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PATH-TMJ
Disease Affecting TMJ
| Question | Answer |
|---|---|
| name 3 disorders of TMJ joint | myofascial pain+dysfunction (MOD) internal derangement syndrome osteoarthritis+rheumatoid arthritis *benign+malignant tumors can also affect TMJ |
| what is the TMJ | articulation b/t condyle of mandible +glenoid fossa of temporal bone highly specialized |
| what divides the space into an upper and lower joint space? | articular disk |
| what nourishes and lubricates avascular surfaces? | synovial membrane lines joint and produces synovial fluid |
| what is the articular disk is attached? hint: 3 locations | to lateral+medial aspects of condyle superior belly of lateral pterygoid muscle to joint capsule |
| (T/F) disk and bony surfaces are muscular? | False. they are avascular |
| how are muscle spasms or dysfunctional muscle activity determined if they are occurring? | palpation of mastication muscles |
| name the 6 muscles of mastication? | masseter, temporalis, medial pterygoid, lateral pterygoid, anterior digastric, mylohyoid |
| what are the 3 elevator muscles? | masseter, medial pterygoid, temporalis |
| where does the mandibular condyle rest during max. occlusal contact? | glenoid fossa |
| where is the articular disk situated during max. occlusal contact? | between the condyle, roof of glenoid fossa, articular eminence |
| what is the first phrase of opening characterized by? | rotational (hinge) movement of condyle followed by anterior translation (sliding) |
| how does the disk move during translation? | posteriorly |
| what are TMDs caused by? | abnormalities in function of either joint or associated structures |
| who are TMD signs and symptoms mroe frequently and severly seen in? | women, other adults |
| what percentage does TMD-related jaw pain, dysfunction or both affect? | 5% |
| what could be the causes of dysfunction? | disorders of muscles, mastication or internal derangements of components of joints |
| what are 3 parts to the evaluation? | history, examination, imaging |
| what factor has been suggested to be the most likely cause of TMD? | trauma |
| iatrogenic | resulting from the action of a healthcare provider |
| iatrogenic causes | indiscriminate use of corticosteriod injection into joint |
| what are the classification of trauma affecting TMJ? | direct(assault), indirect(whiplash injury), secondary to parafunctional habits (clenching, Bruxism) |
| types of imaging used to determine condyle shape and if degenerate joint disease exists: | panoramic, tanscranial, tomography, computed tomography, magnetic resonance imaging, arthrography |
| 3 types of TMD | myofasical pain+dysfunction internal derangements arthritis |
| what do popping and clicking most commonly reflect? | disk displacement w/ reduction |
| comprehensive exam TMJ related includes: | exam of joint, muscles of mastication, oral cavity, cervical spine |
| arthrogenous | joint related |
| mnyogenous | muscle related |
| why is tomography used? | >accuracy in assessing condylar position_randge of mobility |
| why is computerized tomography used? | most accurate for identifying bone abnormalities |
| why is magnetic resonance imaging used? | mandatory for examining disk position, function, morphology, presence of joint effusions (inflammation changes) |
| why is arthrography used? | utilizes radiopaque contrast agent injected into joint |
| myofascial pain and dysfunction | 50% all TMD dysfunctional muscle hyperactivity w/ regional pain, tenderness in affected muscles+ variable amounts of reduced opening +complains of maloocclusion |
| disk displacement with reduction | displaced anteriorly and returns to normal position when the mouth is opened or movement is away from affected side |
| disk displacement without reduction | acts as obstacle to sliding condyle pt. complain: intermittent locking of jaw, lmtd mouth opening, assoc. w/ cessation of joint sounds, deflection of mandible, w/ midline correction upon opening+restricted lateral excursive movements away from affctd sit |
| 3 parts of internal derangements | displacements, ankylosis, hypermobility disorders |
| ankylosis | immobility of condyle b/c fibrous/bony union b/t articulating surfaces classified: tissue (fibrous, bony) location (intra/extra-articular) extent of fusion (complete, incomp.) joint infect.after trauma=50%cases |
| hypermobility disorders- dislocation | one or both of condyles translates anterior to articular eminence-->open lock, pt. can't reduce |
| hypermobility disorders- subluxation | pt. can relocate mandible back into glenoid fossa |
| arthritis classifications | osteoarthritis and rheumatoid arthritis |
| what is arthritis? | inflammation of the joint |
| osteoarthritis | *most common disease affecting TMJ degenerative changes of cartilage pt. pain symptoms worse in evening, lmtd opening, muscle splinting, crepitus |
| rhematoid arthritis | 50-70% have TMJ involvement inflammatory, immunologic disorder of joints pt. pain symptoms worse in morning, lmtd opening, occlusal changes, preauricular edema+tenderness |
| Tx of TMD | nonsurgical, surgical, multidisciplinary |
| nonsurgical Tx (phase 1) | pharmalogic+physical therapy, moist heat, soft mechanical diet, streching pain meds., muscle relaxants, antianxiety (reduce musclehypertonicity) occlusal adj. may be preformed |
| goals of nonsurgical Tx | improving function (range of motion) + reducing pain |
| nonsurgical Tx (phase 2) | occlusal appliances, relax muscles, protect dentition+joint, biofeedback so pts aware of bruxing, relieving load of disk |
| surgical Tx | for pt. w/ TMD other than MPD if they dont respond to nonsurgical therapy |
| surgical tx- arthrocentesis | involves lavaging joint through needle |
| surgical tx-arthroscopy | allows direct visualization and manipulation of joint |
| surgical tx-condylectomy | involves surgical repositioning of needle |
| surgical tx-open joint surgery | used to preform disk reconstruction w/ prosthetic device or autogenous graft |
| multidisciplinary management | pt. may require referral to specialists (neurologist, otolaryngologist) |
| fact about osteogenic sarcoma | one of the most commonly occurring malignant bone tumors |
| fact about synovial chondromatosis | most common benign neoplasm of synovium |
| name 4 of the most common benign tumors | osteochondroma, osteoblastoma, chondroblastoma, osteoma |
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