surgery of the tmj Flashcards
What are some symptoms of TMJ disorders
- Pain
- Click
- Limited opening
- Crepitus (crunching)
- Closed lock
- Dislocation
Name the muscles involved in jaw closure
- Temporalis
- Medial ptergoid
- Masseter
Name the muscles involved in jaw opening
- Lateral pterygoid
- Myelohyoid
- Suprahyoid muscles
Name the nerves that supply the TMJ
- Auriculotemporal nerve
- Masseteric nerve (branch of trigeminal nerve)
What can patients with jaw pain also present with
Ear ache
Do you need radiography to diagnose a solicited TMJ
No not to diagnose we may take it for more information
What will a pt who has dislocated their tmj present with
Won’t be able to close their mouth
Will dribble as they can’t close mouth
How do we relocate a dislocated joint
Push the jaw down and back using your body weight
Define internal derangement
Disruption within the internal aspects of the TMJ in which there is displacement of the disc from its normal functional relationship with the mandibular condyle and the articular portion the temporal bone
What can be a difficulty in treating internal derangement
1/3 of patients who have an MRI will present with internal derangement but will have no symptoms
How do we classify internal derangement
Using the Wilkes classification of internal derangement
What is a class 1 on the Wilkes internal derangement scale
Painless clicking- slight forward displacement of the dic
What is a class II on the Wilkes internal derangement scale
Occasional painless click, intermittent locking headaches suggesting the beginning of deformity and thickening of posterior edge
What is a class III on the Wilkes internal derangement scale
Frequent pain, joint tenderness, headaches, restricted motion suggestign anterior disc displacement and significant deformity
What is a class IV on the Wilkes internal derangement scale
Chronic pain, headaches and restricted motion suggestign degenerative changes flattening of eminence deformed condyle
What is a class V on the Wilkes internal derangement scale
Variable pain, crepitus, painful function suggesting disc perforation and goes anatomical deformity
Give examples of minimally invasive surgical options for TMJ problems
- Joint injection
- Muscle injection
- Arthrocentesis
- Arthroscopy
Give examples of open joint procedures
- Disc repair/repositioning (meniscopexy)
- Disc removal (meniscectomy)
- Articular eminence/ zygomatic arch procedures
- Joint reconstruction procedures”
What is the indication for joint injections with steroids
- Failed conservative management
- Pain
- Degenerative joint disease (arthritis)
What is Arthrocentesis
Joint wash out
What are the indications for Arthrocentesis (joint wash out)
- Failed conservative management
- Pain
- Closed lock
How does Arthrocentesis (joint wash out)
- Wash out debris
- Clear joint of inflammatory mediators
- Divide adhesions
- Remove restrictions of disk
What are some indications for Arthroscopy
- Failed conservative management
- Pain
- Closed lock
Name some Arthroscopic procedures
- Eminectomy
- Meniscopexy
What are seen complications associated with Arthroscopy
- Swelling
- Bruising
- Bleeding
- Pain
- No improvement
- Facial nerve damage
- Damage to ear canal
- Damage to middle ear
Give examples of invasive TMJ patients
- Open joint surgery
- “Meniscopexy (move disk back)
- Menisectomy (remove it)
- Smooth joint surfaces
- Gap arthroplasty (ankylosis)
Give examples of invasive TMJ patients
- Open joint surgery
- Meniscopexy (move disk back)
- Menisectomy (remove it)
- Smooth joint surfaces
- Gap arthroplasty (ankylosis)
What are seen complications associated with TMJ replacement
- Facial nerve damage
- Infection
- Damage to ear canal
- Hearing loss
- CSF leak
- Failure of implant
What other procedures aside from surgery can we do to help manage TMJ disorders
- Physiotherapy
- Exercises
- Psychological input
