TMJ Path and Dx

Question 1

___% of patients reporting to an
orofacial pain center had pain
sources beyond the trigeminal
system

Answer 1

81%

Question 2

___% of general population in
America experienced 1 of 5
ofofacial pain types in the past 6
months (3)

Answer 2

22%

Question 3

A collective term that includes a number of clinical
problems that involve the masticatory muscles, TMJ &
associated structures:
1. Musculoskeletal Disorders
2. Articular Disc Disorders
3. Inflammatory & non-inflammatory Disorders

Answer 3

TMD

Question 4

What direction is the disc typically displaced?

Answer 4

Anterior and medially

Question 5

1. Abnormal relationship/misalignment of articular
   disc and condyle.
2. Displacement is usually anterior or anteromedial
   direction.
3. Pain or mandibular symptoms are not specific
   for disc derangement disorders.

Answer 5

Articular Disc Displacement

Question 6

1. From a closed mouth position, the “temporarily”
   misaligned disc reduces or improves its
   structural relation with the condyle during
   translation resulting in a joint noise (clicking or
   popping).
2. Reciprocal click (opening/closing click)
3. Asymptomatic clicking does not require
   treatment.
4. Also called internal derangement.

Answer 6

DISC DISPLACEMENT WITH
REDUCTION

Question 7

Do we. need to tx asymp disc displacement with reduction?

Answer 7

No

Question 8

HOw do we image for disc displacements?

Answer 8

MRI

Question 9

What are the 3 Diagnostic Criteria (must be present) to dx disc displacment w reduction?

changes.

Answer 9

1. Reproducible joint noise occurring during
   opening & closing.
2. Soft tissue imaging reveals displaced disc
   which improves its position during
   opening.
3. Absence of extensive degenerative bone

Question 10

1. Disc is non-reducing or permanently
   displaced.
2. Disc does not improve its relation with
   the condyle on translation.
3. “closed lock”
4. MRI shows no disc recapture on mouth
   opening

Answer 10

DISC DISPLACEMENT
WITHOUT REDUCTION

Question 11

1. Sudden & marked limited mouth opening due
   to jamming or fixation of disc .
2. Secondary to disc adhesion, deformation, or
   dystrophy.
3. Pain is often present when attempting to open
   mouth.
4. Straight line deflection to affected side on
   opening.

Answer 11

Acute Disc displacement w/out reduction

Question 12

What is the mm opening that dx disc reduction w/out reduction?

Answer 12

Less than 35 mm

Question 13

How do you tx disc reduction w/out reduction??

Answer 13

Arthrocentesis + physical therapy

Question 14

 What are the 4 Diagnostic Criteria (must be present) to dx disc reduction w/out reduction?

Answer 14

1. Persistent limited mouth opening <35mm with hx of sudden onset
2. Deflection to affected side on mouth opening
3. Marked limited laterotrusion to the contralateral side (if unilateral disorder)
4. MRI reveals displaced disc without reduction. X-rays show no extensive osteoarthritic changes

Question 15

1. Needle is inserted into the superior joint space and lactated Ringer’s solution is used to distend joint space. Done under IV sedation.
2. A second needle is then placed into the superior joint space and the TMJ is lavaged.
3. During arthrocentesis, the jaw can be gently manipulated to increase range of motion since patient is sedated.
4. Local anesthetic &/or steroids are injected at completion of procedure for pain management.

Answer 15

Arthrocentesis

Question 16

1. Acute closed lock with limited ROM that
   does not resolve. Best success occurs if
   procedure is done within 2-3 weeks
   following jaw locking.
2. Acute pain in TMJ not responsive to
   medications and conservative treatment
   (i.e. splint therapy , physical therapy or
   intra-articular steroid injection).

Answer 16

Indications for Arthrocentesis

Question 17

1. Allows visualization of glenoid fossa and superior aspect of disc
2. Forceps, scissors, sutures, medication, needles, cautery probes, burs and shavers can be used through the arthroscope to correct problem.
3. Small cannula is inserted into the superior joint space & is connected to a TV camera and video monitor
4. Lasers can be used to eliminate adhesions, inflamed tissue, & incise tissue within the joint.

Answer 17

Arthroscopy

Question 18

Indications for _____:
1. Chronic TMJ pain with limited range of opening that
has failed to respond to conservative treatment or
arthrocentesis
2. Always re-evaluate patient prior to

Answer 18

Arthroscopy indication

Question 19

Inflammation of synovial lining of TMJ due to trauma or
infection

Answer 19

Synovitis/capsulitis

Question 20

Diagnostic Criteria (must be present) for _____
1. Localized TMJ pain exacerbated by function (esp.
posterior or superior loading)
2. No extensive osteoarthritic changes seen on x-rays.

Answer 20

Synovitis/capsulitis

Question 21

1. Limited mandibular opening due to pain
2. Edema can cause inferior displacement of the
   mandible due to swelling creating a
   malocclusion. Edema is visible on MRI of TMJ.
3. Posterior teeth do not occlude on closing

Answer 21

SYNOVITIS AND CAPSULITIS
(ARTHRALGIA)

Question 22

Inflammation of retrodiscal tissue
(posterior attachment)
Occurs following trauma, bruxism or wide
opening
Occurs after constant clicking or
dislocation
Constant deep pain

Answer 22

Retrodiscitis

Question 23

 Must be present to DX:
1. Pain with jaw function
2. Point tenderness on TMJ palpation
3. Limited range of motion secondary to pain
4. Radiographic evidence of extensive TMJ changes

Answer 23

Polyarthridites

Question 24

 Primary: All of the following must be present:
1. No other identifiable etiological factor
2. Pain with jaw function & movement
3. Point tenderness on TMJ palpation
4. Radiographic evidence of structural bony change (not as
extensive as seen in inflammatory arthritis)

Answer 24

Osteoarthritis

Question 25

1. Chronic arthritis of non-inflammatory character
2. No pain report or pain on palpation
3. Coarse crepitus in TMJ during any movement
4. NO radiographic degenerative changes

Answer 25

Osteoarthrosis

Question 26

1. Pain with jaw function
2. Pain on TMJ palpation
3. No TMJ noises

Answer 26

Arthralgia