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OMFS Year 2 > TMJ Surgery > Flashcards

Flashcards in TMJ Surgery Deck (25)
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1
Q

There are two approaches for open TMJ surgery, what are they?

A
  1. Preauricular approach
    - menisectomy (without replacement)
    - menisectomy (with replacement)
    - eminectomy
  2. Modified retro-mandibular approach
    - subcondylar ostectomy for correction of ankylosis
2
Q

What study/scan do we use for the join in order to study an anterior displaced disk?

A

MRI - enchanted resolution, static and kinetic images. MRI will show soft tissue –> internal aspects of joints
We do not use CT

3
Q

What does clicking/popping mean for the TMJ?

A

Pop is from the articulate disk popping out of place and then popping back.

When you close the disc gets displaced anteriorly, the condyle then gets popped back posteriorly when you open

4
Q

What does it mean if popping and clicking are painful?

A

There might be pain because the retrodiscal tissue gets stretched out (richly innervated) –> pain

5
Q

What does reducing and non-reducing mean?

A

Reducing means that the disc pops back into place when the mouth opens.

Non-reducing means that the disc stays far forward without going back.

There is a lot of pain for non-reducing

6
Q

What is the criteria for open joint surgery?

A
  • imaging techniques demonstrate anatomical change
  • clinical symptoms that disturb daily living
  • conservative (less invasive) treatments unsuccessful
7
Q

What is arthrotomy?

A

It is a surgical procedure that creates an opening in the joint

8
Q

What are the candidates for TMJ arthrotomy?

A
  1. Symptomatic internal derangements
    - meniscal dislocation (with or without reduction)
    • anatomical changes of the meniscus including morphogenesis and tearing
    • narrowing of joint space
      • bony changes of the glenoid fossa and condylar head
      • recurrent dislocation
  2. Fibrous and bony ankylosis
  3. Fracture dislocation of condylar neck
9
Q

What are the current goals to open joint surgery?

A
  1. Decrease pain
    • treating inflammatory changes
  2. Restore normal physiologic function without altering occlusal relationships
    • awareness of static and kinetic relationship of joints
  3. Reduce potential for arthritic degeneration
    • preservation of existing structures with reverence for fibrocartilage and synovial tissue
  4. Minimize aesthetic deformity
10
Q

What is menisectomy?

A

It is the surgical removal of all or part of a torn meniscus

Can be done with or without a replacement

11
Q

What can you replace the meniscus with after a meniscectomy with replacement?

A
  • temporary alloplast
  • vascularized autogenous grafting
  • temporalis flap
  • free autogenous grafts
12
Q

When do you use temporary alloplast as a replacement for meniscectomy?

A

Utilized when the meniscus is torn or morphological lay nonfunctional, with normal fibrocartilage of the condylar head and glenoid fossa

13
Q

When do you use temporalis muscle graft (temporalis flap?) in meniscectomy?

A

It is utilized with severe internal derangement with discharge and a fibrocartilage of the condylar head and glenoid fossa

14
Q

Patient complains of intermittent clicking and pain of the right TMJ. Patient has limited opening of 29mm. The mass enter, temporalis, and pterygoid muscles are tender to palpation. Diagnosis and treatment?

A

Diagnosis - internal derangement of right TMJ – anterior dislocation of meniscus without reduction upon opening

Treatment plan - arthrotomy with meniscocondylar fusion

15
Q

Patient is female with chronic pain dysfunction of left TMJ. She has a history of clicking which has no stopped and replaced with grating sound. Severe limitation of opening at 22mm with limited lateral excursions. Diagnosis and treatment?

A

Diagnosis - internal derangement of left TMJ with severe arthritic changes of the mandibular condyle

Treatment - arthrotomy with temporalis muscle graft and arthroplasty

16
Q

What is arthroscopy and when do we use this treatment?

A

We use this treatment when conservative non-surgical treatment fails.

Arthroscopy is lysis and lavage

  • Lyse fibrous lesions
  • Flush the joint

Big difference from arthoscanthesis because it lets you visualize inside the joint. You stick little hammers into joint itself

17
Q

What is arthoscanthesis and when do we use it?

A

We use arthoscanthesis when conservative non-surgical treatment fails

Arthoscanthesis is where we flush the joint and get all the inflammatory mediators out. This is done by putting a needle in the joint and flushing it out.

We also inject cortisone (steroid) to break and reduce inflammatory mediators

18
Q

What should we look for when examining patients with TMJ disorders?

A
  1. Feel the muscles of mastication (palpate masseter, etc)
  2. Look at range of motion
    - how wide can they open?
    - deviations (often caused by displaced disk)
19
Q

What is the first method of treatment you should try?

A

Non-surgical:

  • soft diet
  • warm compress on muscle tissue
  • ice if join inflammation and not muscles
  • anti-inflammatory (ibuprofen, aleve)
  • night guard to separate teeth and joint space giving the disc more free space
20
Q

What is the time frame to determine if non-surgical treatment failed?

A

6 months with no improvement of symptoms

21
Q

What is a complication of open joint procedure?

A

Injury of facial nerve because branches of facial nerve come out right by the ear

22
Q

True or false: TMJ disorders are mostly related to joint injury?

A

False - it is usually muscle related often from parafunctional disorders – nail biting, grinding, clenching, etc

23
Q

If someone complains of jaw pain/TMJ pain and they point with one finger in front of their ear, what does this indicate?

A

It most likely means that the problem is joint related, pre-auricle are point tenderness

24
Q

If someone complains of jaw pain/TMJ pain and they use hole hand on the side of their face, what does this indicate?

A

This indicates that it is muscle related and there is generalized tenderness

25
Q

What are the two basic types of joints in the TMJ

A

Joint that hinges
-first motion when you open (20-25mm)

Joint that slides
- glides down the articulate eminence after hinging (35-55mm)