pathology and diagnosis pt 1 Flashcards

1
Q

Congenital or Developmental
Disorders scale

A
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2
Q

Aplasia of cranium

A

 Faulty or incomplete development of the cranial
bones or mandible

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3
Q

most common developmental defect.

A

Lack of condylar growth is the most common
developmental defect.

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4
Q

is aplasia unilateral or bilat?

A

both

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5
Q

what other structure is often affected with aplasia

A

Auditory apparatus is often affected (i.e. Pinna of
ear deformed)
deafness can occur

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6
Q

occlusion with aplasia

A

Occlusal shift & deviation on opening may occur

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7
Q

aplasia occurenace and severity

A

Rare
 More SEVERE than Hypoplasia !

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8
Q

Aplasia

defined? signs? common?

A

Lack of condylar growth is the most common developmental defect.
Occlusal shift & deviation on opening may occur.
Rare.

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9
Q
A

aplasia

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10
Q

Treatment of
Condylar Aplasia

A

can perform osteplasty on normal side to make sides equal if mild case
condylar and tmj replacements possible

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11
Q

Hypoplasia
 defined?
 Congenital or acquired?
 Growth?
 Condylar hypoplasia can be secondary to ?

A

Incomplete development/underdevelopment of the cranial bones or the
mandible.
 Congenital or acquired (i.e. Treacher-Collins syndrome).
 Growth is normal but proportionately reduced & less severe than in
aplasia
 Condylar hypoplasia can be secondary to trauma.

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12
Q

Treacher-Collins syndrome:

signs

A

mandibulofacial dysostosis
1. Downward-slanting eyes
2. Notched lower eyelids
3. Underdeveloped midface
4. Deafness

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13
Q

Mandibular Hypoplasia:
High risk for?

A

High risk for obstructive sleep apnea

class 2 div 2

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14
Q

what landmarks can we use for man restro/prognathism

A

ala of nose and chin (WNL: equal in saggital plane)

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15
Q

Mandibular Hypoplasia sx tx?

A

Post-treatment with mandibular advancement surgery (bilateral sagittal
split osteotomy)

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16
Q

Condylar Hypoplasia
 Unilateral or bilateral?
 Congenital causes?
 Acquired causes?

A

 Unilateral or bilateral
 Congenital: idiopathic, early onset
 Acquired: forceps deliveries, trauma especially after jaw fracture, radiation, infection, circulatory disorder, endocrine disorders

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17
Q

Condylar Hypoplasia
 Growth?
 Condylar hypoplasia can be secondary to?

A

 Growth is normal but proportionately reduced & less severe than in
aplasia
 Condylar hypoplasia can be secondary to trauma.

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18
Q

what is happening

A

man hypoplasia secondary to trauma

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19
Q

Condylar Hypoplasia Clinical Symptoms
 If unilateral:

A

 Facial asymmetry
 Limitation of lateral excursion
 Mandibular midline shift

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20
Q

Hyperplasia:
* cranial bones or mandible.
* Congenital or acquired?
* cell numbers?
* Localized form?
* Mandibular prognathism?

A

Overdevelopment of cranial bones or mandible.
Congenital or acquired.
Non-neoplastic increase in the number of normal cells.
Localized: condylar hyperplasia
Mandibular prognathism – excessive size of mandible causing protrusion of chin but normal condyle size, shape, & function

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21
Q

sx tx of man prognathism

A

Osteotomy with rigid fixation with titanium plate & screws

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22
Q

Condylar Hyperplasia Clinical Symptoms
If Unilateral growth, it will cause:

A
  1. A progressive crossbite on the contralateral side
  2. Open bite in adults
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23
Q

Treatment options of Condylar Hyperplasia

A

 Leave alone
 Wait until after mandibular growth is completed
 Orthognathic surgery & possible osteotomy of enlarged condyle
 Orthodontics
 Symptomatic care

24
Q
A

coronoid myperplasia

25
Q

Coronoid Hyperplasia
 Coronoid Impingement may result from?
 May result in?
 Visible on?

A

 Coronoid Impingement may result from benign overgrowth of the coronoid process
 May result in limited jaw opening developing slowly overtime
 Visible on Panorex, CBCT, MDCT or MRI

26
Q

Transpharyngeal projection:

A

radio graphic technique to view condyle; Condylar head is enlarged, and the neck is thick.

