TMJ Abnormalities Flashcards by Abigail Cook

describe mandibular condyle

cylindrical

2cm mediolateral

variable shape

angled 15-33 degrees with sagittal plane

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temporal component of TMJ - implication for?

formed by squamous portion

posterior – glenoid / madnibualr fossa

anterior - articular emninence and tubercle
- WHERE YOU WILL MOST LIKELY SEE OSTEOARTHRITIS

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where will you see artheroarthritis in TMJ?

anterior portion at the articular eminence and tubercle

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interarticular disc - describe

avascular fibrous connective tissue

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which part is thicker in the disc

thicker anterior band

thinner in middle and VERYT HICK POSTERIOR BAND
- also thicker medially than laterally

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displacement in what direction?

medio-anterior

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where does interarticular disc (meniscus) attach?

to the condylar poles both medially and laterally

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Retrodiscal tissues aka

posterior disc attachment

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Retrodiscal tissue describe

well-innervated and may be the cause of paon in the case of anterior disc displacement

VASCULAR
- expands in volume via venous distension

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superior vs inferior aspects of Retrodiscal tissues

sueprior - very flexible

inferior - not as flexible

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when to image the TMJ?

supplements clinical inforamtion
- osseous abnormalities
- conservative tx has failed
- symptoms are worsening
- history of significant trama, dysfunctin, alteration in ROM, nerve abnormalities, changes in occlusion

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TMJ imaging modalities

PANO
CBCT
MDCT
MRI

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MDCT and TMJ imaging?

see soft tissue – but CANOT VISUALIZE THE DISC

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MRI of disc?

FLUID IS MORE NOTICEABLE

- provides contrast for disc and other SOFT TISSUE structures

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MRI of disc?

FLUID IS MORE NOTICEABLE

- provides contrast for disc and other SOFT TISSUE structures

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condylar hyperplasia

developmental abnormality that results in ENLARGED and occasionally deformed condylar head
- possible enlarged glneoid fossa, condylar neck, ramus and body

female >male

age less than 20

self-limiting

mandibular assymetry

normal cortical thickness and trabecular pattern – condylar head and neck may bend forward or lateral

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differential diagnosis with condylar hyperplasia

tumor – more irregular like osteochondroma

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coronoid hyperplasia presents as

elongated coronoid process, extending at least 10mm above the inferior rim of the zygomatic arch

male > female

often bilateral and can contact the posterio surface of zygomatic arch, restricting condylar translation

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bifid condlye is what?

anatomical VARIANT

developmental depression or notch in teh superior condylar surface
more of an anomoly and cannot say pathiology
usually incidental finding
occasionally TMD symptoms
more often unilateral and can be anterio-posterior or mediolateral

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bifid condlye is what?

anatomical VARIANT

developmental depression or notch in teh superior condylar surface
more of an anomoly and cannot say pathiology
usually incidental finding
occasionally TMD symptoms
more often unilateral and can be anterio-posterior or mediolateral

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describe disc displacement

direction most likely to occur?

abnormally positioned disc relative to the condylar and temporal components of the TMJ

MOST COMMONLY ANTERIOR
- but can be antero-medially, medially, or anterior-laterally displaced

can interfere with function, cause pain, or be asympotmatic

POPPING, CLICKING,
crepitus (sign of degeneration)
decreased ROM
may be locking

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normal appearance of the disc usually look?

liek a bow-ties

at 11 or 12 o-clock

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disc deformities and perforatin

long-term displacement leads to loss of normal shape

may be impossible to identify
perforations occur most commonly in retrodiscal tissue
not reliable on MRI
bone to bone contact of osseous componenets is suggestive of perforation or displacement

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DJD aka

inflammatory?

osteoarthritis

not considered inflammatory but signs are kind of liekt hat

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describe DJD

breakdown of articulating fibrocartilage leading to deterioration of teh osseouos structures non-inflammatory bone erosion as well as new bone formation (osteophytes and sclerosis) - incidence increases with age and females more likely than males

DJD occurs where?

most likely where things are occluding | - anterior glenoid fossa- posterior articualr eminence

