TMJ Path and Dx Flashcards
___% of patients reporting to an
orofacial pain center had pain
sources beyond the trigeminal
system
81%
___% of general population in
America experienced 1 of 5
ofofacial pain types in the past 6
months (3)
22%
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
TMD
What direction is the disc typically displaced?
Anterior and medially
- Abnormal relationship/misalignment of articular
disc and condyle. - Displacement is usually anterior or anteromedial
direction. - Pain or mandibular symptoms are not specific
for disc derangement disorders.
Articular Disc Displacement
- 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). - Reciprocal click (opening/closing click)
- Asymptomatic clicking does not require
treatment. - Also called internal derangement.
DISC DISPLACEMENT WITH
REDUCTION
Do we. need to tx asymp disc displacement with reduction?
No
HOw do we image for disc displacements?
MRI
What are the 3 Diagnostic Criteria (must be present) to dx disc displacment w reduction?
changes.
- Reproducible joint noise occurring during
opening & closing. - Soft tissue imaging reveals displaced disc
which improves its position during
opening. - Absence of extensive degenerative bone
- Disc is non-reducing or permanently
displaced. - Disc does not improve its relation with
the condyle on translation. - “closed lock”
- MRI shows no disc recapture on mouth
opening
DISC DISPLACEMENT
WITHOUT REDUCTION
- Sudden & marked limited mouth opening due
to jamming or fixation of disc . - Secondary to disc adhesion, deformation, or
dystrophy. - Pain is often present when attempting to open
mouth. - Straight line deflection to affected side on
opening.
Acute Disc displacement w/out reduction
What is the mm opening that dx disc reduction w/out reduction?
Less than 35 mm
How do you tx disc reduction w/out reduction??
Arthrocentesis + physical therapy
What are the 4 Diagnostic Criteria (must be present) to dx disc reduction w/out reduction?
- Persistent limited mouth opening <35mm with hx of sudden onset
- Deflection to affected side on mouth opening
- Marked limited laterotrusion to the contralateral side (if unilateral disorder)
- MRI reveals displaced disc without reduction. X-rays show no extensive osteoarthritic changes
- Needle is inserted into the superior joint space and lactated Ringer’s solution is used to distend joint space. Done under IV sedation.
- A second needle is then placed into the superior joint space and the TMJ is lavaged.
- During arthrocentesis, the jaw can be gently manipulated to increase range of motion since patient is sedated.
- Local anesthetic &/or steroids are injected at completion of procedure for pain management.
Arthrocentesis
- Acute closed lock with limited ROM that
does not resolve. Best success occurs if
procedure is done within 2-3 weeks
following jaw locking. - Acute pain in TMJ not responsive to
medications and conservative treatment
(i.e. splint therapy , physical therapy or
intra-articular steroid injection).
Indications for Arthrocentesis
- Allows visualization of glenoid fossa and superior aspect of disc
- Forceps, scissors, sutures, medication, needles, cautery probes, burs and shavers can be used through the arthroscope to correct problem.
- Small cannula is inserted into the superior joint space & is connected to a TV camera and video monitor
- Lasers can be used to eliminate adhesions, inflamed tissue, & incise tissue within the joint.
Arthroscopy
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
Arthroscopy indication
Inflammation of synovial lining of TMJ due to trauma or
infection
Synovitis/capsulitis
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.
Synovitis/capsulitis
- Limited mandibular opening due to pain
- Edema can cause inferior displacement of the
mandible due to swelling creating a
malocclusion. Edema is visible on MRI of TMJ. - Posterior teeth do not occlude on closing
SYNOVITIS AND CAPSULITIS
(ARTHRALGIA)
Inflammation of retrodiscal tissue
(posterior attachment)
Occurs following trauma, bruxism or wide
opening
Occurs after constant clicking or
dislocation
Constant deep pain
Retrodiscitis
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
Polyarthridites
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)
Osteoarthritis
- Chronic arthritis of non-inflammatory character
- No pain report or pain on palpation
- Coarse crepitus in TMJ during any movement
- NO radiographic degenerative changes
Osteoarthrosis
- Pain with jaw function
- Pain on TMJ palpation
- No TMJ noises
Arthralgia
