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DMD3 sem 2 > TMJ arthritis > Flashcards

TMJ arthritis Flashcards

1
Q

Does the condyle articulate directly with the glenoid fossa?

A

Glenoid fossa at base of temporal bone

No contact between the condyle and the post glenoid surface even during retrusion

Articular disc forms cap around the head of the condyle

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2
Q

How are the mandibular condyles shaped?

A

Mandibular condyles are olive shaped and the axis is not straight lined. Lateral pole is anteriorly placed and medial pole is posteriorly placed.

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3
Q

What is the articular disc of the TMJ?

A

Articular disc is a biconcave fibrous structure that divides upper and lower compartment of the TMJ. It fits around the condyle like a cap and in front of the condyle. Between the 2 bands is an avascular thin area.

Disc is attached to the neck of the condyle on the posterior condyle and elastic tissue fuses with the squamotympanic fissure

Anteriorly some fibers fuse with the capsule and some fibers superior head of the lateral pterygoid muscle.

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4
Q

What movements do the different compartments allow?

A

Superior compartments allows translatory movements

Inferior compartment allows hinge movements

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5
Q

What are the attachments of the joint capsule of the TMJ?

A

Medial and lateral poles of the condyle beneath the articular disc as well as laterally along the roots of the zygomatic process and medially along the medial aspect of the glenoid process

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6
Q

What ligaments improve TMJ stability?

A

Strengthened laterally by a band of fibrous tissue called the lateral ligament preventing lateral dislocation of the joint.

Sphenomandibular ligament and stylomandibular ligament help to stabilize the TMJ

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7
Q

What are the roles of the synovial membrane?

A

Lubrication

Nutrition

Removal of wastes

protection

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8
Q

What is arthritis?

A

Inflammation of the articular surfaces of the joint

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9
Q

How common is arthritis in Australia?

A

> 3.1 million people self-report arthritis

1.6 million affected by osteoarthritis

> 428000 suffer from Rheumatoid arthritis

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10
Q

How does age affect arthritis?

A

Prevalence of arthritis increases with age most common in people over 45 years of age. Higher in females of older age groups

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11
Q

What are the types of arthritisi that can affect the TMJ?

A

Degenerative

Traumatic

Infectious

Metabolic

Immune-mediated

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12
Q

What is osteoarthritis?

A

Inflammatory condition affecting the articular cartilage of synovial joints.

Affected by mechanical loading, physical stress and traumatic injury of the joints

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13
Q

How does osteoarthritis affect the TMJ?

A

Most common disease affecting the TMJ

May be present in TMJ in absence of other joints

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14
Q

What are the subtypes of osteoarthritis?

A

Primary of unknown aetiology

Secondary due to macrotrauma or chronic microtrauma

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15
Q

What is osteoarthrosis?

A

Non-inflammatory condition that produces similar degenerative changes to O. However, this is now a redundant term and is just called osteoarthritis.

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16
Q

What are the symptoms of osteoarthritis of the TMJ?

A

Pain during chewing and worse in late afternoon or evening.

Masticatory muscles are hyperactive to protect the TMJ

Masticatory muscle fatigue.

Limited mouth opening and decreased range of motion

Crepitation

Other symptoms of referred pain like headaches.

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17
Q

What radiographic imaging should be used for TMJ arthritis?

A

No general consensus as to which imaging modality should be gold standard.

OPG is often not enough for diagnosis of TMJ arthritis

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18
Q

What is the radiolucency seen in the head of the condyle on CT in arthritis?

A

Subchondral cyst formation which is a difference in attentuation of the beam in that area not a true cyst

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19
Q

What are the radiological findings of arthritis on CT?

A

Birds beak appearance of glenoid fossa due to osteophyte appearance

Subchondral cyst

Reduction in joint space

Irregularities of the bone

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20
Q

What is used for diagnosis of osteoarthritis?

A

Clinical findings + Radiographic features

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21
Q

What are the DDx for OA?

A

Rheumatoid arthritis

Myofascial pain

Internal derangement

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22
Q

What is the prognosis for OA?

A

Symptoms most severe for the first 4 - 7 months. Worst at 8 - 9 months and least painful at 10 -12 months

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23
Q

How is TMJ OA managed?

A

Treat symptomatic OA not radiographic changes

Supportive therapy (education and reassurance, habit reduction, etc)

Medications (Analgesics and NSAIDs)

Intra-articular treatments

Surgery (arthroseptesis, arthroplasty)

Dental treatment indicated if bite has changed.

24
Q

What is traumatic arthritis?

A

Secondary to sudden acute macrotrauma

Depends on severity of trauma to the joint. If severe enough can cause haemarthrosis and damage to the synovial membrane with inflammatory response leading to fibrosis contractions and adhesions in the joint space with fibrous ankylosis). Minor trauma can cause dislocation of the disc.

In severe cases can cause degenerative joint disease and joint asymmetry.

25
Q

What are the clinical symptoms of traumatic arthritis?

A

Severe pain at rest and with movement

Joint tender to palpation, occassionally swollen

Decreased ROM

Posterior open bite on affected side

26
Q

What are the clinical and radiographic findings of traumatic arthritis?

A

Severe pain at rest and with movement

Joint tender to palpation occassionally swollen

Decreased ROM

Posterior open bite on affected side

Radiograph shows oedema and swelling of intracapsular and capsular structures, and late changes such as a degenerative joint disease or bony ankylosis

27
Q

How is traumatic arthritis managed?

A

Rule out mandibular fractures

Supoprtive therapy such as education and reassurance, jaw rest, habit reduction, physical therapy, and exercises at home may be useful. Stabilisation appliance is given occassionally.

