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face pain > intro/anatomy of TMJ > Flashcards

intro/anatomy of TMJ Flashcards

1
Q

what is orofacial pain

A

Evaluation, diagnosis and treatment of:₁
1. Temporomandibular Joint Disorders (TMD)
2. Masticatory muscle pain
3. Cervical muscle pain
4. Neurovascular pain/headaches
5. Neuropathic pain (nerve dysfunction)
6. Obstructive Sleep apnea
7. Intraoral, intracranial & systemic disorders that cause facial pain

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2
Q

OF pain as a bridge

A

 Bridges the gap between medicine and
dentistry

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3
Q

causes of OF

A

trauma or medical disorders

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4
Q

trauma to jaw

A
  • Sports Injuries
  • Motor Vehicle Accidents
  • Domestic Abuse
  • Clenching and Bruxing
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5
Q

medical dx leading to OFP

A

 Arthritis
 Migraine Headaches
 Nerve Dysfunction
 Viruses/infections
 Muscle Disorders
 Neurological Disorders

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6
Q

common jaw symptoms

A

 Jaw pain
 Limited mouth opening
 Clicking and grinding noises
 Difficulty with normal daily activities (i.e. eating, talking, opening)

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7
Q

common TMDs

A
  1. Disc displacement
  2. Inflammatory disorders
  3. Arthritis
  4. Masticatory muscle disorder
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8
Q

when was OF recognized as special

A

2020

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9
Q

professional associations of OFP

A

 American Academy of Orofacial Pain (AAOP)
 American Headache Society
 American Pain Society
 International Headache Congress

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10
Q

why is OFP a special

A

 To help people in pain
 To help diagnose difficult disorders
 To help patient psychologically and to give
the patient a sense of control over their pain
 To improve sleep apnea symptoms which can
save the patient’s life
 Patients are typically very appreciative of your
assistance and their quality of life is
significantly improved

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11
Q

what type of joint is the TMJ? what does this mean?

A

 The TMJ is a ginglymoarthrodial joint with hinging or rotation movements in one plane (ginglymoid joint) & gliding or translation movements in another plane (arthrodial joint)

 The condyles/jaw move synchronously- both sides move together (pain can be opposite of trauma)

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12
Q

Temporomandibular Joint
 Two of?
 Articulation between?
 The mandibular condyle fits into?
 The articular disc seperates?

A

Temporomandibular Joint
 Two of the most complex joints in the body.
 Articulation between the cranium & mandible.
 The mandibular condyle fits into the mandibular (glenoid) fossa
 The articular disc separates these 2 bones from direct contact

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13
Q

TMJ Capsule

A

 A fibrous capsule contains the synovial fluid, limits its motion and maintains the
relationship between the joint components.

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14
Q

Temporomandibular Joint (TMJ) as a synovial joint
 Is a Synovial joint
 Synovial fluid(synovia) roles?
 Synovial fluid is secreted by? how much present?
 Articular Disc separation?

A

 Is a Synovial joint
 Synovial fluid(synovia) transports nutrients to & waste products from the articular surfaces & lubricates joint
 Synovial fluid is secreted by the membrane lining the synovial joint and there is approximately 1cc in each compartment of the joint spaces
 Articular Disc separates the condyle & mandibular fossa from direct contact & divides joint into superior and inferior joint spaces

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15
Q

why would these ondyles be less mobile

A

elongated articular eminences

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16
Q

label

A
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17
Q

Functions of Disc

A
  1. Distributes loading forces
  2. Decreases wear
  3. Stabilizes condylar movement
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18
Q

Disc
1. Articular portion is composed of?
2. Has some ability to?
3. Is devoid of?
4. The posterior attachment of the disc is?

A

Disc
1. Articular portion is composed of dense fibrous connective tissue NOT cartilage
2. Has some ability to repair itself
3. Is devoid of nerves or blood vessels in the intermediate zone which articulates with the superior aspect of the condyle during translation
4. The posterior attachment of the disc is highlyvascularized and innervated

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19
Q

histology slide of TMJ

A
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20
Q

disc/ posterior attatchment histo

A
  1. Dense, fibrous connective tissue
  2. Non-vascular in center
  3. Non-innervated in center

B. Posterior attachment (Retrodiscal Tissue)
1. Loose, vascular, connective tissue (contains collagen fibers, adipose tissue, elastin, arteries & a venous plexus)
2. Richly innervated by auriculotemporal nerve

21
Q

The articulating surfaces of tmj are lined with?

