part 3

Question 1

What effects can increase tone in the tensor tympani have and what nerve is involved

Answer 1

1.loss of low tone hearing because increased tone will decrease the mobility of the ossicular chain 2.CN V mandibular branch

Question 2

What effect does dysfunction of the tensor veli palatini have and what nerve is involved?

Answer 2

1.since it opens the eustachian tube you could get symptoms such as hissing sounds, fullness in the ears, increase pressure in the ear and/or hearing loss 2.CN V

Question 3

What muscle on CN V can contribute to barohypoacusis?

Answer 3

1.tensor tympani 2.tensor veli palatini 3.medial pterygoid

Question 4

How can the medial pterygoid contribute to symptoms of hypoacusis?

Answer 4

1.in order for the tensor veli palatini to open the eustachian tube it must push the medial pterygoid to the side 2.if the tone of the medial pterygoid is increased then it may not be able to push it to the side (1964 theory, Rameryiez 2011 references) 3. MP assists in ventilation and chronic tone can keep it open subjecting it to irritation (mcDonald 2012)

Question 5

What impact does premature contact of the posterior teeth have on the disc of the TMJ?

Answer 5

premature contact posteriorly brings the condyles forward compressing the disc against the articular eminence

Question 6

What impact will a lack of molars have on the TMJ disc?

Answer 6

late posterior contact will cause posterior compress of the disc

Question 7

How can posterior compression of the TMJ led to reciprocal clicking?

Answer 7

1.the posterior portion of the TMJ is rich in aveolar tissue and will be painful to compress 2.pain increases tone of the TMJ stabilizers 3.the tone of the lateral pterygoid superior fibers pulls the disc forward 4.forward disc results in clicking with opening and closing

Question 8

At what point does stabilizing clicking TMJ disc become very difficult?

Answer 8

1.the average reciprical clicking is greater than 3 cm 2.this point is indicative of high chronicity and severity of the problem

Question 9

How would you diagnosis a complete anterior dislocation of the TMJ disc?

Answer 9

1.there is no reciprical click 2.there is extreme limitation in mouth opening

Question 10

What is significant about clicking with lateral deviation of the jaw?

Answer 10

if the ipsalateral joint clicks this could be indicative of anterioromedial dislocation of the disc

Question 11

How would you differentiate a TMJ capsule injury?

Answer 11

1.typically secondary to trauma 2.painful active ROM in all directions 3.active opening will demonstrate an ipsalateral “c” curve 4.ipsalateral deviation with protrusion 5.decreased lateral deviation

Question 12

How would you differentiate TMJ adhesive capsulitis?

Answer 12

1.Same as capsule injury -typically secondary to trauma -painful active ROM in all directions -active opening will demonstrate an ipsalateral “c” curve -ipsalateral deviation with protrusion -decreased lateral deviation 2.decreased mobility 3.length of pathological state

Question 13

What is goal of TMJ splints?

Answer 13

improve the vertical dimension of the joint by separating the condyle from the fossa

Question 14

What impact does a maxillary splint have on breathing patterns?

Answer 14

1.the maxillary splint will cause the tongue to drop off the roof of the mouth 2.with the tongue off the roof of the mouth you develop mouth breathing and forward head position 3.the change in tongue position also increases tension on the TMJ

Question 15

What impact can TMJ splinting have on the cervical spine?

Answer 15

1.Tension through the TMJ capsule will facilitate upper cervical extension tone 2.you can also get a secondary increase in compensatory mid cervical flexion

Question 16

How can you strengthen the suprahyoids and inhibit the pterygoids?

Answer 16

1.keep the tongue against the roof the mouth (ie hard palate) 2.isometrically resist opening of the mouth with the teeth apart

Question 17

How can you use the tongue to promote mouth opening?

Answer 17

1.tongue depressor isometrics can promote protrusion by pushing forward and opening by pushing down 2.popping or clicking against the hard palate strengthens the intrinsics of the mouth and tongue.

Question 18

What are the muscles of swallowing?

Answer 18

extrinsic 1.genioglossus 2.hyoglossus 3.stlyoglossus 4.palatoglossus Instrinsic 1.superior longitudinal of tongue- shortens and 2.raises side and tips 3.inferior longitudinal of tongue- shortens and depresses side and tips 4.trasversus of tongue- narrows and lengthens 5.verticalis- flattens

Question 19

What is the basic sequence of swallowing?

