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My BDS4 > OS - TMD > Flashcards

OS - TMD Flashcards

1
Q

Name the origin (2) & Insertion (1) of the Masseter

A

origin x2
– zygomatic arch
- another origin on the underside of the zygomatic arch

insertion – angle of the mandible

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2
Q

Name the origin (1) & Insertion (1) of the Temporalis

A

Origin – temporal fossa

Insertion - Coronoid process (can extend down the anterior body of the ramus)

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3
Q

Name the origin (1) & Insertion (1) of the Medial Pterygoid

A

Origin – medial surface of lateral pterygoid plate

Insertion – medial side of the angle of the mandible (opposite to the masseter)

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4
Q

Name the origin (2) & Insertion (1) of the Lateral pterygoid

A

Origin 1 – Base of the skull
Origin 2 – lateral surface of the lateral ptergoid plate

Insertion – pterygoid fovea and some fibres extend into the capsule of the TMJ

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5
Q

What supplies the blood to the TMJ?

A

Deep auricular artery (branch of 1st part of the maxillary artery)

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6
Q

What supplies the innervation to the TMJ? (3)

A

auriculotemporal, masseteric, posterior (deep) temporal nerve

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7
Q

Why can patients with TMJ pain also experience discomfort in the ear?

A

as the auriculotemporal nerve also provides sensation to the external auditory meatus

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8
Q

List the 4 suprahyoid muscles (accessory MoM)

A

– Digastric
– Mylohyoid
– Geniohyoid
– Stylohyoid

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9
Q

List the 4 infrahyoid muscles (accessory MoM)

A

– Thyrohyoid
– Sternohyoid
– Omohyoid
– sternothyroid

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10
Q

How does TMJ pain arise and why?

A

when the articular disc slips forward the bilaminar area of the articular disc gets compressed by the condyle
- the bilaminar area has the nerve innervation

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11
Q

What are the causes of TMJ pain? (8)

A
  • Myofascial pain (common)
  • Disc displacement (common)
  • Degenerative disease (less common)
  • Chronic recurrent dislocation
  • Ankylosis – condyle fused to the base of the skull (most people have a psudoankylosis)
  • Hyperplasia – one condyle grows more than the other (can be bilateral but not as common)
  • Neoplasia
  • Infection – can result in ankylosis
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12
Q

What are the causes of myofacial (muscle) pain? (5)

A
  • Inflammation secondary to parafunctional habits
  • Trauma, either directly to the joint or indirectly
  • Stress (muscles tense and px clench teeth)
  • Psychogenic
  • Occlusal abnormalities - although a restoration that is significantly “high” may cause muscle pain due to posturing
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13
Q

How do we identify a possible arthritic change in the TMJ?

A

Crepitus (crunching) during E/O TMJ assessment

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14
Q

What are intra-oral signs of parafucntional habits? (5)

A
  • Cheek biting (morsicatio buccarum)
  • Linea alba
  • Tongue scalloping
  • Occlusal non-carious tooth surface loss (toothwear)
  • Hypertrophic muscles of mastication
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15
Q

What patients are most commonly affected by TMD (age and sex)?

A

Females
18-30

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16
Q

How do patients with TMD usually present? (5)

A
  • Intermittent pain of several months or years duration
  • Muscle / joint / ear pain, particularly on wakening
  • Trismus / locking
  • ‘Clicking/popping’ joint noises
  • Headaches
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17
Q

What are other possible causes of similar symptoms? (11)

A
  • Dental pain
  • Sinusitis
  • Ear pathology
  • Salivary gland pathology
  • Referred neck pain
  • Headache
  • Atypical facial pain (common in post menopausal women)
  • Trigeminal neuralgia
  • Angina – area of skin near the angle of the mandible is supplied by the same nerve as the heart
  • Condylar fracture – hx of trauma
  • Temporal arteritis
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18
Q

How do we treat TMD? 4 general Reversible options

A

Counselling
medication
Physical therapy
splints

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19
Q

What is involved in counselling of a TMD patient? (9)

A
  • Reassurance
  • Soft diet
  • Masticate bilaterally
  • No wide opening
  • No chewing gum
  • Don’t incise foods
  • Cut food into small pieces
  • Stop parafunctional habits e.g. nail biting, grinding
  • Support mouth on opening e.g. yawning
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20
Q

What medications are used to manage TMD? (5)

A
  • NSAIDs
  • Muscle relaxants
  • Tricyclic antidepressants (have muscle relaxant properties)
  • Botox of masseter = prevents clenching (last resort tx)
  • Steroids
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21
Q

What is involved in physical therapy of a TMD patient? (7)

A
  • Physiotherapy
  • Massage/heat
  • Acupuncture
  • Relaxation
  • Ultrasound therapy (not used as much)
  • TENS (Transcutaneous Electronic Nerve Stimulation)
  • Hypnotherapy and CBT
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22
Q

What splints are used to manage a TMD patient? (2)

A
  • Bite raising appliances
  • Anterior repositioning splint e.g. wenvac or Michigan splint
23
Q

How do bite raising appliances work? (2)

A

They stabilize the occlusion and improve the function of the masticatory muscles, thereby decreasing abnormal activity.

They also protect the teeth in cases of tooth grinding

24
Q

What is the requirement for splints?

A

Must cover all of the teeth

25
Q

What are the 2 types of disc displacement?

