Tmj Disoreders Flashcards
How to treat the chronic form of arthritis ?
Depend in reason and changes in joint
What’s osteoarthritis causes ?
Microtrauma ( bruxism)
Disk displacement without reduction
Excessive load on tmj lead to flatten joint and bone degeneration , then sclerosis , bone cysts , osteophytes and inflammation
What crepitis ?
Due to horn and worn through the disk cause bone to graft on bone = clicking sounds
What’s osteoarthritis symptoms ?
Stiffness and pain during activity , tender on plapaltion , grating , bilateral
Osteoarthritis x ray and CT , MRI ?
Flatting , lipping condyle .
Narrow and irregular joint space
Osteophytes
MRI , subchondral sclerosis , opaque
What’s osteoarthritis treatment ?
Converstive
NSAIDs , soft diet , rest , occlusal splint , myo facial pain treatment
Intraarticular steroids, doxycycline
Advanced stages , arthropoasty to remove osteophytes and erosion areas
What’s osteoarthrosis ?
Structural changes of joint surface SECONDRY to excessive remodeling mechanism
Without arthlagia
Neoarthrosis main symptoms ?
Limit transverse movement
Facial asymmetry
Facial malformations and underdevelopment
In which cases there is X-ray changes in traumatic acute arthritis ?
. X-ray results are negative
except when intra-articular edema or hemorrhage widens the joint space.
Acute arthritis treatment ?
Motion restriction
Physiotherapy
Heat
NSAID
Antibiotics , painkillers
Hydration
X ray changes in chronic arthritis ?
Wide joint space
Unequal joint spaces expansion
Infection arthritis ?
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.
Joint inflammation signs ?
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.
Inflamed joint diagnosis aids ?
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.
Chronic arthritis symptoms ?
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
What’s joint related and non joint related arthrosis symptoms ?
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
What’s TMJ arthrosis ?
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.
What’s osteoarthrosis ?
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
Osteoarthrosis possible outcomes ?
a) neoarthrosis b) secondary degenerative osteoarthrosis c) ankylosis * bone ankylosis * fibrous ankylosis
What’s Secondary degenerative arthritis ?
This type of arthritis usually develops after trauma or in people with persistent myofascial pain syndrome
What helps in distinguishing secondary degenerative arthritis from osteoarthritis?
Unilateral joint involvement.
Secondary degenerative arthritis diagnosis ?
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.
Children with ankylosis have multiple functional disorders:
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
Unilateral ankylosis complications in children may result in ?
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).
Ankylosis in adults complications ?
limited jaw opening and decreased translation
What’s the common cause of ankylosis ?
Trauma
1. It is hypothesized that the formation of an intra-articular hematoma with subsequent scarring and new bone formation is the common precipitant.
- medially displaced fracture dislocation of the condyle is found.
How tmj get infected then ankylosis ?
- most commonly the result of contiguous spread from an odontogenic infection, otitis media, or mastoiditis
- Hematogenous spread of infection :: tuberculosis, gonorrhea, and scarlet fever.
After which surgeries ankylosis developed ?
- sequela of the treatment of head and neck malignancies 2. after intracranial
- secondary to neurosurgical procedures performed through the temporal bone requiring an incision of the temporalis muscle 4.
Which maxillofacail surgeries lead to ankylosis ?
- 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
Which surgery used to treat ankylosis and its complications?
**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
What’s prober treatment for ankylosis ?
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.
Longstanding ankylosis frequently results in ?
muscle fibrosis and coronoid hyperplasia
What Complications Associated with Treatment of ankylosis ?
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
