TMJ Pathology and Diagnosis Flashcards
1
Q
what are the congenital and developmental disorders
A
- aplasia
- hypoplasia
- hyperplasia
- neoplasia
2
Q
what is aplasia
A
faulty or incomplete development of the cranial bones or mandible
3
Q
what is the most common developmental defect
A
lack of condylar growth
4
Q
aplasia can be ___ or _____
A
unilateral or bilateral
5
Q
what is often affected in aplasia
A
auditory apparatus
6
Q
is aplasia more severe than hypoplasia
A
yes
7
Q
what may occur with aplasia
A
occlusal shift and deviation on opening
- rare
8
Q
what is the tx of condylar aplasia
A
- osteoplasty
- correction of malocclusion
- other surgical treatment possible depending on function and esthetics
9
Q
what is hypoplasia
A
- incomplete development/underdevelopment of the cranial bones or the mandible
- growth is normal but proportionately reduced and less severe than in aplasia
10
Q
what type of condition is hypoplasia
A
congenital or acquired (Treacher-Collins)
11
Q
condylar hypoplasia can be secondary to:
A
trauma such as a fracture
12
Q
what are the facial features in treacher collins syndrome: mandibular dysostosis
A
- downward slanting eyes
- notched lower eyelids
- underdeveloped midface
- deafness
13
Q
mandibular hypoplasia (retrognathia) is a high risk for:
A
obstructive sleep apnea
14
Q
condylar hypoplasia is ___ or ____
A
unilateral or bilateral
15
Q
describe the congenital condylar hypoplasia
A
- idiopathic
- early onset
16
Q
describe the acquired condylar hypoplasia
A
- forceps deliveries
- trauma especially after jaw fracture
- radiation
- infection
- circulatory disorder
- endocrine disorders
17
Q
in condylar hyoplasia growth is normal but:
A
proportionately reduced and less severe than in aplasia
18
Q
condylar hypoplasia can be secondary to:
A
trauma
19
Q
what are the clinical symptoms of condylar hypoplasia if unilateral
A
- facial asymmetry
- limitation of lateral excursion
- mandibular midline shift
20
Q
describe hyperplasia
A
- overdevelopment of cranial bones or mandible
- congenital or acquired
- non neoplastic increase in the number of normal cells
- localized: condylar hyperplasia
21
Q
what is manidbular prognathism
A
- excessive size of mandible causing protrusion of chin but normal condyle size, shape, and function
22
Q
what is the tx for hyperplasia
A
- LeForte I Osteotomy
- Bilateral Sagittal Osteotomy
- Chin Augmentaiton
23
Q
in condylay hyperplasia if unilateral growth it will cause:
A
- a progressive crossbite on the contralateral side
- open bite in adults
24
Q
what are the treatments for condylar hyperplasia
A
- leave alone
- wait until after mandibular growth is completed
- orthognathic surgery and possible osteotomy of enlarged condyle
- orthodontics
- symptomatic care
25
coronoid impingement may result from:
benign overgrowth of the coronoid process
26
coronoid hyperplasia may result in:
limited jaw opening
27
coronoid hyperplasia is visible on:
panorex, CBCT, MDCT, or MRI
28
what is neoplasia
- benign, malignant or metastatic from a distant site
- uncontrolled growth of abnormal tissue
- rare as an underlying cause of TMD
29
_____ of malignant neoplasias (breast, prostate, lung cancers) metastasize to the mandible
1%
30
neoplasia can affect:
condyle (osteoma, fibrous dysplasia, chondrosarcoma, benign giant cell tumor)
31
when do osteochondromas occur
in young adults (30 y/o) but also appear during middle age or later (greater than or equal to 50 yo)
32
what bones are susceptible to single or multiple osteochondritic lesions
bones that form from a cartilage anlagen
33
when do osteochondromas present
remains asymptomatic until they become large enough to interfere with mandibular function or cause a shift in the midline and malocclusion
34
neoplasia is rare in _____ but more common in ______
condyle;ramus
35
describe benign neoplasias
does not usually destroy bony margins
36
describe malignant neoplasias
usually destroys bony margins - examine cortical outline of mandible on pano
37
what carcinomas should be considered with neoplasias
parotid and regional carcinomas
38
what are hypermobility disorders
- 2 typs
- the disc-condyle complex is positioned anterior to the articular eminence and is unable to return to a closed position without a specific maneuver by the patient or by the clinician
