Temporomandibular Joint Disorders — MCQs
Severe disability in primary osteoarthritis of hip is best managed by -
At the temporomandibular joint (TMJ), two joints work synchronously, and hence, are known as:
Which of the following is NOT a feature of Moebius syndrome?
Which of the following is the most commonly used extraoral orthodontic appliance:
A patient reports to the dentist with symptoms of joint involvement, obscure pain and discomfort, and clicking sounds. The patient is a complete denture wearer. The denture should be checked for:
Voluntary retrusion of the mandible in a closed mouth is done by which muscles?
The most frequent direction in which the articular disc gets displaced is:
Following are the TM joint ligaments except -
A swelling behind the ear suggests fracture of:
Which of the following is not a ball and socket type of joint?
Temporomandibular Joint Disorders Indian Medical PG Practice Questions and MCQs
Question 1: Severe disability in primary osteoarthritis of hip is best managed by -
- A. Arthroplasty (Correct Answer)
- B. Arthrodesis
- C. Mc Murray's osteotomy
- D. Intra-articular hydrocortisone and physiotherapy
Explanation: ***Arthroplasty*** - **Total hip arthroplasty (THA)** is the most effective treatment for severe osteoarthritis of the hip, providing significant pain relief and functional improvement. - It involves replacing the damaged joint surfaces with **prosthetic components**, addressing advanced cartilage loss and structural damage. *Arthrodesis* - **Arthrodesis (joint fusion)** is an older technique that fixes the joint in a permanent position, eliminating pain but sacrificing all motion in that joint. - While it relieves pain, the severe loss of motion makes it generally less desirable than arthroplasty for the hip, especially in active patients. *Mc Murray's osteotomy* - **McMurray's osteotomy** is a surgical procedure primarily used for some types of **femoral neck fractures** or a specific type of **avascular necrosis** of the femoral head, not for severe osteoarthritis affecting the entire joint. - It involves cutting and realigning the bone, but it does not address advanced, widespread articular cartilage degeneration seen in severe osteoarthritis. *Intra-articular hydrocortisone and physiotherapy* - **Intra-articular hydrocortisone injections** and **physiotherapy** are conservative treatments used for mild to moderate hip osteoarthritis to manage pain and improve function. - These methods do not resolve severe structural damage and are typically insufficient for managing severe disability due to advanced osteoarthritis.
Question 2: At the temporomandibular joint (TMJ), two joints work synchronously, and hence, are known as:
- A. Ginglymoid joint.
- B. Biarthrodial joint.
- C. Compound joint. (Correct Answer)
- D. Synovial joint.
Explanation: ***Compound joint*** - A compound joint is defined by the presence of **more than two articulating bones** or the involvement of an **intervening disc**, like the temporomandibular joint, which involves the temporal bone, mandible, and an articular disc. - The TMJ operates as a compound joint because the **articular disc divides the joint cavity** into two separate compartments, allowing for both hinge-like and gliding movements. *Ginglymoid joint* - A ginglymoid joint, or **hinge joint**, primarily allows for movement in **one plane**, such as flexion and extension. - While the TMJ has a hinge-like component in its lower compartment, its overall function is more complex and involves multiple planes of movement. *Biarthrodial joint* - This term is not a standard anatomical classification for joints; the TMJ is often described as a **ginglymoarthrodial joint**, combining hinge and gliding actions. - The term "biarthrodial" does not accurately capture the specific structural and functional characteristics of the TMJ. *Synovial joint* - A synovial joint is a broad category of joints characterized by a **synovial cavity**, articular cartilage, and a joint capsule. - While the TMJ is indeed a synovial joint, this classification is too general and does not specifically describe its unique compound nature with an articular disc.
Question 3: Which of the following is NOT a feature of Moebius syndrome?
- A. Bilateral facial paralysis
- B. Impaired lateral eye movement
- C. Unilateral or bilateral abducens nerve involvement
- D. Decreased chest movements (Correct Answer)
Explanation: ***Decreased chest movements*** - **Decreased chest movements** are not a characteristic feature of **Moebius syndrome**, which primarily affects cranial nerves, particularly the **facial and abducens nerves**. - While other systemic issues can coexist, respiratory problems like decreased chest movements are not considered a direct or defining symptom of this condition. *Bilateral facial paralysis* - **Bilateral facial paralysis** is a hallmark of **Moebius syndrome**, resulting from congenital underdevelopment or absence of the **facial (VII) cranial nerves**. - This leads to a characteristic **mask-like facial expression**, difficulty with smiling, frowning, and other facial movements. *Impaired lateral eye movement* - **Impaired lateral eye movement** is a common feature due to involvement of the **abducens (VI) cranial nerves**, which control the **lateral rectus muscle**. - Patients often present with **esotropia** (crossed eyes) and are unable to move their eyes past the midline when looking to the side. *Unilateral or bilateral abducens nerve involvement* - **Unilateral or bilateral abducens (VI) nerve involvement** is a core diagnostic criterion for **Moebius syndrome**. - This leads to the characteristic deficit in **lateral gaze**, as the abducens nerve innervates the **lateral rectus muscle**.