A

Anterior displacement with reduction - where the disc slips forward but can move back to its original place

Anterior displacement without reduction

26
Q

How do patients with anterior disc displacement with reduction present and why?

A

Present with a painful clicking TMJ
- Joint clicking is due to lack of coordinated movement between the condyle and the articular disc

27
Q

What is the most common cause of TMJ clicking?

A

anterior disc displacement with reduction

28
Q

What can disc dispalcemtn progress to if they are untreated?

A

osteoarthritis

29
Q

How do we treat disc displacement? (5)

A
  • Counselling (education, reassurance, advice)
  • Limit mouth opening
  • Bite raising appliance
  • Surgery occasionally may be required
  • If painless, no treatment required = Reassure
30
Q

List the (3) components of TMD.

A
  • muscular initiation
  • Leads to excessive mechanical loading of joint

*. underlying causes – psychological or trauma

31
Q

What are the 2 underlying causes of TMD?

A

Psychological

trauma

32
Q

What causes TMD? (4)

A
  • Macrotrauma – one sudden incident
  • Microtrauma (most common) – repetitive chronic overloading
  • Occlusal factors:
  • Anatomical factors – class II jaw relationship
33
Q

List examples of macrotrauma that can cause TMD. (2)

A

physical trauma - punched etc

mouth opening for too long

34
Q

List examples of microtrauma that can cause TMD. (2)

A

(repetitive chronic overloading)
clenching and bruxism

35
Q

What occlusal factors can lead to TMD? (3)

A
  • Deep bite (class 2)
  • Occlusal disharmony e.g. high filling
  • Lack of teeth
36
Q

What are the superior and inferior compartments lines with? What is the function of this?

A

The superior and inferior compartment lined with synovial membrane
= synovial fluid = smooth movement of joint

37
Q

What is the anterior section of the articualr disc attached to?

A

the superior head of the lateral pterygoid

38
Q

What is the posterior region of the articualr disc called? what is this attached to? (2)

A

bilaminar zone

attached to;
posterior area of condyle
posterior area of the eminence

39
Q

What is suggested if the lateral pterygoid is painful on palpation?

A

if painful = spasmed lateral pterygoid muscles = bruxism/clenching

40
Q

what do patients with anterior disc displacement without reduction present with? (1)

A

Limited mouth opening

(and a history of pain and clicking)

41
Q

How do we manage anterior dislocation? (6)

A
  • Counselling (treat the cause)
  • Stress management
  • Pain management (pain killers and anti-inflammatory ibu 400mg 3x daily)
  • Joint rest (soft food, supported yawning, chewing on both sides, avoid wide mouth opening)
  • Physical therapy (warm compress and resting)
  • Restoration of occlusal stability (use lower hard biting appliance)
42
Q

How do lower hard bite raising appliances help anterior dislocation? (3)

A
  • Eliminated occlusal interference
  • Reduces loading on TMJ
  • Prevents the join head from rotating so far posteriorly in the glenoid fossa
43
Q

Apart from managing anterior dislocation what else can lower hard bite raising appliances be used for?

A

habit breaking

44
Q

What investigations do we use for TMD? (4)

A

Radiographs
- 2D (OPT)
- MRI
- arthrogram (MRI with radioactive contrast medium)

Arthroscopy

45
Q

What compartment is punctured during arthroscopy?

A

the superior compartment - penetrated from the front

46
Q

What is arthroscopy used for? (7)

A
  • Biopsy
  • Diagnosis
  • Disc reduction
  • Lysis&lavage
  • Remove foreign body/loose bodies
  • Eminectomy – remove part of eminence
  • Arthrocentesis = wash of the joint = increase lubrication
47
Q

What are the intra & post op complications of arthroscopic procedures? (12)

A
  • Iatrogenic scuffing
  • Broken instruments
  • Middle ear perforation
  • Glenoid fossa perforation
  • Extravasation
  • Haemorrhage
  • Hemarthrosis
  • Damage to the trigeminal & facial nerve?
  • Infection
  • Disocclusion
  • Laceration of EAM (External auditory meatus?)
  • Perforation of tympanic membrane
48
Q

What post-op instructions/management is provides after arthroscopic procedures? (5)

A
  • Bite raising appliance
  • Pain management
  • Restore occlusal stability
  • Physical therapy
  • Joint rest (soft food, supported yawning, chewing on both sides, avoid wide mouth opening)
49
Q

List the procedures that can be used if conservative measures fr TMD are ineffective? (7)

A
  1. Menisectomy = remove the disc completely
  2. Disc plication = move the disc to correct position
  3. Eminectomy = remove part of the boney eminence
  4. High condylar shave
  5. Condylotomy
  6. Condylectomy
  7. Reconstructive procedures
50
Q

What are the indications for TMJ reconstruction? (3)

A

Joint destruction from;
- Trauma
- Infection
- Tumours
- Previos surgery
- Radiation

  • Ankylosis
  • Developmental deformity
51
Q

Define class 1 TMJ ankylosis.

A

flattened deformity of the condyle, little joint space and extensive fibrous adhesions

52
Q

Define class 2 TMJ ankylosis.

A

boney fusion at the outer edge of the articular surface

53
Q

Define class 3 TMJ ankylosis.

A

marked fusion bone between upper part of ramus of the mandible and the zygomatic arch

54
Q

Define class 4 TMJ ankylosis.

A

entire joint replaced by a mass of bone

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