Extraoral Exam Part 2 Flashcards
Submental-
Just below the chin
Submandibular-
3-6 nodes, beneath the body of the mandible
Tonsillar/Jugulodigastric-
Tends to be some of they largest lymph
nodes in the cervical chain due to their significant lymphatic
drainage. It does decrease in size with age in a cancer free patient.
Anterior cervical chain-
nodes that lie both on top and beneath the
sternocleidomastoid muscles (SCM) on either side of the neck, from
the angle of the mandible to the top of the clavicle
Supraclavicular-
in the hollow above the clavicle, just lateral to
where it joins the sternum.
Posterior cervical chain-
extends in a line posterior to the SCM but
in front of the trapezius.
Infected lymph nodes tend to be – (5)
firm, tender, enlarged and warm.
Inflammation can spread to the overlying skin, causing it to appear reddened
Maligancies may also involve the lymph nodes-
either (2)
primary (e.g.. Lymphoma), or as a site of
metastasis
These nodes tend to be- (5)
firm, non-tender, matted (stuck to each other), fixed (not freely mobile but attached to underlying tissue) and increase in size over time
TMD vs TMJ
TMD is a disease
TMJ is the joint
TMD is a collection of
symptoms
who does TMD affect
20% of the US
85.4% women
TMD is a common condition in adults but becoming more prevalent in
adolescents and children
TMD symptoms (6)
Joint pain Headaches Tinnitus–ringing in the ears Insomnia Neck ache Teeth become sensitive to hot, and cold-this is one of the 1st signs of bruxism
Causes of TMD (7)
Bruxism Clenching Stress Malocclusion Arthritis Trauma Stimulants
3 broad diagnostic classes of TMD
Muscles
Soft tissue of the joint
Hard tissues of the joint
Muscles of mastication (3)
Temporalis
Masseter
Pterygoids-medial and lateral
tenderness scale
0=
10=
0= no discomfort 1-= extreme sensitivity
Temporalis = generally causes pain of the
ant teeth
Masseter = generally causes pain of the
post teeth
skipped
TMJ screening questions (9)
Do you have difficulty, pain or both when opening your mouth wide (yawning, etc)?
Does your jaw get “stuck,” “locked,” or “go out”?
Do you have difficulty, pain or both when chewing, talking or using your jaws?
Are you aware of noises in the jaw joints?
Do you have pain in or around the ears, temples, or cheeks?
Does your bite feel uncomfortable or unusual?
Do you have frequent headaches?
Have you had a recent injury to your head, neck, or jaw?
Have you previously been treated for a jaw joint problem? If so, when?
TMJ palpation (3 steps)
palpate bony prominence just anterior to the ear and ask if there is any discomfort
then have patient open and close (any discomfort?)
then palate all around the joint
TMJ diagnostic exam (3)
- Measure range of motion
- opening
- right and left lateral
- Palpate for crepitus
(grinding) & clicking while
opening and closing. - Palpate for tenderness in
the masseter and temporalis
muscles.
TMD exam (6)
Excessive tooth mobility Widened PDL seen radiographically Migration in the absence of perio ds Buccal mucosal ridging Lateral tongue scalloping. Inspect symmetry and alignment of • face, • jaws, • dental arches.
Treatment of TMD
night guards/bruxism splints
Night guards/Bruxism splints-used to: (3)
- Redistribute occlusal forces
- Relax the masticatory muscles and stabilize the joint.
- Protect dentition and dental work
Treatment of TMD with medication (3)
NSAIDs
anti anxiety
muscle relaxers
Anti-inflammatory (NSAIDs)-
used for joint pain, inflammation, and stiffness. Tend to be inexpensive, easily accessible and well tolerated.
Anti-anxiety-
help relieve the stress that may aggravate TMD
Muscle relaxers-
relax muscles and decrease spasms
botox for treatment of TMD
lasts 3-4 months and no FDA approved
physical therapy for TMD
Helps ease pain and increase
movement and normal jaw
function
surgery for TMD
very rare
skipped
treatment of TMD (6)
Joint rest and reducing jaw movement. Keeping teeth slightly ajar. Soft-food diet Medications to relieve pain and/or relax muscles Hot or cold compresses TMJ physical therapy Wearing of a night guard/splint
