TMD + Surgery Flashcards
What is the BLOOD SUPPLY of the TMJ? (1)
- Deep auricular artery
1st (superior) branch of maxillary artery
What is the NERVE SUPPLY to the TMJ? (3)
- Auriculotemporal nerve
- Masseteric nerve
- Posterior (deep) temporal nerve
Maxillary branches of trigeminal nerve (V2)
What are the SUPRAHYOID muscles? (4)
- Geniohyoid
- Mylohydoid
- Digastric
- Stylohyoid
What are the INFRAHYOID muscles?
- Sternothryoid
- Sternohyoid
- Thyrohyoid
- Omohyoid
Which anatomical areas does pain usually occur in the TMJ?
- Bilaminar zone
- Posterior band
What is an ‘anterior disc displacement’?
- Articular disc slips forward when resting
- Pt needs to manipulate jaw to encourage disc back
WITH REDUCTION = disc reduces self back into position (click)
WITHOUT REDUCTION = cannot reduce self, limited mouth opening
What are the causes of TMD?
- Disc displacement (w or w/o reduction)
- Myofascial pain
- Degenerative disease (local-OA, generalised-RA)
- Chronic recurrent dislocation
- Ankylosis
- Neoplasm (of bone)
- Infection (middle ear)
What are the pathogeneses of TMD?
- MoM inflammation = due to parafunction
- Trauma = direct/ indirect (force, sustained opening)
- Stress = micro-trauma; clenching
- Psychogenic
During an assessment (full history, I/O and E/O), what can be commonly seen in patients with TMD?
Usually F 18-30yrs
- C/O pain jaw joint/ muscle/ ear, worse during morning/ evening, headaches
- SH! (stress)
- E/O = clicking/ crepitus/ locking of TMJ
- I/O = mouth opening may be limited, parafunction signs (linea alba, tongue scalloping, occlusal NCTSL)
What may be the differential diagnoses for TMD?
- Dental pain
- Sinusitis
- Ear pathology
- Salivary gland pathology
- Referred neck pain
- Headaches/ migraines
- Atypical facial pain
- Trigeminal neuralgia
- Angina
- Condylar #
- Temporal arteritis
What are the NON-INVASIVE approaches for managing TMD?
ASYMPTOMATIC
- No tx, reassure & monitor
CONSERVATIVE ADVICE
- Reassurance
- Soft diet
- Chew both sides
- Support yawning/ wide opening
- No gum and incising food
- Cut food small pieces
- Stop parafunctional habits (chewing pens, nails etc.)
MEDICATION
- NSAIDs
- Muscle relaxants
- Tricyclic antidepressants
- Botox
- Steroids
PHYSICAL THERAPY
- Physio
- Massage
- Hypnotherapy
- Acupuncture
- Relaxation techniques
- TENS
SPLINTS
- BRAs
- Ant repositioning splints
What are the INVASIVE treatment options for managing TMD?
SURGERY
- Arthrocentesis (wash joint, can inject steroid)
- Arthroscopy
- Disc repositioning surgery
- Disc repair/ removal
- High condylar shave
- Total joint replacement
What degenerative changes may be seen in TMD?
- Collagen degeneration (chondromalacia, collagen fibrillation, subchondral bone exposure)
- Disc perforation
- Adhesive capsulitis
- Ostephytes
- Flattening of condyle and eminence
- Subchonrdral cysts
What special investigations can be carried out for TMD?
- If bony abnormality suspected –> XR (OPT)
- Arthrogram (dye into joint inferior and superior space)
- MRI
What is arthrocentesis?
Surgical procedure which consists of washing out the joint with saline
