TMJ/Facial Pain Flashcards
What type of cartilage makes up the TMJ?
A. type 1 and 2
B. type 2 and 3
C. type 3 and 4
D. type 4 and 5
A. type 1 and 2
TMJ disc is composed of dense fibrous connective tissue that is avascular, aneural, alymphatic. It is comprised of type 1 and 2 cartilage.
Type I collagen is the main structural protein found in fibrocartilage, and it provides strength and durability to the TMJ disc, allowing it to withstand the compressive forces generated during chewing and other jaw movements.
Type II collagen is typically found in hyaline cartilage (such as in the articular cartilage of joints), but it is not the dominant type in the TMJ disc.
Type III collagen is often present in connective tissues and is involved in the elasticity of tissues, but is not a major component of the TMJ disc.
What structures are comprised of the remnants of Meckel’s cartilage?
The sphenomandibular ligament, the incus, and the malleus
The presence of what cell type causes increased TMJ pain in female patients?
A. Fibroblasts
B. Mast Cells
C. Neutrophils
D. Macrophages
B. Mast Cells
Mast cells play a significant role in inflammation and pain. They release various mediators such as histamine, prostaglandins, and cytokines, which can cause vasodilation, increased vascular permeability, and sensitization of nerve endings, contributing to pain and inflammation in the TMJ.
Studies have shown that there is a higher presence of mast cells in the synovial tissues of the TMJ, especially in patients with TMJ disorders, and this is thought to contribute to increased pain sensitivity in certain individuals, including a higher prevalence in female patients.
Raghavendra et al. (2015)
Zeng et al. (2013)
What is the mechanism of action of sodium hyaluronate when injected in the TMJ?
A. Anti inflammatory
B. Increases viscoelasticity
C. Analgesia
D. Palliative therapy
B. Increases viscoelasticity
Why are TMJ prosthetic infections so difficult to treat?
A. Antibiotics cannot penetrate the biofilm
B. Bacteria in the biofilm proliferate too quickly
C. The biofilm dissolves over 4-6 months
D. The bacteria in a biofilm exhibit higher resistance to antibiotics
A. antibiotics cannot penetrate the biofilm
What are the characteristics of C fibers?
A. myelinated, small diameter, fast conducting
B. unmyelinated, small diameter, slow conducting
C. myelinated, large diameter, fast conducting
D. unmyelinated, large diameter, slow conducting
B. unmyelinated, small diameter, slow conducting
Unmyelinated: C fibers lack myelin sheaths, which makes them slower in transmitting electrical impulses compared to myelinated fibers (such as A fibers).
Diameter and Conduction Velocity: C fibers are the smallest in diameter among sensory nerve fibers and have the slowest conduction velocity. This slow conduction contributes to their role in transmitting dull, aching pain and temperature sensations.
Function: C fibers are primarily involved in the transmission of nociceptive (pain) signals, temperature sensations, and some autonomic functions. They are associated with chronic pain and inflammatory pain.
Treacher Collins Syndrome is not associated with which of the following?
A. Autosomal dominant inheritance
B. Convex facial profile
C. Hypoplasia of the ears, mandible, maxilla, cranial nerves, and soft tissues
D. Coronal synostosis
D. Coronal synostosis
Treacher Collins is not associated with coronal synostosis. Crouzon syndrome is associated with coronal synostosis.
Which branchial arches are affected in hemifacial microsomia?
A. 1 and 2
B. 2 and 3
C. 3 and 4
D. 4 and 5
A. 1 and 2
Hemifacial microsomia (HFM) is one of the syndromes within the oculi-auriculo-vertebral spectrum. It’s a craniofacial malformation resulting from defects in branchial arches 1 and 2. There can be unilateral or bilateral asymmetries that result in hypoplasia of the orbits, maxilla, mandible, ear, cranial nerves, and facial soft tissues.
Moderate to severe hypoplasia of the glenoid fossa with no functional articulation between the fossa and condyle is indicative of what Kaban classification?
A. I
B. IIA
C. IIB
D. III
C. IIB
Kaban I - Generalized mild hypoplasia of the condyle/ramus unit, glenoid fossa, and muscles of mastication. TMJ: normal rotation, restricted translation
Kaban IIA - Condylar head hypoplastic and cone shaped, displaced anteromedially. Hypoplastic glenoid fossa. Hypoplasia of 1+ muscles of mastication. Acceptable TMJ function.
Kaban IIB - Moderate - severe hypoplasia of the glenoid fossa and condyle/ramus unit. No functional articulation between the fossa and condyle - limited ROM. Retrognathia with anterior open bite. Hard stop with jaw manipulation between posterior condyle and posterior slope of fossa
Kaban III - No ramus or condyle present - no posterior stops with jaw manipulation.
