TMJD Flashcards

Question

Which joint disease produces worsening pain with function?

Answer 1

Osteoarthritis

Answer 2

Rheumatoid arthritis

Answer 3

``` Bilateral involvement (unlike OA, or other gout dz which is usually unilat) Pain with limited range of movement Preauricular swelling Pain which is worse in morning which improves over course of the day Late presentations: - condylar resorption - class 2 malocclusion - AOB - ankylosis ```

Answer 4

Bilateral involvement of the joint Condylar flattening Cortical erosion Loss of ramus height

Answer 5

``` <12 years Bilateral Flattening and erosion of radiograph Loss of ramus height Aperthognathia (AOB) Skeletal class 2 with bird face deformity Positive RF (20%) and ANA (60-80%) ```

Answer 6

Serological markers: ACPAs (anti-citrullinated protein antibodies) RF (rheumatoid factors) ANAs (antinuclear antibodies) HLA Dw5, DRw ESR: to indicate/monitor disease progression or clinical course

Answer 7

Narrowing of joint space Cortical erosions Osteophyte formation Subchondral cysts

Answer 8

Disease management: NSAIDs, steroids, soft diet, physiotherapy, immunosuppressive drugs - referral to rheumatology Structural defect mx: arthrocentesis/arthroscopy/open joint surgery, ogs

Answer 9

Erosion Sclerosis Flattening Reduced joint space

Answer 10

Conservative: soft diet, medications, occlusal splint, physiotherapy. Surgical: removal of osteophytes and smoothening of erosions (Only indicated if conservative mx not effective after 6 months)

Answer 11

Inflammatory arthritis that develops from an infection else where in the body (cross reactivity) Classic triad: Arthritis (cannot climb) Uveitis (cannot see) Urethritis (cannot pee) Labs: RF negative

Answer 12

Yes. | As it continues to retrodiscal tissues that contains vessels and nerves

Answer 13

Elongation of styloid process that causes pain in the neck

Answer 14

Bilateral symmetric progressive condylar resorption Followed by stabilization without further loss of height down to sigmoid notch Occuring in young teenage females at pubertal growth spurt

Answer 15

``` Mild symptoms of TMJD without restriction in function Thinning and flattening of the condyle Loss of posterior ramus height Anterior open bite Mandibular retrusion Class 2 ```

Answer 16

Bone scintigraphy (Technetium 99) to assess activity inflammation, resorption or stabilization of disease

Answer 17

Treatment to restore function, stable occlusion and aesthetic - conservative tx with splints, medications and physiotherpay if symptomatic, and to stabilize progress of disease - orthognathic surgery requiring BSSO to advance mandible once disease has been stabilized - associated with an increase risk of relapse due to reactivation of ICR - TMJ reconstruction/replacement is considered gold standard with complete removal of disease - controversial as to be too invasive surgery

Answer 18

1. Severity of AOB whether increasing or similar 2. Dentals casts to allow comparisons from previous review dates 3. Lateral cephalogram, able to assess the condyle and extension of skeletal discrepancy, able to measure post ramus height 4. Opg to look at changes in the condylar flattening or erosion 5. Bone scan with Technetium to look for activity of inflammation, growth or condylysis (destruction)

Answer 19

``` End stage joint disease of OA or RA (usually presents with severe pain and severe resorption) Adult ankylosis Severe ICR with total loss of condylar Neoplasm of TMJ requiring resection Avascular necrosis of the tmj ```

Answer 20

``` Active infection Inadequate local bone Known allergy to TJR material (nickel, titanium) Pediatric (or still growing) Inability to under rehabilitation ```

Answer 21

Failure of hardware - breakage of component - loosening or displacement of hardware - wearing through of fossa material - prosthesis does not fit - fixation failure Biologic - infection - immune response (allergy or foreign body reaction) Operative related - Nerve injury (facial nerve, ATN) - otologic complications (hemotynpanum, perforation of EAC or tympanic membrane) - bleeding (superficial temporal artery during flap approach; masseteric artery/internal maxillary artery during resection of condyle which is located 20mm below condylar head; pterygoid venous plexus, middle meningeal artery) - intracranial injury (glenoid fossa thickness is 0.9mm) - rarely reported

Answer 22

1. Prefabricated (stock prosthesis) - allows 1 stage procedure to resect and reconstruct 2. Custom prosthesis - requires 2 stage procedure, resection - ct scan for custom joint fabrication - reconstruction