Question 4: Which of the following is the most commonly used extraoral orthodontic appliance:
- A. Face mask.
- B. Head gear. (Correct Answer)
- C. None.
- D. Chin cup.
Explanation: **Head gear.** * **Headgear** is a widely recognized and utilized **extraoral orthodontic appliance** in dental practice due to its versatility in controlling maxillary growth, especially in patients with Class II malocclusion. * It consists of an **outer bow** (facebow) and an **inner bow**, connected to bands on the molars, which exerts orthopedic force on the maxilla and teeth. *Face mask.* * A **face mask** (or protraction headgear) is primarily used for **Class III malocclusions** to encourage maxillary protraction and inhibit mandibular growth. * While an important extraoral appliance, its usage is less common than headgear, as Class III skeletal patterns are less prevalent than Class II. *None.* * This option is incorrect because there are several commonly used extraoral orthodontic appliances, with **headgear** being a prime example. *Chin cup.* * A **chin cup** is an extraoral appliance used specifically for the orthopedic management of developing **Class III malocclusions** by restraining mandibular growth. * Its primary application is to redirect the growth of the mandible downward and backward, but it is less frequently prescribed compared to headgear for Class II correction.
Question 5: A patient reports to the dentist with symptoms of joint involvement, obscure pain and discomfort, and clicking sounds. The patient is a complete denture wearer. The denture should be checked for:
- A. Very large denture base coverage (over-extended denture)
- B. Improper centric relation
- C. Reduced vertical dimension
- D. Increased vertical dimension (Correct Answer)
Explanation: ***Increased vertical dimension*** - An **increased vertical dimension** (VDO) can lead to excessive occlusal force on the temporomandibular joint (TMJ) and surrounding structures, causing **pain, discomfort, and clicking sounds**. - This occlusal discrepancy forces the condyles into an abnormal position, stressing the joint and muscles, which can manifest as **joint involvement and obscure pain**. *Very large denture base coverage (over-extended denture)* - An **over-extended denture base** often causes **sore spots and irritation** on the mucosa, leading to discomfort and problems with retention due to muscle impingement. - While it causes discomfort, it is less likely to be the primary cause of chronic TMJ pain and **clicking sounds** directly, as these are more related to occlusal or joint biomechanics. *Improper centric relation* - An **improper centric relation (CR)**, where the dentures are not occluding in the jaw's most retruded and superior position, can lead to occlusal instability. - This primarily results in **denture instability, discomfort, and potential damage** to the supporting tissues, but clicking sounds are more typically associated with VDO issues or direct TMJ derangement. *Reduced vertical dimension* - A **reduced vertical dimension** can cause a prognathic appearance, "sunken-in" facial features, and **lips that look thin**. - It also increases the interocclusal space, leading to **chewing inefficiency** and sometimes discomfort, but it is less likely to cause TMJ clicking sounds.
Question 6: Voluntary retrusion of the mandible in a closed mouth is done by which muscles?
- A. Anterior belly of digastric
- B. Posterior belly of digastric
- C. Deep fibers of masseter
- D. Posterior fibers of temporalis (Correct Answer)
Explanation: The original text does not contain any relevant citations from the provided reference set to include. ***Posterior fibers of temporalis*** - The posterior fibers of the **temporalis muscle** are primarily responsible for **retrusion of the mandible**, pulling it backward. - This action is particularly effective when the mouth is closed, as the muscle's pull retracts the condyle into the glenoid fossa. *Anterior belly of digastric* - The anterior belly of the **digastric muscle** is mainly involved in **depressing the mandible** (opening the mouth) and elevating the hyoid bone. - It does not directly contribute to the retrusion of the mandible. *Posterior belly of digastric* - The posterior belly of the **digastric muscle** functions to **elevate the hyoid bone** and assist in depressing the mandible when the hyoid is fixed. - It does not play a direct role in retracting the mandible. *Deep fibers of masseter* - The **masseter muscle**, including its deep fibers, is a powerful muscle of **mastication** primarily responsible for **elevating the mandible** (closing the mouth). - It also contributes to protraction and only minimally to retrusion, not as a primary mover.
Question 7: The most frequent direction in which the articular disc gets displaced is:
- A. Anterior and lateral direction
- B. Posterior and lateral direction
- C. Posterior and medial direction
- D. Anterior and medial direction (Correct Answer)
Explanation: ***Anterior and medial direction*** - The **articular disc** is most frequently displaced in the **anterior and medial direction** due to sustained clenching/bruxism which leads to hyperactivity of the superior lateral pterygoid muscle. - This displacement leads to various **internal derangements** of the **temporomandibular joint (TMJ)**, often characterized by clicking, popping, or pain during jaw movement. *Anterior and lateral direction* - While anterior displacement is common, the **lateral component** is less frequent combined with anterior displacement because the **medial pole of the condyle** is more vulnerable to displacement. - The morphology of the glenoid fossa and the attachments of the collateral ligaments usually prevent significant lateral displacement of the disc. *Posterior and lateral direction* - **Posterior disc displacement** is very rare because the **retrodiscal tissue** is highly vascularized and innervated, making posterior displacement extremely painful and mechanically difficult. - The combination with lateral deviation is also atypical given the predominant forces acting on the disc. *Posterior and medial direction* - Similar to other posterior displacements, **posterior and medial displacement** is uncommon due to the anatomical constraints and the protective function of the **retrodiscal tissue**. - No primary force or muscle activity typically drives the disc in this particular direction.
