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Musculoskeletal III > TEMPOROMANDIBULAR JOINT > Flashcards

TEMPOROMANDIBULAR JOINT Flashcards

1
Q

Ligaments of the TMJ

A
  1. Lateral TMJ (late phase biomechanics)
  2. Sphenomandibular
  3. Stylomandibular
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2
Q

TMJ articular disc regions attachments:

A
  • Posterior
  • Intermediate
  • Anterior
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3
Q

Posterior region of the TMJ articular disc attaches to the following:

A
  • Collagen rich inferior retrodiscal lamina
  • Elastin rich superior retrodiscal lamina
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4
Q

Anterior region of the TMJ disc attaches to the following:

A
  • Tendon of the superior head of the lateral pterygoid muscle
  • Temporal bone anterior to articular eminence
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5
Q

Masseter muscle:

A
  • Origin: inferior zygomatic bone and arch
  • Insertion: external surface of the mandible between the angle and coronoid process
  • Action: bilaterally elevates and protrudes the mandible unilaterally ipsilateral lateral excursion
  • Innervation: mandibular nerve, branch of CN V – trigeminal nerve
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6
Q

Temporalis muscle

A
  • Origin: temporal fossa
  • Insertion: coronoid process and ramus of the mandible
  • Action: bilaterally elevates and protrudes the mandible; unilaterally ipsilateral lateral excursion
  • Innervation: mandibular nerve, branch of CN V – trigeminal nerve
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7
Q

Medial pterygoid:

A
  • Origin: lateral pterygoid plate
  • Insertion: internal surface of the mandible between the angle and mandibular foramen (anterior to ramus)
  • Action: bilaterally elevates and protrudes the mandible; unilaterally contralateral lateral excursion
  • Innervation: mandibular nerve, branch of CN V – trigeminal nerve
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8
Q

Lateral pterygoid (superior head):

A
  • Origin: greater wing
  • Insertion: medial capsule, TMJ, disc, and pterygoid fossa
  • Action: bilaterally eccentrically controls the disc during closing; unilaterally contralateral lateral excursion
  • Innervation: mandibular nerve, branch of CN V – trigeminal nerve)
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9
Q

Lateral pterygoid (inferior head):

A
  • Origin: lateral pterygoid plate
  • Insertion: pterygoid fossa and neck of mandible
  • Action: bilaterally DEPRESSES and protrudes the mandible; unilaterally contralateral lateral excursion
  • Innervation: mandibular nerve branch of CN V Trigeminal
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10
Q

what three muscles close the mouth (elevation of the mandible)

A
  1. Masseter
  2. Temporalis
  3. Medial pterygoid
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11
Q

what two muscles open the mouth (depression of madible)

A
  1. Lateral pterygoid (inf head)
  2. Suprahyoid
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12
Q

3 lateral excursion muscles

A
  • Medial pterygoid
  • Lateral pterygoid (Inf and superior heads)
  • All contralateral excursion
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13
Q

protrusion muscles

A

lateral pterygoid (inferior and superior heads)

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14
Q

retrusion muscles

A

temporalis

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15
Q

What are the secondary muscles of mastication?

A
  • infrahyoids
  • suprahyoids
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16
Q

In the adult the mouth can be opened an average of_____ as measured between the incisal edges of the upper and lower front teeth

A

50 mm

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17
Q

Maximal opening of the mouth typically occurs during actions such as…

A

yawning and singing

18
Q

The interincisal opening is typically large enough to fit ______ adult “knuckles” (proximal interphalangeal joints)

A

three

19
Q

Functional movement (depression) for eating is about ___ mm or ____ knuckles

A

18 mm

one knuckle

20
Q

The early phase of depression of the mandible, constituting the first 35% to 50% of the range of motion, involves primarily ______ of the mandible relative to the cranium.

A

rotation

the condyle rolls posteriorly

21
Q

The late phase of opening the mouth consists of the final 50% to 65% of the total range of motion. This phase is marked by a gradual transition from primary rotation to primary ​

A

translation.

