TEMPOROMANDIBULAR JOINT Flashcards by Megan Musa

What are symptoms of Costen’s syndrome?

pain in or near the ear, tinnitis, dizziness, fullness in the ear, and difficulty swallowing

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What is Eagle syndrome?

Ossification of the stylomandibular joint

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What does the Malleomandibular or Discomalleolar or Pinto’s ligament do?

Connects malleus of the

middle ear to the posterior TMJ capsule, lateral pterygoid, and disc. Link between TMJ and ear.

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The TMJ is richly supplied by the external carotid artery through the …

superficial temporal, deep auricular, anterior tympanic, ascending pharyngeal, and maxillary branches

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Nerve supply to the TMJ is supplied through the…

auriculotemporal and messeteric branches of the mandibular division of the Trigeminal Nerve CN(V).

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Which area of the intra-articular disc is avascular and aneural?

Intermediate zone

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Where does the anterior TMJ disc connect?

Superior head of lateral

pterygoid

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Where is the posterior-bilaminar zone attachment of the TMJ disc?

Upper lamina-elastic fibers

* Lower Lamina-collagenous fibers

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What are the medial and lateral attachments of the TMJ disc?

Collateral ligaments

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In terms of Maxillomandibular Relationships, what is an over bite?

Vertical overlap

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In terms of Maxillomandibular Relationships, what is an over jet?

Horizontal overlap

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In terms of Maxillomandibular Relationships, what is an orthognathic?

Normal

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In terms of Maxillomandibular Relationships, what is a retrognathic?

Posterior mandible/ micro-gnathic

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In terms of Maxillomandibular Relationships, what is a prognathic?

Anterior mandible/ Norwegian jaw

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If I extend my neck and head, what happens to my freeway space and mandible?

◼ Increases freeway space

◼ Retrudes mandible

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If I flex my head and neck, what happens to my freeway space and mandible?

◼ Decreases freeway space

◼ Protrudes mandible

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What does forward head posture do to freeway space and the mandible?

◼ Decreases freeway space

◼ Elevates/Retrudes mandible

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A forward head posture _________s the tongue

Depresses

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What is the classification of the TMJ?

◼ Synovial, complex, modified ovoid

◼ Ginglymus/Sliding-Hinge

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What is the capsular pattern of the TMJ?

Depression

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What is the resting position of the TMJ?

Rests in loose packed

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How does the TMJ rotate?

Posterior- anterior

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How does the TMJ glide?

Anterior- posterior

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What is the elevation (MIP) of the TMJ?

Fully elevated

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What is the depression (MIO) of the TMJ?

40-50mm

What is the lateral excursion of the TMJ?

8mm

What is the protrusion of the TMJ?

8mm

What is the retrusion of the TMJ?

4mm

Does the TMJ follow the convex or concave rule?

Convex

What actions does the masseter perform?

◼ Elevator ◼ Protrusion ◼ Clenching

What innervates the masseter?

CN V

What actions does the temporalis perform?

◼ Elevator ◼ Retrusion • Posterior fibers ◼ Clenching

What innervates the temporalis?

CN V

Which actions does the medial pterygoid perform?

◼ Elevator ◼ Lateral Excursion • Contra-lateral side ◼ Clenching

What innervated the medial pterygoid?

CNV

Which actions do the lateral pterygoid perform?

◼ Superior Head • Disc control and repositioning on elevation ``` Inferior Head • Protrusion • Lateral Excursion --Contra-lateral --• Depression ```

What innervates the lateral pterygoid?

CN V

Which actions do the digastrics perform?

Anterior -depression Posterior - recursion Works bilaterally to also elevate the hyoid during swallowing

What innervates the anterior digastrics?

CN V

What innervated the posterior digastrics?

CN VII

What are the arthrokinematics of opening and closing the TMJ?

⦿ Phase 1 ◼ opening = rotation only. This involves a posterior mandibular rotation around the X-axis. Estimated range is between 10 – 15 mm. ⦿ Phase 2 ◼ opening (15 - 40 mm) = rot/translation of the disc/condyle complex. This involves a posterior X-axis rotation with anterior translation along the Z-axis. ⦿ Phase 3 ◼ opening (40-50 mm) = further anterior translation of the disc/condyle complex, along the Z-axis. Range of normal opening as measured between the anterior incisors of the mandibular and maxillary teeth (MIO) is 40 – 50 mm.

Jaw protrusion is | associated with ...

bilateral anterior translation of the TMJ disc/condyle complex.

