Surgical Options in TMD

Question 1

What is the aetiology of TMD?

Answer 1

Macrotrauma
Microtrauma
–chronic joint overloading secondary to stress related repetitive clenching or bruxism
Occlusal factors
–a deep bite
–occlusal disharmony e.g. high filling
–lack of teeth
Anatomical factors- Class II jaw relation

Question 2

What does the articular cartilage consist of?

Answer 2

Chrondocysts
Collagen fibres in proteoglycan matrix
Inflammatory disease produces proteases which degrade proteoglycans

Question 3

What is the conservative management of TMJ dysfunction?

Answer 3

Counselling
Pain Management
Joint rest
Physical therapy
Restoration of occlusal stability

Question 4

What are the functions of a bite appliance?

Answer 4

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

Question 5

What are the indications for TMJ reconstruction?

Answer 5

Joint destruction
-trauma
-infection
-tumours
-previous surgery
-radiation
Ankylosis
Developmental deformity
Tumours- usually slow growing

Question 6

What is the ankylosis classification of TMJ?

Answer 6

Type I- flattening deformity of the condyle, little joint space & extensive fibrous adhesions
Type II- bony fusion at outer edge of articular surface
Type III- marked fusion bone between upper part of ramus of mandible & zygomatic arch
Type IV- entire joint replaced by mass of bone

Question 7

What post-operative management do you give for TMD?

Answer 7

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

Question 8

What investigations of TMD can be carried out?

Answer 8

Radiographic investigations
Arthrogram
–series of images of a joint after injection of a contrast medium
MRI Scan
Arthroscopy