tmj Flashcards
what are temporomandibular disorders
subgroup of craniofacial pain problems that
involve the TMJ (arthrogenous), associated muscles of mastication (myogenous), and associated head and neck musculoskeletal structures
why might earache be associated with tmj pain
meckel’s cartilage remnants form ear ossicles. meckel’s cartilage is formed in the mandibular process
what other sites may ache that are associated with tmd
neck, shoulder, back
earache
headache
symptoms related to headache in tmd
photophobia, nausea
other symptoms associated with tmd
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
what kind of special investigations might you do for tmd
radiographic investigations if you suspect osseous components of jaw/joint, disc displacement
laboratory investigations for metabolic or autoimmune disorders
consultation with other healthcare professionals
differentials for tmj pain
- 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
what are the types of tmd
masticatory muscle disorders ie myofascial pain
internal derangement/disc displacement
arthritides/degenerative joint disease
congenital/developmental abnormalities
ankylosis
dislocations
neoplasms
initial treatment of tmd should be directed towards
relief of symptoms
non surgical management of TMD
reassurance
medications
physical therapy
trigger point injections
do you give occlusal appliances for treatment of TMD
no, because no longer believe that TMD related to occlusal concepts
what are the 4 categories of internal derangement
early phase
anterior disc displacement with reduction
anterior disc displacement without reduction
anchored disc phenomenon
what is early phase internal derangement
slight catching on opening and closing of the mouth, increase in frictional properties of joint
joint sound suggests what kind of tmd
internal derangement
degenerative disease involving TMJ
what are the 3 options for surgical management of tmd
arthocentesis
arthoscopy
open joint surgery
what is arthrocentesis and its indications
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
what kind of nerve block given for arthrocentesis
auriculotemporal nerve block
where are needles inserted into for arthrocentesis
anterior and posterior parts of superior joint space
what is a normal mouth opening
44mm female
51mm male
pros and cons of arthroscopy vs arthrocentesis
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
indications for arthoscopy
diagnostic eg biopsy closed lock lysis of adhesions and lavage disc plication abrasion arthroplasty electrocautery
where is arthroscope inserted into
superior joint space
risks of arthroscopy
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
what are the absolute indications for open joint surgery
over or underdevelopment of the condyle/mandible affecting condylar growth
mandibular ankylosis
tumour at the joint
what are the relative indications for open joint surgery
dislocation
osteoarthritis
internal derangement
fracture/traumatic injury