The transition can be readily appreciated by palpating the condyle of the mandible during the full opening of the mouth.

During the translation the condyle and disc slide together in a forward and inferior direction against the slope of the articular eminence

22
Q

The early phase of elevation of the mandible involves primarily ______ of the mandible relative to the cranium.

A

translation

in a posterior and superior direction

23
Q

The late phase of closing (elevation) the mouth is marked by a

A

rotation

condyle roll anteriorly

24
Q

protrusion normal ROM

A

3 mm

25
Q

Protrusion arthrokinematics

A
  • Condyle and disc translate anteriorly without significant rotation
  • Mandible slides slightly downward during protrusion and upward during retrusion
  • Extremely important for full opening
26
Q

Pain dominant vs. Stiff dominant

A
  • pain dominant = no mobs
  • stiff dominant = mobs
27
Q

lateral excursion normal ROM

A

11 mm each way

28
Q

lateral excursion arthrokinematics

A
  • Side to side translation of the condyle and disc in the fossa
  • could be a good exam for finding hyper-mobility
29
Q

branches of the trigeminal nerve

A
  • Opthalamic
  • Maxillary
  • Mandibular: proprioceptive fibers TMJ
30
Q

there is a crossing between the trigeminal nerve and C1 to C4 cervical nerve roots

A

Trigemino-cervical nucleus

31
Q

many patient with TMJ pain have headaches, why?

A
  • Trigemino-cervical nucleus
  • C1-C4 spinal nerves: Afferent pain fibers from C1-C4 have projections through the spinal nucleus of the trigeminal nerve as it coordinates sensation from the opthalamic, maxillary and mandibular portions
  • Consequently, suboccipital compression of C1-C4 nerves can present as TMD symptoms in the head and face.
32
Q

what is extremely important for full opening of the mandible?

A

protrusion

33
Q

Categorizing TMJ Disorders:

(all have pain in and around the TMJ, altered mandibular mechanics/motions, +/- joint noises)

A
  • Osteoarthritis: crepitus
  • Capsulitis/ligaments: loss of motion all directions
  • Internal Derangement:
    • Functional dislocation of the disc anteriorly with reduction (clicks present)
    • Functional dislocation without reduction (clicks not present, limitation of motion to rotation, no translation, motion limited to 25mm opening
  • Psychological:
    • Up-regulation of central nervous system, trigeminal nucleus
    • Those with TMJ tend to be over-reactive to their environment
    • Anxiety, depression, anger, fear all tend to increase with chronicity and may contribute to increased pain
34
Q

TMJ disorders differential diagnosis

A
  • Vascular: migraine or cluster headaches
  • Intra-cranial disorder: weight loss, ataxia, weakness, fever, etc
  • Neuropathies: trigeminal neuralgia
  • Ear or sinus disorders
35
Q

resting position of the TMJ

A

with tongue resting on the palate and mouth slightly open

36
Q

Intraoral lateral pterygoid palpation

A

upper vestibule

37
Q

intraoral medial pterygoid palapation

A

bottom lingual aspect of the teeth

38
Q

Internal Derangement Disc Dysfunction:

Stage I

A

disc slightly anterior, inconsistent click, mild or no pain

39
Q

Internal Derangement Disc Dysfunction:

Stage II

A
  • disc anterior reciprocal click
  • painful
40
Q

Internal Derangement Disc Dysfunction:

Stage III

A

reciprocal click, now later during opening and earlier during closing, most painful stage

41
Q

Internal Derangement Disc Dysfunction:

Stage IV

A

click rare, disc no longer relocates, stays anterior, pain rare

42
Q

TMJ

Is there a C-shaped? or an S-shaped? deviation to movement?

A
  • C-shaped: hypomobility on side of direction
  • S-shaped: motor control problem

Musculoskeletal III (5 decks)

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