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MFDS > TMJ/masticatory system > Flashcards

TMJ/masticatory system Flashcards

1
Q

What is TMJ?

A

It is a unique joint that contains 2 joint spaces separated by a fibrocartilage disc.
The non articulate surfaces are lined by a synovial membrane which produces synovial fluid that lubricates the joint.

The joint is supported by ligaments which surround the joint capsule.

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2
Q

Describe the condyle?

A

Articulating surface covered by thin layer of fibrocartilage, lateral ptyergoid attaches below ridge running medial laterally on anterior surface of condyle.

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3
Q

Describe the glenoid fossa?

A

Found on the interior surface of the squamous temporal bone where fossa is covered by thin layer of fibrocartilage

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4
Q

Describe the inter articular disc?

A

Biconcave sheet of vascular fibrous CT which divides the joint space into superior and inferior joint space.
It blend with margins of lateral ptyergoid muscle anteriorly and posteriorly attached to bilaminar zone which consist of loose CT and contains nerves lined by synovial membrane

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5
Q

Describe the capsule

A

Thin fibrous CT attached to articulate eminence of the fossa, articulate disc and neck of the mandibular condyle. The disc attached to it medial and laterally.
The lateral aspect are thickened by the TMJ ligament

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6
Q

Describe the retrodiscal tissue

A

The tissue is vascular and highly innervated which is the major contributor to pain of TMD partially when there is inflammation or compression of the joint

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7
Q

Describe the TMJ ligaments

A

The lateral ligament lies lateral to the TMJ and runs from the root of the zygomatic to the posterior aspect of condylar neck. It limits anterior posterior joint movement.
The sphenomandibular and stylomandibular ligaments also limit movement.

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8
Q

What is the TMJs bloody supply?

A

Deep auricular artery - branch of maxillary artery

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9
Q

What is the TMJs nerve supply?

A

Auriculotemporal, masseteric and posterior temporal nerves

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10
Q

What muscle is responsible for protrusion of mandible?

A

Lateral pterygoid

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11
Q

What muscles are responsible for retraction of mandible?

A

Geniohyoid and digastric muscles

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12
Q

What muscles are responsible for depression of mandible?

A

Digastric, geniohyoid and mylohyoid muscles along with gravity

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13
Q

What muscles are responsible for elevation?

A

Temporalis, masseter and medial pterygoid muscles

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14
Q

What is the prevalence of TMJD?

A

10-30% of individuals but only 15% seek help

3rd most common chronic pain syndrome

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15
Q

What are the 3 categories of TMJD?

A

Arthritis

  • inflammatory pathology
  • RA

Arthrosis

  • non inflammatory, mechanical derangement or degenerative diseases
  • normal wear and tear

Musculoskeletal
- most common due to inflammation of masticatory muscles

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16
Q

What is the aetiology of TMJD?

A 
Inflammation secondary to parafunctional 
Trauma\
Stress
Psychogenic
Occlusal abnormalities
17
Q

What are the presenting signs and symptoms of TMJD?

A 
Limited opening or trismus 
Clicking/joint noises
Crepitus (arthritis changes) 
Jaw locking 
Headaches
Preauricular pain 
Muscle/joint or ear ache
18
Q

What are the management options for TMJD?

A

Reassurance

Conservative advice

  • limiting jaw opening
  • soft diet and small pieces
  • no wide opening and support yawning
  • no chewing gum/pens
  • stopping parafunctional habits
  • masticate bilaterally

Stress management

  • relaxation
  • CBT
  • mindfullness
  • exercise/massage

Physio therapy

  • Acupuncture
  • muscle manipulation

Pharmacotherapy

  • NSAIDs
  • diazepam
  • antidepressants

Splint therapy

  • full coverage splints
  • soft splints
  • stabilisation Michigan upper splint

Surgery

  • arthrocentesis: flush out joint to break down adhesions
  • arthroscopy - remove adhesions
  • arthroplasty or joint replacement

Secondary care referral with multiple unsuccessful testaments

19
Q

What is internal derangement of TMJ?

A

It is lack of coordinate movement between condyle and articulate disc as the condyle overcomes mechanical obstruction before full movement is achieved which caused clicking and possible jaw locking

20
Q

What is temporal arteritis?

A

It is a form of vasculitis where the temporal arteries that supply blood to scalp become inflamed and constricted.
It is a multifactorial condition caused by jaw claudication as muscle ischaemia causes reduced arterial blood flow.

21
Q

What are the red flag symptoms for temporal arteritis?

A 
Cranial nerves dysfunction 
Severe weight loss
Very sudden increase in pain 
Usually older >50yr patients with new onset of headaches
Near absolute trismus 
Scalp tenderness
22
Q

What is the management of temporal arteritis?

A

Urgent referral for US scan, biopsy and steroid treatment due to possibility of blindness or stroke.

23
Q

What is the difference between disc displacement with and without reduction?

A

Disc displacement + reduction
- click +/- signs and symptoms of TMD

Disc displacement - reduction
- limited opening or without limited opening

24
Q

A 58yr old female Pt complains of a dull, throbbing pain on right side of her face. When she removes glasses, she reports tenderness on the right side.
Haematological investigation reveals the ESR is 81mm/hr. what is the likely diagnosis?

A

Giant cell arteritis (temporal arteritis) due to increase in ESR

25
Q

What limits the movement protecting the TMJ?

A

Ligaments pertaining to the joint limit movement

- stylomandibular, sphenomandibular, pterygomandibular ligaments

26
Q

What do the periodontal mechanoreceptors do?

A

They influence the shape of posselt’s envelope.

They also evaluate intensity and direction of stress back to MoM

27
Q

What should the SDA have?

A

At least 10 pairs of occluding teeth

28
Q

What are the suprahyoid muscles?

A

Digastric
Mylohyoid
Geniohyoid
Stylohyoid

29
Q

What are The infrahyoid muscles?

A

Thyrohyoid
Sternohyoid
Omohyoid
Sternothyroid

30
Q

A patient had osteophytes and crepitus in TMJ. What is the likely cause?

A

Osteoarthritis/osteoarthrosis

31
Q

In dentate Pts with minimal toothwear and in class I molar and incisal relationship, what tooth position is generally 0.5-1mm posterior to ICP?

A

Retruded contract position

- when mandibular condylar head is in its most superior, posterior position.

32
Q

What best describes a mutually protected occlusion?

A

Working side contacts and posterior disclusion in protrusion.

33
Q

How would you describe an occlusal contact on the opposite side to lateral excursive movements of the mandible?

A

Non working side interference

34
Q

What is another name for the arc of movement when the condyle is rearmost and upper most in the glenoid fossa?

A

Terminal hinge axis

- Arc of closure when the condyle is in its most superior posterior position

35
Q

What muscle differentiates the sublingual and submandibular tissue spaces?

A

Mylohyoid

36
Q

What best describes the role of the masticatory muscles?

A

To primarily direct movement of the TMJ

37
Q

What is the name of the side to which the mandible moves on lateral excursions?

A

Working side

38
Q

What is the role of the lateral pterygoid muscle?

A

Protrusive movement and opening of the mandible

MFDS (37 decks)

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