Flashcards in TMJ Deck (70):
What are the divisions of the disk? Which parts are innervated?
Anterior--innerv and vasc
Intermediate: avascular and aneural
Posterior--innervated & vascular
What is the function of the temporomandibular ligament?
limits posterior displacement of the condyle--therefore protecting the retrodiskal pad
What is the action of the masseter?
elevation of the mandible
superficial Bilat: protrusion
Deep fibers bilat: retraction of mandible
What is the action of the temporalis?
Bilat: elevate and retract the mandible
Unilat: ipsilateral lateral deviation
With mouth opening, what are the arthorkinematics? What ligament is stressed?
Initially, the condyle rolls posterior and slide anteriorly
in the late phase: the condyle slides and translates anteriorly
The oblique fibers of the temporomandibular ligament are stretched
Patient deviates his jaw to the L, what muscles are working?
Ipsilateral temporalis and masseter
Contralateral lateral and medial pterygoids
What is the action of the medial pterygoid?
Bilateral: elevation and protrusion of the mandible
unilateral: contralateral lateral excursion
Your patient has upper molar and incisor tooth pain, what is a possible myogenic cause?
Trigger point from the temporal is muscle
What muscles work with retrusion of the mandible
deep fibers of masseter, temporalis, suprahyoids
What is the primary role of the inferior head of the lateral pterygoid?
depression of the mandible during mouth opening
What is the arthrokinematics of mouth closing?
rolling anteriorly and sliding posteriorly of the condyle
How is overjet measured?
distance of the top teeth over hanging the bottom teeth
How is overbite measured?
amount of front teeth covering the mandibular teeth
Why do the masseters/temoralis and depressors have to work during protrusion?
to prevent dropping of the mandible and maintain balance
With what condition will you hear 2 clicks?
Anterior disk displacement WITH reduction
What is seen with anterior disk displacement WITHOUT reduction?
lacks mouth opening--no joint sounds
If someone has a Class 2 occlusion, what does this mean?
> 6 mm overjet
Normal = 3-6 mm
What is a Class 3 occlusion Also known as?
What is freeway space?
Amount of space between top/bottom teeth when is physiological resting position--usually 3 mm
What condition is associated with open lock patients?
Posterior disk displacement
Patient complains of bottom molar tooth pain, what myogenic cause could be creating this pain?
Trigger point in the masseter
What is trismus? Why might someone have it?
Muscle spasming creating the jaw not to open fully
Usually after prolonged mouth opening after dental procedure
You suspect a patient has capsulitis, what is the deviation you might see? How do you differentiate from synovitis?
Ipsilateral lateral excursion (to the side of dysfunction)
hard to differentiate capsulitis and synovitis
What nerves congregate in the trigeminocervical nucleus?
What is this associated with?
CN V, VII, IX, X, XI; cervical nerves 1-3
it is associated with ear symptoms
What nerve innervates the TMJ?
Patient has pain in the jaw and mandible region (CN V-max and manx regions). What neuropathic condition could cause this?
Tic douloureux--trigeminal neuralgia
Patient complains of pain and stiffness when chewing especially as he does it more, what condition could this be suggestive of?
Temporal arteritis: subacute inflame of the superficial temporal artery and the vertebral artery
Patinet complains of sharp stabbing pain in the 1st division of the CN V, what likely condition is this?
post-herpatic neuralgia (herpes zoster)
What imaging technique do you want with a disk problem?
Kinematic MRI: 33% false positive
What is the relationship bet/ween lateral excursion and mouth opening?
Lateral excursion = 1/4 of mouth opening
What are the normal ROM for
retrusion: 3 mm
lateral deviation: 10 mm
What is an S curve associated with?
How many mm is considered hyper mobile with mouth opening?
What is the cotton roll test?
biting down on cotton roll of back molar
if pain increases on that side, it is indicative of capsular or muscular involvement
if pain decreases on that side, it is indicative of joint or disk problem
You suspect capsulitis, what direction will the lateral excursion be limited?
R TMJ pain will have limited L lateral excursion
What would make you think trismus vs ADDWOR
Patient hx: prolonged mouth opening
Trismus: increased muscle tone of masseters
feeling of muscle spasming
ADDWOR: may have had previous ADDWR, but not anymore
Does a forward head cause the mouth to open more or less?