27
Q

Neoplasia
* defined?
* growth?
* common underlying cause of TMD?
* % of malignant neoplasias (breast, prostate, lung cancers)metastasize to
the mandible?
* can affect?

A
  • Benign, malignant, or metastatic from a distant site.
  • Uncontrolled growth of abnormal tissue
  • RARE as an underlying cause of TMD.
  • 1% of malignant neoplasias (breast, prostate, lung cancers)metastasize to
  • the mandible
  • can affect condyle (I.e. osteoma, fibrous dysplasia, chondrosarcoma, benign giant cell tumor)
28
Q

OSTEOCHONDROMA

arise due to?

A

Benign, Solitary Osteochondromas (OCs) arise in response to an event (e.g. trauma, X-radiation) [1] rather than as a true neoplasm.

29
Q

osteochondroma:
Typically, OCs represent % of all bone tumors and % of benign bone tumors

A

Typically, OCs represent 10-15% of all bone tumors and ~35% of benign bone tumors

30
Q

osteochondroma demo

A

OCs generally occur in young adults (~30 y/o),
but also appear during middle age or later
(~≥ 50y/o).

31
Q

susceptiable bones for osteochondromas

A

Bones that form from a cartilage anlagen
(e.g., mandible) are susceptible to single or
multiple osteochondritic lesions.

32
Q

are osteochondromas often symptomatic?

A

This species of bone tumor frequently remains
asymptomatic until they become large enough
to interfere with mandibular function (i.e.
opening, lateral excursion) or cause a shift in
the midline & malocclusion.

33
Q

Neoplasia
 rare/common where in mandible?
 Benign app?
 Malignant app?
 Consider what carcinomas?

A

 Rare in condyle but more common in ramus
 Benign: does not usually destroy bony margins
 Malignant: Usually destroys bony margins- Examine cortical outline of mandible on Panorex
 Consider parotid and regional carcinomas

34
Q
A

Unilateral fibrous dysplasia in the right maxilla and
mandible.

35
Q

how many hypermobility dx are there

A

2

36
Q
A

subluxation

37
Q

Subluxation
* defined?
* Usually accompanied by?
* May result from ?

A
  • Partial or incomplete condylar dislocation during wide mouth opening but the patient can close voluntarily
  • Usually accompanied by a joint sound (soft pop or click)
  • May result from anatomical difference , habit, or trauma
38
Q

Diagnosis of Subluxation
 Normal translation beyond eminence?
 Soft pop at?
 Deviation to?
 Excessive ? on opening

A

 Normal translation beyond eminence which
does not lead to open lock (luxation) & condyle
can return to mandibular fossa voluntarily.
 Soft pop at maximum opening
 Deviation to opposite side (if unilateral)
 Excessive translation on opening

39
Q

Treatment of Subluxation
1. exercise?
2. controlling opening?
3. AVOID?
4. Manage?
5. what can be sx reduced?

A
  1. Retruded opening exercises
  2. Control yawn with hand under chin; Avoid Big Macs, cut up apples and fruits into small pieces
  3. AVOID prolonged mouth opening at DENTAL APPT.- this can cause an open lock.
  4. Manage muscle hyperactivity
  5. Eminectomy (surgical reduction of articular eminence)
40
Q

Dislocation of Condyle
(Luxation, open lock)
 Condyle is?
 closed postion possible?
 May be caused by?
 Sudden open?

A

 Condyle is forcibly moved beyond the articular eminence
 Unable to return to a closed position voluntarily
 May be caused by yawning, dental appt. or trauma
 Sudden open lock of jaw

41
Q

Diagnosis of Dislocation of Condyle
(Luxation, open lock)
1. Inability to ?
2. Radiograph reveals that?
3. The dislocation may be?
4. Pain ?

