Tmj Disoreders

Question 1

How to treat the chronic form of arthritis ?

Answer 1

Depend in reason and changes in joint

Question 2

What’s osteoarthritis causes ?

Answer 2

Microtrauma ( bruxism)
Disk displacement without reduction

Excessive load on tmj lead to flatten joint and bone degeneration , then sclerosis , bone cysts , osteophytes and inflammation

Question 3

What crepitis ?

Answer 3

Due to horn and worn through the disk cause bone to graft on bone = clicking sounds

Question 4

What’s osteoarthritis symptoms ?

Answer 4

Stiffness and pain during activity , tender on plapaltion , grating , bilateral

Question 5

Osteoarthritis x ray and CT , MRI ?

Answer 5

Flatting , lipping condyle .
Narrow and irregular joint space
Osteophytes

MRI , subchondral sclerosis , opaque

Question 6

What’s osteoarthritis treatment ?

Answer 6

Converstive
NSAIDs , soft diet , rest , occlusal splint , myo facial pain treatment
Intraarticular steroids, doxycycline

Advanced stages , arthropoasty to remove osteophytes and erosion areas

Question 7

What’s osteoarthrosis ?

Answer 7

Structural changes of joint surface SECONDRY to excessive remodeling mechanism

Without arthlagia

Question 8

Neoarthrosis main symptoms ?

Answer 8

Limit transverse movement
Facial asymmetry
Facial malformations and underdevelopment

Question 9

In which cases there is X-ray changes in traumatic acute arthritis ?

Answer 9

. X-ray results are negative

except when intra-articular edema or hemorrhage widens the joint space.

Question 10

Acute arthritis treatment ?

Answer 10

Motion restriction
Physiotherapy
Heat
NSAID
Antibiotics , painkillers
Hydration

Question 11

X ray changes in chronic arthritis ?

Answer 11

Wide joint space
Unequal joint spaces expansion

Question 12

Infection arthritis ?

Answer 12

Infection of the TMJ may result from direct extension of adjacent infection or hematogenous spread of bloodborne organisms.
The child complains of the edema and pain in the parotid area with the irradiation into the ear and occiput, limited lower jaw movement, rise of temperature.

Question 13

Joint inflammation signs ?

Answer 13

Clinically the area is inflamed, asymmetry of the face is present due to edema of the soft tissues of parotid area
jaw movement is limited.
The mouth opening is painful and limited.
The lower jaw is shifted towards the affected side.

Question 14

Inflamed joint diagnosis aids ?

Answer 14

X-ray results are negative in the early stages .
If suppurative arthritis is, the joint is aspirated to confirm the diagnosis and to identify the causative organism.
Diagnosis must be made rapidly to prevent permanent joint damage.

Question 15

Chronic arthritis symptoms ?

Answer 15


Typical complaints: “crunch” during mouth opening,

ear noise (tinnitus), poor hearing,

morning limitation of movements and moderate pain, which increases during eating, 
headache, 
dizziness, 

 sometimes – dryness in the mouth/burning of the tounge, long-lasting course of the disease. 
Clinical picture: painful joint and tragus palpation, increasing of the pain during pressing of the mental region. 

X-ray picture: unequal expantion and widening of the joint space between surfaces

Question 16

What’s joint related and non joint related arthrosis symptoms ?

Answer 16

Joint related: movements limitation, rapid fatigability during eating. “Started pain” appears after rest period.

Non-joint related: unilateral microgenia which increases with time, clearly seen on X-ray

Question 17

What’s TMJ arthrosis ?

Answer 17

primary chronic inflammation of the joints of degenerative genesis with primary deformation and deconstruction of the joint cartilage and with following reactive degenerative processes of the joint surfaces.

results in chrondromalacia because of constant inflammation In children arthrosis is the continuation of the long-lasting and untreated arthritis and doctors have the deal with arthritoarthrosis.

Question 18

What’s osteoarthrosis ?

Answer 18

noninflammatory articular disorders of the TMJ, the most common are often idiopathic.

Osteoarthrosis can manifest as chondromalacia (softening of the cartilage), degenerative changes within bone and cartilage often with osteophyte formation and
remodeling,
fibrosis, or any combination of these.

