Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Oral Surgery 2 > Surgery for Temporomandibular Joint Disorders > Flashcards

Surgery for Temporomandibular Joint Disorders Flashcards

1
Q

TMD includes what?

A

joint and related extraarticular disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

T/F: TMJ is a diagnosis or disease

A

false, is NOT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

orthopedic principles of TMD

A
  1. lubrication
  2. nutrition
  3. joint stability
  4. loading
  5. articular ligaments
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

rotational movement of TMJ

A

20 mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

translational movement of TMJ

A

40-50 mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

lateral excursions move contralateral joint

A

7-10 mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what movement translates both joints?

A

protrustion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what type of patients benefits from TMJ surgery?

A

patients…

  1. with mechanical or inflammatory joint disease
  2. who have failed nonsurgical therapy
  3. in whom muscle disorders are not the only problem
  4. where invasive tx will correct a mechanical dysfunction or reduce persistent inflammation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what type of operation that is best used to tx TMD is determined by what?

A

diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

T/F: treatment sequence for internal derangement is consistent among surgeons

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

operations to tx internal derangement

A
  1. arthrocentesis
  2. arthroscopy
  3. open surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

open operations vary widely according to what?

A
  1. region
  2. patient-specific conditions
  3. background and experience of the surgeon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are some minimally invasive procedures to tx TMD?

A
  1. arthrocentesis

2. arthroscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

T/F: arthrocentesis and arthroscopy have comparable list of indications

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is the most common diagnosis to tx with arthrocentesis and arthroscopy?

A

internal derangement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

why might one skip arthrocentesis?

A
  1. long duration of symptoms
  2. hx of failed steroid injection/arthrocentesis
  3. long hx of late, hard, painful pop
  4. unable to obtain MRI
  5. anticipated difficulty with arthrocentesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what might make some patients be unable to obtain MRI?

A
  1. certain implants
  2. severe claustrophobia
  3. morbid obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

why might some patients have anticipated difficulty with arthrocentesis?

A
  1. obesity

2. anxious but has anesthetic risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

indicatiosn for arthrocentesis

A
  1. acute closed lock
  2. acute trauma (hemarthrosis)
  3. capsulitis/synovitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

advantages of arthrocentesis

A
  1. minimally invasive
  2. fast, simple procedure - usually done in office
  3. doesn’t require general anesthetic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

arthrocentesis is highly effective at what?

A
  1. increasing joint mobility

2. reducing pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

disadvantages of arthrocentesis

A
  1. indication not well established except for acute closed lock
  2. may not adequately release adhesions, etc.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

arthrocentesis has limited success for what?

A

chronic or more severe conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

indications for arthroscopy

A

pain and dysfunction with the following conditions:

  1. decreased condylar translation due to disk hypomobility
  2. anteriorly displaced disk with or without reduction
  3. closed lock
  4. traumatic injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

advantages of arthroscopy

A
  1. minimally invasive
  2. outpatient procedure
  3. rapid recovery
  4. excellent success
  5. low morbidity
  6. allows for examination under anesthesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what is the success rate of arthroscopy

A

80-95%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

disadvantages of arthroscopy

A
  1. advanced disease may not improve
  2. disk unlikely to reposition
  3. requires aggressive postoperative physical therapy and patient compliance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

failure to tx TMD with arthroscopy usually requires what?

A

open surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

although extremely rare, morbidity of arthroscopy includes what?

A

nerve or middle ear injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

steps for arthroscopy

A
  1. walk cannula into joint
  2. penetrate capsule: palpable pop
  3. switch to blunt trocar
  4. advance to contact articular eminence
  5. remove trocar and insert camera
  6. introduce egress cannula (18 ga needle)
  7. apply gentle irrigation pressure
  8. inspect joint systematically
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

approximately how far should you advance trocar before contacting articular eminence during arthroscopy?

A

25 mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what is inspected during arthroscopy?

A
  1. retrodiscal tissue
  2. articular eminence and disk
  3. base of eminence and disk
  4. anterior joint space
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

findings of synovial pathology progresses through what?

