Surgical Options for TMJ Diseases Flashcards
Give examples of different TMJ diseases?
- TMD
- Jaw dislocation
- Osteoarthritis
- Rheumatoid arthritis
- Chondromatosis
- Foreign body granuloma
- Infection
- Trauma/radiation damage
- Ankylosis
- Tumour
What are the different components of TMJ diseases?
- Muscular issues (most common)
- Mechanical TMJ dysfunction
- Psychological underlying cause
- Trauma
What psychological causes can lead to TMJ disease?
- bruxism
- clenching
- grinding
- having teeth in occlusion all the time
- lack of FWS
What occlusal factors may lead to TMD?
- deep overbite
- occlusal disharmony (eg high filling)
- lack of teeth leads to overclosing
- class II jaw relation
What symptoms are associated with TMD?
- reduced opening
- clicking
- locking
- deviation
What important anatomical considerations are involved in TMD?
- glenoid fossa
- condylar head
- articular disc
- lateral ligament
- inner surface of capsule
- synovial membrane
What is found in the superior compartment of the TMJ?
- superior part of articulating disc
- inferior surface of the glenoid fossa
What is found in the inferior compartment of the TMJ?
- superior surface of condyle
- inferior surface of articulating disc
What is involved in anterior disc displacement without reduction TMD?
- exceeds elasticity of fibre (bilaminar zone)
- disc cannot be pulled back
- mechanically blocked
How will a patient with TMD (anterior disc displacement without reduction) present?
- limited mouth opening
- unable to move jaw back
- jaw propped open
How can TMD be managed conservatively?
- counselling (most important)
- pain management = analgesics & muscle relaxation
- joint rest = supported mandible during yawning, appropriate diet, avoid parafunction
- physical therapy
- restoration of occlusal stability (lower any high fillings etc)
What special investigations can be done to assess TMD?
- OPT including condyles
- Arthrogram
- MRI
What are examples of surgical procedures that can be used to treat TMD?
- DISC PLICATION = recapturing dislocated disc & relocated into anatomical position
- EMINECTOMY = remove articular eminence, increase gap to allow spontaneous recapturing
- HIGH CONDYLAR SHAVE
- CONDYLECTOMY = remove condyle usually due to tumour or ankylosis
- MENISCECTOMY = removal of disc, usually due to fibrosis
- RECONSTRUCTIVE SURGERY = remove joint & replace
What important structure is at risk of being damaged during TMD surgery?
Facial nerve
What type of surgery investigation can be done to the TMJ?
Arthroscopy
When arthroscopy is used to investigate the TMJ, what may be seen? Give an explanation of each:
Fibrous joint space = sign of degeneration
Inflammatory tissue = this will be the cause of pain
What is Type I ankylosis of TMJ?
Flattening deformity of condyle, little
joint space & extensive fibrous adhesions
What is Type II ankylosis of TMJ?
Bony fusion at outer edge of
articular surface
What is Type III ankylosis of TMJ?
Marked fusion bone between upper
part of ramus of mandible & zygomatic arch.
What is Type IV ankylosis of TMJ?
Entire joint replaced by mass of
bone
