diseases Of TMJ by TS

Question 1

Goldenhar syndrome is a triad of what

Answer 1

Craniofacial microsomia, ocular dermoid cysts and vertebral anomalies. Falls under hemifacial microsomia

Question 2

What are the three factors causing hemifacial microsomia

Answer 2

1) genetic factors - single gene mutation
2) external environmental factors - thialidomide and retinoic acid
3) intrinsic maternal factors eg gestational diabetes

Question 3

What is OMENS and the meaning of it

Answer 3

Classification used for HFM
If OMENS score >6, increased likelihood of extracranial comorbidities

Question 4

What classification used for mandible

Answer 4

Kabans modification of Pruzansky classification
Got type I, type II A, type II B, type III

Question 5

What classification used for development of ear

Answer 5

Marx’s grading system (for microtia)
Grades 1-4, increasing level of deformation (ear is smaller and smaller )

Question 6

What is Mx for HFM

Answer 6

Mandibular distraction osteogenesis +/- orthognathic surgery

Or costochondral graft + oral appliance

Question 7

What is the etiology of treachercollins

Answer 7

• genetic disorder
• 5th and 8th week of embryonic development
• failure of neural crest cells

Question 8

What are some skeletal defects for TCS

Answer 8

• shallow orbit
• hypoplastic zygoma
• Mandibular hypoplasia
• marked antagonism notch
• retrogenia

Question 9

What is the main problem for TCS

Answer 9

Complex airway ( because of the retrogenia)

Question 10

What are the operations to be done on patient with TCS

Answer 10

Mnemonic is Tr E A C H E R S

1) Tr = trachea and airway adjuncts eg tracheostomy
2) E = eye protection
3) A = Angular osteotomy and distraction of mandible in extreme retrognathia to control airway
4) C = cleft palate repair at 6 months
5) H = hearing eg bone anchored hearing aid at about 4 yo when cranial temporal bone is 4mm thick and able to hold osseointegrated implant
6) E = ear reconstruction
7) R = reconstruction of mature facial skeleton, genioplasty
8) S = soft tissue refinements eg midface lift

Question 11

What are the 2 features of PRS and main associated issue?

Answer 11

Glossoptosis = backward positioned tongue
Micrognathia = undervelopment of jaw

Associated with airway obstruction

Question 12

What is the tubingen palatal plate used for

Answer 12

Management of PRS, to correct the micrognathia and retrognathia

Question 13

What is the definition of true ankylosis of TMJ

Answer 13

Fibrous or bony fusion of condyle and glenoid fossa

Question 14

Causes of TMJ ankylosis

Answer 14

1) trauma (main aetiology )
2) infection
3) systemic diseases

Question 15

3 clinical features of TMJ ankylosis

Answer 15

1) limitation in mouth opening
2) facial deformity
3) KIV OSA

Question 16

what is the difference in clinical features for unilateral and bilateral TMJ ankylosis

Answer 16

1) for unilateral, there is chin pt deviation to affected side, but for bilateral it is just retrusion because both cannot grow

2) unilateral may have maxillary cant whereas bilateral is steep occlusal plane since posterior maxillary height is shortened

Question 17

which deformity gives a bird face of andy gump look

Answer 17

bilateral tmj ankylosis

Question 18

6 reasons why kids are at greater risk of TMJ ankylosis

Answer 18

1) articulating surfaces highly vascular
2) flat and broad glenoid fossa
3) vascular articulating disc
4) thick and stout condylar neck
5) hemarthrosis (articular bleeding into joint cavity)
6) greater osteoblastic activity

Question 19

what type of facial malformations are caused by the underdevelopment of first and second pharyngeal arches

Answer 19

craniofacial microsomia

Question 20

what muscles are derived from 1st pharyngeal arch

Answer 20

MOM

Question 21

what nerve and artery are derived from 1st pharyngeal arch

Answer 21

trigeminal nerve, maxillary artery

Question 22

what muscles are derived from 2nd pharyngeal arch

Answer 22

MOFE

Question 23

what nerve and artery derived from 2nd pharyngeal arch

Answer 23

facial nerve, stapedial artery

Question 24

what nerve and artery derived from 3rd pharyngeal arch

Answer 24

glossopharyngeal nerve and common carotid/ internal carotid artery

Question 25

what nerve from 4th and 6th arch

Answer 25

vagus

Question 26

what are the 3 paired prominences that fuse to form the face

Answer 26

1) maxillary
2) lateral nasal
3) mandibular

Question 27

what is the main blood supply to TMJ

Answer 27

1) branches of superficial temporal
2) deep auricular
3) anterior tympanic
4) ascending pharyngeal arteries

Question 28

what is the nerve supply to TMJ

Answer 28

from branches of mandibular division of trigeminal nerve:

1) auriculotemporal nerve
2) masseteric branch
3) deep temporal branch

Question 29

what muscles help TMJ to close and open jaw

Answer 29

• elevate and close jaw: masseter, temporalis, medial pterygoid
• depress/open jaw: lateral pterygoid, geniohyoid, mylohyoid and digastric

Question 30

what principal maxillofacial defects in hemifacial microsomia

Answer 30

MANDIBLE
- mandibular hypoplasia
- malformed glenoid fossa

EAR
- microtia
- preauricular tags
- conductive hearing loss

MIDFACE
- maxillary hypoplasia
- zygomatic
hypoplasia
- occlusal canting

SOFT TISSUE
- masticatory muscle hypoplasia
- cranial VII nerve palsy

Question 31

diagnostic criteria for HFM

Answer 31

either ipsilateral mandibular and ear defects or

asymmetric mandibular or ear defects in association with either
a) two or more indirectly associated anomalies

b) positive family history of CFM