Answer 19

1.propulsion posteriorly 2.enlargemnt of the canal 3.closure of the tube behind the bolus 4.closure of the other systems

Question 20

How is the first phase of swallowing accomplished?

Answer 20

1.Move the bolus posteriorly 2.tongue is brought up against the hard palate by -genioglossus -mylohyoid -geniohyoid 3.this pushes the bolus back to the soft palate where the tube is enlarged

Question 21

How is the second step in swallowing accomplished?

Answer 21

1.The canal is enlarged by 2.soft palate is raised by -levetor palatini -tensor palatini 3.Styloglossus kicks in to move the bolus further back 4.The pharynx is also raised and expanded -mylohyoid -geniohyoid -stylohyoid -posterior digastric -stylopharyngeus -salpinogpharyngeus -palatopharyngeus

Question 22

How is the third stage of swallowing accomplished?

Answer 22

1.closure of the tube behind the bolus 2.the bolus should lie in the field of the phyarngeal constrictors

Question 23

How is the fourth stage of swallowing accomplished?

Answer 23

1.closure of other systems 2.when the bous passes through the isthmus of the pharynx palatoglossus contracts to close of the the mouth 3.nasopharynx is closed with the soft palate is raised 4.larynx is closed superiorly by the epiglottidus folding back and inferiorly by the rima glottidis

Question 24

What is the key sign of a unilateral hypoglossal nerve lesion?

Answer 24

the tongue will deviate to the side of the lesion with protrusion

Question 25

what are the muscle involved in opening (depression) and closing (elevation) of the mouth

Answer 25

1. open - inferior lateral ptyerygoid and supra hyoids
2. closing - masseter, temporalis and superior head of the

Question 26

what muscle perform lateral deviation of the mandible

Answer 26

1. ipsalateral - temporalis, massetter
2. contralateral - pterygoids

Question 27

what are the different phases of mouth opening arthokinematics?

Answer 27

1. role and rotation around an axis in the condylar head 2. slide and anterior translation with a slight rotation in an axis in the mandibular ramus

Question 28

Normal ROM for the mouth?

Answer 28

1. depressio n40-45 male, 45-50 female 2. lateral excursion 10mm 2. protrusion 6-9mm 4. retrusion 3mm

Question 29

What is over bite?

Answer 29

the overlap of the maxillary incisor and the mandibular incisor

Question 30

What is over jet?

Answer 30

distance between the maxillary incisor and mandibular incisor

Question 31

What is the stomatognathic system

Answer 31

structure of the mouth and jaw and functions of mastication, swallowing and respiration and speech

Question 32

What trigger point is know to refer to the teeth?

Answer 32

temporalis maxillary molars masseter mandibular molars

Question 33

Describe the Rocabado TMJ pain map

Answer 33

1. anterior inferior capsule 2.anterior superior capsule 3.lateral collateral ligament - vertical condylar head 4.TM ligament - oblique anterior condylar head 5.posterior capsule 6.posterio striatum during contralateral deviation 7..posterior billaminar zone with manual distraction 8.posterior retro disc area hold position 7 and gliding anterior

Question 34

Describe the cotton roll test

Answer 34

1. bite down on a cotton roll with the back mollars
   a. ispsalateral TMJ will gap
   b. contralateral side with compress

Question 35

What are the stages of TMD

Answer 35

Stage 1 - inconsistent clicking and minimal pain

Stage 2 - inreased frequency of popping with severe and constant pain

stage 3 - Mouth click with opening and closing and is most painful stage

stage 4- clicking and pain derease with loss of opening ROM

Question 36

What is temporal arteritis?

Answer 36

• Temporal arteritis is inflammation and damage to the blood vessels that supply blood to the head, neck, upper body and arms. It is also called giant cell arteritis.
• The cause of the condition is unknown. It is believed to be due in part to a faulty immune response. The disorder has been linked to some infections and to certain genes.
• The problem may develop with or after another inflammatory disorder known as polymyalgia rheumatica. Giant cell arteritis almost always occurs in people over age 50. It is most common in people of northern European descent. The condition may run in families.