39
what is subluxation
- partial or incomplete condylar dislocation during wide mouth opening but the patient can close voluntarily
- usually accompanies by a joint sound (soft pop or click)
- may result from anatomical diffrence, habit or trauma
40
how is subluxation diagnosed
- normal translation beyond eminence which does not lead to open lock (luxation) and condyle can return to mandibular fossa voluntarily
- soft pop at maximum opening
- deviation to opposite side (if unilateral)
- excessive translation on opening (max opening in >60mm)
41
what is the tx for subluxation
- retruded opening exercises
- control yawn with hand under chin; avoid bid macs, cut up apples and fruits into small pieces
- avoid prolonged mouth opening at dental appt - this can cause an open lock
- manage muscle hyperactivity
- eminectomy (surgical reduction of articular eminence if steep)
42
what is another name for the dislocation of condyle
luxation, open lock
43
describe the dislocation of the condyle
- condyle is forcibly moved beyond the articular eminence
- unable to return to a closed position voluntarily
- may be caused by yawning, dental appt, or truama
- sudden open lock of jaw
44
how is luxation, open lock (dislocation of condyle) diagnosed
- inability to close the mouth without a specific manipulative maneuver
- radiograph reveals that condyle translates well beyond the eminence
- the dislocation may be momentary or prolonged
- pain may accompany dislocation and persist afterwards
45
how is luxation, open lock (dislocation of the condyle) treated
- seat the pt upright
- ask pt to relax the jaw muscles
- apply digitial pressure to move mandible in inferior and posterior direction. requires significant force. Call oral surgeon in clinic if available
- rx: NSAIDs or muscle relaxants for pain
46
what are the types of ankylosis
- bony
- fibrous
- intr articular
- extra articular
47
what is TMJ ankylosis
fibrous or bony fusion between the mandibular condyle and fossa, which is usually traumatically causede by condyle fracture
48
what could ankylosis also be caused by
infections, degenerative diseases, injection of corticosteroids, forceps delivery and complications of TMJ surgery
49
if there is right TMJ ankylosis, restricted mandibular movement with deflection to ________ side on opening
affected side
50
what is best for detecting boney ankylosis
CBCT or MDCT
51
what is ordered to detect fibrous ankylosis
MRI
52
ankylosis usually develops at what age
before the age of 10 but could develop at any age
53
ankylosis patients usually present with:
progressive limitation of mouth opening, facial deformity, and obstructive sleep apnea syndrome
54
ankylosis may be associated with:
trauma
55
what is the clinical exam for anklyosis
- firm, unyielding restriction due to either intra-artciular fibrous or bony ankylosis
- not associated with pain
- cannot clinically differentiate between this condition and other disorders causing restriction of mouth opening
- may need MRI to r/o anterior disc displacement or myospasm, or exploratory arthroscopy
56
what is the dx of anklyosis
- limitation of opening
- marked deviation to affected side
- marked limitation lateral movement to opposite side (if unilateral)
- hard end feel when stretching patient to maximum opening
- absence of pain
- CBCT or pano may aid in dx but not always. MRI may show soft tissue ankylosis
- MDCT is best to show bony ankylosis
57
imaging of fibrous anklyosis reveals:
absence of ipsilateral condylar translation on opening but disc space is seen
- MRI is needed for dx
58
describe intra capsular anklyosis
- immobilization location within the joint
59
describe the extracapsular anklyosis
rigidity of periarticular tissues (surrounding the joint) resulting in joint stiffness or immobilization
60
what is the etiology of ankylosis
- abnormal intrauterine development
- birth injury or fractures
- chin trauma (posterior)
- malar- zygomatic fractures
- congenital syphilis
- inflammation or speticemia
- metastatic malignancies
- radiation treatment
61
what are the txs for anklyosis
- range of motion exercises
- therabite
- physical therapy
- surgery
62
what is the surgical proceudre for ankylosis
surgical micro scissors placed through cannula to cut fibrous band in lateral capsular adhesion
63
