis

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16
Q

MRI

A

most effective for TMJ soft tissue

valuable technique for evaluating disk morphology and position

images can be obtained showing dynamic joint function

no ionizing radiation used

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17
Q

most effective for TMJ soft tissue

A

MRI

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18
Q

degenerative condylar changes seen when

A

later on in stages of disease

initially just usually pain and discomfort not necessarily radiographic changes

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19
Q

nuclear imaging

A

involves injection of Tc99 which is concentrated in areas of active bone metabolism

images taken 33 hours after injection

information obtained can be difficuly to interpret

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20
Q

classification of TMJ disorders

A

myofacial pain

disk displacement disorders

DJD

systemic arthritic conditions

chronic recurrent dislocation

ankylosis

neoplasm

infections

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21
Q

MRI look at

A

disk!!

fibers
muscles

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22
Q

main features of myofacial pain and dysfunction (MPD)

A
  1. abnormal or hyperactive muscle activity
    - clenching / bruxims
  2. diffuse, poorly localized pain
    - headaches, bitemporal
  3. NO JOINT NOISES
  4. usually no radiographic abbnormalities

THE MOST COMMON CAUSE OF MASTICATORY PAIN AND LIMITED FUNCTION FOR WHCIH PT’S SEEK TX.

MOSTLY WITH THE MUSCLES AND JOINTS
- not really bone
- could be neck / trapezius as well
with referred pain

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23
Q

MPS management?

A

MPS may settle without medical intervention within 5-10 days but if they become chronic can be quite disabling

early diagnosis and targeted treatment may prevent chronicity occuring

the aim of MPS management is PAIN RELIEF AND RESTORATION OF FULL MUSCLE FUNCTION, which is associated with complete muscle length, posture, and full range of motion, to avoid chronic complications such as muscular dystrophy and permanent disability

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24
Q

MPD treat?

A

enhancing central inhibition – pharmocologial and or behavior techniques and reducing periheral inputs using physical therapy