Analgesia and NSAIDs

28
Q

What is Rheumatoid arthritis?

A

Chronic, systemic, slowly progressive inflammatory disease

Predominantly affects the peri-articular tissue such as the synovial membrane

Progressive destruction of articular and periarticular soft tissue.

Extra articular manifestations can form.

Bones and cartilage can slowly erode.

29
Q

What are the stages of RA?

A

Stage 1: Synovitis where synovial membrane is thickened and bones + cartilage erode

Stage 2: Pannus formation with extensive cartilage loss and exposed and pitted boney surfaes

Stage 3: Fibrous ankylosis

Stage 4 is bony ankylosis

30
Q

What causes RA?

A

Unknown aetiology

Seen in 2.5% of population

F>M

Peak onset at 40 - 60 years of age

31
Q

How common is TMJ involvement in RA patients?

A

50 - 70% of patients with RA have TMJ involvement

32
Q

What are the clinical symptoms ofTMJ RA?

A

Deep, dull aching pain in preauricular area espeially during chewing

Profile alterations

Limited range of motion

Morning stiffness (can be present)

Crepitus

Otalgia

33
Q

What labwork can allow diagnosis of RA?

A

FBC, RF, ANA, anti-CCP, ESR, and CRP

34
Q

What are the differential diagnoses for RA?

A

OA

Psoriatic arthritis

Ankylosing spondylitis

Gout

35
Q

How can RA be seen radiographically?

A

Joint space loss

Condylar flattening

Synovial proliferation and condylar destruction

36
Q

How is RA managed?

A

Medication:

Noncurative but reduce until remission:

NSAIDs

Disease modifying Anti-Rheumatoid Drugs / biologics

Corticosteroids

Dental:

Supportive therapy, monitor for occlusal changes clinically

Other:

Psych support

Surgery

Imaging

37
Q

What is juvenile idiopathic arthritis?

A

Clinically heterogeneous inflammatory joint disease of unknown aetiology in children especially female children. Onset is after 16 years of age.

Can be a systemic, polyarticular or oligoarticular disease

38
Q

How commonly is the TMJ involved in JIA?

A

80% of cases but asymptomatic in 70% of these cases

39
Q

What are the clinical manifestations of JIA?

A

Pain and TMJ tenderness

Stiffness

Decreased ROM

Joint crepitation

Otalgia

Late manifestations

Micrognathia

40
Q

What imaging modality is commonly used for JIA?

A

MRI as children would be sensitive to too much radiation from a CT

Better soft tissue resolution in MRI.

41
Q

What are the radiographic features of JIA?

A

Pannus formation

No bony change

Thinning of the articular disc

Condylar and articular eminence flattening

Diffuse articular surface flattening

42
Q

What are the goals of JIA management?

A

Early recognition

Prevention of damage

Suppressing disease

43
Q

How is JIA managed?

A

NSAIDs

DMARDs/Biologics

Corticosteroids

SAME AS RA

Dental management:

Supportive therapy

Monitor for occlusal changes

Stabilisation splint is usually utilized.

Other:

Imaging

Psychological support

Surgery

44
Q

What is psoriasis? How often does psoriasis affect joints?

A

Psoriasis is a chronic inflammatory dermatologic disease

Joints are affected in up to 30% of patients. TMJ involvement is uncommon but TMD is common in these patients

45
Q

What are the clinical features of psoriatic arthritis?

A

Unilateral sudden onset episodic clinical course

Pain and tenderness of joint and masticatory muscles

Morning stiffness

Jaw fatigue

Crepitus

Occassional painful TMJ capsule swelling

Painful mandibular movements with progressive decrease of opening

In severe cases can cause ankylosis

46
Q

Who most commonly gets ankylosing spondylitis?

A

M > F (10:1 ratio)

0.4 - 1.6% prevalence in caucasian population

20 - 30 years old

TMJ can be affected several years after onset reported that 4 - 50% have TMJ involvement

47
Q

How can infectious arthritis of the TMJ arise?

A

TB

Syphilis

Gonorrhea

Lyme disease

Actinomycosis

Spread of local odontogenic infection through spread through pterygomandibular space. (Odontogenic infections, osteomyelitis, parotid, ear, nose, throat infections)

Direct infection through trauma or joint surgery

48
Q

What risk factors increase chance of infectious arthritis?

A

RA

Diabetes mellitus

IV drug use

HIV

Immunosuppressives

49
Q

What are the clinical features of infectious arthritis?

A

Prodromal period of primary systemic disease

Join pain and tenderness

Limited ROM

50
Q

How is infectious arthritis managed?

A

Primary = treatment of infection

Secondary = supportive therapy

Important to increase range of motion of TMJ to avoid ankylosis or fibrosis.

51
Q

What is metabolic arthritis?

A

Inflammation of joint tissues due to deposition of microcrystals in synovium can be in the form of Gout or pseudogout

52
Q

Who often gets gout?

A

Possible genetic inheritance

Usually in men >40 years of age

53
Q

What is pseudogout?

A

Common disease seen in individuals with other metabolic problems such as diabetes. Seen in M = F and people >40 years of age.

54
Q

Does TMJ get affected often by metabolic arthritis?

A

Yes but rarely.

55
Q

What are the clinical findings of metabolic arthritis?

A

Restricted mouth opening

Mild pain

Joint noises

56
Q

What are the radiographic findings of metabolic arthritis?

A

Several years after onset leading to joint deposits.

Pseudogout deposits in joint more quickly

57
Q

What are the lab findings of gout?

A

Elevated serum uric acid levels

Joint fluid aspirate showing opalescent fluid and polarised light shows monosodium urate crystals on microscopy

DMD3 sem 2 (69 decks)

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