TEMPOROMANDIBULAR JOINT

April 12, 2024
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Q1. Define temporomandibular joint.

Ans. It is a highly specialized snynovial, diarthroidal non-weight bearing joint, both the joints are independent.

Q2. Mention various types of movement in temporomandibular joint.

Ans.

  • Upper joint cavity has gliding movements while lower joint cavity has hinge movements.
  • Protrusion, retrusion, opening, closing, side to side.

Q3. Classify various diseases of temporomandibular joint?

Ans.

I – Joint disorders :

  1. Deviation (disc thinning of perforation).
  2. Disc displacement (with or without reduction).
  3. Disc displacement of disc condyle complex (hyper mobility of dislocation).
  4. Inflammatory conditions (capsulitis and synovitis, retrodiscitis).
  5. Degenerative disease (osteo arthritis, poly arthritis).
  6. Ankylosis (fibrous, bony).

II – Masticatory muscle disorders

  1. Acute (myositis, muscle spasm).
  2. Chronic pain (myofacial pain, hypertrophy).

III – Congenital and developmental disorders

  1. Condylar hyperplasia
  2. Hypoplasia
  3. Aplasia

Q4. Define Ankylosis.

Ans. Ankylosis is a Greek word meaning “stiff joint” it also denotes abnormal immobility and consolidation of the joint.

Q5. Classify Ankylosis.

Ans.

  1. Kazanjian – true false.
  2. Fibrous bony ankylosis, fibroosseous.

Q6. Mention various etiology of pathogenesis of ankylosis.

Ans.

  1. Trauma.
  2. Infection.
  3. Degenerative arthritis.

Q7. Describe various clinical features of ankylosis.

Ans.

  1. Malocclusion.
  2. Prominent antegonial notch on the affected side.
  3. Restricted mouth opening.
  4. Fore shortening of wide ramus on affected side.

Q8. Classify various radiographs for TMJ disorders?

Ans.

  1. Lateral oblique view, OPG.
  2. Cephalometric radiograph.
  3. Submentovetex view.
  4. Transcranial, transorbital, transpharyngeal view.
  5. Tomogram.

Q9. Describe various protocol for ankylosis.

Ans.

  1. Aggressive resection of ankylosis.
  2. Ipsilateral coronoidectomy.
  3. Contralateral coronoidectomy.
  4. Interpositional arthoplasty.
  5. Reconstruction of the joint with costochondral graft.
  6. Rigid fixation of the graft.
  7. Early mobilization and active physiotherapy.

Q10. Mention various surgical approaches to TMJ ankylosis.

Ans.

  1. Pre-auricular.
  2. Risdon’s submandibular approach.
  3. Post auricular.
  4. Endaural approach.
  5. Retromandibular approach.
  6. Temporal approach.

Q11. Define internal derangement.

Ans. They are defined as mal relationship of the meniscus to the condylar head and the articular eminence.

Q12. Classify etiology of internal derangement?

Ans. Macro trauma, micro trauma myofacial pain due to bruxism, occlusal disharmony.

Q13. Classify internalderangement?

Ans. 

  1. Initial stage: Anterior displacement of disc with reduction.
  2. Intermediate stage: Anterior displacement of the disc without

reduction.

  1. Terminal stage: Anterior displacement of disc with perforation of the disc.

Q14. Classify clinical features of internalderangement?

Ans.

  1. Occlusal disharmony.
  2. Midline deviation.
  3. Clicking with pain of mouth opening confirmed by auscultation.
  4. Pain on the joint region of muscle of mastication.

Q15. Mention various treatment protocol for management of internal derangement.

Ans.

  1. Intra articular infection.
  2. Arthroscopy, arthrocentesis lavage.
  3. Supportive therapy.
  4. Appliances [splints]
  5. Stabilization splint.
  6. Repositioning splint.
  7. Physiotherapy
  8. Joint mobilization
  9. Movement education.

Surgical movement

  1. Menisectomy.
  2. High condylectomy.
  3. Condylectomy.
  4. Capsular plication.
  5. Eminectomy.
  6. Temporalis fascia sling.
  7. Plication of capsule.
  8. Condylotomy.

Q16. Define dislocation.

Ans. When the mandibular condyle is displaced anteriorly the articular eminence is known as dislocation.

Q17. Define subluxation.

Ans. When the mandibular condyle is self reducible and liberally moves back to the glenoid fossa it is known as subluxation.

Q18. Enumerate various etiology for subluxation.

Ans.

  1. Integrity of ligaments associated with the joint is lost.
  2. Bony architecture of joint surfaces.
  3. Activity of the musculature acting on the joint.

Q19. Classify various clinical features of subluxation?

Ans.

  1. Inability to close the mouth.
  2. Tense, spasmatic muscles of mastication.
  3. Preauricular depression.
  4. Severe pain of joint.

Q20. Classify various treatment of temporal mandibular joint dislocation?

Ans.

  1. Chemical capsulloraphy (alcohol, 5% sodium psyillate, sodium morrhuate).
  2. Dautrey procedure.
  3. Alteration of Musculature. (injection of botolinum toxoid).
  4. Capsular Plication.

Q21. Define myofacial pain functional disorder.

Ans. Myofacial pain dysfunction is a pain disorder in which unilateral pain is referred from the trigger points in myo facial structures to the muscles of the head and neck. Pain is constant dull in nature, in contrast to the sudden sharp, shooting, intermittent pain of neuralgias (chronic pain) but the pain may range from mild to intolerable.

Q22. Define Temporomandibular joint arthroscopy.

Ans. TMJ arthroscopy consists of insertion of specially designed fiber optic endoscope into the joint compartment for observation (diagnostic) and therapeutic purpose. It was made popular by ohnishi in 1975, with the development of a 1.7 mm diameter needle type arthroscope.

Oral and Maxillofacial Surgery