correct unconscious postural habits

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25
methods of inactivation of inactivation of TP's for?
myofacial pain | dysfunction syndrome
26
forward translation should come back to
12 o clock position deviation from this referred to as internal derangeemnt
27
``` anterior disk displacement with reduction describe and form of? closed position? open position? during closing? ```
type of internal derangement disk is positioned anteiror and medial to the condyle in the closed position during opening - condyle translates forward and passes over thickened posterior band of disk, creatinga clicking noise during closure - the condyle slips posteriorly and rests on the retrodiscal tissues - with the disk then returning to the anterior, medially displaced position joint and muscle tenderness - opening and reciprocal clicks are noted with reduction -- disk COMES BACK - patient usually presents with limited mouth opening
28
anterior disk displacement withOUT reduction describe and form of? affected side? contralateral side?
the disk displacement cannot be reduced and thus the condyle is unable to translate to its full anterior extent prevents maximal opening and causes deviation of the mandible to the AFFECTED SIDE and decreased ateral excursions to the contralateral side NO clicking - b/c the condyle does not translate over the posteiror aspect of the disk fails to come back to position in 12 oc lcok position - now lined in different position
29
anterior disk displacement with reduction | describe and form of
with reduction -- disk COMES BACK - patient usually presents with limited mouth opening BOTH OPEN AND CLOSED CLICK
30
disk position
anterior and medial to the condyle in the closed position
31
wilkes classification of
internal derangement of the TMJ i- V I--V
32
wilkes classification of internal derangement of TMJ that does not reduce
internal derangement of the TMJ stage III - no reduction more frequent pain and tenderness in the joint, associated with headaches and locking and restrcted motion - no degenerative osseous changes IV and V can see disk perforations and degenerative osseous changes
33
DJD cuases usually by (3 main) | degnerative joint disease
direct mechanical trauma hypoxia reperfusion injury neurogenic inflammtion
34
symptoms of DMJ
pain, localized to the joint headaches ear pain clicking crepitus limited opening symproms usually increase with function
35
DJD radiographic findings
CT needed to compliment MRI irregular perforated disks dereased joint space flattened of condyle erosion of cortex of condyle osteophyte formation**
36
rheumatoid arthritis is a? | describe
systemic arthritis condition - usually TMJ in only one of several joints affected - usually bilateral - contrasted to DJD- can occur at any age - abnormal proliferatio of synovial tissue
37
chronic dislocation
condyle is displaced anteriorly and is locked in front of articular eminence (temporal bone) severe muscle spasms pain
38
put disc back how
bring down back and up
39
chronic disloaction tx
surgical - reserved for severe cases eminectomy - aricular eminence is removed so that condyle can return to glenoid fossa
40
eminectomy
aricular eminence is removed so that condyle can return to glenoid fossa elimination of the eminance flaten out the eminence -- remove that portion of the bone
41
intracapsular ankylosis most common etiology?
fusion of joint due to formation of bone or fibrous tissue (or both) most common etiology is trauma, especially in children
42
types of ankylosis
intracapsular extracapsualr
43
extracapsualr ankylosis involves? caused by
causes - usually involves the coronoid process and temporalis muscle - coronoid hypperplasia trauma to the zygomati arch
44
modified kaban's protocol
substitute ramus/ condyle reconstruction using DISTRACTION OSTEOGENESIS, when possible, instead of costochondral grafting this protocol has major advanthetage of eliminating the donor site operation and allowing for immediate vigorous TMJ mobilization
45
the most common cause of masticatory pain and limited function for which patients seek treatment
myofacial pain and dysfunction - no joint noises - usually no raiogtpahic abnormalties
46
aim in MPS management
the aim of MPS management is PAIN RELIEF AND RESTORATION OF FULL MUSCLE FUNCTION, which is associated with complete muscle length, posture, and full range of motion, to avoid chronic complications such as muscular dystrophy and permanent disability
47
affected vs contralateral side in anterior disk displacement without reduction?
affected side -- deviation of mandible to this side contralateral side -- decrease in lateral excursions to the contra lateral side
48
clicking in anterior disk displacement without reduction?
NO -- because condyle does not translate over the posterior aspect of the disk there is an opening and closing click in with reduction
49
internal derangment - general
th disk is positioned anterior and medial to the condyle in the closed position has to pass over thickened posterior aspect to open
50
closing click
in anterior disk displacement with reduction | - condyle goes back posteriorly and the disc returns to the anterior medially displaced position
51
assessment of clicking
it is a brief noise that occurs at some point during opening, closing, or both
52
assessment of crepitus
it is a diffuse, sustained sound usually felt throughout a considerable portion of the opening or closing cycle or both
53
assessment of reciprocal click
noise made on opening and closing from centric occlusion that is reproducible on every opening and closing - early stage disk disorder
54
sign of early stage disk disroder
reciprocal click and popping
55
assessment of reproducible opening click
noise with every opening no noise when closing deviation in form of disk or late stage disk disorder
56
assessment of reproducible closing click
noise with every closing, no noise when opening | - deviation in form of disk
57
assessment of popping
loud sound on opening that is audible to examiner at a distance - early stage disk disorder
58
best to study internal derangments / disk displacment disorders
MRI demonstrates position of articular disk - open and closed mouth views are needed to study disk can demonstrate joint effusion or other soft tissue abnormalities
59
can see osteophyte formation in?
radiogrpahic finding of degenerative joint disease
60
contrast RA with DJD
DJD - usually getting worse with time and age whereas RA can occur at any age aa it is a systemic arthriic condition
61
clinical evaluation of intracapsular vs extracapsular ankylosis
intracapsular - severe restirction of maximal opening - deviation to the affected side - decreased lateral excursions to the lateral side extracapsular - limitation of opening - deviation to the affected side - - limited lateral and PROTRUSIVE movements can usually be performed (think of the temporalis muscle involvment)
62
major difference between modified kaban's protocol and kabans protocol
modified - uses DISTRACTION OSTEOGENESIS instead of osteochondral grafting so substitutes ramus/ condyle reconstruction using this technique
63
basic for kaband protocl
calls for aggressive resection and ipsilateral coronoidectomy and contralateral coronoidectomy when necessary line the TMJ with temporalis fascia or cartilage, reconstruction of the ramus with a COSTOCHONDRAL GRAFT - rigid fixation, and - early mobilization and agressive physiotherapy is presented MODIFIED - DISTRACTION OSEOINTEGRATION with no costochondral grafting
64
neoplasms in the joint?
very rare - will present with pain - asymmetry, deviation of mandible - restricted opening
65
infections could come from
from ear and could cause intrascapular ankylosis
66
evidence from studies of TMD - basic conclusion
recent evidence has suggested that in most cases TMD may be a manifestation of chronc orofacial pain proper dx and managment is of paramount importance follow up is equally significant
67
auto repositioning splint
full arch contact disarticulates the jaws and may place condyles in posterior / retruded position, reducing the disk allows the patient to seek a comfortable muscle and joint position without excessive influence of the occlusion
68
useful tx for anterior disk displacement with reduciton
anterior repositioning splint
69
anterior repositioning splint
anterior ramp forces mandible into protruded position attempts to protrude proper condyle / disk relationship useful for pts. with anterior disk displacement with redution
70
arthrocentesis is what type of tx?
surgical
71
arthrocentesis
lavage of the superior joint space with needles steroids ma be injected into the joint indicated for acute closed lock -- non reducing anteriorly displaced disk may relieve "suction cup effect" of disk eliminiation of biological mediators of pain and inflammatin very effective at reducing pain and increasing function post-op physical therapy is essential
72
indication for arthrocentesis
for actute closed lock -- non reducing anteriorly displaced disk

Oral Surgery (26 decks)

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