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D3 Oral Surgery Ex4 > Surgical Treatment of TMD (Lui) > Flashcards

Surgical Treatment of TMD (Lui) Flashcards

1
Q

What type of joint is the TMJ classified as?

A

Diarthrodial with freedom of movement limited by muscles and ligaments

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2
Q

What are the 4 articular surfaces of TMJ?

A
  1. Temporal bone
  2. Mandibular condyle
  3. Superior disk surface
  4. Inferior disk surface
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3
Q

Which part of the joint capsule is responsible for rotation movement (first 25 mm of opening) / hinge?

A

Inferior

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4
Q

What joint movement is rotation by the inferior TMJ compartment called?

A

Ginglymoid

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5
Q

Which part of the TMJ joint capsule is responsible for translation movement?

A

Superior

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6
Q

What joint movement is translation?

A

Arthroidal

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7
Q

What is the angle of the heads of the condyles as they intersect on an imaginary line in the center of the head?

A

145-160

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8
Q

What is the character of the articular disk?

A
  1. Non-vascular
  2. Non-innervated
  3. 3 zones, anterior is the thickest
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9
Q

What is the thinnest part of the articular disk?

A

Middle / intermediate zone

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10
Q

What is the character of the retrodiscal tissue?

A

Vascular, innervated

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11
Q

Of the bilaminar zone of the retrodiscal tissue, which contains elastic fibers and what is their purpose?

A

Superior retrodiscal tissue lamina. It prevents extreme translational movements.

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12
Q

Of the bilaminar zone of the retrodiscal tissue, which contains collagen fibers and what is their purpose?

A

Inferior retrodiscal tissue lamina. It prevents extreme rotational movement.

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13
Q

What is the number of pairs of supramandibular muscles of mastication?

A

4

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14
Q

What is the number of pairs of inframandibular muscles of mastication?

A

8

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15
Q

How does the inferior head of the lateral pterygoid act on the disk?

A

Activation / movement

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16
Q

How does the superior head of the lateral pterygoid act on the disk?

A

Stabilization

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17
Q

What are 11 etiologies for TMD?

A
  1. Idiopathic
  2. Trauma
  3. Osteoarthritis
  4. Rheumatoid arthritis
  5. Neuralgias
  6. Tumors
  7. Collagen-vascular disease
  8. Ankylosis
    9, Dislocation
  9. Parafunctional habits
  10. Stress
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18
Q

Cartilage, ligaments, and bone are what factors of TMJ pathology?

A

Intrinsic

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19
Q

The muscles are what factors of TMJ pathology?

A

Extrinsic

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20
Q

What is the pathway of the pathophysiology of pain?

A
  1. Initiating event
  2. Inflammatory response
  3. Cytokines / prostaglandins
  4. PAIN
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21
Q

What is the goal of either surgical or non-surgical treatment?

A
  1. Restore function

2. Relieve pain

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22
Q

What are 7 non-surgical treatments for TMD?

A
  1. Splint therapy
  2. Occlusal adjustment
  3. Myofascial release / physical therapy
  4. Ultrasound
  5. Trigger point injections
  6. Bio-feedback
  7. Pain medicine
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23
Q

What are 4 surgical treatments for TMD?

A
  1. Arthrocentesis
  2. Arthroscopy
  3. Arthroplasty
  4. Joint replacement
24
Q

What is the term for treatment in which 2 needles are inserted into the superior joint space, which flush the joint space and inject Healon (hyaluronic acid) as a joint lubricant (can also inject steroids)?

A

Arthrocentesis

25
Q

What is the term for treatment in which direct visualization and inspection of joint is done internally, can be diagnostic and therapeutic, can be used to release adhesions (can still flush the joint space and inject Healon or antibiotics)?

A

Arthroscopy

26
Q

What is the term for an open joint procedure done to reposition and recontour the cartilage, osseous recontouring?

A

Arthroplasty

27
Q

Is it preferred to do a menisectomy during arthroplasty?

A

No. No good meniscus replacement.

28
Q

What is the donor site for an autograft in arthroplasty where the condyle will be replaced?

A

Rib

29
Q

What is the donor mandible?