Jaw retrusion is associated with ...

bilateral posterior translation of the TMJ | disc/condyle complex

Lateral excursion to | the left is associated with...

anterior translation of the right TMJ disc/condyle complex and spin of the left.

Lateral excursion to | the right is associated ...

with anterior translation of the left TMJ with spin on the right.

What is the TMJ triad?

⦿ Jaw Pain ⦿ Tinnitus (ringing, buzzing, etc.) ⦿ Ear fullness/blockage

Which pattern is associated with OA of the TMJ?

Depression [(U)-lateral deviation to uninvolved>involved]

What are the clinical signs of OA of the TMJ?

◼ Crepitus ◼ Painful mastication ◼ Limited depression ◼ Females>Males

What do compression and traction of the TMJ do?

◼ Compression: ↑ pain ◼ Traction: ↓ pain

True or false; an anterior disc displacement with reduction will have a capsular pattern

False

What are the characteristics of an anterior disc displacement with reduction?

``` ◼ Bilaminar zone laxity ◼ SLP hyper-tonicity ◼ Reciprocal Clicking ◼ “Opening Click”-Reduction • May exhibit brief deviation ◼ “Closing Click”-Displacement • Potential for “Close-lock” • Ending in positional deflection ```

What are the characteristics of an anterior disc displacement without reduction?

``` ◼ Bilaminar zone laxity ◼ SLP hypertonicity ◼ Disc thickens/folds ◼ NO clicking ◼ “Closed-lock” ```

True or false; deflection of the TMJ will have a sustained position from the midline to the contralateral side of the tight capsule

False; same side

True or false; deflection is caused by mircotraumas

False; macrotrauma

What would you expect to see with a subluxed TMJ?

* Deflects to opposite side of hyper-mobile capsule | * Possible “Open-lock”

What are the overuse injuries common to the TMJ?

Bruxism | Clenching

What are the causes of Trismus?

AKA LOCK JAW Myofacial Bacterial infection Radiation therapy

What do the letters RPTTLB stand for in terms of postural re-education?

``` Relax Teeth apart Tongue up Lips together Breathe nasodiaphragmatically ```

What are the causes of condylar/ mandibular hypoplasia?

◼ Facial asymmetry ◼ Muscle imbalance ◼ Hyper-/hypomobility

What is the cause of Tic Douloureux?

Unknown etiology

True or false; Tic Douloureux is common in children

False; occurs in adults

What is the pattern of pain of Tic Douloureux?

Facial pain (U)

What are the triggers of Tic Douloureux?

Touch, sounds, brushing | teeth, chewing, shaving, tumor/swollen vessel

What action does the tempromandibular ligament prevent?

Downward and backward motion

What action does the sphenomandibular ligament prevent?

Anterior motion

What action does the stylomandibular ligament prevent?

Downward motion

In the TMJ, the (LCL/MCL) gets more stressed.

LCL

Which vertebral region may cause the trigeminal nerve to refer pain to the TMJ?

C1 C2

True or false; the bilaminar zone is avascular and aneural

False; highly vascular and innervated

What are you doing if you can measure MIP?

Clenching your teeth

How do you calculate free space?

Vertical dimension of rest- vertical dimension of occlusion

What is a normal amount of over bite? Over jet?

3mm

Forward head posture causes the mandible to be ________, which causes __________.

Mandible= elevated and retracted | Causes altered rest position of the jaw

Forward head posture causes the tongue to become ________, which causes...

Tongue= depressed | Causes altered swallow and jaw position

Forward head posture causes _________ tone of the ________, which causes ...

Causes increased tone of the temporalis which causes | TMJ-myofascial pain and tension type headaches

When the jaw opens, there is a _____ roll and a ______ glide

Posterior roll | Anterior glide

When the jaw closes, there is a _____ roll and a ______ glide

Anterior roll | Posterior glide

True or false; the temporalis is a weak contralateral lateral excursion muscle

False; ipsilateral

Anterior disc displacement with or without reduction has a click?

With

What is the difference between derangement and displacement?

Derangement involved damage to the disc

What is the difference between a deflection and a deviation?

Deflections are permanent, deviations are temporary

You assess your patient has a RIGHT deflection. Their RIGHT lateral excursion is 8mm, LEFT is 4mm. Which is tight and which is loose?

Right is tight, left is loose

In the context of condylar/mandibular hypoplasia, a larger ramus will result in...

Facial convexity

In the context of condylar/mandibular hypoplasia, a smaller ramus will result in...

Facial concavity