A
  1. hypertrophy
  2. hyperemia
  3. capillary dilation
  4. microbleeding
  5. granulation, fibrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

findings of articular surface pathology progresses through what?

A
  1. softening
  2. vascularization
  3. fibrillation
  4. bone exposure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

adhesion types of pathology

A
  1. light, filmy
  2. fibrous bands
  3. pseudowall
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

types of disk pathology

A
  1. neovascularization
  2. fibrillation
  3. perforation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

when is lysis of light adhesions done?

A

in course of inspection

38
Q

how to perform adhesion lysis of heavier bands, walls

A
  1. use blunt trocar
  2. sweeping motion lateral-medial
  3. light contact with articular surface
  4. reassess with arthroscope
39
Q

what is rarely a concern when it comes to lavage of adhesion lesions?

A

quantity - typically 2-300 ml or more

40
Q

recent evidence questions efficacy of any joint medication. there is no difference between what?

A
  1. steroid
  2. hyaluronate
  3. no drug
41
Q

what is a joint medication widely used in Europe?

A

hyaluronate (Synvisc) but is more expensive and no proven advantage

42
Q

outcomes of arthroscopic lysis and lavage

A
  1. improved range of motion
  2. decreased pain
  3. improved function (primarily measured by diet)
43
Q

what is the success rate of arthroscopic lysis and lavage?

A

80-92%

44
Q

what is rarely altered with arthroscopic lysis and lavage?

A

disk position

45
Q

arthrotomy

A

incision into the joint

46
Q

arthroplasty

A

repair, revision, and/or reconstruction of joint tissues (hard and soft)

47
Q

meniscectomy = disectomy

A

removal of disk

48
Q

advantages of surgical approach for POSTAURICULAR arthrotomy

A
  1. scar is hidden behind ear

2. excellent posterolateral exposure

49
Q

disadvantages of surgical approach for POSTAURICULAR arthrotomy

A
  1. may give limited anterior joint access
  2. longer operating time
  3. keloid formation problematic
50
Q

surgical approach for POSTAURICULAR arthrotomy may cause a greater potential for what?

A

chondritis

51
Q

surgical approach for POSTAURICULAR arthrotomy may result in what?

A
  1. meatal atresia

2. possible psoterior auricle paresthesia

52
Q

advantages of surgical approach for ENDAURAL arthrotomy

A
  1. access similar to preauricular

2. improved aesthetics, scar is mostly hidden

53
Q

disadvantages of surgical approach for ENDAURAL arthrotomy

A
  1. greater potential for chondritis

2. aesthetic compromise if tragal projection is lost (common)

54
Q

advantages of surgical approach for PREAURICULAR arthrotomy

A
  1. excellent access and exposure

2. avoids incision of external auditory canal or meatus

55
Q

disadvantages of surgical approach for PREAURICULAR arthrotomy

A
  1. potential aesthetic compromise

2. risk of 7th nerve injury

56
Q

indications for disk repair/repositioning procedures

A
  1. minimal disk displacement
  2. otherwise generally healthy joint tissues
  3. near-normal disk morphology
57
Q

advantages of disk repair/repositioning procedures

A
  1. preserve maximum “normal” anatomic structure
  2. may restore disk position to normal
  3. improve mandibular ROM
  4. restore “ideal” mechanics of joint by repositioning disk
58
Q

how might disk repair/repositioning procedures improve mandibular range of motion (ROM)?

A

by eliminating mechanical obstruction

59
Q

disadvantages of disk repair/repositioning procedures

A
  1. often does not change disk position

2. pop or click may recur

60
Q

graft materials used in meniscectomy (discectomy) with/without interpositional graft

A
  1. dermis
  2. temporal fascia
  3. auricular cartilage
61
Q

indications for meniscectomy (discectomy) with/without interpositional graft

A
  1. severe degenerative changes in disk
  2. disk beyond repair
  3. severe interference with normal function (i.e. patient with late, hard, painful pop on mouth opening due to disk reduction)
62
Q

advantage of meniscectomy (discectomy) with/without interpositional graft

A

very good success rate with or without replacement

63
Q

disadvantages of meniscectomy (discectomy) with/without interpositional graft

A
  1. malocclusion or failure uncommon but possible
  2. replacement requires graft harvest
  3. replacement may offer little benefit over meniscectomy without graft
  4. alloplastic materials (artificial disks) not available
64
Q

outcomes of meniscectomy (discectomy) with/without interpositional graft

A
  1. improved range of motion
  2. decreased pain
  3. improved function
65
Q

how is improved function measured after meniscectomy (discectomy) with/without interpositional graft procedure?

