TMJ Flashcards
What is para function?
Purposeless oro mandibular movements
What is the stomatoghnathic system?
TMJ
Muscle
Occlusion
What are examples of para function?
Bruxism,
Check biting
Nail biting
Bruxism can be…
Day or night
Most people brux during?
The day 30%
Night time 7-10%
What is the aetiology of bruxism?
Habit
Concentration
Stress
Sleep disorder
What are the TMJ disorders?
Growth and development Trauma Neoplasm Arthritis Degenerative TMD Dislocation Ankylosis Internal derangement
What is an example of a grower abnormality of TMJ?
Condylar hyperplasia
Condylar aplasia
Condylar Hypoplasia
What is an example of a traumatic injury to TMJ?
Fracture of condyles
Guards man
Fracture of body
Fracture of ramus
Why us an example of a condylar neoplasm?
Benign or malignant but are rare
Primary tumours of TMJ are less than 1% of head and neck tumours usually metasteses from 5B’s
Osteoma
Chondroma
Chondrosarcoma
Metastatic
Give an example of a degenerative diseases of TMJ
Osteoarthritis
RA
JA
Give an example of an inflammatory disease of TMJ
Inflammatory arthritis
What are the features of osteoarthitis? And symptoms
Beaking : oesophytes
Flattening: of condylar head
Cysts: subchondral Ely cysts
SSE
Sclerosis of glenoid fossa
Subchondral sclerosis (eburnatjkn)
Erosion of articular surface of condylar head
Chronic pain, crepitus, difficulty in chewing
How does RA of TMJ present?
Flattening of condylar head Erosion and destruction of condylar surface Occasional oesophytes Hollowing of gelonoid fossa Reduced range of movement Usually bilateral and symmetrical
What is TMD?
A narrow spectrum of relatively non specific disorders that affect the TMJ and or MOM
What are the primary symptoms of TMJ?
Pain and muscle or joing Click Limitation Grinding Pain from joint capsule, restrodiscsl tissues muscles Locking
What are the secondary symptoms of TMJ?
Otalgia
Vertigo
Headache
Low grade tinnitus
What is the prevalence of TMD?
Affects all ages
M and f same
Most commonly in young adults peak 20-40
20-75%of people have symptoms but only 2-4% have treatment
What is the aetiology of TMD?
Trauma Bruxism Occlusion Stress Idiopathic
BIOPSYCHOSOCIAL: biological, psycho and social
What is the diff diagnosis of TMD?
Related structure pathology eg teeth, patoid ENT Neuralgia Intra cranial lesions Cervical pain Vascular eg temporal arterits Somatic presentation of psychiatric Diseases of salivary gland Headaches
What is the treatment for TMD?
Physical: massage, heat compress, yoga, homeopathy, US, acupuncture
Drugs: NSAIDS, anxiolytics, muscle relaxants, anti depressant
Occlusal splint
Psychological
Surgery
Acupuncture
Placebo
What should the normal painless Maximal opening be?
40-55mm
What can happen in patients with TMJ when they open their mouth?
Deviation p
What is internal derangement?
Localised mechanical fault innTMJ which interferes with its smooth action
What sign may indicate risk of internal dereangemtn?
Clicking
This is because the disk may become abnormally shaped and displaced and may act as a door stop
What are the symptoms of ineffective arthritis?
Pyrexia Systemic upset Swelling Erythema Suppuration Very restricted mouth opening
What is ankylosis ?
Abnormal,al union across a joint space
What type of tissue may form the union in ankylosis?
Fibrous or bony
What are the two groups of ankylosis ?
Extracapsular and intra capsular
What are the causes of extra capsular ankylosis?
- Trauma eg laceration leading to peri articular fibrosis
- Chronic interested infection next to the joint
- Tumours fibro sarcoma and chondrosarclma
- Peri articular fibrosis: irradiation or prolonged immobilisation of the jaw
Why are the causes of intrscapsular ankylosis ?
Trauma: intra capsular, condylar fracture, penetrating wound and forceps delivery at birth
Infection: otitis media, mastoiditis, osteomyelitis, pyogenic arthritis
Tumour: osteoma, chondroma, osteosarcoma, sarcoma, fibro sarcoma, synovial sarcoma,
Misc: synovial chondromatosis
What are the surgical options for TMJ ?
Arthroscopy and arthocentesis
High condylar shave
Eminectomy
Joint replacement
What is arthocentesis?
Lavage of the joint
What is an eminectomy?
Cut of: to enable joint to slide freely
Build up: stops translational movement
What are the signs which would make you suspicious of a tumour?
New signs of TMD in patient more than 60 Lymph involvemtn Cranial nerve dysfunction Trismus Anosmia Objective ipsilateral hearing loss
What are the imagine options for TMJ?
DPT PA CT MRI NM
When would we do a DPT?
Patient present with trimsus and take open and closed view
When would we take a PA jaws?
Fracture Cysts Tumour Mandib hypo and hyperplasia Maxillofackal deformations
When would we do a CT?
Looks at hard and soft tissue
Shape and condition of condyle, fossa and articular eminence
Position shape and integrity of disk
Nature of condylar head disease
When would we do an MRI?
Assessment of soft tisse
Good when looking at position and from of disk in open and closed views and when diagnosis of internal dereangemtn possible and pre op before disc sugery
When would we take a radiosotope ?
Use technetium 99mTc and will get into areas of active bone growth as well as salivary glands, thyroid, blood liver, lung and heart,
WHere does the manidble deviate towards the side of when there is a problem?
it will deviate towards the side of derangment eg the side that has the problem
