TMD 2015 Flashcards
Where are some potential locations where the masseter may refer pain?
Ear, mandibular molars, above eye
Where are some potential locations where the anterior temporalis may refer pain?
maxillary anterior teeth
Where are some potential locations where the middle temporalis may refer pain?
maxillary premolars
Where are some potential locations where the posterior temporalis may refer pain?
maxillary molars
Where are some potential locations where the sternocleidomastoid may refer pain?
ear, eye, above eye (can be contralateral), occiput
Where are some potential locations where the posterior cervical muscles may refer pain?
temple, eye, ear
Where are some potential locations where the lateral pterygoid may refer pain?
TMJ, eye, zygoma
Where are some potential locations where the temporalis tendon may refer pain?
mimics TMJ and masseter pain
Masseter muscle OINA
Origin: Zygomatic arch
Insertion: Lateral surface of ramus of mandible and coroid process of mandible
Innervation: Masseteric branch of V3
Action: Closes the jaw by elevating/closing the mandible
Temporalis muscle OINA
Insertion: Coronoid process and anterior border of mandible
Origin: Temporal fossa(bone) andfascia
Innervation: Deep temporal branches of V3
Action: It elevates the mandible and closes the jaw. The posterior fibers retract the mandible
Lateral pterygoid muscle OINA
Origin: The upper head originates from the lateral surface of the greater wing of the sphenoid bone. The lower head originates from the lateral surface of the lateral pterygoid plate of sphenoid bone
Insertion: Neck of condyle of mandible and articular disc and capsule of TMJ
Innervation: Branches of V3
Action: It opens the mouth. Acting together, they protrude mandible; acting alternatively, grinding action
Medial pterygoid muscle OINA
Origin: From the medial surface of lateral phterygoid plate of sphenoid and and pyramidal process of palatine bone (deep head) and tuberosity of mandible (superficial head)
Insertion: Lower part of the medial surface of the mandible and angle of the mandible
Innervation: Pterygoid branches of V3
Action: Elevates the mandible and closes the jaw. Acting together, protrude mandible. Acting alone, protrudes one side. Acting alternatively, grinding action
Myofacial pain: description and treatment
Referred Pain From A Tender Point To A Distant Site
Treated With Stretching Heat And Cold And Rest
Muscle Relaxants Can Be Helpful
Myalgia: description and treatment
Muscle Soreness Tender To Palpation Does Not Refer To A Distant Site Most Common Muscle Pain Responds To Stretching
Myositis: description and treatment
Muscle Inflamation.Usually due to Trauma or Infection
Treated Differently Than Muscle Tightness/Myalgia
NSAIDS
Steroids
Rest
No Stretching
Muscle spasm: description and treatment
Muscle Inflamation.Usually due to Trauma or Infection
Treated Differently Than Muscle Tightness/Myalgia
NSAIDS
Steroids
Rest
No Stretching
Protective splinting: description and treatment
Muscle Tighten To Protect Joints Or Other Muscles
Need To Find The Cause Of The Need To Protect
Treat The Cause And Use Muscles Relaxants And Rest And Stretching
Myofibrotic contracture: description and treatment
Muscle That Has Undergone Degenerative Change That Causes The Contracted State To Persist
Usually Due to Injury or infection
Calcified Contracture (Rare)
Can Be Hereditary
What is the distinction between myalgia and myofascial pain?
Myalgia is localized muscle soreness, whereas myofascial pain REFERS from the tender point to a distant location
What are three diagnostic classifications for TMJ disorders?
Deviation in form, disc displacement (with or without reduction), dislocation
From a macro perspective, what are treatment options for TMD?
rest, medication, physical therapy, intra oral applicances, surgery, biofeedback
What is a “healthy” vertical range of motion possible when opening the mouth?
Over 40 mm
What is a typical value for lateral range of motion?
10-12 mm
What is a typical value for protrusion?
8-10 mm
Name several temporalmandibular disorders
Capsulitis, osteoarthritis, internal derrangements, systemic arthritis, traumatic arthritis, myalgia, myositis
What are eight types of occlusal applicances that may be used as part of TMD treatment?
stabilization, antreior positioning, anterior bite, posterior bite, pivot, resilient (soft ones), distraction, and mouth restricting appliances
What are some medications used for prophylactic treatment of migraines?
Amitriptyline, Aspirin, Beta-blockers, Calcium channel blockers, Clonidine, Cyproheptadine, Methysergide, Naproxen
What are some abortive therapies for acute treatment of migraines?
Ergotamine/caffeine, ergotamine derivatives, isometheptene, Sumatriptan
What are some medications that provide symptomatic relief in the acute treatment of migraines?
Aspirin, Acetaminophen +/- codeine, butalbital/caffeine combinations, butorphanol tartrate, metoclopramide, other opiods
Infrequent migraines (less than 5-6 per month) can be managed with abortive medication
Triptan abortive medications include sumatriptan (imitrex) and several others
What are some of Dr. Cohen’s favorite medications commonly used to treat migraines?
Inderal (beta blocker), Verapamil (Ca+ channel blocker), Pamelor (Na+ channel blocker/SNRI), Topamax (anti convulsant)
Peripheral afferent nerve fibers: A-alpha, A-beta, A-gamma
large, myelinated, tactile and proprioceptive (NOT involved in pain transmission, but may begin transmitting pain if it goes on long enough untreated)
Peripheral afferent nerve fibers: A-delta
small myelinated, pain that is prickling, touch, warmth and cold
Peripheral afferent nerve fibers: C fibers
unmyelinated pain, burning, itch, warmth and cold
What are some examples of neurogenic input that may lead to pain perception?
nerve compression, chemical, nerve regeneration, SMP (sympathetically maintained pain when the nerve that opens and closes vasculature transitions into pain transmitter)
What are common forms of medication used to treat peripheral neuropathy?
antiseizure, TCAs, opioids, and topical medications
What are some characteristic neuropathic pain medications?
Tegretol, Depakote, TCAs, Neurontin, Baclofen, Hytrin and Minipress, Gabatril, Topamax, Trileptal, Lamotrigine, Dilantin