Noninflammatory articular disorders may also be secondary to trauma, infection, previous surgery, crystal deposition disorders (gout and pseudogout), avascular necrosis, or structural damage to joint cartilage resulting in disk displacement and/or perforation

Question 19

Osteoarthrosis possible outcomes ?


Answer 19

a) neoarthrosis
 b) secondary degenerative osteoarthrosis
 c) ankylosis
 * bone ankylosis
 * fibrous ankylosis

Question 20

What’s Secondary degenerative arthritis ?

Answer 20


 This type of arthritis usually develops after trauma or in people with persistent myofascial pain syndrome

Question 21

What helps in distinguishing secondary degenerative arthritis from osteoarthritis?

Answer 21

Unilateral joint involvement.

Question 22

Secondary degenerative arthritis diagnosis ?


Answer 22

limited opening of the mouth, unilateral pain during jaw movement, joint tenderness, and crepitus.

Diagnosis is based on x-rays, condylar flattening, lipping, spurring, or erosion.

Question 23

Children with ankylosis have multiple functional disorders:


Answer 23


1. mental state is deteriorating 
2. Oral hygiene Is bad because of inability to clean oral side of teeth 
3. phonetic and sounds pronunciation problem,speech problems
4. breathing problems
5. malocclusion .
6. facial symmetry and facial proportions deformation
7. feeding problems because of inability to process food

Question 24

Unilateral ankylosis complications in children may result in ?

Answer 24

significant problems with lower facial symmetry.
A shortened ramus on the affected .
unilateral mandibular growth disturbances have secondary effects on the maxillary occlusal plane and midfacial structures (pyriform rims and bony orbits).

Question 25

Ankylosis in adults complications ?

Answer 25

limited jaw opening and decreased translation

Question 26

What’s the common cause of ankylosis ?

Answer 26

Trauma
1. It is hypothesized that the formation of an intra-articular hematoma with subsequent scarring and new bone formation is the common precipitant.

2. medially displaced fracture dislocation of the condyle is found.

Question 27

How tmj get infected then ankylosis ?

Answer 27

1. most commonly the result of contiguous spread from an odontogenic infection, otitis media, or mastoiditis
2. Hematogenous spread of infection :: tuberculosis, gonorrhea, and scarlet fever. 


Question 28

After which surgeries ankylosis developed ?

Answer 28

1. sequela of the treatment of head and neck malignancies 
 2. after intracranial
2. secondary to neurosurgical procedures performed through the temporal bone requiring an incision of the temporalis muscle
4.

Question 29

Which maxillofacail surgeries lead to ankylosis ?

Answer 29

1. orthognathic (associated with the bilateral sagittal split osteotomy)

postoperative limited opening has been commonly attributed to muscle atrophy and soft tissue scar formation.
Atrophic muscular changes seem to be exacerbated by prolonged use of maxillomandibular fixation

Question 30

Which surgery used to treat ankylosis and its complications?

Answer 30

**The gap arthroplasty

creates a new area of articulation distal to the fused TMJ and ankylotic segment.

the creation of a pseudoarticulation significantly shortens the ramus height
the procedure is associated with a high degree of reported reankylosis.

Development of postoperative malocclusion
decreased range of motion are the most common problems associated with this procedure as reported .

Because of these limitations, the use of the gap arthroplasty to treat ankylosis has been largely abandoned

Question 31

What’s prober treatment for ankylosis ?

Answer 31

requires excision of the involved structures and immediate reconstruction.

TMJ ankylosis is more commonly treated with complete excision of the ankylotic mass and, if required, by subsequent joint reconstruction.

Question 32

Longstanding ankylosis frequently results in ?

Answer 32

muscle fibrosis and coronoid hyperplasia

Question 33

What Complications Associated with Treatment of ankylosis ?

Answer 33

development of an auralTMJ fistula if the tympanic plate is displaced posteriorly

stenosis of the external auditory meatus and subsequent hearing impairment may follow tympanic plate displacement

Recurrent ankylosis may result from inadequate initial treatment.

Peripheral nerve injuries are possible sequelae of all TMJ operations, with the upper branches of the facial nerve being the most vulnerable.

Parotid gland injury with subsequent sialocele and fistula formation has also been reported

costochondral graft growth pattern can be unpredictable. Linear overgrowth with the subsequent development of asymmetry and malocclusion can take place