TMJ Surgery

Question 1

what are the common symptoms of the TMJ?

Answer 1

• clicking - articular disc goes over the eminence
• pain
• crepitus - degenerative changes
• limited opening - spams in the muscles
• locks
• dislocates

Question 2

describe the anatomy of the joint here:

Answer 2

1. Condyle
2. Disc
3. Glenoid Fossa
4. Eminence
5. External Acoustic Meatus

Question 3

what muscles control - open and close the jaw?

Answer 3

Open
- lateral pterygoid
- myelohyoid
- suprahyoid muscle

Closing
- temporalis
- masseter
- medial pterygoid

Question 4

how does a jaw dislocate?

Answer 4

• condyle moves past the articular eminence
• gets stuck
• can’t pull back

Question 5

what can you do to sort out a disclocated jaw?

Answer 5

1. try put it back - same apical pressure, stand infront, thumbs on wisdom teeth, put down and push with back of hand
2. tell patient to be wary of mouth opening after
3. surgery - decrease the size of eminence (eminectomy)

Question 6

what is internal derangement?

Answer 6

displacement of disc from normal functional relationship with condyle
- often results in a clicking sound

Question 7

what is the only scan which can show the disc?

Answer 7

MRI

Question 8

what is the classification used for internal derangement?

Answer 8

Wilkes Classification

Question 9

what are the surgical options for internal derangement?

Answer 9

minimally invasive
- joint and muscle injections
- arthrocentesis - joint injection or muscle injection
- arthroscopy - can see inside a joint to diagnose

open joint procedure
- disc repair/repositioning (meniscopexy)
- disc removal (meniscectomy)
- articular eminence change
- joint reconstruction

Question 10

what are the indications for joint injections with steroids?

Answer 10

• conservative management has failed - bite guard, rest, NSAIDS, massage
• patient in pain
• MRI evidence of degeneration
• degenerative joint disease - arthritis

Question 11

how does Athrocentesis work?

Answer 11

• washout debris
• clear joint of inflammatory mediator
• divide adhesions
• remove the restrictions of the disk

Question 12

what are the complications of arthroscopy?

Answer 12

• can pierce the ear canal
• damage to ear canal, facial nerve and middle ear
• swelling
• bruising
• bleeding
• pain
• may have no improvement