A

The articulating surfaces are lined with dense
fibrocartilage (instead of hyaline cartilage) which
allows for a greater ability to heal

22
Q

Articular Cartilage
 defined?
 Plays an important role as?
 Research suggests that compressive loading is highest where?
 Composed of?

A

 A thin layer of cartilage covers the articulating surface of the bones.
 Plays an important role as a stress absorber during function.
 Research suggests that compressive loading is highest in the anteromedial region of the condyle (1).
 Composed of cells and extracellular matrix (i.e. collagens & proteoglycans).

23
Q

discal ligaments
 Allow the disc to move in?
 Discal ligaments may become? why?

A

 Allow the disc to move in anterior-posterior direction during condylar translation.
 Discal ligaments may become inflamed & painful because they are vascularized and innervated.

24
Q

capsular ligaments

function?

A

 Attach the disc to the condyle on the medial & lateral surfaces
 Allow the disc to rotate on the condyle during condylar translation
encompass the entire TM joint retaining the synovial fluid and resist medial/lateral/inferior forces that might dislocate the articular surfaces.

25
Q

extracapsular ligaments role

A

Ligaments passively limit joint movement: Sphenoman and styloman ligaments

26
Q

Aa supplying mid face

A

maxillary

27
Q

TMJ vascular supply

A
  1. Superficial temporal artery
    a) Transverse facial
  2. Maxillary artery
    a) Deep auricular
    b) Masseteric
    c) Posterior deep temporal
28
Q

TMJ nn supply

A

 Auriculotemporal (V3) nerve
 Masseteric nerve

29
Q

what is normal disc position

A

11-12 o’clock position of condyle with posterior thick band

30
Q

what is the MC disc displacement

A

medial and anterior, can lead to clicking

31
Q

is clicking always tx?

A

no, only if pain present

32
Q

TMJ translation

A
33
Q

where does tmj rotation occur

A

Rotation occurs
between inferior
disc surface and
condyle

34
Q

where does tmj translation occur

A

Translation occurs
between the superior
disc surface and fossa

35
Q

when mouth is fully open where is condyle

A

Condyle reaches mid-
articular eminence

36
Q

what happens when pt is not centered on pano

A

asymmetry

37
Q

path?

A

no WNL

38
Q

path?

A

no, considered remodeling
flattening and cortical thickening of the antero- superior surface of the condylar
head and glenoid fossa

39
Q

what is likely happening

A

arthrhitis, cystic bone changes and possible osteophyte formation

40
Q

arthrhitis open mouth CT

A

may be Bone on bone contact with decreased joint space indicating severe arthritis, possible MRI to determine state of disc

41
Q

what is happening here?

A

arthirhits

42
Q

Masticatory Muscles

A
  1. Masseter
  2. Medial pterygoid
  3. Temporalis
  4. Lateral pterygoid
  5. Digastric muscle
43
Q

Masticatory Muscles
1. Skeletal muscles which provide movement of?
2. Functional behaviors:
3. Nonfunctional (parafunctional) behaviors:
4. Innervation:

A

Masticatory Muscles
1. Skeletal muscles which provide movement of the TMJ’s
2. Functional behaviors: talking, chewing, and swallowing
3. Nonfunctional (parafunctional) behaviors: bruxism, clenching, or empty-mouth chewing movements (i.e. tardive dyskinesia, orofacial dystonias)
4. Innervation: V3 (Mandibular Nerve)

44
Q

masseter mm functions

A

SUPERFICIAL MASSETER: Elevates the mandible (closes the jaw)
DEEP MASSETER: Retrudes the mandible

45
Q

temporalis actions

A
46
Q

medial pterygoid mm actions

A
47
Q

lateral pterygoid actions

A
48
Q

digastric mm action

A
49
Q

Temporomandibular Disorders (TMD)

A

A collective term that includes a number of clinical problems involving the masticatory muscles, TMJ & associated structures which are identified as the major cause of non-dental pain in the orofacial region:
1. Musculoskeletal Disorders
2. Articular Disc Disorders
3. Inflammatory & non-inflammatory Disorders

face pain (12 decks)

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