TMD

BDS 5
TMJ advanced imaging

Diseases affecting TMJ

 Systemic lupus
 Lyme’s disease
 Rheumatoid arthritis
 Gout
 Osteoarthritis
 Ankylospondylosis

Imaging
 CT/CBCT: with detail but high dosage
 MRI: disc and internal structures
 Ultrasound: effusions and some internal detail
 Nuclear med: growth, inflammation, neoplasia

DPT
 Late presentation of bone erosion, sclerosis, osteophytes
 Potential fracture
Embryology

 Mandible develops intramembranously

 Rod hyaline cartilage = meckels cartilage

 Secondary growth from cartilage

 Condyle cartilage grows till 20 years
 Coronoid cartilage strops growing before birth
 Symphysial cartilage stops growing at 1 years

Things to be aware of during surgical access

 VII at risk

4 histological layers
 Fibrous tissue
 Cellular zone
 Fibrocartilage layer
 Calcified cartilage

Disc = type 1 collagen

Synovial membrane
 Endothelial cells on top of vascular layer
 Secretes synovial fluid

Absolute indications for surgery

 Mandibular growth disturbances
 Ankylosis
 Tumours
 Trauma

Secondary indications to surgery

 Recurrent dislocation
 Disc replacement without reduction
 Arthritis
 Trauma

Pathology – think surgical sieve

Vascular
Infective
Traumatic
Autoimmune
Metabolic
Iatrogenic
Neoplastic
Congenital
Developmental pathogenesis
 Agenesis: total failure to develop
 Hypoplasia
 Reduction in growth on affected side
 Deviates toward affected side on opening
 Hyperplasia
 Acromegaly
 Chin moves away from affected side

Arthritis
 Osteoarthritis – bony changes that are painful
 Osteoarthrosis – remodelling stabilised, asymptomatic
 RA
 S/S: pain on function, crepitus, AOB, tenderness of palpation
 Pathology: synovitis

Treatment of arthritis
 Relieve pain, swelling, fatigue
 Improve TMJ function
 Prevent further joint damage
 Prevent disability

Surgery for arthritis

 Minimally invasive
 Soft tissue procedure
 Bone and joint procedure
 Salvage procedure

RA tx
 Palliation
 Surgery only if fibrosis or AOB – high recurrence
Signs and symptoms of TMD
1. Muscular tenderness: massester, temporalis, post. diagastric, mylohyoid
2. Pain in head
3. Joint noises – clicking and crepitus
4. Locking
5. Ear complaints – otalgia, tiniitus
6. Psychosocial effects – stress, depression, anxiety