surgical options in tmd Flashcards
Give 4 examples of TMJ diseases
Any from:
- TMJ dysfunction
- jaw dislocation
- osteoarthritis
- infection
- tumours
- ankylosis
What are the components of TMJ dysfunction?
Muscular - abnormal muscular movement will mechanically impact the joint
Mechanical (TMJ dysfunction)
Psychological - underlying cause
Trauma (aetiology)
Name 4 components of the aetiology of TMD
Macrotrauma
Microtrauma - chronic joint overloading secondary to stress related clenching or bruxism
Occlusal factors - deep bite, occlusal disharmony (high restoration), lack of teeth
Anatomical factors
What are the symptoms of TMD?
Pain may be muscular, capsular or intra-capsular (the disc)
Reduced mobility
TMJ clicking and locking
What anatomy makes up and surrounds the TMJ?
Glenoid fossa
Condylar head
Articular disc
Lateral ligament
Inner surface of capsule
Synovial membrane
Why is the bilaminar zone important?
It resists the force of the lateral pterygoid, preventing the articular disc from displacing
What is anterior disc displacement without reduction?
When the articular disc is displaced anteriorly but does not reduce back to its original position upon opening and closing the jaw
What is anterior disc displacement with reduction?
Anterior displacement of the TMJ which reduces back into the normal position upon closing the jaw
Give 5 examples of conservative management of TMJ dysfunction
Counselling
Pain management
Joint rest - soft diet for 2 weeks
Physical therapy - slight degree of movement
Restoration of occlusal stability
What are the functions of a bite appliance?
Eliminates occlusal interferences
Prevents the joint head from rotating so far posteriorly in the glenoid fossa
Reduce loading on the TMJ
What is an arthrogram?
Injecting radiopaque material around the condyle to look at the upper compartment and lower compartment of the TMJ
Why is an MRI useful for TMD?
Shows the structure well including muscles of mastication
What is arthroscopy and why is it used for TMD?
Looks into the superior joint space for any abnormalities
- if synovial membrane is degenerated, this is the likely cause of the TMJ dysfunction
What can be done for TMD by arthroscopy?
Diagnosis
Biopsy
Lysis and lavage
Disc reduction - release, cautery’s suturing
Removal of loose bodies
Eminectomy - removal of articular eminence
What is arthrocentesis?
Allowing washout of the superior joint space to remove inflammatory exudate
Give 6 examples of intra and post-op complications of TMJ surgery
Any from:
- broken instruments
- middle ear perforation
- extravasion
- haemorrhage
- haemarthrosis
- damage to CNV and CNVII
- infection
- dysocclusion
- perforation of tympanic membrane
How should TMD be managed post-operatively?
Joint rest - soft diet, avoid wide opening
Pain management
Physical therapy
Restoration of occlusal stability
What is disc plication?
Recapturing the disc and putting it back into place
What is an eminectomy?
Removal of the articular eminence
What is high condylar shave?
Shaving the top of the condyle
What is a condylotomy?
Creating a cut within the area of the condyle
What is a meniscectomy?
Removal of the articular disc
What is a condylectomy?
Removing the entire condyle eg - if tumour or big degenerative change or ankylosis of joint
What are the indications for TMJ reconstruction?
Joint destruction due to - trauma, infection, tumours, previous surgery or radiation
Ankylosis
Developmental deformity
Tumours - usually slow growing eg - giant cell lesions, fibro-osseous lesions and myxomas
