TMD asher lim

Question 1

definition of TMD

Answer 1

defined as a subgroup of craniofacial pain problems that involve TMJ, masticatory muscles, associated H&N musculoskeletal structures

Question 2

Name 3 psychological, biological and social factors for TMD

Answer 2

PSYCHOLOGICAL
- depression
- anxiety
- ocd

BIOLOGICAL
- bruxism
- gender
- trauma (micro or macro)
- smoking

SOCIAL
- disturbed sleep
- culture
- low income

Question 3

What are the two classes of TMD

Answer 3

1) TMJ disorders (joint itself)
2) masticatory muscle disorders

Question 4

What are the types of TMD

Answer 4

1) myofascial (muscle) pain
2) intra articular derangement /. Internal derangement
3) degenerative joint disease eg osteoarthritis, idiopathic condylar resorption
4) auto immune disease eg RA
5) dislocations
6) neoplasia

Question 5

what is axis I and II in TMD

Answer 5

axis 1
- somatosensory
- organic cause

axis 2
- psychogenic
- non organic

Question 6

what type of disorder will present with joint sound

Answer 6

-internal derangmenet
- degenerative disease

Question 7

3 signs and symptoms of TMD

Answer 7

• pain
• limitation in function
• joint sound

Question 8

types of non surgical tx

Answer 8

• explanation, patient education
• medication
• occlusal splint therapy
• physical therapy
• behavioural therapy
• psychiatric managment

Question 9

3 types of surgical tx

Answer 9

• arthrocentesis
• arthoscopy
• open joint surgery

Question 10

defn of arthrocentesis

Answer 10

the lavage of the joint without direct viewing of the joint

Question 11

what is arthrocentesis effective in managing

Answer 11

• TMD internal derangement (eg closed lock - disc displacement with and without reduction)
• anchored disc phenomenon

Question 12

defn of internal derangement

Answer 12

abnormal rs among the disc, condyle, and eminence ie disc displacement

Question 13

what are the 4 categories of internal derangement

Answer 13

1) early phase - slight catching on opening and closing mouth, increase in frictional properties of the joint

2) anterior disc displacement with reduction - mouth opening is accompanied by clicking or popping sound as condyle passes over the posterior band and returns to normal

3) anterior disc displacement without reduction

4) anchored disc phenomenon

Question 14

write about the procedure of arthrocentesis

Answer 14

• drape, surface markings
• topical spray or cream
• auriculotemporal nerve block
• insertion of first 19G needle at posterior space of the superior joint space with mouth open
• introduce 2ml of saline then some marcaine
• introduce 2nd 19G needle into anterior part of the superior joint compartment with mouth closed
• lavage of joint space with saline (80-100ml)
  marcaine injected in joint space

Question 15

what to do post lavage

Answer 15

• analgesia
• AB cover
• jaw exercise
• i/o splint at night

Question 16

indications for arthroscopy

Answer 16

• diagnostic (including biopsy)
• closed lock
• lysis of adhesions and lavage
• abrasion arhtroplasty
• laser / electrocautery
• disc pliation

Question 17

possible complications of TMJ arthroscopy

Answer 17

• damage to facial nerve: temporal and zygomatic branches
• damage to disc and articular surfaces
• perforation of glenoid fossa
• interstitial extravasation of irrigation fluid into the temporal, parotid and masseteric spaces
• otitis (middle ear infection or inflammation), secondary to collection of irrigation fluid in EAM
• hemorrhage due to superficial temporal vessels pierced by trocar

Question 18

absolute indications for open tmj surgery

Answer 18

• underdeveloped condyle
• ankylosis
• tumour

Question 19

relative indications for open tmj surgery

Answer 19

• dislocation
• fractured TMJ/ traumatic injuries
• internal derangement
• osteoarthritis

Question 20

4 approaches to access the TMJ

Answer 20

• Pre auricular
• post auricular
• endaural (incision in ear omg)
• intra oral