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ACP App Part 4 > TMJ/TMD > Flashcards

TMJ/TMD Flashcards

1
Q

Goodacre digital text - Articular disk

  • Predominant collagen in (TMJ) disc (intermediate zone)
  • These fibrils are known for what?
  • What direction are these fibers oriented in the IZ?
A
  1. Type I collagen fibrils
  2. Tensile strength
  3. Anteroposteriorly
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2
Q

Goodacre digital text - Articular disk

  • Type II collagen distribution in disc and the bands?
  • Associated in distribution of what? What do those do?
  • Direction of collagen fibers in AB and PB discal bands?
A
  1. PZ > AZ > IZ
  2. Proteoglycans - Can uptake water, swell and resist compression
  3. Arranged mediolaterally and vertically
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3
Q

Goodacre digital text - Articular disk
- The relative distribution of sulfated proteoglycans within the disc suggest what?

  • Scarcity of proteoglycans suggests what about loading?
A

Suggests that during joint function, compressive force is exerted on posterior band but less so on the intermediate zone

The scarcity of proteoglycans suggest loading is transient

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4
Q

Goodacre digital text - Synovial Sac

  • Two zones of synovial sacs?
  • Synovial sacs are lined with what?
  • These sacs are abundant in the anterior or posterior section?
  • Which sac (superior or inferior) has greater volume?
A
  1. Superior synovial sac (anterior and posterior) and inferior synovial sac (ant/post)
  2. Membrane containing cells that secrete synovial fluid
  3. Abundant in posterior
  4. Inferior joint space is greater (0.75 vs 0.5 cc)
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5
Q

Goodacre digital text - Synovial Sac

  • Synovial membrane consists of two parts?
  • Describe normal synovial fluid
  • Three main functions?
A
  1. Intimal layer with rich blood supply and Subintimal layer - fibrous and adipose tissue (less vascular)
  2. Pale yellow, clear, viscosity is high, composition similar to plasma
  3. Secretion, phagocytosis and regulation of electrolytes, solutes, and proteins
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6
Q

Goodacre digital text - Synovial Sac

  • Do osteoarthritic joints have elevated or decreased synovial fluid?
  • What about patients with inflammatory joint disease (like RA)?
A
  1. OA: Elevated synovial fluid

2. RA: Decreased synovial fluid

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7
Q

Goodacre digital text - Articular disk

- Etiology of “retrodiscal bilaminar zone” term

A

It is located posterior (distal) to mand. condyle and made of two laminae (layers)

  • Superior lamina attaches the disc to the post-glenoid process
  • Inferior lamina attacks to posteroinferior condylar aspect
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8
Q

Goodacre digital text - Bilmanar retrodiscal zone - Articular disk

  • Is superior or inferior lamina rich in protein and elastin?
  • Does this lamina has low or high modulus of elasticity?
  • How does this factor into articular disc displacement?
A
  1. Superior is rich in protein/elastin
  2. Low modulus - very elastic
  3. Factors in because unduly stressed/stretch elastin loses elasticity. This means the superior lamina cannot destabilize the disc and recapture the normal relationship
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9
Q

Goodacre digital text - Articular disk

  • Inferior lamina consists of what?
  • Inferior lamina attaches to what?
  • Vascularized?
A
  1. Inelastic collagen
  2. Attaches to posterior condylar non-articular surface
  3. Highly vascularized
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10
Q

Goodacre digital text - Articular disk

  • Which portion of the disc (AB, IZ, or PB) is thinnest?
  • Which portion of the disc is thickest laterally?
A
  1. Thinnest: IZ

2. Thickest laterally: PB

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11
Q

Goodacre digital text - Malposition

  • Most displaced disks dislocate in what direction?
  • Breakdown of rest of directions
A
  1. 57% of disks dislocate ANTEROMEDIAL to condyle

2. Anteriorly (25%), anterolaterally (10%), medially (5%), laterally (3%), posteriorly (<1%)

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12
Q

Goodacre digital text - Malposition

  • What displacement results in clicking/popping with jaw movement?
  • What displacement results in locking such that the jaw does not fully open?
A
  1. Click/pop: Acute disk displacement with reduction

2. Lock: Acute disc displacement without reduction

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13
Q

Goodacre digital text - Malposition

  • How does unloading the TMJ via a occlusal appliance affect proteoglycans?
  • Embryonic lineage of the disk?
  • How does the lateral pterygoid physically interact with the TMJ?
A
  1. Diminishes proteoglycans
  2. Mesenchymal connective tissue
  3. Superior belly of lateral pterygoid attaches to capsular ligament and condyle, and inserts via tendon into the anterior discal band
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14
Q

Goodacre digital text - Malposition

- The condyle/disc complex is NOT parallel to the inferior lateral pterygoid muscle. What is the difference?

A

30° change from condylar path to axis of lateral pterygoid

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15
Q

Goodacre digital text - Imaging

What does DICOM stand for?

A

Digital Imaging and Communications in Medicine

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16
Q

Goodacre digital text - Imaging

- Who developed CBCT?

A

Hounsfield and Cormack

17
Q

Goodacre digital text

- What are the two categories of TMJ related pain?

A

TMD and MPD

Temporomandibular Disorder and Myofascial Pain and Dysfunction

18
Q

Goodacre digital text

- Four types of TMD?

A
  1. Internal derangement
  2. Masticatory muscle disorders (MPD)
  3. Degenerative joint disease and disorders
  4. Fractures, infections, tumors, and other diseases affecting the TM joint
19
Q

Goodacre digital text

- Seven etiologic factors associated with MPD

A
  1. Psychophysiologic factors
  2. Malalignment of jaws
  3. Incorrect position of internal joint space resulting in muscle fatigue
  4. Incorrect position of the condyle in fossa
  5. Excessive vertical spacing between maxilla/mandible
  6. Habitual jaw parafunction
  7. Muscle splinting/posturing to limit movement of painful/inflamed joints
20
Q

Ch1. What four ligaments attach the mandible to the skull base?

What are their functions?

A

Ch1. Right and left stylomandibular and sphenomandibular ligaments

Stylomandibular: Supports the mandible. It gets more lax as the jaw opens.

Sphenomand: Protects the neuromuscular structures that pass through the mandibular foramen during jaw protrusion. If damaged, may result in TMJ referred pain.

21
Q

Ch1. Temporomandibular ligament is made of which two fibrous bands?

Function?

Forms boundary of what?

A

Horizontal and oblique

F(x): Stabilizes the jaw and resists displacement of the mandible posteriorly and inferno-posteriorly

Forms lateral boundary of the joint capsule

22
Q
A

ACP App Part 4 (7 decks)

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