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Caroline > LECTURE 4- TMJ > Flashcards

LECTURE 4- TMJ Flashcards

1
Q

what are the main 2 articular structures that make up the TMJ

A

mandible and temporal

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2
Q

other bones contributing to the TMJ structure

A

maxilla , zygomatic , sphenoid, hyoid

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3
Q

what forms the 2 TMJs

A

condole of mandible and articular eminence of temporal

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4
Q

what type of joint is the TMJ

A

synovial joint

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5
Q

are the surfaces of the TMJ covered in fibrocartilage or hyaline cartilage?

A

avascular fibrocartilage

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6
Q

what type of movement joint is the TM joints

A

ginglymoarthrodial (diarthrosis) allowing for free movement

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7
Q

which layers of the joint surfaces are perpendicular to bony surface and what do they do

A

deep layers and withstand stress

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8
Q

how are the superficial layers of the joint surfaces arranged and what do they facilitate in the TMJ

A

parallel and facilitate sliding of joint

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9
Q

how much can a bite force be

A

up to 1200 N

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10
Q

what structure is the largest of facial bones

A

mandible

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11
Q

where do the mandible condyles sit in relation to the ear

A

anterior to external auditory meatus

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12
Q

what part of the mandible is the attachment site for temporalis muscle

A

coronoid process

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13
Q

what makes up for joint incongruence and separates articulation into inferior and superior TMJ functions

A

articular disc

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14
Q

how does the inferior TMJ function (type of joint and motion)

A

as an hinge joint - rolling posterior during opening

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15
Q

how does the superior TMJ function

A

as a plane joint , sliding anterior during opening

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16
Q

the articular disc of the TMJ is what shape?

A

bioconcave

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17
Q

what purposes do the articular disc of the TMJ serve

A

joint stability
minimize loss of mobility
reduce frication
decrease biomechanical stress at joint

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18
Q

where does the disc attach at the TMJ? what bony landmarks

A
  • medial and lateral poles of the mandible condyle
  • the bilaminar retrodiscal pad (posterior)
  • joint capsule and tendon of lateral pteryoid muscle (anteriorly)
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19
Q

what do superior and inferior lateral pterygoid muscle restrict ?

A

posterior translation

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20
Q

what does the superior lamina allow the disc to do

A

translate anteriorly by stretching

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21
Q

what does the interior lamina limit

A

forward translation

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22
Q

what is the articular disc of the TMJ made up of

can it remodel?

A

collagen , proteoglycans , and elastin

no

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23
Q

what is the vascularity of the anterior band of the disc and where does it attach to

A

minimal to no vascular supply and attaches to joint capsule anteriorly

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24
Q

what is the vascularity of the intermediate zone of the disc and where does it attach to

A

no vascular supply and attached to medal and lateral condyle of mandible

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25
Q

what is the vascularity of the posterior band of the disc and where does it attach to

A

rich innervation and vascular supply from retrodiscal tissue and attached to retrodiscal tissue which is attached to capsule

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26
Q

where is the capsule for TMJ the stronger

A

laterally

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27
Q

what is the vascularity of the capsule forTMJ

A

highly vascular and innervated

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28
Q

3 ligaments of the TMJ

A

TM lig
stylomandibular lig
sphenomandibular lig

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29
Q

what does the oblique TM lig do

A

limits downward and posterior motion/ rotation of mandible

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30
Q

what does the horizontal TM lig do

A

resist posterior motion of condyle

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31
Q

what do both TM ligs do (what movement do they resist)

A

resists lateral displacement

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32
Q

what does the stylomandibular and sphenomandibular lig do

A

styloid - may limit protrusion of jaw , weakest

spheno - prevent foward translation

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33
Q

when is the TMJ engaged

A

mastication , swallowing and speaking

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34
Q

what are the arthokinematic movements of the TMJ

A

rolling
anterior slide
distraction
lateral glide

35
Q

what are the osteokinematic motions of TMJ

A

depression
elevation
protrusion
retrusion
L/R lateral excursions

36
Q

what is the Normal depression ROM of the TMJ

A

40-50 mm
2 finger functional
3 normal

37
Q

what happens 1st during normal depression

A

11-25 mm anterior rotation of condyle on disc which leads to posteior roll of mandible

38
Q

what happens 2nd during normal depression

A

translation : both condyle and disc anterior and interior which leads to

anterior slide of condyle

39
Q

passive depression involves what

A

disc translate along the articular eminence and retrodiscal lamina limits translation

40
Q

if there is active depression of the tmj what happens

A

there is no active contraction of superior lateral pterygoid

41
Q

what happens passively during elevation of the mandible

A

elasticity of the superior retrodisc lamina apples traction force posteriorly

42
Q

during active elevation of what eccentrically contracts to control posterior gliding and rotation of condyle

A

superior lateral pterygoid

43
Q

what 3 muscles provide contrast pressure on disc to prevent dislocation during elevation

A

temporalis , medial pterygoid and masseter

cant win them all its ok

44
Q

where do protrusion and retrusion occurs - superior or inferior joint of TMJ

A

in superior portion of the joint

45
Q

what is anterior translation without rotation of inferior joint

A

protrusion

46
Q

bilateral lamina stretch _____ to allow complete motion during protrusion

A

6-9mm

47
Q

during protrusion teeth touching = ____ and lower teeth passing upper teeth = ___

A

normal
max

48
Q

what does retrusion do

A

translation posteriorly (3mm)

49
Q

what is retrusion limited by

A

TM lig and soft tissue in retrodiscal area

remember the earlier slide, TM limits posterior motion!

