tmj

Question 1

what are temporomandibular disorders

Answer 1

subgroup of craniofacial pain problems that
involve the TMJ (arthrogenous), associated muscles of mastication (myogenous), and associated head and neck musculoskeletal structures

Question 2

why might earache be associated with tmj pain

Answer 2

meckel’s cartilage remnants form ear ossicles. meckel’s cartilage is formed in the mandibular process

Question 3

what other sites may ache that are associated with tmd

Answer 3

neck, shoulder, back
earache
headache

Question 4

symptoms related to headache in tmd

Answer 4

photophobia, nausea

Question 5

other symptoms associated with tmd

Answer 5

jaw noises
altered sensation
limitation of mandibular movement
tinnitus/perceived hearing loss
related cognitive losses or affective disorders eg loss o f energy, appetite, memory, concentration, feelings
sleep disturbance
mood changes

Question 6

what kind of special investigations might you do for tmd

Answer 6

radiographic investigations if you suspect osseous components of jaw/joint, disc displacement

laboratory investigations for metabolic or autoimmune disorders

consultation with other healthcare professionals

Question 7

differentials for tmj pain

Answer 7

• TMD
• Direct traumatic injuries
• Neoplasms of TMJ components/related structures
• Referred pain
• Cracked tooth syndrome
• Headache
• Trigeminal neuralgia
• Post traumatic disorders and centrally mediated pain syndromes
• Idiopathic arthralgia

Question 8

what are the types of tmd

Answer 8

masticatory muscle disorders ie myofascial pain

internal derangement/disc displacement

arthritides/degenerative joint disease

congenital/developmental abnormalities

ankylosis

dislocations

neoplasms

Question 9

initial treatment of tmd should be directed towards

Answer 9

relief of symptoms

Question 10

non surgical management of TMD

Answer 10

reassurance
medications
physical therapy
trigger point injections

Question 11

do you give occlusal appliances for treatment of TMD

Answer 11

no, because no longer believe that TMD related to occlusal concepts

Question 12

what are the 4 categories of internal derangement

Answer 12

early phase
anterior disc displacement with reduction
anterior disc displacement without reduction
anchored disc phenomenon

Question 13

what is early phase internal derangement

Answer 13

slight catching on opening and closing of the mouth, increase in frictional properties of joint

Question 14

joint sound suggests what kind of tmd

Answer 14

internal derangement

degenerative disease involving TMJ

Question 15

what are the 3 options for surgical management of tmd

Answer 15

arthocentesis
arthoscopy
open joint surgery

Question 16

what is arthrocentesis and its indications

Answer 16

lavage of the joint to return disc of cartilage to normal position within the joint

effective for tmj internal derangements. also applicable to orthoarthritis of tmj with acute pain

Question 17

what kind of nerve block given for arthrocentesis

Answer 17

auriculotemporal nerve block

Question 18

where are needles inserted into for arthrocentesis

Answer 18

anterior and posterior parts of superior joint space

Question 19

what is a normal mouth opening

Answer 19

44mm female

51mm male

Question 20

pros and cons of arthroscopy vs arthrocentesis

Answer 20

arthroscopy allows for visualisation of the joint. can insert instrument into the scope to do fine surgery

however, increased risk of damage to surrounding structures due to larger instruments, more instrumentation required

results don’t show that arthroscopy superior to arthrocentesis

Question 21

indications for arthoscopy

Answer 21

diagnostic eg biopsy 
closed lock
lysis of adhesions and lavage
disc plication
abrasion arthroplasty
electrocautery

Question 22

where is arthroscope inserted into

Answer 22

superior joint space

Question 23

risks of arthroscopy

Answer 23

damage to facial nerve (zygomatic and temporal branch)

damage to disc and articular surfaces

perforation of glenoid fossa

interstitial extravasation of irrigation fluid into temporal, parotid, masseteric spaces

otitis secondary to interstitial fluid in the external aurditory meatus

hemorrhage due to piercing od superficial temporal vessels

Question 24

what are the absolute indications for open joint surgery

Answer 24

over or underdevelopment of the condyle/mandible affecting condylar growth

mandibular ankylosis

tumour at the joint

Question 25

what are the relative indications for open joint surgery

Answer 25

dislocation
osteoarthritis
internal derangement
fracture/traumatic injury