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5th yr- CMS2- TMJ Symposium > Intro into tmj pain and imagining > Flashcards

Intro into tmj pain and imagining Flashcards

1
Q

List the different causes of chronic primary ono facial pain

A
  1. TMJ Pain (facial arthromyalgia)
  2. Atypical facial pain
  3. Burning mouth syndrome
  4. Atypical odontalgia
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2
Q

How do we classify chronic pain

A
  1. Pain that presents for 3 months or longer
  2. Pain that has significant functional and emotional impairment
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3
Q

Define pain

A

An unpleasant sensory and emotional experience associated with or resembling that associated with actual or potential tissue damage

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4
Q

Define nociplastic pain

A

Pain that arises from altered nocicpetion despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral noicicpetors or evidence got disease or lesion of the somatosensory system causing the pain

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5
Q

What is involved in moving the TMJ

A
  1. Muscles: Temporalis + Master + neck muscles
  2. Teeth
  3. Joints
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6
Q

What do we need to gather when gathering a history of a patent with chronic TMJ pain

A

Physical signs and symptoms
Psychosocial symptoms

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7
Q

How do we ensure we have all try information from A pt with TMJ pain

A

By using the masticatory system examination

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8
Q

What does the masticatory system examination include

A
  1. Temderness on palpation
  2. Range of motion
  3. Notes on the joints eg clicks
  4. Muscle tenderness
  5. Trismus check list
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9
Q

What should the history of a patent with TMJ pain include

A
  1. Site, descriptors
  2. Duration, pattern, exacerbating/ reliving factors
  3. Psychosocial history
  4. Co morbidities
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10
Q

Give examples of some TMD diagnosises

A
  1. Intra articular joint disorders
  2. Degerneative joint disorders
  3. Pain related TMD and headache
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11
Q

Give examples of intra articular joint disorders

A

Disc displacement with or without reductio and with to without locking

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12
Q

Give examples fo degenerative joint disorders

A

Osteo / rheumatoid arthritis

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13
Q

Give examples of pain related TMD and headache

A
  1. Myalgia
  2. Myofascial pain
  3. Headache attributed to TMD
  4. Arthralgia
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14
Q

What can TMD be mis diagnosed for

A

Otalgia
Toothache
Persistent idiopathic facial pain
Acute and chronic maxillary sinusitis

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15
Q

What can TMD be mis diagnosed for

A

Otalgia
Toothache
Persistent idiopathic facial pain
Acute and chronic maxillary sinusitis

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16
Q

What are some physical self regulation tips, advice and techniques we can give to pts with TMD pain

A
  1. Soft diet
  2. Avoid activities that involve wide opening (yawning)
  3. Clenching and grinding reversal exercises
  4. Massage muscles and hot/cold compress
  5. Posture contro
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17
Q

What is the role of imaging in TMJ pain patients

A

1, To supplement information gained through clinical examination
2. To evaluate integrity and relationship of hard and soft tissues
3. To confirm extent and progression of known disease
4. To evaluate effects of tx

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18
Q

Which radiogrpahs can we take to assess TMJ

A
  1. Plain film
  2. CT and Cone beam CT
  3. MRI
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19
Q

What can a plain film examination give us an assessment of

A

Low to moderate value in the assessment of:
1. TMJ Osseous components
2. Facial skeletel symmetry
3. Internal jaw anatomy/ pathology

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20
Q

What are the disadvantages of plain film examination

A

Cannot assess soft tissue component of joint

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21
Q

What are the advantages of panoramic radiographs

A
  1. Quick and readily available
  2. Comfortable position for patent
  3. Dedicated programme for condyles
  4. Open and closed views
  5. Can assess for referred causes of pain
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22
Q

What are some of the limitations of panoramic radiogrpahs

A
  1. Fronto lateral view of condyle
  2. Inconsistent magnification and hermetic distortion
  3. Sensitive to positioning errors
  4. Superimposition of structures and ghost images
  5. Cannot exclude early bony change
  6. Does not image soft tissue component of the joints
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23
Q

What the indications to take an OPT for TMJ problems

A
  1. Change in occlusion
  2. Mandibular shift
  3. Change in movement range
  4. Sensory or motor alterations
  5. Recent trauma
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24
Q

What the contra indications to take an OPT for TMJ problems

A
  1. Joint noises
  2. Myofacial pain
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25
Q

What is TMJ dislocation

A

Condyle displacement out of glenoid fossa but remaining within the joint capsule

26
Q

Where is TMJ dislocation most common

A

Anterior dislocation where condyle is anterior to articular eminence
Patient cannot close mouth

