pathology and diagnosis pt 1 Flashcards
Congenital or Developmental
Disorders scale
Aplasia of cranium
Faulty or incomplete development of the cranial
bones or mandible
most common developmental defect.
Lack of condylar growth is the most common
developmental defect.
is aplasia unilateral or bilat?
both
what other structure is often affected with aplasia
Auditory apparatus is often affected (i.e. Pinna of
ear deformed)
deafness can occur
occlusion with aplasia
Occlusal shift & deviation on opening may occur
aplasia occurenace and severity
Rare
More SEVERE than Hypoplasia !
Aplasia
defined? signs? common?
Lack of condylar growth is the most common developmental defect.
Occlusal shift & deviation on opening may occur.
Rare.
aplasia
Treatment of
Condylar Aplasia
can perform osteplasty on normal side to make sides equal if mild case
condylar and tmj replacements possible
Hypoplasia
defined?
Congenital or acquired?
Growth?
Condylar hypoplasia can be secondary to ?
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.
Treacher-Collins syndrome:
signs
mandibulofacial dysostosis
1. Downward-slanting eyes
2. Notched lower eyelids
3. Underdeveloped midface
4. Deafness
Mandibular Hypoplasia:
High risk for?
High risk for obstructive sleep apnea
class 2 div 2
what landmarks can we use for man restro/prognathism
ala of nose and chin (WNL: equal in saggital plane)
Mandibular Hypoplasia sx tx?
Post-treatment with mandibular advancement surgery (bilateral sagittal
split osteotomy)
Condylar Hypoplasia
Unilateral or bilateral?
Congenital causes?
Acquired causes?
Unilateral or bilateral
Congenital: idiopathic, early onset
Acquired: forceps deliveries, trauma especially after jaw fracture, radiation, infection, circulatory disorder, endocrine disorders
Condylar Hypoplasia
Growth?
Condylar hypoplasia can be secondary to?
Growth is normal but proportionately reduced & less severe than in
aplasia
Condylar hypoplasia can be secondary to trauma.
what is happening
man hypoplasia secondary to trauma
Condylar Hypoplasia Clinical Symptoms
If unilateral:
Facial asymmetry
Limitation of lateral excursion
Mandibular midline shift
Hyperplasia:
* cranial bones or mandible.
* Congenital or acquired?
* cell numbers?
* Localized form?
* Mandibular prognathism?
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
sx tx of man prognathism
Osteotomy with rigid fixation with titanium plate & screws
Condylar Hyperplasia Clinical Symptoms
If Unilateral growth, it will cause:
- A progressive crossbite on the contralateral side
- Open bite in adults
Treatment options of Condylar Hyperplasia
Leave alone
Wait until after mandibular growth is completed
Orthognathic surgery & possible osteotomy of enlarged condyle
Orthodontics
Symptomatic care
coronoid myperplasia
Coronoid Hyperplasia
Coronoid Impingement may result from?
May result in?
Visible on?
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
Transpharyngeal projection:
radio graphic technique to view condyle; Condylar head is enlarged, and the neck is thick.
Neoplasia
* defined?
* growth?
* common underlying cause of TMD?
* % of malignant neoplasias (breast, prostate, lung cancers)metastasize to
the mandible?
* can affect?
- 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)
OSTEOCHONDROMA
arise due to?
Benign, Solitary Osteochondromas (OCs) arise in response to an event (e.g. trauma, X-radiation) [1] rather than as a true neoplasm.
osteochondroma:
Typically, OCs represent % of all bone tumors and % of benign bone tumors
Typically, OCs represent 10-15% of all bone tumors and ~35% of benign bone tumors
osteochondroma demo
OCs generally occur in young adults (~30 y/o),
but also appear during middle age or later
(~≥ 50y/o).
susceptiable bones for osteochondromas
Bones that form from a cartilage anlagen
(e.g., mandible) are susceptible to single or
multiple osteochondritic lesions.
are osteochondromas often symptomatic?
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.
Neoplasia
rare/common where in mandible?
Benign app?
Malignant app?
Consider what carcinomas?
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
Unilateral fibrous dysplasia in the right maxilla and
mandible.
how many hypermobility dx are there
2
subluxation
Subluxation
* defined?
* Usually accompanied by?
* May result from ?
- 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
Diagnosis of Subluxation
Normal translation beyond eminence?
Soft pop at?
Deviation to?
Excessive ? on opening
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
Treatment of Subluxation
1. exercise?
2. controlling opening?
3. AVOID?
4. Manage?
5. what can be sx reduced?
- Retruded opening exercises
- Control yawn with hand under chin; Avoid Big Macs, cut up apples and fruits into small pieces
- AVOID prolonged mouth opening at DENTAL APPT.- this can cause an open lock.
- Manage muscle hyperactivity
- Eminectomy (surgical reduction of articular eminence)
Dislocation of Condyle
(Luxation, open lock)
Condyle is?
closed postion possible?
May be caused by?
Sudden open?
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
Diagnosis of Dislocation of Condyle
(Luxation, open lock)
1. Inability to ?
2. Radiograph reveals that?
3. The dislocation may be?
4. Pain ?
- Inability to close the mouth without a specific
manipulative maneuver - Radiograph reveals that condyle translates
well beyond the eminence - The dislocation may be momentary or
prolonged - Pain may accompany dislocation and persist
afterwards
Treatment of Dislocation of Condyle (Luxation, open lock)
1. Seat the patient?
2. Ask pt to ?
3. Apply what force? Call who?
4. Rx:
- Seat the patient upright.
- Ask pt to relax the jaw muscles.
- Apply digital pressure to move mandible in inferior &
posterior direction. Requires significant force. Call
ORAL SURGEON in clinic if available. - Rx: NSAIDs or Muscle Relaxants for pain.
Types of Ankylosis
- Bony
- Fibrous
- Intra-articular
- Extra-articular
Ankylosis
Temporomandibular joint ankylosis represents? usually caused by?
It could also be caused by ?
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.
Ankylosis signs
mandibular movement?
best imaging for detecting boney ankylosis
what is ordered to detect fibrous ankylosis
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
ANKYLOSIS
Usually develops before?
Patients usually present with?
May be associated with?
- 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
Bony Ankylosis of R. Condyle with obliteration of disc space & no condylar
translation :R L Condyle is Fused to glenoid fossa
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.
- 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.
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.
- 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.
Fibrous Ankylosis
Imaging reveals?
? is needed for diagnosis
Imaging reveals absence of ipsilateral condylar translation on opening but disc space is seen
MRI is needed for diagnosis
Ankylosis
Intracapsular:
Extracapsular:
Intracapsular: immobilization located within the joint
Extracapsular: rigidity of periarticular tissues (surrounding the joint) resulting in joint stiffness or immobilization
Etiology of Ankylosis
Abnormal?
Birth?
Chin trauma?
Malar-zygomatic?
Congenital?
Inflammation or septicemia?
Metastatic malignancies?
treatment?
Abnormal intrauterine development
Birth injury or fractures
Chin trauma (posterior)
Malar-zygomatic fractures
Congenital syphilis
Inflammation or septicemia
Metastatic malignancies
Radiation treatment
Treatment options of Ankylosis
- Range of Motion (ROM) exercises
- Therabite
- Physical therapy
- Surgery
what can often occur with sx tx of the mandible
IAN parathesia
bilat condylar fx
mostcommon in? where in condyle? ROM?
most common in elderly and children, occurs at the neck of the condyle
ROM normal except protrusion and lateral movement
