TMJ Flashcards
What supplies synovium to the TMJ
The capsular ligament
What is the primary vascular supply to the TMJ
Superficial temporal, maxillary, masseteric arteries
What is the nerve supply to the TMJ
auriculotemporal nerve
What is your treatment for myofascial pain dysfunction?
NSAIDs, occlusal appliance, soft diet, warm compresses, muscle relaxants (cyclobenzaprine 5 mg nightly), botox injections
What is degenerative joint disease?
A chronic inflammatory arthritis resulting in degradation of articular cartilage with remodeling of the subchondral bone
What cytokines are found in osteoarthritis
TNF-alpha, IL-1, IL-6
What is internal derangement of the TMJ?
Disorder in which the articular disk is in an abnormal position
At which Wilkes classification would you consider surgical intervention?
Between Wilkes class 2 and 3. Class 2 does not exhibit bony changes and the disk reduces. I would perform an arthocentesis
What are the types of true TMJ ankylosis
Bony, fibrous, fibro-osseous
What May cause a pseudoankylosis?
Muscle fibrosis secondary to radiation, myofascial pain, tumors, infection, myositis ossificans
Do you know of a classification for ankylosis?
Sawhney- type 1 flattened condylar head with close approximation to joint space
Type 2- flattened condyle close to glenoid fossa, bony fusion on lateral aspect
Type 3- bony block bridging the ramus and zygomatic arch
Type 4- bony block bridging the ramus, zygomatic arch, replacing complete architecture of joint
What is the MIO goal for joint surgery?
At least 35 mm
What is the 7 step Kaban protocol?
Pediatric joint replacement
1. Resection
2. Coronoidectomy on affected side, measure MIO
3. Coronoidectomy on other side
4. Lining with temporalis myofascial flap or native disc
5. Recon with distraction osteogenesis or costrochondral graft
6. Early mobilization
7. Aggressive physical therapy
What imaging would you get for ankylosis and why
CT with contrast. Outline bony mass, evaluate vasculature and planning for custom joint replacement