A
  1. Inability to close the mouth without a specific
    manipulative maneuver
  2. Radiograph reveals that condyle translates
    well beyond the eminence
  3. The dislocation may be momentary or
    prolonged
  4. Pain may accompany dislocation and persist
    afterwards
42
Q

Treatment of Dislocation of Condyle (Luxation, open lock)
1. Seat the patient?
2. Ask pt to ?
3. Apply what force? Call who?
4. Rx:

A
  1. Seat the patient upright.
  2. Ask pt to relax the jaw muscles.
  3. Apply digital pressure to move mandible in inferior &
    posterior direction. Requires significant force. Call
    ORAL SURGEON in clinic if available.
  4. Rx: NSAIDs or Muscle Relaxants for pain.
43
Q

Types of Ankylosis

A
  1. Bony
  2. Fibrous
  3. Intra-articular
  4. Extra-articular
44
Q

Ankylosis
 Temporomandibular joint ankylosis represents? usually caused by?
 It could also be caused by ?

A

 Temporomandibular joint ankylosis represents fibrous or bony fusion between the mandibular condyle and fossa, which is usually traumatically caused by condyle fracture.

 It could also be caused by infections, degenerative diseases, injection of corticosteroids, forceps delivery and complications of TMJ surgery.

45
Q

Ankylosis signs
 mandibular movement?
 best imaging for detecting boney ankylosis
 what is ordered to detect fibrous ankylosis

A

 Restricted mandibular movement with deflection to the affected side on opening
 CBCT or MDCT is best for detecting boney ankylosis
 MRI is ordered to detect fibrous ankylosis

46
Q

ANKYLOSIS
Usually develops before?
Patients usually present with?
May be associated with?

A
  • Usually develops before age of 10, however, it could develop at any age.
  • Patients usually present with progressive limitation of mouth opening, facial deformity, and obstructive sleep apnea syndrome.
  • May be associated with TRAUMA
47
Q
A

Bony Ankylosis of R. Condyle with obliteration of disc space & no condylar
translation :R L Condyle is Fused to glenoid fossa

48
Q

Ankylosis- Clinical Exam
* restriction? due to?
* pain?
* Cannot clinically differentiate between this condition and?
* May need what image to r/o anterior disc displacement or myospasm, or exploratory arthroscopy.

A
  • Firm, unyielding restriction due to either intra-articular fibrous or bony ankylosis
  • Not associated with pain
  • Cannot clinically differentiate between this condition and other disorders causing restriction of mouth opening.
  • May need MRI to r/o anterior disc displacement or myospasm, or exploratory arthroscopy.
49
Q

Diagnosis of Ankylosis
* Limitation of?
* Marked deviation to ?
* Marked limited lateral movement to ?
* end feel at full opening?
* pain quality?
* ? may aid in diagnosis but not always. ?may show soft tissue ankylosis.

A
  • Limitation of opening
  • Marked deviation to affected side
  • Marked limited lateral movement to opposite side (if unilateral)
  • Hard-end feel when stretching patient to maximum opening
  • Absence of pain
  • CBCT or Panorex may aid in diagnosis but not always. MRI may show soft tissue ankylosis.
50
Q

Fibrous Ankylosis
 Imaging reveals?
 ? is needed for diagnosis

A

 Imaging reveals absence of ipsilateral condylar translation on opening but disc space is seen
 MRI is needed for diagnosis

51
Q

Ankylosis
 Intracapsular:
 Extracapsular:

A

 Intracapsular: immobilization located within the joint

 Extracapsular: rigidity of periarticular tissues (surrounding the joint) resulting in joint stiffness or immobilization

52
Q

Etiology of Ankylosis
 Abnormal?
 Birth?
 Chin trauma?
 Malar-zygomatic?
 Congenital?
 Inflammation or septicemia?
 Metastatic malignancies?
 treatment?

A

 Abnormal intrauterine development
 Birth injury or fractures
 Chin trauma (posterior)
 Malar-zygomatic fractures
 Congenital syphilis
 Inflammation or septicemia
 Metastatic malignancies
 Radiation treatment

53
Q

Treatment options of Ankylosis

A
  1. Range of Motion (ROM) exercises
  2. Therabite
  3. Physical therapy
  4. Surgery
54
Q

what can often occur with sx tx of the mandible

A

IAN parathesia

55
Q

bilat condylar fx

mostcommon in? where in condyle? ROM?

A

most common in elderly and children, occurs at the neck of the condyle
ROM normal except protrusion and lateral movement