surgical options in tmd

Question 1

Give 4 examples of TMJ diseases

Answer 1

Any from:
- TMJ dysfunction
- jaw dislocation
- osteoarthritis
- infection
- tumours
- ankylosis

Question 2

What are the components of TMJ dysfunction?

Answer 2

Muscular - abnormal muscular movement will mechanically impact the joint
Mechanical (TMJ dysfunction)
Psychological - underlying cause
Trauma (aetiology)

Question 3

Name 4 components of the aetiology of TMD

Answer 3

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

Question 4

What are the symptoms of TMD?

Answer 4

Pain may be muscular, capsular or intra-capsular (the disc)
Reduced mobility
TMJ clicking and locking

Question 5

What anatomy makes up and surrounds the TMJ?

Answer 5

Glenoid fossa
Condylar head
Articular disc
Lateral ligament
Inner surface of capsule
Synovial membrane

Question 6

Why is the bilaminar zone important?

Answer 6

It resists the force of the lateral pterygoid, preventing the articular disc from displacing

Question 7

What is anterior disc displacement without reduction?

Answer 7

When the articular disc is displaced anteriorly but does not reduce back to its original position upon opening and closing the jaw

Question 8

What is anterior disc displacement with reduction?

Answer 8

Anterior displacement of the TMJ which reduces back into the normal position upon closing the jaw

Question 9

Give 5 examples of conservative management of TMJ dysfunction

Answer 9

Counselling
Pain management
Joint rest - soft diet for 2 weeks
Physical therapy - slight degree of movement
Restoration of occlusal stability

Question 10

What are the functions of a bite appliance?

Answer 10

Eliminates occlusal interferences
Prevents the joint head from rotating so far posteriorly in the glenoid fossa
Reduce loading on the TMJ

Question 11

What is an arthrogram?

Answer 11

Injecting radiopaque material around the condyle to look at the upper compartment and lower compartment of the TMJ

Question 12

Why is an MRI useful for TMD?

Answer 12

Shows the structure well including muscles of mastication

Question 13

What is arthroscopy and why is it used for TMD?

Answer 13

Looks into the superior joint space for any abnormalities
- if synovial membrane is degenerated, this is the likely cause of the TMJ dysfunction

Question 14

What can be done for TMD by arthroscopy?

Answer 14

Diagnosis
Biopsy
Lysis and lavage
Disc reduction - release, cautery’s suturing
Removal of loose bodies
Eminectomy - removal of articular eminence

Question 15

What is arthrocentesis?

Answer 15

Allowing washout of the superior joint space to remove inflammatory exudate

Question 16

Give 6 examples of intra and post-op complications of TMJ surgery

Answer 16

Any from:
- broken instruments
- middle ear perforation
- extravasion
- haemorrhage
- haemarthrosis
- damage to CNV and CNVII
- infection
- dysocclusion
- perforation of tympanic membrane

Question 17

How should TMD be managed post-operatively?

Answer 17

Joint rest - soft diet, avoid wide opening
Pain management
Physical therapy
Restoration of occlusal stability

Question 18

What is disc plication?

Answer 18

Recapturing the disc and putting it back into place

Question 19

What is an eminectomy?

Answer 19

Removal of the articular eminence

Question 20

What is high condylar shave?

Answer 20

Shaving the top of the condyle

Question 21

What is a condylotomy?

Answer 21

Creating a cut within the area of the condyle

Question 22

What is a meniscectomy?

Answer 22

Removal of the articular disc

Question 23

What is a condylectomy?

Answer 23

Removing the entire condyle eg - if tumour or big degenerative change or ankylosis of joint

Question 24

What are the indications for TMJ reconstruction?

Answer 24

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

Question 25

What is the type I ankylosis classification?

Answer 25

Flattening deformity of condyle, little joint space and extensive fibrous adhesions

Question 26

What is the type II ankylosis classification?

Answer 26

Bony fusion at outer edge of articular surface

Question 27

What is the type III ankylosis classification?

Answer 27

Marked fusion at outer edge of articular surface

Question 28

What is the type IV ankylosis classification?

Answer 28

Entire joint replaced by mass of bone