27
Q

What is a key difference between Cone beam CT and normal CT

A

Cone beam CT cannot view soft tissues

28
Q

What can CBCT/CT allow us to do

A

Allows bony structures to be assessed without super imposition
Good for assessing osseous structures and extent of ankylosis

29
Q

When is a CT scan indicated

A

When a neoplasm is suspected to extend beyond the osseous structures

30
Q

What does an MRI provide

A

Contrast between soft tissues

31
Q

What are the contra indications for an MRI

A
  1. Claustrophobia
  2. Pacemaker
  3. Metallic foreign body
32
Q

What are some indications for an MRI

A
  1. Assessment of disk position/ status
  2. To asses presence of synovitis in inflammatory arthritis
  3. Bony changes for diagnosis of arthritis
33
Q

Name the most common disorder in the TMJ region

A

Myofascial pain syndrome

34
Q

What is myofascial pain syndrome caused by

A

Pain caused by muscle tension fatigue or spasm
coudl be related to parafuncitonal habits such as bruxism

35
Q

How can we diagnose myofacial pain syndrome

A

History and examination

36
Q

Describe the radiograph of a pt with myofascial pain syndrome

A

As joints are often normal there is usually no relevant imaging findings

37
Q

What are the symptoms fo internal derangement

A
  1. Clicking
  2. Pain from joint and/or musculature
  3. Trismus/ locking
38
Q

What is internal derangement

A

Displacement of disk from normal position most commonly anterior to the condylar head

39
Q

What is degenerative joint disease

A

Non inflammatory process of wear and tear due to sustained micro trauma over prolonged periods

40
Q

What can happen in degenerative joint disease

A

Deterioration of articular cartilage exposing bone and causing flattening of the condylar head and bony defects

41
Q

What are the symptoms of degenerative joint disease

A

May be asymptomatic and an incidental finding
Coudl be painful crepitus and trismus

42
Q

What is an osteophyte

A

A projection of bone at the site of muscle attachment usually seen anteriorly in the TMJ

43
Q

What can happen to an osteophyte

A

can fracture and form loose bodies in the joint

44
Q

What is sclerosis

A

Increased density in the condylar head

45
Q

How does sclerosis appear on a radiograph

A

Bone appears lighter on plain film and CT
BUT Bone marrow appeared darker on MRI

46
Q

What is a subcentral cyst

A

Formation of fluid filled cavity beneath the articular surface

47
Q

Give examples of inflammatory arthropathies

A
  1. Rheumatoid arthritits
  2. Juvenile idiopathic arthritis
48
Q

What is rheumatoid arthritis

A

A synovial membrane inflammation and secondary bony erosion
Granulomatous tissue growth int eh synovial

49
Q

What is juvenile idiopathic arthritis

A

Chronic intermittent synovial inflammation causing swollen and painful joints

50
Q

List some imaging features of rheumatoid arthritis

A
  1. Sharpened pencil like erosions condylar head
  2. Joint effusion and marrow oedema
  3. Synovial enhancement on MRI
51
Q

List some imaging features of juvenile idiopathic arthritis

A
  1. flat deformed condyle with wide glen oid fossa
  2. Joint effusion and marrow oedema
  3. Synovial enhancement on MRI
52
Q

What is joint effusion

A

Collection of fluid in the joint spaces leaden to an increase in joint space seen on plain film or CT

53
Q

What is ankylosis

A

Fusion of elements of the joint causing truisms
can be fibrous or bony

54
Q

What is ankylosis usually a result of

A
  1. Trauma
  2. Infection
  3. Severe juvenile inflammatory arthritis
55
Q

Give some radiographic features of ankylosis

A

Reduced or no joint spave
Bony bridge or jigsaw puzzle interlocking articular surfaces

56
Q

What happens in condylar hyperplasia

A

Large condyle with normal morphology
Glenoid fossa may remodel to accommodate enlarged condyle

57
Q

What is condylar hyperplasia associated with

A

Enlargement of ipsilateral hemimandible

58
Q

What might a patient with condylar hyperplasia present with

A

Facial asymmetry

59
Q

What are some of the indications for imaging

A
  1. Suspected osseous abnormality or infection
  2. Failure of conservative treatment
  3. Worsening symptoms
  4. History of trauma
  5. Significant dysfucntion
  6. Alteration in range of motion
  7. Sensory of motor abnormalities
  8. Significant change in occlusion
60
Q

When is imaging not indicated

A
  1. Joint sounds in the absence of other signs or symptoms
  2. Asymptotic children/ adolescences prior to starting orthodontic treatment

5th yr- CMS2- TMJ Symposium (2 decks)

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