Question 8: Following are the TM joint ligaments except -
- A. Temporomandibular
- B. Sphenomandibular
- C. Tympanomandibular (Correct Answer)
- D. Stylomandibular
Explanation: ***Tympanomandibular*** - The **tympanomandibular ligament** is not a formally recognized ligament associated with the temporomandibular joint (TMJ). - This term may be a misspelling or a non-existent anatomical structure when discussing TMJ ligaments. *Temporomandibular* - The **temporomandibular (or lateral) ligament** is a primary intrinsic ligament of the TMJ, composed of an outer oblique and an inner horizontal portion. - It plays a crucial role in preventing excessive posterior and inferior movement of the mandible, thereby protecting the retrodiscal tissues. *Sphenomandibular* - The **sphenomandibular ligament** is an accessory ligament of the TMJ, originating from the spine of the sphenoid bone and inserting into the lingula of the mandible. - It acts as a passive support, limiting excessive opening of the mouth. *Stylomandibular* - The **stylomandibular ligament** is another accessory ligament of the TMJ, running from the styloid process to the angle and posterior border of the ramus of the mandible. - It helps to limit excessive protrusion and lateral movements of the mandible.
Question 9: A swelling behind the ear suggests fracture of:
- A. Zygomatic complex
- B. Temporal bone
- C. Condylar fracture (Correct Answer)
- D. Orbital floor fracture
Explanation: ***Condylar fracture*** - A swelling behind the ear (known as the **Battle sign** if associated with ecchymosis) is a classic indicator of a **basilar skull fracture**, which often involves the temporal bone but can also be seen with severe condylar fractures affecting the base of the skull or mastoid area. - While a direct condylar fracture itself doesn't cause swelling *behind* the ear, **indirect condylar fractures** or those with significant associated trauma could compromise nearby structures leading to such a presentation. *Zygomatic complex* - Fractures of the **zygomatic complex** typically cause swelling, ecchymosis, and pain around the **cheekbone** and orbit, not specifically behind the ear. - These fractures can also lead to limited jaw movement due to impingement on the coronoid process, or orbital symptoms like **diplopia**. *Temporal bone* - A **temporal bone fracture** can indeed cause swelling and ecchymosis behind the ear (**Battle sign**). - However, direct temporal bone fractures are more commonly associated with **otorrhea**, **hemotympanum**, facial nerve palsy, or hearing loss. *Orbital floor fracture* - **Orbital floor fractures** are characterized by periorbital swelling, ecchymosis, **diplopia** (especially on upward gaze), and sometimes **enophthalmos** (sunken eye). - These signs are localized to the **eye region** and do not typically involve swelling behind the ear.
Question 10: Which of the following is not a ball and socket type of joint?
- A. Incudostapedeal joint
- B. Talocalcaneonavicular joint
- C. Calcaneocuboid joint (Correct Answer)
- D. Shoulder joint
Explanation: ***Calcaneocuboid joint*** - The calcaneocuboid joint is a **saddle joint** (or modified plane joint), which allows for movement primarily in gliding motions, but not the multi-axial movement characteristic of a ball-and-socket joint. - Its structure, specifically the **reciprocally saddle-shaped articular surfaces** of the calcaneus and cuboid bones, limits its range of motion to primarily inversion and eversion during foot movements. *Talocalcaneonavicular joint* - This joint functions as a **modified ball-and-socket joint**, allowing for complex movements like pronation and supination of the foot. - It involves the head of the talus acting as the 'ball' articulating with the navicular anteriorly and the sustentaculum tali of the calcaneus posteriorly, forming a socket. - This unique configuration allows for multi-axial movement essential for foot adaptation to terrain. *Incudostapedial joint* - This is a **synovial saddle-type joint** (not a ball-and-socket joint) found in the middle ear, connecting the lenticular process of the incus and the head of the stapes. - It allows for limited rocking motion to efficiently transmit sound vibrations through the ossicular chain. - The joint permits only small amplitude movements necessary for auditory function, not the multi-axial freedom of a ball-and-socket joint. *Shoulder joint* - The shoulder joint, also known as the **glenohumeral joint**, is a classic example of a **ball-and-socket joint**, offering the widest range of motion in the human body. - The **head of the humerus** (ball) articulates with the **glenoid fossa** of the scapula (socket), allowing for flexion, extension, abduction, adduction, rotation, and circumduction.
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