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 spaceType 2- flattened condyle close to glenoid fossa, bony fusion on lateral aspectType 3- bony block bridging the ramus and zygomatic archType 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 replacement1. Resection2. Coronoidectomy on affected side, measure MIO3. Coronoidectomy on other side4. Lining with temporalis myofascial flap or native disc5. Recon with distraction osteogenesis or costrochondral graft6. Early mobilization7. 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
Describe your rib graft harvest
See page 28
Describe what a T1 MRI will show?
Fat is bright and will appear white
In T1 and T2 how will avascular necrosis appear
T1 marrow will be black and T2 bright
Describe what a T2 MRI will show
Water is bright and fat dark. Good for effusions
Describe your TMJ HPI
OLD CARTSonsetLocationDurationCharacterAggravating factorsRelieving factorsTimingSeverity
Describe your arthrocentesis
IV sedation or general anesthesia. Prep and drape. Scrub and gown. Marking pen for canthal tragal line (Holmlund-Hellsing line). First mark is 10 mm forward and 2 mm down. Second mark is 20 mm forward and 10 mm down. Local anesthetic at the skin. Manipulate jaw to open joint space. Superior joint space entered with 18 gauge needle. Joint space is 3 cc. Second 18 gauge needle. Lavage with at least 100 cc lactated ringers, 400 has been shown to remove inflammatory markers. Inject with kenalog and bupivacaine. Manipulate jaw. Post op exercise, NSAIDs, splints
What is the concentration of kenalog injected?
40 mg per ml
Describe the layers dissected to enter the joint space
Nerve monitor. Preauricular incision. Facial nerve is 8-35 mm from external auditory meatus. Skin, subcutaneous tissue, temporoparietal fascia, temporalis fascia (glistening white), palpate zygomatic arch, incise through periosteum
What layer is the facial nerve found?
Temporal branch within the temporoparietal fascia
What is Frey syndrome
Auriculotemporal nerve syndrome. gustatory sweating, flushing, warmth. Auriculotemporal nerve damage. Usually will resolve in 6 months.
What is the test for auriculotemporal nerve syndrome?
Iodine starch test (the Minor test). 3 g Iodine, 20 g castor oil, 200 mL absolute alcohol. Lemon drop. Yellow iodine will turn dark blue
Aside from waiting what are treatments for auriculotemporal nerve syndrome
40 IU botox. scopolamine ointment. surgical transection of nerve
Complication. Your patient is bleeding during condylotomy procedure. Where could the bleed be from?
Internal maxillary artery (runs 3 mm medial from sigmoid notch and 20 mm below condylar head). Bleeding could also be from the masseteric artery
Complication. Bleeding during discectomy?
Retrodiscal tissue, lateral pterygoid muscle, middle meningeal artery (31 mm medial to zygomatic arch, 2.4 mm anterior from glenoid fossa)
In a carotid artery cut down where is the artery ligated?
Above the facial branch (3rd of the anterior branches)
What considerations regarding a Biomet stock prosthesis should you take into account?
The condylar portion is a chromium cobalt alloy and may contain nickel. Nickel allergy would be a contraindication
What is the glenoid fossa component made of in a Biomet prosthesis?
Ultra high molecular weight polyethylene
What is a TMJ concepts made of?
Condylar component is pure titanium. Fossa component is pure titanium and ultra high molecular weight polyethylene
