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PATH II > pathology and diagnosis pt 1 > Flashcards

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
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
26
Transpharyngeal projection:
radio graphic technique to view condyle; Condylar head is enlarged, and the neck is thick.
27
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)
28
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.
29
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
30
osteochondroma demo
OCs generally occur in young adults (~30 y/o), but also appear during middle age or later (~≥ 50y/o).
31
susceptiable bones for osteochondromas
Bones that form from a cartilage anlagen (e.g., mandible) are susceptible to single or multiple osteochondritic lesions.
32
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.
33
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
34
Unilateral fibrous dysplasia in the right maxilla and mandible.
35
how many hypermobility dx are there
2
36
subluxation
37
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
38
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
39
Treatment of Subluxation 1. exercise? 2. controlling opening? 3. AVOID? 4. Manage? 5. what can be sx reduced?
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
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
41
Diagnosis of Dislocation of Condyle (Luxation, open lock) 1. Inability to ? 2. Radiograph reveals that? 3. The dislocation may be? 4. Pain ?
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
Treatment of Dislocation of Condyle (Luxation, open lock) 1. Seat the patient? 2. Ask pt to ? 3. Apply what force? Call who? 4. Rx:
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
Types of Ankylosis
1. Bony 2. Fibrous 3. Intra-articular 4. Extra-articular
44
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.
45
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
46
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
47
Bony Ankylosis of R. Condyle with obliteration of disc space & no condylar translation :R L Condyle is Fused to glenoid fossa
48
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.
49
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.
50
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
51
Ankylosis  Intracapsular:  Extracapsular:
 Intracapsular: immobilization located within the joint  Extracapsular: rigidity of periarticular tissues (surrounding the joint) resulting in joint stiffness or immobilization
52
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
53
Treatment options of Ankylosis
1. Range of Motion (ROM) exercises 2. Therabite 3. Physical therapy 4. Surgery
54
what can often occur with sx tx of the mandible
IAN parathesia
55
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

PATH II (32 decks)

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