More--can lead to hypermobility
What position of the neck creates more occlusal contact?
ipsilateral SB and rotated away
What other muscle was coactivated while the masseter was activated?
What does the research say about head posture and TMD?
It is unclear as studies do and do NOT show a relationship
What ROM is significant for hypo mobility?
less than 30 mm
What should be the position of the mouth?
tip of tongue to palate, teeth apart, lips together
What is the 6x6
6 exercises 6x/day (every 2 hours)
What is one muscle contraction you can perform to get relaxation of the masseter/temporalis/elevators?
isometrically open mouth against resistance causes an inhibition of hyperactive mandibular elevators
What are the steps for the cndylar remodeling exercise program
0.5" tubing--laterally rolled to the contralateral side and back--if pain free then a bite is incorporate
Next phase: maintain contraction as you roll tubing contra-laterally
If still no pain, then do it with protrusion
Then you can do isometric stabilization
**no good research on this
What exercise does the monograph suggest for clicking due to ADDWR?
open mouth maximally to the point of the opening click
protrude the mandible then contact the teeth in this protruded position
retrude mandible before closing click
Open up mouth without opening click--do 5 mins after each meal
**further research on long-term effects is required
What should be avoided with Posterior displaced disk?
maximal mouth opening
What things are recommended for myofascial pain disorder syndrome of TMJ?
patient education, CBT, aerobic reconditioning
Patient has TMJ and cheek bone pain, what trigger point do you suspect?
medial or lateral pterygoid
When should NSAIDs take effect?
What is the effect of capsacicin cream on the TMJ pain?
Winocur et al no significant effect in relieving symptoms
What does the Cochrane review say about hyaluronate injection?
in favor for symptom relief
What does the Cochrane review say about occlusal adjustment?
No evidence to show that occlusal adjustment can prevent or relieve TMD
What does the Cochrane review say about the stabilization splint on TMJ?
Reported insufficient evidence earlier for or against the use of stabilization splint therapy when compared to other treatments
**may be beneficial in reducing pain compared to no treatment
Does orthodontic treatment increase the prevalence of TMD?
What is an arthrocentesis
lavage of the joint done without viewing the joint space
What is the origin, insertion, and action of the medial pterygoid?
O: pterygoid fossa
I: pterygoid tuberosity of the angle of the mandible
A: elevates and protrudes mandible; unilateral: contralateral lateral exercursion
What is the origin, insertion, and action of the lateral pterygoid
superior head: infratemporal crest of the sphenoid bone
inferior head: pterygoid process of sphenoid
Superior head: articular disk
Inferior head: condylar process of mandible
A: opens the jaw, protrusion
ipsilateral contraction leads to lateral excursion to the other side
What muscles open the mouth?
lateral pterygoid (inferior fibers), suprahyoids, and infrahyoids
What muscles close the mouth?
masseter, temporalis, medial pterygoids
What muscles protrude the mandible?
masseter (superficial fibers), medial and lateral pterygoids
What muscles retrude the mandible?
Deep fibers of masseter, suprahyoids, and temporalis
If there are absent sounds yet you suspect anterior disk displacement. What type of ADD do you think?
Your patient has joint noises, C curve, and limited opening - do you think capsulitis or disk displacement?
Your patient has seen some improvements with PT, but the symptoms still vary day to day. She still wants to get back to sports activities. What is the best course of action.
A. refer back to physician
B. educate regarding slow progression and how it takes time
C. refer patient to psych for CBT
D. start sports specific training
C. refer to psych for CBT
**since she is refractory to conservative management CBT can be effective
What are the 4 things that have been shown to help improve myofascial pain disorder syndrome?
2. spray and stretch
4. Aerobic conditioning
What is the best exercise program for a patient with anterior disk displacement with reduction?
condylar remodeling exercise
What is a good mobilization technique to capture the anteriorly displaced disk?
longitudinal distraction, add ulnar deviation of the hand, then go into anterior translation
Initial hx of clicks and now patient without clicking noises is indicative of what?