part 3 Flashcards
What effects can increase tone in the tensor tympani have and what nerve is involved
1.loss of low tone hearing because increased tone will decrease the mobility of the ossicular chain 2.CN V mandibular branch
What effect does dysfunction of the tensor veli palatini have and what nerve is involved?
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
What muscle on CN V can contribute to barohypoacusis?
1.tensor tympani 2.tensor veli palatini 3.medial pterygoid
How can the medial pterygoid contribute to symptoms of hypoacusis?
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)
What impact does premature contact of the posterior teeth have on the disc of the TMJ?
premature contact posteriorly brings the condyles forward compressing the disc against the articular eminence
What impact will a lack of molars have on the TMJ disc?
late posterior contact will cause posterior compress of the disc
How can posterior compression of the TMJ led to reciprocal clicking?
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
At what point does stabilizing clicking TMJ disc become very difficult?
1.the average reciprical clicking is greater than 3 cm 2.this point is indicative of high chronicity and severity of the problem
How would you diagnosis a complete anterior dislocation of the TMJ disc?
1.there is no reciprical click 2.there is extreme limitation in mouth opening
What is significant about clicking with lateral deviation of the jaw?
if the ipsalateral joint clicks this could be indicative of anterioromedial dislocation of the disc
How would you differentiate a TMJ capsule injury?
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
How would you differentiate TMJ adhesive capsulitis?
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
What is goal of TMJ splints?
improve the vertical dimension of the joint by separating the condyle from the fossa
What impact does a maxillary splint have on breathing patterns?
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
What impact can TMJ splinting have on the cervical spine?
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
How can you strengthen the suprahyoids and inhibit the pterygoids?
1.keep the tongue against the roof the mouth (ie hard palate) 2.isometrically resist opening of the mouth with the teeth apart
How can you use the tongue to promote mouth opening?
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.
What are the muscles of swallowing?
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
What is the basic sequence of swallowing?
1.propulsion posteriorly 2.enlargemnt of the canal 3.closure of the tube behind the bolus 4.closure of the other systems
How is the first phase of swallowing accomplished?
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
How is the second step in swallowing accomplished?
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
How is the third stage of swallowing accomplished?
1.closure of the tube behind the bolus 2.the bolus should lie in the field of the phyarngeal constrictors
How is the fourth stage of swallowing accomplished?
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
What is the key sign of a unilateral hypoglossal nerve lesion?
the tongue will deviate to the side of the lesion with protrusion
what are the muscle involved in opening (depression) and closing (elevation) of the mouth
- open - inferior lateral ptyerygoid and supra hyoids
- closing - masseter, temporalis and superior head of the
what muscle perform lateral deviation of the mandible
- ipsalateral - temporalis, massetter
- contralateral - pterygoids
what are the different phases of mouth opening arthokinematics?
- 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
Normal ROM for the mouth?
- depressio n40-45 male, 45-50 female 2. lateral excursion 10mm 2. protrusion 6-9mm 4. retrusion 3mm
What is over bite?
the overlap of the maxillary incisor and the mandibular incisor
What is over jet?
distance between the maxillary incisor and mandibular incisor
What is the stomatognathic system
structure of the mouth and jaw and functions of mastication, swallowing and respiration and speech
What trigger point is know to refer to the teeth?
temporalis maxillary molars masseter mandibular molars
Describe the Rocabado TMJ pain map
- 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
Describe the cotton roll test
- bite down on a cotton roll with the back mollars
a. ispsalateral TMJ will gap
b. contralateral side with compress
What are the stages of TMD
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
What is temporal arteritis?
- 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.