What subnucleus of the trigeminal brainstem nucleus complex is primarily involved in the receiving and
processing of facial pain?
A. Subnucleus interpolaris of cranial nerve V.
B. Subnucleus caudalis of cranial nerve IX.
C. Subnucleus caudalis of cranial nerve V.
D. Subnucleus oralis of cranial nerve V.
C. Subnucleus caudalis of cranial nerve V.
The “subnucleus oralis” is the upper part of the spinal trigeminal nucleus, primarily responsible for transmitting fine touch sensations from the face, while the “subnucleus caudalis” is the lower part of the same nucleus, primarily responsible for processing pain and temperature sensations from the face; essentially, “oralis” handles discriminative touch, while “caudalis” handles nociception and thermal sensations
Syncope associated with glossopharyngeal neuralgia is thought to result from which of the
following?
A. Severe paroxysmal pain
B. Bradycardia or asystole
C. Reflex tachycardia
D. Styloid process nerve impingement
B. Bradycardia or asystole
Syncope is associated with glossopharyngeal neuralgia in up to 2% of individuals with the condition. Although not definitively proven, this is thought to result from sudden bradycardia, and in some cases asystole. Severe paroxysmal pain may occur with other facial pain syndromes, but has not been associated with syncope. Reflex tachycardia, styloid process impingement on the glossopharyngeal nerve, and carotid sinus hypersensitivity have not been associated with glossopharyngeal neuralgia
Increased bruxism may be seen in which of the following classes of drugs?
A. Tricyclic antidepressants
B. Benzodiazepines
C. Selective serotonin reuptake inhibitors
D. Monoamine oxidase inhibitors
C. Selective serotonin reuptake inhibitors
Increased bruxism is most commonly associated with the use of selective serotonin reuptake inhibitors (SSRIs). Several studies have documented this association. For instance, a study by Revet et al. found a significant association between SSRIs and bruxism, with a high reporting odds ratio (ROR) for bruxism among users of SSRIs
What neurotransmitter is most closely associated with pain transmission?
A. Glutamine
B. Glutamate
C. Acetylcholine
D. Substance P
B. Glutamate
The neurotransmitter most closely associated with pain transmission is glutamate. Glutamate is the principal excitatory neurotransmitter in the nervous system and plays a critical role in nociceptive signaling, including both acute and chronic pain pathways.
Substance P is also involved in pain transmission, particularly in the modulation of pain and the development of chronic pain states, but it is not the primary neurotransmitter for pain transmission.
The mechanism of action of the sumatriptan (Imitrex) in the management of migraine headache is:
A. Inhibition of pre-synaptic serotonin receptors.
B. Inhibition of cerebral vessel and dural pain fibers.
C. Down regulation of pain fibers by inhibition of Substance-P re-uptake.
D. Inhibition of the vasoconstrictor phase of migraine headache.
B. Inhibition of cerebral vessel and dural pain fibers
The mechanism of action of sumatriptan (Imitrex) in the management of migraine headache is B. inhibition of cerebral vessel and dural pain fibers. Sumatriptan is a selective agonist for the 5-HT1B/1D receptors, which are located on intracranial blood vessels and sensory nerves of the trigeminal system. Activation of these receptors results in cranial vessel constriction and inhibition of pro-inflammatory neuropeptide release, which correlates with the relief of migraine headache
Which of the following cytokines may predict successful treatment by arthrocentesis when found
in TMJ synovial fluid from joints with chronic closed lock?
A. Tumor necrosis factor alpha (TNF-a)
B. Interleukin 1 (IL-1)
C. Interleukin 6 (IL-6)
D. Interleukin 10 (IL-10)
D. Interleukin 10
The presence of IL-10 in the aspirated synovial fluid was significantly associated with a successful outcome of TMJ irrigation in patients with chronic closed lock.[1] This suggests that IL-10, which has anti-inflammatory properties, may play a role in predicting positive treatment outcomes in these cases.
TNFa, IL1, IL6 are proinflammatory cytokines released from macrophages and IL-10 is a macrophage inhibitor, thus its presence is an indicator that the TMJ has healed after arthrocentesis. MMP-2, MMP-3 MMP-9 are found in the lavage of osteoarthritis.
The amount of joint effusion is known to correlate with the severity of synovitis detected at arthroscopic surgery in patients with internal derangement. Biochemical analysis of effusion fluid in both internal derangement and osteoarthrosis contains higher concentrations of total protein and proinflammatory cytokines IL-6 and IL-8 than does synovial fluid from joints without effusion, strongly suggesting that effusion fluid is released from inflamed synovial tissue.
