TMD Flashcards
masseter muscle origin and insertion
origin
- zygomatic arch
insertion
-mandibular angle
temporalis origin and insertion
origin
- temporal fossa
insertion
- coronoid process
medial pterygoid origin and insertion
origin
-medial surface of lateral pterygoid plate
insertion
- angle of mandible
lateral pterygoid origin and insertion
origin
- base of skull
-lateral surface of lateral pterygoid plate
insertion
- fovi
-capsular disc
Nerve supply (TMJ)
nerve supply - auriculotemporal , masseteric , posteriorior deep temporal nerve
Blood supply (TMJ )
Deep auricular artery
Blood supply
Suprahyoid muscles
- digastric
- mylohyoid
- geniohyoid
- stylohyoid
Infrahyoid muscles
- thyrohyoid
- sternohyoid
- omohyoid
- sternothyroid
Causes Of TMD
-degenerative disease - arthritis
-disc displacement
- myofascial pain
- chronic recurrent dislocation
- ankylosis - condyle fused to base of skull
- hyperplasia - one condyle grows more than other
- neoplasia - tumour
- infection
Two different types of disc displacement
- anterior with reduction - disc slips forward but can slip back to where its meant to be
- anterior without reduction - stuck infront of condyle permanently
Pathogenesis of TMD
- inflammation of MOM or TMJ secondary to parfunctional habits
- trauma, direct or indirect
-stress
-psychogenic - occlusal abnormalities
Special investigation for TMD
- OPT
- CT/cone beam CT
- MRI
- transcranial view (TMJ view)
- nuclear imaging (technetium-99)
- arthrography
- ultrasound
Differential diagnosis for TMD
- dental pain
- sinusitis
- ear pathology
- salivary gland pathology
- referred neck pain
- headache
- atypical facial pain
- trigeminal neuralgia
- angina
- condylar fracture
- temporal arteritis
Common clinical features
- females>males
- age: most common between 18-30yrs
- intermittent pain of several months or years duration
- muscles/joint/ear pain, particularly on wakening
- trismus
- clicking/popping joint noises
- headaches
- crepitus indicates late degenerative changes
Reversible TMD treatment
- education
-jaw excercises
-medications - Botox , NSAIDS
-splints - bite raising appliances - massage heat
- accupuncture
-TENS
-hypnotherapy
Counselling instructions for TMD
- soft diet
- masticate bilaterally
- no wide opening
- no chewing gum
- dont incise foods
- cut into small pieces
- stop parafunctional habits e.g. nail biting, grinding
- support mouth on opening e.g. yawning
Irreversible TMD treatment
- occlusal adjustment
- TMJ surgery
- arthrocentesis
- arthroscopy
-disc repositioning surgery
-disc repair/removal
-high condylar shave
-total joint replacement
Internal derangement of TMJ presentation
(Anterior disc displacement with reduction)
clicking
Lack of coordinated movement between condyle and articular disc
Click is it snapping back
How to treat trismus
-physio
-therabite
-jaw screw
Red flags for TMD
- elderly with TMD first time
-blurred vision
-frequent headaches
Could be temporal arthritis - significant occlusal changes
- history or previous malignant tumours
- significant swellings
- infection - fever , swellings
- unplanned weight loss
- neurological signs and symptoms
- nasal symptoms
- pain with exertion, coughing ,wheezing
History taking for TMD
- how long
-what triggers pain
-clicking or crepitus
-limited opening
-constant or intermittent
-stresses in general life
-what helps
-what have they tried
-pain on chewing - impact on sleep
What to do if patient phones up with jaw stuck open
- side, ask to open further (big yawn)
- muscles all go into spasm
- struggle to relocate even after 20 mins - after this send to A&E
- diazepam really good to muscle relax
Why should a splint cover all teeth
Prevent overeruption
Causes of trismus
infection, trauma, muscle spasm , haematoma formation, submucous fibrosis, radiotherapy of head and neck , dental treatment, arthritis, TMD, ankylosis of joint