6 signs of DJD

1. flattening? - some people jsut have that though 2. reduced joint space 3. sclerosis - formation 4. osteophyte - formation of bone 5. subchondral cyst - usually small / round / W-D 6. erosion - right on the surface of the joint

what may be first sifgn of DJD

flattening

symptoms of osteoarthritis is usually?

pain within the joint and crepitits

DD with DJD

1. inflammatory arthritis (rheumatoid) - more erosice | 2. benign tumor - more scleortic (osteoma or osteochondroma)

rheumatoid arthritis

synovial membrane inflammation in several joints affects TMJ in half of patients

RA looks?

jigaw pattern? - fribrous ankylosis generalized osteopenia of the TMJ with synovial inflammation very erosive can occur from secondary DJD

fibrous anklylosis occurs with ?

RA DD importance of what ?

medical history

Juvenile arthrosis aka?

idiopathic condylar resorption or cheerleader syndrome

idiopathic condylar resorption looks? who usually gets it ?

"toad-stool" appearance females -- younger

treatment for juvenile arthrosis? (ICR)

surgery | - to fix disc and correct plane of occlusion

juvenile idopathic arthritis looks? who gets it

even younger than IRC -- "bird-face" and open bite

major things to note about septic arthritis

1. unilateral 2. redness and swelling 3.

defintion of effusion

influx of fluid into the joint may be associated with trauma (hemarthrosis) disc displacement or arthritis typical TMD symptoms and fluid in the ear, tinnitus, hearing difficulties, difficulty occluding post teeth

condylar disloction presents as?

usually locked open | - condyle

fracture look for

discontiuity in cortical outlines or overlapping

ankylosis two types

fibrous or osseous / bony fibrous - jigsaw

fibrous ankylosis

irregular, narrow oint space and jigsaw puzzle

bony ankylosis

joint space is obliterated by osseous bridge | - degenerative changes

most common benign tumor

osteochondroma | - radio-opaque

loss of cortex on condyle in younger?

not a pathological sign for anything -- they take longer to develop

Pano and CBCT and MT for TMJ?

Pano - gross disease CT - hard tissue (ossseeous changes) MCT- hard tissue plus soft tissues **MRI FOR DISC AND FLUID (EFFUSION)

developmental hyperplasia of condyle DD?

osteochondroma (most common benign tumor in jaw) but developmental will STOP after puberty and is usually more unilateral and 'regular enlargment'

pronounced antegonial notch seen in?

condylar HYPO-plasia

downward bowing of the inferior border?

HYPER- plasia of condylar

hypo and hyperplasia of condyle tend to be?

unilateral -- whereas coronoid hyperplasia (10mm above the inferior rim of zygomatic arch) may be bilateral

effusion / fluid in the joint is early sign of?

DJD -- degenerative joint disease

DJD AKA

osteoarthritis

sign of eroding condyles?

anterior OPEN bite | -- like seen in RA which is more likely to cause erosion than DJD

sign of fibrous ankylosis?

jig saw looking of the condylar and eminence -- with erosion vs osseous ankylosis -- bone on bone

RA vs osteoarthritis

multiple joints involved and severe erosions think RA

severe erosion in young patient (before age 16) think

Juvenile idiopathic arthritis - bird face appearance

sign of juvenile arthrosis

"toad-stool appearance" of condylar head and flattened

septic arthritis signs?

unilateral and from infection / inflammation with PERIOSTEAL REACTION - like double contour redness, lymphadonopathy, fevere malaise

synovial chondromatosis looks? what is it?

little pebbles within the synovial membrane BENIGN tumor -- one of most common affecting the TMJ

chondromatosis vs chondroCALCINOIS

CALCIONIS -- finer more evenly distributed tadio-opacities

condylar dislocation usually?

way anterior to the eminence

most common benign tumor of jaw

osteochondroma | - mixed appearance

location of osteochondrom

almost looks like a large osteophyte - Radio-opaque

chondrosarcoma is location?

malignant condyle anterior mandible mandibular symphysisi

malignant tumors more likely to be intrinisc or extrinisic?

EXTRINSIC - Like they metastisize here - look for PATHOLOGICAL FRACTURES

'common' malignant tumors that metastisize to the jaw

breast, lung, kidney, thyroid, prostate, colon, multiple myeloma salivary gland tumors