A

by diet

66
Q

what is the success rate of meniscectomy (discectomy) with/without interpositional graft?

A

80-85%

67
Q

T/F: after meniscectomy (discectomy) with/without interpositional graft, joint sounds are altered by often remain

A

true, pop/click usually eliminated

68
Q

what is common after a patient undergoes meniscectomy (discectomy) with/without interpositional graft?

A

mild crepitus

69
Q

failures of meniscectomy (discectomy) with/without interpositional graft become what?

A

challenging cases

70
Q

joint reconstruction

A

autogenous grafting and total joint replacement

71
Q

indications for costochondral (rib) grafting

A
  1. reconstruction of joint in children
  2. reconstruction of congenital or acquired deformity
  3. fibrous or bony ankylosis
72
Q

advantages of costochondral (rib) grafting

A
  1. allows restoration of joint mobility
  2. allows for restoration or posterior vertical height
  3. replaces growth center in children
73
Q

disadvantages of costochondral (rib) grafting

A
  1. requires rib harvest, donor site morbidity
  2. may not grow at proper rate in children
  3. grafts are subject to ankylosis, decreased mobility
74
Q

T/F: repeat costochondral (rib) grafting after failure is usually beneficial

A

false, isn’t

75
Q

indications for total joint replacement

A
  1. severe degeneration, usually mostly of the condyle
  2. recurrent fibrous or bony ankylosis
  3. failure of other reconstructive procedure (e.g. costochondral graft)
76
Q

what can cause severe degeneration of condyle?

A
  1. foreign body giant cell rxn
  2. rheumatoid arthritis
  3. juvenile idiopathic arthritis
  4. idiopathic condylar resorption
77
Q

advantages of total joint replacement

A
  1. allows reconstruction in severely damaged joints
  2. avoids graft harvest
  3. effective at restoring reasonable interincisal opening
78
Q

disadvantages of total joint replacement

A
  1. components have finite lifespan
  2. may not improve pain
  3. expensive
  4. treatment of last resort
79
Q

what is the current estimated lifespan of total joint replacement?

A

15 years

80
Q

reconstruction alternatives

A
  1. partial alloplastic reconstruction

2. autogenous reconstruction

81
Q

T/F: partial alloplastic reconstruction is commonly done

A

false, generally not done

82
Q

what is the most common donor site for autogenous reconstruction?

A

costochondral graft

83
Q

where are some other donor sites for autogenous reconstruction?

A

cranial bone

84
Q

what is sometimes used for fossa reconstruction?

A

cranial bone

85
Q

contemporary systems

A
  1. patient-fitted TMJ reconstruction prosthesis (TMJ concepts)
  2. biomet microfixation prosthesis
86
Q

which contemporary system has “stock” components and isn’t a custom CAD-CAM prosthesis?

A

biomet microfixation prosthesis

87
Q

goals of TMJ reconstruction

A
  1. restore and maintain jaw fxn
  2. resotre and maintain facial symmetry
  3. long-term skeletal and occlusal stability
88
Q

secondary goal of TMJ reconstruction

A

alleviate pain

89
Q

postoperative care after TMJ reconstruction

A
  1. immediate mobility
  2. soft diet
  3. physical therapy when necessary
90
Q

outcomes of TMJ reconstruction

A
  1. improved ROM
  2. decreased (NOT eliminated) pain
  3. improved diet
91
Q

what percent of patients who underwent TMJ reconstruction had improved quality of life long-term?

A

85%

Oral Surgery 2 (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions