Temporomandibular Disorders Quiz
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Questions and Answers

What is the primary role of the superior head of the lateral pterygoid muscle?

  • Facilitates contralateral excursion
  • Active during lateral movements of the mandible
  • Responsible for closing the jaw (correct)
  • Aids in jaw depression

    • Which nerve provides motor innervation to the anterior belly of the digastric muscle?

  • Masseteric nerve
  • Auriculotemporal nerve
  • Deep temporal nerve
  • Mandibular division of the trigeminal nerve (correct)

    • What is the main function of the buccinator muscle during chewing?

  • Positions the cheek (correct)
  • Facilitates jaw opening
  • Aids in tongue movement
  • Raises the mandible

    • What is the average rotation range of the condyle during mandibular motion?

    <p>24°</p> Signup and view all the answers

    Which artery bifurcates at the level of the condyle to supply the muscles of mastication?

    <p>External carotid artery</p> Signup and view all the answers

    What is the purpose of the jaw jerk reflex?

    <p>To contract jaw closing muscles</p> Signup and view all the answers

    What condition is considered a possible cause of disc displacements in the temporomandibular joint?

    <p>Injury to the inferior lamina of the posterior attachment</p> Signup and view all the answers

    During maximum opening of the jaw, what is the average distance achieved?

    <p>40-45 mm</p> Signup and view all the answers

    What is a commonly considered factor in the development of intra-articular disorders?

    <p>Angle of the mandibular fossa</p> Signup and view all the answers

    Which clinical test is most widely used for assessing temporomandibular disorders (TMD)?

    <p>Muscle palpation</p> Signup and view all the answers

    What symptom is most commonly associated with TMD?

    <p>Pain</p> Signup and view all the answers

    What could cause acute closed lock of the jaw?

    <p>Adhesion of the disc in the fossa</p> Signup and view all the answers

    Which factor is NOT listed as a contributing etiology of TMD?

    <p>Traumatic brain injury</p> Signup and view all the answers

    What demographic is most affected by TMD?

    <p>Adults between 20 and 40</p> Signup and view all the answers

    What is one of the indicators for expert psychological evaluation in TMD patients?

    <p>Significant distress</p> Signup and view all the answers

    Which of the following is NOT a procedure for assessing mandibular range of motion?

    <p>Lateral jaw movements</p> Signup and view all the answers

    What structure connects the posterior band of the disc to the posterior slope of the condyle?

    <p>Inferior lamina</p> Signup and view all the answers

    Which muscles are involved in producing the powerful forces required for chewing?

    <p>Masseter and medial pterygoid</p> Signup and view all the answers

    What is the primary function of the lateral pterygoid muscle?

    <p>Protrusion and opening of the mandible</p> Signup and view all the answers

    Which part of the temporalis muscle is responsible for elevating the mandible?

    <p>Superficial head</p> Signup and view all the answers

    Where does the deep head of the masseter muscle originate?

    <p>Medial surface of the zygomatic arch</p> Signup and view all the answers

    Which muscle is primarily involved in retracting the mandible?

    <p>Temporalis</p> Signup and view all the answers

    What is the role of the capsular ligament in relation to the temporomandibular joint?

    <p>Encapsulates the temporomandibular joint</p> Signup and view all the answers

    Which muscle does NOT elevate the mandible?

    <p>Lateral pterygoid</p> Signup and view all the answers

    What type of joint is the temporomandibular joint (TMJ)?

    <p>Bilateral synovial joint</p> Signup and view all the answers

    Which component primarily contributes to the normal mouth opening in the TMJ?

    <p>Rotation of the condyle</p> Signup and view all the answers

    What type of tissue occupies the space behind the disc and the condyle in the TMJ?

    <p>Retrodiscal tissue</p> Signup and view all the answers

    How is the articular disc of the TMJ characterized in terms of vascularization?

    <p>Completely avascular</p> Signup and view all the answers

    At what age does the S-shaped form of the fossa and eminence begin to develop?

    <p>6 years of age</p> Signup and view all the answers

    What is the anatomical term for the mass of soft tissue located behind the articular disc in the TMJ?

    <p>Retrodiscal tissue</p> Signup and view all the answers

    Which structures are involved in the management of temporomandibular disorders?

    <p>The masticatory muscles and the TMJ</p> Signup and view all the answers

    What is one of the possible etiological factors associated with TMJ pain dysfunction syndrome?

    <p>Skeletal misalignment</p> Signup and view all the answers

    Which of the following is NOT a characteristic symptom of rheumatoid arthritis?

    <p>Sudden severe pain without previous symptoms</p> Signup and view all the answers

    What is a common result of a blow to the chin?

    <p>Fractures in the mandibular area</p> Signup and view all the answers

    Which factor is a known risk for septic arthritis?

    <p>Previous joint disease</p> Signup and view all the answers

    What is a feature distinguishing synovial chondromatosis?

    <p>Multiple cartilaginous nodules free floating in the joint</p> Signup and view all the answers

    Which of the following conditions may present with trismus and deviation of the mandible?

    <p>Septic arthritis</p> Signup and view all the answers

    Which imaging technique is commonly used in the diagnosis of conditions affecting the TMJ?

    <p>Conventional radiography</p> Signup and view all the answers

    What is the primary treatment for chronic recurring dislocations of the temporomandibular joint?

    <p>Bone grafting to the eminence</p> Signup and view all the answers

    Which developmental disturbance involves the absence of the condyle?

    <p>Agenesis of the condyle</p> Signup and view all the answers

    What is the primary goal of treatment for anterior disc displacement without reduction?

    <p>To eliminate pain and restore function</p> Signup and view all the answers

    Which type of treatment modality does NOT belong to the category of physiotherapy?

    <p>Cognitive Behavioral Therapy (CBT)</p> Signup and view all the answers

    Which condition is characterized by the condyle slipping over the anterior rim of the disc?

    <p>Posterior disc displacement</p> Signup and view all the answers

    What is a common symptom of anterior disc displacement with reduction?

    <p>Clicking or popping during mandibular movements</p> Signup and view all the answers

    Which of the following is NOT typically a pharmacotherapy used in managing temporomandibular disorders?

    <p>Biofeedback</p> Signup and view all the answers

    During which stage of articular disc disorders might there be intermittent locking of the jaw?

    <p>ADD with intermittent locking</p> Signup and view all the answers

    What treatment option could be used for posterior disc displacement?

    <p>Occlusal stabilization appliance</p> Signup and view all the answers

    Which of the following is a characteristic of temporomandibular joint arthritis?

    <p>Degeneration of articular cartilage</p> Signup and view all the answers

    Study Notes

    Temporomandibular Joint (TMJ) Disorders

    • The TMJ is a bilateral synovial joint formed by the articulation of the temporal bone and the mandibular condyle.
    • Temporomandibular disorders (TMDs) encompass a range of problems involving the masticatory muscles, the temporomandibular joints, and associated structures.

    Learning Outcomes

    • Define the TMJ
    • Classify TMJ diseases
    • Assess TMJ
    • Manage TMJ disorders

    Functional Anatomy of the TMJ

    • The TMJ exhibits hinge and gliding movements.
    • The fossa and eminence develop fully by the second decade.
    • Condylar rotation is more significant for mouth opening than translation.
    • Synovial fluid facilitates lubrication (weeping lubrication).
    • Fibrocartilage covers the articulating surfaces.

    Articular Disc

    • The articular disc is composed of dense collagen fibers.
    • It fills the space between the fibrocartilage coverings of the condyle and mandibular fossa.
    • The disc is primarily avascular and has limited sensory nerve innervation.
    • The disc attaches to the medial and lateral aspects of the condyle
    • The disc consists of anterior and posterior bands, thickest in the intermediate zone.
    • Fibers from the temporalis, masseter, and lateral pterygoid muscles insert into the anterolateral and anteromedial two-thirds of the disc.

    Retrodiscal Tissue

    • Retrodiscal tissue is soft tissue positioned behind the disc and condyle, often referred to as the posterior attachment.
    • A superior lamina connects the posterior band of the disc to the squamotympanic fissure and tympanic part of the temporal bone.
    • An inferior lamina connects to the inferior margin of the posterior slope of the condyle.

    TMJ Ligaments

    • Capsular ligament
    • Lateral temporomandibular ligament
    • Sphenomandibular ligament
    • Stylomandibular ligament

    Muscles of Mastication

    • Mandibular movements toward tooth contact are driven by masseter, temporalis, and medial pterygoid muscles.
    • Masseter forms a sling that generates significant forces for chewing.
    • The masseter muscle, with superficial and deep heads, elevates the mandible.
    • Temporalis muscle has anterior, middle, and posterior segments, inserting into the coronoid process and anterior aspect of the mandibular ramus.
    • Medial pterygoid muscle, with superficial and deep heads, participates in jaw movement and excursion.
    • Lateral pterygoid muscle helps in jaw protrusion and lateral movement.
    • Contraction of the anterior belly of diagastric muscle results in mandible depression.
    • Mylohyoid and geniohyoid muscles contribute to mandibular depression.
    • Buccinator assists in cheek positioning during chewing.

    Vascular Supply of Masticatory System

    • The external carotid artery bifurcates into superficial temporal and internal maxillary arteries at the level of the condyle.
    • These arteries supply the masticatory muscles and the TMJ.

    Nerve Supply of Masticatory System

    • The mandibular division of the trigeminal nerve provides motor innervation to mastication muscles.
    • The auriculotemporal nerve innervates the TMJ.
    • Deep temporal and masseteric nerves supply the anterior part of the joint.

    Anatomy of Clinical Interest

    • Jaw jerk reflex is a monosynaptic reflex of jaw closing muscles.
    • Jaw opening reflex inhibits jaw closing muscles.
    • Rest position / centric relation is the maxillomandibular relationship where each condyle articulates with the thinnest portion of the disc against the posterior slope of the articular eminence.
    • The mandibular range of motion includes rotation and translation of the condyle and varies in individuals.
    • Articular covering is thickest at areas with greatest functional load.

    Disc Displacement

    • Injury to the inferior lamina of posterior attachment is considered a cause of disc displacement.
    • The angle of mandibular fossa might contribute to intra-articular disorders and chronic subluxation or dislocation of the condyle.
    • Disc adhesions in the fossa could cause acute closed lock syndrome.

    Clinical Tests for TMJ Assessment

    • Muscle palpation
    • Jaw jerk reflex
    • Electromyography (EMG) activity
    • Identifying the silent period

    Joint Noises and Nerve Entrapment

    • TMJ clicking might be due to condylar hypermobility, lateral pole enlargement, intra-articular bodies, and dysfunctional movement patterns.
    • Nerve entrapment can occur.

    Ear Symptoms Associated with TMDs

    • Possible symptoms include earache, tinnitus, and fullness, or feeling of stiffness.

    Etiology, Epidemiology, Classification of TMJ Disorders

    • Etiology includes premature occlusal contacts, masticatory muscle hyperactivity (bruxism and parafunction), psychological distress, trauma, and rheumatic disorders.

    • Prevalence of TMJ disorders is higher in women between the ages of 20 and 40 years.

    • Classification is based on the taxonomy of joint disorders, disc disorders, masticatory muscle disorders, and associated structures.

    Diagnostic Imaging

    • Plain film radiography
    • Plain film tomography
    • Arthrography
    • CT scan
    • MRI
    • Single photon emission CT
    • Radioisotope scanning

    Diagnostic Local Anesthetic Nerve Blocks

    • Injections in the TMJ, masticatory muscles, or trigger areas.

    Prediction of TMD Chronicity

    • Pain that extends beyond a certain period.
    • Pain persisting beyond usual healing time.
    • Pain not responding to usual treatment.

    General Principles of Treating TMDs

    • Patient categorisation (remission, recurring, persistent symptoms).
    • Implement surgical intervention.
    • Use relaxation and cognitive behavioral therapy (CBT).
    • Consulting a specialist when necessary.

    Specific Disorders and their Management

    • Myalgia and Myofascial Pain - Education, self-management, physiotherapy (active/passive modalities).
    • Instructions to patients for self-care.
    • Intra oral appliances (splints, orthotics).
    • Pharmacotherapy (NSAIDs, muscle relaxants).
    • Behavioral therapy (relaxation techniques, biofeedback, hypnosis).
    • Trigger point therapy, injections of local anesthetic.
    • Restorative dental procedures.

    Intra Oral Appliances

    • Splints, orthotics, night guards, bite guards.

    Articular Disc Disorders

    • Abnormal relationships between the disc, condyle, and articular eminence.
    • Common disc displacement is anterior and medial.
    • Classified based on signs, symptoms, (e.g., ADD with/without reduction, intermittent locking) and diagnostic imaging.

    Types of Disc Displacement

    • Anterior disc displacement with reduction
    • Anterior disc displacement without reduction
    • Posterior disc displacement

    Temporomandibular Joint Arthritis

    • Degenerative joint diseases involve cartilage and subchondral bone, with secondary synovial membrane inflammation.
    • Risk factors include gender, diet, genetics, and psychological stress.
    • Presentation can include joint space narrowing, irregular joint space, flattening of articular surfaces, osteophyte formation, and anterior condylar lipping.

    Other Types of TMJ Disorders

    • Rheumatoid arthritis (primarily affecting periarticular tissue then bone, bilateral involvement, morning stiffness)
    • Synovial chondromatosis (rare, cartilage nodules, progressive swelling)
    • Septic arthritis (infection)
    • Developmental disturbances (hyperplasia, hypoplasia, agenesis)
    • Fractures (trauma)
    • Dislocation
    • Ankylosis (fusion) (bone fusion)

    Sleep Bruxism

    • Oral appliance therapy,
    • Selective serotonin uptake inhibitors,
    • Botulinum toxin

    Oral Dyskinesia and Dystonia

    • Abnormal, involuntary movements of tongue, lips, and jaw.
    • Often related to poor fitting dentures associated with lack of replacement of teeth (important to manage).
    • Emphasize management, including Botulinum toxin and neurosurgery.

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    Related Documents

    Temporomandibular Disorders - LIAQUAT University Medical & Health Sciences - 2016 PDF

    Description

    Test your knowledge on the anatomy and functions related to temporomandibular disorders (TMD). This quiz covers various aspects, including muscle roles, nerve innervations, and clinical symptoms. Perfect for students in dental or medical fields seeking to strengthen their understanding of TMD.

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