TMJD Flashcards
What two bones does that the TMJ lie in between.
The mandible and the temporal bone
What the blood supply of the TMD
Deep auricular artery which is a branch of the maxillary artery
What is the nerve supply of theTMJ
Auriculotemporal nerve
What kind of movement is the upper joint cavity of the TMJ
Gliding movements
Protrusion retraction side to side
Lower cavity of the TMJ is responsible for what kind of movement
Rotation
Elevation and depression
What ligaments are associated with the TMJ and what is their function
Lateral, spehnomandibular and stylomandubuliar
They limit movement
What divides the joint into superior and inferior join space
The intrartiucalr disc
What part of the intrarticular disc is innervated
Not the anterior portion
It is the posteior and the bilaminar zone
What is the normal range of movement of the TMJ
35-40mm
How can we indirectly assess the lateral pterygoid
Noting a reposne ( pre auricular pain) to attempted opening against the examiners hand below the chin
Which MOM cannot be examined
Medial pterygoid
What is the only radiographic projection to show the whole joint
Trans-cranial oblique lateral view
A clincal diagnosis of suspected internal derangement might lead to the requirement of what kind of imaging
MRI
What does arthroscopy allow
Visualisation of the upper joint space and opportunity for minor surgical intervention under LA
Why in arthroscopy is it only the upper joint cavity space we access
This is because the lower space is more difficult to access without their being risk of damage to the articular disc
Name 5 managment strategies of someone complaining of TMJ pain and dysfunction
Reassurance and explanation of condition to the patient
Jaw rest and soft diet
Analgesic advice
Occlusal splints to interfere with parafunction
Physiothepry
Muslce relaxants
Supported yawning, no chewing gum, dont chew on pencils
Local measures ; cold compresses or heat pad
Where does the articular disc normally sit
In the anteior aspect of the condylar head
Define internal derangement
Abnormality in position of the articular disc that interferes with function and may be associated with other symtoms
What the most common type internal derangement
Anteior disc displacement
What is disc displacement with reduction
Reduction means that a displaced disc reduces into a normal position on opening but reverts back to an abnormal positioning on closing
What clincal features would you see in disc displacement with reduction
Clicking!!! - on opening and closing
Deviation of the maidble
What is disc displacement without reduction
If there is no reduction a displaced disc remains in the displaced position regardless of the state of opening
What clinical features may be seen in disc displacement without reduction
No click !!
Reduction in opening
Pain in front of the ear
When is surgery indicated for TMD
Surgery is only indicateed where non surgical methods have failed and the Symtoms are severe
What is arthocetesis
Involves lavage ( washing out) of the upper joint space using hydraulic pressure and manipulation to release adhesions
What is meniscoplasty
Procedure to responsition the articular disc
Capsule opened, disc visualised and sutured into place
What is menisectomy
The disc may be removed if it cannot be reposition due to deformity or degeration
What are some factors associated with the development of chronic TMD pain and a worse prognosis
Being female
Increasing age at presentation
Co morbid psychological factors ; anxiety or depression
Poor coping skills
What kind of approach should be taken when managing paitents with TMJD
Bio-psychosocial approach
Takes into account the pathology and psychology associated with it
Pyschological side of it tends to affect the pain
Simple analgesia and NSAIDS can be advised for patients with TMD however what other medications could be tried if symptoms severe
Short course of benzodiazepine i.e diazepam 2mg 3x daily max 2 weeks
A trial of amitriptyline or Gabapentin
What may be seen intra-orally in a patient with TMD
Linea alba
Scalloping of the tongue
Signs of toothwear
What are factors that can affect peoples pain
Age
Previous or current mental health diagnosis
Anxiety/ stress
Habits
Previous traUMA
What are the aims of a splint in TMJD
Dissoccluding the occlusion
Protecting the teeth
What are the 4 basic principles of TMJD
Muscular - initiation
Mehchanical - Tmj dysfunction
Psychological - underlying cause
Trauma - aetiology
The articular cartilage is made up of chrondroblasts and collagen fibres in a proteoglycan matrix
How can inflammatory disease affect this
Inflammatory disease produces proteases which degrade the proteoglycans
What has to be the first stage in conservative management if the TMD is caused by a habit
Counselling - if a patient cannot stop their habit no treatment will be useful
What are three functions of a bite raising appliance
Elimates occlusal interference
Prevents the joint head from rotating so far posteriorly in the glenoid fossa
Reduces load on TMJ
What is an arthogram
Injecting Radiopaque material around condyle to look at upper and lower compartment
- this allows us to see the integrity of the disc and if there is a perforation
When inside the upper joint space during an arthroscopy - what may we see that indicates to us that there is inflammation
Varicose veins - if there is can do cauterisation