A

Allogenic (Cadaver)

30
Q

What is the thickness of the glenoid fossa as a surgical consideration?

A

0.9mm

31
Q

What innervates the retrodiscal tissue and therefore transmits pain when there is an internal derangement of the TMJ?

A

Auriculotemporal nerve

32
Q

What is the term for a disruption of the internal aspects of the TMJ in which an abnormal relationship exists between the disk and the condyle, fossa, and articular eminence?

A

TMJ internal derangement

33
Q

What is the most common reason why the TMJ disc displaces?

A

Increased friction / lubrication impairment

34
Q

What is the Wilkes staging where there is opening and reciprocal clicking, but no pain or limitation of movement?

A

Wilkes Stage I

35
Q

What is the Wilkes stage where pt has one or more episodes of pain associated with clicking or popping?

A

Wilkes Stage II

36
Q

What is the Wilkes stage where pt has major mechanical symptoms with locking either intermittently or fully closed, and a restriction of motion?

A

Wilkes Stage III

37
Q

What is the Wilkes stage where tomography shows early-to- moderate degenerative changes with flattening of the eminences, deformed condylar head, sclerosis, but there is no perforation of the disk or attachments?

A

Wilkes Stage IV

38
Q

What is the Wilkes Stage with disk or attachment perforation, with possible subcortical cyst formation?

A

Wilkes Stage V

39
Q

What is the concern of going too far medially when doing TMJ surgery?

A

Hitting internal maxillary artery

40
Q

Is the proplast-teflon used for joint replacement?

A

No, can cause foreign body response

41
Q

What is the nerve concern during TMJ surgery?

A

Facial nerve

42
Q

What is the distance from the anterior concavity of the external auditory meatus that the facial nerve crosses the zygomatic arch?

A

8-35 mm

43
Q

On what surface of the temporoparietal fascia is the facial nerve located?

A

The deep surface

44
Q

What is the risk of damaging the facial nerve?

A

Can cause Bell’s palsy

45
Q

What are 2 means for vascular control in surgery?

A
  1. Periauricular

2. Submandibular to access external carotid artery

46
Q

What is the most effective means to control maxillary artery hemorrhage?

A

Ligate external carotid artery in the retromandibular fossa, distal to the origin of the posterior auricular artery, combined with ligation of the superficial temporal artery at the root of zygoma

47
Q

What is another method to control bleeding?

A

Embolization of the area and coil

48
Q

What are 11 indications for alloplastic joint reconstruction?

A
  1. Arthritic conditions
  2. Ankylosis (recurrent w/ heterotrophic bone formation) 3. Revision procedures
  3. Avascular necrosis
  4. Multiple operated joints
  5. Fracture
  6. Functional deformity
  7. Benign neoplasms
  8. Malignancy (post-tumor excision)
  9. Degenerated or resorbed joints with severe anatomic discrepancies
  10. Developmental abnormalities
49
Q

What is the etiology of TMJ Disc Displacement?

A
  1. Trauma
  2. Functional overloading
  3. Joint laxity
  4. Degenerative joint disease
  5. Masticatory muscle spasm
  6. Increased friction / lubrication impairment
50
Q

What is a major advantage of alloplastic total joint reconstruction?

A
  1. No donor site

2. No fixation

51
Q

Why is ultra-high molecular weight polyethylene (UHMWPE) used as the Fossa implant for Alloplastic joint reconstruction?

A

Orthopedic literature supports it

52
Q

What is the main difference between arthrosentesis and arthroscopy?

A

Arthroscopy uses a camera

53
Q

Study the internal derangement diagram slide (with nine pictures)

A

The middle row of images on that slide is normal

54
Q

What are 3 indications for arthrocentesis?

A
  1. Dislocation of the articular disc ± reduction
  2. Limitations of mouth opening originating in the jaw joint
  3. Joint pain and other internal derangements of the TMJ
55
Q

What are indications for TMJ arthroscopy?

A
  1. Radiological bone changes in TMJ characteristic to
    osteoarthritis with disc displacement or deformity
  2. Non effectiveness of conservative
    treatment with NSAIDs, intraoral splints or arthrocentesis.

D3 Oral Surgery Ex4 (5 decks)

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