50
Q

what is a important component of mandibular elevation from maximally depressed mandible

A

retrusion

51
Q

what is the normal range of lateral excursion

A

8-11 mm

52
Q

if someone does a right lateral excursion what happens at the joint

A

right TMJ rotation and L TMJ translation

53
Q

limited right lateral excursion of the jaw, the muscles on the ____ side (especially the ___ lateral pterygoid) are likely tight or dysfunctional. This can restrict the ability to move the jaw to the right,

A

left

54
Q

during lateral excursion there is an …

A

ipsilateral mandibular condyle rotation and contralateral mandibular condyle translations

55
Q

what is it called if the mandible moves away from mandible during mandibular depression and stays to the L or R

A

deflection

C CURVE

56
Q

what is a deviation

A

when the mandible move away from mideline during depressions or protrusion but then returns to midline at end range

S CURVE

57
Q

what muscles help depression

A

digastric & suprahyoids
inferior lateral pterygoid
gravity

DIGS

58
Q

what muscles help elevation

A

temporalis
masseter
medial pterygoid
superior lateral pterygoid

TMMP

59
Q

what muscles help assist protrusion

A

Bil: masseter , medial and lateral pterygoid

60
Q

what muscles help assist with retrusion

A

bil: temporalis , assisted by anterior digastric

61
Q

what muscles help with lateral deviation

A

unilateral contraction of medial and lateral pterygoids to pull to contralateral side ( R medial and lateral will pull to L)
temporalis will pull to ipsilateral side

62
Q

what are considered secondary muscle of TMJ

A

diagastric muscle (anterior belly)
mylohyoid
stylohyoid
geniohyoid

63
Q

what are considered deep cervical flexors

A

longus colli and longus capitus

64
Q

what are the bilateral and unilateral actions of the longus colli

A

bilateral: neck flexion
uni: SB with contralateral rotations

same as SCM

65
Q

what is the unilateral and bilateral action for longus capitus

A

bilateral: neck flexion
unilateral: SB with ipsilaterla rotation

66
Q

what position does forward heard posture put the mandible in?

A

retraction of mandible after malalignment

67
Q

Contact of the upper and lower teeth limits TMJ motions when the mouth is ___ (closed or open)

So losing teeth would…

A

affect the mechanics!

68
Q

Should the teeth touch during the day at rest?

A

no

69
Q

maximal intercuspation

A

teeth are approximated occlusion position

linked together maximally in normal jaw closed position

70
Q

what is the freeway space of the teeth

A

normal rest position with 1-5 mm of space between supper and lower teeth at rest

71
Q

foward head ___ freeway space

A

decreases

72
Q

what are teh structural changes of the disc

A

wear and tear may lead to OA

73
Q

is it possible for normal wear and tear to occur without symptoms or disfunction?

A

yes!

74
Q

what might lead to dysfunctions of the TMJ

A

trauma, postural habits, oral habits, bruxism (grinding)

75
Q

capsular fibrosis of TMJ will lead to

A

overproduction of connective tissue leading to loss of tissue function with painful movements

76
Q

inflammation of TMJ will lead to

A

capsulitis and synovitis leading to RA

77
Q

joint hyper mobility of the TMJ is when there is …

A

an opening over 40 mm

78
Q

if you have joint hypermobility at the TMJ what will happen

A

there will be a deflection of mandible to contralateral side when opening

79
Q

what muscle hypertrophy, atrophy, or contracture if someone has joint hypermobility

A

lateral pterygoid muscle

80
Q

dislocation of the TMJ will cause

A

opening with deviation and inability to close due to anterior translated disc

81
Q

if you have an articular disc displacement with reduction then what happens

A

the condyle is behind the disk at rest so it translates anteriorly with depression with a click and translates posterior and slips out from under the disc during elevation with a click

82
Q

if you have articular disc displacement without reduction then what happens

A

the posterior attachments to the disc are overstretched and are unable to relocate during depression

no clicking

disc stays in front the whole time, and condyle never pops on it, no clicking sound, locked jaw

83
Q

if you have articular disc displacement without reduction when do you have pain

A

chewing , talking , yawning

Caroline (20 decks)

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